Changes In Gastroesophageal Reflux Disease Research Articles

Esophageal Motility Abnormalities in Lung Transplant Recipients With Esophageal Acid Reflux Are Different From Matched Controls.

There is an increased incidence of gastroesophageal reflux disease (GERD) after lung transplantation (LT) that can be associated with graft dysfunction. It is unclear if the underlying esophageal motility changes in GERD are different following LT. This study aimed to use esophageal high-resolution manometry (HRM) to explore GERD mechanisms in LT recipients compared to matched controls. This was a retrospective study including patients with pathologic acid reflux who underwent HRM and pH testing at our healthcare facility July 2012 to October 2019. The study included 12 LT recipients and 36 controls. Controls were matched in a 1:3 ratio for age, gender, and acid exposure time (AET). LT recipients had less hypotensive esophagogastric junction (EGJ) (mean EGJ-contractile integral 89.2 mmHg/cm in LT vs 33.9 mmHg/cm in controls, P < 0.001). AET correlated with distal contractile integral and total EGJ-contractile integral only in LT group (r = -0.79, P = 0.002 and r = -0.57, P = 0.051, respectively). Following LT, acid reflux is characterized by a less hypotensive EGJ compared to controls with similar AET. The strongest correlation with AET after LT was found to be esophageal peristaltic vigor. These results add to the understanding of reflux after LT and may help tailor an individualized treatment plan.

Gastroesophageal reflux in lockdown.

This study examines the changes in gastroesophageal reflux disease (GERD) symptom frequency among patients with GERD throughout the COVID-19 pandemic. A structured questionnaire was distributed among 198 GERD patients. The questionnaire consisted of a demographic characteristic assessment, the GerdQ questionnaire, and a reflux symptom index (RSI) questionnaire. A statistically significant increase in GerdQ score was identified among participants during the COVID-19 pandemic (t=7.055, df=209, p<0.001), who had experienced an increase in the frequency of positive predictors of GERD and a decrease in the frequency of negative predictors of GERD. The COVID-19 pandemic and its related lockdown countermeasures may have led to exacerbating and worsening GERD symptoms.

Functional Changes of the Upper Esophageal Sphincter in Gastroesophageal Reflux

Introduction The upper esophageal sphincter (UES) is a muscular structure located at the transition from the pharynx to the esophagus, with the cricopharyngeal muscle as the most important component. During gastroesophageal reflux, the pressure in the UES elevates, which is apparently a protective mechanism to prevent esophagopharyngeal reflux and airway aspiration. In gastroesophageal reflux disease (GERD), there may be functional changes in the UES. Objective The objective of the present review was to determine UES functional changes in GERD. Data Synthesis In healthy individuals, gastroesophageal reflux causes an increase in the UES pressure. This response of the sphincter is at least partially impaired in patients with GERD. In the disease, the UES has a reduced length and decreased resting pressure. However, other publications found that in chronic gastroesophageal reflux the basal sphincter pressure increase, differences which may be consequent to the measurement method or to disease severity. The UES opening during swallowing has a smaller diameter, and the bolus transit time through the sphincter is longer. Conclusion The UES of patients with GERD does not open as expected and the bolus flow through the sphincter is longer. This behavior may be associated with dysphagia, a frequent complaint in patients with GERD.

Non-dental oral cavity findings in gastroesophageal reflux disease: a systematic review and meta-analysis

Gastroesophageal reflux disease (GERD) is known as the most prevalent gastrointestinal disorder in the United States, leading to substantial morbidity, although associated mortality is rare. Based on the appearance of esophageal mucosa on upper endoscopy, GERD is divided into erosive esophagitis (ERD) and nonerosive reflux disease (NERD). Heartburn and acid regurgitation are the typical symptoms of the disease, although some patients may present atypical manifestations such as epigastric pain, nausea, asthma, chronic cough, pharyngitis, laryngitis, sleep disturbances, otitis, and sinusitis. Other signs, such as oral mucosal lesions may result from GERD by direct acid or acidic vapor contact in the oral cavity. Oral manifestations such as tooth erosion, periodontitis, gingivitis, palatal erythema, ulceration, glossitis, oral acid burning sensation, halitosis, xerostomia have recently been reported in GERD patients. A considerable percentage of the patients are affected by oral manifestations before the onset of gastrointestinal symptoms, although in most cases the gastrointestinal signs and symptoms dominate the clinical picture. The injured oral mucosa negatively impacts the quality of life, especially functional limitation, physical inability and psychological disabilities, thus leading to social isolation. There is plenty of non-standardized information on the oral mucosal changes in GERD. In this context, we aimed at synthesizing and analyzing the current available evidence on non-dental oral cavity lesions and complaints that are present in patients diagnosed with GERD.

