Acid Reflux Research Articles

Questionnaire Survey for Inflammatory Bowel Disease Patients in Japan; A Web-Based Japan, Crohn's Disease, Ulcerative Colitis, Patients Survey.

The prevalence of inflammatory bowel disease (IBD) in Japan has been increasing. We aimed to clarify the symptoms of patients with IBD in Japan using an internet-based questionnaire survey. Overall, 805 patients with IBD were asked to complete an internet-based questionnaire addressing their history of disturbances in daily activities, prevalence of fecal urgency, incontinence, and treatment preferences. Responses were obtained from 447 patients with IBD (mean age: 54 years; 70% were men), comprising 363 patients with ulcerative colitis (UC), and 84 with Crohn's disease (CD). Notably, 16% of patients with UC and 35% with CD took over 1 year until the diagnosis of IBD, and 5% of patients with CD visited more than 5 medical institutions. Patients with CD were more likely to experience disturbances in their diet, work, travel, and outings than those with UC. Fecal urgency and incontinence were significantly more frequent in patients with CD than in those with UC (72% vs. 44%, and 50% vs. 26%, respectively). In contrast, 26% of the men and 37% of women with IBD had constipation. Acid reflux, sleep disorders, and depressive symptoms were present in approximately 30% of the patients. Oral administration was preferred. Patients with IBD in Japan experience more severe disturbances in their daily activities, and these are more severe in those with CD than those with UC. In addition to fecal urgency and incontinence, care is required for constipation, acid reflux, sleep disorders, and depressive symptoms.

Comparison of direct effects of rice-thickened formula vs routine feeds on symptoms and gastroesophageal reflux indices: A crossover cohort study.

We compared the direct effects of routine vs rice-thickened formula on 24-h pH-impedance and symptom characteristics and then examined if dietary effects were modified by acid reflux index severity in infants. Forty infants under consideration for gastroesophageal reflux disease and therapies were evaluated at 43 ± 1 weeks postmenstrual age. Each infant was equally fed routine diet and thickened formula during evaluations. Postprandial sessions were analyzed for acid reflux index, reflux events, clearance times, distal baseline impedance, and symptoms. Thickened formula has no effect (P ≥ 0.05) on acid reflux events' characteristics or overall symptom frequency. However, refluxate height and frequency of weakly acidic events and cough were decreased (P < 0.05). Prolonged bolus clearance and a decrease in distal baseline impedance were noted with thickened feeds (vs routine feeds) when acid reflux index was >7 (P < 0.05). Our pH-impedance testing protocol identifies direct effects of potential therapies at the point of care. Acutely, thickened formula does not impact acid-specific reflux indices but decreases full-column reflux and cough reflexes. In those with an acid reflux index of >7, thickened formula prolongs the distal esophageal bolus clearance (the mechanisms of which are uncertain). Clinical trials are needed to clarify objective indications and therapeutic use of thickened formulas for infants with gastroesophageal reflux disease, along with short- and long-term side effects.

A novel hollow CuMn-PBA@NiCo-LDH nanobox for efficient detection of glucose in food

Designing a rapid and sensitive glucose detection method is of great significance to public health. Herein, hollow CuMn-PBA@NiCo-LDH nanoboxes (CuMn-PBA@NiCo-LDH NBs) were prepared using acid etching, cation exchange, and reflux method. The modified electrode exhibited outstanding electrocatalytic performance for glucose oxidation due to the unique hollow nanostructure and synergistic effects. The CuMn-PBA@NiCo-LDH NBs electrode displayed excellent electrocatalytic oxidation activity for glucose in an alkaline solution. Under optimal conditions, the electrode achieved a wide linear range (0.0005–1 mmol L–1, and 1–7 mmol L–1) and high sensitivity (10,300 μA L/mmol cm−2 and 5310 μA L/mmol cm−2), with a limit of detection (LOD) of 19 nmol L–1. The feasibility of the sensor applied to the detection of glucose was verified in real food samples through spiked recovery experiments. This electrode material offers an alternative method for the non-enzymatic glucose sensors.

