Different clinical symptom patterns in patients with reflux micro-micro-aspiration

BackgroundPulmonary manifestation of gastro-oesophageal reflux disease (GORD) is a well-recognised entity, however little primary reported data exists on presenting symptoms of patients in whom reflux micro-aspiration is confirmed. The aim of this study is to report symptoms and presenting patterns of a large group of patients with confirmed reflux micro-aspiration.Patients and methodsData was extracted from a prospectively populated database of patients referred to a tertiary specialist centre with severe, refractory, or atypical reflux. Patients with reflux micro-aspiration on scintigraphy were included in this study. Separate group included patients with evidence of proximal reflux to the level of pharynx when supine and/or upright.ResultsInclusion criteria were met by 243 patients with confirmed reflux micro-aspiration (33% males; mean age 59). Most common symptoms amongst patients with micro-aspiration were regurgitation (72%), cough (67%), heartburn (66%), throat clearing (65%), and dysphonia (53%). The most common two-symptom combinations were heartburn/regurgitation, cough/throat clearing, regurgitation/throat clearing, cough/regurgitation and dysphonia/throat clearing. The most common three-symptom combinations were cough/heartburn/regurgitation, cough/regurgitation/throat clearing and dysphonia/regurgitation/throat clearing. Cluster analysis demonstrated two main symptom groupings, one suggestive of proximal volume reflux symptoms and the other with motility/inflammatory bowel syndrome (IBS)-like symptoms (bloat, constipation).ConclusionCombination of typical symptoms of GORD such as heartburn or regurgitation and a respiratory or upper aero-digestive complaint such as cough, throat clearing, or voice change should prompt consideration of reflux micro-aspiration.

641 CLINICAL SYMPTOM PATTERNS IN PATIENTS WITH REFLUX ASPIRATION

Multiple papers have discussed pulmonary manifestation of gastro-oesophageal reflux disease (GORD), however little primary reported data exists on presenting symptoms of patients in whom reflux aspiration is confirmed. The aim of this study is to report symptoms and presenting patterns of a large group of patients with confirmed reflux aspiration. Methods Data was extracted from a prospectively populated database of patients referred to a tertiary specialist centre with severe, refractory, or atypical reflux. Patients with reflux aspiration on scintigraphy were included in this study. Separate group included patients with evidence of proximal reflux to the level of pharynx when supine and/or upright. Results Inclusion criteria were met by 243 patients (33% males; mean age 59). Most common symptoms amongst patients with aspiration were regurgitation (72%), cough (67%), heartburn (66%), throat clearing (65%), and dysphonia (53%). The most common two-symptom combinations were heartburn/regurgitation, cough/throat clearing, regurgitation/throat clearing, cough/regurgitation and dysphonia/throat clearing. The most common three-symptom combinations were cough/heartburn/regurgitation, cough/regurgitation/throat clearing and dysphonia/regurgitation/throat clearing. Clusters analysis demonstrated two main symptom clusters one suggestive of proximal large volume reflux symptoms (regurgitation, heartburn) and the other with IBS type symptoms (bloat, dysphagia, constipation). Conclusion Combination of typical symptoms of GORD and a respiratory or upper aero-digestive complaint should prompt consideration of reflux aspiration. Cluster analysis of symptoms in this group supports previously postulated hypothesis of reflux aspiration pathogenesis by either large volume proximal reflux or by ineffective oesophageal motility.

Prevalencia de mucosa gástrica heterotópica cervical y su relación con síntomas de reflujo gastroesofágico. Estudio observacional

Introduction. The heterotopic gastric mucosal patch or inlet patch is the presence of gastric columnar mucosa outside the stomach, most frequently located in the proximal esophagus. Its manifestations vary from esophageal and extraesophageal reflux symptoms to major complications, most of them being asymptomatic. Aim. To determine the prevalence of cervical heterotopic gastric mucosa in our environment and its association with esophageal and extraesophageal reflux symptoms. Material and methods. Prospective cross-sectional and observational study; consecutive patients who came to our institution between December 2018 and October 2019 for diagnostic upper gastrointestinal videoendoscopy were included, following a questionnaire on clinical manifestations. Results. A total of 1,408 patients were included. In 89 (6.3%), a cervical heterotopic gastric mucosal patch was described. The mean age of the patients without this condition was 54.6 and 55.5 in patients with it. The esophageal symptoms of gastroesophageal reflux (heartburn, regurgitation, and chest pain) in patients with cervical heterotopic gastric mucosa was observed in 40 (44.9% / p = 0.473), 12 (13.5% / p = 0.783) and 4 (4.5% / p = 0.199) patients respectively. The presence of extraesophageal symptoms (globus, chronic cough, dysphonia, and throat clearing) in patients with cervical heterotopic gastric mucosa was: 9 (10.1% / p = 0.011); 7 (7.9% / p = 0.155); 4 (4.5% / p = 0.458) and 9 (10.1% / p = 0.036) respectively. Conclusions. A statistically significant association was found between the presence of cervical heterotopic gastric mucosal patch and symptoms of globus (p = 0.011) and throat clearing (p = 0.036). It could be interpreted that this group of patients would benefit from the research and treatment of this condition with the intention of improving their symptoms.

