Aspiration and development of subglottic stenosis in patients with Wegener’s granulomatosis

2009 ◽  
Vol 124 (4) ◽  
pp. 393-396 ◽  
Author(s):  
A C Church ◽  
K Goldsmith ◽  
P Sivasothy
Keyword(s):  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Bile Salts ◽  
Wegener’S Granulomatosis ◽  
Ph Monitoring ◽  
Wegener's Granulomatosis ◽  
Middle Lobe ◽  
Subglottic Stenosis ◽  
Aetiological Factor ◽  
Significant Difference

AbstractObjective:In patients with Wegener’s granulomatosis, subglottic stenosis can develop due to active disease; however, some patients develop subglottic stenosis with no clear evidence of airway inflammation. In some cases of idiopathic subglottic stenosis, an association with gastroesophageal reflux disease has been found. Our study assessed the potential role of gastroesophageal reflux as an aetiological factor in the development of subglottic stenosis in patients with Wegener’s granulomatosis.Design:We assessed evidence of active reflux disease, using 24-hour pH monitoring and assessment of bile salts in bronchoalveolar lavage fluid.Subjects:Ten Wegener’s granulomatosis patients with subglottic stenosis underwent 24-hour pH monitoring and bronchoscopy and lavage of the right middle lobe. A similar number of control patients were included.Results:There was no statistically significant difference in the occurrence of bronchoalveolar bile salts in patients with subglottic stenosis (n = 2) versus control patients (zero) (p = 0.457). There was good correlation between the detection of reflux by 24-hour pH monitoring and the detection of bronchoalveolar bile salts (κ = 0.769).Conclusion:In this small study of patients with Wegener’s granulomatosis, there was no evidence of an association between the development of subglottic stenosis and gastroesophageal reflux.

scholarly journals The Relationship Between Gastroesophageal Reflux Disease and Laryngopharyngeal Reflux Based on pH Monitoring

2020 ◽  
pp. 014556132097191
Author(s):  
Yun Wu ◽  
Junyao Wang ◽  
Qing Huang ◽  
Tao Peng ◽  
Lili Zhao ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Esophageal Manometry ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Reflux Time ◽  
Total Reflux ◽  
Significant Difference ◽  
The Relationship

Objectives: Many studies on the relationship between gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) were based on symptoms, but there are few research on it using reflux monitoring. This study was designed to investigate the relationship between GERD and LPR based on pH monitoring. Methods: All patients were scheduled for esophageal manometry and pH monitoring sequentially. They were stratified into 4 groups as no reflux disease, isolated GERD, isolated LPR (iLPR), and GERD combined with LPR (GERD&LPR) according to pH monitoring. Results: The incidence of LPR in GERD was 46.3%, while the probability of combining GERD in LPR was 52.7%. The reflux profile in the laryngopharynx showed a significant difference in the total reflux time (17.82 ± 18.4 vs 9.62 ± 9.58, P = .023) and the percentage of total reflux time (1.31% ± 1.37% vs 0.71% ± .0.73%, P = .023) between the GERD&LPR and iLPR groups. Conclusion: Laryngopharyngeal reflux can be combined with GERD or it can exist as an independent diagnosis. In patients with GERD&LPR, the total reflux time and the percentage of reflux time in the laryngopharynx are higher than those in the iLPR group. Reflux episodes in the laryngopharynx of patients with GERD&LPR may be derived from GERD.

scholarly journals Role of Duodenogastroesophageal Reflux in the Pathogenesis of Esophageal Mucosal Injury and Gastroesophageal Reflux Symptoms

2006 ◽  
Vol 20 (2) ◽  
pp. 91-94 ◽  
Author(s):  
Xiao-rong Xu ◽  
Zhao-shen Li ◽  
Duo-wu Zou ◽  
Guo-ming Xu ◽  
Ping Ye ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Bile Reflux ◽  
Acid Reflux ◽  
Upper Gastrointestinal Endoscopy ◽  
Esophageal Ph ◽  
Duodenogastroesophageal Reflux ◽  
Significant Difference

BACKGROUND AND AIM: Patients with gastroesophageal reflux disease (GERD) usually suffer from acid reflux and duo-denogastroesophageal reflux (DGER) simultaneously. The question of whether DGER has an important effect on the development of GERD remains controversial. The aim of the present study was to investigate the role of DGER in the pathogenesis of GERD and its value for the diagnosis of nonerosive reflux disease (NERD).METHODS: GERD was initially diagnosed using the reflux disease questionnaire. For further diagnosis, results of the upper gastrointestinal endoscopy (excluding a diagnosis of Barrett’s esophagus) were considered in conjunction with simultaneous 24 h esophageal pH and bilirubin monitoring.RESULTS: According to endoscopic findings, 95 patients (43 men, 50±10 years of age) were divided into two groups: the reflux esophagitis (RE) group (n=51) and the NERD group (n=44). Three DGER parameters, the percentage of time with absorbance greater than 0.14, the total number of reflux episodes and the number of bile reflux episodes lasting longer than 5 min, were evaluated in the study. For the RE group, the values of the DGER parameters (19.05%±23.44%, 30.56±34.04 and 5.90±6.37, respectively) were significantly higher than those of the NERD group (7.26%±11.08%, 15.68±20.92 and 2.59±3.57, respectively, P<0.05 for all) but no significant difference was found in acid reflux. Of NERD patients, 18.5% were diagnosed with simple DGER. The positive diagnosis rate of NERD could be significantly elevated from 65.9% to 84.1% (P<0.05), if bilirubin monitoring was employed in diagnosis.CONCLUSIONS: DGER may occur independently but plays an important role in the development of RE and GERD symptoms. Simultaneous 24 h esophageal pH and bilirubin monitoring is superior to simple pH monitoring in helping identify patients at risk for NERD.

