Course Of Gastroesophageal Reflux Disease Research Articles

Esophageal squamous cell papilloma on the background of gastroesophageal reflux disease: a clinical case in a 23-year-old obese man.

Background. A number of weighting factors, primarily obesity and manifestations of duodenogastroesophageal reflux (DGER), are correlated with the presence of inflammation and an increased risk of progression of negative changes in the esophagus with gastroesophageal reflux disease (GERD). This should be considered when screening for GERD using esophagogastroduodenoscopy (EGDS). Objective: to draw the attention of doctors to the need for early screening of morphological changes in the mucous membrane of the esophagus among young people with obesity, as an example of a clinical case. Methods. 23-year-old man with overweight, heartburn, bloating. Heartburn has been troubling for more than two years. Smokes. Has a family history of cancer of the upper gastrointestinal tract. On endoscopy: 38 cm from the upper incisors, a single, 3 mm in diameter, polypoid whitish formation was found, it rises on a broad basis. In the stomach – a significant amount of bile. Pylorus – open. Biopsy samples of the gastric mucosa (antrum, body) were taken. A quick urease test is negative. The removal of the formation of the esophagus. In a histological examination of the formation of the esophagus, we revealed squamous papilloma with low-grade epithelial dysplasia, chronic esophagitis, and reflux gastritis. Final diagnosis: GERD with chronic esophagitis. Squamous cell papilloma of the esophagus with mild epithelial dysplasia. Reflux gastritis, inactive. Obesity of 1 degree. Results. According to the literature, obesity, smoking, a family history of cancer are risk factors for GERD and the most common events among patients with squamous esophageal papilloma. DHER promotes the formation of GERD, esophagitis, metaplasia and neoplasia of the surface epithelium of the mucous membrane of the esophagus. But there is no scientific evidence for the benefits of endoscopic screening for GERD among obese young adults. Conclusion. A clinical case demonstrates that screening endoscopy in a young man against the background of factors aggravating the course of GERD revealed lesions of the esophagus in the form of squamous papilloma with epithelial dysplasia. Further studies are needed to confirm the benefits of endoscopic screening for GERD in obese young adults.

Gastroesophageal Reflux Disease and Coronary Heart Disease: Is There a “Mutual Burden” Syndrome?

Aim. This review aims to generalize data on the mutual aggravating effect on the course of gastroesophageal reflux disease (GERD) and coronary heart disease (CHD).General findings. The combination of CHD and GERD is a common clinical situation. In recent years, more and more information has appeared indicating a non-accidental character of the comorbidity of both diseases. In addition to common risk factors, a number of pathophysiological mechanisms have been established that determine a pathogenetic relationship between CHD and GERD. Reflux disease contributes adversely to chronic coronary heart disease, e.g. by increasing the risk of developing myocardial infarction (MI). The co-occurrence of myocardial ischemia episodes (registered by ECG) with those of heartburn has been identified. A correlation between pathological reflux and ST segment depression has been found. A trigger role of reflux in relation to angina attacks and heart rhythm disturbances has been determined. The pro-arrhythmic effects of GERD on the myocardium are explained by an imbalance of the autonomic nervous system with a predominance of the parasympathetic tone. In turn, both stable angina and myocardial infarction contribute to a more aggressive and refractory course of reflux esophagitis (RE), thus triggering reflux symptoms.Conclusion. The comorbid course of coronary heart disease and GERD is based on complex associations; this clinical situation is characterized by a mutual burden syndrome. Given the high prevalence of a combination of both diseases, it seems relevant to develop pathogenetically substantiated approaches to the management of this category of patients.

