scholarly journals Current advances in the treatment of gastroesophageal reflux disease: a focus on esophageal protection

2019 ◽  
Vol 91 (8) ◽  
pp. 4-11 ◽  
Author(s):  
I V Maev ◽  
D N Andreev ◽  
Yu A Kucheryavyy ◽  
R I Shaburov
Keyword(s):  
Molecular Weight ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Mucous Membrane ◽  
Reflux Disease ◽  
Barrier Function ◽  
Poloxamer 407 ◽  
Low Molecular Weight ◽  
Esophageal Mucosa ◽  
Refractory Gerd

Gastroesophageal reflux disease (GERD) is characterized by high morbidity and a significant decrease in the quality of life of patients, and is a major risk factor for esophageal adenocarcinoma. Nowadays, antisecretory therapy with proton pump inhibitors (PPI) is the "gold standard" of conservative treatment of GERD, but in some cases this therapy is unsuccessful. According to various studies, the prevalence of refractory GERD can reach 30-40%. The latest scientific data in the field of genetics and pathophysiology of GERD demonstrate that a disruption of the barrier function of the esophageal mucosa and an increase of its permeability can be the leading causes of refractoriness. Thus, the optimal therapy for patients with GERD should not only suppress the secretion of hydrochloric acid, but also restore the barrier function of the mucous membrane, providing an esophagoprotective effect. To achieve these goals, Alfasoxx was developed, which consists of a mixture of low molecular weight hyaluronic acid and low molecular weight chondroitin sulfate dissolved in a bioadhesive carrier (poloxamer 407). The clinical efficacy of this product has been confirmed by three prospective, randomized, placebo - controlled trials. Alfasoxx has a healing and restorative effect towards the esophageal epithelium and due to high ability for bioadhesion provides long - term protection of the mucous membrane of the esophagus. Combination therapy for GERD with the use of PPI and an esophagoprotector offers new perspectives for the treatment of patients with GERD.

Endoscopic Management of Gastroesophageal Reflux Disease

2021 ◽  
Author(s):  
Colin G. DeLong ◽  
Joshua S. Winder
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Endoscopic Management ◽  
Esophageal Mucosa ◽  
Surgical Morbidity ◽  
Transoral Incisionless Fundoplication ◽  
Endoscopic Techniques ◽  
Refractory Gerd ◽  
Patients Experience

AbstractGastroesophageal reflux disease (GERD) occurs in up to 20% of the population. Effective management of the condition is essential to reduce both symptoms and the risk for dysplastic changes of esophageal mucosa. Although lifestyle and diet modification and proton-pump inhibitors (PPIs) remain the standard of therapy, approximately 30% of patients experience persistent or recurrent symptoms with this therapy, which has been labeled PPI-refractory GERD. Surgical antireflux procedures have long been the standard therapy for PPI-refractory GERD, but drawbacks include cost and surgical morbidity. Endoscopic techniques for GERD management have been developed over the past 20 years including transoral incisionless fundoplication, the Stretta procedure, and antireflux mucosectomy. This article will review the current literature on each of these endoscopic procedures as well as highlight areas where further research is needed to fully understand the best practices for use of these endoscopic techniques for the management of PPI-refractory GERD.

scholarly journals Refractory gastroesophageal reflux disease

2012 ◽  
Vol 49 (4) ◽  
pp. 296-301 ◽  
Author(s):  
Joaquim Prado P. Moraes-Filho
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Reflux Disease ◽  
Skin Diseases ◽  
Pharmacological Therapy ◽  
Genotypic Differences ◽  
Esophageal Mucosa ◽  
Refractory Gerd