scholarly journals Clinical features and prevalence of gastroesophageal reflux disease in infants attending a pediatric gastroenterology reference service

2010 ◽  
Vol 47 (1) ◽  
pp. 66-71 ◽  
Author(s):  
Yu Kar Ling Koda ◽  
Marcos J Ozaki ◽  
Kelly Murasca ◽  
Eliana Vidolin
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Clinical Features ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Clinical Manifestations ◽  
Esophageal Ph Monitoring ◽  
Pediatric Gastroenterology ◽  
Esophageal Ph ◽  
Significant Difference

CONTEXT: In infants, it is not always easy to distinguish between pathological and physiological gastroesophageal reflux based only on clinical criteria. In Brazil, studies about gastroesophageal reflux disease in infants are few and are even rare those that used prolonged esophageal pH monitoring for its evaluation. OBJECTIVE: To describe the clinical features of gastroesophageal reflux disease and to determine its prevalence in infants with gastroesophageal reflux attending a tertiary Pediatric Gastroenterology Service and submitted to esophageal pH monitoring for investigation. METHODS: Descriptive study in 307 infants in whom esophageal pH monitoring (Mark III Digitrapper, Synectics Medical AB, Sweden) was performed during the period December, 1998-December, 2008. The clinical features studied were age group (1-12 months and 13-24 months), and clinical manifestations that motivated the indication of pH monitoring. RESULTS: One hundred twenty-four (40.4%) were female and 183 (59.6%) male with mean age 12.2 ± 6.2 months (1-23 months). The prevalence of gastroesophageal reflux disease was 18.2% (56/307). One hundred forty-eight (48.2%) were 1-12 months old and 159 (51.8%), 13-24 months. No significant difference was found between the prevalence of these two age groups (P = 0.3006). Gastroesophageal reflux disease was more frequent in those with digestive manifestations (24.2%), crisis of cyanosis/apnea (23.8%) and mixed manifestations (21.5%). Respiratory manifestations were the most frequent indication (39.1%) of pH monitoring. However, the prevalence of gastroesophageal reflux disease was lower (12.5%) in this group compared with in those with digestive manifestations (P = 0.0574), crisis of cyanosis/apnea (P = 0.0882) and mixed manifestations (P = 0.1377). All infants that presented clinical manifestations as crisis of cyanosis/apnea and abnormal pH-metry were < 3 months of age. CONCLUSIONS: In our Service, the prevalence of gastroesophageal reflux disease associated with acid reflux in infants revealed elevated. Infants with crisis of cyanosis/apnea constitute risk population for gastroesophageal reflux disease in which diagnostic investigation needs to be considered.

Gastroesophageal Reflux Disease and Idiopathic Lung Fibrosis. From Heartburn to Lung Transplant, and Beyond

2021 ◽  
pp. 000313482199868
Author(s):  
Fernando A. M. Herbella ◽  
Marco G. Patti
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Lung Fibrosis ◽  
Bronchiolitis Obliterans ◽  
Lung Transplant ◽  
Ph Monitoring ◽  
Objective Evaluation ◽  
Bronchiolitis Obliterans Syndrome ◽  
Laparoscopic Operation

Idiopathic pulmonary fibrosis (IPF) and gastroesophageal reflux disease (GERD) are undoubtedly related. Even though it is not clear yet which one is the primary disease, they certainly interact increasing each other’s severity. Symptoms are unreliable to diagnose GERD in patients with IPF, and objective evaluation with pH monitoring and/or bronchoalveolar lavage analysis is mandatory. Pharmacological treatment with proton pump inhibitors (PPIs) may bring control of IPF in few patients, but PPIs do not control reflux but just change the pH of the gastric refluxate. Surgical therapy based on a fundoplication is safe and effective as it controls any type of reflux, independently from the pH of the gastric refluxate. In patients waiting for lung transplantation (if they can tolerate a laparoscopic operation under general anesthesia), a fundoplication before the operation might block the progression of IPF, while after transplantation it might prevent rejection by preventing the bronchiolitis obliterans syndrome.

