Gastroesophageal reflux disease and salivary pepsin in patients with heterotopic gastric mucosa in the upper esophagus

2021 ◽  
Author(s):  
Xin Xiong ◽  
Suyu He ◽  
Fei Xu ◽  
Zhihong Xu ◽  
Xiumei Zhang ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastric Mucosa ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Acid Reflux ◽  
Heterotopic Gastric Mucosa ◽  
Control Group ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Demeester Score

Summary Background Heterotopic gastric mucosa in the upper esophagus (HGMUE) is reported to be related to gastroesophageal reflux disease (GERD). This study investigated the prevalence of GERD and the use of salivary pepsin to diagnose gastroesophageal reflux, especially proximal reflux, in HGMUE patients. Methods One hundred and fifty-three HGMUE patients and 50 healthy volunteers were studied. All subjects took a reflux symptom index questionnaire (RSI); underwent endoscopy, barium esophagogram, high-resolution manometry (HRM), and 24-hour multichannel intraluminal impedance-pH-metry (MII-pH); and salivary pepsin test. Results Ninety-five (62.1%) HGMUE patients but no control subjects were diagnosed with GERD. The salivary pepsin concentration, RSI score, DeMeester score, acid exposure time (AET), total reflux episodes, proximal acidic reflux episodes, and proximal weakly acidic reflux episodes were significantly higher in the HGMUE group than in the control group (P < 0.05). The salivary pepsin test showed a sensitivity of 85.9% and specificity of 56.9% for diagnosing GERD using the optimal cut-off value of 75 ng/mL. One hundred and seven (69.9%) and 46 (30.1%) HGMUE patients were categorized as pepsin (+) and pepsin (−), respectively when 75 ng/mL was used as a cut-off value. Male sex, RSI, AET, and proximal acid reflux episodes were positive predictive factors for the occurrence of pepsin (+) in HGMUE patients. Conclusions GERD, especially GERD with proximal acid reflux and related symptoms, was common in HGMUE patients. The salivary pepsin test could be an additional useful test for testing reflux in HGMUE patients, but it will not replace the MII-pH.

scholarly journals Sex-Based Differences in pH Parameters and Esophageal Impedance of Patients With Gastroesophageal Reflux Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Bixing Ye ◽  
Yanjuan Wang ◽  
Lin Lin ◽  
Liuqin Jiang ◽  
Meifeng Wang
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Mucosal Barrier ◽  
Esophageal Mucosa ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Esophageal Impedance

Background/Aims: The incidence of reflux esophagitis (RE) has a striking predominance in males. Conversely, non-erosive reflux disease (NERD) is more common in females. This imbalance of gastroesophageal reflux disease (GERD) implies sex-related differences in its pathogenesis. However, limited studies have analyzed the sex-based differences in pH parameters and esophageal impedance of GERD patients.Methods: This study evaluated sex-based pathogenesis differences by comparing reflux episodes, mean nocturnal baseline impedance (MNBI) values, and post-reflux swallow-induced peristaltic wave (PSPW) index values of males with GERD and females with GERD using 24-h multichannel intraluminal impedance and pH monitoring.Results: We analyzed 181 patients (102 males and 79 females) with GERD. Reflux symptom index (RSI) scores were higher in females than that in males (P < 0.05). Males had significantly longer acid exposure times, higher DeMeester scores, and more acid reflux episodes than females (P < 0.05). Females had more instances of weakly acidic reflux than males (P < 0.01). The PSPW index values of males and females were similar (P > 0.05). Compared with females, males had lower MNBI values for the mid and distal esophagus (P < 0.05). However, with increasing age, the MNBI values of females decreased more rapidly than those of males. MNBI values of elderly patients of both sexes older than 60 years were similar.Conclusions: Acid reflux is more likely to occur in males; however, females tend to have more instances of weakly acid reflux. The integrity of the esophageal mucosa is more fragile in males than in females; however, the esophageal mucosal barrier attenuates more rapidly with increasing age in females than in males.

scholarly journals Peculiarities of the Pathology of Gastrointestinal Tract in Patients with Gastroesophageal Reflux Disease on the Background of Hypothyroidism

2021 ◽  
Vol 6 (1) ◽  
pp. 125-131
Author(s):  
Reva T. V. ◽  
◽  
V. B. Reva ◽  
I. V. Trefanenko ◽  
G. І. Shumko ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Gastroesophageal Reflux Disease ◽  
Gastric Mucosa ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Erosive Esophagitis ◽  
Control Group ◽  
Esophageal Mucosa ◽  
Gastric Evacuation ◽  
Duodenogastroesophageal Reflux

