The burden of gastroesophageal reflux disease on the cost of managing chronic diseases in Australia. The need for a new diagnostic and management paradigm

2020 ◽  
pp. 174239532096637
Author(s):  
Leticia Burton ◽  
John Beattie ◽  
Gregory L Falk ◽  
Hans Van der Wall ◽  
William Coman
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Cost Burden ◽  
Good Tool ◽  
Demeester Score ◽  
Atypical Symptoms ◽  
Visual Evidence ◽  
The Cost ◽  
Scintigraphic Finding

Introduction Chronic disease poses a major problem for the Australian healthcare system as the leading cost-burden and cause of death. Gastroesophageal reflux disease (GORD) typifies the problems with a growing prevalence and cost. We hypothesise that a scintigraphic test could optimise the diagnosis, especially in problematic extraoesophageal disease. Materials and Methods Data was collected from 2 groups of patients. Patients undergoing fundoplication for severe GORD (n = 30) and those with atypical symptoms (n = 30) were studied by scintigraphy and 24-hour oesophageal pH, impedance and manometry. Results Mean age of cohort was 55.8 years with 40 females and 20 males. Body mass index was a mean of 28.3. DeMeester score was normal in 12/60 with atypical symptoms and abnormal in the rest. Good correlation was shown between scintigraphy and impedance, manometry and distal pH readings. Pulmonary aspiration was shown in 25/60 (15 with atypical symptoms) and LPR in 20/30. Several impedance, manometric and scintigraphic finding were good predictors of lung aspiration of refluxate. Conclusion Scintigraphy provides a good tool for screening patients with typical and atypical symptoms of GORD. It is well correlated with the standard methods for the diagnosis and provides visual evidence of LPR and lung aspiration.

Gastroesophageal Reflux Disease: A Gastroenterologist's Perspective

2011 ◽  
Vol 21 (3) ◽  
pp. 89-99
Author(s):  
Michael F. Vaezi
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Best Practice ◽  
Clinical Care ◽  
Diagnostic Testing ◽  
Diagnostic Tools ◽  
Swallowing Function ◽  
Atypical Symptoms

Gastroesophageal reflux disease (GERD) is a commonly diagnosed condition often associated with the typical symptoms of heartburn and regurgitation, although it may present with atypical symptoms such as chest pain, hoarseness, chronic cough, and asthma. In most cases, the patient's reduced quality of life drives clinical care and diagnostic testing. Because of its widespread impact on voice and swallowing function as well as its social implications, it is important that speech-language pathologists (SLPs) understand the nature of GERD and its consequences. The purpose of this article is to summarize the nature of GERD and GERD-related complications such as GERD-related peptic stricture, Barrett's esophagus and adenocarcinoma, and laryngeal manifestations of GERD from a gastroenterologist's perspective. It is critical that SLPs who work with a multidisciplinary team understand terminology, diagnostic tools, and treatment to ensure best practice.

scholarly journals Diagnosis and management of gastroesophageal reflux disease

2014 ◽  
Vol 27 (3) ◽  
pp. 210-215 ◽  
Author(s):  
Maria Aparecida Coelho de Arruda Henry
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Gastroesophageal Reflux Disease ◽  
Drug Use ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Disease Diagnosis ◽  
Clinical Treatment ◽  
Atypical Symptoms

INTRODUCTION: Gastroesophageal reflux disease (GERD) is probably one of the most prevalent diseases in the world that also compromises the quality of life of the affected significantly. Its incidence in Brazil is 12%, corresponding to 20 million individuals. OBJECTIVE: To update the GERD management and the new trends on diagnosis and treatment, reviewing the international and Brazilian experience on it. METHOD: The literature review was based on papers published on Medline/Pubmed, SciELO, Lilacs, Embase and Cochrane crossing the following headings: gastroesophageal reflux disease, diagnosis, clinical treatment, surgery, fundoplication. RESULTS: Various factors are involved on GERD physiopathology, the most important being the transient lower esophageal sphincter relaxation. Clinical manifestations are heartburn, regurgitation (typical symptoms), cough, chest pain, asthma, hoarseness and throat clearing (atypical symptoms), which may be followed or not by typical symptoms. GERD patients may present complications such as peptic stenosis, hemorrhage, and Barrett's esophagus, which is the most important predisposing factor to adenocarcinoma. The GERD diagnosis must be based on the anamnesis and the symptoms must be evaluated in terms of duration, intensity, frequency, triggering and relief factors, pattern of evolution and impact on the patient's quality of life. The diagnosis requires confirmation with different exams. The goal of the clinical treatment is to relieve the symptoms and surgical treatment is indicated for patients who require continued drug use, with intolerance to prolonged clinical treatment and with GERD complications. CONCLUSION: GERD is a major digestive health problem and affect 12% of Brazilian people. The anamnesis is fundamental for the diagnosis of GERD, with special analysis of the typical and atypical symptoms (duration, intensity, frequency, triggering and relief factors, evolution and impact on the life quality). High digestive endoscopy and esophageal pHmetry are the most sensitive diagnosctic methods. The clinical treatment is useful in controlling the symptoms; however, the great problem is keeping the patients asymptomatic over time. Surgical treatment is indicated for patients who required continued drug use, intolerant to the drugs and with complicated forms of GERD.

