Symptoms Of Acid Regurgitation Research Articles

Prevalence and risk factors of gastro-oesophageal reflux symptoms among adolescents, the HUNT study

Background Gastro-oesophageal reflux disease (GORD) is recognized by symptoms of heartburn and acid regurgitation. These gastro-oesophageal reflux symptoms (GORS) are common in adults, but data from adolescents are sparse. This study aimed to assess the prevalence and risk factors of GORS among adolescents in a large and unselected population. Methods This study was based on the Trøndelag Health Study (HUNT), a longitudinal series of population-based health surveys conducted in Nord-Trøndelag County, Norway. This study included data from Young-HUNT4 performed in 2017–2019, where all inhabitants aged 13–19 years were invited and 8066 (76.0%) participated. The presence of GORS (any or frequent) during the past 12 months and tobacco smoking status were reported through self-administrated questionnaires, whereas body mass index (BMI) was objectively measured. Results Among 7620 participating adolescents reporting on the presence of GORS, the prevalence of any GORS and frequent GORS was 33.2% (95% confidence interval [CI] 32.2 − 34.3%) and 3.6% (95% CI 3.2 − 4.0%), respectively. The risk of frequent GORS was lower among boys compared to girls (OR 0.61; 95% CI 0.46 − 0.79), higher in current smokers compared to never smokers (OR 1.80; 95% CI 1.10 − 2.93) and higher among obese compared to underweight/normal weight adolescents (OR 2.50; 95% CI 1.70 − 3.66). Conclusion A considerable proportion of adolescents had GORS in this population-based study, particularly girls, tobacco smokers, and individuals with obesity, but frequent GORS was relatively uncommon. Measures to avoid tobacco smoking and obesity in adolescents may prevent GORS.

A pilot study comparing the initial clinical response to different proton pump inhibitors within first week in treating erosive esophagitis

AbstractGastroesophageal reflux disease (GERD) characterized by heartburn and/or acid regurgitation symptoms is one of the most common gastrointestinal disorders. The rapid onset of proton pump inhibitors (PPIs) to improve annoying symptom is an essential need in treating GERD. There was no report about the short‐term clinical effects comparing lansoprazole 30 mg to rabeprazole 20 mg. This pilot study was designed to compare the initial one‐week clinical response of the two drugs in GERD with erosive esophagitis. Total 44 patients with GERD were enrolled in this study and randomized into two groups. The patients had the symptoms of acid regurgitation, heartburn, or feeling of acidity in the stomach and erosive esophagitis proven by endoscopy. They respectively received once‐daily dose of lansoprazole 30 mg (n = 23) and rabeprazole 20 mg (n = 21) for treatment of GERD. The primary end point was complete symptom resolution (CSR). The CSR rate was evaluated by questionnaire including acid regurgitation, heartburn sensation and epigastric pain at day 1, 3 and 7. Two patients in the arm of rabeprazole had poor compliance of drugs and were excluded from analysis. The final patient numbers were 23 in the arm of lansoprazole and 19 in rabeprazole. The baseline characteristics of two groups were similar in age, gender, body mass index (BMI), Helicobacter pylori infection, GERD severity, smoking, alcohol, coffee, spicy, sweet food and laboratory data. The ingestion of tea was the only one variable with significant difference between the two groups (65.2% and 31.58%, p = .03). At day 1, 3 and 7, the CSR rate of lansoprazole and rabeprazole were 21.74% and 26.32% (p = 1.000), 34.78% and 31.58% (p = .827), 47.83% and 47.37% (p = .976), respectively. The other clinical factors, including age, gender, BMI, Helicobacter pylori infection, smoking, alcohol, coffee, tea, spicy, sweet food and laboratory data, have also no significant influence on CSR rates at day 1, 3, 7. However, the patients with GERD C and D had significantly higher CSR rate than patients with GERD A and B at day 1 and 7 (CSR rate at day 1: 50.00% vs. 15.63, p = .040; day 3: 60.00% vs. 25.00%, p = .059; day 7: 90.00% vs. 34.38%, p = .003). In multivariate regression analysis, the patients with GERD C and D still had significantly higher CSR rate than patients with GERD A and B at day 7 (Odds ratio: 28.27, 95% CI: 2.10–380.03, p = .012). The CSR rates between lansoprazole group and rabeprazole group at day 1, 3, 7 were not significantly different, so the difference of PPIs did not play the role on the initial clinical response within 1 week for the erosive GERD patients. However, the patients with more severe erosive GERD on endoscopy had higher CSR rate at day 7.

