Development Of Gastroesophageal Reflux Disease Research Articles

Influence of laparoscopy-aided gastrostomy on gastroesophageal reflux in neurologically impaired patients using multichannel intraluminal impedance pH measurements.

Development of gastroesophageal reflux disease (GERD) after gastrostomy remains debatable. Therefore, this study aimed to evaluate whether laparoscopy-aided gastrostomy (LAG) influence on the occurrence of GERD in neurologically impaired (NI) patients. Furthermore, we investigated whether preoperatively excluding NI patients with GERD can reduce the number of patients requiring subsequent anti-reflux surgery (ARS) after LAG. This retrospective study included 35 NI patients (median age: 11.0; interquartile range 5.0-23.5years) who underwent LAG according to our criterion from October 2012 to June 2020 and MII-pH before and after LAG. MII-pH parameters were compared in all patients and among three age groups between before and after LAG. There were no significant differences in MII-pH parameters before and 1year after LAG in all patients, and no patient underwent subsequent ARS. Only one paediatric patient with 64 number of reflux episodes before LAG required subsequent ARS 3years after LAG. Generally, LAG did not influence the postoperative GERD at 1year after LAG, and our criteria could reduce the number of patients requiring subsequent ARS. However, paediatric NI patients with higher number of reflux episodes in preoperative MII-pH study may need careful long-term follow-up after LAG.

Relationship between metabolic syndrome structure and gastroesophageal reflux disease development and treatment outcome

Relationship between metabolic syndrome structure and gastroesophageal reflux disease development and treatment outcome

Evaluations of Gastric Acid Pocket Using Novel Vertical 8-Channel pH Monitoring System and Effects of Acid Secretion Inhibitors.

Background/AimsThe gastric acid pocket has an important role in gastroesophageal reflux disease development. In this study, we utilized a novel 8-channel pH monitoring system with sensor intervals of 1 cm on the vertical axis for evaluation of postprandial gastric acid pocket in healthy Japanese adults, as well as the effects of vonoprazan and rabeprazole.MethodsTwelve healthy volunteers without Helicobacter pylori infection were enrolled. A catheter was inserted transnasally and positioned under X-ray guidance, then postprandial acid pocket formation was monitored over time in a sitting position. Thereafter, acid pocket changes were assessed following administration of vonoprazan (20 mg) or rabeprazole (20 mg).ResultsThe gastric acid pocket was successfully measured by use of the present system in 10 cases, while failure occurred in 2 because of inappropriate catheter positioning. Observed acid pockets were visualized with a mean length of 2.2 ± 0.4 channels on the top layer of food contents approximately 20 minutes after finishing a meal. There were some variations for lasting time of the acid pocket. Complete elimination within 3 hours after administration of vonoprazan was noted in all cases. Likewise, following administration of rabeprazole, the acid pocket was eliminated in 7 cases, while acidity was reduced though the pocket remained observable in 3.ConclusionsGastric acid pocket observations were possible using our novel vertical 8-channel sensor catheter. The present findings showed that vonoprazan strongly suppressed acid secretion within a short period, suggesting its effectiveness for gastroesophageal reflux disease treatment.

Stomach in the chest or what we know about giant hiatal hernias

A hernia of the esophageal aperture of the diaphragm is considered as one of the factors contributing to the development of gastroesophageal reflux disease and requires a complete and comprehensive examination of the patient. Routine esophagogastroduodenoscopy does not give a complete picture of the disease, and therefore patients receive symptomatic treatment for a long time. Paraesophageal hernia of the esophageal aperture of the diaphragm are not well understood yet due to their relatively low frequency of occurrence, may be asymptomatic or manifest as chest pain of noncardiac origin. A patient with a long history of gastroesophageal reflux disease associated with a giant paraesophageal hernia of the esophageal aperture of the diaphragm is presented as a clinical case.

