The role of nitric oxide in the development of gastroesophageal reflux disease against the backdrop of obesity

Today gastroesophageal reflux disease (GERD) occupies a leading position among chronic diseases of the gastrointestinal tract. The prevalence of GERD in people with normal BMI ranges from 15 to 20%, with obesity – from 50% to 100%. The basis of GERD is a violation of the motor – evacuation function of the gastroesophageal zone, which is accompanied by a steady relaxation of the antireflux barrier. Nitric oxide (NO) plays an important role in this process. The aim of this work is to study the level of nitric oxide in patients with gastroesophageal reflux disease on the background of obesity and to assess its impact on the course of the disease. Materials and methods. The study involved 80 young people. Questionnaire was conducted using the GERDQ questionnaire, BMI, serum nitric oxide level by Griss spectrophotometric method with sulfanilic acid and 1-naphthylamine, FGDS to determine the severity of reflux esophagitis. Study participants were divided into 3 groups: patients with GERD with concomitant obesity, patients with GERD without concomitant pathology, the control group, which consisted of almost healthy individuals. Analyzing the obtained results, a significant increase in the concentration of nitric oxide in the blood of patients with GERD with concomitant obesity, compared with patients with GERD without concomitant pathology and the control group. There is a direct correlation between the level of nitric oxide in the blood and the severity of reflux esophagitis in patients with GERD with concomitant obesity. Further study of the role of nitric oxide in the pathogenesis of comorbid GERD and obesity will contribute to the development of improved methods for diagnosis, treatment and prediction of disorders.

Diagnosis and Etiological Analysis of Gastroesophageal Reflux Disease by Gastric Filling Ultrasound and GerdQ Scale

Objective. To investigate the diagnosis and etiological analysis of GERD by gastric filling ultrasound and GerdQ scale. Methods. The clinical data of 100 suspected GERD patients were selected for retrospective analysis. The selection time was from June 2016 to June 2019. According to the gold standard (endoscopy) results, they were divided into the gastroesophageal reflux group (positive, n = 62) and the nongastroesophageal reflux group (negative, n = 38); both gastric filling ultrasound and GerdQ scale examination were performed to compare the positive predictive value and negative predictive value, evaluate the abdominal esophageal length, His angle, and GerdQ scale score, and analyze the AUC value, sensitivity, specificity, and Youden index of His angle, length of abdominal esophagus, combined ultrasound parameters, and GerdQ scale in the diagnosis of GERD. Results. 100 patients with suspected GERD were diagnosed as GERD by endoscopy; in a total of 62 cases, the percentage was 62.00%. Among them, 28 cases were caused by the abnormal structure and function of the antireflux barrier, accounting for 45.16%, 18 cases were caused by the reduction of acid clearance of the esophagus, accounting for 29.03%, and 16 cases were caused by the weakening of the esophageal mucosal barrier, accounting for 25.81%. After ultrasound detection, the positive predictive value was 88.71% and the negative predictive value was 81.58%; after the GerdQ scale was tested, the positive predictive value was 71.43% and the negative predictive value was 54.05%. The length of the abdominal esophagus in the gastroesophageal reflux group was lower than that of the nongastroesophageal reflux group, while the scores of His angle and GerdQ scale were higher than those in the gastroesophageal reflux group ( P < 0.05 ). ROC curve analysis showed that the AUC values of His angle, length of abdominal esophagus, combined ultrasound parameters, and GerdQ scale to diagnose GERD were 0.957, 0.861, 0.996, and 0.931 ( P < 0.05 ), their sensitivity was 93.5%, 98.40%, 98.40%, and 90.30%, and the specificity was 92.10%, 63.20%, 100.00%, and 92.10%, respectively. Conclusion. Both gastric filling ultrasound and GerdQ scale have a certain application value in the diagnosis of GERD, but the former has a higher accuracy rate, and it is more common for gastroesophageal reflux caused by abnormal structure and function of antireflux barrier in etiological analysis.

CHARACTERIZATION OF GASTROESOPHAGEAL REFLUX ACCORDING TO PH-IMPEDANSOMETRY

Summary. Aim. To study the characteristics of gastroesophageal reflux using pH-impedance monitoring. Materials and methods. pH-impedance monitoring was carried out in 38 patients with GERD symptoms without endoscopic signs and 22 patients with endoscopic signs of reflux esophagitis and reflux gastritis. Results. All studied parameters confirmed the physiological nature of GER in 38 patients of group I and 9 patients of group II; the presence of pathological GER and impaired gastroesophageal antireflux barrier function in 13 patients of group II. Conclusions. The conducted pH-impedance monitoring made it possible to determine not only acidic GER and superrefluxes, but also weakly acidic and weakly alkaline ones, most accurately obtain quantitative and qualitative characteristics of GER, as well as establish a violation of the chemical and volumetric clearance of the esophagus. The data obtained can be used when choosing the method of antireflux surgery in patients with GERD.