The Dubai Definition and Diagnostic Criteria of Laryngopharyngeal Reflux: The IFOS Consensus.

The objective of this work was to gather an international consensus group to propose a global definition and diagnostic approach of laryngopharyngeal reflux (LPR) to guide primary care and specialist physicians in the management of LPR. Forty-eight international experts (otolaryngologists, gastroenterologists, surgeons, and physiologists) were included in a modified Delphi process to revise 48 statements about definition, clinical presentation, and diagnostic approaches to LPR. Three voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 8/10. Votes were anonymous and the analyses of voting rounds were performed by an independent statistician. After the third round, 79.2% of statements (N = 38/48) were approved. LPR was defined as a disease of the upper aerodigestive tract resulting from the direct and/or indirect effects of gastroduodenal content reflux, inducing morphological and/or neurological changes in the upper aerodigestive tract. LPR is associated with recognized non-specific laryngeal and extra-laryngeal symptoms and signs that can be evaluated with validated patient-reported outcome questionnaires and clinical instruments. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing can suggest the diagnosis of LPR when there is >1 acid, weakly acid or nonacid hypopharyngeal reflux event in 24 h. A global consensus definition for LPR is presented to improve detection and diagnosis of the disease for otolaryngologists, pulmonologists, gastroenterologists, surgeons, and primary care practitioners. The approved statements are offered to improve collaborative research by adopting common and validated diagnostic approaches to LPR. 5 Laryngoscope, 134:1614-1624, 2024.

Contraction reserve in high resolution manometry is correlated with lower esophageal acid exposure time in patients with normal esophageal motility: A retrospective observational study.

In high resolution manometry (HRM), distal contractile integral post multiple rapid swallow augmentation is considered as contraction reserve. The relationship between contraction reserve and esophageal acid reflux remains unclear. The aim of this study was to explore the correlation between contraction reserve and esophageal acid exposure in ineffective esophageal motility (IEM) and normal HRM. Patients who underwent HRM and ambulatory reflux monitoring were retrospectively screened. Those with diagnosis of normal HRM or IEM were included in the analysis. The proportion of patients with abnormal acid exposure time (AET) was compared between patients with and without contraction reserve. Multivariate regression analysis was performed to determine the predictors of abnormal AET and contraction reserve. A total of 338 patients, including 264 normal HRM and 74 IEM, were included in the analysis. In patients with normal HRM, proportion of abnormal total AET (AET > 6.0%) was significantly lower in patients with supine contraction reserve than patients without contraction reserve (13.85% vs. 24.63%, p = 0.027). Multivariate regression analysis showed that supine contraction reserve could independently predict abnormal total AET (OR = 0.468, 95% CI: 0.249-0.948, p = 0.034), while upright contraction reserve trended strongly (OR = 0.558, 95% CI: 0.290-1.071, p = 0.079). Subgroup analysis showed that upright contraction reserve was an independent predictor of abnormal total AET in patients with 50-70% infective swallows (OR = 0.205, 95% CI: 0.051-0.821, p = 0.025), whereas supine contraction reserve did not have predictive value (p = 0.359). Supine contraction reserve correlates with esophageal acid reflux in patients with normal HRM, while only upright contraction reserve correlates with esophageal acid reflux in patients with infective swallows of 50-70%.

Pilot study of an endoluminal-suturing device as a treatment for patients with gastroesophageal reflux disease.

Background and study aims Endoscopic therapy is a promising option for patients with gastroesophageal reflux disease (GERD). The aim of this study was to assess safety and feasibility of the Endomina suturing platform as a treatment for GERD. Patients and methods This was a two-center study of patients with chronic GERD symptoms that responded at least partially to proton pump inhibitors (PPIs). Primary endpoints were to assess the safety of the procedure and persistence of the sutures. Secondary endpoints were to assess esophageal pH-impedance and manometry parameters changes at 6 months, as well as GERD symptoms and PPI use up to 12 months of follow-up. Results Fourteen patients were treated (13 males, mean of 43±12 years), with a mean number of three plications per patient. Thirteen, 10, and nine patients were analyzed at 3, 6, and 12 months of follow-up, respectively. One device-related adverse event occurred (loss of needle tip requiring endoscopic retrieval 1 week later). A mean of two plications persisted at 3 and 12 months. A decrease in median acid exposure time and reflux episodes was observed after the procedure. Mean Reflux Symptom Index and GERD-Health-Related Quality of Life scores decreased during follow-up visits and 90% of the patients discontinued PPI use at 1 year. Conclusions Endoscopic full-thickness suturing of the esophagogastric junction with the Endomina suturing platform is feasible, allowing persistence of two-thirds of the plications, with promising results for decreasing reflux and improving GERD symptoms.

