Factors predictive of gastroesophageal reflux disease and esophageal motility disorders in patients with non-cardiac chest pain

2018 ◽  
Vol 53 (6) ◽  
pp. 643-649 ◽  
Author(s):  
Juan Gomez Cifuentes ◽  
Rocio Lopez ◽  
Prashanthi N. Thota
Keyword(s):  
Chest Pain ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Esophageal Motility ◽  
Esophageal Motility Disorders ◽  
Motility Disorders

scholarly journals Silent Gastroesophageal Reflux Disease in Patients with Morbid Obesity Prior to Primary Metabolic Surgery

2020 ◽  
Vol 30 (12) ◽  
pp. 4885-4891
Author(s):  
Ivan Kristo ◽  
Matthias Paireder ◽  
Gerd Jomrich ◽  
Daniel M. Felsenreich ◽  
Mario Fischer ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Metabolic Surgery ◽  
Reflux Disease ◽  
Esophageal Motility ◽  
Esophageal Motility Disorders ◽  
Objective Testing ◽  
Motility Disorders ◽  
Asymptomatic Patients

Abstract Purpose Long-term follow-up after sleeve gastrectomy (SG) revealed a high incidence of gastroesophageal reflux disease (GERD) frequently caused by preoperative silent pathologic reflux. We aimed to evaluate prevalence and phenotypes of GERD in asymptomatic patients with morbid obesity prior to metabolic surgery according to modern objective testing. Material and Methods Prospective collection of data including consecutive patients with morbid obesity (body mass index (BMI) ≥ 35 kg/m2) prior to metabolic surgery was applied for this study between 2014 and 2019. Patients underwent clinical examinations, endoscopy, pH metry, and high-resolution manometry and were analyzed according to the Lyon consensus. Results Of 1379 patients undergoing metabolic surgery, 177 (12.8%, females = 105) asymptomatic individuals with a median age of 42.6 (33.8; 51.6) years and a median BMI of 44.6 (41.3; 50.8) kg/m2 completed objective testing and were included during the study period. GERD was diagnosed in 55 (31.1%), whereas criteria of borderline GERD were met in another 78 (44.1%). GERD was mediated by a structural defective lower esophageal sphincter (p = 0.004) and highlighted by acidic (p = 0.004) and non-acidic (p = 0.022) reflux episodes. Esophageal motility disorders were diagnosed in 35.6% (n = 63) of individuals with a novel hypercontractile disorder found in 7.9% (n = 14) of patients. Conclusion GERD affects a majority of asymptomatic patients with morbid obesity prior to primary bariatric surgery. Future longitudinal trials will have to reveal the clinical significance of esophageal motility disorders in patients with morbid obesity.

PS01.022: EVALUATION OF THE EFFECT OF THE HORMONE STATUS ON GASTROESOPHAGEAL REFLUX DISEASE, ESOPHAGEAL MOTILITY DISORDERS AND GASTROINTESTINAL SYMPTOMS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 56-56
Author(s):  
Michael Weitzendorfer ◽  
Lisa Wahl ◽  
Klaus Emmanuel ◽  
Oliver Koch
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Esophageal Motility ◽  
Gastrointestinal Symptoms ◽  
Esophageal Motility Disorders ◽  
Motility Disorders ◽  
Demeester Score ◽  
Group I ◽  
Group Ii

