Combination of Symptom Profile, Endoscopic Findings, and Esophageal Mucosal Histopathology Helps to Differentiate Achalasia from Refractory Gastroesophageal Reflux Disease

: Achalasia, a rare primary esophageal motility disorder, is often misdiagnosed as refractory gastroesophageal reflux disease (GERD). This study is aimed to identify the clinical and histopathologic features that may help to differentiate these two entities. Patients with untreated achalasia and those with refractory reflux symptoms despite ≥8 weeks of proton-pump inhibitor treatment were enrolled prospectively. All patients underwent validated symptom questionnaires, esophagogastroduodenoscopy with biopsy, and high-resolution impedance manometry (HRIM). Histopathology of esophageal mucosa was compared based on four pre-determined histological criteria: basal cell hyperplasia or papillae elongation, eosinophilic infiltration, petechiae formation, and hypertrophy of the muscularis mucosae (MM). Compared with the GERD patients, patients with achalasia had similar reflux symptoms, but higher Eckardt scores, fewer erosive esophagitis and hiatal hernia, more esophageal food retention on endoscopy, and higher prevalence of hypertrophy of the MM and petechiae formation on histopathology. Multivariate logistic regression based on Eckardt score ≥4, normal esophagogastric junction morphology or esophageal food retention, and coexistence of petechiae formation and hypertrophy of the MM, established the best prediction model for achalasia. Therefore, combination of routinely accessible variables, including Eckardt score, endoscopic features, and histopathology obtained via esophageal mucosal biopsy, may provide an earlier identification of achalasia.

Download Full-text

Peculiarities of the Pathology of Gastrointestinal Tract in Patients with Gastroesophageal Reflux Disease on the Background of Hypothyroidism

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs06.01.125 ◽

2021 ◽

Vol 6 (1) ◽

pp. 125-131

Author(s):

Reva T. V. ◽

◽

V. B. Reva ◽

I. V. Trefanenko ◽

G. І. Shumko ◽

...

Keyword(s):

Gastrointestinal Tract ◽

Gastroesophageal Reflux Disease ◽

Gastric Mucosa ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Erosive Esophagitis ◽

Control Group ◽

Esophageal Mucosa ◽

Gastric Evacuation ◽

Duodenogastroesophageal Reflux

The article identifies the features of the pathology of the gastrointestinal tract in patients with gastroesophageal reflux disease on the background of hypothyroidism. The frequency of gastroesophageal reflux disease and the severity of this disease increase with age and the presence of comorbid pathology. In the elderly, the frequency of the typical esophageal manifestations decreases, and the erosive esophagitis with atypical symptoms is more common. The growing number of cases of combined thyroid dysfunction with gastropathology requires in-depth study of the reasons for the relationship between these processes. Pathological changes in the gastrointestinal tract in these patients make their condition severer, contributing to the development and progression of metabolic disorders. An important aggravating effect on the regulatory mechanisms of esophageal kinetics has a pathological functioning of the thyroid gland on the background of iodine deficiency. Results and discussion. In patients with gastroesophageal reflux disease with hypothyroidism, all changes in gastric and duodenal function are associated with a decrease in the acid-forming function of the gastric mucosa, due to its atrophy, decreased tone and contractility of the stomach. This in turn leads to a slowing of gastric and duodenal evacuation, dysfunction of the closing capacity of the cardia and, as a consequence, the development of duodenogastroesophageal reflux. The esophageal contents are not so pronounced, so patients with non-erosive forms of esophagitis predominate (46.2%) against 16% of patients in the second group (patients with gastroesophageal reflux disease). At the same time, erosive forms predominate among patients in the control group with predominant acid reflux. It should be noted that there is a clear relationship between the frequency of erosive changes in the esophageal mucosa and the duration of the disease. Thus, among patients of the main group with a 5-year history of the disease, the number of erosive forms of gastroesophageal reflux disease was minimal. The number of erosive changes in the esophageal mucosa increased sharply in patients with a 10-year history and reached its maximum after 15 years from the onset of the disease. Conclusion. The delay in gastric evacuation is more pronounced in patients with gastroesophageal reflux disease on the background of hypothyroidism. It can be explained by a decrease in gastric motility and the presence of duodenostasis. The slowing of gastric evacuation was more pronounced in patients with gastroesophageal reflux disease on the background of reduced thyroid function. In patients with gastroesophageal reflux disease on the background of hypothyroidism there is an alkaline duodenogastroesophageal reflux as a consequence of reduced acid-forming function of the gastric mucosa and reduced contractility of the stomach and duodenum