Narrative Review: Lifestyle Intervention of Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease (GERD) is the most common gastrointestinal (GI) complaints in all ages. GERD varies in presentation and diagnosis based on typical symptoms of heartburn and acid regurgitation. There is many symptoms or complications of GERD such as acid regurgitation, heartburn and chronic cough. GERD causes troublesome symptoms for the patient who experience it. The patient’s lifestyle is the risk factor for GERD. Obesity, high dietary fat, consumption of carbonated drinks have increased GERD symptoms. Chocolate and carbonated beverages decrease the pressure in the lower esophageal sphincter, so they may cause reflux. Therefore, this article review of GERD will include information of lifestyle intervention as part of GERD management.

Using Banxia Xiexin Decoction for Chronic Atrophic Gastritis

Chronic atrophic gastritis is often accompanied by stomach pain, belching, abdominal distension, acid regurgitation, nausea and other symptoms, which not only reduces the quality of life of patients, but also affects their health and safety. Most patients are treated with conventional western medicine, such as metronidazole and amoxicillin capsules, but the effect is poor. The pathogenesis of this disease is mainly a mixture of cold and heat, and the treatment is mainly to relieve the pain and regulate the cold and heat. The prescription is pinellia heart purging decoction, with good results. This article analyzes professor Wang Jiehong's thought and experience in treating chronic atrophic gastritis with Banxia Xiexin Decoction.

Prevalence, Clinical Characteristics, and Treatment Response in Patients with Post Cricoid Inlet Patch—A Descriptive Retrospective Study

Abstract Objectives The aim of this study was to determine the incidence of post cricoid inlet patch (PC-IP) and to assess the clinical characteristics, pathological features, and treatment response. Materials and Methods A retrospective cross-sectional study was conducted from April 2016 to April 2021 in the tertiary gastroenterology unit of urban India. All patients with symptoms of globus sensation, chronic cough, heartburn, hoarseness, throat pain, dysphagia, and acid regurgitation after a thorough clinical examination underwent esophagogastroduodenoscopy by experienced endoscopists including biopsy. Sociodemographic data, symptoms and its duration, previous hospital visits, and chronic proton pump inhibitor (PPI) use were noted during the study. Results Three-thousand two-hundred fifty upper gastrointestinal endoscopies were performed during the study period. The prevalence of PC-IP was 2.7%, comprising 36.3% males and rest females. Mean age was 36.2 ± 17years. The most common symptom among these patients was globus sensation (81.8%) followed by acid regurgitation (75%), dyspepsia (64.7%), dysphagia (48.8%), throat pain (29.54%), chronic cough (22.72%), hoarseness (22.72%), and others (6.81%). Mean diameter of PC-IP was 1.5 ± 0.5 cm, more than one patch was found in 23.76% of patients. Histopathological examination showed heterotrophic gastric mucosa in 77.27%, out of which 38.23% had oxyntic type, 44.11% had mucoid type, and the rest had mixed cell type. On median follow-up after 20 months, 68.18% of patient had persistent symptoms, 77.27% were PPI responsive, and 22.73% were PPI refractory. On follow-up, 38.63% of patients had a repeat endoscopic procedure and biopsy (20.45%); none showed any changes in size or dysplasia. Conclusion Prevalence of PC-IP could be higher than the estimated. Careful examination of upper esophagus and use of narrow band imaging will increase the possibility of identifying IP. Those symptomatic patients need treatment with PPI, sometimes for long term. Ablative therapy with radiofrequency or argon plasma coagulation needs further clarification.

Association between gastroesophageal reflux disease and coronary atherosclerosis.

