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 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 Endoscopic pH Monitoring for Patients with Suspected or Refractory Gastroesophageal Reflux Disease

2007 ◽  
Vol 21 (11) ◽  
pp. 737-741 ◽  
Author(s):  
Brian G Turner ◽  
John R Saltzman ◽  
Ling Hua ◽  
Rie Maurer ◽  
Natan Feldman ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Esophageal Acid Exposure ◽  
Acid Exposure ◽  
Refractory Gerd ◽  
Abnormal Esophageal Acid Exposure ◽  
Gerd Symptoms ◽  
Ambulatory Ph

BACKGROUND: Wireless pH studies can offer prolonged pH monitoring, which may potentially facilitate the diagnosis and management of patients with gastroesophageal reflux disease (GERD). The aim of the present study was to evaluate the detection rate of abnormal esophageal acid exposure using prolonged pH monitoring in patients with suspected or refractory GERD symptoms.METHODS: Patients undergoing prolonged ambulatory pH studies for the evaluation of GERD-related symptoms were assessed. Patients with a known diagnosis of GERD were tested on medical therapy, while patients with suspected GERD were tested off therapy. The wireless pH capsules were placed during upper endoscopy 6 cm above the squamocolumnar junction.RESULTS: One hundred ninety-one patients underwent a total of 198 pH studies. Fifty ambulatory pH studies (25%) were excluded from the analysis: 27 patients (14%) had insufficient data capture (less than 18 h on at least one day of monitoring), 15 patients had premature capsule release (7%), seven were repeat studies (3.5%) and one had intolerable pain requiring capsule removal (0.5%). There were 115 patients undergoing pH studies who were off medication, and 33 patients were on therapy. For the two groups of patients, results were as follows: 32 (28%) and 22 (67%) patients with normal studies on both days; 58 (50%) and five (15%) patients with abnormal studies on both days; 18 (16%) and three (9%) patients with abnormal studies on day 1 only; and seven (6%) and three (9%) patients with abnormal studies on day 2 only, respectively.CONCLUSIONS: Prolonged 48 h pH monitoring can detect more abnormal esophageal acid exposure but is associated with a significant rate of incomplete studies.

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 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.

scholarly journals Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis

2021 ◽  
Vol 09 (11) ◽  
pp. E1740-E1751
Author(s):  
Enrique Rodríguez de Santiago ◽  
Carlos Teruel Sanchez-Vegazo ◽  
Beatriz Peñas ◽  
Yuto Shimamura ◽  
Mayo Tanabe ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Ph Monitoring ◽  
Clinical Success ◽  
Meta Analysis ◽  
Pool Data ◽  
Technical Success ◽  
Technical Success Rate ◽  
Refractory Gerd

Abstract Background and study aims Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) are new endoscopic procedures for patients with gastroesophageal reflux disease (GERD). We conducted a meta-analysis to systematically assess the feasibility, clinical success, and safety of these procedures. Patients and methods We searched Embase, PubMed, and Cochrane Central from inception to October 2020. Overlapping reports, animal studies, and case reports were excluded. Our primary outcomes were clinical success and adverse events (AEs). Secondary outcomes included technical success, endoscopic esophagitis, 24-hour pH monitoring, and proton pump inhibitor (PPI) use. A random effects model was used to pool data. Results In total, 15 nonrandomized studies (12 ARMS, n = 331; 3 ARMA, n = 130) were included; 10 were conducted in patients with refractory GERD. The technical success rate was 100 %. The pooled short-term (first assessment within the first 6 months), 1-year, and 3-year clinical success rates were 78 % (95 % confidence interval [95 %CI] 70 %–85 %), 72% (95 %CI 47 %–92 %), and 73 % (95 %CI 65 %–81 %), respectively. ARMS and ARMA yielded similar clinical success. The proportion of patients off PPIs at 1 year was 64 % (95 %CI 52 %–75 %). There were significant drops (P < 0.01) in validated clinical questionnaires scores, presence of esophagitis, and acid exposure time. The most common AE (11 %, 95 %CI 8 %–15 %) was dysphagia requiring dilation (7%, 95 %CI 5 %–11 %). Four cases of perforation were recorded, all in patients undergoing ARMS. Conclusions Our meta-analysis of nonrandomized studies suggests that ARMS and ARMA are safe and effective for patients with GERD.

scholarly journals Belching in Gastroesophageal Reflux Disease: Literature Review

2020 ◽  
Vol 9 (10) ◽  
pp. 3360
Author(s):  
Akinari Sawada ◽  
Yasuhiro Fujiwara ◽  
Daniel Sifrim
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Psychological Treatment ◽  
Ph Monitoring ◽  
Physiological Mechanism ◽  
Behavioral Disorder ◽  
High Dose ◽  
Reflux Symptoms ◽  
Refractory Gerd

Belching is a common phenomenon. However, it becomes bothersome if excessive. Impedance–pH monitoring can classify the belching into two types: gastric belching and supragastric belching (SGB). The former is a physiological mechanism to vent swallowed air from the stomach, whereas the latter is a behavioral disorder. Gastroesophageal reflux disease (GERD) is the most relevant condition in both types of belching. Recent findings have raised awareness that excessive SGB possibly sheds light on the pathogenesis of a part of proton pump inhibitor (PPI) refractoriness in GERD. SGB could cause typical reflux symptoms such as heartburn, regurgitation or chest pain in two ways: SGB-induced gastroesophageal reflux or SGB-induced esophageal distension. In PPI-refractory GERD, it is important to detect hidden SGB as a cause of reflux symptoms since SGB requires psychological treatment instead of high dose PPIs or pain modulators. In the case of PPI-refractory GERD with excessive SGB, recent studies imply that the combination of a psychological approach and conventional treatment can improve treatment outcome.

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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