Development Of Reflux Esophagitis Research Articles

Esophageal Mucosal Resistance in Reflux Esophagitis: What We Have Learned So Far and What Remains to Be Learned.

Gastroesophageal reflux disease (GERD) has the highest prevalence among diseases of the digestive system and is characterized by a significant decrease in patients' quality of life, comparable to arterial hypertension and coronary heart disease. One in every ten cases of reflux esophagitis leads to the formation of Barrett's esophagus, which is associated with a high risk of esophagus adenocarcinoma. The key factors determining the progression of the disease are the frequency and duration of the reflux of the stomach's contents. As a result, refluxate, which includes hydrochloric acid, pepsin, and, in the case of concomitant duodeno-gastric reflux, bile acids and lysolecithin, is thrown into the overlying sections of the digestive tract. At the same time, in addition to aggression factors, it is necessary to take into account the state of resistance in the esophageal mucosa to the effects of aggressive refluxate molecules. This review was prepared using systematized data on the protective properties of the esophageal mucosa and modern methods to assess the mucosal barrier in reflux esophagitis. Lesions of the epithelial barrier structure in the esophagus are recognized as the main pathogenetic factor in the development of reflux esophagitis and are a potentially significant therapeutic target in the treatment of GERD and Barrett's esophagus. This article presents the characteristics of the esophageal mucosal barrier and the protective mechanisms of the esophagus's mucous membrane in conditions of gastroesophageal reflux. Diagnostic approaches for assessing the course of reflux esophagitis are described for both histological criteria and the possibility of a comprehensive assessment of the state of mucins, tight-junction proteins, and the proliferative activity of the mucosa, including under the conditions of ongoing therapy.

Effect of gastric helicobacter pylori colonization in the development of erosive esophagitis in patients with hiatal hernia.

There may be various factors that determine gastroesophageal reflux disease (GERD) as a result of hiatal hernia (HH) (such as the size of the hernia, age, other host and environmental factors) and the presence of protective factors to explain the absence of reflux disease should not be ignored. Helicobacter pylori (Hp) infection can prevent the development of GERD or cause it. This study aimed to determine whether Hp colonized in the stomach and hernia affects the development of erosive esophagitis (EE) in patients with HH. In this case-controlled study, 111 patients with HH were eligible for the study. Study group with EE (n = 61, 55%) and control group without EE (n = 50, 45%) were formed. Groups were compared for gastric Hp and Hp in the hernia. While the frequency of Hp in the antrum was 55.7% in the group with EE, it was 30% in the control group (p = 0.01, OR: 2.94 in 95% CI 1.34-6.46). The rates in terms of HP frequency in the corpus were 43.6% and 32.1%, respectively, (p = 0.45). Hp colonization in HH was detected in 18 cases (29.50%) and 14 cases (28%), respectively, (p = 0.86). In regression analysis, antral Hp was found to be effective in the development of EE (p = 0.01). As a result of this study, we think that antral Hp may have a causative role in the development of reflux esophagitis, but the presence of Hp in HH does not have an effective role in reflux esophagitis formation.

17. EFFECT OF BILE ACID AND PANCREATIC JUICE IN REFLUX ESOPHAGITIS AFTER TOTAL GASTRECTOMY IN RAT MODEL

Abstract Esophagitis after total gastrectomy has been associated with the reflux of duodenal content into the esophagus. This study is to determine which fraction of the duodenum content reflux, pancreatic juice or bile acids contributes to the development of reflux esophagitis. 8 week Wistar Rats were used. 1. Reflux of Pancreatic juice and Bile(TG):End-to-end esophago-duodenostomy with total gastrectomy (n = 8) 2. Reflux of Pancreatic Juice (TG + P):End-to-end esophago-duodenostomy with total gastrectomy. Then, a bypass operation of the upper bile duct was made 25 cm below the esophagoduodenostomy anastomosis. Choledocho-jejunostomy was performed. (n = 6) 3. Reflux of Bile (TG + B) (n = 4):Roux-en-Y esophagojejunostomy with total gastrectomy. The bile duct was then divided and reimplanted into the proximal portion of the Roux limb, preceding the esophagojejunostomy to produce biliary reflux. Three weeks after, all rats were euthanized and the esophagus was evaluated histologically. 1. Macroscopy: In TG rats, the esophageal wall was thickened and covered with whitish nodular patches. The gross appearance of the esophagus from TG + P and TG + B group showed only scattered erosions. The ulcer score in TG + P and TG + B were significantly lowered compared to TG. 2. Microscopy: TG group developed large and long longitudinal ulcers. The inflammatory cell infiltration scores and hyperplasia scores were significantly decreased in the TG + B and TG + P group compared to TG group. The reflux of pancreatic juice alone and bile acid alone are not significant development of reflux esophagitis. Reflux of combined of bile acid and pancreatic juice to esophagus caused sever reflux esophagitis.

