Modern concepts on the state of esophagus epithelial barrier at gastroesophageal reflux disease and possibilities of correction with alginates

2021 ◽  
Author(s):  
M. B. Shcherbynina ◽  
N. E. Solovіovа ◽  
M. V. Patratiy
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Randomized Clinical Trials ◽  
Clinical Medicine ◽  
Experimental Studies ◽  
Clinical Manifestations ◽  
Epithelial Barrier ◽  
Esophageal Epithelium ◽  
Dilated Intercellular Spaces

Gastroesophageal reflux disease (GERD) remains an urgent problem in clinical medicine. The search for ways of effective treatment leads to the need to set new accents in the multifactorial pathogenesis of the disease. According to current trends, special attention is paid to the epithelial barrier of the esophagus. The article presents considerations of the structure of the mucosal epithelial layer, the features of transport routes and intercellular interactions of the esophageal epithelium. Special attention is paid to the phenomenon of the Dilated Intercellular Spaces (DIS) and the syndrome of increased epithelial permeability (SІEP) at GERD. An interpretation of these concepts is given, their role in the implementation of inflammatory processes and the formation of clinical manifestations of the disease, such as heartburn and pain, is revealed. The data on the possible mechanisms of the formation of the DIS and SІEP phenomenon, methods of their diagnosis and aspects that are discussed in the scientific world are presented. The possibilities of cytoprotective therapy using alginate preparations have been shown. Among the alginates, available on the pharmaceutical market of Ukraine, the pharmacological line Gaviscon® (LLC Reckitt Benckiser Ukraine, Great Britain) is presented. The results of experimental studies with the use of the latest technologies, and data from randomized clinical trials confirming the alginates’ clinical efficacy, have been outlined. The phenomenon of DIS of the esophageal epithelium and SІEP for aggression factors is one of the leading links in GERD pathogenesis, in particular, its non‑erosive form, and to some extent determines the features of the clinical manifestations of the disease. Treatment of GERD with the use of alginates is logically justified, successfully used in clinical practice, and continues to be actively studied. The use of Gaviscon® products is expedient due to their unique mechanism of action to increase the resistance of the esophagus.  

675 FUNDOPLICATION VERSUS ORAL PROTON PUMP INHIBITORS FOR GASTROESOPHAGEAL REFLUX DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Luca Schiliró Tristão ◽  
Francisco Tustumi ◽  
Guilherme Tavares ◽  
Letícia Nogueira Datrino ◽  
Maria Carolina Andrade Serafim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Adverse Events ◽  
Proton Pump ◽  
Reflux Disease ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Oral Intake

Abstract   Gastroesophageal reflux disease (GERD) is a widely studied and highly prevalent condition. However, few is reported about the exact efficacy and safety of fundoplication (FPT) compared to oral intake proton-pump inhibitors (PPI). This systematic review and meta-analysis of randomized clinical trials (RCT) aims to compare PPI and FPT in relation to the efficacy, as well as the adverse events associated with these therapies. Methods This systematic review was guided by PRISMA statement. Search carried out in June 2020 was conducted on Medline, Cochrane, EMBASE and LILACS. The inclusion criteria were (I) patients with GERD; (II) Randomized clinical trials, comparing oral intake PPI with FPT; (III) relevant outcomes for this review. The exclusion criteria were (I) reviews, case reports, editorials and letters (II) transoral or endoscopic FPT (III) studies with no full text. No restrictions were set for language or period. Certainty of evidence and risk of bias were assessed with GRADE Pro and with Review Manager Version 5.4 bias assessment tool. Results Ten RCT were included. Meta-analysis showed that heartburn (RD = −0.19; 95% CI = −0.29, −0.09) was less frequently reported by patients that underwent FPT. Furthermore, patients undergoing surgery had greater pressure on the lower esophageal sphincter than those who used PPI (MD = 7.81; 95% CI 4.79, 10.83). There was no significant difference between groups in the percentage of time with pH less than 4 in 24 hours, sustained remission and Gastrointestinal Symptom Rating Scale. Finally, FPT did not increase significantly the risk for adverse events such as postoperative dysphagia and impaired belching. Conclusion FPT is a more effective therapy than PPI treatment for GERD, without significantly increasing the risk for adverse events. However, before indicating a possible surgical approach, it is extremely important to correctly assess and select the patients who would benefit from FPT, such as those with severe erosive esophagitis, severe respiratory symptoms, low adherence to continuous drug treatment and patients with non-acid reflux, to ensure better results.

