Ambulatory pH Research Articles

The diagnostic value of 24-hour ambulatory intraesophageal pH-impedance in patients with laryngopharyngeal reflux symptoms comparable with typical symptoms.

The diagnosis of laryngopharyngeal reflux is currently based on a combination of the patient history of multichannel intraluminal impedance and ambulatory pH (MII-pH); however, none of these findings alone is specific for the diagnosis of laryngopharyngeal reflux. We aimed to compare the baseline characteristics and esophageal baseline impedance values between patients with and without laryngopharyngeal reflux symptoms. We retrospectively analyzed data from two groups of patients with laryngopharyngeal reflux according to their reflux finding score (RFS) as scored by ENTs. Control patients were nonerosive reflux disease patients without laryngopharyngeal reflux. All MII-pH parameters and baseline impedance were analyzed from six levels and the proximal and distal baseline impedance and the ratio of the proximal to distal baseline impedance levels was calculated. Altogether 123 patients with laryngopharyngeal reflux and 49 control patients were included. A total of 81 of 123 patients had RFS ≥ 7, and 42 of 123 patients had RFS < 7. Baseline impedance analysis showed that patients with laryngopharyngeal reflux symptoms had significantly lower proximal baseline impedance values (1997 ± 51 vs 2245 ± 109, p < 0.05) than the control group. Additionally, patients with laryngopharyngeal reflux symptoms had a significantly lower proximal-to-distal ratio (1.28 ± 0.05 vs 1.53 ± 0.09, p < 0.05). In the subgroup analysis, patients with RFS < 7 were found to have a significantly lower acid exposure time than either the patients with RFS ≥ 7 (3.85 ± 0.65 vs 8.2 ± 1.52, p < 0.05) or the control group (3.85 ± 0.65 vs 6.1 ± 0.81, p < 0.05). Additionally, patients with RFS ≥ 7 had significantly lower proximal baseline impedance levels than the control group (1970 ± 63 vs 2245 ± 109, p < 0.05). Patients with pathologic laryngopharyngeal reflux symptom scores had lower proximal baseline impedance levels and lower proximal-to-distal ratios, which may reflect the proximal mucosal noxious effect of the refluxate. These results may indicate that laryngopharyngeal reflux symptoms may be due to chronic acid exposure in the proximal segments of the esophagus, and the proximal-to-distal ratio may be used as a new metric for diagnosis.

Sedation and Afternoon Placement of the 48-Hour Wireless Ambulatory pH Capsule Results in More Reflux on the First Day.

A 48-hour wireless capsule results often vary from the first to second day. Previous investigations comparing discrepant acid reflux readings have yielded variable results. In this study we investigated differences in data obtained on day 1 versus day 2, and the effect of time of capsule placement on discrepancies. We performed a retrospective cohort study. Patients undergoing a 48-hour wireless capsule study between January 2012 through November 2013 were eligible for inclusion. We collected reflux data for each patient and calculated the proportion of patients in four groups based on abnormal DeMeester score groups (+/+, -/+, +/-, -/-). We placed patients into morning placement or afternoon placement categories and calculated the proportions of patients with various DeMeester score discrepancies. This study evaluated 229 patients. The mean day 1 DeMeester score was 28.38 and the mean day 2 DeMeester score was 23.24 (P<0.0001). The mean day 1 DeMeester score in the morning group was 24.9 and 31.7 in the afternoon group (P<0.05). The mean total DeMeester score in the morning placement group was 23.1 and 30.6 in the afternoon group (P<0.05). Twenty-five percent of afternoon patients had a +day 1/-day 2 DeMeester discordance, whereas only 12% of morning placement patients had this discordance (P=0.26). Afternoon capsule placement is associated with a significantly increased amount of acid reflux on day 1. Approximately 10% of 48-hour esophageal wireless monitoring studies may falsely overestimate reflux when the capsule is placed in the afternoon. Capsule placement should ideally be performed in the morning.

Hiatus Hernia as a Cause of Dysphagia.