DIAGNOSTIC VALUE OF MORPHOLOGICAL CHANGES IN GASTROESOPHAGEAL REFLUX DISEASE IN BIOPSY MATERIAL OF THE DISTAL ESOPHAGUS IN ADOLESCENTS SICKLY WITH ACUTE RESPIRATORY DISEASES

The article dedicated to the problem of the diagnostic value of morphological changes in gastroesophageal reflux disease in the biopsy of the distal esophagus in pubertal children of childbearing age. Aim of the research is to investigate the diagnostic value of morphological changes in gastroesophageal reflux disease in esophageal biopsy material in adolescents sickly with acute respiratory diseases. Methodology. The objective of the study was achieved through examination of 90 adolescents (10 to 16 years old, average age 13.1±3.54 years) kept under observation at the Children’s Clinical Hospital No. 9 of Kyiv and on the basis of the Department of Pediatrics No. 1 Center of Primary Health Care No. 4 of the Desnianskyi district of Kyiv. All adolescents belonged to the group of sickly with a number of respiratory diseases averaging 6-8 times a year, lasting from 8 to 18 days (on average 12.8±5.41 days). All children have undergone endoscopic examination of the esophagus, stomach and duodenum with the esophagus mucosa biopsy using the OLYMPUS GIF-P3 flexible fiberscope. Results. It was found that the least valuable diagnostic feature in the morphological examination of the mucous membrane of the distal esophagus in the pain-causing children with GERD was thickening of the epithelium with a sensitivity of 13,0 %, a specificity of 96.0 %, and total value of 65.0 %. It has been proved that hyperplasia of cells of the basal layer of the mucous membrane of the distal esophagus at the GERD in the infected children is 46.7 % (specificity – 93.3 %, the total value is 75.6 %). Increase in the number of papillae and their prolongation in 33.3 % cases (sensitivity – 33.3 %, specificity – 93.3 %, overall diagnostic value – 70.8 %). Conclusion. The peculiarity of the morphological manifestations of GERD in childbearing children is dystrophic changes in keratocytes in the superficial parts of the multilayer squamous epithelium, which are detected at 100.0 % of patients (specificity is 93.3 %, total value is 96.8 %), with parakeratosis centers at 13.3 % of cases. It has been shown that a frequent and diagnostically valuable indication is inflammatory infiltration of the esophageal mucosa, which are verified in all cases (100.0 %, with dilatation and hyperemia in 46.7 % of patients (specificity – 40.0 %, total value – 81.3 %).

How the pathologist can aid in the assessment of gastroesophageal reflux disease.

To provide new concepts regarding the early pathologic changes of gastroesophageal reflux disease (GERD) that are associated with damage to the lower esophageal sphincter (LES). A body of evidence exists that cardiac mucosa is a metaplastic esophageal epithelium rather than a normal gastric epithelium. Recent studies in asymptomatic volunteers suggest a potential mechanism for cardiac metaplasia in the squamous epithelium of the esophagus. The concept that cardiac mucosa is esophageal, not gastric, suggests that the widely accepted endoscopic definition of the gastroesophageal junction (GEJ) is incorrect. I propose that the true GEJ is the proximal extent of gastric oxyntic epithelium. If there is cardiac mucosa lining proximal rugal folds, that cardiac mucosa-lined region is the dilated distal esophagus, not the proximal stomach. The dilated distal esophagus is the pathologic expression of damage to the abdominal segment of the LES. This concept suggests a new test for measuring damage to the abdominal LES and a new understanding of the disease of GERD based on the measured amount of LES damage. This opens the door to new research and change in objectives in the management of reflux disease from control of symptoms to prevention of complications such as Barrett's esophagus and adenocarcinoma.

