Associations Between Sleep Position and Nocturnal Gastroesophageal Reflux: A Study Using Concurrent Monitoring of Sleep Position and Esophageal pH and Impedance

CONTEXT AND OBJECTIVE: Association between neurological lesions and gastroesophageal reflux disease (GERD) in children is very common. When surgical treatment is indicated, the consensus favors the fundoplication technique recommended by Nissen, despite its high morbidity and relapse rates. Vertical gastric plication is a procedure that may have advantages over Nissen fundoplication, since it is less aggressive and more adequately meets anatomical principles. The authors proposed to compare the results from the Nissen and vertical gastric plication techniques. DESIGN AND SETTING: Randomized prospective study within the Postgraduate Surgery and Experimentation Program of Unifesp-EPM, at Hospital do Servidor Público Estadual (IAMSPE) and Hospital Municipal Infantil Menino Jesus. METHODS: Fourteen consecutive children with cerebral palsy attended between November 2003 and July 2004 were randomized into two groups for surgical treatment of GERD: NF, Nissen fundoplication (n = 7); and VGP, vertical gastric plication (n = 7). These were clinically assessed by scoring for signs and symptoms, evaluation of esophageal pH measurements, duration of the operation, intra and postoperative complications, mortality and length of hospital stay. RESULTS: The mean follow-up was 5.2 months; symptoms were reduced by 42.8% (NF) (p = 0.001) and 57.1% (VGP) (p = 0.006). The Boix-Ochoa score was favorable for both groups: NF (p < 0.001) and VGP (p < 0.042). The overall mortality was 14.28% in both groups and was due to causes unrelated to the surgical treatment. CONCLUSION: The two operative procedures were shown to be efficient and efficacious for the treatment of GERD in neuropathic patients, over the study period.

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Associations of Obstructive Sleep Apnea, Obestatin, Leptin, and Ghrelin with Gastroesophageal Reflux

Journal of Clinical Medicine ◽

10.3390/jcm10215195 ◽

2021 ◽

Vol 10 (21) ◽

pp. 5195

Author(s):

Piotr Pardak ◽

Rafał Filip ◽

Jarosław Woliński ◽

Maciej Krzaczek

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Gastroesophageal Reflux ◽

Ph Monitoring ◽

Sleep Study ◽

Esophageal Ph ◽

Obstructive Sleep ◽

The Relationship ◽

Gerd Symptoms ◽

Severe Sleep Apnea

Gastroesophageal reflux disease (GERD) is commonly observed in patients with obstructive sleep apnea (OSA). Hormonal disorders observed in OSA may be relevant in the development of GERD. The aim of the study was to assess the correlations between ghrelin, obestatin, leptin, and the intensity of GERD in patients with OSA. The study included 58 patients hospitalized due to clinical suspicion of sleep disorders during sleep. All patients underwent a sleep study, and blood samples were collected overnight for hormonal tests. Survey data concerning symptoms of GERD, gastroscopy, and esophageal pH monitoring results were included in the study. In patients with OSA, GERD was twice as common when compared to the group without OSA. Among subjects with severe sleep apnea (AHI > 30; n = 31; 53%), we observed lower ghrelin levels, especially in the second half of the night and in the morning (p5.00 = 0.0207; p7.00 = 0.0344); the presence of OSA had no effect on obestatin and leptin levels. No significant differences in hormonal levels were observed between the groups depending on the diagnosis of GERD. However, correlations of ghrelin levels with the severity of esophagitis, leptin and ghrelin levels with the severity of GERD symptoms, and leptin levels with lower esophageal pH were found. GERD is more frequent among patients with OSA. In both GERD and OSA, deviations were observed in the levels of ghrelin and leptin. However, our analysis demonstrates that the relationship between OSA and GERD does not result from these disorders.

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

Terapevticheskii arkhiv ◽

10.26442/00403660.2020.08.000760 ◽

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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Gastroesophageal Reflux and Wheezing in Pediatry pH-metry studies

Revista de Chimie ◽

10.37358/rc.19.7.7402 ◽

2019 ◽

Vol 70 (7) ◽

pp. 2668-2670

Author(s):

Alina Mihaela Elisei ◽

Dana Tutunaru ◽

Camelia Ana Grigore ◽

Ciprian Adrian Dinu ◽

Laura Florescu ◽

...