Comparative Analysis and Options to Improve the Immediate and Long-Term Effects of Gastric Cancer Surgical Treatment

Introduction. Currently, there are absolute and relative indications for splenectomy in the surgical treatment of gastric cancer.The aim of the study was to improve clinical outcomes of treatment in patients with gastric cancer identifying risks associated with splenectomy, and developing options to correct them. Methods. The study included clinical findings and parameters of the quality of life of 380 patients with gastric cancer who were treated at the Voronezh Regional Clinical Oncological Hospital in 2013-2019. All patients were conventionally divided into 2 groups. The patients of the first group (study group, 172 people) underwent gastrectomy with D2 lymphadenectomy, including splenectomy. The patients of the second group (comparison group, 208 people) underwent spleen-preserving gastrectomy with dissection of lymph node groups 10 and 11. The average follow-up was 39.6 months. In the postoperative period, all patients were examined according to the Clinical Recommendations of the Russian Federation. The SF-36, GSRS questionnaires were used to assess quality of life.Results. Splenectomy increased the incidence of early postoperative complications, including severe complications grades 3 - 5 according to the Clavien-Dindo classification, contributed to the development of reflux esophagitis and, in general, a worsen quality of life in the late postoperative period, but did not affect the patients survival.Conclusion. The data obtained evidence a significantly worse and generally unfavorable safety profile of patients undergoing splenectomy compared to patients who underwent spleen-preserving gastrectomy. Reduced indications for splenectomy appear to be the option to solve this problem. Measures for correction of postoperative complications have been developed for patients with absolute indications for splenectomy.

Морфофункціональний стан слизової оболонки стравоходу у хворих на гастроезофагеальну рефлюксну хворобу залежно від трофологічного статусу пацієнтів

Вивчено морфофункціональний стан слизової оболонки (СО) стравоходу у 57 хворих на гастроезофагеальну рефлюксну хворобу (ГЕРХ) із нормальною (індекс маси тіла (ІМТ) — 18,5–24,9 кг/м2) і надмірною (ІМТ понад 25 кг/м2) масою тіла. Проведено гістологічне та морфометричне дослідження СО стравоходу, імуногістохімічний аналіз експресії маркера апоптозу CD95 і маркера запалення циклооксигенази-2 (ЦОГ-2). Для рефлюкс-езофагіту найбільш характерні зміни багатошарового епітелію — гіперкератоз, паракератоз, проліферація базальних клітин і акантоз. При цьому вірогідних відмінностей морфометричних характеристик у хворих із нормальним ІМТ і надмірною масою тіла виявлено не було. Розвиток рефлюкс-езофагіту супроводжувався порушенням проапоптотичної здатності клітин СО стравоходу і підвищенням експресії ЦОГ-2, найбільш вираженим у хворих з високим ІМТ. Виявлені порушення можуть обумовлювати механізми ускладненого перебігу ГЕРХ у цієї категорії хворих.

Correction of gastrocardial syndrome in patients with hernias of the esophageal orifice of the diaphragm during antireflux operations