Prenatal Ultrasound Measurement of Fetal Stomach Size Is Predictive of Postnatal Development of GERD in Isolated Cleft Lip and/or Palate.

To determine whether prenatal ultrasound measurement of fetal stomach size, as a surrogate marker of fetal swallowing, is predictive of postnatal development of gastroesophageal reflux disease (GERD) in cases of isolated cleft lip and/or palate (CL/P). This is a retrospective case-control study. The outcome of interest is postnatal diagnosis of GERD in isolated CL/P. The exposure of interest is prenatal stomach size measurement by ultrasound. The study population was selected from an academic, tertiary care center between 2003 and 2011. Cases were neonates undergoing CL/P repair during the study period. Cases with other known structural or chromosomal abnormalities were excluded. Controls were contemporary, nondiabetic neonates that matched gestational age (within one week) to cases. Each case measurement was matched ∼1:2 with control measurement. None. The primary outcome was difference in mean prenatal ultrasound measurement of fetal stomach size between cases and controls. We hypothesized that patients with postnatal development of GERD would have smaller mean fetal stomach size. There were 32 cases including 19 patients with unilateral cleft lip and palate, 8 with unilateral cleft lip, and 4 with bilateral cleft lip and palate. Cases were noted to have smaller mean anterior-posterior and transverse fetal stomach measurements as compared to controls. This was statistically significant from 16 to 21 weeks, 25 to 27 weeks, and 28 to 36 weeks (P < .01 for all). Prenatal ultrasound measurement of fetal stomach size as a surrogate marker of fetal swallowing is predictive of postnatal development of GERD in isolated CL/P.

Objectively Confirmed Gastroesophageal Reflux Disease Following Per Oral Endoscopic Myotomy Higher in Obese Patients (BMI>30).

Per oral endoscopic myotomy (POEM) is a promising minimally invasive therapy in the treatment of achalasia and other esophageal motility disorders. A concern surrounding POEM is the development of gastroesophageal reflux disease (GERD) postoperatively. This study was designed to report outcomes and identify risk factors for the development of postoperative GERD. Patients who underwent POEM between January 1, 2015 and December 12, 2019 were prospectively followed in an Institutional Review Board approved database. All patients were invited for a full comprehensive workup 6 months post-POEM including symptom scores, pH testing, manometry and esophagogastroduodenoscopy. In a retrospective review of this database, those who developed postoperative GERD were compared with those who did not. There were 82 patients that met study criteria (median age 59). Indications for POEM include 35 type I achalasia, 16 type II achalasia, 21 type III achalasia and other spastic esophageal motility disorders, and 10 esophagogastric junction outflow obstruction. Mean Eckardt scores post-POEM were 2.67 compared with 6.79 pre-POEM (P<0.05). Mean integrated relaxation pressure improvement decreased from 27 to 13.1 (P<0.05). The presence of postoperative GERD was defined as an abnormal DeMeester score (>14.7) with pH testing off-medications or the presence of Grade C/D esophagitis on endoscopy. Thirty-five percent (29/82) of patients developed postoperative GERD following POEM. Negative predictive factors for the development of postoperative GERD include myotomy length and normal body mass index (BMI). Obesity (BMI>30) was a positive predictive risk factor in the development of GERD (P=0.029). POEM provides symptomatic relief and reduced Eckardt scores in patient with achalasia and other esophageal motility disorders. Patients who undergo POEM are at risk for developing gastroesophageal reflux disease especially in obese patients.

Allergic rhinitis as a key factor for the development of gastroesophageal reflux disease in children.