CONTEXT: Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Its pathophysiology, diagnosis and treatment have frequently been analyzed but it is interesting to review some aspects of the GERD refractory patients to the proton pump inhibitors treatment. The treatment encompasses behavioral measures and pharmacological therapy. The majority of the patients respond well to proton pump inhibitors treatment but 20%-42% of them may not do so well. Patients who are unresponsible to 4-8 weeks' treatment with proton pump inhibitors (omeprazole, pantoprazole, rabeprazole, lansoprazole, esomeprazole, pantoprazole-Mg) might have so-called refractory GERD. RESULTS: In some cases the patients are not real refractory because either they do not have GERD or the disease was not correctly treated, but the term refractory is still employed. Although debatable, the Brazilian GERD Consensus based upon evidences recommends as first step in the diagnosis, the upper digestive endoscopy to exclude the diagnosis of peptic ulcer and cancer and in some cases identify the presence of esophageal mucosa erosions. CONCLUSIONS: The main causes of the so-called refractory GERD are: (1) functional heartburn; (2) low levels of adherence to proton pump inhibitors treatment; (3) inadequate proton pump inhibitors dosage; (4) wrong diagnosis; (5) co-morbidities and pill-induced esophagitis; (6) genotypic differences; (7) nonacid gastroesophageal reflux; (8) autoimmune skin diseases; (9) eosinophilic esophagitis.

scholarly journals Modern achievements in the diagnosis and treatment of the refractory gastroesophageal reflux disease

2018 ◽  
Vol 90 (8) ◽  
pp. 4-12 ◽  
Author(s):  
V T Ivashkin ◽  
I V Maev ◽  
A S Trukhmanov ◽  
D E Rumyantseva
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Standard Dose ◽  
Lifestyle Changes ◽  
Diagnosis And Treatment ◽  
Alternative Methods ◽  
Esophageal Mucosa ◽  
Refractory Gerd

Purpose of the review to present up-to-date data on the causes, methods of diagnosis and treatment of the refractory form of gastroesophageal reflux disease (GERD). Refractory GERD is the preservation of typical symptoms of the disease and/or incomplete healing of the esophageal mucosa against the background of taking a standard dose of proton pump inhibitors (PPI) once a day for 8 weeks. The reasons for the lack of response to the treatment are divided into related to the patient, related to therapy, and not related to GERD. Diagnostic approaches include x-ray examination of the esophagus and stomach, endoscopy with biopsy, 24-hour Impedance-pH monitoring, esophageal manometry. Depending on the reasons for the lack of response to the therapy, treatment may include lifestyle changes, doubling the dose of PPI, replacing PPI with another, adding H2-receptor antagonists, prokinetics, antacids, alginates and adsorbents. If conservative treatment is ineffective, it is possible to consider alternative methods, such as surgical treatment. Refractory GERD is a serious clinical problem. The absence of an answer to 8-week therapy with PPI requires a thorough differential diagnosis using additional examination methods. The identification of the causes of refractory to the therapy allows to optimize the approaches to its overcoming and to choose the optimal treatment.

Zonulin is not increased in the cardiac and esophageal mucosa of patients with gastroesophageal reflux disease

Peptides ◽  
2009 ◽  
Vol 30 (6) ◽  
pp. 1082-1087 ◽  
Author(s):  
Thomas Wex ◽  
Klaus Mönkemüller ◽  
Doerthe Kuester ◽  
Lucia Fry ◽  
Arne Kandulski ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Esophageal Mucosa

scholarly journals Gastroesophageal reflux disease: new approaches to optimizing pharmacotherapy

2021 ◽  
pp. 30-37
Author(s):  
D. N. Andreev ◽  
A. V. Zaborovsky ◽  
E. G. Lobanova
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Barrier Properties ◽  
Nerve Fibers ◽  
Esophageal Mucosa ◽  
Mucosal Permeability ◽  
Other Substances ◽  
Maintenance Of Remission

