scholarly journals Comparative analysis of the results of 3-hour esophageal-gastric-pH monitoring in patients with combined course of gastroesophageal reflux disease and arterial hypertension depending on the available antihypertensive pharmacotherapy

2019 ◽  
Vol 23 (4) ◽  
pp. 605-610
Author(s):  
I.G. Paliy ◽  
O.O. Ksenchyn ◽  
S.V. Zaika
Keyword(s):  
Comparative Analysis ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Arterial Hypertension ◽  
Reflux Disease ◽  
Negative Impact ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Gastric Ph ◽  
Gastric Ph Monitoring

Annotation. Hypotensive drugs, which patients with arterial hypertension take, can have a negative impact on the motility of the esophagus and lower esophageal sphincter, increasing the likelihood of gastroesophageal reflux disease, and worsen it. The aim is to study the features of acid gastroesophageal refluxes and gastric secretory function in patients with combined course of gastroesophageal reflux disease and arterial hypertension, depending on the available anti-hypertensive pharmacotherapy. Patients were divided into four groups, depending on available monotherapy with valsartan, lisinopril, bisoprolol, and amlodipine. Patients were subjected to 3-hour esophageal-gastric-pH monitoring. We conducted a comparative analysis of the following indicators: the number of acid refluxes, the presence of refluxes lasting more than 5 minutes, the average and maximum duration of episodes of reflux. The values of the minimum pH, maximum pH, average pH and median pH in the esophagus, cardiac part of stomach and stomach body were also compared. The results showed that in the group of patients taking valsartan, there was a significant increase in the number of episodes of acid reflux, an increase in the minimum pH in the esophagus, and an increase in % of time with a pH <4 in the esophagus, unlike patients taking lisinopril or amlodipine. There were no differences in gastro-pH monitoring between patients treated with valsartan, lisinopril, bisoprolol, and amlodipine monotherapy. It indicates that increase of gastroesophageal reflux in the valsartan group was not caused by the acid-induced effect of valsartan, but other factors that lead to a decrease and/or disorganization of esophageal motility.

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.

scholarly journals Diagnostic Efficacy of 24-hr Esophageal pH Monitoring in Patients with Refractory Gastroesophageal Reflux Disease

2018 ◽  
Vol 6 (7) ◽  
pp. 1235-1238 ◽  
Author(s):  
Atoosa Gharib ◽  
Mojgan Forootan ◽  
Marjan Sharifzadeh ◽  
Saied Abdi ◽  
Mohammad Darvishi ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Impedance Analysis ◽  
Acid Reflux ◽  
Diagnostic Efficacy ◽  
Weakly Acid ◽  
Refractory Gerd ◽  
Acid Acid

BACKGROUND: Gastric reflux is one of the most important causes of the referral of patients to the internal clinic, which in some cases causes problems for patients due to resistance to common treatments. Therefore, timely diagnosis and treatment of this group of patients are very important.AIM: The purpose of the present study was to determine the off-proton pump inhibitor (off-PPI) 24 h pH-impedance analyses in patients with refractory gastroesophageal reflux disease (GERD) attending to Taleghani Hospital since 2009 to 2017.METHODS: In this observational descriptive-comparative off-PPI study, 572 patients with refractory GERD who were referred to Taleghani Hospital in Tehran from 2009 to 2017 were selected, and the results of 24 h pH Impedance analysis were then assessed.RESULTS: The results of 24h pH-impedance indicated that 7% of cases belonged to Pure Acid Reflux followed by weakly Acid (1%), non-acid (0.3%), mixed & gas (5.2%), functional (58.4%) and oesophagal hypersensitivity (28%). Furthermore, weakly acid plus acid was also found to be 8% and Weakly Acid + Acid + Non-Acid were determined as 8.3%.CONCLUSIONS: Our findings suggested that nearly more than half of the patients with refractory GERD would have a functional disorder in the 24h pH-impedance analysis.

scholarly journals THE ROLE OF PEPSINOGENES AND SOME INTESTINAL HORMONES IN PATHOGENESIS OF GASTROESOPHAGEAL REFLUX DISEASE

2018 ◽  
Vol 1 ◽  
pp. 3-8 ◽  
Author(s):  
Vira Boichuk
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Half Life ◽  
Breath Test ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Solid Food ◽  
Intestinal Hormones ◽  
Mean Values