This review aims to discuss the putative relationship between hiatus hernia and dysphagia. Proposed mechanisms of dysphagia in patients with hiatus hernia are usually difficult to identify, but recent advances in technology (high-resolution manometry with or without concomitant impedance, ambulatory pH with impedance, videofluoroscopy, and the endoluminal functional lumen imaging probe (EndoFLIP)) and methodology (inclusion of swallows of various consistencies and volumes or shifting position during the manometry protocol) can help induce symptoms and identify the underlying disorder. Chronic reflux disease is often associated with hiatus hernia and is the most common underlying etiology. Dysmotility because of impaired contractility and vigor can occur as a consequence of repeated acid exposure from the acid pocket within the hernia, and the resultant poor clearance subsequently worsens this insult. As such, dysphagia appears to be more common with increasing hiatus hernia size. Furthermore, mucosal inflammation can lead to fibrotic stricture formation and in turn obstruction. On the other hand, there appears to be a difference in the pathophysiology of smaller sliding hernias, in that those with dysphagia are more likely to have extrinsic compression at the crural diaphragm as compared to those with reflux symptoms only. Sliding hiatus hernia, especially when small, does not commonly lead to dysmotility and dysphagia; however, in those patients with symptoms, the underlying etiology can be sought with new technologies and, in particular, the reproduction of normal eating and drinking during testing.

Foods Inducing Typical Gastroesophageal Reflux Disease Symptoms in Korea.

Background/AimsSeveral specific foods are known to precipitate gastroesophageal reflux disease (GERD) symptoms and GERD patients are usually advised to avoid such foods. However, foods consumed daily are quite variable according to regions, cultures, etc. This study was done to elucidate the food items which induce typical GERD symptoms in Korean patients.MethodsOne hundred and twenty-six Korean patients with weekly typical GERD symptoms were asked to mark all food items that induced typical GERD symptoms from a list containing 152 typical foods consumed daily in Korea. All patients underwent upper gastrointestinal endoscopy followed by 24-hour ambulatory esophageal pH monitoring. The definition of “GERD” was if either of the 2 studies revealed evidence of GERD, and “possible GERD” if both studies were negative.ResultsOne hundred and twenty-six cases (51 GERD and 75 possible GERD) were enrolled. In 19 (37.3%) of 51 GERD cases and in 17 (22.7%) of 75 possible GERD cases, foods inducing typical GERD symptoms were identified. In the GERD group (n = 19), frequent symptom-inducers were hot spicy stews, rice cakes, ramen noodles, fried foods, and topokki. In the possible GERD group (n = 17), frequent symptom-inducers were hot spicy stews, fried foods, doughnuts, breads, ramen noodles, coffee, pizza, topokki, rice cakes, champon noodles, and hotdogs.ConclusionsIn one-third of GERD patients, foods inducing typical symptoms were identified. Hot spicy stews, rice cakes, ramen noodles, fried foods, and topokki were the foods frequently inducing typical symptoms in Korea. The list of foods frequently inducing typical GERD symptoms needs to be modified based on their own local experiences.

New Approaches to Gastroesophageal Reflux Disease

BackgroundGastroesophageal reflux disease (GERD) is the most common gastrointestinal disorder of the esophagus. It is a chronic, progressive disorder that presents most typically with heartburn and regurgitation and atypically with chest pain, dysphagia, chronic cough, globus, or sore throat. The mainstay for diagnosis and characterization of the disorder is esophagoduodenoscopy (EGD), high-resolution esophageal manometry, and symptom-associated ambulatory esophageal pH impedance monitoring. Additional studies that can be useful in certain clinical presentations include gastric scintigraphy and oral contrast upper gastrointestinal radiographic series. DiscussionRefractory GERD can be surgically managed with various techniques. In obese individuals, laparoscopic Roux-en-Y gastric bypass should be considered due to significant symptom improvement and lower incidence of recurrent symptoms with weight loss. Otherwise, laparoscopic Nissen fundoplication is the preferred surgical technique for treatment of this disease with concomitant hiatal hernia repair when present for either procedure. The short-term risks associated with these procedures include esophageal or gastric injury, pneumothorax, wound infection, and dysphagia. Emerging techniques for treatment of this disease include the Linx Reflux Management System, EndoStim LES Stimulation System, Esophyx® and MUSE™ endoscopic fundoplication devices, and the Stretta endoscopic ablation system. Outcomes after surgical management of refractory GERD are highly dependent on adherence to strict surgical indications and appropriate patient-specific procedure selection.

Ineffective esophageal motility: clinical, manometric, and outcome characteristics in patients with and without abnormal esophageal acid exposure.