Background and aimGastroesophageal reflux disease (GERD) typically presents with symptoms of heartburn and acid regurgitation but occasionally manifests as atypical chest pain. Coronary artery disease (CAD) and GERD share some risk factors, such as smoking and obesity. The aims of this study were to evaluate the association between GERD and coronary atherosclerosis and to assess the risk factors for coronary atherosclerosis in GERD patients.MethodsA total of 16616 subjects who underwent upper gastrointestinal endoscopy from 2003 to 2017 and a cardiac computed tomography (CT) scan within one year were included in this study. Coronary atherosclerosis was evaluated by the coronary artery calcium score (CACS). The severity of GERD was evaluated based on endoscopic findings using the Los Angeles classification.ResultsThe proportion of high CACSs (≥100) increased significantly in subjects with severe GERD (p = 0.008). However, the presence of a high CACS did not increase the risk of GERD (OR = 1.007, 95% CI 0.857–1.182), nor did that of GERD increase the risk of a high CACS (OR = 1.018, 95% CI 0.865–1.198). The risk factors for a high CACS in GERD patients included age (OR = 1.087, 95% CI 1.066–1.109), male sex (OR = 5.645, 95% CI 2.561–12.446), hypertension (OR = 1.800, 95% CI 1.325–2.446), and hypercholesterolemia (OR = 1.684, 95% CI 1.213–2.338).ConclusionsAlthough the presence of a high CACS did not increase the risk of GERD or vice versa, the proportion of high CACSs was significantly higher in subjects with severe GERD. Therefore, it might be helpful to assess the CACS in GERD patients with multiple risk factors.

The impact of low-fat and full-fat dairy foods on symptoms of gastroesophageal reflux disease: an exploratory analysis based on a randomized controlled trial.

Gastroesophageal reflux disease (GERD) is a widely prevalent condition. High consumption of dairy foods and dietary fat are associated with worse GERD symptoms. However, existing data are inconsistent and mostly based on observational studies. The purpose of this exploratory analysis of a randomized controlled trial was to investigate the impact of low-fat and full-fat dairy food consumption on GERD symptoms. Seventy-two participants with metabolic syndrome completed a 4-week wash-in diet during which dairy intake was limited to three servings of nonfat milk per week. Participants were then randomized to either continue the limited dairy diet or switch to a diet containing 3.3 servings per day of either low-fat or full-fat milk, yogurt and cheese for 12weeks. Here, we report intervention effects on the frequency of acid reflux, and the frequency and severity of heartburn, exploratory endpoints assessed by a questionnaire administered before and after the 12-week intervention. In the per-protocol analysis (n = 63), there was no differential intervention effect on a cumulative heartburn score (p = 0.443 for the time by diet interaction in the overall repeated measures analysis of variance). Similarly, the intervention groups did not differentially affect the odds of experiencing acid regurgitation (p = 0.651). The intent-to-treat analyses (n = 72) yielded similar results. Our exploratory analyses suggest that, in men and women with the metabolic syndrome, increasing the consumption of either low-fat or full-fat dairy foods to at least three servings per day does not affect common symptoms of GERD, heartburn and acid regurgitation compared to a diet limited in dairy. ClinicalTrials.gov Identifier: NCT02663544, registered on January 26, 2016.

Smoking, diabetes mellitus, and obesity as risk factors of gastroesophageal reflux disease and extraesophageal symptoms of gastroesophageal reflux disease: A case-control study

Background: Gastroesophageal reflux disease (GERD) is a spectrum of disease usually producing symptoms of heartburn and acid regurgitation. Its prevalence in general population is about 12–17% worldwide. There are many suggested risk factors for GERD. Aim and Objective: This study was conducted to find out whether smoking, diabetes mellitus (DM), and obesity are risk factors of GERD and to find out the extraesophageal symptoms of GERD. Materials and Methods: This is a case–control study matched for age done in 46 GERD patients who were cases and 92 subjects with dyspepsia who were not having GERD as controls. The statistical analysis was done to find out proportions and odds ratio (OR) with 95% confidence interval (CI). Results: Most of the study subjects were in the age group of 40–49 years. About 59% were males. About 14% were smokers and 25% were diabetics. OR for smoking, DM, and obesity was 3.706, 5.571, and 3.618, respectively. About 28% of the GERD patients had easy tiredness. Conclusion: In this study, smoking and DM were found to be the risk factors of GERD based on OR with 95% CI. The most frequent extraesophageal symptom among GERD patients was found to be tiredness.