Introduction. Hernia of the esophageal opening of the diaphragm in 90% of cases is the main cause of the development of reflux esophagitis. The doctrine highlighted a large group of extraesophageal manifestations of reflux esophagitis, including gastrocardiac syndrome.Аim. The purpose of this publication is to evaluate the effectiveness of antireflux surgery in patients with hiatal hernia through the prism of its effectiveness in the dynamics of gastrocardial syndrome regression.Material and мethods. The paper presents the results of diagnostics and surgical treatment of 101 patients with hiatal hernia.Results. According to the data of instrumental research methods, cardiac hernias of the esophageal opening of the diaphragm were detected in 45 (44.5%) patients, cardiofundal in 40 (39.6%), subtotal in 15 (14.8%), total in 1 (0.9%). The main place in the clinical picture of gastrocardial syndrome was occupied by the pain syndrome behind the breastbone (83.1%). Thus, arrhythmias were found in 16 (40.0%) patients with cardiofundal, in 10 (66.6%) subtotal and in 1 (100.0%) total hiatal hernia, and angina pectoris is characteristic of cardiac hernias and was observed in 20 (44.4%) patients. The clinical manifestation of reflex angina pectoris and arrhythmias depended on the degree of shortening of the esophagus. Thus, arrhythmias were more common in patients with cardiofundal (50.0%), subtotal (71.4%), total (100.0%) hiatal hernia with II degree of shortening of the esophagus, and angina pectoris characteristic of cardiac (75.0%) hiatal hernia. with II degree of shortening of the esophagus. Reflex angina is typical for patients of the older age group, and manifestations of arrhythmia are recorded at a younger age. Heart rate variability was considered, according to electrocardiogram and Holter ECG monitoring before and after surgical treatment, where the parameters significantly (p> 0.05) decreased.Conclusions. The phenomena of gastrocardial syndrome regressed after antireflux surgery in 44 (43.5%) patients. Surgical treatment from the endovideosurgical approach did not worsen the results of surgical treatment.

Relationship Among Helicobacter Pylori, Lower Esophagus Sphincter Pressure, and Gastroesophageal Reflux: A Single-Center Experience.

ObjectivesThe aim of the study was to evaluate the relationship among lower esophageal sphincter pressure (LESP), Helicobacter pylori (Hp), and gastroesophageal reflux (GER).MethodsThe retrospective study included patients with isolated hypertensive or hypotensive lower esophageal sphincter (LES) who underwent esophageal manometry in our gastroenterology motility laboratory and had normal manometry results. Demographic characteristics, complaints on admission, upper endoscopy findings, 24-h esophageal pH monitoring results, and presence of Hp in gastric biopsy were evaluated.ResultsA total of 1226 patients were included in the study, among whom women comprised 54% of all patients. Mean age was 45.4±13.4 years. Most common presenting complaint was pyrosis (85.4%). Pathological reflux was detected in 61.4% of the patients in 24-h esophageal pH monitoring. Reflux esophagitis was detected in 22.9% and LES laxity was present in 17.4% of the patients. In gastric biopsy, Hp was positive in 40% of the patients. The age of patients with hypertensive LES was significantly higher and female gender and body mass index (BMI) were associated with hypertensive LES. Pyrosis was significantly less prevalent in patients with hypertensive LESP. Esophagitis and LES laxity were significantly more prevalent in patients with hypotensive LES. No significant difference was found among the three groups with regard to reflux and Hp positivity. No significant difference was found between Hp-positive and Hp-negative groups with regard to reflux and reflux esophagitis.ConclusionNo clear relationship was found among LES disorders, GER, and Hp. Moreover, no significant difference was found among LES disorders with regard to GER, while the presence of hypotensive LESP, rather than Hp, was found to be an important factor in the development of reflux esophagitis.

Inhibition of the BMP pathway prevents development of Barrett's-associated adenocarcinoma in a surgical rat model.

SummaryIntroductionEsophageal adenocarcinoma (EAC) is an aggressive cancer, associated with reflux esophagitis and intestinal metaplasia (IM). One underlying biological mechanism, which possibly drives the development of EAC, is the dysregulated expression of Bone Morphogenetic Proteins (BMPs).AimTo investigate if local delivery of Noggin, a BMP antagonist, reduced EAC.MethodsAfter obtaining proof of principal on local delivery of a Noggin/Sucralfate substance, a randomized controlled trial to test the effects of Noggin on EAC development was performed in a surgical rat model. In the model, an esophago-jejunostomy leads to development of reflux-esophagitis, IM and eventually EAC. Rats were treated by Noggin/Sucralfate or Sucralfate alone. Treatment was administered from 26 to 29 weeks after the operation.ResultsOf the 112 operated rats, 52 survived beyond 26 weeks. Finally, 25 rats treated with Noggin/Sucralfate and 21 with Sucralfate, were evaluated. At the end, 39 (85%) of the animals had IM while 28 (61%) developed cancer. There were significantly more cancers in the Noggin/Sucralfate arm (50%) versus the Sucralfate group (73%) (Chi square, P < 0.05). Most cancers were mucous producing T3 adenocarcinomas. There were no significant differences in the amount of IM, size or grade of the cancers, or expression of columnar and squamous markers between the two groups.ConclusionIn this study, we demonstrated that inhibition of BMPs by Noggin reduced development of EAC in a surgical esophagitis-IM-EAC rat model. In future, effective targeting of the BMP pathway with selective BMP-inhibitors could become an important asset to improve EAC patient outcome.