Gastroesophageal reflux disease (GERD) may cause airway symptoms and some airway diseases exacerbate GERD symptoms. Asthma and allergic rhinitis (AR) have been identified as united airway disease because of their similar epidemiology and pathophysiology. Asthma has been considered a risk factor to develop GERD. However, the association between AR and GERD is not clear. We tried to investigate whether AR could increase the development of GERD. Children diagnosed as AR without a prior history of GERD were conducted from the National Health Insurance Research Database between 2000 and 2005. After propensity score matching, we enrolled 36,588 children with AR and 36,588 non-AR children as the controls. Cox regression models were adopted to calculate the hazard ratio (HR) of GERD. AR children had a significantly increased risk of GERD than non-AR children (adjusted HR 1.91, 95% CI=1.73-2.11, p<0.001), especially in the age less than 6 years old (adjusted HR 2.68, 95% CI=1.64-4.38, p<0.001). The risk factor related to increased risk of GERD including age, gender, and chronic sinusitis. AR is a risk factor associated with the development of GERD in children.

Study of Gastroesophageal Reflex Disease in adult Type II Diabetes Mellitus Patients with Upper Gastrointestinal Symptoms

Gastrointestinal symptoms are relatively common in clinical practice in patients with type II diabetes mellitus. type II DM has been described as possible risk factor for the development of gastroesophageal reflux disease, in this study we aim to detect the prevalence of GRED in symptomatic patients with type II DM , also to see the accuracy of reflex disease questionnaire ( RDQ) in the diagnosis of GERD in patients with type II DM in relation to the esophagogastroduodenoscopy finding and to study the relation of autonomic neuropathy to the prevalence and stages of GERD in diabetic patients . Methods: A ninety patients with upper gastrointestinal symptoms was divided in to tow groups according to whether had type II DM or not and then each group involved in a two stage process (a ) – a RDQ , ( b ) – OGD . And patients in the DM group underwent another step to detect diabetic neuropathy by a bed side clinical test. Results: The prevalence of esophagitis in this study was higher in the DM group. RDQ had a statistical significance in detecting esophagitis in the DM group. There is no relation of autonomic neuropathy to the prevalence of GERD in diabetic patients . Conclusion : The prevalence of GERD was high in patients with type II DM, RDQ is a sensitive tool for the diagnosis of GERD in diabetic pateints , Autonomic neuropathy did not increase prevalence of esophagitis in diabetic patients .

Study of Gastroesophageal Reflex Disease in Adult Type II Diabetes Mellitus patients with Upper Gastrointestinal Symptoms

Gastrointestinal symptoms are relatively common in clinical practice in patients with type II diabetes mellitus. type II DM has been described as possible risk factor for the development of gastroesophageal reflux disease, in this study we aim to detect the prevalence of GRED in symptomatic patients with type II DM , also to see the accuracy of reflex disease questionnaire ( RDQ) in the diagnosis of GERD in patients with type II DM in relation to the esophagogastroduodenoscopy finding and to study the relation of autonomic neuropathy to the prevalence and stages of GERD in diabetic patients . Methods: A ninety patients with upper gastrointestinal symptoms was divided in to tow groups according to whether had type II DM or not and then each group involved in a two stage process (a ) – a RDQ , ( b ) – OGD. And patients in the DM group underwent another step to detect diabetic neuropathy by a bed side clinical test . Results: The prevalence of esophagitis in this study was higher in the DM group. RDQ had a statistical significance in detecting esophagitis in the DM group. There is no relation of autonomic neuropathy to the prevalence of GERD in diabetic patients . . Conclusion : The prevalence of GERD was high in patients with type II DM , RDQ is a sensitive tool for the diagnosis of GERD in diabetic pateints , Autonomic neuropathy did not increase prevalence of esophagitis in diabetic patients .

Which drugs are risk factors for the development of gastroesophageal reflux disease?

