Laryngopharyngeal reflux diagnostics: review article

Laryngopharyngeal reflux (LPR) is an actual, modern problem for the practice of an ENT doctor, because majority of complaints lead the patient, first of all, to an otorhinolaryngologist. LPR is an extraesophageal manifestation of gastroesophageal reflux disease (GERD), which leads to a recurrent course of symptoms resulting from the direct action of gastric contents on the mucous membrane of the laryngopharynx when ingested through the upper esophageal sphincter, as well as a decrease in the quality of life. Patients with LPR represent 4% to 10% of outpatients visiting an ENT physician. The main problem of diagnosing of LPR is that there are not any exact researches for this disease, such as PCR-test or biopsy. GERD diagnostic methods performed by gastroenterologists include: assessment of complaints, esophagogastroduodenoscopy (EGDS), intraesophageal pH-metry, esophageal manometry, impedance-pH-metry with the placement of 2 probes in the esophagus and pharynx, gastrointestinal fluoroscopy (GI) with barium, gastroesophageal scintigraphy, abdominal ultrasound (abdominal ultrasound), and pepsin test. All these tests are widely using for diagnosis and sometimes helps us. But the question remains: do all these research methods allow to establish the presence of LPR? Interpretation of existing studies is difficult due to the ambiguous diagnostic criteria for LPR, varying rates of response to treatment, and the significant effect of placebo treatment. Therefore, diagnostic methods for LFR require further study and development.

794 DOES TRACHEOSTOMY PREDISPOSE GASTROESOPHAGEAL REFLUX?

Lung diseases have a strong relationship with gastroesophageal reflux disease (GERD). It has been previously demonstrated that conditions such as tracheal stenosis, asthma and even lung transplantation may worsen with reflux and these patients have few symptoms of GERD. With the COVID-19 pandemic, the number of people who needed mechanical ventilation and tracheostomy increased. Our objective was to demonstrate the prevalence of gastro-oesophageal reflux in patients with tracheostomy and describe its characteristics. Methods Esophageal manometry and 24 h pH-metry was performed in 137 consecutive patients with a tracheostomy already in a chronic phase, independent of symptoms. Inquire on respiratory and digestive symptoms was also carried out at the time of the examination. Prevalence of gastroesophageal reflux was identified in this population and description of the groups with reflux and without it, as well as comparison between them. Results Of the 137 patients, 49 were male, the average age was 40.94 ± 17.3 and the body mass index was 26.3 ± 4.85. The prevalence of gastroesophageal reflux was 45.2%. Baseline characteristics were similar between the groups with and without reflux. In the reflux group, the mean DeMeester score was 36.5 ± 20.8 and the presence of lower sphincter hypotonia was found in only 31% of the patients and was not correlated with reflux between the groups (p = 0.285). Regarding the symptoms, 48% had heartburn symptoms and only 30% had a combination of typical symptoms (heartburn + regurgitation). Conclusion The presence of tracheostomy is related to an increased prevalence of reflux, even without typical symptoms most of the time. The mechanism for this is still unknown, perhaps the altered respiratory dynamics has a role. These patients should be investigated with functional exams if they develop any condition that may be affected by reflux.

GENERATION OF SYNTHETICAL MEDICAL DATA BY MDR-ANALYSIS

Purpose: The purpose of this article is to determine the dependence of the rate of gel formation on the type of reagent-inhibitor of the gel formation process, and to study the kinetic dependences of gel formation of silicate compositions in the presence of compounds that regulate the rate of gel formation. Research methods: Direct and reverse titration, potentiometric titration, pH-metry, determination of the dynamic viscosity on a rotational viscometer, axial compression method to determine the elastic modulus were used to study the possibility of using chemical reagents as gelation inhibitors. Results: The possibility of using inorganic and organic additives to slow down the gel formation process and the effect of these additives on the strength of the gel, their thermodynamic parameters have been researched. Discussion: The adding of organic acids into the silicate composition as "crosslinking agents" slows down the gel formation process, while replacing hydrochloric acid with other gel acids that slow down the gel formation process does not lead to a decrease in the strength characteristics of these systems compared to the standard. It was found that with an increase in the gelation time, the strength of the gels decreases, and the syneresis increases; the adding of inhibitor additives insignificantly worsens the filterability of silicate compositions, which in general have bad filterability, leading to an increase in resistance during filtration at the inlet section of the sample. Observations have shown that the addition of additives-inhibitors does not affect the thermal stability of gels, regardless of the additives' nature.