Особливості ендоскопічних змін при гастроезофагеальній рефлюксній хворобі у хворих на цукровий діабет ІІ типу

Особливості ендоскопічних змін при гастроезофагеальній рефлюксній хворобі у хворих на цукровий діабет ІІ типу

Improved Cough and Cough-Specific Quality of Life in Patients Treated for Scleroderma-Related Interstitial Lung Disease: Results of Scleroderma Lung Study II

Cough is a common symptom of scleroderma-related interstitial lung disease (SSc-ILD), but its relationship to other characteristics of SSc-ILD, impact on cough-specific quality of life (QoL), and response to therapy for SSc-ILD have not been well studied. We investigated frequent cough (FC) in patients with SSc-ILD (N= 142) enrolled in the Scleroderma Lung Study II, a randomized controlled trial comparing mycophenolate mofetil (MMF) and oral cyclophosphamide (CYC) as treatments for interstitial lung disease (ILD). We determined the impact of FC on QoL (Leicester Cough Questionnaire [LCQ]), evaluated the change in FC in response to treatment for SSc-ILD, and examined the relationship between gastroesophageal reflux disease (GERD) and cough during the trial. Study participants who reported FC at baseline (61.3%) reported significantly more dyspnea, exhibited more extensive ILD on high-resolution CT, had a lower diffusing capacity for carbon monoxide, and reported more GERD symptoms than did those without FC. Cough-specific QoL was modestly impaired in patients with FC (total LCQ score, 15.4 ± 3.7; normal range, 3-21 [higher scores indicate worse QoL]). The proportion of patients with FC at baseline declined by 44%and 41%over 2 years in the CYC and MMF treatment arms, respectively, and this decline was significantly related to changes in GERD and ILD severity. FC occurs commonly in SSc-ILD, correlates with both the presence and severity of GERD and ILD at baseline, and declines in parallel with improvements in both ILD and GERD over a 2-year course of therapy. Frequent cough might serve as a useful surrogate marker of treatment response in SSc-ILD trials. ClinicalTrials.gov; No.: NCT00883129; URL: www.clinicaltrials.gov.

Clinical, endoscopic and histologic evaluation of gastroesophageal reflux disease in patients treated with proton pump inhibitor: a prospective study

This study was done to demonstrate the histological changes in gastroesophageal reflux disease (GERD) before and after proton pump inhibitor (PPI) therapy as well as, to evaluate the efficacy of PPI in patients with GERD and to find out the healing rate of erosion in erosive reflux disease after PPI therapy. This hospital based prospective study was conducted among 57 patients suffering from gastroesophageal reflux disease who were recruited from the outpatient department of gastroenterology of Bangabandhu Sheikh Mujib Medical University. It was carried out from May 2008 to December 2008. Most of the GERD patients had non erosive disease (63.2% vs 36.8%). PPI was effective to relieve the major symptoms of GERD. In erosive group (n=21), at the end of 28th day, heartburn was present in 3(14.3%) patients. In non-erosive group (n=36), at the end of 28th day heartburn was present in 6(16.7%) patients. Changes in histological parameters were also found to be significant before and after therapy. GERD patients had characteristic histologic changes in lower esophagus and after 4 weeks of treatment with PPI, there was significant improvement of symptoms, endoscopic and histological features of reflux disease.Bangladesh Med J. 2015 Sep; 44 (3): 121-124

Laparoscopic Nissen fundoplication mainly reduces the volume of acid reflux and potentially improves mucosal integrity up to the middle esophagus in neurologically impaired children detected by esophageal combined pH–multichannel intraluminal impedance measurements

BackgroundThe aim of this study was to evaluate detailed changes of gastroesophageal reflux disease (GERD) in children before and after laparoscopic Nissen fundoplication (LNF) utilizing esophageal combined pH–multichannel intraluminal impedance (pH/MII) measurements. Patients and methodsThirteen patients with neurological impairment, who received laparoscopic Nissen fundoplication (LNF) owing to refractory pathological GERD, were enrolled in this study. 24h pH/MII was conducted in all patients before and one year after LNF. Each parameter of the pH/MII was evaluated and compared each other. ResultsBoth the mean pH index and bolus exposure index after LNF were significantly lower than those before LNF. The mean numbers of total and nonacid reflux episodes after LNF were significantly lower than those before LNF. The mean numbers of total, acid and nonacid proximal reflux episodes after LNF were significantly lower than those before LNF. The mean baseline impedance values from Z3 to Z6 after LNF were significantly higher than those before LNF. ConclusionsThe present study provides new insights into the effects of LNF in pediatric patients, which prevents mainly acid reflux episodes from rising to the proximal esophagus, and is expected to improve the mucosal integrity up to the middle esophagus.