Proton pump inhibitors (PPIs) are baseline drugs for induction and maintenance of remission in gastroesophageal reflux disease (GERD). PPIs have proven to be highly effective in healing esophageal mucosal lesions and relieving the symptoms of the disease in most cases. However, according to the literature data, the incidence rate of clinical ineffectiveness of PPIs in the form of partial or complete persistence of current symptoms during administration of standard doses of PPIs ranges from 10 to 40%. Optimization of GERD therapy in PPI refractory patients is a significant challenge. In most cases, experts advise to increase a dose / dosage frequency of PPIs, switch to CYP2C19-independent PPIs (rabeprazole, esomeprazole, dexlansoprazole), add an esophagoprotective or promotility agents to therapy. At the same time, these recommendations have a limited effect in some patients, which opens up opportunities for looking for new solutions related to the optimization of GERD therapy. Today there is growing evidence of the relevance of the role of disruption of the cytoprotective and barrier properties of the esophageal mucosa in the genesis of GERD and the formation of refractoriness. Intercellular contacts ensure the integrity of the barrier function of the esophageal mucosa to protect it from various exogenous intraluminal substances with detergent properties. Acid-peptic attack in patients with GERD leads to alteration of the expression of some tight junction proteins in epithelial cells of the esophageal mucosa. The latter leads to increased mucosal permeability, which facilitates the penetration of hydrogen ions and other substances into the submucosal layer, where they stimulate the terminals of nerve fibers playing a role in the induction and persistence of the symptoms of the disease. The above evidence brought up to date the effectiveness study of the cytoprotective drugs with tropism to the gastrointestinal tract, as part of the combination therapy of GERD.

scholarly journals DIAGNOSTIC VALUE OF MORPHOLOGICAL CHANGES IN GASTROESOPHAGEAL REFLUX DISEASE IN BIOPSY MATERIAL OF THE DISTAL ESOPHAGUS IN ADOLESCENTS SICKLY WITH ACUTE RESPIRATORY DISEASES

2019 ◽  
Vol 1 ◽  
pp. 15-23
Author(s):  
Olena Zhuravel ◽  
Tetyana Pochinok ◽  
Tamara Zadorozhna ◽  
Tetyana Archakova ◽  
Valentyna Zamula
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Mucous Membrane ◽  
Reflux Disease ◽  
Respiratory Diseases ◽  
Morphological Changes ◽  
Diagnostic Value ◽  
Distal Esophagus ◽  
Biopsy Material ◽  
Acute Respiratory Diseases

The article dedicated to the problem of the diagnostic value of morphological changes in gastroesophageal reflux disease in the biopsy of the distal esophagus in pubertal children of childbearing age. Aim of the research is to investigate the diagnostic value of morphological changes in gastroesophageal reflux disease in esophageal biopsy material in adolescents sickly with acute respiratory diseases. Methodology. The objective of the study was achieved through examination of 90 adolescents (10 to 16 years old, average age 13.1±3.54 years) kept under observation at the Children’s Clinical Hospital No. 9 of Kyiv and on the basis of the Department of Pediatrics No. 1 Center of Primary Health Care No. 4 of the Desnianskyi district of Kyiv. All adolescents belonged to the group of sickly with a number of respiratory diseases averaging 6-8 times a year, lasting from 8 to 18 days (on average 12.8±5.41 days). All children have undergone endoscopic examination of the esophagus, stomach and duodenum with the esophagus mucosa biopsy using the OLYMPUS GIF-P3 flexible fiberscope. Results. It was found that the least valuable diagnostic feature in the morphological examination of the mucous membrane of the distal esophagus in the pain-causing children with GERD was thickening of the epithelium with a sensitivity of 13,0 %, a specificity of 96.0 %, and total value of 65.0 %. It has been proved that hyperplasia of cells of the basal layer of the mucous membrane of the distal esophagus at the GERD in the infected children is 46.7 % (specificity – 93.3 %, the total value is 75.6 %). Increase in the number of papillae and their prolongation in 33.3 % cases (sensitivity – 33.3 %, specificity – 93.3 %, overall diagnostic value – 70.8 %). Conclusion. The peculiarity of the morphological manifestations of GERD in childbearing children is dystrophic changes in keratocytes in the superficial parts of the multilayer squamous epithelium, which are detected at 100.0 % of patients (specificity is 93.3 %, total value is 96.8 %), with parakeratosis centers at 13.3 % of cases. It has been shown that a frequent and diagnostically valuable indication is inflammatory infiltration of the esophageal mucosa, which are verified in all cases (100.0 %, with dilatation and hyperemia in 46.7 % of patients (specificity – 40.0 %, total value – 81.3 %).