Clinical characteristics and esophageal function tests of refractory gastroesophageal reflux disease

Objective: To analyze the clinical characteristics and pathogenesis of refractory gastroesophageal reflux disease(RGERD). Methods: The patients with acid regurgitation, heartburn and extraesophageal symptoms were enrolled in the study from November 2015 to September 2017 at Peking University Third Hospital. All the subjects filled the informed consent.Questionnaire, SCL-90, SAS and SDS scales were recorded. A 24 hour pH-impedance monitoring and esophageal high resonance manometry were carried out. According to the response to proton pump inhibitor(PPI), the patients were divided into RGERD and non-RGERD(NRGERD)groups. The clinical characteristics were compared between these two groups. Logistic regression was used to analyze the risk factors of RGERD. Results: One hundred and nineteen patients were finally enrolled in the study including 61 RGERD (51.3%) and 58 NRGERD patients (48.7%).The body mass index (BMI) and rates of, typical GER symptoms including acid regurgitation in RGERD patients were significantly lower than those in NRGERD patients (P<0.05).While the atypical GER symptoms such as poststernal discomfort or chest pain were more common in RGERD group (P<0.05).RGERD patients presented less acid reflux events and lower proximal segment reflux ratio than NRGERD patients. No obvious differences were found in the manometry metrics between these two groups. The scores of somatization, depression and hostility in RGERD patients by SCL-90 scales were significantly higher than those in NRGERD patients (P<0.05), and depression score was an independent risk factor for RGERD [OR=3.915 (95%CI 1.464-10.466), P =0.007]. Conclusions: RGERD patients present more atypical symptoms and pathological non-acid reflux.Depression is an independent risk factor for RGERD.

GERD: A practical approach.

Gastroesophageal reflux disease (GERD) is mainly a clinical diagnosis based on typical symptoms of heartburn and acid regurgitation. Current guidelines indicate that patients with typical symptoms should first try a proton pump inhibitor (PPI). If reflux symptoms persist after 8 weeks on a PPI, endoscopy of the esophagus is recommended, with biopsies taken to rule out eosinophilic esophagitis. This review discusses the evidence for different medical, endoscopic, and surgical therapies and presents a management algorithm.

Phase 4 Study in Patients From Asia With Gastroesophageal Reflux Disease Treated With Dexlansoprazole.

Background/AimsSince the use of dexlansoprazole in Asian subjects with gastroesophageal reflux disease (GERD) has not been adequately characterized, this study was conducted to evaluate the efficacy and safety of dexlansoprazole modified-release in Asian subjects with non-erosive reflux disease (NERD) and erosive esophagitis (EE).MethodsIn this phase 4, open-label, non-randomized, uncontrolled, multicenter, multi-country study sponsored by Takeda, subjects aged ≥ 20 years with persistent typical GERD symptoms for at least 6 months underwent endoscopy. Based on endoscopic findings, they were assigned to either dexlansoprazole modified-release 30 mg once-daily for 4 weeks (NERD group) or dexlansoprazole modified-release 60 mg once-daily for 8 weeks (EE group). The primary endpoint was the percentage of days that subjects did not experience any 24-hour heartburn or acid regurgitation.ResultsOf the 445 subjects screened from Hong Kong, South Korea, and Taiwan, 208 were enrolled in the NERD group (mean age: 53.6 years, male: 34.6%) and 88 in the EE group (mean age: 51.7 years, male: 55.7%). Over the treatment period, the median percentage of days that subjects did not experience any 24-hour heartburn or acid regurgitation was 26.9% and 65.5% in the NERD and EE groups, respectively; for nighttime heartburn or acid regurgitation the proportions were 59.3% and 83.3%, respectively. The treatment was well tolerated with low incidence of treatment-related adverse events in NERD and EE groups (6.7% and 5.7%, respectively).ConclusionIn Asian patients with GERD, treatment with dexlansoprazole modified-release indicates a favorable efficacy and safety profile in relieving heartburn and acid regurgitation symptoms.