Течение пептических гастродуоденальных язв на фоне коморбидного сахарного диабета

Актуальность. Коморбидный сахарный диабет (СД) 2 типа ухудшает течение пептических язв желудка (ЯЖ) и двенадцатиперстной кишки (ЯК), а также эффективность лечебных мероприятий, при этом является независимым фактором риска развития гастродуоденальных кровотечений. Серопозитивность больных СД по носительству хеликобактерной инфекции составляет 50–60 %, которая регистрируется на 90 % чаще, чем в общей популяции. Цель: проанализировать характер течения гастродуоденальных язв на фоне коморбидного СД, выделить прогностические критерии. Материалы и методы. Под наблюдением находилось 1392 пациента с ЯЖ и ЯК. СД диагностирован у 215 больных (17 %), которые включены в основную группу, а остальные (83 %) составили группу сравнения. Соотношение ЯК : ЯЖ : ЯЖ + ЯК в группе с СД составило 6 : 2 : 1, а среди остальных обследованных — 10 : 4 : 1, соотношение мужчин и женщин в первой группе было 2 : 1, а во второй — 3 : 1, средний возраст больных — соответственно 52 года, длительность манифестации пептических язв — 6 лет. Индекс тяжести болезни составил 6 о.е., показатель глюкозы в крови — 10 ммоль/л, гликозилированного гемоглобина (HbA1c) — 8 %, инсулина — 25 мкМЕ/мл, коэффициента инсулинорезистентности (HOMA) — 12 о.е. Легкая, средней тяжести и тяжелая степень СД соотносились как 1 : 2 : 1. Результаты. СД относится к факторам риска тяжелого течения ЯЖ и ЯК, определяет локализацию ульцерации, размеры изъязвлений, развитие рефлюкс-эзофагита и дуоденогастрального рефлюкса, изменений физико-химических адсорбционно-реологических свойств желудочного сока и тяжесть гистологических повреждений слизистой оболочки желудка, которые зависят от характера инсулинорезистентности. Коморбидный СД является фактором риска тяжелого течения гастродуоденальных кровотечений, влияет на кардиоваскулярные показатели гемодинамики (уровни среднего артериального давления, периферического сосудистого сопротивления, объема циркулирующей крови) и определяет 60-часовую выживаемость больных, а к прогнознегативным критериям относятся уровни гликемии, HbA1c и НОМА. Выводы. Коморбидный СД значительно ухудшает течение пептических гастродуоденальных язв и является фактором риска их рецидивов.

Increased Reflux Esophagitis after Helicobacter pylori Eradication Therapy in Cases Undergoing Endoscopic Submucosal Dissection for Early Gastric Cancer

Simple SummaryHelicobacter pylori infection is associated with the development of gastric cancer. Reflux esophagitis may occur in the postoperative period of patients undergoing surgical therapy for gastric cancer. The role of eradication therapy of Helicobacter pylori in reflux esophagitis is controversial. Here, we evaluated the occurrence of reflux esophagitis before and after Helicobacter pylori eradication in patients having endoscopic submucosal resection for early gastric cancer. Reflux esophagitis before and after eradication therapy was evaluated during the follow-up. While reflux esophagitis incidence increased from 3.1% to 18.8% in the successful eradication group, no case of reflux esophagitis was observed in the failed eradication group. There was a significant correlation between successful Helicobacter pylori eradication rate and reflux esophagitis development. This study demonstrates that a successful Helicobacter pylori eradication therapy is a risk factor for newly developed reflux esophagitis in patients having endoscopic submucosal dissection for early gastric cancer.Background: The role of Helicobacter pylori in the pathogenesis of reflux esophagitis is controversial. This study investigated the frequency of reflux esophagitis before and after H. pylori eradication in patients having endoscopic submucosal dissection for early gastric cancer. Methods: This study included 160 patients that fulfilled the study’s criteria. Endoscopy was performed before and after H. pylori eradication, and reflux esophagitis was evaluated during the follow-up period. Results: Seropositivity for H. pylori in patients with early gastric cancer was 68.8%, 101 of them received eradication therapy. During the follow-up period, the incidence of reflux esophagitis increased from 3.1% to 18.8% in the successful eradication group but no case of reflux esophagitis was observed in the failed eradication group. The univariate and multivariate analyses showed a significant correlation between successful H. pylori eradication rate and the development of reflux esophagitis. Conclusions: This study demonstrated that a successful H. pylori eradication therapy is a risk factor for newly developed reflux esophagitis in patients with endoscopic submucosal dissection for early gastric cancer.