The etiology and clinical impact of ineffective esophageal motility (IEM) remain poorly understood. Unless gastroesophageal acid reflux (GERD) is identified, symptomatic patients with IEM are challenging to treat. We sought to determine whether any clinical or functional characteristics could distinguish those patients with IEM and either normal or abnormal esophageal acid exposure.In this retrospective cohort study, we identified 46 consecutive patients presenting with heartburn, and other GER symptoms who underwent clinical, endoscopic, and functional evaluation that included high-resolution manometry (HRM) and ambulatory pH monitoring. IEM was defined using the Chicago Classification criteria (v.3) as ≥50% ineffective swallows (DCI ≤ 450 mmHg.s.cm). Esophageal acid exposure by ambulatory pH monitoring was considered abnormal when total time with esophageal pH < 4 exceeded 4.2%.Of the 46 IEM patients identified, 19 (mean age: 42 years, 37% female), had normal esophageal acid exposure and 27 patients, mean age 54 years, 33% female, evidence of pathologic acid reflux. There was a 12 years age difference between the groups, with those with normal acid exposure being significantly younger (P < 0.01); the mean body mass index (BMI) was 22.6 ± 0.6 in the normal group and 25.4 ± 0.7 in the abnormal group (P < 0.001); otherwise the groups were endoscopically and histologically similar. Symptoms were not discriminatory and heartburn and regurgitation were the most prevalent in both groups. HRM did not discriminate symptomatic patients with IEM and either normal or abnormal esophageal acid exposure. Proton pump inhibition (PPI) therapy was significantly more effective (74% vs. 10%) in patients with pathologic acid reflux (P < 0.001). As pH exposure becomes abnormal in the context of IEM, there is dominance for supine reflux.IEM appears to be an early, primary event, eventually associated with pathologic acid exposure, particularly supine. Higher BMI is also associated with abnormal esophageal acid exposure in such patients. GER symptoms are not discriminatory in patients with IEM with and without underlying pathologic acid reflux. Clinical response to PPI in such patients depends on the presence of esophageal pathologic acid exposure. Those with IEM and normal acid exposure remain symptomatic and mostly resistant to therapy.

Upper esophageal sphincter abnormalities and high-resolution esophageal manometry findings in patients with laryngopharyngeal reflux

Background: The association between laryngopharyngeal reflux (LPR) and abnormalities of upper esophageal sphincter (UES) and esophageal motility is not clearly known. High-resolution esophageal manometry (HREM) has allowed accurate measurement and evaluation of UES and esophageal function.Goals: To evaluate the UES function and esophageal motility using HREM in patients with LPR and compare them to patients with typical gastroesophageal reflux disease (GERD).Study: All patients evaluated for GERD or LPR symptoms with esophageal function testing including HREM, ambulatory distal pH monitoring and upper endoscopy between 2006 and 2014 were retrospectively studied (n = 220). The study group (group A, n = 57) consisted of patients diagnosed with LPR after comprehensive evaluation. They were compared to patients who had typical GERD symptoms only (group B, n = 98) and patients with both GERD and LPR symptoms (group C, n = 65).Results: Abnormalities in UES pressures and relaxation were found in about one-third of patients in all groups. There were no significant differences between the groups. Group B had higher prevalence of abnormal esophageal motility compared to others (group A vs. B vs. C = 20.8% vs. 28% vs. 12.5%, p = .029). Group B patients also had higher prevalence of Barrett’s esophagus compared to others (group A vs. B vs. C = 0% vs.12.2% vs. 4.6%, p = .01). Distal pH testing revealed no significant differences between the three groups.Conclusions: Abnormal UES function was noted in one-third of patients with LPR or GERD. However, there were no abnormalities on esophageal function testing specific for LPR.

Secrets for successful laparoscopic antireflux surgery: preoperative workup

Gastroesophageal reflux disease (GERD) is a highly-prevalent multifactorial disease, with primary symptoms including heartburn and regurgitation. Despite the widespread pharmacologic treatment of GERD, antireflux surgery is cur-rently the most effective and definitive treatment for the disease. An accurate indication for surgery and the appropriate preoperative workup are the best predictors of surgical success in those patients. Several factors affect the decision of performing anti-reflux surgery, including the patient’s response to anti-acid medication and therapy duration, presence of side-effects, and progression of disease. Other diagnoses, such as esophageal cancer, must also be ruled out. A proper preoperative workup includes esophageal symptom evaluation and esophageal testing. Ambulatory pH testing is the gold standard for GERD diagnosis, and it is crucial for the assessment of the relationship between symptom presen-tation and reflux episodes. High-resolution manometry evaluates esophageal body motility and lower esophageal sphincter function, playing an important role in the definition of the surgical technique to be adopted. Upper GI endoscopy is the exam of choice for the diagnosis of disease progression and presence of other complications. Esophagram provides a detailed anatomy of the esophagus and stomach. In summary, a meticulous preoperative workup done by experts is crucial for improving patient outcomes.