Vegetative accompaniment of the combined course of gastroesophageal reflux disease in young patients with autoimmune thyroiditis

Objective — to establish the presence of autonomic dysfunction and to assess the frequency and severity of its manifestations in patients with autoimmune thyroiditis (AIT) and gastroesophageal reflux disease (GERD) with the use of the A. M. Vein questionnaire.Materials and methods. The examinations involved 83 students aged (22.1 ± 2.11) years with comorbidity of GERD and AIT. Women consisted the majority, 73.5 % (61 person), of patients with GERD with history from «newly diagnosed» to three-years’ duration; and AIT from «newly diagnosed» up to 2.5 years’ duration. The GERD verification of was performed by endoscopic method, which allowed to establish the non-erosive disease form in 74 (87.8 %) cases, and erosive form in 9 cases (12.2 %). The AIT presence was confirmed in clinical, instrumental and immunological studies: antibodies to the thyroid gland exceeded the normal values; the serum of thyroid-stimulating hormone, FT3 and FT4 level corresponded to the euthyroid state. Autonomic dysfunction was assessed with A. M. Vein questionnaire (11 questionings). The statistical processing included the calculation of the χ2 criterion with the Yates amendment.Results. The assessment of results of A. M. Vein questioning showed that the most often manifestations of the autonomic dysfunction were: changes in the colour of the skin during agitation (92.8 %), excessive sweating (88 %), heartbeat (68.7 %), the appearance of lower dyspeptic syndrome (69.9 %), headaches (51.8 %), decreased performance and rapid fatigue (97.6 %). At the same time, a number of autonomic dysfunction manifestations were less common. So, numbness and coldness of the extremities were characteristic for 37.3 % respondents; difficulty breathing — for 32.5 %, fainting — 10.8 %, which was explained by the young age of the patients and a small history of nosological forms. In total, 78.3 % of the surveyed subjects had manifestations of autonomic dysfunction, and disease duration, gender and form of the esophageal mucosa damage did not matter. As a result of two-month observation on these patients, the presence of a «vegetative tail» has been revealed in 51.8 % of cases in a form of asthenic syndrome: general weakness, decreased performance, rapid fatigue, palpitations, pulse lability and pressure; and 37.3 % of individuals had some of its manifestations within 4 — 5 weeks after discharge from the hospital.Conclusions. The combined course of GERD and AIT in most cases (78.3 %) was accompanied by vegetative dysfunction, the manifestations of which aggravated the disease course. The «vegetative tail» in a form of asthenic syndrome, the manifestations of which have a negative impact on the quality of life of patients with GERD and AIT for 1 — 2 months after clinical remission of diseases can be observed.

Discoordination of Autonomic Support of Functions in the Pathogenesis Gastroesophageal Reflux Disease.

A cross-sectional study performed on a continuous sample of 32 patients (mean age 46.36±3.31 years) with gastroesophageal reflux disease and excess body weight showed that the disturbance of sympathetic/parasympathetic relationships, disruption of segmental and compensatory increase in the suprasegmental mechanisms of autonomic regulation determines the course of gastroesophageal reflux disease in these patients.

The role and place of Actovegin in the complex therapy of cytokine metabolism in patients with GERD with concomitant bronchial asthma

Objective — to study the advisability of the Actovegin inclusion in the standard treatment regimen for patients with GERD and concomitant mild to moderate BA in terms of its effects on the clinical course of this comorbid pathology, as well as on the level of proinflammatory and anti-inflammatory cytokines.Materials and methods. The study involved 60 patient with GERD and concomitant mild to moderate BA who were divided into 2 treatment groups. The first group of patients received standard GERD therapy (proton pump inhibitor— omeprazole 20 mg twice daily) and standard BA therapy (beta2-agonists of short and long-acting, m-cholinolytics), and Actovegin 200 mg twice daily day for 28 days. Patients of the second treatment group (comparison group) received only standard therapy— proton pump inhibitors and bronchodilators at the same dose for 4 weeks. The GERD diagnosis was established according to the Montreal Consensus (2006), with account of the data of esophagogastroduodenoscopy, fluoroscopy of the esophagus and stomach and the results of pH-metry. Verification of the diagnosis of asthma was carried out in accordance with the recommendations of the WHO (GJNA) and the order of the Ministry of Health of Ukraine (2013), with account of the spirography and chest radiography. The blood levels of interleukins (IL-4 and IL-6) were determined with the method of immuno-enzyme analysis using the «Vector Best» test systems. Statistical processing was carried out by the method of variational statistics using standard programs of correlation analysis with calculation of arithmetic mean values: M, m. The reliability of the indicators was assessed according to Student’s t-criterion.Results. It has been established that against the background of therapy, most patients began to feel well, less worried about esophageal complaints (heartburn, belching, pain in the epigastric region) and bronchial symptoms (dyspnea, cough, bronchospasm attacks, disturbed breathing during sleep. However, in patients of the first group these clinical manifestations completely disappeared by 3 to 5 days earlier (an average in 9.3 ± 0.51 and 11.4 ± 1.21 days) than in patients on second group (in 12.1 ± 1.10 and 14.3 ± 1.12 days) Moreover, in most patients of the first group, the most pronounced effect, particularly with regards to arresting the night-time attacks of laboured breathing, led to a decrease in the dose and frequency of use of beta2-agonists of short action, while in 7 (22.5 %) patients of the second group, on the contrary, it was necessary to mimic the frequency of beta2-agonists reception. After the course of therapy, the clinical effect of the improvement of quality of life, was accompanied by the reduction of cytokines’ levels, more significant in patients of the first group.Conclusions. The obtained results clearly demonstrate the positive effect of Actovegin not only on the clinical course of gastroesophageal reflux disease with concomitant asthma, but also confirms the pathogenetic feasibility of its inclusion in the standard treatment regimen for this category of patients.