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Pediatric Practice ◽

First Semester ◽

Esophageal Ph ◽

Esophageal Sphincter ◽

Specific Symptoms ◽

Acidity Level ◽

Ph Metry

Analysis of esophageal pH is useful and recommended by specialists when the gastroesophageal reflux disease does not show specific symptoms such as chest pain or burnings, but a form of asthma and chronic cough. The investigation is performed after a mild anesthesia, inserting a thin and flexible catheter in the patient�s nostril; it reaches the esophagus, particularly the esophageal sphincter that connects the stomach to the esophagus. The catheter has a sensor that monitors the acidity level, the number of reflux episodes, their duration and the part of the esophagus reached by the acid in the stomach. Gastroesophageal reflux disease is frequently met in pediatric practice, rooting in the intrauterine life, a physiologic phenomenon in infants during the first semester of life.

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A novel endoscopic assessment of the gastroesophageal junction for the prediction of gastroesophageal reflux disease: a pilot study

Endoscopy International Open ◽

10.1055/a-0990-9737 ◽

2019 ◽

Vol 07 (11) ◽

pp. E1468-E1473 ◽

Cited By ~ 3

Author(s):

Haruhiro Inoue ◽

Yusuke Fujiyoshi ◽

Mary Raina Angeli Abad ◽

Enrique Rodriguez de Santiago ◽

Kazuya Sumi ◽

...

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Gastroesophageal Junction ◽

Optimal Cutoff ◽

Esophageal Ph ◽

Impedance Monitoring ◽

Acid Exposure Time ◽

Sensitivity Specificity ◽

Endoscopic Assessment

Abstract Background and aim Hiatal hernia and lower esophageal sphincter (LES) dysfunction play major roles in gastroesophageal reflux disease (GERD) pathogenesis. We developed a novel endoscopic assessment to evaluate the gastroesophageal junction (GEJ). This study aims to evaluate the feasibility of this method for the diagnostic prediction of GERD. Methods A retrospective analysis of patients with GERD symptoms who underwent gastroscopy and esophageal pH-impedance monitoring was conducted. The novel assessment evaluated the following in retroflex view: 1) Cardiac Opening (CO): diameter of the opening of the cardia, 2) Sliding Hernia (SH): length from the diaphragmatic crus to the squamocolumnar junction, 3) Scope Holding Time% (SHT%): the percentage of time that the Scope Holding Sign (SHS) was observed out of 30 seconds. The SHS is defined as the lower esophagus holding the endoscope under excessive insufflation. The results of this assessment and that of pH-impedance monitoring were compared. Results In total, 61 patients (mean age ± SD, 54.1 ± 16.4 years, 32 males) were enrolled. CO and SH were significantly correlated with acid exposure time (AET) (ρ = 0.36, P = 0.005, and ρ = 0.36, P = 0.004). The optimal cutoff of CO for AET > 6 % was 3 cm (Sensitivity = 72.4 %, Specificity = 46.9 %, AUC = 0.64) and that of SH was 2 cm (Sensitivity = 55.2 %, Specificity = 75.0 %, AUC = 0.70). When the population was stratified according to this cutoff, patients with CO > 3 cm and those with SH > 2 cm presented higher AET (15.1 vs 4.1 %, P = 0.037, and 23.0 vs 3.6 %, P = 0.026). Optimal cutoff of SHT% for the number of all reflux episodes > 80 was 75 % (Sensitivity = 81.8 %, Specificity = 54.6%, AUC = 0.67). Patients with SHT% < 75 % presented a higher number of all reflux episodes (88 vs 65, P = 0.014). Sensitivity, specificity, and accuracy of SHT% < 75 % for all reflux episodes > 80 were 81.8 % (95 %CI: 67.7 – 91.8), 54.5% (95 %CI: 40.4 – 64.5), and 68.2 % (95 %CI: 54.0 – 78.1). Conclusion This novel endoscopic assessment of GEJ significantly predicted the presence of GERD and merits further testing in future studies.

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