The Physiology and Pathophysiology of Gastroesophageal Reflux in Patients with Laparoscopic Adjustable Gastric Band.

The effect of the laparoscopic adjustable gastric band (LAGB) on esophageal acid exposure and reflux is poorly understood. Optimal technique and normative values for acid exposure have not been established in this group. High-resolution manometry (HRM) and 24-h ambulatory esophageal pH monitoring were performed in three groups: asymptomatic LAGB, symptomatic LAGB, and pre-operative reflux patients. This technique utilized intraluminal pressure signatures during HRM to guide accurate pH sensor placement. The LAGB groups were well matched: age 48 vs 51years (p=0.249), weight loss 27.3 vs 26.7kg (p=0.911). The symptomatic group had a larger gastric pouch (5.2 vs 3.3cm, p=0.012), with higher esophageal acid exposure (10.8 vs 0.9%, p<0.001). Two acidification patterns were observed: irritant and volume acidification, associated with substantial supine acidification. Symptomatic LAGB had altered esophageal motility, with poorer lower esophageal sphincter basal tone (8.0 vs 17.7mmHg, p=0.022) and impaired contractility of the lower esophageal segment (90 vs 40%, p=0.009). Compared to pre-operative reflux patients, symptomatic LAGB patients demonstrated higher total and supine esophageal acid exposure (10.8 vs 7.0%, p=0.010; 14.9 vs 5.1%, p<0.001), less symptoms (2 vs 6, p=0.001) and lower symptom index (0.7 vs 0.9, p=0.010). Ambulatory pH monitoring is an effective technique if the pH sensor is positioned appropriately using HRM. The correctly positioned LAGB appears associated with low esophageal acidification. In contrast, patients with symptoms or pouch dilatation can have markedly elevated esophageal acidification, particularly when supine. This is a different pattern compared to pre-operative patients and importantly can be disproportionate to symptoms.

Mo1512 - Characterization of High Resolution Manometry (HRM) and Ambulatory PH Findings in Patients Being Evaluated for Bariatric Surgery

Mo1512 - Characterization of High Resolution Manometry (HRM) and Ambulatory PH Findings in Patients Being Evaluated for Bariatric Surgery

Research on Gastroesophageal Reflux Disease Based on Dynamic Features of Ambulatory 24-Hour Esophageal pH Monitoring.

Ambulatory 24-hour esophageal pH monitoring has been considered as the gold standard for diagnosing gastroesophageal reflux disease (GERD), and in clinical application, static parameters are widely used, such as DeMeester score. However, a shortcoming of these static variables is their relatively high false negative rate and long recording time required. They may be falsely labeled as nonrefluxers and not appropriately treated. Therefore, it is necessary to seek more accurate and objective parameters to detect and quantify GERD. This paper first describes a new effort that investigated the feasibility of dynamic features of 24-hour pH recording. Wavelet energy, information entropy, and wavelet entropy were estimated for three groups (severe, mild-to-moderate, and normal). The results suggest that wavelet energy and entropy are physiologically meaningful since they differentiated patients with varying degrees of GERD. K-means clustering algorithm was employed to obtain the sensitivity and specificity of new parameters. It is obvious that information entropy goes with the highest sensitivity of 87.3% and wavelet energy has the highest specificity of 97.1%. This would allow a more accurate definition of the best indicators to detect and quantify GERD as well as provide an alternative insight into the early diagnosis of GERD.

The Additional Role of Symptom-Reflux Association Analysis of Diagnosis of Gastroesophageal Reflux Disease Using Bravo Capsule pH Test

Since the development of ambulatory esophageal pH monitoring test to diagnose gastroesophageal reflux disease (GERD), several parameters have been introduced. The aim of this study was to assess whether using the symptom index (SI), symptom sensitivity index (SSI), and symptom association probability (SAP), in addition to the DeMeester score (DS), would be useful for interpreting the Bravo pH monitoring test. A retrospective study, which included 68 patients with reflux symptoms refractory to proton pump inhibitor (PPI) therapy who underwent a Bravo capsule pH test between October 2006 and May 2015, was carried out. Acid reflux parameters and symptom reflux association parameters were analyzed. The median percent time of total pH<4 and DS were 2.90% (interquartile range [IQR] 1.13-6.03%) and 11.10 (IQR 4.90-22.80), respectively. According to the analysis of the day-to-day variation in percent time of total pH<4 (r=0.724) and DS (r=0.537), there was a significant correlation between Day 1 and Day 2. The positive rate of Bravo test according to DS was 27 (39.7%). Although thirty patients experienced symptoms during the test, there were no significant differences of reflux parameters compared with other patients. In the symptom group, 7 patients (23.3%) were identified as having negative DS and an abnormal symptom-related index. There were no significant test-related complications. In addition to the analysis of traditional acid parameters of the Bravo capsule pH test, diagnosis of GERD, including reflux hypersensitivity, can be improved by performing an analysis of the symptom-reflux association and of the day-to-day variation.

