Chronic Gastroesophageal Reflux Research Articles

Advanced endoscopic imaging for detection of Barrett's esophagus.

Barrett's esophagus (BE) is the precursor to esophageal adenocarcinoma (EAC), and is caused by chronic gastroesophageal reflux. BE can progress over time from metaplasia to dysplasia, and eventually to EAC. EAC is associated with a poor prognosis, often due to advanced disease at the time of diagnosis. However, if BE is diagnosed early, pharmacologic and endoscopic treatments can prevent progression to EAC. The current standard of care for BE surveillance utilizes the Seattle protocol. Unfortunately, a sizable proportion of early EAC and BE-related high-grade dysplasia (HGD) are missed due to poor adherence to the Seattle protocol and sampling errors. New modalities using artificial intelligence (AI) have been proposed to improve the detection of early EAC and BE-related HGD. This review will focus on AI technology and its application to various endoscopic modalities such as high-definition white light endoscopy, narrow-band imaging, and volumetric laser endomicroscopy.

Esophageal Cancer: Etiology, Modern Treatment Methods and Future Directions

Esophageal cancer (EC) is globally recognized as the sixth most often diagnosed cancer and the eighth most frequent cancer in terms of total occurrence. At the time of diagnosis, it exhibits a notable fatality rate and poor healing outcomes. Esophageal squamous cell carcinoma (ESCC) is commonly brought on by carcinogens entering and exiting the esophageal mucosa directly, such as via mechanical stress, alcohol intake, smoking, and obesity. The main pathophysiologic pathway for esophageal adenocarcinoma (EAC) is chronic gastroesophageal reflux disease (GERD). The treatment of different types of EC varies. The primary strategy for treating locally advanced malignancies is surgery, with the inclusion of neoadjuvant chemotherapy or radiotherapy for combination management. The purpose of adding chemotherapy in EC is to lower the tumor stage, reduce the risk of the tumor, and facilitate subsequent targeted therapy. In this paper, we will discuss the etiology of EC, modern treatment methods and future directions.

Gastro-Esophageal Junction Precancerosis: Histological Diagnostic Approach and Pathogenetic Insights.

Barrett's esophagus (BE) was initially defined in the 1950s as the visualization of gastric-like mucosa in the esophagus. Over time, the definition has evolved to include the identification of goblet cells, which confirm the presence of intestinal metaplasia within the esophagus. Chronic gastro-esophageal reflux disease (GERD) is a significant risk factor for adenocarcinoma of the esophagus, as intestinal metaplasia can develop due to GERD. The development of adenocarcinomas related to BE progresses in sequence from inflammation to metaplasia, dysplasia, and ultimately carcinoma. In the presence of GERD, the squamous epithelium changes to columnar epithelium, which initially lacks goblet cells, but later develops goblet cell metaplasia and eventually dysplasia. The accumulation of multiple genetic and epigenetic alterations leads to the development and progression of dysplasia. The diagnosis of BE requires the identification of intestinal metaplasia on histologic examination, which has thus become an essential tool both in the diagnosis and in the assessment of dysplasia's presence and degree. The histologic diagnosis of BE dysplasia can be challenging due to sampling error, pathologists' experience, interobserver variation, and difficulty in histologic interpretation: all these problems complicate patient management. The development and progression of Barrett's esophagus (BE) depend on various molecular events that involve changes in cell-cycle regulatory genes, apoptosis, cell signaling, and adhesion pathways. In advanced stages, there are widespread genomic abnormalities with losses and gains in chromosome function, and DNA instability. This review aims to provide an updated and comprehensible diagnostic approach to BE based on the most recent guidelines available in the literature, and an overview of the pathogenetic and molecular mechanisms of its development.

EE633 Analysis of Cost-Effectiveness in Switzerland for a New Implantable Device to Treat Chronic Gastroesophageal Reflux Disease

EE633 Analysis of Cost-Effectiveness in Switzerland for a New Implantable Device to Treat Chronic Gastroesophageal Reflux Disease

Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000-2016 cohort.