Laparoscopic sleeve gastrectomy makes acid reflux symptoms worse or better?: a prospective short-term observational study in patients with morbid obesity.

Gastroesophageal reflux symptom (GERS) occur frequently in obese patients. Although some surgeons avoid laparoscopic sleeve gastrectomy (LSG) in these patients for fear of postoperative exacerbation of GERS, this notion is not supported by sufficient medical evidence. This prospective study aimed to evaluate the impact of LSG on GERS. Shanghai East Hospital, Shanghai, China. Seventy-five LSG candidates were enrolled between April 2020 and October 2021. Only patients with completed preoperative and 6-month postoperative evaluation of GERS with the Reflux Symptom Score (RSS) and the Gastrointestinal Quality of Life index were included. Each patient's characteristics, including sex, age, drinking and smoking history, body mass index (BMI) at the time of surgery, recent BMI, comorbidities, glucose and lipid metabolism-related laboratory results, and uric acid and sex hormone levels were obtained. Sixty-five patients (33.8 ± 9.1 years) were finally included in our study. The mean preoperative BMI was 36.4 ± 6.8 kg/m2. Preoperative GERS were reported in 32 (49.2%) patients (RSS > 13), and 26 of them (81.3%) had dramatic remission at 6 months postoperatively. Four patients (12.1%) developed de novo GERS postoperatively, which were well-controlled with oral proton pump inhibitors. Furthermore, GERS were significantly correlated with preoperative BMI; the risk of developing new or worsening GERS postoperatively was positively associated with preoperative insulin resistance. A low incidence of de novo GERS and significant alleviation in preoperative GERS occurred in most obese patients after LSG. A patient with preoperative insulin resistance may not be suitable for LSG surgery owing to the increased risk of new or worsening of GERS postoperatively.

Two-year outcomes of anti-reflux mucosectomy in treating gastroesophageal reflux disease: A Chinese prospective cohort study.

Anti-reflux mucosectomy (ARMS) is an emerging and promising endoscopic treatment for gastroesophageal reflux disease (GERD). In the current study we aimed to evaluate the safety and efficacy of ARMS in treating Chinese GERD patients. This was a single-center prospective cohort study. ARMS was performed in GERD patients by an experienced endoscopist. The patients were required to undergo symptom assessment as well as endoscopic examination, high-resolution manometry (HRM), and impedance-pH monitoring before and after ARMS. Twelve patients were enrolled. Follow-up was completed by all patients at 3 and 6 months, 11 patients at 1 year, and 8 patients at 2 years after ARMS, respectively. Symptom improvement was achieved in 66.7%, 75.0%, 72.7%, and 50.0% of the patients at 3 months, 6 months, 1 year, and 2 years after ARMS, respectively. Postoperative dysphagia was reported by 25.0%, 25.0%, 27.3%, and 25.0% of patients at 3 months, 6 months, 1 year, and 2 years after surgery, none of whom required additional invasive treatment. All patients with preoperative esophagitis healed after ARMS. For impedance-pH monitoring parameters, number of acidic reflux episodes and the proportion of patients with acid exposure time (AET) >4.0% decreased significantly after ARMS. ARMS was safe and effective in Chinese GERD patients. The efficacy of ARMS was not short-term and remained evident throughout the 2-year follow-up. Further multicenter studies with larger sample sizes are needed to verify our findings.

Pilot study to evaluate control of nausea and vomiting in patients with esophageal cancer (EC) receiving concomitant chemoradiotherapy (cCRT).