Abstract Background The aim of the study was to evaluate, if gastroesophageal reflux disease (GERD), esophageal motility disorders and gastrointestinal symptoms are influenced by the levels of hormones. Methods One-hundred patients with symptoms of GERD were included in the study. All patients routinely underwent 24-hours esophageal impedance pH-monitoring (MII-pH) and high-resolution esophageal manometry (HRM). Symptoms were evaluated using the Reflux-symptom index (RSI) and symptom check list (SCL) questionnaire. Blood samples were taken to analyze the levels of thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free tetraiodothyronine (FT4), gastrin, vasoactive intestinal peptide (VIP) and calcitonin. According to the results of HRM, patients were subdivided into three motility disorder groups: patients with EGJ (esophageal gastric junction) outflow obstruction or major motility disorders (group I), patients with minor motility disorders (group II) and patients with normal esophageal motility (group III). According to the results of 24h-pH-impedence-monitoring patients were divided in patients with and without objective GERD. Results Complete data was available from 86/100 patients (44 men, 42 women with a median age of 56 years). Motility disorders were found in 38/86 patients (22 in group I, 16 in group II). A pathological DeMeester score was found in 45/86 patients (median score 35). No correlation between different hormone levels and DeMeester score, LES-pressure and patients with motility disorders (group I, II) was found. A significant difference regarding calcitonin level was found between group I and III (P = 0043). Furthermore a strong inverse relation between calcitonin and the Integrated Relaxation Pressure (IRP) was found (r = -0492; P = 0000). Positive correlations were found between VIP and GI-Symptoms (r = 0298; P = 0011), as well as correlations between FT3 and dysphagia (r = 0283, P = 0016). Conclusion Calcitonin could have an effect on the function of the EGJ and esophageal motility. The hormones TSH, FT3, FT4, VIP and gastrin do not affect the motility of the esophagus and the EGJ. The levels of the evaluated hormones do not influence distal acid exposure. Thyroid hormones, as well as VIP seem to influence gastrointestinal symptoms. Disclosure All authors have declared no conflicts of interest.

Peroral endoscopic myotomy (POEM) is effective in treatment of noncardiac chest pain caused by hypercontractile esophageal motility disorders: results of the POEM-HYPE-Study

2018 ◽  
Vol 56 (11) ◽  
pp. 1337-1342 ◽  
Author(s):  
David Albers ◽  
Thomas Frieling ◽  
Dani Dakkak ◽  
Rita Kuhlbusch-Zicklam ◽  
Ulrich Töx ◽  
...  
Keyword(s):  
Chest Pain ◽  
High Resolution ◽  
Gastroesophageal Reflux ◽  
Esophageal Motility ◽  
Symptom Relief ◽  
Peroral Endoscopic Myotomy ◽  
Esophageal Motility Disorders ◽  
Noncardiac Chest Pain ◽  
Motility Disorders ◽  
Endoscopic Myotomy

Abstract Background Noncardiac chest pain (NCCP) is recurrent angina pectoris-like pain without evidence of coronary heart disease in conventional diagnostic evaluation. In gastroenterology, managing of patients with NCCP is ambiguous to detect gastroesophageal reflux and hypercontractile esophageal motility disorders. Recently, peroral endoscopic myotomy (POEM) was established as treatment option in achalasia. However, limited data exist on the effectivity of POEM in NCCP with hypercontractile esophageal motility disorders. Material and methods In this prospective study (POEM-HYPE), we evaluated 14 patients with NCCP and hypercontractile esophageal motility disorders (type III achalasia, n = 7; hypercontractile esophagus, n = 6; distal esophageal spasm, n = 1). All patients underwent standardized diagnostic work-up including esophagogastroduodenoscopy with esophageal biopsies, high-resolution esophageal manometry, and combined intraluminal impedance and pH testing before and 3 weeks after POEM. A standardized symptom questionnaire was disposed before POEM, 3 weeks after, and every 6 months after the POEM. Results After POEM, 12 patients showed significant symptom relief (pre-Eckardt score: 7.78 ± 1.47, 3 weeks post: 1.64 ± 1.44, 6 months: 2.0 ± 1.84 and 1.86 ± 1.89 after 15.0 ± 10.0 months post-intervention). High-resolution manometry showed significant reduction in integrated relaxation pressure (pre-POEM: 24.74 ± 18.9 mm Hg, post-POEM: 13.8 ± 16.5 mm Hg) and distal contractile integral (pre-POEM: 2880 ± 3700 mmHg*s*cm, post-POEM: 1109 ± 1042 mmHg*s*cm). One lesion of the submucosal tunnel occurred as a moderate adverse event and was handled endoscopically. The long-term clinical success rate was 85.7 %. No severe gastroesophageal reflux occurred after interventions. Two patients required secondary therapy with injection of botulinum toxin in the tubular esophagus and balloon dilation. Conclusion The results suggest that POEM is an effective and safe therapeutic option for patients with NCCP and hypercontractile esophageal motility disorders.

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