Role of human leukocyte antigens DRB1-DQB1 haplotype in the susceptibility to gastroesophageal reflux disease

Gastro oesophageal reflux disease is due to involuntary gastric contents reflux into the esophagus from stomach, causing heartburn and acid regurgitation symptoms. Genetic and environmental factors are important factors in the causation of disease. Human Leukocyte antigens considered as an excellent marker for population genetics analysis and disease association. This study aimed to investigate the association between HLA-DRB1-DQB1 haplotype that inherited in linkage and its association with gastro oesophageal reflux disease (GERD). Patients and healthy controls were prospectively recruited from gastrocolonoscope unit at Al-Kindy Teaching Hospital (Baghdad-Iraq) between January and July 2016. Forty Iraqi Arab Muslims patients with a history of heartburn and dyspepsia compared with 100 Iraqi Arab Muslims control. All study patients and control group underwent upper gastroesophageal endoscope examination and HLA-DRB1 and HLA-DQB1 genotype were done using sequence spesific oligonucleotide primer to both groups. The frequencies of two haplotype HLA-DRB1⁄03-DQB1⁄03 and HLADRB1⁄ 13-DQB1⁄06 were significantly higher in patients with GERD while haplotype HLA-DRB1⁄03-DQB1⁄02 was significantly higher in control group. Sex had an effect in disease developing that haplotype HLADRB1⁄ 03-DQB1⁄03 was significantly more common in female patients that increased susceptibility to disease. This study identified that two haplotypes HLA-DRB1⁄03- DQB1⁄03 and HLA-DRB1⁄13- DQB1⁄06 leads to increased susceptibility to GERD and haplotype HLA-DRB1⁄03-DQB1⁄02 was protective against GERD development.

Decline in perception of acid regurgitation symptoms from gastroesophageal reflux disease in diabetes mellitus patients.

ObjectivesTo determine if a discrepancy exists between subjective symptoms and the grade of endoscopic gastroesophageal reflux disease (GERD) in diabetes mellitus (DM) patients.MethodsAll 2,884 patients who underwent esophagogastroduodenoscopy completed the modified Gastrointestinal Symptom Rating Scale (GSRS), an interview-based rating scale consisting of 16 items including a question on acid regurgitation. Patients were divided into DM and non-DM groups (1,135 and 1,749 patients, respectively). GERD was diagnosed endoscopically and graded according to the Los Angeles classification. Grade B or more severe GERD was defined as severe endoscopic GERD. The intergroup GSRS score was compared statistically.ResultsIn severe endoscopic GERD patients, the prevalence of patients with a positive GSRS score in the acid regurgitation question was statistically lower in DM patients than non-DM patients. Of the 60 non-DM patients with severe endoscopic GERD, 40 patients (67%) had a positive GSRS score for acid regurgitation; however, of the 51 DM patients with severe endoscopic GERD, 23 patients (45%) had a positive GSRS score. Multivariate analysis showed that severe endoscopic GERD (OR: 2.01; 95% CI: 1.21–3.33; p = 0.0066), non-DM (OR: 0.74; 95% CI: 0.54–0.94; p = 0.0157), younger age (OR: 0.98; 95% CI: 0.97–0.99; p = 0.0125), and hiatal hernia (OR: 1.46; 95% CI: 1.12–1.90; p = 0.0042) were associated with acid regurgitation symptoms.ConclusionsThere is a discrepancy between subjective symptoms and endoscopic GERD grade in DM patients. The ability of DM patients to feel acid regurgitation may be decreased.

P268 Role of human leukocyte antigens DRB1-DQB haplotype in the susceptibility to gastroesophageal reflux disease