scholarly journals CLINICAL PRESENTATION FEATURES IN THE ORAL CAVITY PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE

2020 ◽  
pp. 5-8
Author(s):  
O.P. Kerzyuk ◽  
N.M. Rozhko ◽  
A.V. Kindrat
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Oral Cavity ◽  
Oral Mucosa ◽  
Reflux Disease ◽  
Social Issues ◽  
Atypical Symptoms ◽  
Periodontal Tissues ◽  
Number Of Patients

Nowadays, gastroesophageal reflux disease (GERD) is particularly relevant because it concerns many health and social issues. According to international and national statistics, the number of GERD patients is constantly increasing, especially among the socially active segments of the population. GERD is one of the most important problems of modern gastroenterology due to the increase in the number of patients with this pathology, the presence of both typical and atypical symptoms significantly impair the quality of patients’ life. Atypical symptoms of GERD may lead to overdiagnosis of some diseases and worsen their course; sometimes patients run the risk of developing serious complications with the need of long-term medical treatment in case of insufficient awareness of physicians about GERD. Increased attention should be given to issues of concomitant pathology of the oral cavity and diseases of the esophagus taking into account the anatomical proximity, the commonness of the blood supply, innervation and humoral regulation, because the mouth is the first division of the alimentary canal. Therefore, all GERD-associated changes in the oral cavity can be divided into change in soft tissues (the vermilion border, mucosa, tongue, periodontal tissues) and hard tissues of teeth and a deterioration of the content and quality of oral fluid. Our study aimed at examining the prevalence and variation of pathological changes in the oral mucosa of GERD patients. We examined 90 patients aged 25–35 years and 45–55 years. Patients were divided into 3 groups of 30 patients in each group: 1 group – patients with diagnosed GERD with high acidity; 2 group – patients with low acidity, 3 group – control. The patients have been examined by a gastroenterologist based on generally accepted criteria, esophageal pH monitoring data as well as fibrogastroduodenoscopy of esophagus and stomach. Dental assessment included evaluating the state of oral hygiene (index Green-Vermilion), and oral mucosa condition; the periodontal status was assessed by the index Rassel. In conclusion, the findings indicate a variety of changes in oral cavity in patients with GERD, both with high and with low acidity. The prospect of our further research will be to develop an algorithm for diagnosis and treatment of oral GERD manifestations and secondary dental disease prevention.

scholarly journals COMBINED 24-HOURS ESOPHAGEAL PH MONITORING AND MULTICHANNEL INTRALUMINAL IMPEDANCE FOR COMPARISON OF GASTROESOPHAGEAL REFLUX IN CHILDREN WITH TYPICAL VERSUS ATYPICAL SYMPTOMS OF GASTROESOPHAGEAL REFLUX DISEASE

2016 ◽  
Vol 53 (3) ◽  
pp. 130-135 ◽  
Author(s):  
Seyed Mohsen DEHGHANI ◽  
Seyed Alireza TAGHAVI ◽  
Hazhir JAVAHERIZADEH ◽  
Maryam NASRI
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
P Value ◽  
Multichannel Intraluminal Impedance ◽  
Symptom Index ◽  
Atypical Symptoms ◽  
Intraluminal Impedance ◽  
The Mean

ABSTRACT Background - Gastroesophageal reflux disease is the most common esophageal disorder in pediatrics. Objective - The aim of this study was to compare reflux parameters of typical and atypical symptoms of gastroesophageal reflux disease using 24-hour esophageal pH monitoring and multichannel intraluminal impedance in pediatric population. Methods - In this prospective study, 43 patients aged less than 18 year with suspected gastroesophageal reflux disease were enrolled. The patients were divided into two groups based on the main presenting symptoms (typical versus atypical). Twenty four-hour pH monitoring and multichannel intraluminal impedance were performed in all the patients for comparing these two group regarding association of symptoms and reflux. Number of refluxes, pH related reflux, total reflux time, reflux more than 5 minutes, longest time of the reflux, lowest pH at reflux, reflux index were recorded and compared. Data comparison was done using SPSS. Results - The mean age of the patients was 5.7±3.4 years and 65.1% were male. Out of 43 patients 24 cases had typical symptoms and 19 had atypical symptoms. The mean reflux events detected by multichannel intraluminal impedance was more than mean reflux events detected by pH monitoring (308.4±115.8 vs 69.7±66.6) with P value of 0.037, which is statistically significant. The mean symptom index and symptom association probability were 35.01% ± 20.78% and 86.42% ± 25.79%, respectively in multichannel intraluminal impedance versus 12.73% ± 12.48% and 45.16% ± 42.29% in pH monitoring (P value <0.001). Number of acid reflux was 46.26±47.16 and 30.9±22.09 for atypical and typical symptoms respectively. The mean symptom index was 18.12% ± 13.101% and 8.30% ± 10.301% in atypical and typical symptoms respectively (P=0.034). Bolus clearance was longer in atypical symptoms compared typical symptoms(P<0.05). Conclusion - Symptom index was significantly higher in atypical symptoms compared to typical symptoms. Higher number of acid reflux was found in children with atypical symptoms of reflux. Longer duration of bolus clearance was found in group with atypical symptoms of reflux.

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.

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