scholarly journals The Diagnostic Significance of Coapplying a Rabeprazole Test with the SF-36 for Gastroesophageal Reflux Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Ying Chen ◽  
Feng Wang ◽  
Yuanxi Jiang ◽  
Chen Wang ◽  
Liwen Yao ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Low Cost ◽  
Clinical Manifestations ◽  
Life Quality ◽  
Diagnostic Significance ◽  
Sf 36 ◽  
Before And After

Gastroesophageal reflux disease is a diversity disease that affects life quality of people in the world. Due to the complicated pathogenesis and variations in clinical manifestations, there is still no true gold standard for GERD diagnosis, and it is still difficult to diagnose this disease in some patients. The proton pump inhibitor’s diagnostic test (the PPI test) is noninvasive, of low cost, tied to treatment, and widely accepted. Our aim is to evaluate the diagnostic significance of coapplying a rabeprazole test with the SF-36 for GERD in this study. Our study shows that the SF-36 in combination with the rabeprazole test can screen GERD patients and increase the sensitivity and specificity of GERD diagnosis through reference to the change in SF-36 score before and after the treatment (65 in the trial).

scholarly journals The Safety and Efficacy of Lansoprazole plus Metoclopramide among Neonates with Gastroesophageal Reflux Disease Resistant to Conservative Therapy and Monotherapy: A Clinical Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Peymaneh Alizadeh Taheri ◽  
Elahe Validad ◽  
Kambiz Eftekhari
Keyword(s):  
Clinical Trial ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Response Rate ◽  
Clinical Manifestations ◽  
Secondary Outcome ◽  
Double Blind ◽  
Term Neonates ◽  
Significant Difference

Background. Gastroesophageal reflux disease (GERD) is one of the most common problems in neonates. The main clinical manifestations of neonatal GERD are frequent regurgitation or vomiting associated with irritability, crying, anorexia or feeding refusal, failure to thrive, arching of the back, and sleep disturbance. Aims. The efficacy and safety of ranitidine plus metoclopramide and lansoprazole plus metoclopramide in reducing clinical GERD symptoms based on I-GERQ-R scores in neonatal GERD resistant to conservative and monotherapy. Study Design. This study was a randomized clinical trial of term neonates with GERD diagnosis (according to the final version of the I-GERQ-R), resistant to conservative and monotherapy admitted to Bahrami Children Hospital during 2017-2019. Totally, 120 term neonates (mean age 10.91 ± 7.17 days; girls 54.63%) were randomly assigned to a double-blind trial with either oral ranitidine plus metoclopramide (group A) or oral lansoprazole plus metoclopramide (group B). The changes of the symptoms and signs were recorded after one week and one month. At the end, fifty-four neonates in each group completed the study and their data were analyzed. Results. There was no significant difference in demographic and baseline characteristics between the two groups. The response rate of “lansoprazole plus metoclopramide” was significantly higher than “ranitidine plus metoclopramide” ( 7.44 ± 3.86 score vs. 9.3 ± 4.57 score, p = 0.018 ) after one week and ( 2.41 ± 3.06 score vs. 4.5 ± 4.12 score, p = 0.003 ) after one month (primary outcome). There were no drug adverse effects in either group during intervention (secondary outcome). Conclusions. The response rate was significant in each group after one week and one month of treatment, but it was significantly higher in the “lansoprazole plus metoclopramide” group compared with the “ranitidine plus metoclopramide” group. The combination of each acid suppressant with metoclopramide led to a higher response rate in comparison with monotherapy used before intervention. This study has been registered at the Iranian Registry of Clinical Trails (RCT20160827029535N3).

scholarly journals The problem of concomitant diseases with a focus on the cardiovascular system condition in patients with arterial hypertension and acid-related diseases