Gastroesophageal reflux disease (GERD), which is common in many communities, is associated with structural factors, eating habits, and the use of certain drugs. The use of such drugs can lead to the emergence of GERD and can also exacerbate existing reflux symptoms. These drugs can contribute to GERD by directly causing mucosal damage, by reducing lower esophageal sphincter pressure (LESP), or by affecting esophagogastric motility. In this article, we report our investigation of the relationships between GERD and medications within the scope of the "Turkish GERD Consensus Group." For the medication groups for which sufficient data were obtained (Figure 1), a systematic literature review in English was conducted using the keywords "gastroesophageal reflux" [MeSH Terms] and "anti-inflammatory agents, non-steroidal" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "acetylsalicylic acid" [MeSH Terms], "gastroesophageal reflux" [All Fields] and "estrogenic agents" [All Fields], "gastroesophageal reflux" [All Fields] and "progesterones" [All Fields], "gastroesophageal reflux" [All Fields] and "hormone replacement therapy" [All Fields], "gastroesophageal reflux" [MeSH Terms] and "diphosphonates" [MeSH Terms] OR "diphosphonates" [All Fields], "calcium channel blockers" [MeSH Terms] and "gastroesophageal reflux" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "nitrates" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "antidepressive agents" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "benzodiazepines" [MeSH Terms] and "hypnotic drugs" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "cholinergic antagonists" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "theophylline" [MeSH Terms], and "gastroesophageal reflux [MeSH Terms] AND "anti-asthmatic agents" [MeSH Terms]. The studies were analyzed and the results are presented here.

Menthol relieves acid reflux inflammation by regulating TRPV1 in esophageal epithelial cells

Transient receptor potential cation channel subfamily V member 1 (TRPV1) plays an important role in pain and inflammatory responses. Previous studies have shown that the expression of TRPV1 increases in the sensory neurons of the esophagus during the development of gastroesophageal reflux disease and esophagitis, but the response of TRPV1 in esophageal epithelial cells (EECs), which directly confront the refluxed acid, is still unknown. Here, we found that acid reflux triggered esophageal damage, which was accompanied by increased expression of TRPV1 in EECs and TRPV1 channel activity in these cells. Furthermore, menthol inhibited the Ca2+ influx induced by acid stimulation in EECs. After menthol treatment, the expression of TRPV1 in EECs was significantly reduced, and their hyperplasia was significantly reduced; finally, the inflammation pathway elicited in EECs was diminished in mice with acid reflux. These results suggest that menthol improves the clinical symptoms caused by gastroesophageal acid reflux by interfering with TRPV1 in EECs.

Gastro-esophageal reflux and obstructive sleep apnea – is there a link?

Introduction. The epidemic of obesity has led to an increase in the occurrence of obstructive sleep apnea and gastro-esophageal reflux disease. The mechanism of development of gastro-esophageal reflux disease is multifactorial, and studies conducted in the last decade have shed new light on the causes of its development in patients with sleep apnea and obesity. Aim. The aim of the study was to discuss the mechanism of development of gastro-esophageal reflux disease is multifactorial, and studies conducted in the last decade have shed new light on the causes of its development in patients with sleep apnea and obesity and the dysfunction of the lower esophageal sphincter. Material and methods. An analysis of literature regarding gastro-esophageal reflux and obstructive sleep apnea. Results. In obstructive sleep apnea and obesity, high levels of cytokines and insulin resistance are observed, resulting in disorders in the levels of ghrelin – a hormone responsible for normal gastrointestinal motility. Conclusion. The effect of deviations in the ghrelin profile on the development of gastro-esophageal reflux disease remains a matter for further research.

Development of scores assessing the refluxogenic potential of diet of patients with laryngopharyngeal reflux.