The article identifies the features of the pathology of the gastrointestinal tract in patients with gastroesophageal reflux disease on the background of hypothyroidism. The frequency of gastroesophageal reflux disease and the severity of this disease increase with age and the presence of comorbid pathology. In the elderly, the frequency of the typical esophageal manifestations decreases, and the erosive esophagitis with atypical symptoms is more common. The growing number of cases of combined thyroid dysfunction with gastropathology requires in-depth study of the reasons for the relationship between these processes. Pathological changes in the gastrointestinal tract in these patients make their condition severer, contributing to the development and progression of metabolic disorders. An important aggravating effect on the regulatory mechanisms of esophageal kinetics has a pathological functioning of the thyroid gland on the background of iodine deficiency. Results and discussion. In patients with gastroesophageal reflux disease with hypothyroidism, all changes in gastric and duodenal function are associated with a decrease in the acid-forming function of the gastric mucosa, due to its atrophy, decreased tone and contractility of the stomach. This in turn leads to a slowing of gastric and duodenal evacuation, dysfunction of the closing capacity of the cardia and, as a consequence, the development of duodenogastroesophageal reflux. The esophageal contents are not so pronounced, so patients with non-erosive forms of esophagitis predominate (46.2%) against 16% of patients in the second group (patients with gastroesophageal reflux disease). At the same time, erosive forms predominate among patients in the control group with predominant acid reflux. It should be noted that there is a clear relationship between the frequency of erosive changes in the esophageal mucosa and the duration of the disease. Thus, among patients of the main group with a 5-year history of the disease, the number of erosive forms of gastroesophageal reflux disease was minimal. The number of erosive changes in the esophageal mucosa increased sharply in patients with a 10-year history and reached its maximum after 15 years from the onset of the disease. Conclusion. The delay in gastric evacuation is more pronounced in patients with gastroesophageal reflux disease on the background of hypothyroidism. It can be explained by a decrease in gastric motility and the presence of duodenostasis. The slowing of gastric evacuation was more pronounced in patients with gastroesophageal reflux disease on the background of reduced thyroid function. In patients with gastroesophageal reflux disease on the background of hypothyroidism there is an alkaline duodenogastroesophageal reflux as a consequence of reduced acid-forming function of the gastric mucosa and reduced contractility of the stomach and duodenum

Laparoscopic Nissen Fundoplication Ameliorates Symptoms of Reflux, Especially for Patients with Very Abnormal DeMeester Scores

2008 ◽  
Vol 74 (7) ◽  
pp. 635-643 ◽  
Author(s):  
Sharona B. Ross ◽  
Desiree Villadolid ◽  
Harold Paul ◽  
Sam Al-Saadi ◽  
Javier Gonzalez ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Nissen Fundoplication ◽  
Acid Reflux ◽  
Laparoscopic Nissen Fundoplication ◽  
Demeester Score ◽  
Reflux Symptoms ◽  
Before And After ◽  
Laparoscopic Nissen

Intuitively, more severe acid reflux causes more severe symptoms. This study was undertaken to correlate preoperative DeMeester scores with symptoms before and after laparoscopic Nissen fundoplication. Before fundoplication, all patients with gastroesophageal reflux disease underwent 24 to 48 hour pH testing. Before and after fundoplication, the frequency and severity of reflux symptoms were scored using a Likert scale. Four hundred and eighty-one patients underwent fundoplication and were followed for a mean of 32 months. The preoperative median DeMeester score was 41 (range 14.8 to 361.5). Before fundoplication, DeMeester scores correlated with severity of gastroesophageal reflux disease symptoms (Spearman regression analysis, P < 0.05 for all). Postoperatively, all symptom scores improved (Wilcoxon matched pairs test, P < 0.05 for all). After fundoplication, preoperative DeMeester scores did not correlate with the frequency or severity of symptoms. For patients with excessive acid reflux, reflux severity impacts the frequency and severity of symptoms before fundoplication. Laparoscopic Nissen fundoplication improves the frequency and severity of all reflux symptoms. The severity of preoperative reflux does not impact the frequency or severity of symptoms after fundoplication. Relief of excessive acid reflux, regardless of severity or degree ( i.e., DeMeester scores), ameliorates symptoms of acid reflux thereby encouraging fundoplication, especially for patients with very abnormal DeMeester scores.

