scholarly journals Impaired Esophageal Mucosal Integrity and the Related Motility Factors in Refractory Gastroesophageal Reflux Disease

2021 ◽  
Author(s):  
Yu Cheng ◽  
Dong Yang ◽  
Xiaoyu Sun ◽  
Lixia Wang ◽  
Zhifeng Zhang ◽  
...  
Keyword(s):  
Risk Factor ◽  
Los Angeles ◽  
Reflux Disease ◽  
Esophageal Motility ◽  
Ph Monitoring ◽  
Erosive Esophagitis ◽  
Functional Heartburn ◽  
Mucosal Integrity ◽  
Refractory Gerd ◽  
The Impact

Abstract Backgrounds. Research on esophageal mucosal integrity in gastro-oesophageal reflux disease (GERD) has been taken seriously in recent years, especially in refractory GERD. Mean nocturnal baseline impedance (MNBI) is proposed as an indicator of impaired mucosal integrity. We aimed to compare the MNBI value and investigate the impact of esophageal motility on MNBI in different subtypes of refractory GERD. Methods. Endoscopy, high-resolution manometry, and 24h impedance-pH monitoring were performed in 412 refractory GERD patients. From these patients, 94 erosive esophagitis (EE), 52 non-erosive reflux disease (NERD), and 31 Barrett's esophagus (BE) patients were enrolled in the study. EE group 54 included Los Angeles (LA) Grade-A/B and 40 LA Grade-C/D patients. 52 functional heartburn (FH) patients were used as the control. MNBI was acquired at 3 and 5 cm above lower esophageal sphincter (LES) and was compared between groups. Parameters of esophagogastric junction (EGJ) and LES, along with esophageal peristaltic sequences were recorded. Univariate and multivariate regression analysis were performed to determine the impact of these motility factors on MNBI in different subtypes of refractory GERD. Results. MNBI values were signifiantly lower in all subgroups of refractory GERD patients than in FH patients. MNBI in NERD patients was similar with LA-A/B and LA-C/D patients. MNBI in NERD and LA-C/D patients was signifiantly lower than in BE patients. No difference in MNBI was found between LA-A/B and BE patients. Ineffective esophageal motility and absent contractility were the risk factor for decreased MNBI in LA-A/B and LA-C/D patients, respectively. Type III EGJ (hiatus hernias) and decreased LES length were the risk factor for decreased MNBI in NERD and BE patients, respectively. Conclusions. Impaired mucosal integrity of NERD patients was as severe as that of EE patients and hiatus hernias were the risk factor, therefore, mucosal protections and explorations of hiatus hernias should be emphasized in refractory NERD patients. Weakened esophageal body peristalsis and decreased LES length were the risk factor for the impaired mucosal integrity of refractory EE patients and BE patients, respectively, and thus the therapy on peristaltic disorders and LES function was recommended for them. These results provided new ideas for optimizing the treatment of refractory GERD.

scholarly journals Prevalence of Esophageal Motility Abnormalities in Patients With “True” Non-Erosive Reflux Disease, Erosive Esophagitis, Barrett Esophagus and Functional Heartburn

2011 ◽  
Vol 140 (5) ◽  
pp. S-622
Author(s):  
Edoardo Savarino ◽  
Lorenzo Gemignani ◽  
Patrizia Zentilin ◽  
Elisa Marabotto ◽  
Manuele Furnari ◽  
...  
Keyword(s):  
Reflux Disease ◽  
Esophageal Motility ◽  
Erosive Esophagitis ◽  
Barrett Esophagus ◽  
Functional Heartburn

scholarly journals Objective Evidence of Gastro-Esophageal Reflux Disease is Rare in Patients with Autoimmune Gastritis

2021 ◽  
Vol 30 (1) ◽  
pp. 30-36
Author(s):  
Valentina Pilotto ◽  
Gemma Maddalo ◽  
Costanza Orlando ◽  
Matteo Fassan ◽  
Massimo Rugge ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Serum Biomarkers ◽  
Functional Heartburn ◽  
High Resolution Manometry ◽  
Reflux Symptoms ◽  
Objective Evidence ◽  
Rome Iv