The study aimed to investigate comorbidities, major adverse respiratory events, and mortality in patients with idiopathic pulmonary fibrosis (IPF). We established an IPF cohort and a comparative cohort matched for sex, age, and the date of IPF diagnosis. We recorded the most frequent comorbidities, the proportions, and time durations to the episode of major adverse respiratory events and death. Both cohorts were followed up to the end of 2016. We included 921 patients in the IPF cohort and 3,677 individuals in the comparative cohort. Comorbidities associated with IPF included pulmonary hypertension, chronic obstructive pulmonary disease, heart failure, asthma, and gastroesophageal reflux disease. The IPF cohort was more likely to have pneumonia (47.6 vs 12.0%), acute respiratory failure (17.8 vs 4.30%), chronic respiratory failure (4.23 vs 0.63%), and death (36.3 vs 15.0%) than the comparative cohort. The time durations to the first episode of pneumonia, acute respiratory failure, chronic respiratory failure, and death were 2.09 ± 2.98, 3.12 ± 3.62, 3.20 ± 4.03, and 3.27 ± 3.03 years in the IPF cohort. In conclusion, patients with IPF had significant comorbidities, particularly pulmonary and cardiovascular comorbidities. The duration from diagnosis to the major adverse respiratory events or death was short.

Revisiting Proton Pump Inhibitors as Chemoprophylaxis Against the Progression of Barrett's Esophagus.

Barrett's esophagus (BE) is associated with chronic gastroesophageal reflux disease and is a known precursor to esophageal adenocarcinoma. While endoscopic surveillance strategies and the role for endoscopic eradication therapy have been well established, there has been much interest in identifying chemopreventive agents to disrupt or halt the metaplasia-dysplasia-carcinoma sequence in patients with BE. No pharmacological agent has held more hope in reducing the risk of neoplastic progression in BE than proton pump inhibitors (PPIs). However, data supporting PPIs for chemoprevention have largely been from observational cohort and case-control studies with mixed results. In this review, we revisit the literature and highlight the role of PPIs in patients with BE as it pertains to chemoprophylaxis against the progression of BE to dysplasia and esophageal adenocarcinoma.

Oral Disintegrating Tablets of Proton Pump Inhibitors for Chronic Gastroesophageal Reflux Disease: An Update.

Oral disintegrating tablets (ODT) offer an attractive choice for Gastroesophageal Reflux Disease (GERD) patients suffering from dysphagia. In chronic condition, GERD patient suffers from severe erosive esophagitis. Thus patients feel difficulty and pain during swallowing, which results in patient in-compliance toward medication of tablets or capsules- especially in geriatrics and pediatric patients. These symptoms of GERD patients have attracted the formulation scientists in improving the formulation methodology for such patients. Orally disintegrating tablets could increase the therapeutic impact and drug compliance in these patients. The aim of this compilation is to provide a more convenient way to develop an oral disintegrating drug delivery system of proton pump inhibitors in patients suffering from odynophagia, associated with chronic Gastroesophageal Reflux Disease (GERD). Oral disintegrating tablets (ODT), when placed on the tongue, can quickly disintegrate and release the medicament. It later dissolves or disperses in saliva without any additional water. The saliva containing drug can easily be swallowed and descends into the stomach leading to maximum absorption from the mouth, throat, and upper esophagus. The patient compliance and bio-availability of Oral disintegrating tablets (ODT) are high compared to other conventional tablets.

Endoscopic Management of Dysplastic Barrett's Oesophagus and Early Oesophageal Adenocarcinoma.

Barrett's oesophagus is a pathological condition whereby the normal oesophageal squamous mucosa is replaced by specialised, intestinal-type metaplasia, which is strongly linked to chronic gastro-oesophageal reflux. A correct endoscopic and histological diagnosis is pivotal in the management of Barrett's oesophagus to identify patients who are at high risk of progression to neoplasia. The presence and grade of dysplasia and the characteristics of visible lesions within the mucosa of Barrett's oesophagus are both important to guide the most appropriate endoscopic therapy. In this review, we provide an overview on the management of Barrett's oesophagus, with a particular focus on recent advances in the diagnosis and recommendations for endoscopic therapy to reduce the risk of developing oesophageal adenocarcinoma.

