Diagnosis Of Gastroesophageal Reflux Disease Research Articles

Latin American consensus on diagnosis of gastroesophageal reflux disease.

Diagnosing gastroesophageal reflux disease (GERD) can be challenging given varying symptom presentations, and complex multifactorial pathophysiology. The gold standard for GERD diagnosis is esophageal acid exposure time (AET) measured by pH-metry. A variety of additional diagnostic tools are available. The goal of this consensus was to assess the individual merits of GERD diagnostic tools based on current evidence, and provide consensus recommendations following discussion and voting by experts. This consensus was developed by 15 experts from nine countries, based on a systematic search of the literature, using GRADE (grading of recommendations, assessment, development and evaluation) methodology to assess the quality and strength of the evidence, and provide recommendations regarding the diagnostic utility of different GERD diagnosis tools, using AET as the reference standard. A proton pump inhibitor (PPI) trial is appropriate for patients with heartburn and no alarm symptoms, but nor for patients with regurgitation, chest pain, or extraesophageal presentations. Severe erosive esophagitis and abnormal reflux monitoring off PPI are clearly indicative of GERD. Esophagram, esophageal biopsies, laryngoscopy, and pharyngeal pH monitoring are not recommended to diagnose GERD. Patients with PPI-refractory symptoms and normal endoscopy require reflux monitoring by pH or pH-impedance to confirm or exclude GERD, and identify treatment failure mechanisms. GERD confounders need to be considered in some patients, pH-impedance can identify supragrastric belching, impedance-manometry can diagnose rumination. Erosive esophagitis on endoscopy and abnormal pH or pH-impedance monitoring are the most appropriate methods to establish a diagnosis of GERD. Other tools may add useful complementary information.

Does severe and chronic esophageal distension by air (observed in SGB and GB) affect the esophageal mucosa integrity (MNBI).

Supragastric belching (SGB) and aerophagia are behavioral disorders characterized by air induced esophageal distension. SGB is known to be associated with Gastro Esophageal Reflux Disease (GERD). Low Mean Nocturnal Baseline Impedance (MNBI) values support GERD diagnosis. We aimed to assess if chronic esophageal distension by air affects the esophageal mucosa integrity by assessing changes in MNBI. In a single-center database study, we searched retrospectively for patients with a diagnosis of pathological SGB (n = 146) or aerophagia (n = 34) based on impedance-pH reflux monitoring. During the examined period, patients with a conclusive negative diagnosis of SGB and no evidence of aerophagia were used as a control cohort (n = 191). MNBI at 3, 5, and 17 cm over Lower Esophageal Sphincter (LES) was evaluated. GERD was diagnosed if acid exposure time (AET) >6%. All impedance studies of included patients were prospectively reevaluated. GERD was diagnosed in 31.7% patients with SGB, a rate not different in comparison to patients without SGB (30.8%, p = 0.906). MNBI at 3 and 5 cm above the LES was significantly decreased among patients with SGB. SGB was not correlated with MNBI at 3 cm over the LES, (p: 0.086 OR: 1.000 95% CI: 0.999-1.001) when using multivariate analysis. Moreover no difference was spotted as far as MNBI at 3, 5, and 17 cm over the LES is concerned among patients with or without aerophagia. Even if patients with SGB do show lower MNBI values, esophageal distention due to excessive air movement does not directly lead to impairment of esophageal mucosa integrity.

Modern strategy for management of pediatric patients with gastroesophageal reflux disease in compliance with the international and national guidelines

Recent epidemiological studies demonstrated that gastroesophageal reflux disease (GERD) takes a leading place among acid‑dependent gastroenterological diseases. The problems of GERD development prevention and its treatment are topical since GERD significantly reduces the quality of life, especially when extraesophageal symptoms appear. Timely and correct GERD diagnosis, treatment and monitoring in pediatric patients prevents the development of complicated course of the disease in adults. Last decade, priority attention has been given to improving the quality of medical care in most countries worldwide. To achieve this purpose, effective medical care should be provided and the results of treatment of patients should be improved.
 The review presents analysis of current strategies for GERD diagnosis and treatment in pediatric patients based on the international and national guidelines. To ensure the proper quality of medical care, it is necessary to standardize approaches to diagnosis and treatment of diseases in childhood. The preparation of the Medical Standards of Care «Gastroesophageal Reflux Disease in Children» by a multidisciplinary group of experts and the adaptation of the clinical guideline are purposed to the improvement of existing diagnostic and treatment approaches to GERD pediatric patients in Ukraine, to ensuring high‑quality and effective medical care and establishing the uniform requirements for prevention, diagnosis and treatment of this group of patients. The results of modern investigations, based on international consensuses on the GERD diagnosis and treatment in childhood, have been highlighted. The latest information on the expediency of administration of instrumental examinations and treatment tactics has been presented.