Download Full-text

Non-dental oral cavity findings in gastroesophageal reflux disease: a systematic review and meta-analysis

Journal of Mind and Medical Sciences ◽

10.22543/7674.81.p6070 ◽

2021 ◽

Vol 8 (1) ◽

pp. 60-70

Author(s):

Madalina-Gabriela Indre ◽

Darius Sampelean ◽

Vlad Taru ◽

Angela Cozma ◽

Dorel Sampelean ◽

...

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Oral Cavity ◽

Reflux Disease ◽

Functional Limitation ◽

Gastrointestinal Symptoms ◽

Erosive Esophagitis ◽

The United States ◽

Esophageal Mucosa ◽

Oral Manifestations

Gastroesophageal reflux disease (GERD) is known as the most prevalent gastrointestinal disorder in the United States, leading to substantial morbidity, although associated mortality is rare. Based on the appearance of esophageal mucosa on upper endoscopy, GERD is divided into erosive esophagitis (ERD) and nonerosive reflux disease (NERD). Heartburn and acid regurgitation are the typical symptoms of the disease, although some patients may present atypical manifestations such as epigastric pain, nausea, asthma, chronic cough, pharyngitis, laryngitis, sleep disturbances, otitis, and sinusitis. Other signs, such as oral mucosal lesions may result from GERD by direct acid or acidic vapor contact in the oral cavity. Oral manifestations such as tooth erosion, periodontitis, gingivitis, palatal erythema, ulceration, glossitis, oral acid burning sensation, halitosis, xerostomia have recently been reported in GERD patients. A considerable percentage of the patients are affected by oral manifestations before the onset of gastrointestinal symptoms, although in most cases the gastrointestinal signs and symptoms dominate the clinical picture. The injured oral mucosa negatively impacts the quality of life, especially functional limitation, physical inability and psychological disabilities, thus leading to social isolation. There is plenty of non-standardized information on the oral mucosal changes in GERD. In this context, we aimed at synthesizing and analyzing the current available evidence on non-dental oral cavity lesions and complaints that are present in patients diagnosed with GERD.

Download Full-text

Mucosal Protective Compounds in the Treatment of Gastroesophageal Reflux Disease. A Position Paper Based on Evidence of the Romanian Society of Neurogastroenterology

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.254.dea ◽

2016 ◽

Vol 25 (4) ◽

pp. 537-546 ◽

Cited By ~ 5

Author(s):

Teodora Surdea-Blaga ◽

Ion Băncilă ◽

Daniela Dobru ◽

Vasile Drug ◽

Ovidiu Frățilă ◽

...

Keyword(s):

Quality Of Life ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Reflux Disease ◽

Position Paper ◽

Esophageal Mucosa ◽

Reflux Symptoms

Background & Aims: Gastroesophageal reflux disease (GERD) therapy is challenging and suppression of acid secretion or prokinetics do not cure all cases. Some drugs with protective action on the esophageal mucosa have been used alternatively or in association with proton pump inhibitors (PPIs) and/or prokinetics. The Romanian Society of Neurogastroenterology undertook an Evidence-Based analysis, from which this position paper evolved. Methods: We performed a systematic literature search in PubMed until October 2015, using the terms: sucralfate, guaiazulene, gaiazulene, dimethicone, alginate, antacids and gastroesophageal reflux. Forty-seven papers were included and analyzed. Several statements were elaborated regarding the use of these drugs in GERD. The evidence and recommendations were discussed between the authors. Results: There is evidence in the medical literature suggesting the benefit of these drugs in GERD. In patients with persistent or mild reflux symptoms antacids rapidly relieve heartburn. Alginate-antacid combination is superior both over placebo and antacids to treat mild reflux symptoms, and can be used to treat persistent reflux symptoms despite acid suppressant therapy. Sucralfate is superior over placebo in alleviating GERD symptoms and can be used as maintenance therapy. Guaiazulene-dimethicone improves the quality of life in patients with GERD. Conclusions: Drugs used to protect the esophageal mucosa against acid are useful in alleviating chronic heartburn, especially in patients with mild reflux symptoms. Abbreviations: CS: Chondroitin sulfate; DA: Double Action; EE : Erosive esophagitis ; GERD: Gastroesophageal reflux disease; HA: Hyaluronic acid; H2RA: Histamine 2 receptor antagonist; ITT: Intention to treat; IM: Irsogladine maleate; NERD: Non-erosive reflux disease; PPIs: Proton pump inhibitors; RCT: Randomized controlled trial; RDQ: Reflux disease questionnaire; QoL: Quality of life.