255 Preliminary findings from a prospective cohort study of Ireland’s first community Fibreoptic Endoscopic Evaluation of Swallowing (cFEES) service

Abstract Background Dysphagia is a common and resource-demanding symptom of many conditions. Dysphagia prevalence increases with age and can affect quality of life, nutritional status, hydration and increase healthcare utilisation/cost. Instrumental swallowing assessment is essential for accurate diagnosis and treatment. FEES is a gold standard diagnostic tool carried out by speech and language therapists (SLTs), typically in the acute setting. The aim of this study is to profile participants who accessed Ireland’s first cFEES service by describing clinical and process outcomes. Methods Adult patients referred for cFEES were invited to participate. Demographic, clinical and process data were recorded at index visit. A structured phone interview was completed at six months. Descriptive analysis was completed. Results In total, 53 participants were included: 70% were aged >65 years, median age was 72. Diagnoses included progressive neurological conditions such as motor neuron disease, multiple sclerosis and others (23%), Parkinson’s Disease, including Parkinson’s Plus Syndromes (15%), stroke (13%), head and neck cancer (11%), dysphagia unknown aetiology (9%), other (9%), chronic obstructive pulmonary disease (8%), other cancers (6%), and gastro-oesophageal reflux disease (4%). Nutritional status was screened using the Malnutrition Universal Screening Tool (MUST) at index visit for 44 participants. Of those, 23% (N = 10) had a MUST score ≥ 1. Dysphagia Outcome Severity Scale was used to rate swallowing: 43% had some degree of dysphagia (mild to severe). FEES referrals originated mainly from primary care SLTs: 75%, the remaining 25% from older person’s services (community nursing facilities, inpatient rehabilitation and integrated care for older persons). One participant was unable to tolerate the procedure, which was abandoned. Three participants experienced non-limiting gagging or hypersensitivity. Conclusion cFEES is a novel service model which was accessed mainly by older people. cFEES was tolerated well by most, leading to evidence-based outcomes including ruling out significant dysphagia in 57% of cases.

Relation between Chronic Rhinosinusitis and Gastroesophageal Reflux in Adults: A Systematic Review

Background: It is not entirely apparent how chronic rhinosinusitis (also known as CRS) develops. Since the 1970s, medical professionals have debated whether or not gastroesophageal reflux (GOR) could be a factor in the development of certain patients' conditions. The purpose of this research is to the relation between chronic rhinosinusitis and gastroesophageal reflux in adults.
 Methods: By evaluating the preferred reporting items for systematic review and meta-analysis (PRISMA) 2020 standards, this study demonstrated that it met all of the requirements. This enabled the researchers to ensure that the study was as up to date as feasible. Publications published between 2000 and 2023 were included in the search strategy, which included a variety of electronic reference databases (including Pubmed and SagePub). We did not consider review papers, duplicate publications, or half completed articles.
 Results: In the PubMed database, the results of our search brought up 133 articles, whereas the results of our search on SagePub brought up 69 articles. The results of the search conducted for the last year of 2000 yielded a total of 20 articles for PubMed and 8 articles for SagePub. In the end, we compiled a total of 21 papers, six of which came from PubMed and three of which came from SagePub. We included nine research that met the criteria.
 Conclusion: According to the findings of most studies, the number of cases of CRS seen in patients with GERD is around two to three times higher than that seen in the general patient group.

A multicenter study analyzing the impact of pre-existing comorbidities on laryngotracheal reconstruction (LTR) outcomes.