Endoscopic Management of Severe Subglottic Stenosis in Wegener's Granulomatosis

2000 ◽  
Vol 19 (4) ◽  
pp. 315-317 ◽  
Author(s):  
I. Stappaerts ◽  
C. Van Laer ◽  
K. Deschepper ◽  
P. Van de Heyning ◽  
P. Vermeire
Keyword(s):  
Wegener’S Granulomatosis ◽  
Wegener's Granulomatosis ◽  
Subglottic Stenosis ◽  
Endoscopic Management

scholarly journals THE EFFICACY OF THE DIFFERENT ENDOSCOPIC TREATMENTS VERSUS SHAM, PHARMACOLOGIC OR SURGICAL METHODS FOR CHRONIC GASTROESOPHAGEAL REFLUX DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

2018 ◽  
Vol 55 (3) ◽  
pp. 296-305 ◽  
Author(s):  
Martin Andrés CORONEL ◽  
Wanderley Marques BERNARDO ◽  
Diogo Turiani Hourneaux de MOURA ◽  
Eduardo Turiani Hourneaux de MOURA ◽  
Igor Braga RIBEIRO ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Meta Analysis ◽  
Short Term ◽  
Significant Difference ◽  
Objective Outcomes

ABSTRACT BACKGROUND: Endoscopic antireflux treatments for gastroesophageal reflux disease (GERD) are still evolving, and most of the published studies address symptom relief in the short-term. Objective - We aimed to perform a systematic review and meta-analysis focused on evaluating the efficacy of the different endoscopic procedures. METHODS: Search was restricted to randomized controlled trials (RCTs) on MedLine, Cochrane, SciELO, and EMBASE for patients with chronic GERD (>6 months), over 18 years old and available follow up of at least 3 months. The main outcome was to evaluate the efficacy of the different endoscopic treatments compared to sham, pharmacological or surgical treatment. Efficacy was measured by different subjective and objective outcomes. RESULTS: We analyzed data from 16 RCT, totaling 1085 patients. The efficacy of endoscopic treatments compared to sham and proton pump inhibitors (PPIs) treatment showed a significant difference up to 6 months in favor of endoscopy with no heterogeneity (P<0.00001) (I2: 0%). The subgroup analysis showed a statistically significant difference up to 6 months in favor of endoscopy: endoscopy vs PPI (P<0.00001) (I2: 39%). Endoscopy vs sham (P<0.00001) (I2: 0%). Most subjective and objective outcomes were statistically significant in favor of endoscopy up to 6 and 12 months follow up. CONCLUSION: This systematic review and meta-analysis shows a good short-term efficacy in favor of endoscopic procedures when comparing them to a sham and pharmacological or surgical treatment. Data on long-term follow up is lacking and this should be explored in future studies.

scholarly journals Objective Evidence of Gastro-Esophageal Reflux Disease is Rare in Patients with Autoimmune Gastritis

2021 ◽  
Vol 30 (1) ◽  
pp. 30-36
Author(s):  
Valentina Pilotto ◽  
Gemma Maddalo ◽  
Costanza Orlando ◽  
Matteo Fassan ◽  
Massimo Rugge ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Serum Biomarkers ◽  
Functional Heartburn ◽  
High Resolution Manometry ◽  
Reflux Symptoms ◽  
Objective Evidence ◽  
Rome Iv

Background and Aims: Patients with autoimmune atrophic gastritis (AAG) often complain of acid reflux symptoms, despite the evidence of hypo-achlorhydria. Rome IV criteria are used to define functional esophageal disorders. Our aim was to characterize gastroesophageal reflux disease (GERD) phenotypes in patients with AAG. Methods: Between 2017-2018, 172 AAG patients were evaluated at Gastro-Oncology outpatient clinic of University of Padua. Of them, 38 patients with reflux symptoms underwent high-resolution manometry (HRM) and multichannel intraluminal impedance-pH monitoring (MII-pH). Seventy-six AAG consecutive patients asymptomatic for gastroesophageal reflux were selected as age and gender matched controls. Serum biomarkers (pepsinogens, gastrin-17 and Helicobacter pylori antibodies), upper endoscopy, histology and clinical data were compared. Results: Out of 38/172 (22%) AAG patients with reflux symptoms, 2/38 had a GERD diagnosis based on abnormal esophageal acid exposure and 6/38 had a major motility disorder (i.e. outflow obstruction). Among the 30/38 patients with normal endoscopic findings, 9/30 had reflux hypersensitivity, 19 functional heartburn, 1 functional globus, 1 functional chest pain according to the Rome IV criteria. Antral atrophy, advanced corpus atrophy and OLGA stage were more frequent in controls than in reflux patients (p=0.01, p=0.031, p=0.01, respectively). No differences were found for serum biomarkers and symptom presentation. Most of the patients received proton pump inhibitors (PPIs) treatment (87%), with a minority (34%) reporting clinical benefit. Conclusions: Reflux symptoms are relatively common in AAG patients, but a firm diagnosis of GERD is rare (5%), whereas most of the patients have a functional disorder. PPI treatment is mostly clinical ineffective and should not be largely indicated.

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