Asymmetrical elevation of esophagogastric junction pressure suggests hiatal repair contributes to antireflux surgery dysphagia

ABSTRACT The radial distribution of esophago-gastric junction (EGJ) pressures with regard to troublesome dysphagia (TDysph) after antireflux surgery is poorly understood. Before and after antireflux surgery, end-expiratory and peak-inspiratory EGJ pressures were measured at eight angles of 45° radial separation in patients with reflux disease. All 34 patients underwent posterior crural repair, then either 90° anterior (N = 13) or 360° fundoplication (N = 21). Dysphagia was assessed prospectively using a validated questionnaire (score range 0–45) and TDysph defined as a dysphagia score that was ≥5 above pre-op baseline. Compared with before surgery, for 90° fundoplication, end-expiratory EGJ pressures were highest in the left-anterolateral sectors, the position of the partial fundoplication. In other sectors, pressures were uniformly elevated. Compared with 90° fundoplication, radial pressures after 360° fundoplication were higher circumferentially (P = 0.004), with a posterior peak. Nine patients developed TDysph after surgery with a greater increase in end-expiratory and peak-inspiratory EGJ pressures (P = 0.03 and 0.03, respectively) and significantly higher inspiratory pressure at the point of maximal radial pressure asymmetry (P = 0.048), compared with 25 patients without TDysph. Circumferential elevation of end-expiratory EGJ pressure after 90° and 360° fundoplication suggests hiatal repair elevates EGJ pressure by extrinsic compression. The highly localized focal point of elevated EGJ pressure upon inspiration in patients with TDysph after surgery is indicative of a restrictive diaphragmatic hiatus in the presence of a fundoplication.

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Quality of life after anti-reflux surgical interventions: possible solutions to the problem

Hirurg (Surgeon) ◽

10.33920/med-15-2001-01 ◽

2020 ◽

pp. 3-25

Author(s):

D. Lukanin ◽

G. Rodoman ◽

M. Klimenko ◽

A. Sokolov ◽

A. Sokolov

Keyword(s):

Quality Of Life ◽

Hiatal Hernia ◽

Antireflux Surgery ◽

Nissen Fundoplication ◽

Laparoscopic Nissen Fundoplication ◽

Partial Fundoplication ◽

Surgical Interventions ◽

Number Of Patients ◽

Laparoscopic Nissen

The article presents the results of a prospective controlled parallel clinical study of a new modification of laparoscopic antireflux surgery in the treatment of gastroesophageal reflux disease in combination with a hiatal hernia compared with laparoscopic Nissen fundoplication in terms of assessing quality of life after surgery. Clinical and instrumental examination of patients was carried out a year after surgical interventions. In accordance with the results of instrumental examination after surgery, the proposed modification of laparoscopic partial fundoplication is not inferior to laparoscopic Nissen fundoplication both, in terms of relief of reflux esophagitis symptoms and in relation to the recurrence of hiatal hernia. Clinical monitoring indicates a significantly higher quality of life for patients after the modified antireflux surgery, which is associated with a number of factors. The implementation of this fundoplication led to a decrease in the number of patients with complaints of dysphagia, the development of which is directly related to the surgery performance, as well as to a statistically significant reduction of bloating in the upper abdomen. Another advantage of the modified surgery is a significantly smaller number of cases of gas-bloat syndrome. In addition, the disorders developing in the framework of the gas bloat syndrome after laparoscopic Nissen fundoplication are more severe.

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Faculty Opinions recommendation of Antireflux surgery preserves lung function in patients with gastroesophageal reflux disease and end-stage lung disease before and after lung transplantation.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718000906.793475046 ◽

2013 ◽

Author(s):

Keith Meyer

Keyword(s):

Gastroesophageal Reflux Disease ◽

Lung Function ◽

Gastroesophageal Reflux ◽

Lung Transplantation ◽

Lung Disease ◽

Reflux Disease ◽

Antireflux Surgery ◽

Before And After ◽

End Stage

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Gastroesophageal Reflux Disease: Integrating the Barium Esophagram before and after Antireflux Surgery

Radiology ◽

10.1148/radiol.2432050057 ◽

2007 ◽

Vol 243 (2) ◽

pp. 329-339 ◽

Cited By ~ 29

Author(s):

Mark E. Baker ◽

David M. Einstein ◽

Brian R. Herts ◽

Erick M. Remer ◽

Gaspar Alberto Motta-Ramirez ◽

...