Comorbidities such as chronic lung disease and gastroesophageal reflux (GERD), prematurity, and numerous other conditions may impact the success of LTR. Single-center studies are limited in terms of patient numbers and may be underpowered. To analyze the impact of specific comorbidities on the operation-specific and overall surgical success of LTR in a large multicenter cohort and validate a predictive model for surgical success. A large retrospective multicenter 10-year review was undertaken to validate the data of a previous single-center study (Wertz et al. Laryngoscope 2020) which identified specific predictive comorbidities which impacted LTR outcomes. A Monte Carlo simulation based on the previous data set suggested that 300-400 cases would be needed to optimize the statistical power of a Bayesian model developed from the single-center data to predict surgical success. An IRB-approved data-sharing agreement was executed for 4 large U.S. A virtual REDCap® data entry form inquired about patient characteristics that best predicted surgical success in the single-center model. These included demographics, surgical approaches, cardiac, airway, genetic, endocrine, musculoskeletal, gastrointestinal, and pulmonary comorbidities; details of the surgical procedures, and results of esophagogastroduodenoscopy (EGD), esophageal pH/impedance and flexible bronchoscopy with bronchioalveolar lavage (BAL) were included. Surgical success defined as successful decannulation or resolution of airway symptoms was recorded as single surgery success and overall success following open surgical revision surgery. Multivariate Bayesian analysis, logistical regression, and Kaplan-Meier analysis were performed. 542 patients were identified, including 165 from the single-center study and an additional 377 patients from the multicenter group. The median age was 36 months at the time of the most recent surgery. 70.9% of the LTRs were double-staged procedures. The overall success rate was 86.4% and operation-specific success rate was 69.2%. The specific comorbidities and aerodigestive test results that impacted success based on univariate analysis included staging, bronchiectasis, pulmonary hypertension, GERD, ASD, PDA, grade of stenosis, advanced levels of stenosis, Trisomy 21, MRSA, prior open surgery at another hospital, and gross appearance on EGD. Bayesian model averaging with backward selection was used to validate and refine a predictive model for surgical success with favorable receiver operating curve characteristics - AUC values of 0.827 for single surgery success and 0.797 for overall success. With over 500 patients reviewed, this was the largest multicenter study of LTR to date, which elucidated the impact of comorbidities on success with LTR and was able to improve upon the predictive modeling based on single-center data. Patient factors are most critical in the outcome of LTR. Stage and levels of stenosis, as well as pulmonary and GI conditions most strongly impact the likelihood of success. Future prospective case-control studies will be performed to further optimize the current model for outcome prediction and patient management.

E54 The Ehlers-Danlos syndrome, a disease of late diagnosis: report two cases

Abstract Introduction Ehlers-Danlos syndromes (EDS) are a heterogeneous group of rare inherited collagen disorders. Clinical signs are dominated by generalized joint hyper laxity, skin hyper elasticity and tissue fragility. The diagnosis is clinical in the absence of genetic testing. There is no curative treatment but it is possible today to improve the quality of life of these patients. We report two cases of EDS from a non-consanguineous marriage, without similar cases in their families. Observations CASE 1: Mrs N.B, 31 years old, 2nd of 4 siblings, with a history of heterozygous beta thalassemia, she presented with mechanical gonalgias secondary to patellar dislocations associated with ankle sprains since the age of 5 years. On clinical examination: generalized hyper mobility (Beighton score 9/9), hyper elasticity of the skin, skin fragility, atrophic scarring, papery skin of the knees, hyper transparency of the skin, epistaxis at the slightest scratching, the rest of the somatic examination was unremarkable. The standard biological workup, X-ray and ultrasound of the knees and ankles were without abnormalities. Classic EDS (I and II) was retained according to the 2017 international classification. The patient responded to tier I analgesics. Case 2 Mrs B.L, 24 years old, the third of five siblings, with a history of bronchial asthma, presented with bilateral and symmetrical polyarthralgia affecting the large and small joints with mixed type spinal pain associated with spontaneous myalgia in a context of profound asthenia evolving for 14 years. On osteoarticular examination, generalized joint hypermobility was noted (Beighton score 9/9); on the cutaneous level, transparency and hyperextensibility of the skin with multiple ecchymoses due to tissue fragility associated with delayed healing with cutaneous hyperesthesia, all associated with exertional dyspnea, chronic abdominal pain and gastroesophageal reflux since the onset of his illness. Biologically, no inflammatory syndrome. The autoimmune workup (RF, ACPA, FAN) was negative and other investigations were without abnormalities. X-rays of the chest, hands, wrists and knees were unremarkable. The patient was classified as having hypermobile EDS (type III) according to the international classification of the disease. The patient responded only partially to analgesics (levels I, II and III) and to tricyclic antidepressants. Conclusion The diagnosis of EDS must be made early in order to ensure optimal symptomatic management. The management must be multidisciplinary, including an evaluation, a psychological follow-up, a treatment of the pain and physiotherapy.