Bio-Inspired Untethered Robot-Sensor Platform for Minimally Invasive Biomedical Sensing.

Conventional catheter- or probe-based in vivo biomedical sensing is uncomfortable, inconvenient, and sometimes infeasible for long-term monitoring. Existing implantable sensors often require an invasive procedure for sensor placement. Untethered soft robots with the capability to deliver the sensor to the desired monitoring point hold great promise for minimally invasive biomedical sensing. Inspired by the locomotion modes of snakes, we present here a soft kirigami robot for sensor deployment and real-time wireless sensing. The locomotion mechanism of the soft robot is achieved by kirigami patterns that offer asymmetric tribological properties that mimic the skin of the snake. The robot exhibits good deployability, excellent load capacity (up to 150 times its own weight), high-speed locomotion (0.25 body length per step), and wide environmental adaptability with multimodal movements (obstacle crossing, locomotion in wet and dry conditions, climbing, and inverted crawling). When integrated with passive sensors, the versatile soft robot can locomote inside the human body, deliver the passive sensor to the desired location, and hold the sensor in place for real-time monitoring in a minimally invasive manner. The proof-of-concept prototype demonstrates that the platform can perform real-time impedance monitoring for the diagnosis of gastroesophageal reflux disease.

Сучасне розуміння етіопатогенезу гастроезофагеальної рефлюксної хвороби: висвітлення ключових аспектів та перспектив

Gastroesophageal reflux disease (GERD) is one of the most common diseases among gastroenterological pathologies. The relevance of GERD is due not only to medical aspects, but also to economic ones, since the vast majority of patients are young working-age people. The prevalence of GERD ranges from 20% to 30% of the adult population. GERD is associated with a significant decrease in quality of life and the development of Baretta’s esophagus and esophageal adenocarcinoma. GERD is a chronic disease with spontaneous repetitive spillage of gastric or duodenal-gastric contents into the esophagus, with typical complaints of heartburn and regurgitation. The pathogenesis is complex and includes the following aspects: decreased tone of the lower esophageal sphincter, diaphragmatic hernia, impaired protective function of the esophageal mucosa and esophageal motility, and increased intra-abdominal pressure. Obesity plays a significant pathogenetic role in the development of GERD. Weight loss is associated with symptom relief and a reduced risk of complications. Diagnosis of GERD is based primarily on typical clinical symptoms and empirical trial therapy with PPI. Treatment includes lifestyle changes, medications, and surgery. Еndoscopy and pH monitoring additionally contribute to the correct diagnosis. Further research on pathogenetic mechanisms is needed to implement effective strategies for diagnosis, treatment and prevention of complications.

Portable and Rapid Fluorescence Turn-On Detection of Total Pepsin in Saliva Based on Strong Electrostatic Interactions.

Salivary pepsin has been proposed as a promising diagnostic marker for gastroesophageal reflux disease (GERD). However, the activity of human pepsin is strongly influenced by pH, and the acidic condition (pH ∼ 2) is optimal, which is a contradiction for the pepsin detection kit based on its catalytic activity. Thus, its accurate quantification in saliva (neutral pH) by readily rapid tools with simplicity and low cost is still challenging. Herein, a convenient fluorescence assay has been developed for the rapid detection of pepsin at neutral pH based on its electrostatic interaction with SYBR Green (SG) rather than the bioactivity. At neutral pH, the positively charged SG fluorophore can be effectively adsorbed by the negatively charged pepsin due to the low isoelectric point (pI) and large molecular size of pepsin. Thus, the molecular rotation of SG is limited, and its fluorescence intensity is significantly increased. The strategy was further confirmed to have the same fluorescence response as that of normally active and inactivated pepsin. Due to the unique pI of pepsin, the fluorescence strategy is highly selective for pepsin compared to other proteins. On the basis of this strategy, a smartphone-based fluorescence capture device integrated with a programmed Python program was fabricated for both color recognition and the accurate detection of pepsin within 3 min. Under the optimal conditions, this turn-on sensor allowed for the on-site analysis of pepsin with a detection limit of 0.2 μg/mL. Moreover, this strategy was successfully used to assess salivary pepsin to aid in the noninvasive diagnosis of GERD.