To develop clinical tools assessing the refluxogenic potential of foods and beverages (F&B) consumed by patients with laryngopharyngeal reflux (LPR). European experts of the LPR Study group of the Young-Otolaryngologists of the International Federation of Oto-rhino-laryngological societies were invited to identify the components of Western European F&B that would be associated with the development of LPR. Based on the list generated by experts, four authors conducted a systematic review to identify the F&B involved in the development of esophageal sphincter and motility dysfunctions, both mechanisms involved in the development of gastroesophageal reflux disease and LPR. Regarding the F&B components and the characteristics identified as important in the development of reflux, experts developed three rational scores for the assessment of the refluxogenic potential of F&B, a dish, or the overall diet of the patient. Twenty-six European experts participated to the study and identified the following components of F&B as important in the development of LPR: pH; lipid, carbohydrate, protein composition; fiber composition of vegetables; alcohol degree; caffeine/theine composition; and high osmolality of beverage. A total of 72 relevant studies have contributed to identifying the Western European F&B that are highly susceptible to be involved in the development of reflux. The F&B characteristics were considered for developing a Refluxogenic Diet Score (REDS), allowing a categorization of F&B into five categories ranging from 1 (low refluxogenic F&B) to 5 (high refluxogenic F&B). From REDS, experts developed the Refluxogenic Score of a Dish (RESDI) and the Global Refluxogenic Diet Score (GRES), which allow the assessment of the refluxogenic potential of dish and the overall diet of the LPR patient, respectively. REDS, RESDI and GRES are proposed as objective scores for assessing the refluxogenic potential of F&B composing a dish or the overall diet of LPR patients. Future studies are needed to study the correlation between these scores and the development of LPR according to impedance-pH study.

Increase in lumbar kyphosis and spinal inclination, declining back muscle strength, and sarcopenia are risk factors for onset of GERD: a 5-year prospective longitudinal cohort study.

The objective was to identify risk factors for new development of gastroesophageal reflux disease (GERD) 5years later in a prospective longitudinal cohort study. A total of 178 subjects (male 72, female 106, mean age 68years) without GERD in 2013 were examined for GERD in 2018. A Frequency Scale for Symptoms of GERD score ≥ 8 was used for diagnosis of GERD. Body mass index, spinal alignment, muscle strength, physical ability, number of oral drugs per day, sarcopenia, and frailty determined in 2013 and 2018 were compared between the GERD(+) and GERD(-) groups in 2018. Aggravation of lumbar kyphosis and spinal inclination from 2013 to 2018 was defined as a change of ≥ 5° or ≥ 10°, and weakening of back muscle strength as a change of ≥ 10kg. QOL (SF-36) was also examined. Of the 178 subjects, 38 (21%) were diagnosed as GERD(+) in 2018. Sarcopenia in 2018 was significantly related to a GERD(+) status (p < 0.05). The GERD(+) group had significantly higher rates of changes of lumbar kyphosis ≥ 5° (p < 0.005) and ≥ 10° (p < 0.0001), of spinal inclination ≥ 5° (p < 0.0001), and of decreased back muscle strength ≥ 10kg (p < 0.05). SF-36 were also significantly worse in the GERD(+) group (p < 0.05). This prospective longitudinal study firstly demonstrated that lumbar kyphotic change, aggravation of spinal inclination, decreased back muscle strength, and sarcopenia are significant risk factors for new development of GERD. Management and prevention of these factors may contribute to reduction of GERD symptoms and increased QOL in middle-aged and elderly people. These slides can be retrieved under Electronic Supplementary Material.

Gastroesophageal reflux disease and esophagitis associated with the use of drugs: the modern state of the problem

From the standpoint of evidence - based medicine, the ability of various drugs to induce the development of gastroesophageal reflux disease and esophagitis is considered. Thus, all known drugs can be divided into 3 groups: drugs that have the ability to reduce pressure in the lower esophageal sphincter, for example, β-adrenoreceptor agonists, α-adrenoreceptor antagonists, anticholinergics, calcium channel blockers, nitrates, benzodiazepines (diazepam), estrogen, progesterone, aminophylline (theophylline), tricyclic antidepressants, selective serotonin reuptake inhibitors, glucocorticosteroids; means providing a direct damaging effect on the esophageal mucosa, as well as lowering its resistance reflyuktatu, e.g., bisphosphonates, acetylsalicylic acid / non - steroidal anti - inflammatory agents, anticoagulants, antiplatelet drugs, iron preparations, ascorbic acid, potassium chloride, quinidine, phenytoin, calcium dobesilate, 131I sodium iodide, antibiotics (tetracycline, doxycycline, clindamycin, ciprofloxacin, ornidazole, clindamycin, rifampicin), antitumor agents; drugs that impede gastric emptying: calcium channel blockers, anticholinergics. These data can be used in practice in the choice of treatment tactics, especially in individuals with a diagnosis of gastroesophageal reflux disease or heartburn.