A Clinicopathologic Study of Oral Changes in Gastroesophageal Reflux Disease, Gastritis, and Ulcerative Colitis.

The aim and objectives of this study are to identify oral changes in certain gastrointestinal (GI) diseases, namely gastroesophageal reflux disease (GERD), ulcerative colitis, gastritis, and to evaluate these oral symptoms as indicators for assessing GI disorders. In this study, the oral manifestations of various GI disorders were assessed in a varying age group of 250 patients in Government Stanley Medical College and Hospital, Chennai. Out of 250 patients, 142 were affected by GERD, 99 were affected by gastritis, and 9 patients were affected by ulcerative colitis. Of these patients, 177 were males and 73 were females. Evaluation of patients with gastritis revealed that 66.7% affected with gingivitis, 19.2% with dental erosion on the palatal and lingual aspects of maxillary and mandibular teeth predominantly in the anterior region, 10.1% with periodontitis, 2% with gingival erythema. Among the patients with GERD, 44% of the cases showed dental erosion, 25.5% periodontitis, 9.9% gingivitis, 5.7% gingival erythema, 2.8% palatal erythema, 2.1% gingival ulcers, glossitis 2%, 1.4% floor of the mouth erythema, and 0.7% erythema of the tongue. Patients with ulcerative colitis showed 44.4% of gingival erythema, 33.3% of dental erosions, and 22.2% of gingival ulcers and periodontitis. In our study of 250 patients, oral manifestations were observed in 88% of the patients. Both soft tissue and hard tissue changes were evident. There was a high correlation between various GI disease and dental erosion, erythema at various sites of the oral cavity, oral ulcers, gingivitis, periodontitis, and glossitis. Careful evaluation of oral cavity may unveil many GI disorders and help the patient by providing early diagnosis, which further facilitates the prognosis.

Visceral Hypersensitivity in Non-erosive Reflux Disease: Neurogenic Overwhelming in Esophagus?

The mechanism underlying the pathogenesis of heartburn and chest pain in gastro-esophageal reflux disease (GERD) has not been clearly established. An important advance in understanding how heartburn is experienced has been accomplished with the reporting of dilated intracellular spaces (DIS) in the esophageal mucosa of patients with erosive GERD and non-erosive reflux disease (NERD) [1]. Although the presence of DIS provides a theoretical pathway for direct entry of hydrogen ions into the mucosa [2], its relationship to esophageal barrier function is still controversial since there are no direct measurements of esophageal acid permeability in vivo to support its contribution to barrier function. Another important breakthrough is the detection of transient receptor potential vanilloid subfamily member-1 receptors (TRPV1) in the esophageal mucosa [3], which may potentially contribute to visceral hypersensitivity as one of the important mechanisms in patients with NERD [4]. This notion is supported by the observation that perception of heartburn and esophageal sensitization can be induced by TRPV1 activation after the exposure to capsaicin and related TRPV1 activators such as heat and acid [5]. TRPV1 activation has also been hypothesized to induce neurogenic inflammation by the release of substance P and calcitonin-gene-related peptide (CGRP) in primary afferent neurons [6]. These neuropeptides mediate nociception and neurogenic inflammation via neurokinin 1 receptor (NK1R) for substance P and receptor activity-modifying protein 1 (RAMP1) for CGRP [7–9]. Therefore, the upregulation of TRPV1 expression in the esophageal mucosa is likely explanation for the phenomenon of visceral sensitization in NERD. Moreover, an induction of proteinase-activated receptor-2 (PAR-2) expression was reported in the esophageal mucosa of GERD patients, which correlated well with mucosal inflammatory changes and elevated tissue interleukin (IL)-8 concentrations, providing a possible mechanism for proinflammatory changes in GERD [10]. Furthermore, PAR-2 also mediates nociception via the release of substance P [11]. Finally, although anion-sensing ion channels (ASICs) have been implicated in the chemosensitivity in primary afferent fibers [12], its clinical implication is yet unclear in GERD and is thought to be more likely referred to the mechanosensitivity of the esophagus. In this issue of Digestive Diseases and Sciences [13], Yoshida et al. test the hypothesis regarding the role of nociceptors and neuropeptides in the pathogenesis of visceral hypersensitivity of NERD by examining the expression of acid-sensitive nociceptors including TRPV1, ASIC3, PAR-2, and neuropeptides such as substance P and CGRP with their cognate receptors NK1R and RAMP1 in the esophageal mucosa of NERD patients as compared with age-matched healthy controls. Not surprisingly, increased mRNA expression for TRPV1 and PAR-2 was present in the esophageal mucosa of NERD patients accompanied by a similar increase in substance P protein level and mRNA of its receptor NK1R. They also reported the presence of substance P-positive and CGRP-positive nerves in lamina propria of the esophageal mucosa of their patients by immunohistochemistry. They reported a positive correlation between substance P protein level and acid reflux score. Their data suggest that visceral hypersensitivity in NERD patients appears to be related to nociception and neurogenic inflammation, which supports their hypothesis C.-L. Chen (&) Department of Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien 970, Taiwan e-mail: harry.clchen@msa.hinet.net