Personal and situational anxiety in young patients with the combined course of gastroesophageal reflux disease and autoimmune thyroiditis

Objective — to assess the psychoemotional status of young patients with gastroesophageal reflux disease (GERD) associated with autoimmune thyroiditis (AIT). Materials and methods. The examinations involved 57 students with a combined course of GERD and AIT with the mean age of of 22.1 ± 2.11 years. The male subjects prevailed (56.1 %). The GERD screening was conducted with the use of GERD Screener questionnaire. Verification of GERD form was carried out endoscopically. The clinical data, instrumental examinations, the level of antibodies to the thyroid gland (TG), its function was taken into account in the diagnosis of AIT. Statistical processing included the calculation of the chi-square test with the Yates correction (Yates’ᵪ2). Results . Erosive GERD form was established in 9 patients (15.8 %). The presence of AIT was confirmed by an increase in the level of antibodies to TG. Euthyroidism was observed in 75.4 % of cases, a decrease in thyroid function was detected in 17.5 % of the examined patients, hyperthyroidism was diagnosed in 7.0 % of patients. Testing by the Spielberger-Hanin technique showed the following results. A high level of situational anxiety was observed in 39 (68.4 %) cases, moderate manifestations of situational anxiety occurred in 11 (19.3 %) patients, «relative comfort» was noted by 7 patients. Assessment of personal anxiety showed that the majority of patients with GERD and AIT (from 80.7 % to 93 %) indicated serious manifestations of this type of anxiety. They predisposed to the perception of certain incentives, as dangerous for self-esteem. The levels of personal and situational anxiety correlated among themselves in 45 (78.9 %) individuals. However, in 12 cases there was a dissonance between the T-property and the T-state, including: in 2 patients with hyperthyroidism; in 5 patients with hypothyroidism; in 5 patients with an euthyroid status. Hormonal thyroid dysfunction significantly influenced the development of «personality-situational anxiety dissonance». At the same time, the relationship between manifestations of anxiety and morphological changes in the mucosa of the esophagus has not been noted. Conclusions. The students refer to the category of subjects with prerequisites for changes in the central nervous system and in the behavioural sphere due to the specifics of the learning process and interpersonal communication. The combined course of GERD and AIT in young people occurs against the background of heightened situational and personal anxiety, or under conditions of «personality-situational anxiety dissonance». These psychoemotional disorders can aggravate the clinical manifestations of diseases and promote their frequent recurrence (exacerbation, progression).

Helicobacter pylori and nonmalignant upper gastrointestinal diseases.

The review of the most important recent publications concerning the relation of Helicobacter pylori with peptic ulcer disease (PUD), noninvestigated and functional dyspepsia, and gastroesophageal reflux disease (GERD) is presented. H.pylori remains the main etiopathogenetic factor in complicated and uncomplicated PUD. Nevertheless, the role of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin is increasing. The novel data did not confirm that PUD caused by NSAIDs and aspirin is less symptomatic. The role of glucocorticoids, immunosuppressants, and antidepressants seems to be of some importance. Although the involvement of H.pylori in functional dyspepsia is controversial, several data support the importance of H.pylori-induced gastritis in the pathogenesis of dyspeptic symptoms. Recent interventional studies have reported that H.pylori eradication improves dyspepsia mainly in areas with a high prevalence of this bacterium. Novel data regarding the relation of gastrointestinal peptides, ghrelin and obestatin, with H.pylori infection are also presented. Intriguing findings support the involvement of the gastric microbiota in the causation of chronic functional dyspepsia. Finally, some data concerning negative, positive, or neutral associations of H.pylori with gastroesophageal reflux disease (GERD) were published. In this context, today there is no evidence indicating that H.pylori eradication could worsen the symptoms or the course of GERD.