Deteksi pepsin pada saliva pasien refluks laringofaring

Latar belakang: Refluks laringofaring (RLF) didefinisikan sebagai aliran balik cairan lambungke daerah laring dan faring, sehingga berkontak dengan saluran pencernaan dan pernapasan bagian atasyang menyebabkan keluhan suara serak, batuk, sensasi globus, throat clearing, dan post nasal drip. RLFmemberikan dampak negatif terhadap kualitas hidup terutama fungsi fisik dan emosi. Diagnosis RLFditegakkan dengan mengetahui riwayat penyakit, gejala klinis, pemeriksaan laringoskopi, serta menentukanadanya aliran balik cairan lambung ke laringofaring. Pemeriksaan ambulatory 24 hours double-probepHmetri merupakan baku emas untuk diagnosis RLF, tetapi pemeriksaan ini masih belum ideal. Salahsatu cara untuk menentukan RLF saat ini adalah dengan menentukan keberadaan pepsin pada laring danfaring, menggunakan metode Enzyme Linked Immunosorbent Assay (ELISA). Hal ini berdasarkan faktabahwa pepsin hanya dihasilkan pada lambung. Tujuan: Mengetahui karakteristik pasien, gambaran refluxsymptom index (RSI), gambaran reflux finding score (RFS) dan mengetahui kadar pepsin pada salivapasien RLF. Metode: Penelitian ini merupakan penelitian deskriptif untuk mengetahui gambaran hasilpemeriksaan RSI, RFS, dan kadar pepsin dalam saliva pasien RLF dengan metode ELISA di bagian TelingaHidung Tenggorok-Bedah Kepala dan Leher Rumah Sakit Dr. M. Djamil Padang, mulai Januari–Oktober2015. Hasil: Dari 30 responden yang terdiri dari perempuan 23 orang (76,7%), dan laki-laki 7 orang(23,3%), didapatkan kelompok usia terbanyak 48-57 tahun (40%), dengan rata-rata usia 47,2+12,06 tahun.Nilai rerata RSI 18,53+4,46, nilai rerata RFS 11,47+2,50, dan pada semua sampel didapatkan pepsin (+)dengan nilai rerata kadar pepsin dalam saliva responden 2,75+1,23 ng/ml. Kesimpulan: Pepsin terdeteksipada semua sampel saliva responden RLF. ABSTRACTBackground: Laryngopharyngeal reflux (LPR) is defined as the backflow of gastric contents intolarynx and pharynx areas, making contacts with upper digestive and respiratory tracks causing hoarseness,cough, globus sensation, throat clearing and post nasal drip. LPR has a negative impact on quality oflife. LPR diagnosis is confirmed by disease history, clinical symptoms, laryngoscopy examination andthe backflow of gastric fluid into laryngopharynx. Ambulatory examination of 24 hours double-probepHmetry is the gold standard for LPR diagnosis, although it is not yet ideal. To detect the presence ofpepsin in the larynx and pharynx using ELISA is now being used to determine LPR, based on the fact thatpepsin is only produced in the stomach. Purpose: To investigate patient characteristics, reflux symptomindex (RSI) and reflux finding score (RFS) descriptions, and pepsin level in the saliva of LPR patients.Methods: A descriptive research to describe RSI, RFS, and levels of pepsin in the saliva of LPR patientsusing ELISA at the Otorhinolaryngology Head and Neck Surgery Departement of Dr. M. Djamil Hospital,Padang, from January-October 2015. Results: Thirty respondents consisted of 23 females (76.7%),and 7 males (23.3%), revealed the largest age group was 48-57 years (40%), with an average age of 47.2+12.06 years. The average value of RSI 18.53+4.46, the average value of RFS 11.47+2.50, andpepsin result (+) in all samples, with an average value of pepsin level in respondents’ saliva 2.75+1.23ng ml. Conclusion: Pepsin was detected in all samples of LPR patients’ saliva.

Sensory thresholds

Pet peeves about others’ behaviors are normal. When a par­ticular behavior occurs daily in a classroom, however, it can drive a teacher (and students) to severe annoyance. The key to minimizing issues is remembering that our frenzy over someone’s quirky behavior is more often our problem than theirs. Our five senses function to orient us in the world, to give us information about what is happening outside our skin. Visual, auditory, kinesthetic, olfactory, and gustatory senses work con­stantly to feed us information. When we have a “sensory sensitiv­ity,” we can become anxious and intolerant, often reaching our threshold quite quickly. Kinesthetic: leg jiggling, close proximity, itchy fabrics, touching and hugging, close talking, an uncomfortable chair, pain thresholds (squeezing a hand or shoulder), room temperature Auditory: gum popping, fingernails on metal or slate, loud throat clearing or chewing, scraping teeth on a fork, screech of tires and birds, loud talking, whispering, alarms and honking, pencil tapping Visual: messy desk, clashing colors, too much or too little decor, crooked picture frames, hair too long or too short, chairs not in alignment, too much light/ not enough light Olfactory: strong smells of raw onions, fish, sweat, old carpet, perfume Gustatory: texture and taste of squid, eggs, unbuttered toast The key to tolerance for our own sensory tipping points is to avoid blaming the offender. We acknowledge that these are our sensitivities, not everyone else’s. We choose wisely whether or not to reveal our sensitivities. Others often cannot imagine we have such strong aversions to sensations they like or do not even notice. And someone of any age may choose to use our sensitivi­ties to rile us. Take a deep breath and minimize your response with a bit of private humor: “I’ll just move over here to give you a bit more room.” “I’m going to pretend I don’t hear that sound.” “I will not threaten to nail his shoe to the floor to stop his leg from jiggling!”