Changes in Ghrelin-Related Factors in Gastroesophageal Reflux Disease in Rats

To examine gastrointestinal hormone profiles and functional changes in gastroesophageal reflux disease (GERD), blood levels of the orexigenic hormone ghrelin were measured in rats with experimentally induced GERD. During the experiment, plasma acyl ghrelin levels in GERD rats were higher than those in sham-operated rats, although food intake was reduced in GERD rats. Although plasma levels of the appetite-suppressing hormone leptin were significantly decreased in GERD rats, no changes were observed in cholecystokinin levels. Repeated administration of rat ghrelin to GERD rats had no effect on the reduction in body weight or food intake. Therefore, these results suggest that aberrantly increased secretion of peripheral ghrelin and decreased ghrelin responsiveness may occur in GERD rats. Neuropeptide Y and agouti-related peptide mRNA expression in the hypothalamus of GERD rats was significantly increased, whereas proopiomelanocortin mRNA expression was significantly decreased compared to that in sham-operated rats. However, melanin-concentrating hormone (MCH) and prepro-orexin mRNA expression in the hypothalamus of GERD rats was similar to that in sham-operated rats. These results suggest that although GERD rats have higher plasma ghrelin levels, ghrelin signaling in GERD rats may be suppressed due to reduced MCH and/or orexin synthesis in the hypothalamus.

963 Esophageal Electrical Tissue Impedance Spectroscopy Can Detect Esophageal Permeability Changes in Gastroesophageal Reflux Disease During Upper Endoscopy

963 Esophageal Electrical Tissue Impedance Spectroscopy Can Detect Esophageal Permeability Changes in Gastroesophageal Reflux Disease During Upper Endoscopy

Effect of adjustable gastric banding on changes in gastroesophageal reflux disease (GERD) and quality of life