Effectiveness of eradication therapy for Hp infection of residents of Perm and the Perm region

Purpose: to evaluate the effectiveness of eradication therapy for Hp infection in Perm and the Perm region. Materials and methods: a retrospective analysis of 88 case histories of patients who underwent eradication of Hp infection was carried out at the Perm Medical Center (GASTROCENTER). Primary infection with H. pylori was confirmed by: serological blood test or determination of Hp antigen in feces, rapid urease test, and C13 urease breath test. Hp eradication therapy regimens, depending on the source of prescription, included standard triple therapy with the addition of bismuth preparations for a period of 14 days (main group) or 7-10-day triple therapy (control group). Results and discussion: the main indications for Hp eradication were: chronic gastritis and gastroesophageal reflux disease. In the main group, all patients received Hp eradication therapy with the inclusion of: esomeprazole (emanera) 40 mg, amoxicillin 1000 mg, clarithromycin (fromilid) 50 mg and bismuth tripotassium dicitrate (ulcavis) 240 mg twice a day for 14 days. The control group included patients who received Hp eradication schemes with various proton pump inhibitors, amoxicillin and clarithromycin or metronidazole or levofloxacin or even rifaximin for 7 or 10 days. Adverse events: abdominal pain and diarrhea occurred in both groups. Patients of the main group complained about bitterness in the mouth, where all patients received clarithromycin. Approximately the same small number of patients complained of nausea. With a differentiated assessment by groups, in the main group, Hp eradication was highly effective and reached 93%, while in the control group it was significantly lower and did not exceed 48% (p=0,00087) Conclusions: modern detection of Hp infection and its eradication is an effective approach to the prevention of atrophic gastritis, gastric cancer and peptic ulcer of the stomach and duodenum. The “gold” standard for diagnosing Hp infection is the 13C-urease breath test. For residents of Perm and the Perm Territory, it is recommended to use Hp eradication with the appointment of a 14-day regimen with the inclusion of esomeprazole (Emaner), clarithromycin (Fromilide), amoxicillin and bismuth tripotassium dicitrate (Ulkavis) as the first line of therapy.

Assessment of asthma mimics among newly diagnosed bronchial asthma patients in Zagazig University Hospitals