Risk of Reflux-Related Symptoms and Reflux Esophagitis after Helicobacter pylori Eradication Treatment in the Japanese Population.

Backgrounds: A meta-analysis of reports primarily from Western countries showed no association between Helicobacter pylori eradication and reflux esophagitis development. The risk of reflux esophagitis may differ among different populations based on H. pylori virulence factors and acid secretion ability. We evaluated the prevalence rates of reflux esophagitis in H.-pylori-positive Japanese subjects and assessed risk factors for reflux esophagitis after eradication. Methods: Among 148 H.-pylori-positive subjects who underwent H. pylori eradication from August 2015 to December 2019, we evaluated the prevalence of reflux esophagitis on endoscopy at 12 months after eradication success and the severity of reflux-related symptoms by the F-scale questionnaire at 2 months after treatment and 12 months after eradication success. Results: The prevalence of reflux esophagitis in H.-pylori-positive patients at entry was 2.0% (3/148). At 12 months after eradication success, the prevalence was 10.8% (16/148) (p < 0.01). In the F scale, the median total score before treatment was 4 (range: 0–49), which significantly decreased to 2 (range: 0–22) (p < 0.01) at 2 months after treatment and 3 (range: 0–23) (p < 0.01) at 12 months after eradication success. Following multivariate analysis, the pretreatment total F-scale score was a risk factor for the development of reflux esophagitis (odds ratio: 1.069, 95% confidence interval: 1.003–1.139, p < 0.01). Conclusions: In this H.-pylori-positive Japanese population, eradication therapy was associated with reflux esophagitis in around 10% of patients, particularly in those with severe reflux-related symptoms at baseline. Reflux-related symptoms may improve throughout the 12 months after successful eradication therapy, irrespective of the development of reflux esophagitis.

Intraoperative impedance planimetry (EndoFLIP™) results and development of esophagitis in patients undergoing peroral endoscopic myotomy (POEM).

Peroral endoscopic myotomy (POEM) is a minimally invasive treatment for achalasia. Considerable evidence demonstrates a high incidence of gastroesophageal reflux disease (GERD) after POEM. The endoluminal functional lumen imaging probe (FLIP) uses impedance planimetry to obtain objective measurements of the gastroesophageal junction. This study aims to determine whether FLIP measurements collected at the time of POEM are associated with the development of reflux esophagitis postoperatively. Patients who underwent POEM between 2012 and 2019 who subsequently had esophagogastroduodenoscopy (EGD) were included. Intraoperative FLIP measurements before and after myotomy, clinical data from EGD, and reflux specific quality of life questionnaires were collected. Comparisons between groups were made using the Wilcoxon rank-sum and Fisher's exact tests. Receiver operating characteristic (ROC) curves were used to determine optimal cutoffs of measurements to classify patients into those with high risk of postoperative esophagitis and those with lower risk. A total of 43 patients were included. Of those, 25 (58.1%) were found to have esophagitis on postoperative EGD: four patients (16%) with LA Grade A, five (20%) with LA Grade B, 11 (44%) with LA Grade C and two (8%) with LA grade D esophagitis. Patients with a final distensibility index ≥ 2.7 and a final cross-sectional area ≥ 83 were significantly more likely to develop esophagitis on postoperative EGD (p = 0.016 and p = 0.008, respectively). Gastroesophageal reflux disease health-related quality of life (GERD-HRQL) and reflux symptom index (RSI) scores were not significantly different in patients who developed esophagitis and those who did not. Reflux affects some patients after POEM. We show that FLIP measurements collected during POEM may help predict which patients are more likely to develop reflux esophagitis postoperatively. Subjective symptoms on quality of life questionnaires are not reliable in determining which patients are at risk for esophagitis.

Proton Pump Inhibitors and Radiofrequency Ablation for Treatment of Barrett's Esophagus.