291 Background: The standard treatment for patients with locally advanced EC is cCRT +/- surgery. Chemotherapy and radiation both attribute to nausea and vomiting and pose significant challenges to patients’ compliance with the treatment. We conducted a pilot study to evaluate their level of control during cCRT. Methods: Weekly surveys were administered during cCRT for first consecutive 5 weeks. Scores scale range was 1-10 to assess nausea and vomiting and related risk factors. Analyses was performed using SPSS v26.0. Wilcoxson test was used to compare medians of pairs and Friedman’s test to compare medians of groups. Results: We had 28 evaluable patients. Majority were males (M=25 vs F=3), median age 64.1 years (range 44-80 yrs.) and ethnicity was Caucasian at 89.29% (n=25). Scores for ‘expect to experience nausea and vomiting’ were below 5 (1=do not expect), medians: 4.00 (SD 2.136), 4.00 (SD 1.939), 3.00 (SD 2.408), 3.50 (SD 2.505) and 4.00 (SD 2.801) for weeks 1 (baseline), 2, 3, 4 and 5, respectively. Significant improvement in the ‘expectation scores’ between weeks 3 and 4 (p=0.022) and baseline to week 5 (p=0.049). Scores for ‘nausea and vomiting control’ vs prior week were also in the lower range (1= better control) indicating good overall control (highest median score 3.00 [SD 2.580] in week 4). ‘Acid reflux episodes’ median scores were on lower range (1=I have episodes very frequently) through all weeks without significant change. On the other hand, ‘acid reflux control’ showed significant improvement in median scores: 2.50 (SD 2.44), 2.00 (SD 2.76), 3.00 (SD 2.40), 2.00 (SD 2.43) and 1.00 (SD 1.81) (p=0.020). ‘Anxiety levels’ scores were highest on baseline (median 3.00 SD 2.299, p=0.022) then deescalated through subsequent weeks (2.00, 1.00, 2.00 &amp; 1.00 at weeks 2, 3, 4 and 5, respectively), p=NS. Conclusions: During cCRT, EC patients demonstrated significant anxiety at baseline, likely due to ‘perceived expectations. Acid reflux control peaks as an important component of treatment strategy for clinicians during cCRT. This suggests that focused control of these symptoms may improve nausea and vomiting control and treatment compliance.

Diagnosis and Treatment of GastroEsophageal Reflux Disease at the Primary Health Care Clinics in Korea

The prevalence of GERD and treatment costs are continuously rising in Korea, and the importance of primary health care clinics where the most treatment of actual patients is conducted is increasing. In this study, the diagnosis of GERD, selection of therapeutic drugs, and treatment methods in primary health care clininics were investigated through a large-scale multi-dimensional surveys. From January 2015 to December 2018, the study data of 18,010 patients with GERD were retrospectively investigated based on eletronic medical record at 542 primary health care clinics in Korea. Among all GERD patients, endoscopy was used for diagnosis in 16.11% of cases, and the most frequently performed in gastroenterology department (28.85%). The average BMI and the proportion of patients in stages 1 to 3 of obesity were highest in the ERD group, and the majority of the severity of ERD group was mild. Symptoms of the patients with GERD were mainly heartburn, gastric acid reflux, and chest pain. Drug treatment was performed in most of the patients with GERD, and PPI was the main drug, and Esomeprazol was prescribed the most among the main ingredients, and the ratio of PPI alone was high. The rate of symptom improvement after GERD treatment was slightly higher in the ERD group (75.91%) and the NERD group (74.36%) than in the GERD diagnosed without endoscopy group (63.89%). In domestic primary health care clinics, the majority were diagnosed with GERD without endoscopy on the basis of symptoms. The most preferred treatment for GERD was PPI, which was prescribed alone in the majority.

Endoscopic pressure study integrated system for the diagnosis of achalasia.