Interactions between Helicobacter pylori and gastroesophageal reflux disease.

Interactions between Helicobacter Pylori (HP) and gastroesophageal reflux disease (GERD) are a complex issue. Several pathophysiological factors influence the development and the course of GERD, HP infection might be only one of these. Many studies emphasize the co-existence of these diseases. HP infection could contribute to GERD through both a protective and an aggressive role. Gastric acid secretion is a key factor in the pathophysiology of reflux esophagitis. Depending on the type of gastritis related to HP, acid secretion may either increase or decrease. Gastritis in corpus leads to hypoacidity, while antrum gastritis leads to hyperacidity. In cases of antral gastritis and duodenal ulcers which have hyperacidity, the expectation is an improvement in pre-existing reflux esophagitis after eradication of HP. In adults, HP infection is often associated with atrophic gastritis in the corpus. Atrophic gastritis may protect against GERD. Pangastritis which leads to gastric atrophy is commonly associated with CagA strains of HP and it causes more severe gastric inflammation. In case of HP-positive corpus gastritis in the stomach, pangastritis, and atrophic gastritis, reflux esophagitis occurs frequently after eradication of HP. Nonetheless, as a predisposing disease of gastric cancer, HP should be treated. In conclusion, as the determinative factors affecting GERD involving in HP, detailed data on the location of gastric inflammation and CagA positivity should be obtained by the studies at future.

Mechanisms of formation of the gastroesophageal reflux disease and coronary heart disease comorbidity

Objective — to identify possible transnosological mechanisms for the formation of comorbidity of gastroesophageal reflux disease (GERD) and coronary heart disease (CHD).Materials and methods. The study involved patients (n = 65) with GERD in combination with CHD: 54 men (83.08 %) and 11 women (16.92 %) aged 32 to 89 years; the mean age 61.57 ± 11.37 years. The laboratory-biochemical, clinical-instrumental and statistical methods were used during the study.Results. According to the anamnesis history, GERD duration varied 0.5 to 11 years (the mean duration 4.12 ± 2.25 years; median — 4 years); CHD duration ranged from 1 to 21 years; the average — 7.07 ± 4.61 years; the central trend (Me) — 6 years. All patients were divided into two groups: group I (n = 21; 32.31 %) consisted of subjects with non-erosive GERD and CHD; group II (n = 44; 67.69 %) included patients with erosive GERD and CHD. In both groups, women had an average lower cardiovascular risk (CVR) on different scales than men, and a higher percentage of associated 10-year survival, associated with modified risk factors (smoking, alcohol, body mass index, unhealthy diet, low physical activity, lipid metabolism). The dependence of severity obstructive sleep apnea (OSA) syndrome on the endoscopic form GERD (p = 0.0007) and dependence of level sleep disorders on clinical and morphological manifestations GERD (p = 0.0498) have been determined. The obtained data indicated the important transnosological mechanisms of formation of the GERD and CHD comorbidity: increased CVR and comorbidity level, changes in lipid spectrum and synthesis neurohormones, the presence of cardiac («cardiac mask») and pulmonary («pulmonary mask») manifestations, depressive and sleep disorders.Conclusions. The obstructive sleep apnea (OSA), as an insomnia variant, was established as a factor of the adverse course of GERD and CHD comorbidity. This is one of transnosological mechanisms that promotes the emergence of numerous organic and functional systematic violations.At the GERD and CHD comorbidity, the severity of insomnia and depression depends on the patient’s age, the CHD duration and level of body mass index (p < 0.05); at different forms GERD there are differences in the main diagnostic parameters of severity OSA; the OSA severity was associated with the endoscopic GERD form (p = 0.0007); there is a dependence degree of sleep disorders on the clinical and morphological GERD manifestations (p = 0.0498). The increase in the comorbidity degree is proportional to the higher probability of mortality (r = 0.782; p < 0.001); correction of the comorbidity indexes with CVR indexes allowed to determine more correctly the remote prognosis of combined disease and significantly improve the effectiveness of therapeutic and prophylactic actions.