2013 ◽  
Vol 94 (1) ◽  
pp. 80-85 ◽  
Author(s):  
O V Khlynova ◽  
A V Tuev ◽  
L N Beresneva ◽  
A V Agafonov
Keyword(s):  
Blood Pressure ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Arterial Hypertension ◽  
Reflux Disease ◽  
Medical Science ◽  
Clinical Manifestations ◽  
Pressure Profile ◽  
Arterial Blood ◽  
Blood Pressure Profile

At present, the problem of concomitant diseases still remains very important for medical science as well as for medical practice. Arterial hypertension is one of the most actual global healthcare problems, holding the leading place among cardiovascular diseases. Acid-related diseases, including gastroesophageal reflux disease and duodenal ulcer are also widely-spread with the tendency of prevalence growth, and are having the leading place among gastrointestinal diseases. The combination of arterial hypertension and acid-related diseases is a new state of an organism regulation. Their synchronism is not accidental, as both diseases share links of the general etiology and pathogenesis. The daily arterial pressure profile and heart rhythm variability has a number of distinctive features when the diseases collide. The presence and progression of esophageal and duodenal mucous membranes inflammation in these patients promotes the certain arterial blood pressure profile formation. The data concerning the prevalence, common etiology and pathogenesis, features of hemodynamics and clinical manifestations in patients with arterial hypertension associated with peptic ulcer disease and gastroesophageal reflux disease are reviewed. Data of autonomic regulation features, 24-hour blood pressure profile and central hemodynamics condition in patients the combination with the mentioned diseases are also covered.

scholarly journals SIMULTANEOUS HIATAL HERNIA PLASTICS WITH FUNDOPLICATION, LAPAROSCOPIC CHOLECYSTECTOMY AND UMBILICAL HERNIA REPAIR

2021 ◽  
Vol 74 (1) ◽  
pp. 168-171
Author(s):  
Valeriy V. Boiko ◽  
Kyrylo Yu. Parkhomenko ◽  
Kostyantyn L. Gaft ◽  
Oleksandr E. Feskov
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Reflux Disease ◽  
Umbilical Hernia ◽  
Clinical Manifestations ◽  
Simultaneous Surgery ◽  
Umbilical Hernia Repair ◽  
Onlay Mesh

The article presents a case report of patients with multimorbid pathology – hiatal hernia with gastroesophageal reflux disease, cholecystolithiasis and umbilical hernia. Simultaneous surgery was performed in all cases – laparoscopic hiatal hernia with fundoplication, laparoscopic cholecystectomy and umbilical hernia alloplasty (in three cases – by IPOM (intraperitoneal onlay mesh) method and in one – hybrid alloplasty – open access with laparoscopic imaging). After the operation in one case there was an infiltrate of the trocar wound, in one case – hyperthermia, which were eliminated by conservative methods. The follow-up result showed no hernia recurrences and clinical manifestations of gastroesophageal reflux disease.

Significance of gastroesophageal reflux disease in the formation of chronic rhinosinusitis

2021 ◽  
Vol 88 (2) ◽  
pp. 26-30
Author(s):  
V.E. Kokorina ◽  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Nasal Cavity ◽  
Gastric Juice ◽  
Paranasal Sinuses ◽  
Reflux Disease ◽  
Inflammatory Diseases ◽  
Clinical Manifestations ◽  
Chronic Inflammatory Diseases

The research conducted by the author establishes the role of gastroesophageal reflux disease (GERD) in the genesis of chronic inflammatory diseases of the nasal cavity and paranasal sinuses. The author notes the characteristic changes in the mucous membrane of the nasal cavity and paranasal sinuses during the application of gastric juice. The analysis of the dynamics of clinical manifestations of diseases of the nasal cavity and paranasal sinuses with various methods of GERD correction was carried out

The features of GERD pharmacotherapy

2021 ◽  
pp. 5-24
Author(s):  
Albina Ayratovna Zvegintseva ◽  
Lyudmila Yurievna Kulagina ◽  
Maksim Leonidovich Maksimov ◽  
E.V. Matveev
Keyword(s):  
Clinical Practice ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Clinical Manifestations ◽  
Diagnosis And Therapy

The widespread prevalence of gastroesophageal reflux disease in clinical practice makes urgent the issue of therapy. This article describes the clinical manifestations, considers the recommended methods of diagnosis and therapy, including in pediatrics.

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