The endoscopic pressure study integrated system (EPSIS) is a novel diagnostic tool used to evaluate lower esophageal sphincter (LES) function. EPSIS allows the measurement of intragastric pressure (IGP) during gastric insufflation through esophagogastroduodenoscopy (EGD) and records its pressure waveform. This study aimed to assess the usefulness and applicability of EPSIS as an adjunct diagnostic modality for achalasia. This case-control study was conducted using a database of patients who underwent EGD, barium swallow (BS), high-resolution manometry (HRM), and EPSIS between January 2022 and December 2022. The achalasia (experimental) group (n = 35) consisted of patients with a definitive diagnosis of achalasia. The control group (n = 34) consisted of patients with no abnormalities in EGD, BS, or HRM and no abnormal acid reflux confirmed with 24-h pH-impedance monitoring. EPSIS findings were compared between the two groups and characterized by the waveform pattern (uphill or flat), maximum IGP (IGP-Max), pressure difference, and the gradient of the waveform. All patients in the achalasia group showed an uphill pattern, in contrast to 21 patients (61.8%) in the control group. IGP-Max demonstrated the best diagnostic accuracy for achalasia, with a cut-off value of 15.8 mmHg (100% sensitivity, 58.8% specificity, and area under the curve [AUC] 0.78). The pressure gradient also demonstrated good diagnostic accuracy, with a cut-off value of 0.40 mmHg/s (80% sensitivity, 61.8% specificity, and AUC 0.76). This study demonstrated that EPSIS can be applied as a diagnostic modality in patients with achalasia.

Preventive and Healing Effects of the Total Aqueous Extract of the Trunk Bark of Zanthoxylum gilletii (De Wild.) P. G. Waterman (Rutaceae) on Gastric Acid Reflux and Non-reflux Induced Esophagitis in Rats

Zanthozylum gilletii is a medicinal plant well known for its richness in phytochemicals and its use in Côte d’Ivoire in the traditional treatment of burns in esophagus. However, its bioactive anti-reflux and non-reflux oesophagitis potential has not yet been scientifically proven. This work aims at evaluating the preventive and curative anti-esophagitis potential of a total aqueous extract of Z. gilletii trunk bark (TAEZg) in rats. Thirty-six rats were subjected to 24 hours fast and divided into six groups of six rats each were used for each model of esophagitis induction, in particular the preventive model (acute, chronic, chronic exposure to naproxen followed by forced swimming test) and the healing model. Rats received as a pretreatment (preventive model) and treatment (healing model), TAEZg at 125, 250 and 500 mg / kg of body weight (b.w.) as well as omeprazole (preventive model) and misoprostol (healing model) at 30 and 0.012 mg / kg b.w respectively. As for the control groups, they received distilled water at 1 mL/ 100 g b.w. The animals were sacrificed by over dose of ether and then the ulcer macroscopic parameters (ulceration surface, ulceration index, scores and inhibition percentages) and gastric secretion parameters (gastric volume, gastric acidity and gastric pH) were assessed. Biochemical parameters such as total proteins and some oxidative stress parameters (Malondialdehyde (MDA) and catalase (CAT)) were assessed. The results showed that pretreatment and treatment of rats with TAEZg at doses ranging from 125 to 500 mg / kg b.w significantly (P &lt;0.001) and dose dependently reduced ulceration surface, ulceration index, gastric volume, gastric acidity, score and significantly (P &lt;0.001) increase pH and inhibition percentage compared to control group 2. The inhibition percentages such as 93.71; 95.89; 91.03 and 98.20 % were recorded at 500 mg / kg in preventive model (acute, chronic and chronic exposure to naproxen followed by forced swimming test) and healing model respectively. Biochemical analysis showed a significant (P &lt;0.001) increase in total protein, CAT levels and a significant decrease (P &lt;0.001) in MDA level of the treated groups compared to the control group 2. In conclusion, TAEZg possessed a real preventive and healing anti-esophagitis effects in rats.