BackgroundBronchial asthma may mimic different diseases regarding their similar clinical presentations, so accurate assessment is required to exclude other possible diagnosis before confirming the diagnosis of bronchial asthma. The aim of the study was to identify the percentage of patients in whom the diagnosis of current asthma was confirmed or ruled out after clinical, spirometric assessment, and utilizing all the possible investigations.MethodsA cohort study of newly diagnosed bronchial asthma in adults aged ≥ 18 years were recruited from chest outpatient clinic and chest department. History taking, clinical examination, chest X-ray, and spirometry were done for all patients, while chest high-resolution computed tomography (HRCT), CT pulmonary angiography, or different endoscopies were done when indicated.ResultsTwo hundred recently clinically diagnosed asthmatic patients were recruited with a mean age of 43.2 and 53.4 years in the asthma group and asthma rule out group, respectively. About 55.5% of the studied patients were ruled out to have bronchial asthma after serial assessments of symptoms and spirometric function. There was increased chest wheeze as a respiratory symptom among asthma patients than the other group (p ˂ 0.001), while hemoptysis was significantly a more presenting symptom among patient group whose asthma diagnosis is ruled out (p = 0.009). About 87.6% of asthma confirmed group showed predominant reversible airway obstructive. The sputum cytology analysis of the bronchial asthma group of patients was 42.7% eosinophilic, 24.7% neutrophilic, and 32.6% mixed cellularity. After consuming all the available investigational tools, the most common diseases found among asthma rule out group were cardiac disorders, chronic obstructive pulmonary disease, psychological disorders, rhinitis, and gastro-esophageal reflux disease with percent of 11.5%, 9%, 8.5%, 8%, and 6%, respectively.ConclusionsUtilizing all the available investigational tools in the present study allowed to exclude bronchial asthma and diagnose critical diseases that need specific and urgent therapies as heart diseases, subglottic stenosis, pulmonary hypertension, and interstitial lung diseases.Trial registrationClinicalTrials.gov NCT05776537. Retrospectively registered on 6 March 2023.

Corrosive Esophageal Strictures: Alarming News for Gastroenterologists

Dysphagia is a common yet alarming symptom reported by patients during routine visits to outpatient clinics of gastroenterology. Most of them have a chronic history gastroesophageal reflux disease and use of proton pump inhibitors or anti reflux medications for years. The agonising part is that they are not referred by the physicians in the general practice. One of the major reasons behind this is persistent reluctance of patients to go for invasive investigations Gastroesophgeal reflus disease, achalasia ,hiatal hernia,benign esophgeal strictures, barrets esophagus and esophageal carcinoma are common causes of dysphagia. One of the causes which has been quite prevalent in our country is use of corrosives especially young girls and boys who are emotionaland depressed. They do something very outrageous in a moment which becomes a reason for regret for a long time .Corrosive esophgeal strictures isn’t that difficult got gastroenterology experts in normal circumstances but the cases can get complicated rarely including the risk of perforation in early stages of injury. Endoscopic dilatation either by Savory or TTS Balloon has been the cardinal line of management of corrosive strictures. They are done after necessary workup and investigations including barium swallow . The real dilemma is that patent develop complications like tracheoesophageal fistula after repeated dilatations. The length of follow up session are also difficult to determine with some centres opting for one weekly and others for two weekly sessions .Weekly sessions have been reported to ease off symptoms like dyphagia but causes higher risk of complications while in case of two weekly follow up there is enhanced risk of recurrence of symptoms and lesser complications.

Clinical Characteristics and Economic Burden of Asthma in China: A Multicenter Retrospective Study.

Asthma is a common chronic airway inflammation that produces a healthcare burden on the economy. We aim to obtain a better understanding of the clinical status and disease burden of patients with asthma in China. A retrospective study was carried out based on the computerized medical records in the Jinan Health Medical Big Data Platform between 2011 and 2019 (available data from 38 hospitals). The asthma severity of each patient was assessed retrospectively and categorized as mild, moderate, or severe according to Global Initiative for Asthma 2020 (GINA 2020). The results revealed that the majority (75.0%) of patients suffered from mild asthma. Patients treated with inhaled corticosteroids (ICS)/long-acting beta-agonists (LABA) at emergency department visits had lower frequencies of exacerbations compared with non-ICS/LABA-treated patients. The incidence rates for 1, 2, 3, and 4 exacerbation of the patients treated with ICS/LABA are lower than those treated without ICS/LABA (14.49 vs. 15.01%, 11.94% vs. 19.12%, 6.51% vs.12.92% and 4.10% vs. 9.35%). The difference got a statistical significance Chronic obstructive pulmonary disease (COPD) and gastroesophageal reflux disease (GERD), two comorbidities related to asthma, were risk factors for asthma exacerbation. Finally, patients who suffered from exacerbations produced a heavier economic burden compared to the patients who never suffered exacerbations (mean costs are ￥3,339.67 vs. ￥968.45 separately). These results provide a reference for clinicians and patients to obtain a better treatment and therapy strategy management for people living with asthma.