Download Full-text

The role of dexlansoprazole modified-release in the management of gastroesophageal reflux disease

Therapeutic Advances in Gastroenterology ◽

10.1177/1756283x16681701 ◽

2017 ◽

Vol 10 (2) ◽

pp. 243-251 ◽

Cited By ~ 6

Author(s):

Ronnie Fass ◽

Rosita Frazier

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Sleep Disturbances ◽

Erosive Esophagitis ◽

Esophageal Mucosa ◽

Side Effect Profile ◽

Modified Release ◽

Nonerosive Reflux Disease

Dexlansoprazole modified-release (MR) is the R-enantiomer of lansoprazole and is currently the only proton-pump inhibitor (PPI) with a novel dual delayed release (DDR) formulation. Overall, dexlansoprazole MR demonstrates a similar safety and side-effect profile as lansoprazole. Dexlansoprazole MR has been shown to be highly efficacious in healing erosive esophagitis, maintaining healed esophageal mucosa in patients with erosive esophagitis and controlling symptoms of patients with nonerosive reflux disease (NERD). Recent studies have also demonstrated that dexlansoprazole MR is highly effective in improving nocturnal heartburn, gastroesophageal reflux disease (GERD) related sleep disturbances and bothersome regurgitation. Dexlansoprazole MR is well tolerated and can be taken without regard to food.

Download Full-text

Gastroesophageal reflux disease in residents of the Trans-Baikal Territory

Kazan medical journal ◽

10.17816/kmj2020-661 ◽

2020 ◽

Vol 101 (5) ◽

pp. 661-668

Author(s):

A A Zhilina ◽

N V Lareva ◽

E V Luzina

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Morphological Changes ◽

Smoking Status ◽

Erosive Esophagitis ◽

Coffee Consumption ◽

Esophageal Mucosa ◽

Prevalence Of Obesity ◽

Gerd Symptoms

Aim. To study the prevalence of gastroesophageal reflux disease (GERD) symptoms and lesions of the esophageal mucosa in residents of Zabaikalsky krai, taking into account ethnicity. Methods. The first stage: 371 residents of Zabaikalsky krai over 18 years old, were door-to-door interviewed by using the GERD questionnaire (GerdQ). The respondents with 8 or more points were classified as having GERD symptoms. Additionally, we collected passport data, smoking status, alcohol and coffee consumption, anthropometric data and social status. The second stage: we analyzed 2130 upper gastrointestinal (GI) endoscopy reports from Regional Clinical Hospital in Chita. Results. 48 (12.9%) of 371 respondents had GERD symptoms. 135 (36.4%) respondents were Buryats, and 236 (63.6%) were non-Buryats, with the latter more often had GerdQ total score of 8 or more [38 (16.1%) non-Buryats and 10 (7.4%) Buryats, p=0.009]. The average age of non-Buryats respondents with GERD symptoms was 53.417.47 years and exceeded that in the group without symptoms (46.219.2 years), p=0.035. The age of Buryats with and without GERD symptoms did not differ (42.6711.52 and 37.8915.54 years, respectively, р=0.087). The prevalence of obesity, smoking, alcohol and coffee consumption of respondents with and without GERD symptoms, both among Buryats and non-Buryats was the same. Of the 2130 patients who underwent endoscopy, 164 (7.8%) had morphological changes in the esophagus, 105 (4.9%) had erosive esophagitis (EE). Catarrhal and erosive changes in the esophagus were detected in 156 non-Buryats (91 men and 66 women) (7.7%), while EE was diagnosed in 97 (4.8%) patients. 6.5% (5 women and 3 men) Buryats had the esophagus pathology, which caused by erosion. It was found that in non-Buryats group EE develop more often in male respondents (p=0.0019). Only non-Buryats had catarrhal changes in the esophagus (37.8%, 59 people), p=0.0312. At the same time, the incidence of complicated disease course in groups with EE was the same (p=0.8934). Conclusion. About 13% of residents of Zabaikalsky krai have weekly symptoms of GERD, male of a non-Buryat ethnic group are more likely to develop erosive esophagitis than women; the incidence of complications of esophagitis is the same in Buryats and non-Buryats respondents groups.