Threshold level of Peptest in diagnosing gastroesophageal reflux disease with extraesophageal symptoms: Evidence from Vietnam.

We aimed to evaluate the application of Peptest, a novel technique to detect pepsin in the saliva, and identify its threshold level for the diagnosis of gastroesophageal reflux disease (GERD) with extraesophageal symptoms. A cross-sectional study was conducted in two groups: patients with extraesophageal GERD symptoms (symptomatic group divided into GERD and non-GERD groups according to 24-h esophageal pH-impedance monitoring [pH-I] results) and healthy controls. For the symptomatic group, endoscopy, pH 24 h, high-resolution manometry (HRM), and salivary Peptest were performed. For the healthy control group, only Peptest was done. The accuracy of Peptest was compared with that of pH-I by the Lyon consensus criteria. Chronic laryngitis was the most frequent extraesophageal symptom. On saliva testing, the GERD group had a higher prevalence of positive samples and pepsin concentration than the control group. Between GERD and non-GERD groups, the optimal threshold level was 31.2 ng/mL, with a sensitivity of 86.7% and specificity of 27.5%. The optimal threshold level was 31.4 ng/mL to differentiate GERD from healthy controls, with a sensitivity of 86.7% and specificity of 66.0%. Age, number of total refluxes, DeMeester score, post-reflux swallow-induced peristaltic wave (PSPW) index, and mean nocturnal baseline impedence (MNBI) were associated with pepsin concentration. Regarding HRM metrics, there was no significant difference of pepsin concentration between low/normal upper esophageal sphincter (UES) resting pressure, low/normal lower esophageal sphincter (LES) resting pressure, low/normal 4-s integrated relaxation pressure (IRP4s), and hypomotility/normal motility. Patients with extraesophageal symptoms had a higher prevalence of positive Peptest. The optimum threshold level of 31.4 ng/mL had high sensitivity and moderate specificity to differentiate between patients with GERD and healthy controls.

Real-World Evidence to Evaluate the Efficacy and Safety of Vonoprazan in Gastrointestinal Disorders in the Pakistani Population.

While proton pump inhibitor (PPI) therapy has proven to be effective in managing gastroesophageal reflux disease (GERD), a notable portion of patients who experience GERD symptoms may not respond to this treatment. Research suggests that roughly 30% of individuals with a presumed GERD diagnosis may continue to experience symptoms, whether partially or completely, even when receiving PPI therapy. The aim of this study was to assess the treatment of gastrointestinal diseases with a novel potassium-competitive acid blocker (P-CAB), vonoprazan, in terms of its effectiveness and safety in the Pakistani population. This prospective, multicenter, observational study was conducted in Pakistan. This study included 1,642 patients from January 2023 to August 2023, aged 18 years, with gastrointestinal disorders. All demographic data, medical history, GERD severity assessment questionnaire (GerdQ), and laboratory parameters, including stool assessment for Helicobacter pylori (H. pylori), were observed. Patients were orally treated with vonoprazan at doses of 10 mg or 20 mg, once or twice daily. Statistical analysis was done by one-way ANOVA. Out of 1,642 patients, 840 (51.2%) were males and 802 (48.8%) were females, with a mean age of 39.81±14.61 years. The mean GerdQ score at baseline was 20.37±15.87, 7.24±8.15 at the secondweek of treatment, and 3.70±6.31 at the fourth week of treatment (p<0.001). 90.74% of patients achieved H. pylori eradication. Most patients were acid regurgitation and heartburn-free for >70% of days. Most of the patients, 1,283 (78.13%), exhibited good treatment compliance. Mild adverse events were reported in 37 (2.3%) patients. The use of vonoprazan significantly reduced the likelihood of GERD by improving symptoms and was also highly effective in the elimination of H. pylori infections. Vonoprazan was generally well tolerated.