Objective:Bariatric surgery is an effective treatment for the reduction of weight in obese patients (BMI ≥ 40 kg/m2 or 30 kg/m2 with ≥1 comorbidities), who are refractory to behavioral and medical therapies. This study examined the effect of the adjustable gastric band (AGB) system on changes in gastroesophageal reflux disease (GERD) and patient-reported outcomes, including measures of quality of life.Methods:Two-year interim analysis of patients (N = 171) in the 5 year, prospective APEX study who reported GERD prior to the AGB procedure. An unrecorded number of hiatal hernia repairs were conducted during the APEX study.Results:At baseline, 171 of 395 patients (43%) reported GERD requiring daily medical therapy. After 2 years, 122 patients had sufficient data to assess outcome (71%). Complete resolution of GERD was reported in 98 patients (80%), improvement in 13 (11%), no change in 9 (7%), and worsening in 2 (2%). Overall, 91% of GERD patients experienced resolution and/or improvement of GERD. Baseline BMI was not significantly different among the GERD response categories (resolved, improved, and stable/worse), p = 0.4581. Mean ΔBMI and percentage excess weight loss (%EWL) were: −8.8 kg/m2/−0.9%, −11.4 kg/m2/−53.9%, −6.4 kg/m2/−36.1%, and −7.1 kg/m2/−31.2%, respectively. There were no significant differences in reductions in BMI or %EWL between responder groups (resolved versus stable/worse ΔBMI p = 0.1031, %EWL p = 0.0667 OR resolved/improved versus stable/worse ΔBMI p = 0.0918, %EWL p = 0.0552). After 2 years, resolution or improvement occurred in pre-existing comorbidities: type 2 diabetes (96%), hypertension (91%), hyperlipidemia (77%), obstructive sleep apnea (86%), osteoarthritis (93%), and depression (75%). Patient satisfaction with AGB was assessed as: very satisfied/satisfied (87%), very satisfied (50%), dissatisfied (5.0%). Quality of life measured by the Obesity and Weight-Loss Quality of Life Instrument (GERD patients) significantly improved from baseline.Conclusion:Obese patients with GERD had meaningful improvement in patient-reported outcomes with the AGB system. In addition, other obesity-related comorbidities and measures of quality of life improved.

High resolution endoscopic features of nonerosive reflux disease

Objective To detect the changes of gastroesophageal reflux disease （GERD） with high resolution endoscopy, and to explore its diagnostic value for nonerosive reflux disease （NERD）. Methods From April 2007 to January 2008, consecutive out-patients visiting the Department of Gastroenterology due to continuous or recurrent symptoms of acid reflux, heartburn, cardiac-like chest pain for at least three months and volunteer healthy controls were recruited to the study. The subjects were classified into the normal group （n =48）, the NERD group （n =70）, the erosive esophagitis （EE） group （n =70）, and the Barrett esoph- agus （BE） group （ n = 48）. All subjects underwent endoscopy, and the shape of Z-lines, the shape of mu- cosal pits, mucosa roughness above Z-line and the shape of mucosal blood vessels were observed. The NERD changes were analyzed with optimal scale. Results Z-line shape of NERD group showed a significant differ- ence from that of EE and BE groups （P 〈 0. 01 ）, which was not different from that of normal controls （P 〉 0.01 ）. The shape of mucosal pits of NERD group was different from that of EE and BE （P 〈0.01 ）, which also was not different from that of control （P 〉 0.01 ）. Roughness of the mucosa above Z-line of NERD group was different from other 3 groups （P 〈 0. 05）. And the shape of mucosal blood vessels of NERD was different from the control （P 〈 0.05 ）, but was not from two others. Features of NERD relative images were thin, straight and spiral blood vessels, bar-like pits, plat mucosa, round, smooth and wide tooth-like Z-line and mucosa of white particle hypertrophy. Conclusion High resolution endoscopic features of most NERD patients are cloudy, white and rough mucosal surface, with white particular hypertrophy, spiral vascular dilation, extending to Z-line. These features can be indicators of NERD. Key words: Nonerosive reflux disease; High resolution endoscopic; Endoscopic classification; Minimal changes

S1478: The Clinical Significance of Minimal Changes in Gastroesophageal Reflux Disease Based on GerdQ: A Prospective, Multicenter Study - Might Study Group

S1478: The Clinical Significance of Minimal Changes in Gastroesophageal Reflux Disease Based on GerdQ: A Prospective, Multicenter Study - Might Study Group

Evaluation of GERD Symptoms during Therapy

Background/Aims: The changes in gastroesophageal reflux disease (GERD)-related symptoms on treatment are variously described, but currently available questionnaires have shortcomings. We therefore developed a self-assessment reflux questionnaire (ReQuest™). This article describes the process of development and testing. Materials and Methods: For the first version of ReQuest™the symptom spectrum of GERD and the various symptom descriptions were investigated. The 67 identified symptom descriptions were condensed empirically into 6 dimensions, to which a 7th dimension on general well-being was added. The symptom burden of the dimensions was measured by frequency and/or intensity. ReQuest™ was translated into different languages and then tested in focus groups. The initial validation was based on data from a clinical trial of patients with erosive GERD, treated with pantoprazole 20 or 40 mg daily for 28 days. Factor analyses determined the contribution of each symptom to the different dimensions. Additionally, correlation analyses between the identified factors and the dimensions were performed. Results: On the basis of factor analyses, ReQuest™ was reduced to a 60-item scale. The factors generated correlated strongly with the dimensions and confirmed the empirical process mathematically. Conclusion:ReQuest™ provides a valuable, self-assessment tool for evaluating the daily treatment response in patients with erosive GERD.