Download Full-text

The Prevalence, Risk Factors, and Clinical Correlates of Erosive Esophagitis and Barrett’s Esophagus in Iranian Patients with Reflux Symptoms

Gastroenterology Research and Practice ◽

10.1155/2014/696294 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Alireza Sharifi ◽

Shahab Dowlatshahi ◽

Hedieh Moradi Tabriz ◽

Fatemeh Salamat ◽

Omid Sanaei

Keyword(s):

Risk Factors ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Barrett’S Esophagus ◽

Reflux Disease ◽

Barrett's Esophagus ◽

Erosive Esophagitis ◽

Endoscopic Findings ◽

Reflux Symptoms ◽

H Pylori

Background.Erosive esophagitis (EE) and Barrett’s esophagus (BE) are the two important complications of gastroesophageal reflux disease. We aimed to investigate the prevalence of and the risk factors for EE and BE in an Iranian group of patients with reflux symptoms. We also examined the relationship between reflux symptoms and endoscopic findings.Methods.A total of 736 patients with gastroesophageal reflux disease (GERD) symptoms were enrolled and all underwent upper gastrointestinal endoscopy. Diagnosis of Barrett’s esophagus was confirmed by pathologic examination and Helicobacter pylori (H. pylori) infection was demonstrated by rapid urease test.Results.Two hundred eighty-three and 34 patients were found to have EE and BE, respectively. Multivariate analysis showed that hiatal hernia (P<0.001) and H. pylori infection (P<0.002) were the two significantly related risk factors for esophagitis. Only age was related to BE, with BE patients being more likely to be older (P<0.001) than others.Conclusions.Prevalence of EE and BE in Iranian reflux patients is similar to that seen in western countries. H. pylori infection and the presence of hiatal hernia may be strong risk factors for esophagitis as does older age for Barrett’s esophagus. Finally, reflux symptoms have no significant relationship with endoscopic findings.

Download Full-text

Food and Gastroesophageal Reflux Disease

Current Medicinal Chemistry ◽

10.2174/0929867324666170515123807 ◽

2019 ◽

Vol 26 (19) ◽

pp. 3497-3511 ◽

Cited By ~ 16

Author(s):

Teodora Surdea-Blaga ◽

Dana E. Negrutiu ◽

Mariana Palage ◽

Dan L. Dumitrascu

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Lower Esophageal Sphincter ◽

Reflux Disease ◽

Current Knowledge ◽

Positive Association ◽

Sphincter Pressure ◽

Low Carbohydrate Diet ◽

Reflux Symptoms ◽

Esophageal Sphincter

Gastroesophageal reflux disease is a chronic condition with a high prevalence in western countries. Transient lower esophageal sphincter relaxation episodes and a decreased lower esophageal sphincter pressure are the main mechanisms involved. Currently used drugs are efficient on reflux symptoms, but only as long as they are administered, because they do not modify the reflux barrier. Certain nutrients or foods are generally considered to increase the frequency of gastroesophageal reflux symptoms, therefore physicians recommend changes in diet and some patients avoid bothering foods. This review summarizes current knowledge regarding food and gastroesophageal reflux. For example, fat intake increases the perception of reflux symptoms. Regular coffee and chocolate induce gastroesophageal reflux and increase the lower esophageal exposure to acid. Spicy foods might induce heartburn, but the exact mechanism is not known. Beer and wine induce gastroesophageal reflux, mainly in the first hour after intake. For other foods, like fried food or carbonated beverages data on gastroesophageal reflux is scarce. Similarly, there are few data about the type of diet and gastroesophageal reflux. Mediterranean diet and a very low carbohydrate diet protect against reflux. Regarding diet-related practices, consistent data showed that a “short-meal-to-sleep interval” favors reflux episodes, therefore some authors recommend that dinner should be at least four hours before bedtime. All these recommendations should consider patient’s weight, because several meta-analyses showed a positive association between increased body mass index and gastroesophageal reflux disease.

Download Full-text