A Comparison of the Three Objective Measures of Gastroesophageal Reflux Disease: Johnson-DeMeester Score, DeMeester Score, and Percent Time pH<4

2013 ◽  
Vol 108 ◽  
pp. S6
Author(s):  
Ryan Kwok ◽  
Steven Armbruster ◽  
Corinne Maydonovitch ◽  
Yen-Ju Chen ◽  
Lavern Belle ◽  
...  
2021 ◽  
pp. 000313482199867
Author(s):  
Hordur M. Kolbeinsson ◽  
Cameron Lawson ◽  
Amy Banks-Venegoni ◽  
Reda Girgis ◽  
David E. Scheeres

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.


2009 ◽  
Vol 1 ◽  
pp. CMT.S2538
Author(s):  
Keith M. Olsen ◽  
Margaret L. Hitzeman

Dexlansoprazole MR, an enantiomer of lansoprazole, is a unique proton pump inhibitor with a duel release mechanism. This release mechanism produces two distinct peak concentrations that result in a prolonged mean residence time with increased duration of plasma concentrations and a greater percent time the pH is maintained above 4. The prolonged residence time allows dexlansoprazole MR to be administered throughout the day without regards to meals or the timing before a meal. In two trials of patients with erosive esophagitis, dexlansoprazole MR 60 mg and 90 mg demonstrated comparable healing rates to lansoprazole 30 mg. In patients with healed EE, dexlansoprazole MR 30 mg (75%) and 60 mg (83%) were superior to placebo (27%; p < 0.0025) in maintenance of healing. Dexlansoprazole MR 30 mg and 60 mg had a greater pecentage of heartburn-free days (91%-96%) and heartburn-free nights (96%-99%) than placebo (29%-72%) over the 6-month maintenance trial. Dexlansorpazole MR appears to be well tolerated with the safety profile being similar to lansoprazole with gastrointestinal adverse events being the most common. Dexlansoprazole MR provides a new treatment option for gastroesophageal reflux disease due to the flexible dosing, the unique release mechanisms and prologned pharmacodynamic effect.


2020 ◽  
pp. 174239532096637
Author(s):  
Leticia Burton ◽  
John Beattie ◽  
Gregory L Falk ◽  
Hans Van der Wall ◽  
William Coman

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.


2008 ◽  
Vol 74 (7) ◽  
pp. 635-643 ◽  
Author(s):  
Sharona B. Ross ◽  
Desiree Villadolid ◽  
Harold Paul ◽  
Sam Al-Saadi ◽  
Javier Gonzalez ◽  
...  

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.


Author(s):  
Xin Xiong ◽  
Suyu He ◽  
Fei Xu ◽  
Zhihong Xu ◽  
Xiumei Zhang ◽  
...  

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 &lt; 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.


2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Elena-Roxana Săraru ◽  
Vlad Enciu ◽  
Razvan Peagu ◽  
Carmen Fierbinţeanu-Braticevici

AbstractGastroesophageal reflux disease (GERD) is considered one of the most frequent chronic gastrointestinal diseases globally with high costs due to treatment and investigations.First line therapy is with proton pump inhibitors, those who do not respond to initial treatment usually require further investigations such as upper gastrointestinal endoscopy or ambulatory 24-hours esophageal pH monitoring. The total time of exposure to acid and the DeMeester score represent the most useful parameters associated with conventional pH-metry, because they can identify gastroesophageal reflux disease.Although pH-metry is considered the gold standard for the evaluation of gastroesophageal reflux disease, new impedance-based parameters have been introduced in recent years with the role of increasing the accuracy of diagnosing gastroesophageal reflux disease and characterizing the type of reflux. The development of multichannel intraluminal pH-impedance has improved the ability to detect and quantify gastroesophageal reflux. New parameters such as post-reflux swallowing peristaltic wave (PSPW) index and the mean nocturnal basal impedance (MNBI) have recently been introduced to assess GERD phenotypes more accurately. This review evaluates current GERD diagnotic tools while also taking a brief look at newer diagnostic parameters like PSPW and MNBI.


2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 56-56
Author(s):  
Michael Weitzendorfer ◽  
Lisa Wahl ◽  
Klaus Emmanuel ◽  
Oliver Koch

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.


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