Transoral incisionless fundoplication with an ultrasonic surgical endostapler for the treatment of gastroesophageal reflux disease: 12-month outcomes

Endoscopy ◽  
2020 ◽  
Vol 52 (06) ◽  
pp. 469-473
Author(s):  
Pier Alberto Testoni ◽  
Sabrina Testoni ◽  
Giorgia Mazzoleni ◽  
Giuseppe Pantaleo ◽  
Maria Bernadette Cilona ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Reflux Symptom Index ◽  
Transoral Incisionless Fundoplication ◽  
Symptom Index ◽  
High Resolution Manometry ◽  
Related Quality ◽  
Health Related

Background Transoral incisionless fundoplication (TIF) with the Medigus ultrasonic surgical endostapler (MUSE) is a new intervention for the treatment of the gastroesophageal reflux disease (GERD). The aim of this study was to assess the 12-month clinical, functional, and endoscopic effects of TIF by MUSE. Methods Patients undergoing MUSE completed the GERD-Health Related Quality of Life (GERD-HRQL) and Reflux Symptom Index (RSI) questionnaires, and underwent endoscopy, esophageal 24-hour pH-impedance recording, and high resolution manometry (HRM) before the TIF procedure and 12 months later, or after 6 months for HRM. Results Among the 37 patients treated, esophageal intubation was not possible in one and esophageal perforation occurred in another. Clinical and endoscopic follow-up at 12 months was completed in 20 patients, with significant improvements in GERD-HRQL, RSI, heartburn, regurgitation scores, and proton pump inhibitor (PPI) consumption observed. One patient required surgery for persisting symptoms. Functional follow-up was possible in 13 patients and showed no significant improvements in the analyzed parameters. Conclusions TIF with MUSE significantly improved symptoms at 1-year follow-up, allowing the consumption of PPIs to be stopped or halved in 90 % of patients.

Clinical observation of different anti-reflux methods in the treatment of gastroesophageal reflux disease with hiatus hernia

2021 ◽  
Author(s):  
Zhi-tong Li ◽  
Rui Zhang ◽  
Xin-wei Han ◽  
Chun-xia Li ◽  
Li Wang ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Postoperative Period ◽  
Hiatus Hernia ◽  
Reflux Disease ◽  
Operation Time ◽  
Control Group ◽  
Demeester Score ◽  
Significant Difference ◽  
Experimental Group

Abstract Hiatus hernia (HH) is a common benign disease of the digestive tract, which weaks the function of the anti-reflux barrier and causes gastroesophageal reflux disease (GERD). Laparoscopic HH repair and fundoplication is a classic surgical treatment for GERD patients with HH; however, some patients may complain of dysphagia and gas-bloating after the operation. For reducing complications of fundoplication, we adopted a new type of anti-reflux surgery for GERD treatment. We analysed our database of 40 patients with GERD plus HH who had LDF or a new anti-reflux surgery. At 12 months　after surgery, the total score(Sc), DeMeester score, numbers of reflux detected by impedance monitoring all decreased in two groups postoperatively, and there was no significant difference between the two groups after surgery. The minimum respiratory value increased after the operation in the control group, but there was no significant difference between the two groups. The mean respiratory value both increased in two groups postoperatively, and there was no significant difference between the two groups. The dysphagia in the experimental group was less common than that in the control group from early to 12 months after surgery. There was no significant difference in gas-bloating between the two groups in the early postoperative period but it was significantly lower in the experimental group than that in the control group in the late postoperative period. The short-term efficacy of the new anti-reflux surgery is the same as that of the LDP in the treatment of GERD with HH; however, the operation time, intraoperative blood loss, and the surgical complication rate are lower than that of the LDF, therefore, it is more commonly recommended.

scholarly journals Refluks Laringofaring

2020 ◽  
Vol 2 (1) ◽  
pp. 64-7
Author(s):  
Wita Aulia
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Fiber Optic ◽  
Laryngopharyngeal Reflux ◽  
Reflux Finding Score ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Pharmacological Management ◽  
Lying Down