Gastroesophageal Reflux Disease (GERD) is characterized by acid and bile reflux in the distal oesophagus, and this may cause the development of reflux esophagitis and Barrett's oesophagus (BE). The natural histological course of untreated BE is non-dysplastic or benign BE (ND), then lowgrade (LGD) and High-Grade Dysplastic (HGD) BE, with the expected increase in malignancy transfer to oesophagal adenocarcinoma (EAC). The gold standard for BE diagnostics involves high-resolution white-light endoscopy, followed by uniform endoscopy findings description (Prague classification) with biopsy performance according to Seattle protocol. The medical treatment of GERD and BE includes the use of proton pump inhibitors (PPIs) regarding symptoms control. It is noteworthy that long-term use of PPIs increases gastrin level, which can contribute to transfer from BE to EAC, as a result of its effects on the proliferation of BE epithelium. Endoscopy treatment includes a wide range of resection and ablative techniques, such as radio-frequency ablation (RFA), often concomitantly used in everyday endoscopy practice (multimodal therapy). RFA promotes mucosal necrosis of treated oesophagal region via high-frequency energy. Laparoscopic surgery, partial or total fundoplication, is reserved for PPIs and endoscopy indolent patients or in those with progressive disease. This review aims to explain distinct effects of PPIs and RFA modalities, illuminate certain aspects of molecular mechanisms involved, as well as the effects of their concomitant use regarding the treatment of BE and prevention of its transfer to EAC.

Sex Differences in the Relation between Waist Circumference within the Normal Range and Development of Reflux Esophagitis.

We examined the association of abdominal obesity and waist circumference within normal range with the incidence of reflux esophagitis, separately in men and women. This cohort study involved 142,679 Korean adults without reflux esophagitis, who underwent upper endoscopy at baseline and during follow-up. Waist circumference was categorized into the following quartiles: <80, 80.1–85, 85.1–90, and ≥90.1 cm in men; and <69.3, 69.3–74, 74.1–79.5, and ≥79.6 cm in women. During the 551,877.8 person-years of follow-up, 29,509 participants developed reflux esophagitis. The association between waist circumference quartiles and risk of reflux esophagitis significantly differed with sex (p for interaction < 0.001). In men, multivariable-adjusted hazard ratios (HRs) (95% confidence intervals (CIs)) comparing waist circumference quartiles 2, 3, and 4 to the lowest quartile were 1.03 (0.99–1.07), 1.08 (1.04–1.12), and 1.15 (1.10–1.19), respectively. In women, HRs (95% CIs) comparing quartiles 1, 2, and 4 to the 3rd quartile were 1.10 (1.04–1.17), 1.03 (0.98–1.10), and 1.07 (1.01–1.13), respectively. In this large cohort with endoscopic follow-up, the risk of reflux esophagitis increased with increasing waist circumference even within the normal range in men, whereas the risk increased with low normal waist circumference or with abdominal obesity in women, indicating a U-shaped association.

Gender Specific Differences in Prevalence and Risk Factors for Gastro-Esophageal Reflux Disease.

BackgroundGender-related factors might play an important role in the development of reflux esophagitis (RE) and symptomatic gastro-esophageal reflux disease (GERD). We aimed to evaluate the prevalence and risk factors for RE and symptomatic GERD and determine whether gender specific differences exist.MethodsThis study was conducted on a health cohort consisting of 10,158 participants who underwent comprehensive health screening. Lifestyles and gastrointestinal symptoms were investigated using a self-reported structured questionnaire. Questionnaires about menstrual status were added for the women.ResultsThe prevalence of RE in men was significantly higher than that in women (10.6% vs. 2.0%, P < 0.001); however, symptomatic GERD showed predominance in women (6.2% vs. 2.5%, P < 0.001). Although the prevalence of RE gradually increased with the duration of menopause stratified by decade (P = 0.007), that of symptomatic GERD rapidly increased across the menopausal transit in women. Apart from common risk factors of obesity and current smoking for RE, over 70 years of age in women and hiatal hernia and hypertriglyceridemia in men were significant risk factors. In symptomatic GERD, high somatization was a common risk factor. Excessive alcohol drinking was a significant risk factor in men, but not in women.ConclusionThis study showed a predominance of RE in men, but a predominance of symptomatic GERD in women. In women, dynamic increase in the prevalence of GERD is closely related to the menopause conditions and its duration. There are specific risk factors for RE and symptomatic GERD according to gender differences.