Laryngopharyngeal reflux disease (LPRD) –Review article-

Laryngopharyngeal reflux disease (LPRD) is caused by the back-flow of stomach contents and/or gastric acid into the laryngopharynx. Symptoms of laryngopharyngeal reflux (LPR) include hoarseness, sore throat, throat-clearing, chronic cough, globus sensation, dysphagia, and postnasal drip. LPRD is diagnosed in approximately 10% of patients presenting to outpatient otolaryngology clinics and in more than 50% of patients presenting with voice complaints. Gastroesophageal reflux disease (GERD) and LPRD may be associated with periodontitis, sleep disorders, and otolaryngology disease.Gastric acid reflux with LPRD is thought to cause laryngeal granulomas.The most useful endolaryngeal signs for diagnosing LPRD are erythema, edema, and interarytenoid hypertrophy. Ambulatory 24-h dual-probe pH monitoring can be misleading; false-positive outcomes may occur due to artifacts in the upper probe, and false-negative outcomes can occur as a result of the intermittent character of reflux episodes. In patients with LPRD, proton pump inhibitors (PPIs) have been shown to significantly improve reflux laryngitis. However, some patients are resistant to antacid therapy. Nocturnal acid breakthrough (NAB) on PPI has been suggested as one reason for resistance to PPI therapy. Administration of a PPI with the additional bedtime administration of a histamine-2 receptor antagonist has been shown to be an effective treatment of LPRD with NAB. Recently, potassium-competitive acid blockers have been proposed as an effective treatment of antacid-resistant disease.

Role of gastroesophageal reflux disease in lung transplantation.

Lung transplantation is one of the highest risk solid organ transplant modalities. Recent studies have demonstrated a relationship between gastroesophageal reflux disease (GERD) and lung transplant outcomes, including acute and chronic rejection. The aim of this review is to discuss the pathophysiology, evaluation, and management of GERD in lung transplantation, as informed by the most recent publications in the field. The pathophysiology of reflux-induced lung injury includes the effects of aspiration and local immunomodulation in the development of pulmonary decline and histologic rejection, as reflective of allograft injury. Modalities of reflux and esophageal assessment, including ambulatory pH testing, impedance, and esophageal manometry, are discussed, as well as timing of these evaluations relative to transplantation. Finally, antireflux treatments are reviewed, including medical acid suppression and surgical fundoplication, as well as the safety, efficacy, and timing of such treatments relative to transplantation. Our review of the data supports an association between GERD and allograft injury, encouraging a strategy of early diagnosis and aggressive reflux management in lung transplant recipients to improve transplant outcomes. Further studies are needed to explore additional objective measures of reflux and aspiration, better compare medical and surgical antireflux treatment options, extend follow-up times to capture longer-term clinical outcomes, and investigate newer interventions including minimally invasive surgery and advanced endoscopic techniques.

Pathophysiology and Clinical Applications of Gastro-Esophageal Reflux Disease

Gastro-esophageal reflux disease is a persistent affliction of gastrointestinal tract upper part with the growing prevalence throughout the world. By the time there has been an increase in the cognizance of its pathophysiology, clinical presentation and management. The disease could be identified easily by the symptoms. Many of the risk components are involved in the occurrence of disease including medications, obesity, pregnancy and asthma. It can be diagnosed by a number of procedures like manometry, ambulatory pH monitoring , endoscopy and radiology. Although different drugs are being utilized to treat GERD but PPIs (Proton pump inhibitors) have shown remarkable achievement in the curing the disease. When proton pump inhibitors are utilized for the extended period several of the safety ways are being explored to avoid any side effect. There has been a debate over the use of long term medications and surgery for quite a long time. Although both surgery and long term usage of PPI’s have proven effective in managing the disease.

A Review of Diagnosis of GERD.