Aim Gastro oesophageal reflux disease is due to involuntary gastric contents reflux into the esophagus from stomach, causing heartburn and acid regurgitation symptoms. Genetic and environmental factors are important factors in the causation of disease. Human Leukocyte antigens considered as an excellent marker for population genetics analysis and disease association. This study aimed to investigate the association between HLA-DRB1-DQB1 haplotype that inherited in linkage and its association with gastro oesophageal reflux disease (GERD). Methods Patients and healthy controls were prospectively recruited from gastrocolonoscope unit at Al-Kindy Teaching Hospital (Baghdad-Iraq) between January and July 2016. Forty Iraqi Arab Muslims pattients with a history of heartburn and dyspepsia compared with 100 Iraqi Arab Muslims control. All study patients and control group underwent upper gastroesophageal endoscope examination and HLA-DRB1 and HLA-DQB1 genotype were done using sequence spesific oligonucleotide primer to both groups. Results The frequencies of two haplotype HLA-DRB1∗03-DQB1∗03 and HLA-DRB1∗13-DQB1∗06 were significantly higher in patients with GERD while haplotype HLA-DRB1∗03-DQB1∗02 was significantly higher in control group. Sex had an effect in disease developing that haplotype HLA-DRB1∗03-DQB1∗03 was significantly more common in female patients that increased susceptibility to disease. Conclusions This study identified that two haplotypes HLA-DRB1∗03-DQB1∗03 and HLA-DRB1∗13-DQB1∗06 leads to increased susceptibility to GERD and haplotype HLA-DRB1∗03-DQB1∗02 was protective against GERD development.

Associations between obstructive sleep apnea severity and endoscopically proven gastroesophageal reflux disease.

Obstructive sleep apnea (OSA) is believed to be an important risk factor for gastroesophageal reflux disease (GERD). However, the association between OSA and GERD is not straightforward and has been incompletely characterized. The aim of this study was to assess the relationship between OSA and GERD by performing both polysomnography (PSG) and esophagogastroduodenoscopy (EGD). The enrolled patients underwent both PSG and EGD from October 2003 to July 2015 at Seoul National University Bundang Hospital. All patients were checked for the presence of mucosal injury in the EGD findings and divided into a no-GERD group and a GERD group according to the Los Angeles (LA) classification. In addition, the GERD symptoms of heartburn, acid regurgitation, and reflux-related cough were recorded. A total of 216 patients were enrolled. Ninety-nine patients (45.8%) were in the GERD group, 68 (31.5%) were the minimal-change GERD group, and 49 (22.7%) were in the GERD LA-A/B group. The OSA-related findings were worse in the GERD LA-A/B group than in the no-GERD group: the apnea-hypopnea index was 33.6±25.5 versus 22.0±17.2 (p=0.01), the longest apnea duration was 50.7±24.0 versus 41.6±23.3s (p=0.03), the lowest oxygen saturation was 80.2±7.9 versus 83.2±7.5% (p=0.02), and the oxygen desaturation index was 25.1±22.4 versus 16.1±15.5 (p=0.01), respectively. Sleep efficiency was significantly worse in patients with GERD symptoms (81.2±10.8%) than in those without GERD symptoms (85.1±11.4%) (p=0.03). Endoscopically proven GERD was associated with more severe OSA. GERD symptoms were also associated with deteriorated sleep quality.

Endoluminal Therapy for Gastroesophageal Reflux Disease: In Between the Pill and the Knife?

Gastroesophageal reflux disease (GERD) is a chronic disease characterized by symptoms of heartburn and acid regurgitation. Uncontrolled GERD can significantly impact quality of life, can lead to complications, and increases the risk of esophageal cancer. Over the past few decades, there has been an increasing prevalence of GERD among adults in Western populations. The use of proton pump inhibitors (PPI) in conjunction with lifestyle modifications remains the mainstay therapy. However, the efficacy of this intervention is often hampered by adherence, costs, and the risks of long-term PPI use. Anti-reflux surgery is an option for patients with refractory symptoms or in those in whom medical therapy is contraindicated or not desirable. While conventional surgery has an acceptable safety profile, there has been an increasing interest in alternate treatments that may potentially offer similar results and be associated with a faster recovery. Recent advances in interventional endoluminal techniques have introduced novel incisionless anti-reflux procedures. While the current data are promising, further larger prospective studies are needed in order to assess the long-term efficacy of endoluminal therapies and its place among the treatment options for GERD.