Background and Aims: Patients with autoimmune atrophic gastritis (AAG) often complain of acid reflux symptoms, despite the evidence of hypo-achlorhydria. Rome IV criteria are used to define functional esophageal disorders. Our aim was to characterize gastroesophageal reflux disease (GERD) phenotypes in patients with AAG. Methods: Between 2017-2018, 172 AAG patients were evaluated at Gastro-Oncology outpatient clinic of University of Padua. Of them, 38 patients with reflux symptoms underwent high-resolution manometry (HRM) and multichannel intraluminal impedance-pH monitoring (MII-pH). Seventy-six AAG consecutive patients asymptomatic for gastroesophageal reflux were selected as age and gender matched controls. Serum biomarkers (pepsinogens, gastrin-17 and Helicobacter pylori antibodies), upper endoscopy, histology and clinical data were compared. Results: Out of 38/172 (22%) AAG patients with reflux symptoms, 2/38 had a GERD diagnosis based on abnormal esophageal acid exposure and 6/38 had a major motility disorder (i.e. outflow obstruction). Among the 30/38 patients with normal endoscopic findings, 9/30 had reflux hypersensitivity, 19 functional heartburn, 1 functional globus, 1 functional chest pain according to the Rome IV criteria. Antral atrophy, advanced corpus atrophy and OLGA stage were more frequent in controls than in reflux patients (p=0.01, p=0.031, p=0.01, respectively). No differences were found for serum biomarkers and symptom presentation. Most of the patients received proton pump inhibitors (PPIs) treatment (87%), with a minority (34%) reporting clinical benefit. Conclusions: Reflux symptoms are relatively common in AAG patients, but a firm diagnosis of GERD is rare (5%), whereas most of the patients have a functional disorder. PPI treatment is mostly clinical ineffective and should not be largely indicated.

scholarly journals ARE THE PERSISTENT SYMPTOMS TO PROTON PUMP INHIBITOR THERAPY DUE TO REFRACTORY GASTROESOPHAGEAL REFLUX DISEASE OR TO OTHER DISORDERS?

2018 ◽  
Vol 55 (suppl 1) ◽  
pp. 85-91 ◽  
Author(s):  
Rimon Sobhi AZZAM
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Proton Pump Inhibitor ◽  
Gastroesophageal Reflux ◽  
Proton Pump ◽  
Reflux Disease ◽  
Clinical Condition ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Pathophysiological Mechanism ◽  
Refractory Gerd