Non-alcoholic fatty liver disease and the development of reflux esophagitis: A cohort study.

Non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of the metabolic syndrome, is associated with gastroesophageal reflux disease in cross-sectional studies, but a prospective association has not been evaluated. The current study aimed to determine whether NAFLD increases the risk of incident reflux esophagitis in a large cohort study. We conducted a cohort study of 34063 men and women without reflux esophagitis or other upper gastrointestinal disease at baseline who underwent health checkup examinations between January 2003 and December 2013. Fatty liver was diagnosed by ultrasound based on standard criteria. Reflux esophagitis was defined by the presence of at least grade A mucosal break on esophagogastroduodenoscopy. The prevalence of NAFLD at baseline was 33.2%. During 153520.2 person-years of follow-up, the cumulative incidences of reflux esophagitis for participants without and with NAFLD were 9.6% and 13.8%, respectively (P<0.001). The age-adjusted and sex-adjusted hazard ratio for the risk of reflux esophagitis development in participants with NAFLD compared with those without NAFLD was 1.15 (95% confidence interval 1.07-1.23; P<0.001). However, this association disappeared after adjusting for body mass index and other metabolic factors (hazard ratio 1.01, 95% confidence interval 0.94-1.09; P=0.79). Similarly, in multivariable-adjusted models, there was no significant association between NAFLD severity and the risk of developing reflux esophagitis. Non-alcoholic fatty liver disease is not independently associated with the risk of the development of reflux esophagitis, but rather, reflux esophagitis is primarily the consequence of increased body mass index commonly associated with NAFLD.

Nonalcoholic Fatty Liver Disease Is Associated with Increased Risk of Reflux Esophagitis.

Reflux esophagitis is associated with obesity and metabolic syndrome; however, the relationship between nonalcoholic fatty liver disease (NAFLD) and reflux esophagitis is unclear. We examined the association between NAFLD and the development of reflux esophagitis. Our cohort consisted of 117,377 Korean adults without reflux esophagitis at baseline who underwent a health checkup program including upper endoscopy between 2002 and 2014 and were followed annually or biennially until December 2014. NAFLD was defined as hepatic steatosis on ultrasonography in the absence of excessive alcohol use or any other identifiable cause. Over 520,843.2 person-years of follow-up, 22,500 participants developed reflux esophagitis (incidence density, 43.2 per 1000 person-years). In models adjusted for age and sex, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for incident reflux esophagitis in subjects with NAFLD compared to those without was 1.16 (1.13-1.20). After further adjustment for confounders of center, year of visit, smoking status, alcohol intake, regular exercise, education level, and body mass index, the association between NAFLD and incident reflux esophagitis was attenuated, but remained significant (aHR 1.06; 95% CI 1.02-1.10). In this large cohort of Korean men and women, participants with NAFLD exhibited increased incidence of reflux esophagitis independent of possible confounders, suggesting that NAFLD contributes to the development of reflux esophagitis.

The effect of n-3/n-6 polyunsaturated fatty acids on acute reflux esophagitis in rats.

BackgroundPolyunsaturated fatty acids (PUFAs) play various roles in inflammation. However, the effect of PUFAs in the development of reflux esophagitis (RE) is unclear. This study is to investigate the potential effect of n-3/n-6 PUFAs on acute RE in rats along with the underlying protective mechanisms.MethodsForty Sprague Dawley rats were randomly divided into four groups (n = 10 in each group). RE model was established by pyloric clip and section ligation. Fish oil- and soybean oil-based fatty emulsion (n-3 and n-6 groups), or normal saline (control and sham operation groups) was injected intraperitoneally 2 h prior to surgery and 24 h postoperatively (2 mL/kg, respectively). The expressions of interleukin (IL)-1β, IL-8, IL-6 and myeloid differentiation primary response gene 88 (MyD88) in esophageal tissues were evaluated by Western blot and immunohistochemistry after 72 h. The malondialdehyde (MDA) and superoxide dismutase (SOD) expression in the esophageal tissues were determined to assess the oxidative stress.ResultsThe mildest macroscopic/microscopic esophagitis was found in the n-3 group (P < 0.05). The expression of IL-1β, IL-8, IL-6 and MyD88 were increased in all RE groups, while the lowest and highest expression were found in n-3 and n-6 group, respectively (P < 0.05). The MDA levels were increased in all groups (P < 0.05), in an ascending trend from n-3, n-6 groups to control group. The lowest and highest SOD levels were found in the control and n-3 group, respectively (P < 0.05).Conclusionn-3 PUFAs may reduce acute RE in rats, which may be due to inhibition of the MyD88-NF-kB pathway and limit oxidative damage.

