The relationship between white tongue and gastroesophageal reflux disease

Background Signs of gastroesophageal reflux disease (GERD) are limited, therefore, follow up of treatment are mainly based on patients’ symptoms. The aims of study were: 1) to compare the prevalence of white tongue (WT) between individuals with GERD and control group, 2) to evaluate the correlation between WT extension and severity of symptoms in GERD. Materials and methods This case-control study consisted of 100 consecutive individuals with GERD who were referred to the gastroenterology clinic of a referral hospital during 2019-2020. The diagnosis of GERD was made by a gastroenterologist if heart burn or regurgitation existed. The same number of healthy accompanies of patients without GERD participated as the control group. A single examiner defined WT if whitish-gray discoloration of tongue surface existed in two separate sessions [Kappa = 0.93; p < 0.01]. WT extension was estimated based on the approximate white discoloration of the tongue surface. Results All participants with GERD showed white tongue in the first observation and 98% in the second observation, while only 5% of the individuals in the control group revealed WT in both observations (p < 0.001). There was a positive correlation between the WT extension and GERD symptom severity (r: 0.44; p < 0.001). Conclusion It seems that WT might be a reliable sign of GERD. Considering the association between GERD symptoms severity and the extent of WT in this observation, further studies may assess the utility of WT extension as a reasonable objective in monitoring treatment response.

Demographic and lifestyle risk factors for gastroesophageal reflux disease and Barrett’s esophagus in Australia

Summary We examined demographic and lifestyle risk factors for incidence of gastroesophageal reflux disease (GERD) and Barrett’s esophagus (BE) in an Australian cohort of 20,975 participants aged 40–63 at recruitment (1990–1994). Information on GERD and BE was collected between 2007 and 2010. GERD symptoms were defined as self-reported heartburn or acid regurgitation. BE was defined as endoscopically confirmed columnar-lined esophagus. Risk factors for developing GERD symptoms, BE diagnosis, age at symptom onset, and age at BE diagnosis were quantified using regression. During a mean follow-up of 15.8 years, risk of GERD symptoms was 7.5% (n = 1,318) for daily, 7.5% (n = 1,333) for 2–6 days/week, and 4.3% (n = 751) for 1 day/week. There were 210 (1.0%) endoscopically diagnosed BE cases, of whom 141 had histologically confirmed esophageal intestinal metaplasia. Female sex, younger age, lower socioeconomic position (SEP) and educational attainment, and former smoking were associated with higher GERD risk. Male sex and smoking were associated with earlier GERD symptom onset. Men, older participants, those with higher SEP, and former smokers were at higher BE risk. There was some evidence higher SEP was associated with earlier BE diagnosis. GERD and BE had different demographic risk factors but shared similar lifestyle factors. Earlier GERD symptom onset for men and smokers might have contributed to higher BE risk. The SEP patterns observed for GERD and BE suggest potential inequity in access to care. These findings would be important in the development of clinical risk prediction models for early detection of BE.

Magnetic Sphincter Augmentation In Patients With Paraesophageal Hernia Vs. Large Sliding Hiatal Hernia: Comparison of Clinical Outcome And Complexity Of The Surgery

Introduction: Recent studies encourage the use of magnetic sphincter augmentation (MSA) in patients with large sliding hiatal hernia (LHH). However, the utility of MSA in patients with paraesophageal hernia (PEH) is poorly studied. The aim of this study is to compare the outcome and complexity of surgery in patients with PEH to those with LHH. Methods: A total of 37 (65% female) patients underwent PEH repair with MSA in our institution between 2013 and 2019. A group of 37, age/sex matched patients with LHH (≥ 4 cm) who underwent MSA formed the control group. The clinical outcome and the complexity of the surgery were then compared between groups. Results: At a median follow-up of 25.3 (17–35) months, there was significant improvement in the GERD-HRQL total-scores for PEH (18 vs. 3, p < 0.001) and LHH (26 vs. 4, p < 0.0001) patients when compared to preoperative values. The PEH group was similar to LHH group in regard to pH-normalization (71% vs. 64%, p = 0.76) and freedom from PPI (94.4% vs. 91.9%, p = 1.00). Small asymptomatic hernia recurrence was seen in 19% and 18% of LHH and PEH patients, respectively (p = 0.546). One patient (3%) required surgical intervention for symptomatic recurrence in each group. The rate of dysphagia and need for dilation were similar between the groups. No significant differences in operative time, blood loss, and hospital stay were detected between patients with PEH and those with LHH. However, there was a trend toward higher necessity for additional operative maneuvers (40.5% vs 13.5%, p = 00.17) and longer hospital stay in PEH. Conclusion: Despite the inherent differences between LHH and PEH, repair of hernia and MSA results in high rate of favorable outcome and low rate of recurrence in both groups. GERD symptom control, freedom from PPI and improvement in quality of life are comparable. However, the greater need for additional surgical maneuvers and longer hospital stay reflect the greater complexity of procedures for repair of PEH with MSA.

Endoscopic augmentation of gastroesophageal junction using a full-thickness endoscopic suturing device

Background and study aims This preliminary study was conducted to determine the feasibility and safety of endoscopic augmentation of the gastroesophageal junction (GEJ) using the Apollo OverStitch endoscopic suturing system in patients with gastroesophageal reflux disease (GERD) symptoms. Patients and methods Endoscopic augmentation of GEJ was performed on 10 consecutive patients and the data were analyzed retrospectively. Using a double-channel gastroscope affixed to the endoscopic suturing platform, interrupted sutures were placed on the gastric side of the GEJ in 2 layers in order to create a narrowed and elongated GEJ. Results Technical success was achieved in all patients, including those with a history of previous antireflux procedures (n = 7) and those with a hiatal hernia (n = 6). The median follow-up duration was 5 mo (range: 2 – 12). The median pre-procedure GERD-Health Related Quality of Life Questionnaire improved from 20 (range: 11 – 45) to a post-procedure score of 6 (range: 3 – 25) (P = 0.001). The median duration of GERD symptom improvement after the procedure was 1 mo (range: 0.5 – 4). Adverse events were limited to 1 patient who developed nausea and vomiting, which was self-limited. Conclusions The use of a novel endoscopic suturing technique for the treatment of GERD is feasible and safe. The procedure resulted in short-term GERD symptom improvement. Further prospective studies using refined techniques are currently underway to improve durability and to prove efficacy.