80 patients with gastroesophageal reflux disease (GERD) were examined. The diagnosis of GERD was based on the history of the disease, complaints of patients, the results of daily monitoring of pH in the lower third of the esophagus, data of fibroesophagogastroduodenoscopy, chromoendoscopy, 13C-octanoic breath test, gastrin-17 (G-17) concentration, pepsinogens I and II (P I and II) and cholecystokinin-pancreozymin (C-P) in serum. After 24 hours pH monitoring of the lower third of the esophagus in 40 patients with GERD, the predominance of acid was found, and the other 40 patients had mixed refluxes. In patients with predominance of acid reflux, the mean values of half-life of solid food evaluation (T1/2) according to 13C-octanoic breath test was (45.25±1.34) min. With the predominance of mixed refluxes in patients, there was a tendency towards hypokinetic motility of the stomach, indicating a slowdown in half-life of solid food evaluation from the stomach up to (139.24±11.87) min. With the predominance of acid reflux also was observed a significant reduction in the concentration of G-17 and C-P, an increase in P I and a decrease in the concentration of P II. Hypergastrinemia, high levels of C-P and P II (37.44±3.41) μg/l (p<0,05) were diagnosed with the predominance of mixed refluxes.

scholarly journals Sex-Based Differences in pH Parameters and Esophageal Impedance of Patients With Gastroesophageal Reflux Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Bixing Ye ◽  
Yanjuan Wang ◽  
Lin Lin ◽  
Liuqin Jiang ◽  
Meifeng Wang
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Mucosal Barrier ◽  
Esophageal Mucosa ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Esophageal Impedance

Background/Aims: The incidence of reflux esophagitis (RE) has a striking predominance in males. Conversely, non-erosive reflux disease (NERD) is more common in females. This imbalance of gastroesophageal reflux disease (GERD) implies sex-related differences in its pathogenesis. However, limited studies have analyzed the sex-based differences in pH parameters and esophageal impedance of GERD patients.Methods: This study evaluated sex-based pathogenesis differences by comparing reflux episodes, mean nocturnal baseline impedance (MNBI) values, and post-reflux swallow-induced peristaltic wave (PSPW) index values of males with GERD and females with GERD using 24-h multichannel intraluminal impedance and pH monitoring.Results: We analyzed 181 patients (102 males and 79 females) with GERD. Reflux symptom index (RSI) scores were higher in females than that in males (P &lt; 0.05). Males had significantly longer acid exposure times, higher DeMeester scores, and more acid reflux episodes than females (P &lt; 0.05). Females had more instances of weakly acidic reflux than males (P &lt; 0.01). The PSPW index values of males and females were similar (P &gt; 0.05). Compared with females, males had lower MNBI values for the mid and distal esophagus (P &lt; 0.05). However, with increasing age, the MNBI values of females decreased more rapidly than those of males. MNBI values of elderly patients of both sexes older than 60 years were similar.Conclusions: Acid reflux is more likely to occur in males; however, females tend to have more instances of weakly acid reflux. The integrity of the esophageal mucosa is more fragile in males than in females; however, the esophageal mucosal barrier attenuates more rapidly with increasing age in females than in males.

Gastroesophageal Reflux Disease and Idiopathic Lung Fibrosis. From Heartburn to Lung Transplant, and Beyond

2021 ◽  
pp. 000313482199868
Author(s):  
Fernando A. M. Herbella ◽  
Marco G. Patti
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Lung Fibrosis ◽  
Bronchiolitis Obliterans ◽  
Lung Transplant ◽  
Ph Monitoring ◽  
Objective Evaluation ◽  
Bronchiolitis Obliterans Syndrome ◽  
Laparoscopic Operation

Idiopathic pulmonary fibrosis (IPF) and gastroesophageal reflux disease (GERD) are undoubtedly related. Even though it is not clear yet which one is the primary disease, they certainly interact increasing each other’s severity. Symptoms are unreliable to diagnose GERD in patients with IPF, and objective evaluation with pH monitoring and/or bronchoalveolar lavage analysis is mandatory. Pharmacological treatment with proton pump inhibitors (PPIs) may bring control of IPF in few patients, but PPIs do not control reflux but just change the pH of the gastric refluxate. Surgical therapy based on a fundoplication is safe and effective as it controls any type of reflux, independently from the pH of the gastric refluxate. In patients waiting for lung transplantation (if they can tolerate a laparoscopic operation under general anesthesia), a fundoplication before the operation might block the progression of IPF, while after transplantation it might prevent rejection by preventing the bronchiolitis obliterans syndrome.

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