Особливості лікування гастроезофагеальної рефлюксної хвороби у хворих на цукровий діабету ІІ типу

In the world scientific literature sources, the issue of the combined course of gastroesophageal reflux disease (GERD) and diabetes mellitus (DM) is actively discussed. Along with this, research is necessary to select effective therapeutic complexes that have a multidirectional positive effect in patients with comorbid pathology, especially in type 2 DM and GERD. The purpose of the study is to investigate the effectiveness of complex therapy (ursodeoxycholic acid and itopride hydrochloride) in patients with combination of GERD and type 2 DM.Materials and methods. 54 patients with combination of type 2 DM and GERD were examined. The treatment of the patients with type 2 DM was conducted in accordance with the clinical treatment protocol of the Ministry of Health of Ukraine and local protocols. The standard anti-helicobacter therapy has been carried out for 14 days in HP-positive patients with combination of GERD and type 2 DM. Ulsepan treatment was prolonged to 1 month, if necessary than longer. The itopride hydrochloride was prescribed in dose 50 mg 3 times a day for 1 month to normalize the functioning of upper gastrointestinal tract section. All patients with combination of type 2 DM and GERD have been prescribed ursodeoxycholic acid (UDCA) in dose 15 mg / kg body weight. UDCA treatment lasted for up to 6 months.Results. The study included patients with type 2 DM medium severity. The leading clinical manifestation of the upper digestive tract section in patients with type 2 DM was bloating of acid, heartburn and globus pharyngeus. The prescribed antisecretory therapy (if necessary, anti-helicobacter treatment) in combination with itopride hydrochloride and UDCA in patients with type 2 DM positively influenced on the clinical and endoscopic manifestation of GERD in patients with type 2 DM. Complex therapy with the use of UDCA resulted in a significant reduction in the number of patients with duodeno - gastral reflux (DER), namely from 48.1% to 3.7%, respectively (p <0.01). The expressed positive effect on the dynamics of the body mass index in patients with combination of type 2 DM and GERD was observed on the background of co mplex therapy with the use of UDCA.Conclusion. The use of itopride hydrochloride (Ganaton) in combination with pantoprazole (Ulsepan) is an effective method for correction of the esophageal and extra-esophageal clinical manifestations of GERD in patients with type 2 DM. UDCA (Holudexan) is a safe and effective way to reduce the severity of DGR in GERD, and also helps to reduce body weight in patients with type 2 DM with a violation of body mass index in course of its application.

Аnalysis of features of clinical manifestations of gastroesophageal reflux disease in children of different age periods

Aim. To analyze features of the course of gastroesophageal reflux disease for determining the main clinical symptoms in children of different age groups.Materials and methods. There were examined 126 children of different age with gastroesophageal reflux disease. All children underwent the clinical examination, esophagogastroduodenoscopy (videogastriscope «Fujinon» WG 88 FР) and intragastric endoscopic рН-metry (acidogastrograph AG TC U 33.1-13300318-002:2007,made by “Start” LTD).Results. Children with the endoscopic positive variant of gastroesophageal disease more often demonstrated complaints for nausea (40%) (р<0,02), whereas children with endoscopic negative variant of gastroesophageal reflux disease reliably more often complained for vomiting (31%) (р<0,05). Complaints for nausea (p<0,05) and vomiting (p<0,04) were most typical for preschool children (before 6 years) with reflux-esophagitis. 80% of children with reflux-esophagitis of II stage demonstrated complaints for heartburn in and 40% - for pains behind the breast. At the same time only 13% of their coevals with reflux-esophagitis of I stage complained for heartburn and 3% of them for pains behind the breast. Children with endoscopic negative variant of gastroesophageal reflux disease had practically no complaints for heartburn and pains behind the breast. Children with hypo- and norm-acidity complained for nausea reliably more often (71%), compared with children with hyperacidity (34%) (р<0,01). Heartburn occurred reliably more often in the group of children with hyper-acidity (14% against 6%).Conclusions. Complaints for nausea (p<0,05) and vomiting (p<0,04) are most typical for preschool children with reflux esophagitis. Children with reflux, esophagitis of ІІ st. complain for pains behind the breast (p<0,04) and nausea (p<0,005) reliably more often comparing with children with reflux-esophagitis of I st. Children with gastroesophageal reflux disease with the decreased or normal acidity of gastric contents complain for nausea reliably more often (71%), (р<0,01), and heartburn bothers children with hyperacidity more often