Major depressive disorder plays a vital role in the pathway from gastroesophageal reflux disease to chronic obstructive pulmonary disease: a Mendelian randomization study.

Background: Observational studies have shown a bidirectional association between chronic obstructive pulmonary disease (COPD) and gastroesophageal reflux disease (GERD), but it is not clear whether this association is causal. In our previous study, we found that depression was a hot topic of research in the association between COPD and GERD. Is major depressive disorder (MDD) a mediator of the association between COPD and GERD? Here, we evaluated the causal association between COPD, MDD, and GERD using Mendelian randomization (MR) study. Methods: Based on the FinnGen, United Kingdom Biobank, and Psychiatric Genomics Consortium (PGC) databases, we obtained genome-wide association study (GWAS) summary statistics for the three phenotypes from 315,123 European participants (22,867 GERD cases and 292,256 controls), 462,933 European participants (1,605 COPD cases and 461,328 controls), and 173,005 European participants (59,851 MDD cases and 113,154 controls), respectively. To obtain more instrumental variables to reduce bias, we extracted relevant single-nucleotide polymorphisms (SNPs) for the three phenotypes from published meta-analysis studies. Bidirectional MR and expression quantitative trait loci (eQTL)-MR were performed using the inverse variance weighting method to assess the causal association between GERD, MDD, and COPD. Results: There was no evidence of a causal effect between GERD and COPD in the bidirectional MR analysis [forward MR for GERD on COPD: odds ratios (OR) = 1.001, p = 0.270; reverse MR for COPD on GERD: OR = 1.021, p = 0.303]. The causal effect between GERD and MDD appeared to be bidirectional (forward MR for GERD on MDD: OR = 1.309, p = 0.006; reverse MR for MDD on GERD: OR = 1.530, p < 0.001), while the causal effect between MDD and COPD was unidirectional (forward MR for MDD on COPD: OR = 1.004, p < 0.001; reverse MR for COPD on MDD: OR = 1.002, p = 0.925). MDD mediated the effect of GERD on COPD in a unidirectional manner (OR = 1.001). The results of the eQTL-MR were consistent with those of the bidirectional MR. Conclusion: MDD appears to play a vital role in the effect of GERD on COPD. However, we have no evidence of a direct causal association between GERD and COPD. There is a bidirectional causal association between MDD and GERD, which may accelerate the progression from GERD to COPD.

Outcomes of patients with oesophageal and gastric cancer in relation to their age and metropolitan residential status: A South Australian audit.