A Systematic Review of the Literature Related to Elevating the Head of the Bed for Patients With Gastroesophageal Reflux Disease: Applications in Patients After Esophageal Cancer Surgery

Acid regurgitation typically worsens during nighttime sleep, which influences the quality of life of patients and potentially causes pathological changes. As much as 80% of esophageal cancer patients experience acid regurgitation following esophagectomy and reconstruction surgery. Thus, improving this symptom is important to improving the quality of life of these patients. The purpose of the present study was to evaluate the effect of elevating the head of the bed for patients with gastroesophageal reflux disease (GERD). A systematic review was used. Electronic databases including CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, ProQuest, and PubMed/MEDLINE were retrieved for relevant articles that were published prior to June 2015. Keywords included "elevating the head of the bed/bed position/body position", "flat", "reflux", and the MeSh term "gastroesophageal reflux". A total of 37 articles that matched the search criteria were extracted. After screening the topics and deleting repetitions, three randomized controlled studies and one quasi-experimental designed study were selected. Results of this systemic review revealed that elevating the head of the bed for patients with GERD reduced the duration of exposure of the the esophagus to an acid environment. Furthermore, patients perceived that this intervention not only improved symptoms such as regurgitation and burn sensation without medication but also relieved symptoms better than taking medications alone. The reviewed studies support that elevating the head of the bed is an easy and effective way to alleviate the symptoms of acid regurgitation. A height of elevation of 20 to 28 cm is recommended in the literature. The slope of the elevated bed must also be considered. Elevating the head of the bed may be useful for improving acid regurgitation among esophageal cancer patients after surgery. A randomized controlled study may be used to validate this effect in the future.

Esophagogastric Junction Outflow Obstruction Transformed to Type II Achalasia.

A 53-year-old woman presented with dysphagia for 2 months. She denied any acid regurgitation or heartburn symptoms. Esophagogastroduodenoscopy revealed no abnormal findings. However, bird-beak appearance of the distal esophagus was noticed on the esophagography. For evaluation of esophageal motility disorders, she underwent esophageal high resolution manometry (HRM). On the HRM, the integrated relaxation pressure was elevated and accompanied by compartmentalized esophageal pressurization, while esophageal body peristalsis, distal contractile integral, and distal latency were normal (Figure A). According to the Chicago classification (CC),1 she was diagnosed with esophagogastric junction outflow obstruction (EGJOO).1 The patient’s dysphagia was tolerable without specific treatment. However, the dysphagia became aggravated 1 year later. She underwent esophagography and HRM again. On the HRM, panesophageal pressurization with failed lower esophageal sphincter relaxation was noticed (Figure B). According to the CC she was diagnosed as type 2 achalasia. After pneumatic balloon dilatation, her symptoms improved (Eckardt score, 1). Figure Esophageal high-resolution manometry (HRM) findings of a patient present with dysphagia intially and 1 year later. (A) Esophagogastric junction outflow obstruction. HRM shows preserved esophageal body peristalsis but elevated integrated relaxation pressure ... The CC defines EGJOO as the presence of some instances of intact or weak peristalsis, elevated median integrated relaxation pressure above 15 mmHg, and discrepancy to the criteria of achalasia.1 The revised CC addresses the potential etiology of EGJOO including early form of achalasia, mechanical obstruction, esophageal wall stiffness, or manifestation of hiatal hernia.2 Due to the loose current definition of EGJOO, heterogeneous groups are included in this category. Indeed, EGJOO is presented with various symptoms. In recent studies, patients with EGJOO presented with dysphagia in 36%, heartburn/regurgitation in 25%, atypical symptoms of gastroesophageal reflux disease in 21%, and chest pain in 11%.2,3 In addition, various clinical courses of EGJOO ranging from spontaneous symptom resolution to requirement of myotomy were observed.2–4 EGJOO is just a manometric diagnosis. Thus, we need to investigate the underlying etiology further to manage the patients with EGJOO appropriately. Herein we present a EGJOO patient who transformed to a type II achalasia with time, which may be the most important etiology within the EGJOO category. Although the significance remains unclear, compartmentalized esophageal pressurization was observed in this case. In the future, it would be interesting to evaluate the role of compartmentalized esophageal pressurization in patients with EGJOO.