scholarly journals Efficacy and Safety of Robotic Dor Fundoplication on Severe Gastroesophageal Reflux Disease in Patients With Scleroderma

2021 ◽  
Vol 9 ◽  
pp. 232470962110512
Author(s):  
Priyadarshini Loganathan ◽  
Mahesh Gajendran ◽  
Brian Davis ◽  
Richard McCallum
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Surgical Complication ◽  
Smooth Muscles ◽  
Dor Fundoplication ◽  
High Resolution Manometry ◽  
Refractory Gerd ◽  
Significant Impairment ◽  
Gerd Symptoms

Systemic sclerosis (SSc) is a disease that affects the gastrointestinal tract resulting in its atrophy and fibrosis of smooth muscles. Approximately 80% of SSc patients develop both gastroesophageal reflux disease (GERD) and dysphagia. The nocturnal GERD can cause regurgitation and aspiration, which can further aggravate the pulmonary fibrosis from SSc. Also, their dysphagia is further worsened by performing standard Nissen fundoplication. Therefore, we aimed to investigate whether Dor fundoplication (a 180° anterior wrap) can reduce nocturnal heartburn and regurgitation without worsening dysphagia in patients with SSc and severe GERD. Five SSc patients with drug-refractory severe GERD underwent a Dor fundoplication procedure with a median follow-up of 2 years (range: 1-5 years). In all 5 patients, the preoperative high-resolution manometry showed significant impairment of esophageal motility. Patients were interviewed postoperatively to assess for nocturnal and diurnal GERD symptoms, treatment response, the status of dysphagia, and adverse effects of surgery. The average age of 5 patients was 50 years and all were females. Four of the 5 patients (80%) reported 90% improvement in both diurnal and nocturnal GERD symptoms since surgery, with no nocturnal reflux, heartburn, or regurgitation, and reports to sleep at night without requiring any more pillows or wedges. About 50% of patients reported a decrease in their proton pump inhibitor dosage after surgery compared to before surgery. No surgical complication was reported and specifically, no worsening of dysphagia. The Dor fundoplication performed for refractory GERD in SSc patients substantially decreases heartburn and regurgitation, primarily nocturnal, without affecting dysphagia, thus improving the quality of life.

scholarly journals Resistance of the Esophageal Mucosa in Patients with GERD: the Dialogue Between Clinician and Pathologist

2021 ◽  
Vol 17 (4) ◽  
pp. 34-39
Author(s):  
I.V. Matoshina ◽  
◽  
M.M. Fedorin ◽  
M.A. Livzan ◽  
S.I. Mozgovoy
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Pathological Process ◽  
Mucosal Barrier ◽  
Esophageal Mucosa ◽  
Mucosal Protection ◽  
Natural Factor ◽  
Immunological Mechanisms ◽  
Functional Components

Gastroesophageal reflux disease (GERD) is the most common of all acid-related diseases, it is recognized as the leading cause of esophageal adenocarcinoma. The natural factor of protection against aggressive refluxate components is the integrity of the esophageal mucosa, which performs a barrier function with the participation of a number of mechanical, chemical and immunological mechanisms. Their damage under the regular influence of acidic or mixed reflux causes the development of the pathological process. The review was prepared to systematize knowledge of the main components of mucosal barrier of the esophagus providing resistance of mucosa under conditions of GERD. The literature was searched in Embase, PubMed, and Google Scholar using the keywords: gastroesophageal reflux disease, mucosal protection, esophageal mucosa epithelium, dense contact proteins, epithelial protection, esophagoprotection. The main structural and functional components of esophageal mucosal protection were emphasized

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