Laryngopharyngeal reflux (LPR) is a disease in which retrograde flow occurs from the contents of the stomach to the larynx and pharynx and then this material is in contact with the upper esophagus. This disease is different from gastroesophageal reflux disease (GERD). A man, 58 years old laborer, came with complaints of hoarseness since 3 months ago. Complaints are accompanied by swallowing pain and throat pain that has worsened since 1 month. The patient also complained that the sound had disappeared within 1 month. The patient has a history of smoking and claims that he has had a long-standing heartburn. Physical examination found blood pressure of 150/90 mmHg, pulse 102 x/minute, breathing 20 x/minute, temperature 37.9ºC. Investigations were done using the Fiber Optic Laryngoscope (LFO) and revealed a rigid epiglottis and bilateral hyperemic arytenoids and minimal edema. RSI score calculation results have been 18 and RFS score results have been 9. This pateint’s diagnosis is Laryngopharyngeal reflux (LPR). Pharmacological management for this patient is Omeprazole 40 mg 2x1 tablet, Sucralfate syrup 3x1 teaspoon, and N-acetylcysteine 3x1 tablet. Non-pharmacological management is by telling the patient to give 2 hours time between eating and lying down. The patient is also told to reduce the consumption of fatty foods, coffee, soda, alcohol, and low-acid diets, and position the head slightly higher when lying down. Keywords: Fiber Optic Laryngoscope, laryngopharyngeal reflux, Reflux Finding Score, Reflux Symptom Index     Refluks laringofaring adalah penyakit dimana terjadi aliran retrograde dari isi lambung ke laring dan faring kemudian cairan ini bersentuhan dengan saluran esofagus bagian atas. Penyakit ini berbeda dengan gastroesophageal reflux disease (GERD). Seorang laki-laki, usia 58 tahun seorang buruh datang dengan keluhan suara serak sejak 3 bulan yang lalu. Keluhan disertai dengan nyeri menelan dan nyeri tenggorokan yang memberat sejak 1 bulan ini. Pasien juga mengeluhkan suara sempat hilang timbul dalam 1 bulan ini. Pasien memiliki riwayat merokok dan mengaku bahwa menderita sakit maag sejak lama. Pemeriksaan fisik didapatkan tekanan darah 150/90 mmHg, nadi 102 x/menit, pernapasan 20 x/menit, suhu 37,9ºC. Pada pemeriksaan penunjang Fiber Optic Laryngoscope (LFO), didapatkan epiglotis yang kaku serta aritenoid hiperemis bilateral dan edema minimal. Pada perhitungan skor RSI didapatkan hasil 18 dan skor RFS didapatkan hasil 9. Diagnosis pada pasien ini adalah refluks laringofaring. Penatalaksanaan pada pasien berupa medikamentosa yaitu Omeprazole tablet 40 mg 2x1 tablet, Sukralfat syrup 3x1 sendok teh, dan N-asetilsistein 3x1 tablet. Non-medikamentosa dengan memberitahukan kepada pasien untuk jarak makan dan berbaring kurang lebih 2 jam, mengurangi konsumsi makanan berlemak, kopi, soda, alkohol, dan diet rendah asam, serta memberitahukan kepada pasien untuk memposisikan kepala sedikit lebih tinggi saat berbaring Kata kunci: Fiber Optic Laryngoscope, refluks laringofaring, Reflux Finding Score, Reflux Symptom Index

scholarly journals Magnetic Sphincter Augmentation Outcomes in Severe Gastroesophageal Reflux Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Davide Ferrari ◽  
Stefano Siboni ◽  
Carlo Galdino Riva ◽  
Guglielmo Guerrazzi ◽  
Andrea Lovece ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Severe Disease ◽  
Lower Esophageal Sphincter Pressure ◽  
Control Group ◽  
Sphincter Pressure ◽  
Magnetic Sphincter Augmentation ◽  
Related Factors ◽  
Demeester Score

Introduction: Outcomes of laparoscopic procedures for gastroesophageal reflux disease (GERD) are variable depending on surgical expertise and/or patient-related factors. Some procedures may be inadequate in patients with severe disease. Effectiveness of laparoscopic magnetic sphincter augmentation (MSA) has not been extensively tested in patients with severe disease.Methods: A prospectively collected database was analyzed to identify patients who underwent MSA at a single institution. Individuals who had previous esophago-gastric surgery were excluded. Severe GERD was defined as lower esophageal sphincter pressure &lt;5 mmHg, distal esophageal amplitude &lt;30 mmHg, Barrett's metaplasia, stricture or grade C-D esophagitis, and/or DeMeester score &gt;50. Clinical characteristics and outcomes of patients with severe GERD were compared with those of patients with mild to moderate GERD who served as control group.Results: Over the study period, a total of 336 patients met the inclusion criteria, and 102 (30.4%) had severe GERD. The median follow-up was 24 months (IQR = 75) in severe GERD patients and 32 months (IQR = 84) in those with non-severe GERD. Patients with severe GERD had a higher rate of dysphagia and higher GERD-HRQL scores. After the MSA procedure, symptoms, health-related quality of life scores, and proton-pump inhibitors consumption significantly decreased in both groups (p &lt; 0.05). No difference between groups was found in the prevalence of severe post-operative dysphagia, the need for endoscopic dilation or device removal, and the DeMeester score.Conclusion: Laparoscopic MSA is safe and effective in reducing symptoms, PPI use, and esophageal acid exposure also in patients with severe GERD.