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Antireflux Surgery ◽

Before And After ◽

Barium Esophagram

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Dynamics of acoustic voice parameters in patients after antireflux surgery

Russian otorhinolaryngology ◽

10.18692/1810-4800-2020-4-34-38 ◽

2020 ◽

Vol 19 (4) ◽

pp. 34-38

Author(s):

G. A. Dudaity ◽

◽

L. V. Georgieva ◽

Keyword(s):

Antireflux Surgery ◽

Respiratory Diseases ◽

Ph Monitoring ◽

Control Group ◽

Acoustic Parameters ◽

Voice Analysis ◽

Before And After ◽

Upper Respiratory ◽

The Voice ◽

Late Postoperative Period

The article is devoted to the influence of pharyngolaryngeal reflux on the voice acoustic parameters in patients before and after the antireflux surgery (fundoplication). The study involved 12 patients aged 33 to 64 years with a confirmed impedance–pH monitoring diagnosis of gastroesophageal reflux disease. The control group included 10 patients aged 18 to 33 years. These subjects did not have any upper respiratory diseases (including pharyngolaryngeal reflux) and gastrointestinal tract diseases. Computer voice analysis was used to objectively evaluate the voice acoustic parameters. In patients before fundoplication, a statistically significant increase in Jitter and Shimmer parameters was observed in 100% of cases compared with the control group (p ≤ 0,05). In the late postoperative period, 6 months after surgery, the analysis of acoustic parameters of voice in the study group revealed: Jitter and Shimmer indicators in 100% of cases significantly decreased compared to the preoperative values (p ≤ 0,05), which indicates an improvement in voice function. Jitter and Shimmer were the most diagnostically significant parameters.

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Correction of gastrocardial syndrome in patients with hernias of the esophageal orifice of the diaphragm during antireflux operations

Medical Council ◽

10.21518/2079-701x-2021-21-2-62-71 ◽

2022 ◽

pp. 62-71

Author(s):

T. V. Khorobrykh ◽

A. A. Voevodina ◽

D. A. Efremov ◽

V. I. Korotkiy ◽

N. R. Khusainova ◽

...

Keyword(s):

Surgical Treatment ◽

Angina Pectoris ◽

Hiatal Hernia ◽

Reflux Esophagitis ◽

Antireflux Surgery ◽

Pain Syndrome ◽

Ecg Monitoring ◽

Younger Age ◽

Before And After ◽

Antireflux Operations

Introduction. Hernia of the esophageal opening of the diaphragm in 90% of cases is the main cause of the development of reflux esophagitis. The doctrine highlighted a large group of extraesophageal manifestations of reflux esophagitis, including gastrocardiac syndrome.Аim. The purpose of this publication is to evaluate the effectiveness of antireflux surgery in patients with hiatal hernia through the prism of its effectiveness in the dynamics of gastrocardial syndrome regression.Material and мethods. The paper presents the results of diagnostics and surgical treatment of 101 patients with hiatal hernia.Results. According to the data of instrumental research methods, cardiac hernias of the esophageal opening of the diaphragm were detected in 45 (44.5%) patients, cardiofundal in 40 (39.6%), subtotal in 15 (14.8%), total in 1 (0.9%). The main place in the clinical picture of gastrocardial syndrome was occupied by the pain syndrome behind the breastbone (83.1%). Thus, arrhythmias were found in 16 (40.0%) patients with cardiofundal, in 10 (66.6%) subtotal and in 1 (100.0%) total hiatal hernia, and angina pectoris is characteristic of cardiac hernias and was observed in 20 (44.4%) patients. The clinical manifestation of reflex angina pectoris and arrhythmias depended on the degree of shortening of the esophagus. Thus, arrhythmias were more common in patients with cardiofundal (50.0%), subtotal (71.4%), total (100.0%) hiatal hernia with II degree of shortening of the esophagus, and angina pectoris characteristic of cardiac (75.0%) hiatal hernia. with II degree of shortening of the esophagus. Reflex angina is typical for patients of the older age group, and manifestations of arrhythmia are recorded at a younger age. Heart rate variability was considered, according to electrocardiogram and Holter ECG monitoring before and after surgical treatment, where the parameters significantly (p> 0.05) decreased.Conclusions. The phenomena of gastrocardial syndrome regressed after antireflux surgery in 44 (43.5%) patients. Surgical treatment from the endovideosurgical approach did not worsen the results of surgical treatment.