ДОСВІД ЗАСТОСУВАННЯ МЕЛЬДОНІЮ У КОМПЛЕКСНІЙ ТЕРАПІЇ ХВОРИХ НА СТАБІЛЬНУ СТЕНОКАРДІЮ НАПРУГИ ТА ГАСТРОЕЗОФАГЕАЛЬНУ РЕФЛЮКСНУ ХВОРОБУ

Мета. Вивчити вплив мельдонію (Вазонату) на перебіг гастроезофагеальної рефлюксної хвороби, клініку ГЕРХ, показники ендоскопічного дослідження стравоходу та його рН-моніторування за коморбідної стабільної стенокардії напруги.Матеріали та методи. У дослідження включено 63 хворих на стабільну стенокардію напруги І-ІІ ФК із коморбідною ендоскопічно позитивною ГЕРХ (А, В, С) віком від 48 до 79 років. На початку дослідження та через 30 днів після лікування усім хворим було проведено клінічне (скарги, опитувальник GSRS (Gastrointestinal Symptom Rating Scale)) та інструментальне (езофагогастродуоденофіброскопія та 24-годинна pH-метрія нижньої третини стравоходу) дослідження із метою виявлення вираженості симптомів, стану слизової оболонки стравоходу, частоти виникнення, кількості, тривалості та типу (кислі, лужні) гастроезофагеальних рефлюксів. Усіх хворих, що брали участь у дослідженні, було поділено на дві групи: 1-ша (n=31) приймала базову терапію для лікування стабільної стенокардії напруги (нітрати, бета-адреноблокатори, статини, клопідогрель) та ГЕРХ (інгібітор протонової помпи, прокінетик, антацид) у середніх терапевтичних дозах, 2-га група (n=32) отримувала аналогічну базисну терапію, за виключенням нітратів, та, додатково, мельдоній (Вазонат) по 500 мг 2 рази на добу упродовж 30 днів.Отримані результати. Аналіз отриманих результатів показав, що у пацієнтів 2-ї групи додавання Вазонату до базової терапії призводить до зменшення частоти та інтенсивності симптомів гастроезофагеальної рефлюксної хвороби (ГЕРХ), відновлення кліренсу стравоходу з істотним зменшенням частоти виникнення, кількості за добу, тривалості кислих гастроезофагеальних рефлюксів, у порівнянні із даними у пацієнтів, що отримували лише базисну терапію лікування стабільної ІХС та ГЕРХ, де клінічні симптоми ГЕРХ навпаки посилились.Висновки. У хворих на стабільну стенокардію напруги та гастроезофагеальну рефлюксну хворобу було виявлено виражену симптоматику ГЕРХ, підвищення частоти виникнення, кількості за добу, тривалості кислих гастроезофагеальних рефлюксів, порушення процесів кліренсу стравоходу. Додаткове призначення мельдонію (Вазонату) на тлі базисної терапії хворих на стабільну стенокардію напруги та гастроезофагеальну рефлюксну хворобу дозволило усунути клінічну симптоматику, істотно зменшити частоту, тривалість та кількість епізодів кислих гастроезофагеальних рефлюксів, що сприяло повному загоєнню рефлюкс-езофагіту.

Condition of neuro-endocrine system at comorbid course of chronic obstructive pulmonary disease and gastroesophageal reflux disease

The paper presents the findings of investigating the activity of acetylcholinesterase blood, the catecholamine content in red blood cells, the vegetative nervous system tone under conditions of the combined course of gastroesophageal reflux disease (GERD) and chronic obstructive pulmonary disease (COPD). Cholinergic and adrenergic imbalances induced by a COPD exacerbation have been found to be important components of potentiating an acid-dependent injury of the esophageal mucous coat in GERD.

