scholarly journals High resolution esophageal manometry and life exposure factors in non-cardiac chest pain patients with refractory gastroesophageal reflux disease

2019 ◽  
Author(s):  
Yuan Li ◽  
Peicong Lyu ◽  
Zhifeng Zhang ◽  
Liya Wang ◽  
Xiaoyu Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chest Pain ◽  
High Resolution ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Esophageal Manometry ◽  
Therapeutic Strategies ◽  
Anxiety And Depression ◽  
Esophageal Sphincter

Abstract Background: Refractory gastroesophageal reflux disease (RGERD) is defined by the presence of troublesome GERD symptoms despite proton pump inhibitors (PPIs) treatments for 8-12 weeks. Non-cardiac chest pain (NCCP) is the most common atypical presentations. This study was aimed at clarifying the features of High Resolution Esophageal Manometry (HREM) and life exposure factors of NCCP in RGERD patients for guiding further therapeutic strategies. Methods: 83 RGERD patients were enrolled, in which 44 patients afflicted with NCCP as P group and 39 patients without NCCP as NP group. According to the endoscopy results, P group was further divided into reflux esophagitis group (RE group), non-erosive reflux disease group (NERD group) and Barrett’s esophagus group (BE group). HREM was performed to assess esophageal motility. Diverse questionnaires were conducted to evaluate severity of symptoms, quality of life, risk factors, degrees of anxiety and depression and so on. Results: a)Average resting pressures of the lower esophageal sphincter (LES), residual pressures of the LES and the esophageal distal contractile integral (DCI) score in P group were significantly lower than those in NP group (p<0.05). b)Average resting pressures of the upper esophageal sphincter (UES), residual pressures of the UES, lengths of the LES and the UES showed no difference between the two groups (p>0.05). c)Compared with NP group, the patients in P group had higher exposure to alcohol, coffee, sweets, overeating and stress (p<0.05). d)Anxiety and depression status of patients in P group were remarkably severer than those in NP group (p<0.05). e)The pain intensity in RE group and BE group was higher than NERD group (P<0.05), while there was no difference between RE group and BE group (P>0.05). Conclusions: Esophageal motility related anti-reflux barriers are much weaker in the RGERD patients with NCCP than those without NCCP, which mainly presents as the much lower average resting and residual pressures of the LES and DCI. Alcohol, coffee, sweets, overeating, stress, anxiety and depression are risk factors of RGERD-related NCCP. It’s suggested that the recovery of anti-reflux barriers and the avoidance of risk factors may be essential therapeutic strategies for improving the curative effect.

scholarly journals The importance of functional diagnostics in determining the cause of antisecretary therapy inefficiency in a patient with heartburn: clinical observation

2021 ◽  
pp. 46-53
Author(s):  
E. V. Barkalova ◽  
D. N. Andreev ◽  
M. A. Ovsepian
Keyword(s):  
Differential Diagnosis ◽  
High Resolution ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Research Methods ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Reflux Disease ◽  
Esophageal Manometry ◽  
Clinical Observation

One of the main symptoms of gastroesophageal reflux disease is heartburn, for the relief of which proton pump inhibitors are traditionally prescribed. However, there are frequent cases of heartburn, refractory to antisecretory therapy, when there is no complete relief of the symptom or only a partial clinical effect. The reason for an unsatisfactory response may be the functional genesis of heartburn. The purpose of the presented clinical observation is to demonstrate the heterogeneity of patients with heartburn, the role of functional research methods in the differential diagnosis of various conditions that accompany this symptom. A 42-year-old patient was admitted for an additional clinical examination with complaints of heartburn refractory to antisecretory therapy, which included high-resolution esophageal manometry, 24-hours pH-impedance. The manometric assessment of the structure and function of the lower esophageal sphincter, as well as the contractility of the thoracic esophagus, revealed no violations. The data of 24-hours pH-impedance demonstrated the absence of pathological reflux and the association of active symptoms with refluxes, which determined the functional nature of heartburn and explained the ineffectiveness of treatment with proton pump inhibitors. Heartburn can be functional in  nature and significantly reduce the  quality of  life of  patients. Functional heartburn requires different management tactics from gastroesophageal reflux disease, which is based on an adequate differential diagnosis, including functional research methods such as high-resolution esophageal manometry and 24-hours pH-impedance measurement, which allow to exclude other conditions accompanied by similar symptoms. 

scholarly journals Features of psychoemotional status and eating disorders in patients with gastroesophageal reflux disease and obesity

2021 ◽  
Vol 23 (5) ◽  
pp. 412-416
Author(s):  
Georgy L. Yurenev ◽  
◽  
Ekaterina M. Mironova ◽  
Natalia A. Sirota ◽  
Tamara V. Yureneva-Tkhorzhevskaya ◽  
...  
Keyword(s):  
Risk Factors ◽  
Eating Disorders ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Eating Behavior ◽  
Reflux Disease ◽  
Anxiety And Depression ◽  
Obese Patients ◽  
History Of ◽  
Depressive States

Background. Eating disorders, as well as features of the psychoemotional status as risk factors for obesity, patients with comorbid gastroesophageal reflux disease (GERD) and obesity in the modern literature are not sufficiently disclosed. Further study of these aspects may be one of the additional ways to improve the prognosis of the course of GERD, as well as the correction of the psychoemotional status of patients. Aim. To study the features of the course of GERD in concomitant obesity in the context of the peculiarities of the psychoemotional sphere, as well as to identify the types of eating disorders in this cohort of patients. Materials and methods. The study included 130 patients aged 24 to 72 years with complaints characteristic of the pathology of the upper digestive tract, who, along with a detailed analysis of complaints in order to verify the diagnosis and identify the features of the course of the disease, were tested with the Dutch Eating Behavior Questionnaire (DEBQ) and the hospital scale of anxiety and depression (HADS). Results. It was found that obese patients who had GERD less than 8 years ago were more likely to suffer from external and emotionogenic eating disorders, and the external type was more often associated with the male, and the emotionogenic type with the female sex. Whereas, in patients with obesity and a history of GERD for more than 8 years, the restrictive and emotionogenic types of eating disorders were relatively more often recorded. An increased level of anxiety in patients with GERD was noted, both against the background of obesity and without it, but those with comorbid pathology had a relatively higher score on the anxiety scale. Conclusion. Correction of eating behavior and signs of anxiety-depressive states in patients can open up new prospects for the fight against obesity. And this, in turn, can improve the prognosis of patients with GERD.

Sign in / Sign up

Export Citation Format

Share Document