СУТОЧНАЯ МНОГОКАНАЛЬНАЯ РН-ИМПЕДАНСОМЕТРИЯ ПИЩЕВОДА В ДИАГНОСТИКЕ ГАСТРОЭЗОФАГЕАЛЬНОЙ РЕФЛЮКСНОЙ БОЛЕЗНИ (КЛИНИЧЕСКИЕ СЛУЧАИ)

Background. Gastroesophageal reflux disease (GERD) is an urgent problem of modern gastroenterology as well as the most common pathology of the upper gastrointestinal tract; it is a chronic disease that significantly reduces the patient's quality of life, increases the risk of developing Barrett's esophagus and esophageal adenocarcinoma. Objective. To assess the potentials of multichannel intraluminal pH impedance monitoring in the diagnosis of esophageal diseases. Material and methods. In 3 patients with clinical and endoscopic signs of GERD esophageal multichannel intraluminal pH-impedance monitoring was performed using the diagnostic equipment Digitrapper pH-Z from Given Imaging (USA). Results. 24-hour esophageal pH monitoring enabled to verify the diagnosis of GERD, to reveal a hypersensitive esophagus and manifestations of nocturnal acid breakthrough. Conclusions. Multichannel intraluminal pH-impedance monitoring is the "gold standard" for the diagnosis of esophageal diseases; it significantly expands opportunities of gastroenterologists in the treatment of GERD.

Associations of Obstructive Sleep Apnea, Obestatin, Leptin, and Ghrelin with Gastroesophageal Reflux

Gastroesophageal reflux disease (GERD) is commonly observed in patients with obstructive sleep apnea (OSA). Hormonal disorders observed in OSA may be relevant in the development of GERD. The aim of the study was to assess the correlations between ghrelin, obestatin, leptin, and the intensity of GERD in patients with OSA. The study included 58 patients hospitalized due to clinical suspicion of sleep disorders during sleep. All patients underwent a sleep study, and blood samples were collected overnight for hormonal tests. Survey data concerning symptoms of GERD, gastroscopy, and esophageal pH monitoring results were included in the study. In patients with OSA, GERD was twice as common when compared to the group without OSA. Among subjects with severe sleep apnea (AHI > 30; n = 31; 53%), we observed lower ghrelin levels, especially in the second half of the night and in the morning (p5.00 = 0.0207; p7.00 = 0.0344); the presence of OSA had no effect on obestatin and leptin levels. No significant differences in hormonal levels were observed between the groups depending on the diagnosis of GERD. However, correlations of ghrelin levels with the severity of esophagitis, leptin and ghrelin levels with the severity of GERD symptoms, and leptin levels with lower esophageal pH were found. GERD is more frequent among patients with OSA. In both GERD and OSA, deviations were observed in the levels of ghrelin and leptin. However, our analysis demonstrates that the relationship between OSA and GERD does not result from these disorders.

Endoscopic cardial constriction with band ligation in the treatment of refractory gastroesophageal reflux disease: a preliminary feasibility study

Background Gastroesophageal reflux disease (GERD) is a common digestive disease, could cause extra-esophageal symptoms. Peroral endoscopic cardial constriction with band ligation (PECC-b) is a minimally invasive method for the treatment of GERD in recent years. The goals of this study were to evaluate the clinical efficacy of PECC-b to treat gastroesophageal reflux-related symptoms. Methods A retrospective study of patients undergoing PECC-b between January 2017 and December 2018 at a single institution was conducted. All patients confirmed GERD by endoscopy, esophageal PH-impedance monitoring, esophageal manometry and symptom questionnaires. The outcome measures included reflux-related scores, patients’ satisfaction and drug independence after 12 months following surgery. Results A total of 68 patients, with follow-up of 12 months post surgery, were included in the final analysis. The symptom scores were all significantly decreased as compared with preoperation (P < 0.05). The esophageal symptom scores showed a better improvement than extra-esophageal symptoms (P < 0.001). Fifty-three (77.9%) patients achieved complete drug therapy independence and 52 (76.5%) patients were completely or partially satisfied with the symptom relief following surgery. Conclusions The PECC-b is a safe, effective and recommended approach for the control of GERD-related symptoms. Further multicenter prospective studies are required to confirm these outcomes.

Gastroesophageal refl ux disease and irritable bowel syndrome overlapping: unresolved issues

The review presents literature data concerning the rate and clinical features in cases of the gastroesоphageal refl ux disease (GERD) and irritable bowel syndrome (IBS )overlapping. The mean rate of GERD and IBS overlapping is 36–48 .8%, but in individual articles varies from 8–11% to 71–79%. A signifi cant variation in the rate is explained by diff erent approaches to the diagnosis of GERD and IBS in various studies (use of questionnaires, endoscopic examination, esophageal pH-impedancemetry). The high rate of GERD and IBS overlapping is related to the common pathogenetic mechanisms of both diseases (disorders оf gastrointestinal motility, visceral hypersensitivity). The features of the clinical picture and treatment in cases of GERD and IBS overlapping are studied insuffi ciently and require further research.

Utilizing Multimodal Imaging to Visualize Potential Mechanism for Sudden Death in Epilepsy

Sudden death in epilepsy, or SUDEP, is a fatal condition that accounts for more than 4000 deaths each year. Limited clinical and preclinical data on sudden death suggests critical contributions from autonomic, cardiac, and respiratory pathways. Recent animal (rat) studies on kainic acid induced seizure models explored a potential mechanism for such sudden and severe cardiorespiratory dysregulation being linked to acid reflux induced laryngospasm. Here, we expand on those previous investigations and utilize a multimodal approach to provide visual evidence of acid reflux-initiated laryngospasm and subsequent fatal cardiorespiratory distress in seizing rats. We used systemic kainic acid to acutely induce seizure activity in Long Evans rats, under urethane anesthesia. We recorded electroencephalography (EEG), electrocardiography (ECG), chest plethysmography and esophageal pH signals during simultaneous fast MRI scans of the rat stomach and esophagus. MRI images, in conjunction with electrophysiology data were used to identify seizure progression, stomach acid movement up the esophagus, cardiorespiratory changes, and sudden death. In all cases of sudden death, esophageal pH recordings alongside MRI images visualized stomach acid movement up the esophagus. Severe cardiac (ST segment elevation), respiratory (intermittent apnea) and brain activity (EEG narrowing due to hypoxia) changes were observed only after acid reached the larynx, which strongly suggests onset of laryngospasm following acid reflux. Additionally, absence of stomach acid in the esophagus of animals that survived acute seizure, provided evidence of a causal relationship between acid reflux and sudden death. The complimentary information coming from electrophysiology and fast MRI scans provided insight into the mechanism of esophageal reflux, laryngospasm, obstructive apnea, and subsequent sudden death in seizing animals. The results carry clinical significance as they outline a potential mechanism that may be relevant to SUDEP in humans.