Esophageal dysmotility detection in patients with gastroesophageal reflux-related cough and its influence on the efficacy of anti-reflux therapy

Objective: To investigate the characteristics of esophageal dysmotility in patients with an initial diagnosis of acid/non-acid gastroesophageal reflux-related cough (GERC), and its correlation with the therapeutic response to anti-reflux treatments to search for the useful indicators to screen patients with chronic cough suitable for anti-reflux therapy. Methods: A total of 173 patients with suspicious GERC who attended the Chronic Cough Specialist Clinic of Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University between June 2020 and December 2022 were retrospectively selected for the study. The age of the patients was (45.1±14.6) years old, including 87 males and 86 females. Their demographic characteristics, clinical manifestations, and the results of high-resolution manometry (HRM) and multichannel intraluminal impedance-pH monitoring (MII-pH) were collected. Information on the etiological identification process and final diagnosis was also recorded. The recruited cases were grouped according to therapeutic outcomes and divided into cases with a favourable response to conventional anti-reflux treatment, cases with a favourable response to intensified anti-reflux treatment, and cases with no response to anti-reflux treatment. Factors influencing the efficacy of anti-reflux treatment were investigated. Differences between groups were compared using the χ2 test, Student-Newman-Keuls test, and Kruskal-Wallis H(K) test, where applicable. Logistic regression analysis using forward stepwise regression based on maximum likelihood estimation was used to screen for influence factors. Results: The 175 patients with suspicious GERC included 45 (26.0%) patients who responded to conventional anti-reflux treatment, 54 (31.2%) who responded to intensified anti-reflux treatment and 74 (42.8%) who did not respond to anti-reflux therapies. Esophageal dysmotility was present in 52.0% of patients (90/173), but was less common in patients who responded to conventional anti-reflux treatment (χ2=8.09, P=0.018). Although the majority of reflux episodes were non-acid (136/173, 78.6%), the proportion of acid reflux (χ2=19.49, P<0.001) and acid exposure time (H=11.04, P=0.004) were significantly higher in patients who responded to conventional anti-reflux treatment. The patients with acid and non-acid GERC had comparable proportion of esophageal dysmotility (64.9% vs. 48.5%, χ2=3.11, P=0.078), with a shorter break [2.4 (0.7, 5.6) cm vs. 6.1 (1.4, 10.0) cm, Z=-2.39, P=0.017], longer upper esophageal sphincter [(4.1±0.9) cm vs. (3.7±1.3) cm, t=-2.09, P=0.038], higher percentage of normal esophageal contractions [60.0% (17.8%, 90.0%) vs. 30.0% (0, 80.0%), Z=-2.14, P=0.032], and lower percentage of large break [10.0% (0, 40.0%) vs. 50.0% (0, 100.0%), Z=-2.92, P=0.004] in the patients with non-acid GERC. The mean resting pressure of the lower esophageal sphincter was significantly lower (H=7.49, P=0.024), while the percentage of ineffective esophageal contractions was markedly higher (H=8.60, P=0.014) in the patients who responded to intensified anti-reflux treatment and in the patients who did not respond to the anti-reflux therapies. Multifactorial logistic regression analysis identified the percentage of ineffective contraction as an independent factor predicting the efficacy of conventional anti-reflux treatment, with a cut-off value of≤45% and a moderate predictive value (AUC=0.67, P=0.004). Conclusions: Esophageal dysmotility is common in GERC patients with different characteristics in acid and non-acid GERC. The percentage of ineffective esophageal contraction may be a useful indicator for selecting an anti-reflux strategy and predicting treatment outcomes.

Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease.

The purpose of this study was to examine the characteristics of proximal and distal gastroesophageal reflux in patients with gastroesophageal reflux disorder and analyze their clinical symptoms. A total of 67 patients with typical esophageal symptoms were selected for this study. All participants completed the reflux disease questionnaire and a questionnaire survey of extraesophageal symptoms. Diagnosis was made using a 24-h impedance-pH detection and proton pump inhibitor. The results showed that the proximal reflux group had a higher number of acid reflux episodes compared to the distal reflux group (P < 0.05). Similarly, the proximal reflux group also had a higher number of gas reflux episodes compared to the distal reflux group (P < 0.05). On the other hand, the distal reflux group had a higher number of mixed reflux episodes compared to the proximal reflux group (P < 0.05). These differences were statistically significant. This study revealed that acid reflux and gas reflux were more predominant in the proximal reflux group, while mixed reflux was more predominant in the distal reflux group.