The prevalence of gastroesophageal reflux disease (GERD) and the incidence of some of its complications have risen strikingly over the last few decades. With the accumulation in our understanding on the pathophysiology of GERD along with the development of proton pump inhibitors, the diagnostic and therapeutic approaches to the GERD have changed dramatically over the past decade. However, The GERD still poses a problem to many clinicians since the spectrum of the disease has evolved to encompass more challenging presentations such as refractory GERD and extraesophageal manifestations. The aim of this article was to provide a review of available current diagnostic tests of the GERD, includes proton pump inhibitor test, ambulatory pH monitoring, impedance pH monitoring, mucosa impedance, and high resolution manometry. This review discusses different modalities for the work up of GERD.

Diagnosis of gastro-oesophageal reflux disease and its associated conditions

As the prevalence of gastro-oesophageal reflux disease (GORD) continues to rise, diagnostic modalities are crucial to differentiate GORD from related and overlapping conditions such as Barrett's oesophagus (BO), eosinophilic oesophagitis (EO) and jackhammer oesophagus (JO). Patient medical history and symptom assessment are critical in the diagnosis of GORD, and endoscopy should be utilized when patients present with alarming symptoms or are unresponsive to proton pump inhibitors. Ambulatory pH monitoring is the modality with the highest sensitivity and specificity; it is particularly helpful in unclear cases and during preoperative testing. BO is a consequence of GORD and a well-known preneoplastic condition; endoscopic evaluation is required. EO and JO are important overlapping conditions that should be differentiated when diagnosing GORD; JO is typically diagnosed using high-resolution manometry whereas EO is typically diagnosed by measuring rates of infiltrating eosinophils.

Laryngopharyngeal reflux and chronic rhinosinusitis

Chronic rhinosinusitis(CRS) is a highly prevalent disease, it affects approximately 2%-16% of the adult population. The prevalence of CRS is higher in patients with comorbid diseases, such as asthma, chronic obstructive pulmonary disease, and environmental allergies. The risk factors for chronic rhinosinusitis include genetic mutation, comorbid airway diseases and environmental factors.In recent years, some studies indicated that laryngopharyngeal reflux(LPR) was the potential risk factor for CRS. LPR is a kind of extraesophageal reflux.The diagnostic criteria for LPR include abnormal reflux symptom index, reflux findings score and ambulatory 24h double pHprobe monitoring. The pathogenic mechanisms involved in CRS related to LPR remains obscure. Some researches had shown that antireflux treatment could improve the syndrome of CRS patients. Further studies are need to explore the relationship between LPR and CRS.

A New Algorithm to Reduce the Incidence of Gastroesophageal Reflux Symptoms after Laparoscopic Sleeve Gastrectomy.

Laparoscopic sleeve gastrectomy (LSG) is one of the most prefered treatment option for morbid obesity. However, the effects of LSG on gastroesophageal reflux disease (GERD) are controversial. Asymptomatic GERD and hiatal hernia (HH) is common in obese patients. Therefore, it is important to identify the high risk patients prior to surgery. This study aims to evaluate efficacy of cruroplasty for HH during LSG in morbidly obese patients using ambulatory pH monitoring (APM) results, and to investigate the patients' selection criteria for this procedure. This retrospective study includes outcomes of 59 patients who underwent LSG and HH repair according to our patient selection algorithm. Outcomes included preoperative GERD Health-Related Quality of Life (GERD-HRQL) questionnaire, APM results, percentage of postoperative excess weight loss, and total weight loss. For a total of 402 patients, APM was applied in 70 patients who had a positive score of GERD-HRQL, and 59 patients underwent LSG and concomitant HH repair who had a DeMeester score of 14.7% or above. There was no statistically significant difference in weight loss at 6 and 12-month follow-up. Two patients (3.3%) had symptoms of GERD at 12months postoperatively, and only one (1.6%) patient required treatment of proton pump inhibitor for reflux. In the total cohort, 11 (2.7%) patients also evolved de novo GERD symptoms. This study confirm that careful attention to patient selection and surgical technique can reduce the symptoms of GERD at short-term. Routine bilateral crus exploration could be a major risk factor of postoperative GERD.

Clinical and pH study characteristics in reflux patients with and without ineffective oesophageal motility (IEM)

BackgroundThe aetiology and clinical impact of ineffective oesophageal motility (IEM) remain poorly understood, but the condition is thought to worsen supine gastro-oesophageal acid reflux (GERD).AimsIn this retrospective cohort analysis of...