ABSTRACT BACKGROUND: Gastroesophageal reflux disease (GERD) is a clinical condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Transient lower esophageal sphincter relaxation is the main pathophysiological mechanism of GERD. Symptoms and complications can be related to the reflux of gastric contents into the esophagus, oral cavity, larynx and/or the lung. Symptoms and other possible manifestations of GERD are heartburn, regurgitation, dysphagia, non-cardiac chest pain, chronic cough, chronic laryngitis, asthma and dental erosions. The proton pump inhibitor (PPI) is the first-choice drug and the most commonly medication used for the treatment of GERD. The most widespread definition of Refractory GERD is the clinical condition that presents symptoms with partial or absent response to twice-daily PPI therapy. Persistence of symptoms occurs in 25% to 42% of patients who use PPI once-daily and in 10% to 20% who use PPI twice-daily. OBJECTIVE: The objective is to describe a review of the current literature, highlighting the causes, diagnostic aspects and therapeutic approach of the cases with suspected reflux symptoms and unresponsive to PPI. CONCLUSION: Initially, the management of PPI refractoriness consists in correcting low adherence to PPI therapy, adjusting the PPI dosage and emphasizing the recommendations on lifestyle modification change, avoiding food and activities that trigger symptoms. PPI decreases the number of episodes of acid reflux; however, the number of “non-acid” reflux increases and the patient continues to have reflux despite PPI. In this way, it is possible to greatly reduce greatly the occurrence of symptoms, especially those dependent on the acidity of the refluxed material. Response to PPI therapy can be evaluated through clinical, endoscopic, and reflux monitoring parameters. In the persistence of the symptoms and/or complications, other causes of Refractory GERD should be suspected. Then, diagnostic investigation must be initiated, which is supported by clinical parameters and complementary exams such as upper digestive endoscopy, esophageal manometry and ambulatory reflux monitoring (esophageal pH monitoring or esophageal impedance-pH monitoring). Causes of refractoriness to PPI therapy may be due to the true Refractory GERD, or even to other non-reflux diseases, which can generate symptoms similar to GERD. There are several causes contributing to PPI refractoriness, such as inappropriate use of the drug (lack of patient adherence to PPI therapy, inadequate dosage of PPI), residual acid reflux due to inadequate acid suppression, nocturnal acid escape, “non-acid” reflux, rapid metabolism of PPI, slow gastric emptying, and misdiagnosis of GERD. This is a common cause of failure of the clinical treatment and, in this case, the problem is not the treatment but the diagnosis. Causes of misdiagnosis of GERD are functional heartburn, achalasia, megaesophagus, eosinophilic esophagitis, other types of esophagitis, and other causes. The diagnosis and treatment are specific to each of these causes of refractoriness to clinical therapy with PPI.

OC.03.3: FUNCTIONAL HEARTBURN AND NON-EROSIVE REFLUX DISEASE: THE ADDED VALUE OF IMPEDANCE-PH MONITORING TO ROME III CRITERIA

2011 ◽  
Vol 43 ◽  
pp. S123-S124
Author(s):  
E. Savarino ◽  
P. Zentilin ◽  
M. Frazzoni ◽  
E. Marabotto ◽  
G. Sammito ◽  
...  
Keyword(s):  
Reflux Disease ◽  
Ph Monitoring ◽  
Added Value ◽  
Rome Iii Criteria ◽  
Functional Heartburn ◽  
Rome Iii

scholarly journals ENDOSCOPIC CHANGES RELATED TO GASTROESOPHAGEAL REFLUX DISEASE: COMPARATIVE STUDY AMONG BARIATRIC SURGERY PATIENTS

2015 ◽  
Vol 28 (suppl 1) ◽  
pp. 36-38 ◽  
Author(s):  
Marco Aurelio SANTO ◽  
Sylvia Regina QUINTANILHA ◽  
Cesar Augusto MIETTI ◽  
Flavio Masato KAWAMOTO ◽  
Allan Garms MARSON ◽  
...  
Keyword(s):  
Los Angeles ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Barrett’S Esophagus ◽  
Reflux Disease ◽  
Barrett's Esophagus ◽  
Erosive Esophagitis ◽  
Los Angeles Classification ◽  
Bariatric Patients

Background : Obesity is correlated with several comorbidities, including gastroesophageal reflux disease. Its main complications are detectable by endoscopy: erosive esophagitis and Barrett's esophagus. Aim : To correlate erosive esophagitis and hiatal hernia with the degree of body mass index (BMI). Method : Was performed a retrospective analysis of 717 preoperative endoscopic reports of bariatric patients. Fifty-six (8%) presented hiatal hernia, being 44 small, nine medium and five large. Esophagitis was classified by Los Angeles classification. Results : There was no correlation between the presence and dimension of hiatal hernia with BMI. One hundred thirty-four (18.7%) patients presented erosive esophagitis. Among them, 104 (14.5%) had esophagitis grade A; 25 (3.5%) grade B; and five (0.7%) grade C. When considering only the patients with erosive esophagitis, 77.6% had esophagitis grade A, 18.7% grade B and 3.7% grade C. Were identified only two patients with Barrett's esophagus (0,28%). Conclusion : There was a positive correlation between the degree of esophagitis with increasing BMI.

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