e16095 Background: The incidence of oesophago-gastric cancer (OG) is increasing in the younger population. Factors such as obesity, chronic gastroesophageal reflux disease, smoking or a low dietary intake of fruits and vegetables may be responsible. Inferior survival outcomes are observed in younger patients with OG cancer. Survival rates can differ by geographic location, with poorer outcomes seen in remote and non-metropolitan regions. Aim To evaluate patient characteristics and outcomes of patients with gastro-oesophageal cancers in younger (&lt;50 years) when compared to older (&gt;50 years) patients and those residing in rural versus metropolitan areas in South Australia. Methods: Data from a tertiary referral hospital database in South Australia was retrospectively collected between 2012 to 2022. All patients with OG cancers were included. Baseline characteristics including demographics, risk factors for OG cancer, type and stages of disease, geographic location were collected. Survival outcomes of gastro oesophageal cancer patients &lt;50 years and &gt;50 years of age as well as those living in metropolitan versus rural locations were analysed. Statistical analyses were done using Pearson’s Chi square test, Wilcoxon rank sum test, Fisher exact tests and multivariate models. Results: Of the 937 patients in this audit, 6.5%% (n=61) were &lt; 50 years of age, 72% men (n=670), median age of diagnosis was 72 years. There was statistically significant difference in the proportion of patients with different anatomical types of OG cancer based on age &lt;50 versus &gt;50 (P=0.02), while there was no difference in other baseline characteristics. Within the group of OG cancer patients &lt;50 years, the frequency of gastric adenocarcinoma was more, when compared to older, &gt;50 year group (55.7% vs 31.3%) whilst other cancer types such as GOJ adenocarcinoma (1.6% vs 6.3%), oesophageal squamous (8.2% vs 14.8%) and adenocarcinoma (34.4% vs 47.6%) were found less frequent in &lt;50 year group compared to &gt;50 year group. There were no significant differences observed in the 3 year (P=0.49), 5 year (P=0.61) and overall survival (2.29 vs 1.78 years, P=0.63) rates, in OG cancer patients &lt; 50 years vs &gt; 50 years old. Among 874 OG cancer patients with data available on geographic location, there was no significant differences observed between 3-year (P = 0.25), 5-year (P =0.27) or overall survival (1.72 vs 1.61 years, P = 0.3) in metropolitan versus rural patients in South Australia. Conclusions: In this audit gastric adenocarcinoma was more common in younger patients (&lt;50 years of age). Young-onset OG cancer patients, when defined as aged younger than 50 years, had equivalent survival compared with their older counterparts and there were no significant differences seen in overall survival rates based on their geographic locations.

Comparison of insertion characteristics of LMA ProSeal and Ambu AuraGain in adult patients under controlled ventilation: A randomised study.

Supraglottic devices are preformed or flexible, and the insertion characteristics of the two types may be different. This study aims to compare the insertion characteristics of Ambu AuraGain (AAG), preformed) and LMA ProSeal (PLMA), flexible, requires an introducer tool for placement. Forty American Society of Anesthesiologists (ASA) physical status I/II patients of either sex between 18 and 60 years with no anticipated airway difficulty were randomly allocated to either group AAG or PLMA (n = 20 each). Pregnant females, known case of chronic respiratory disorders and gastroesophageal reflux were excluded. After induction of anaesthesia and muscle relaxation, appropriately sized AAG or PLMA was inserted. Time for successful insertion (primary outcome), ease of device insertion and gastric drain insertion, first attempt success rate (secondary outcomes) were recorded. Statistical analysis was done using SPSS version 20.0. Quantitative parameters were compared using Student's t-test, and qualitative parameters were compared using Chi-square test. A P value of <0.05 was considered significant. Time taken for successful insertion of PLMA was 22.94 ± 6.12 s and for AAG was 24.32 ± 4.96 s, (P = 0.458). Device insertion was significantly easy in PLMA group (P < 0.002). First attempt success rate was achieved in 17 (94.4%) cases in PLMA group compared to 15 (78.9%) cases in AAG group (P = 0.168). Ease of drain tube insertion was comparable among the groups (P = 0.298). The haemodynamic variables were also comparable. PLMA is easier to insert as compared to AAG, but the insertion time and first attempt success rate are similar. The preformed curvature in AAG does not provide any added advantage over the non-preformed PLMA.

Epigenetic Alterations from Barrett's Esophagus to Esophageal Adenocarcinoma.

Barrett's esophagus (BE) is a disease entity that is a sequela of chronic gastroesophageal reflux disease that may result in esophageal adenocarcinoma (EAC) due to columnar epithelial dysplasia. The histological degree of dysplasia is the sole biomarker frequently utilized by clinicians. However, the cost of endoscopy and the fact that the degree of dysplasia does not progress in many patients with BE diminish the effectiveness of histological grading as a perfect biomarker. Multiple or more quantitative biomarkers are required by clinicians since early diagnosis is crucial in esophageal adenocancers, which have a high mortality rate. The presence of epigenetic factors in the early stages of this neoplastic transformation holds promise as a predictive biomarker. In this review, current studies on DNA methylations, histone modifications, and noncoding RNAs (miRNAs) that have been discovered during the progression from BE dysplasia to EAC were collated.