Evaluation of the effectiveness of an innovative approach to barrier amnioplasty in the surgical treatment of primary progressive pterygium

The article evaluates the effectiveness of the proposed new method of barrier amnioplasty in the surgical treatment of primary progressive pterygium. The study involved 40 patients with primary progressive pterygium, who, depending on the method of barrier amnioplasty, were divided into 2 groups. Patients of group 1 underwent barrier amnioplasty in the limbus area, group 2 – in the area of plica semilunaris. Comparison of the methods was carried out using standard examination methods, as well as cytological examination and pH-metry of the lacrimal fluid. The developed method of amnioplasty in the area of the plica semilunaris has shown high efficiency: the time of corneal epithelialization was reduced by 1.7 times and the vitalization of the amnion by 1.5 times. An uncomplicated postoperative course of inflammatory and regenerative reactions made it possible to reduce the frequency of recurrence of pterygium, reduce the degree of postoperative astigmatism, and improve visual acuity

Manometric and pH-monitoring changes after laparoscopic sleeve gastrectomy: a systematic review

Purpose Aim of this systematic review is to assess the changes in esophageal motility and acid exposure of the esophagus through esophageal manometry and 24-hours pH-monitoring before and after laparoscopic sleeve gastrectomy (LSG). Methods Articles in which all patients included underwent manometry and/or 24-hours pH-metry or both, before and after LSG, were included. The search was carried out in the PubMed, Embase, Cochrane, and Web of Science databases, revealing overall 13,769 articles. Of these, 9702 were eliminated because they have been found more than once between the searches. Of the remaining 4067 articles, further 4030 were excluded after screening the title and abstract because they did not meet the inclusion criteria. Thirty-seven articles were fully analyzed, and of these, 21 further articles were excluded, finally including 16 articles. Results Fourteen and twelve studies reported manometric and pH-metric data from 402 and 547 patients, respectively. At manometry, a decrease of the lower esophageal sphincter resting pressure after surgery was observed in six articles. At 24-hours pH-metry, a worsening of the DeMeester score and/or of the acid exposure time was observed in nine articles and the de novo gastroesophageal reflux disease (GERD) rate that ranged between 17.8 and 69%. A meta-analysis was not performed due to the heterogeneity of data. Conclusions After LSG a worsening of GERD evaluated by instrumental exams was observed such as high prevalence of de novo GERD. However, to understand the clinical impact of LSG and the burden of GERD over time further long-term studies are necessary.

Use of a non-invasive accelerometric method for diagnosing gastroesophageal reflux in premature infants

Objective To evaluate the clinical usefulness of a non-invasive accelerometric device to diagnose GER in preterm babies. Study design An accelerometer was taped over the sub-xiphoid process in 110 preterm (GA 29.6 ± 3.3 wk) infants (133 studies). Low frequency, sub-audible signals were captured via digital recording (sampling rate 200 Hz), then re-sampled (rate = 60 Hz) to create a spectrogram (focused range 0–30 Hz). Mean amplitude in the focused range was calculated. Results Of 85 studies with simultaneous pH-metry and accelerometry, 18 had concurrent positive and 23 had concurrent negative scores, 42 had negative pH scores when accelerometry was positive (≥1 µV), consistent with non-acid reflux. Eleven infants at high risk of aspiration received surgical interventions. All but 1 had negative pH scores while 10/11 had positive accelerometry. Conclusions The non-invasiveness of this accelerometric technique allows for GER screening and for repeated testing to assess efficacy of interventions.

Chronic gastroduodenal pathology in schoolchildren: the clinical picture and features of the course

The aim of the study was to study the course and clinical manifestations of chronic gastroduodenal pathology (CGDP) in schoolchildren.Materials and methods. Clinically examined 286 children and adolescents from 6 to 15 years old with СGDP. The research methods included collection of anamnestic data, instrumental and functional (esophagogastroduodenoscopy, pH-metry), clinical and laboratory (general blood analysis, coprology), and Helicobacter pylori infection was tested by respiratory test and fecal immunochromatographic test.Result. Studies have shown that the main clinical manifestations of СGDP in children were dyspeptic syndrome, vegetovascular dysfunction, and pain syndrome, against the background of objectively visible signs of anemia. Symptoms were more characteristic in patients with СGDP from vegetovascular dysfunction: loss of appetite (83.6%), fatigue (83.2%), recurrent headaches (62.2%), and sleep disturbances (59.1%). Among dyspeptic disorders, unstable stools (85%), periodic nausea (57.7%), belching (56.6%), and a feeling of heaviness in the epigastric region after eating (56.3%) prevailed. Clinical symptoms more pronounced in children with chronic gastritis.Conclusion. For schoolchildren with CGDP, vegetovascular dysfunction (98.9%) with severe dyspeptic disorders (100%) and pain (79%), against the background of objective signs of anemia (53%), is more characteristic. In adolescents is more often a less symptomatic.

FEATURES OF REMOTE INTERACTION OF POLYACRYLIC ACID AND POLYETHYLENIMINE HYDROGELS

The remote interaction between a weak polyacrylic acid polyelectrolyte (gpac) and a weak polyethyleneimine polybase (gpei) is studied as a function of time at their different molar ratios and states in an aqueous medium. To predict the possibility of activation of the studied hydrogels, electrochemical properties were studied by conductometry and pH metry. During pH measurement, it was found that 24 hours of pH have the lowest values, indicating a high content of H+ ions in the aqueous medium. The dependence of the specific electrical conductivity, the maximum value at the ratio of 3:3 (PAC:PEI) and it coincides with the result of pH from the ratio of components. The obtained results indicate that significant changes in the electrochemical and conformational values of the initial macromolecules in the interpolymer system occur in this interpolymer system. Thus, studies have shown on the presence of a remote interaction between hydrogels and their mutual activation. With an increase in the content of one of the hydrogels in the solution, a significant increase in the swelling of hydrogels is observed in proportion to the concentration of the second component, which indicates their mutual activation.