Relationship between esophageal cardiac glands and gastroesophageal reflux disease.

The role of esophageal cardiac glands has not been fully determined. This study was performed to clarify the protective role of esophageal cardiac glands against the development of gastroesophageal reflux disease (GERD). The subjects included 2,656 Japanese individuals who visited our institution for a detailed medical checkup. GERD symptoms were assessed using the Japanese version of the Carlsson-Dent self-administered questionnaire (QUEST) and an upper gastrointestinal endoscopy examination in each subject. The presence of reflux esophagitis, size of diaphragmatic hiatus, degree of gastric mucosal atrophy and existence of visible esophageal cardiac glands in the distal esophagus, based on the detection of yellowish elevated areas, were determined using endoscopy. Esophageal cardiac glands were observed in 355 cases (13.4%). Reflux esophagitis was significantly less frequent in the cases with esophageal cardiac glands than in those without. The esophageal cardiac glands were mainly located on the left-posterior side of the esophageal wall of the distal esophagus. A multiple regression analysis showed that the presence of esophageal cardiac glands was an independent factor for preventing reflux esophagitis. On the other hand, the existence of these glands did not correlate with the presence of GERD symptoms (QUEST score of 6 or more). The presence of visible esophageal cardiac glands may have a protective role against the development of reflux esophagitis.

405. The use of the ileocecal segment of bowel for reconstruction after combined gastrectomy

Background: Gastrectomy remains the radical treatment of gastric cancer. The choice of method of restoration of gastrointestinal continuity after gastrectomy is a major factor in the incidence of various organic and functional disorders of the digestive system, especially esophagitises. Tumor invasion to the transverse colon requires transversectomy. Recovery phase of this operation using the ileocecal segment reduces the risk of insolvency of colonic anastomoses and prevent the development of reflux esophagitis. Materials and methods: The study is based on an analysis of the results of treatment 338 patients with locally advanced gastric cancer who were treated at the Institute of General and Urgent Surgery of Academy of Medical Sciences from 1998 till 2013, aged from 29 to 86 years. Mean age was 62.9 years. 208 were males (61.5%), 130 were females (38.5%). All patients showed tumor spread to nearby organs: the pancreas e in 81 (32.9%), colon and mesocolon e in 62 (25.2%), liver e 46 (12.2%), esophagus e in 38 (10, 6%), spleen e 21 (5.0%), diaphragm e 16 (4.3%), hepatoduodenal ligament e 19 (4.0%), duodenum (duodenum) e 9 (3.6%) and invasion in several organs e in 46 (18.2%) patients. Results: Gastrectomy with combined resection of the transverse colon, good intraoperative conditions, we used esophagogastroplasty by ileocecal segment of the intestine (18 patients). The essence of the method is to separate the ileocecal segmentwith the supplying vessel (a. ileocolica),move it to the position of the stomach and the formation of esophago-ileoanastomosis ’end to side’ or ’end to end’ and ceco-duodenoanastomosis. It should be stressed that in such a reconstruction the ileocecal valve is present, which replaces a Gubarev valve and warns gastro e and duodeno-esophagal reflux. Availability of isoperistaltic reconstruction, with the inclusion of duodenum into digestion, and presence of ileocecal valve creates good conditions for the functioning of graft displaced into stomach position, preventing duodeno-esophageal reflux. Among patients undergoing gastro-esophagoplasty by ileocecal segment early postoperative deathswere not reported. On examination in a period of 3 to 9 months, no symptoms of reflux esophagitis were found in patients with ileocecal segment gastroplasty. Radical surgery was performed in 131 (38.7%) patients, palliative and symptomatic in 207 (61.3%). Postoperative complications occurred in 128 (37.9%) patients. Postoperative mortality was 18.3% (62 patients), general mortality e 22.8% (77 patients). The average follow up from radical surgery group and palliative surgery group was 28 months and 16 months respectively. Median survival rate in groups was 16.3 and 9.3 months. Conclusions: Use of the ileocecal segment of colon after combined gastrectomy and traversectomy provides good results, is the prevention of reflux esophagitis development. No conflict of interest.