Gastroesophageal reflux–related physiologic changes after sleeve gastrectomy and Roux-en-Y gastric bypass: a prospective comparative study

BackgroundThe development of gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) is a major concern as it affects the quality of life of the patients and potentially exposes them to the complications of GERD. The reported incidence of GERD after LSG is up to 35%. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the procedure of choice for patients with morbid obesity with GERD but objective evidence based on physiologic studies for the same are limited. ObjectiveThe objectives of the study were to determine the physiologic changes related to gastroesophageal reflux based on symptoms index, 24-hour pH study, impedance, and manometry after LSG and LRYGB. SettingsTertiary care teaching hospital, India. MethodsThis registered study (CTRI/2017/06/008834) is a prospective, nonrandomized, open-label clinical trial comparing the incidence of GERD after LSG and LRYGB. In this study, non-GERD patients were evaluated for GERD based on clinical questionnaires, 24-hour pH study, and impedance manometry preoperatively and 6 months postoperatively. ResultsThirty patients underwent LSG, and 16 patients underwent LRYGB. The mean DeMeester score increased from 10.9 ± 11.8 to 40.2 ± 38.6 (P = .006) after LSG. The incidence of GERD after LSG was 66.6%. The increase in DeMeester score from 9.5 ± 4.6 to 12.2 ± 17.2 after LRYGB was not significant (P = .7). There was a significant increase in the nonacid reflux both after LSG and LRYGB. ConclusionThe incidence of GERD after LSG is high, making it a contraindication for LSG. LRYGB remains the preferred procedure for patients with GERD. However, more studies are needed to understand the physiologic changes in patients with preexisting GERD.

The drug-induced injury of the upper gastrointestinal tract: prophylaxis and treatment

It is well established that non-steroidal anti-inflammatory drugs (NSAIDs) are the causal factor of mucosa damage not only of in the stomach and duodenum, but also in esophagus, triggering the development of gastroesophageal reflux disease (GERD). It is known that NSAIDs’ intake (including low doses of aspirin) can significantly increase the likelihood of developing of the peptic esophagitis with the risk of ulceration, bleeding, or stricture formation. Recent years, there is an increasing number of papers, devoted to the investigation of esophageal lesions and mechanisms of GERD development, occurring during the NSAIDs’ administration (including low doses of acetylsalicylic acid) and other drugs. The structure of drug-induced lesions of the upper gastrointestinal tract in patients taking NSAIDs has been analyzed. The investigation has been performed to study the frequency and characteristics of esophageal lesions in patients with osteoarthrosis of large joints, receiving NSAID treatment, as well as to determine factors that increase risk of developing this pathology. With account of the considered risk factors, the most rational approach to the diagnosis and primary prevention of NSAID-induced esophagitis has been chosen, which in most cases should reduce the incidence of side effects of NSAID-associated lesions of the esophagus. The main directions in the treatment of NSAID-associated injuries of the esophagus, namely, lifestyle change, balanced diet, changing the dose and regimen of NSAIDs or switching to selective NSAIDs, modern pharmacotherapy and surgical treatment have been elucidated. Clinical examples of patients with esophagus and stomach injuries associated with the long-term administration of NSAIDs and antiplatelet drugs were used to discuss the prevention and treatment of this category of patients, using proton pump inhibitors and bismuth-containing drugs.

The role of tea and coffee in the development of gastroesophageal reflux disease.