Modern aspects of managing patients with non-erosive reflux disease

A review of current data on the management of patients with non-erosive reflux disease (NERD) was made. Diagnosis of gastroesophageal reflux disease (GERD) is based on symptom analysis, endoscopic evaluation of the esophageal mucosa, objective evidence of gastric contents reflux into the esophagus during pH-impedancemetry, and response to therapeutic intervention. Treatment for GERD should include weight loss if overweight, lifestyle modification, and dietary modification. Current consensus recommends starting NERD treatment with once-daily proton pump inhibitors (PPIs), but only 50% of patients with this pathology respond to such therapy. Incomplete response to PPIs is a reason to increase the dose of PPI and add Gaviscon to treatment to neutralize the post-prandial “acid pocket”. Gaviscon is especially effective in patients with postprandial or nocturnal symptoms and in those with hiatal hernia. The mechanism of action of Gaviscon is based on the formation of an alginate “raft” on the surface of the gastric contents, which neutralizes the acid and blocks its pathological effect to esophageal mucosa. A modern meta-analysis on the NERD treatment, which included 23 studies and 10,735 patients, showed the efficacy of Gaviscon monotherapy comparable to PPIs in treatment for 4 weeks. The combination of a PPI with Gaviscon offers the opportunity to optimize response to treatment in NERD patients with an incomplete response to PPIs monotherapy. The Russian Gastroenterological Association thinks that alginates can be used both as monotherapy for mild clinical variants of NERD and in complex treatment regimens for various GERD variants.

Choosing the Therapeutic Strategy in Gastroesophageal Reflux Disease in Pediatric Patients: Is it a Challenge for Clinicians?

Abstract Gastroesophageal reflux disease (GERD) affects 8-33% of individuals worldwide, independent of age or gender. Diagnosis relies on mucosal lesions or symptomatic discomfort, validated by proton pump inhibitor (PPI) response. Lyon Consensus categorizes diagnostic tests as supportive, refuting, or inconclusive. A retrospective cohort study on 78 pediatric subjects at the ‘Sfântul Ioan’ Galați Hospital (February 2018-October 2020) aimed to assess GER incidence and management principles. Data analyzed using SPSS v26 revealed urban predominance (66.7%) and varied age distribution (1 month to 18 years), with heartburn as a prevalent symptom. Treatment modalities included antacids, PPIs, H2RAs, and prokinetics. Symptom relief and therapeutic response guided management, with PPIs commonly administered. This study underscores the need for comprehensive GERD diagnosis and tailored therapeutic strategies in pediatric populations.

Revisiting the Role of Esophageal Mucosal Dilated Intercellular Spaces in the Diagnosis and Pathophysiology of Heartburn.

Dilated intercellular spaces (DISs) facilitate the diffusion of noxious agents into the deep layers of the esophageal epithelium. The role of DIS in heartburn pathogenesis is still controversial. Therefore, we aim to reinvestigate DIS in an extensively evaluated group of patients and healthy controls (HCs). We classified 149 subjects into the following groups: 15 HC, 58 mild erosive reflux disease (ERD), 17 severe ERD, 25 nonerosive reflux disease (NERD), 15 reflux hypersensitivity (RH), and 19 functional heartburn (FH). A total of 100 length measurements were performed for each patient's biopsy. The overall intercellular spaces (ISs) value of gastroesophageal reflux disease (GERD) patients was higher than that of HC (P = 0.020). In phenotypes, mild ERD (vs HC [P = 0.036], NERD [P = 0.004], RH [P = 0.014]) and severe ERD (vs HC [P = 0.002], NERD [P < 0.001], RH [P = 0.001], FH [P = 0.004]) showed significantly higher IS. There was no significant difference between the HC, NERD, RH, and FH groups. The 1.12 μm DIS cutoff value had 63.5% sensitivity and 66.7% specificity in the diagnosis of GERD. There was a weak correlation (r = 0.302) between the IS value and acid exposure time, and a weak correlation (r = -0.359) between the IS value and baseline impedance. A strong correlation was shown between acid exposure time and baseline impedance (r = -0.783). Since the IS length measurement had better discrimination power only in erosive groups, it is not feasible to use in daily routine to discriminate other nonerosive phenotypes and FH. The role of DIS in heartburn in nonerosive patients should be reconsidered.