Role of Ambulatory Distal Esophageal pH Monitoring in Patients With Laryngopharyngeal Reflux (LPR) and Gastroesophageal Reflux Disease (GERD)

Introduction: LPR is primarily a clinical diagnosis based on symptoms such as cough, globus, hoarseness and throat clearing thought to be due to reflux of gastric contents into larynx. Some of these patients do not have typical symptoms of heartburn and acid regurgitation which can make the diagnosis challenging. Though not 100% sensitive, the gold standard test for detection of reflux is distal esophageal pH monitoring with 24-hour pH or 48-hour pH testing. Therefore, our aim was to assess the role of distal esophageal pH testing in patients with LPR. Methods: The study group (Group A) consisted of the patients with a diagnosis of LPR who underwent either 24 pH test with a single probe transnasal catheter positioned 5 cm above gastroesophageal junction (GEJ) or 48 hour wireless bravo probe placed endoscopically 6 cm above the GEJ in our GI lab from 2006 to 2014. Group B consisted patients with the diagnosis of GERD only (heartburn or acid regurgitation more than two days a week) and group C comprised of patients with a diagnosis of GERD and LPR. In addition to pH testing, all groups had high resolution esophageal manometry (HREM) and otolaryngeal (ENT) evaluation. Variables such as age, gender, BMI and pH parameters including total acid exposure, supine and upright acid exposure, Symptom index (SI), Symptom sensitivity index (SSI) and symptom association probability (SAP) were noted. Results: A total of 239 patients underwent pH testing during the study period. There were 67 patients in Group A (LPR only), 107 patients in Group B (GERD only) and 68 patients in group C (GERD+ LPR). Only 43.3% in Group A, 50.5% in group B and 55.4% in group C had abnormal pH testing (Table 1). There were no significant differences in the three groups in terms of total, supine and upright acid exposure. SI, SSI and SAP were lower in group A than in group B and group C (although not statistically significant).Table 1: Esophageal pH Testing in LPR and GERDConclusion: Esophageal pH testing is normal in approximately half the patients with a clinical diagnosis of LPR, GERD or a combination. Hence, a diagnosis of LPR cannot be reliably made on the results of distal esophageal pH monitoring alone.

Safety and Tolerability of Esomeprazole in Children With Gastroesophageal Reflux Disease.

To evaluate safety, tolerability, and symptom improvement with once-daily esomeprazole in children with endoscopically proven gastroesophageal reflux disease (GERD). In this 8-week, multicenter, randomized, uncontrolled, double-blind study, children ages 1 to 11 years were stratified by weight to receive esomeprazole 5 or 10 mg (children < 20 kg) or 10 or 20 mg (children ≥ 20 kg) once daily. Safety and tolerability was assessed by evaluating adverse events (AEs; both treatment- and non-treatment-related AEs) and changes from baseline in medical history, physical examinations, and clinical laboratory tests. Investigators scored symptom severity every 2 weeks using the Physician's Global Assessment (PGA). Patients' parents rated GERD symptoms of heartburn, acid regurgitation, and epigastric pain (none to severe, 0-3) at baseline (based on past 72 hours) and daily (from past 24 hours). Of 109 patients randomized, 108 had safety data. AEs were experienced by 68.0% and 65.2% of children < 20 kg receiving esomeprazole 5 and 10 mg, respectively, and 83.9% and 82.8% of children ≥ 20 kg receiving esomeprazole 10 and 20 mg, respectively, regardless of causality. Overall, only 9.3% of patients reported 13 treatment-related AEs; the most common were diarrhea (2.8% [3/108]), headache (1.9% [2/108]), and somnolence (1.9% [2/108]). Vomiting, a serious AE in 2 patients, was not judged by the investigator to be related to treatment. At the final visit, PGA scores improved significantly from baseline (P < 0.001). Of 58 patients with moderate to severe baseline PGA symptom scores, 91.4% had lower scores by the final visit. GERD symptom scores were significantly improved from baseline to the final week of the study in all of the treatment groups (P < 0.01) CONCLUSIONS: In children ages 1 to 11 years with endoscopically proven GERD, esomeprazole (at daily doses of 5, 10, or 20 mg) was generally well tolerated. The frequency and severity of GERD-related symptoms were significantly reduced during the active treatment period.