Objective:The incidence of gastroesophageal reflux disease (GERD) is increasing, and the disease has a close association with dietary habits. This study aims to investigate the role of tea and coffee drinking in the development of GERD.Materials and Methods:This study prospectively enrolled individuals who underwent an upper gastrointestinal endoscopy during a health checkup. Each participant completed the reflux disease questionnaire (RDQ). Coffee or tea drinking was defined as drinking the beverage at least 4 days/week for 3 months. Heavy coffee or tea consumption was defined as drinking at least two cups every day.Results:A total of 1837 participants (970 men; age 51.57 ± 10.21 years), who had data on clinical characteristics and consumption of coffee and tea with or without additives such as milk or sugar were included for final analysis. Among them, 467 (25.4%) were diagnosed as having symptomatic GERD based on the RDQ score, and 427 (23.2%) had erosive esophagitis (EE) on endoscopy. Drinking coffee or tea was not associated with reflux symptoms or EE in univariate and multivariate analyses. In contrast, drinking coffee with milk was associated with reflux symptoms and drinking “tea and coffee” was associated with EE in univariate analysis. However, these associations became insignificant after multivariate analysis.Conclusion:Drinking coffee or tea and adding milk or sugar was not associated with reflux symptoms or EE.

The role of visceral-abdominal obesity in the development of gastroesophageal reflux disease.

Studies of recent years show that the problem of abdominal-visceral obesity is gaining in importance, the steady growth of which is observed in almost all countries. Gastroesophageal reflux disease belongs to the most common diseases in patients with obesity. At present, the question of the metabolic activity of visceral fat as a factor in the pathogenesis of GERD is being investigated. Aim. Investigation of the level of serum concentration of the proinflammatory cytokine (interleukin 6), the biologically active substance -adipokin (leptin) and C-reactive protein, taking into account the BMI of patients with obesity and intra-arterialpH monitoring data and esophagogastroduodenoscopy. Material and methods. The main group consisted of 51 patients, in the age group from 30 to 60 years, suffering from GERD and obesity. The average age of the patients was 42.3 ± 2.11 years. Obesity of the 1st degree in BMI was in 19 people; obesity of the 2nd degree - in 23 people; obesity of the third degree in 9 patients. The level of leptin, interleukin 6 and C-reactive protein was determined, anthropometric examination with calculation of body mass index (BMI) and waist measurement (OT) to determine the degree of obesity and its type. To verify the diagnosis of GERD and determine its endoscopic form, esophagogastroduodenoscopy was performed using flexible endoscopes and intra-esophageal pH monitoring. Results. The level of serum concentration of interleukin 6, leptin and C-reactive protein in patients of the main group is higher than in the control group. A correlation between these indicators, the degree of obesity and the DeMeester index, reflecting the presence and severity of gastroesophageal reflux and the results of esophagogastroduodenoscopy, was revealed. Conclusion. Thus, the metabolic activity of visceral fat is one of the factors contributing to the increase in the duration and the number ofpathological refluxes leading to the development of erosive forms of esophagitis, which must be taken into account when choosing a program for the treatment ofpatients suffering from GERD and obesity.

Concomitant Hiatal Hernia Repair Is more Common in Laparoscopic Sleeve Gastrectomy than During Laparoscopic Roux-en-Y Gastric Bypass: an Analysis of 130,772 Cases.

Obesity is associated with the development of gastroesophageal reflux disease (GERD) and hiatal hernia (HH). This study aimed to assess practice patterns regarding concomitant HH repair (HHR) during laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). The incidence of concomitant HHR with LSG or LRYGB was analyzed using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. One hundred thirty thousand, seven hundred seventy-two patients underwent RYGB (30.5%) and LSG (69.5%). Concomitant HHR was more common, despite less GERD, in SG patients compared to RYGB (21.0% vs 10.8%, p < 0.0001; adjusted OR 2.14, 95% CI 2.06-2.22). This marked difference in the intraoperative management of HH during bariatric surgeries may hinder our ability to evaluate the long-term effects of bariatric surgery on GERD.