Predictors of Pathological Gastroesophageal Reflux among Emirati Patients with Reflux Symptoms Who Undergo Wireless pH Monitoring.

Background: Diagnosis of gastroesophageal reflux disease (GERD) relies on recognizing symptoms of reflux and mucosal changes during esophagogastroduodenoscopy. The desired response to acid suppression therapy is reliable resolution of GERD symptoms; however, these are not always reliable, hence the need for pH testing in unclear cases. Our objective was to identify potential predictors of a high DeMeester score among patients with potential GERD symptoms to identify patients most likely to have pathological GERD. Methods: We conducted a retrospective case-control study on patients who underwent wireless pH monitoring from January 2020 to April 2022. Cases were patients with a high DeMeester score (more than 14.7), indicating pathological reflux, and controls were those without. We collected clinical and demographic data, including age, sex, body mass index (BMI), smoking status, non-steroidal anti-inflammatory drugs (NSAIDs) use, and presence of atypical symptoms. Results: 86 patients were enrolled in the study. 46 patients with high DeMeester scores were considered cases, and 40 patients with DeMeester scores less than 14.7 were considered controls. Esophagitis (grade A) was found in 41.1% of the cases and in 22.5% of the control group. In our study, age of more than 50 years compared with age of 20-29 years and being overweight appeared to be predictors of true pathological reflux among patients with reflux symptoms who underwent wireless pH monitoring. Conclusion: Age above 50 years compared with age between 20-29 years and being overweight appeared to be predictors of true pathological reflux among patients with reflux symptoms who underwent wireless oesophageal pH monitoring. The presence of oesophagitis was approximately four times more likely to be associated with true pathological reflux.

Safety of Intravenous Pantoprazole Sodium in Pediatric Patients Aged 1 Month to < 1 Year: A Real-World Retrospective Cohort Study.

To estimate the incidence rates (IR) of prespecified outcomes of interest in pediatric patients (1month to < 1year) treated with intravenous (IV) pantoprazole using Optum's longitudinal electronic health records database (Optum Market Clarity) from the United States (US). This real-world, non-interventional, retrospective cohort study was conducted from 01 January 2007 to 31 December 2020 in patients who received IV pantoprazole. Premature patients and those weighing < 2.36kg were excluded. Patients were categorized based on diagnosis of gastroesophageal reflux disease (GERD) and erosive esophagitis (EE) into: Subgroup 1 (GERD and EE), Subgroup 2 (GERD and no EE), and Subgroup 3 (absence of GERD and EE). Overall IRs (per 1000 person-years [PY]) and 95% confidence intervals (CI) of outcomes were estimated (overall and subgroups) and stratified by duration of IV pantoprazole treatment (< 4days versus ≥ 4days). Of 1879 eligible patients, none were identified in Subgroup 1; 851 (45.3%) and 1028 (54.7%) patients were identified in Subgroups 2 and 3, respectively. IRs of outcomes of interest ranged from 0.0 to 742.8 per 1000 PY. IRs were highest for vomiting (742.80), diarrhea (377.77), abdominal distension (214.31), hyponatremia (204.99), and hypokalemia (203.49). IRs were comparable between Subgroups 2 and 3. For most outcomes, IRs were higher among patients treated with IV pantoprazole for ≥ 4days versus those treated for < 4days. These results are consistent with the known safety profile of pantoprazole and emphasize the utility of using real-world data from pediatric populations for assessment of safety outcomes.

The Association Between Acidification Time on Wireless Motility Capsule and Gastroesophageal Reflux Disease.