SAT247 CODE STEMI Due To Excessive Ingestion Of TUMS

Abstract Disclosure: E. Hershkop: None. Hypercalcemia is defined as a serum calcium greater than 10.5mg/dL. It is most commonly caused by malignancy or hyperparathyroidism; a less common cause is excess calcium ingestion, referred to as Milk Alkali Syndrome (MAS). Severe hypercalcemia can lead to renal failure, arrhythmias, and coma. A rare EKG finding is ST elevation mimicking an acute ST Elevation Myocardial Infarction (STEMI). We describe a case of severe hypercalcemia caused by excessive ingestion of TUMS antacids that presented as diffuse ST elevations on EKG which were mistaken for an acute MI. To our knowledge, this is the first case in the literature describing hypercalcemia with ST elevations caused by excessive TUMS ingestion. Case: A 74 year old male with a history of diabetes, hypertension, stroke, and acid reflux presented for recurrent falls due to leg weakness. He endorsed constipation with bowel movements every 5-6 days. Upon further questioning, he reported taking 6 to 7 TUMS antacid tablets (each containing 200mg calcium) daily for the past two months to treat ‘heartburn’. He denied having chest pain. His medications included hydrochlorothiazide, losartan, amlodipine, atorvastatin, glimepiride, and famotidine. On physical exam he had reduced strength in both lower extremities - 1/5 left, 3/5 right. EKG on arrival showed ST elevation in leads III, aVF, and V1-V5, with T wave inversions in aVR and aVL, suggestive of a STEMI. A STEMI code was called. Since he denied chest pain, troponins were lateralized at 0.1 ng/mL, and an echocardiogram showed no wall motion abnormalities, cardiology recommended conservative management. Laboratory evaluation revealed calcium of 15.5 mg/dL, albumin of 3.8 g/dL, BUN of 39 mg/dL, creatinine of 2.2 mg/dL, magnesium of 1.4 mg/dL, phosphorus of 3 mg/dL, 25-OH vitamin D of 24 ng/mL, PTH of 9 pg/mL, undetectable 1-25 OH vitamin D and PTHrP, and normal TSH and SPEP. CT head/chest/abdomen/pelvis showed no evidence of malignancy. He was treated with IV hydration and 1 dose of calcitonin. His calcium level, leg strength, and ST elevations began to improve within 12 hours and returned to normal within four days. Conclusion: Our patient had severe hypercalcemia likely secondary to excessive consumption of oral antacid tablets, as other causes were ruled out, and his EKG findings masqueraded as a STEMI-a rare presentation of hypercalcemia. Consumption of supplements may be overlooked when investigating hypercalcemia and should be specifically asked about. In addition, providers should be aware of EKG changes found in hypercalcemia to avoid unnecessary cardiac intervention. Presentation: Saturday, June 17, 2023

Manual censoring of impedance tracings by the Wingate consensus reduces the number of impedance episodes, impacting on reflux categorization.

The Lyon consensus classifies the evidence of gastroesophageal reflux (GERD) based on endoscopic features and results of pH/impedance monitoring (pH-MII) including the post-reflux swallow-induced peristaltic wave index (PSPWI) and mean nocturnal baseline impedance (MNBI). The Wingate consensus established criteria to reduce inter-reviewer variability when assessing reflux episodes and PSPWI by impedance. This study aims to assess the influence of the Wingate criteria on the different pH-MII parameters obtained by automated analysis. Thirty consecutive pH-MII off PPI were reviewed according to Wingate criteria. Number of impedance episodes and PSPWI were compared before and after censoring from automatic analysis. Reflux categorization according to Lyon consensus between censored and uncensored data was compared. Pearson correlations between impedance parameters and censored episodes were calculated. Censoring the tracings significantly reduced the number of reflux episodes (66 [42-90.25] vs. 44.5 [21.5-61.5], p = 0.0105). Reasons for censoring were as follows: 1/ anterograde episode: 9.5 [6-13], 2/ impedance drop <50%: 1 [0-3], 3/ duration <4 s: 1 [0-2], 4/ <2 distal channels: 2.5 [1-4], and 5/ artifacts: 2 [1-5]. Censored episodes were in majority non-acid (16.5 [13-26.5] vs. 2 [0-4], p < 0.00001). Censoring altered the categorization of impedance episodes (<40 episodes, 6 vs. 13 for resp. uncensored vs. censored tracings, 40-80 episodes: 13 vs. 13, and >80 episodes: 11 vs. 4, p = 0.0264), but not the symptom index, the symptom association probability, or the categorization according to the Lyon consensus. Nevertheless, individual tracings were affected. The percentage of censored episodes was inversely correlated with the number of acidic impedance episodes (r = -0.62, p = 0.0002). Manual interpretation of impedance tracings based on the Wingate consensus reduces the number of impedance episodes, impacting on reflux categorization. Acidic reflux episodes are less likely to be censored, harboring a potential at improving automatic pH-MII analysis.