Diet and Nutritional Management in Functional Gastrointestinal Disorder: Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a common condition with a wide range of clinical manifestations. The clinical epidemiology of GERD is related to diet. It has been speculated that certain dietary factors may play a role in the pathogenesis or course of GERD. Physiological studies have shown a decrease in lower esophageal pressure and an increase in esophageal acid exposure in response to consuming a variety of foods. Subjects with GERD are sensitive to acidic juices, such as orange and tomato juices. Some patients are less tolerant to caffeine including coffee. Fatty foods and chocolate may weaken the lower esophageal sphincter, whereas protein may increase lower sphincter tone. Large meals distend the stomach, increase intragastric pressure, and facilitate gastroesophageal reflux. Alcohol consumption is another important risk factor for GERD. However, a wide-rangingreview of the available data revealed conflicting findings regarding the impact of dietary factors on GERD.(Korean J Med2016;90:93-97)

Helicobacter pylori and Nonmalignant Diseases.

Helicobacter pylori is responsible for most peptic ulcers, plays a role in functional dyspepsia and is thought by some to influence the course of gastroesophageal reflux disease. This article addresses recent studies that have been published in connection with these diseases. H. pylori-associated peptic ulcer is declining in prevalence but the incidence of perforation and bleeding remains high especially in the elderly. All H. pylori associated peptic ulcers should be treated by eradication of the infection. Dyspepsia is a common disorder that affects up to 25% of the population. About 8% of cases that are infected with H. pylori will respond to treatment of the infection. The association between H. pylori and gastroesophageal reflux disease continues to be debated, a number of studies have shown that there is a negative association between H. pylori infection and Gastroesophageal reflux disease but treatment of H. pylori has not been shown to induce reflux or to affect the response to medication. Gastric atrophy is known to extend when acid suppression is used in infected patients implying that H. pylori treatment should be used in infected patients who are to undergo long-term Proton Pump Inhibitor therapy.

BariSurg trial: Sleeve gastrectomy versus Roux-en-Y gastric bypass in obese patients with BMI 35-60 kg/m(2) - a multi-centre randomized patient and observer blind non-inferiority trial.

BackgroundRoux-en-Ygastric bypass (RYGB) and sleeve gastrectomy (SG) rank among the most frequently applied bariatric procedures worldwide due to their positive risk/benefit correlation. A systematic review revealed a similar excess weight loss (EWL) 2 years postoperatively between SG and RYGB. However, there is a lack of randomized controlled multi-centre trials comparing SG and RYGB, not only concerning EWL, but also in terms of remission of obesity-related co-morbidities, gastroesophageal reflux disease (GERD) and quality of life (QoL) in the mid- and long-term.MethodsThe BariSurg trial was designed as a multi-centre, randomized controlled patient and observer blind trial. The trial protocol was approved by the corresponding ethics committees of the centres. To demonstrate EWL non-inferiority of SG compared to RYGB, power calculation was performed according to a non-inferiority study design. Morbidity, mortality, remission of obesity-related co-morbidities, GERD course and QoL are major secondary endpoints. 248 patients between 18 and 70 years, with a body mass index (BMI) between 35–60 kg/m2 and indication for bariatric surgery according to the most recent German S3-guidelines will be randomized. The primary and secondary endpoints will be assessed prior to surgery and afterwards at discharge and at the time points 3–6, 12, 24, 36, 48 and 60 months postoperatively.DiscussionWith its five year follow-up, the BariSurg-trial will provide further evidence based data concerning the impact of SG and RYGB on EWL, remission of obesity-related co-morbidities, the course of GERD and QoL.Trial registrationThe trial protocol has been registered in the German Clinical Trials Register DRKS00004766.