Gastric physiological characteristics such as fundus accommodation, gastric distention, emptying/transit time, and basal acid output may contribute to the pathogenesis of gastroesophageal reflux disease (GERD). Wireless motility capsule (WMC) uses pH data to determine gastric transit time but has not been used in the evaluation of GERD. Certain metrics such as acidification time, nadir pH, and gastric transit time may provide insight into the mechanisms of GERD related to gastric physiology, allowing WMC to be a complementary tool in the diagnosis of GERD. We aimed to determine whether pH data and transit time on WMC tests correlated with the presence of GERD on ambulatory reflux testing. This was a retrospective study of 28 patients who had undergone both WMC and reflux testing via wireless pH or pH/impedance. Acidification time (time from capsule ingestion to pH<2), nadir postprandial pH, and gastric transit time were manually determined from the WMC capsule proprietary software. Spearman correlation was used to compare these metrics with gastric transit time, percent esophageal acid exposure, and DeMeester score. Acidification time moderately correlated with gastric transit time, R: 0.44, P=0.02, but not nadir pH, percent esophageal acid exposure, or DeMeester score. Patients with an abnormal reflux test had a significantly longer median acidification time (135.5 vs. 78.5min, P=0.021). After stratifying by patients with normal versus prolonged gastric transit time, there was a trend toward longer acidification time in patients with positive reflux testing in both groups, but this was not statistically significant. Patients with prolonged gastric transit time >300 minutes were not more likely to have a positive reflux test (38% vs. 35%, P=1). The acidification time on WMC was significantly longer in patients with proven GERD and acidification time positively correlated with gastric transit time. Larger studies are needed to determine whether WMC could be used as a complementary tool in investigating patients with GERD symptoms.

Frequency of functional esophageal disorders in patients with refractory reflux symptoms in Lima, Peru

Gastroesophageal reflux disease (GERD) is a clinical condition in which gastric reflux causes symptoms or damage to the esophageal mucosa. It is managed with proton pump inhibitors, however, up to 45% of patients with suspected GERD are refractory to treatment. It is necessary to establish a true GERD diagnosis by means of a digestive endoscopy, which does not show lesions in approximately 70% of patients. In this scenario, it is necessary to perform an esophageal pH-impedance measurement, a procedure that allows to determine whether exposure to gastric acid is pathological. Of this group, patients with pathological acid exposure are diagnosed as true non-erosive reflux disease (NERD). If, in addition to not presenting esophageal lesions, they have a physiological exposure to gastric acid, they suffer from esophageal hypersensitivity or functional heartburn, which are functional disorders. These require a different approach from that of GERD or NERD, as the symptoms are not due to pathological exposure to gastric acid. The aim was to calculate the frequency of esophageal hypersensitivity and functional heartburn in patients with suspected NERD. This was a cross-sectional study. Data was collected by reviewing pH-impedance and manometry reports, 166 patients were selected. The frequency for functional disorders was 86.15%, being 46.9% for functional heartburn and 39.2% for esophageal hypersensitivity. The frequency of functional disorders was higher than that reported in previous studies. In conclusion, age, psychological conditions, dietary, cultural, ethnic or lifestyle factors inherent to our environment might play important roles in the development of functional disorders.

The Role of Distal Mean Nocturnal Baseline Impedance in Differentiating GERD Phenotypes.

Gastroesophageal reflux disease (GERD) is one of the most frequent digestive pathologies. The current diagnosis of GERD either by trial of proton pump inhibitors (PPIs), endoscopy or by multichannel impedance pH study (MII/pH) has limitations. Our study aims to show if mean nocturnal baseline impedance (MNBI) can differentiate between the GERD phenotypes. We recruited 62 patients who underwent upper digestive endoscopy and MII/pH, with some patients undergoing esophageal manometry to exclude motility disorders. Patients were separated into 4 GERD phenotypes: erosive reflux disease (ERD), non-erosive reflux disease (NERD), reflux hypersensitivity (RH) and functional heartburn (FH). Proximal MNBI was calculated as the mean value of the proximal 2 channels (Z1 and Z2), and distal MNBI was calculated as the mean value of the distal 4 channels (Z3, Z4, Z5, Z6). Distal MNBI can help distinguish the abnormal acid exposure time (AET) phenotypes (ERD, NERD) from normal AET phenotypes (RH, FH) with a decent performance (AUROC 0.857). Distal MNBI has good accuracy in separating ERD from other phenotypes (AUROC 0.872). Furthermore, distal MNBI can differentiate FH from ERD, NERD, RH with good accuracy (AUROC 0.879), and on top of that is able to separate FH from RH (AUROC 0.817). Our study showed that distal MNBI is a good method of differentiating GERD phenotypes and should be taken into consideration in future studies to assess its validity in helping physicians make the correct diagnosis.