P35 GASTROESOPHAGEAL REFLUX DISEASE (GERD) AFTER BARIATRIC SURGERY – EXPLORING THE PATHOPHYSIOLOGICAL MECHANISMS AROUND THE OESOPHAGOGASTRIC JUNCTION

Background It is not uncommon to get de novo GERD after certain types of bariatric surgery. Sleeve gastrectomy (SG), Adjustable Gastric Band ( AGB) and the One anastomosis gastric bypass (OAGB) have been frequently implicated to cause GERD. Roux Y gastric bypass (RYGB) is usually proposed as a curative procedure in patients who develop GERD after a LSG or LAGB. Hypothesis The alteration in mechanics around the Oesophagogastric junction (OGJ) after all types of bariatric surgery predispose to the development of GERD in varying proportions including the RYGB. Aims To theoretically explore the changes around the OGJ in the 4 most common types of bariatric procedures: AGB, SG, OAGB and RYGB Methods and results The following 6 variables that are frequently implicated in causing reflux are equated with each procedure and a score produced to quantify the potential effect on the OGJ. Elimination of the angle of HisInterruption of the Sling fibresInterruption of the Phreno-oesophageal membranePredisposition to the herniation through the hiatus.Effect on the Lower Oesophageal Sphincter residual pressure.Creation of a high-pressure zone below the LES promoting reflux. Based in a standardised technique of performing the 4 common operations, the following scores were obtained. AGB affected 5/6 variables, SG affected 6/6 variables, RYGB affected 5/6 variables and OAGB affected 5/6 variables that influence the antireflux barrier mechanism around the OG junction. Conclusion All bariatric surgeries technically affect the dynamics around the OGJ and indirectly reduce the efficacy of the antireflux barrier mechanisms. The varying contribution of certain individual factors may affect the relative incidence of GERD after surgery after different types of bariatric surgeries. The common recommendation that RYGB serves as a magic bullet against GERD is to be taken in context of the above mechanisms in action.

Gastroesophageal Reflux in Critically Ill Children: A Review

Gastroesophageal reflux (GER) is very common in children due to immaturity of the antireflux barrier. In critically ill patients there is also a high incidence due to a partial or complete loss of pressure of the lower esophageal sphincter though other factors, such as the use of nasogastric tubes, treatment with adrenergic agonists, bronchodilators, or opiates and mechanical ventilation, can further increase the risk of GER. Vomiting and regurgitation are the most common manifestations in infants and are considered pathological when they have repercussions on the nutritional status. In critically ill children, damage to the esophageal mucosa predisposes to digestive tract hemorrhage and nosocomial pneumonia secondary to repeated microaspiration. GER is mainly alkaline in children, as is also the case in critically ill pediatric patients. pH-metry combined with multichannel intraluminal impedance is therefore the technique of choice for diagnosis. The proton pump inhibitors are the drugs of choice for the treatment of GER because they have a greater effect, longer duration of action, and a good safety profile.

Radiologic and Endoscopic Characteristics of Laparoscopic Antireflux Wrap: Correlation With Outcome

After antireflux surgery for gastroesophageal reflux disease, 10% to 15% of patients may have unsuccessful results as a result of abnormal restoration of the esophagogastric junction. The purpose of this study was to evaluate the postoperative endoscopic and radiologic characteristics of the antireflux barrier and their correlation with the postoperative results. After surgery, endoscopic and radiologic features of the antireflux wrap were evaluated in 120 consecutive patients. Jobe's classification of the postoperative valve was used for the definition of a “normal” or “defective” wrap. Patients were evaluated 3 to 5 years later in order to determine the clinical and objective failed fundoplication. A “normal” antireflux wrap was associated with successful results in 81.7% of the patients. On the contrary, defective radiologic or endoscopic antireflux wrap was observed in 19% of cases. Among these patients, hypotensive lower esophageal sphincter was observed in 50% to 65% of patients, abnormal 24-hour pH monitoring in 91%, and recurrent postoperative erosive esophagitis in 50% of patients, respectively (P &lt; 0.001). “Defective” antireflux fundoplication is associated with recurrent reflux symptoms, presence of endoscopic esophagitis, hypotensive lower esophageal sphincter, and abnormal acid reflux.

Endoscopic management of gastroesophageal reflux disease in 2012: What works and what doesn′t

Gastroesophageal reflux disease results primarily from the loss of an effective antireflux barrier, which forms a mechanical barrier against the retrograde movement of gastric contents. Multiple devices have been developed for the endoscopic treatment of GERD, using approaches such as sewing, transmural fasteners, endoscopic staplers, and thermal treatment. Devices that are currently commercially available for the endoscopic treatment of GERD in the US include: EndoCinch; EsophyX; Stretta. This article will highlight the endoscopic therapy of gastroesophageal reflux disease with focus on Stretta and EsophyX.