Evaluation of GERD Symptoms during Therapy. Part I

Background/Aims: The changes in gastroesophageal reflux disease (GERD)-related symptoms on treatment are variously described, but currently available questionnaires have shortcomings. We therefore developed a self-assessment reflux questionnaire (ReQuest^TM). This article describes the process of development and testing. Materials and Methods: For the first version of ReQuest^TM the symptom spectrum of GERD and the various symptom descriptions were investigated. The 67 identified symptom descriptions were condensed empirically into 6 dimensions, to which a 7th dimension on general well-being was added. The symptom burden of the dimensions was measured by frequency and/or intensity. ReQuest^TM was translated into different languages and then tested in focus groups. The initial validation was based on data from a clinical trial of patients with erosive GERD, treated with pantoprazole 20 or 40 mg daily for 28 days. Factor analyses determined the contribution of each symptom to the different dimensions. Additionally, correlation analyses between the identified factors and the dimensions were performed. Results: On the basis of factor analyses, ReQuest^TM was reduced to a 60-item scale. The factors generated correlated strongly with the dimensions and confirmed the empirical process mathematically. Conclusion: ReQuest^TM provides a valuable, self-assessment tool for evaluating the daily treatment response in patients with erosive GERD.

The potential role of the esophageal pre-epithelial barrier components in the maintenance of integrity of the esophageal mucosa in patients with endoscopically negative gastroesophageal reflux disease

OBJECTIVE: Patients with gastroesophageal reflux disease (GERD) accompanied by erosive reflux esophagitis (RE) exhibit an impairment within the esophageal pre-epithelial barrier protective components that may facilitate the development and/or progression of the mucosal injury. Little is known, however, whether such impairment is a general phenomenon affecting all patients with GERD or whether this is a characteristic feature only of patients with erosive RE. We therefore studied the rate of secretion of esophageal inorganic and organic protective factors in patients with endoscopically negative [E (−)] GERD and compared these results with the corresponding values in asymptomatic volunteers (CTRL). METHODS: The study was conducted on 33 white asymptomatic volunteers and 10 white patients with a long history of GERD confirmed by 24-h pH monitoring and a grossly negative upper endoscopy. Esophageal secretion was collected during mucosal exposure to NaCl, HCl, HC/pepsin and NaCl using the esophageal perfusion catheter. In collected samples all investigated parameters were measured. RESULTS: The pH of esophageal secretion and its content of bicarbonate, EGF, and PGE 2 in patients with E (−) GERD and asymptomatic volunteers were similar. Unexpectedly, the rate of esophageal glycoconjugate (predominantly mucin) secretion was significantly higher in patients with E (−) GERD than in controls during perfusion with HCl ( p < 0.05). Furthermore, secretion of protein in patients with E (−) GERD was significantly higher than in the control group during the mucosal exposure to HCl/Pepsin ( p < 0.05). The nonbicarbonate buffer secretion during perfusion with HCl and HCl/Pepsin as well as the rate of esophageal TGFα output during infusion of final saline in patients with E (−) GERD were significantly lower than in CTRL group ( p < 0.05). CONCLUSIONS: Our data indicate that patients with E (−) GERD have an esophageal secretory potential, in terms of glycoconjugate and protein, higher than that in asymptomatic controls. This phenomenon in patients with E (−) GERD may, by enhancing the quantity of the esophageal pre-epithelial barrier, help to prevent the development of erosive esophagitis. A significantly lower esophageal secretory response in patients with E (−) GERD in terms of nonbicarbonate buffers and TGFα may facilitate the development of GERD symptoms and histological changes of GERD, respectively.