Helicobacter pylori infection and extragastroduodenal diseases

At present, the clinical significance of Helicobacter pylori infection has been validly determined within the development of a diversity of gastroduodenal diseases, including chronic gastritis, gastroduodenal ulcer, MALT lymphoma, and gastric adenocarcinoma. The Expert Council's Maastricht IV consensus (2010) determining international standards for the diagnosis and treatment of H. pylori infection is that there is evidence that the latter may be associated with the development of a number of extragastroduodenal diseases (EGDDs) presented by iron-deficiency anemia of unspecified etiology, idiopathic thrombocytopenic purpura, and vitamin B12 deficiency. In these diseases, it is recommended that infection with H. pylori be diagnosed and, if the test is positive, this microorganism be eradicated. A large number of investigations have been recently conducted to examine the association of H. pylori infection with other EGDDs. This paper reviews theoretical and epidemiological data on the association of H. pylori with diseases of the cardiovascular (atherosclerosis, myocardial infarction) and central nervous (Alzheimer's disease, Parkinson's disease) systems, pancreas (autoimmune pancreatitis, pancreatic cancer), oncological (colonic adenomas, colorectal cancer, hepatocellular carcinoma), dermatological (chronic spontaneous urticaria), and other EGDDs. The review highlights the potential protective role of H. pylori in diseases with the atopic element of genesis and a complicated course of gastroesophageal reflux disease (Barrett's esophagus, esophageal adenocarcinoma).

Роль вегетативної дисфункції та її корекції при гастроезофагеальній рефлюксній хворобі

У статті проаналізовано результати досліджень щодо впливу вегетативної дисфункції на перебіг гастроезофагеальної рефлюксної хвороби, показано доцільність корекції вегетативного дисбалансу фенібутом на тлі антисекреторної терапії пантопразолом, що сприяє покращенню безпосередніх та віддалених результатів лікування.

Association between gastroesophageal reflux disease after pneumatic balloon dilatation and clinical course in patients with achalasia.

Background/AimsThe occurrence of gastroesophageal reflux disease (GERD) is known to be associated with lower post-treatment lower esophageal sphincter pressure in patients with achalasia. This study aimed to elucidate whether GERD after pneumatic balloon dilatation (PD) has a prognostic role and to investigate how the clinical course of GERD is.MethodsA total of 79 consecutive patients who were first diagnosed with primary achalasia and underwent PD as an initial treatment were included in this retrospective study. Single PD was performed using a 3.0 cm balloon. The patients were divided into two groups: 1) who developed GERD after PD (GERD group) and 2) who did not develop GERD after PD (non-GERD group). GERD was defined as pathological acid exposure, reflux esophagitis or typical reflux symptoms.ResultsTwenty one patients (26.6%) developed GERD after PD during follow-up. There were no significant differences between the two groups in demographic or clinical factors including pre- and post-treatment manometric results. All patients in GERD group were well responsive to maintenance proton pump inhibitor therapy including on demand therapy or did not require maintenance. During a median follow-up of 17.8 months (interquartile range, 7.1–42.7 months), achalasia recurred in 15 patients (19.0%). However, the incidence of recurrence did not differ according to the occurrence of GERD after PD.ConclusionsGERD often occurs after even a single PD for achalasia. However, GERD after PD is well responsive to PPI therapy. Our data suggest that GERD after PD during follow-up does not appear to have a prognostic role.

Clinical and pathogenic evaluation of chronic obstructive pulmonary disease and gastro-esophageal reflux disease co-morbidity

Summary. The aim of this work was to study clinical peculiarities of gastro-esophageal reflux disease (GERD) in patients with chronic obstructive pulmonary disease (COPD) and pathogenic relationships of this co-morbidity. We examined 64 patients with COPD. Additionally to clinical examination, we performed esophagogastroduodenoscopy (EGDS), intraesophageal and intragastric pH-metry, investigated oxidation status, blood oxygen saturation using pulse oxymetry and hormonal status of patients. Results showed that the majority of patients (84.3 %) coughed after eating, in supine position and at night. Endoscopic examination revealed GERD signs in 53 patients (82.8 %). Gastric hyperacidity was found in 56 patients (87.5 %). Changes in intraesophageal pH were dependent on severity of COPD. We revealed correlations between malone dialdehyde concentration and oxygen saturation and severity of COPD. Pathogenic relationships found confirmed a role of hormones in co-morbidity of COPD and GERD. Our study results suggest that changes in lipid peroxidation and hormone status indicate a presence of common pathogenic factors in concomitant course of GERD and COPD.