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Credit Rating Strategies: A Study of GCC Banks

10.31124/advance.11761788.v1 ◽

2020 ◽

Author(s):

Y. Sree Rama Murthy ◽

Saeed Al-Muharrami

Keyword(s):

Financial Crisis ◽

Commercial Banks ◽

Credit Rating ◽

Global Financial Crisis ◽

Focal Point ◽

Credit Ratings ◽

Islamic Banks ◽

Before And After ◽

Capital Ratios ◽

Financial Strategies

Purpose It is difficult to predict when the next financial crisis will happen. Identifying financial strategies, which help a bank to survive a crisis, is the main purpose of the paper. This paper examines the financial strategies of those banks, which managed to retain good credit ratings both before and after the global financial crisis, so as to throw light on the characteristics of banks which managed to remain steady and stable. Design This paper analyses Fitch credit ratings of 51 banks Islamic and commercial banks operating in GCC, divided into pre global financial crisis (2002 to 2007) and post global financial crisis (2008 to 2013) periods. Trend and behavior of average ratios of top rated banks in both the periods is first attempted before moving to “Ordered Choice Logit” regression method to further analyze the data. Findings Size and cost management are very important factors in ratings, both before and after the financial crisis. As long as asset quality is under control, liquidity is the focal point in achieving good ratings. Top rated Islamic banks seem to be following a strategy of allowing capital ratios to trend down during a crisis as long as capital is well above the regulatory requirements. Originality and Value The paper is the first of its kind which examines credit rating strategies of Islamic banks as well as commercial banks. <a>The findings of the paper are extremely important for banks as they throw light on appropriate strategies to be adopted by banks during crises.</a>

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Credit Rating Strategies: A Study of GCC Banks

10.31124/advance.11761788 ◽

2020 ◽

Author(s):

Y. Sree Rama Murthy ◽

Saeed Al-Muharrami

Keyword(s):

Financial Crisis ◽

Commercial Banks ◽

Credit Rating ◽

Global Financial Crisis ◽

Focal Point ◽

Credit Ratings ◽

Islamic Banks ◽

Before And After ◽

Capital Ratios ◽

Financial Strategies

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Effect of a Video-Assisted Teaching Program About ECT on Knowledge and Attitude of Caregivers of Patients with Major Mental Illness

Indian Journal of Psychological Medicine ◽

10.1177/0253717620938038 ◽

2020 ◽

pp. 025371762093803

Author(s):

Padmavathi Nagarajan ◽

Gomathi Balachandar ◽

Vikas Menon ◽

Balachandar Saravanan

Keyword(s):

Bipolar Affective Disorder ◽

Single Session ◽

Video Assisted ◽

Validated Questionnaire ◽

Before And After ◽

Post Test ◽

Conservative Attitude ◽

Level Of Knowledge ◽

Knowledge And Attitude ◽

Persons With Schizophrenia

Background: Electroconvulsive therapy (ECT) is a widely used treatment modality for mental disorders such as major depression, bipolar affective disorder (BPAD) and catatonia. However, it is considered as one of the most controversial and misunderstood procedures, especially among caregivers. Methods: An experimental pre-test, post-test design was adopted. Forty caregivers of persons with schizophrenia ( n = 12), depression ( n = 13), BPAD with mania ( n = 8), and BPAD with depression ( n = 7) were selected using convenience sampling. The caregiver’s knowledge and attitude toward ECT were assessed before and after the intervention with a single session video-assisted teaching on ECT. The data collection tool used to assess the caregiver’s knowledge and attitude was based on a pre-validated questionnaire. Results: The pre-test evaluation demonstrated poor knowledge among 12 (30%) and a moderate level of knowledge on the remaining 28 (70%) of the study subjects. The attitude scores revealed a neutral attitude among 47.5% and a conservative attitude among 10% of the subjects toward ECT. There was a significant improvement in both mean (±SD) knowledge (13.4 ± 4.7 vs 25.6 ± 2.9) and attitude (10.7 ± 3.5 vs 14.6 ± 3.9) scores following intervention with video-assisted teaching. Conclusion: A single session involving video-assisted teaching improves the knowledge and attitude toward ECT among caregivers by removing the myths and misconceptions about ECT.

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