Study of gastroesophageal reflux. Interpretation of functional tests in the obese patient

Overweight and obesity are a public health problem and in 1997 obesity was recognized as a global epidemic by the World Health Organization (WHO). Overweight and obesity affect almost 60% of adults and one in three children in Europe according to the most recent WHO report. Objectively, gastroesophageal reflux disease (GERD) is defined as the presence of characteristic esophageal mucosal damage assessed by endoscopy and/or the demonstra-tion of pathological acid exposure by reflux monitoring studies. The prevalence of GERD is increased in obese patientsIn overweight and obese patients, the clinical symptoms of GERD are especially present in the supine position and this correlates with more frequent episodes of nocturnal reflux in the 24-h pH monitoring, there is also an increase in the number of refluxes with content acid. In the population with symptoms, digestive endoscopy detects data of erosive esophagitis in 50% of patients, while 24-h pH-impedanciometry diagnoses 92% of patients with non-erosive reflux disease (NERD)The presence of persistent GERD in the mucosa affects esophageal motility and patients may develop ineffective esophageal motility-type disorders, so we will review the interpre-tation of the functional tests that determine motility, which is esophageal manometry, and those that determine reflux gastroesophageal, acid and non-acid, which is the pH measure-ment with or without 24-h impedanciometry.

Three cases of GERD treated by endoscopic cardiac constriction in Tibetan District County Hospital

Gastroesophageal reflux disease (GERD) is a common disease in the outpatient clinic. The symptoms of GERD are typical heartburn, acid reflux and chest pain, and a few are accompanied by extra-esophageal symptoms, such as cough. The recurrence rate of gastroesophageal reflux disease (GERD) is high in medical treatment. Three patients with gastroesophageal reflux disease who failed to receive standard medical treatment were treated by endoscopic cardiac coachectomy in the secondary hospital of Chayu County, Tibet Autonomous Region.

INCREASING THE EFFECTIVENESS OF CHITOSAN GELS TO PROTECT THE OESOPHAGEAL MUCOSA

The troublesome symptoms of gastro-oesophageal reflux disease are a serious health, medical, and social problem for patients. The main problem is gastro-oesophageal acid reflux. In this study, I investigated hydrogels that could prevent the destruction of the oesophageal mucosa. I investigated the effect of chitosan and poloxamer 407 on the protective properties of gels. The addition of chitosan to all the tested gels increased their pH and dynamic viscosity. Preparations containing 25% poloxamer 407 showed the highest pH. Texture tests showed the effect of the poloxamer concentration on the adhesion performance of the tested gels. The findings suggest that the gels can be used to treat advanced acid reflux.

CHITOSAN GELS TO PREVENT REFLUX DISEASE

Reflux disease is one of the most frequently diagnosed conditions in developed countries. The problem is both the acidic content of the stomach and the alkaline content of the intestines. In each case, the oesophageal mucosa is destroyed. I analysed hydrogels that prevent irritation of the oesophageal mucosa. Specifically, I investigated the effect of chitosan and sodium alginate on the properties of gels protecting the oesophagus. Gels containing chitosan and 1.0% sodium alginate can be used to treat advanced alkaline reflux. The addition of chitosan to all the tested gels increased their pH and dynamic viscosity, making it possible to neutralise acid reflux. Texture studies showed the influence of chitosan and sodium alginate on the adhesiveness of the tested gels.