Treatment of Gastroesophageal Reflux Disease After Lung Transplant Using Radiofrequency Ablation to the Lower Esophageal Sphincter (Stretta Procedure)

2021 ◽  
pp. 000313482199867
Author(s):  
Hordur M. Kolbeinsson ◽  
Cameron Lawson ◽  
Amy Banks-Venegoni ◽  
Reda Girgis ◽  
David E. Scheeres
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Lung Transplant ◽  
Case Series ◽  
Acid Reflux ◽  
Median Number ◽  
Demeester Score ◽  
Stretta Procedure ◽  
Percent Time

Background Gastroesophageal reflux disease (GERD) is associated with chronic lung allograft dysfunction after lung transplant. Treating GERD after lung transplant has been shown to improve lung allograft function. This case series describes the efficacy of the Stretta procedure to control GERD after lung transplant at our institution. Methods Eleven patients underwent the Stretta procedure at our institution for GERD after lung transplant during the years 2016-2017. Pre- and post-Stretta reflux parameters were gathered. Pulmonary function was followed up until subsequent fundoplication surgery, death, or end of study observation. Results Reflux on esophagram was noted in 9 patients before Stretta and 8 patients after Stretta. The median number of acid reflux events was 31.5 vs. 26 after Stretta ( P = .95), and median percent time in reflux was 17.7% before vs. 14.5% after Stretta ( P = .76). Median DeMeester score before Stretta was 65.5 (range: 33.2-169.8) vs. 42.5 (range: 19.2-109.8) after the procedure ( P = .14). Median lower esophageal resting pressure was 20.7 mm Hg (n = 7) compared to 25.9 mm Hg (n = 9) on post-Stretta follow-up ( P = .99). Median FEV1% predicted was 84% (41-97%) before compared to 71% (23-108%) at 1 year after the procedure ( P = .14). Seven patients required fundoplication surgery for continued reflux. All patients were on triple immunosuppression, most commonly prednisone, tacrolimus, and mycophenolate (n = 9). Discussion The Stretta procedure did not provide expected results at our institution after lung transplant surgery. Based on our limited series, we do not recommend routine use of the Stretta procedure for management of GERD in lung transplant patients.

scholarly journals Food patterns in Russian patients with gastroesophageal reflux disease: the results of pilot comparative study

2020 ◽  
Vol 92 (8) ◽  
pp. 66-72
Author(s):  
V. S. Kropochev ◽  
S. V. Morozov ◽  
M. A. Lantseva ◽  
A. N. Sasunova ◽  
V. I. Pilipenko ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Healthy Eating ◽  
Reflux Disease ◽  
Final Analysis ◽  
Control Group ◽  
Esophageal Ph ◽  
Symptom Evaluation ◽  
Source Data ◽  
Acid Exposure Time

Aim. To evaluate nutritional patterns in patients with gastroesophageal reflux disease (GERD) compared to the control group without GERD. Materials and methods. The data of complex examination of patients referred to perform esophageal pH-impedance recording and who gave written informed consent to participate in the study served as a source data. All the participants underwent complex examination, including clinical data (presence of heartburn and acid regurgitation), symptom evaluation (GERD-Q questionnaire), esophagogastroscopy, esophageal pH-impedance recordings and food frequency questionnaire. Diagnosis of GERD was based on GERD-Q score 8, acid exposure time 6%, number of gastroesophageal refluxes 80/day by 24-hrs esophageal pH-impedance recordings. Nutritional patterns were assessed with the use of healthy eating pyramid principles. Results. Overall 165 patients were enrolled and the data of 150 of them (34 with confirmed GERD and 116 of the control group) were available for the final analysis. The patients of the both groups consumed lower compared to the recommended amounts of dairy and higher amounts of meat. Those with GERD consumed larger amounts of fruits (0.910.68 compared to the values of healthy eating pyramid vs 0.520.57 in the control group, p=0.001), and fats (0.690.55 vs 0.490.55, p=0.001). Compared to the controls, patients with GERD consumed lower amounts of vegetables (0.860.46 of the healthy eating pyramid vs 0.940.63 in the control group, р=0.004) and sugars confectionaries (0.380.39 vs 1.930.98, p=0.0001). Conclusion. Nutritional patterns of patients with gastroesophageal reflux disease significantly differ compared to the control group. The obtained data may be used for diet modification in patients with arterial hypertension.

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