Anxiety and Depression and Health-Related Quality of Life in Adults with Gastroesophageal Reflux Disease: A Population-Based Study.

Adults with gastroesophageal reflux disease (GERD) are susceptible to mental disorders that might significantly affect their health-related quality of life (HRQoL). Therefore, the purpose of this study was to evaluate how HRQoL in individuals with GERD is related to coexisting anxiety and depression. A cross sectional study was conducted among 3068 adult patients 22 years of age and older with GERD diagnoses have been identified using the data from the Medical Expenditure Panel Survey from 2017 to 2020 for United States adults. Data are gathered by MEPS using an overlapping panel design over a period of two and a half years. HRQoL was established using the Physical and Mental Component Summary (PCS & MCS) values from the SF-12. Multivariate forward linear regression analysis was used to assess the relationship between anxiety, depression, and HRQoL in people with GERD after accounting for various factors. Of the 3068 people with GERD who had been identified, 56.4% were women, 59.4% were in their 50s or 60s and 64.8% were employed. Thirteen per cent of people with GERD had depression, thirteen per cent had anxiety, and ten per cent had both. Adults with concurrent anxiety and depression had the lowest mean PCS and MCS scores compared to those with GERD. After adjusting for all independent factors, GERD patients with anxiety (MCS = -10.819, p-value < 0.0001), depression (MCS = -6.395, p-value < 0.0001), and both (MCS= -42.869, p-value < 0.0001) had substantially worse HRQoL than those without these comorbidities. Notably, better HRQoL scores were positively associated with marital status, employment, perceived overall health, and physical activity. The results from this nationally representative sample shed insight into the relationships between low HRQoL and anxiety and depression among individuals with GERD. It also demonstrated the detrimental impacts of co-occurring chronic illnesses, low socioeconomic status, and the positive benefits of employment and exercise on HRQoL. This study emphasizes the clinical, policy, and public health implications for better healthcare, allocation of resources, and promotion of lifestyle modifications to improve the HRQoL in patients with GERD.

Study of the possibility of using osteopathic correction for the treatment of patients with non-erosive gastroesophageal refl ux disease

Introduction. Gastroesophageal refl ux disease (GERD) is a chronic relapsing disease characterized by regularly repeated refl ux of gastric and, in some cases, duodenal contents into the esophagus. The urgency of the GERD problem is due to the widespread prevalence of this disease, a signifi cant decrease in the life quality and working capacity of patients, and it leads to signifi cant material losses and increases the risk of complications with long-term use of proton pump inhibitors. There is evidence of the effectiveness of osteopathic correction as a non-drug method as part of the complex treatment of non-erosive GERD. However, taking into considertion the potential risk of complications (osteoporosis and fractures, vitamin B12 and iron defi ciency, dementia, hypomagnesemia, impaired renal function, infectious complications, neoplasms, cardiovascular complications) caused by the use of the drugs′ treatment of GERD, it is in demand to search for evidence of the effectiveness of osteopathic correction as monotherapy for non-erosive GERD. The aim of the study was to investigate the possibility of using osteopathic correction as a monotherapy for the treatment of patients with non-erosive GERD. Materials and methods. The study involved 26 patients with non-erosive form of GERD. The age of patients was from 22 to 50 years old. Using the method of randomization envelopes, the two groups were formed (control and main). There were 13 patients (4 females and 9 males) in each group. All the study participants were prescribed a correction of the diet and regime of work and rest. Participants in the control group received basic drug therapy according to the Guidelines of the Russian Gastroenterological Association for the diagnosis and treatment of GERD. The dosage and duration were selected individually depending on the clinical manifestations and their duration. Participants of the main group received a course of osteopathic correction (2 sessions with an interval of 12–14 days). All participants underwent an esophagogastroduodenoscopy (EGD) examination at the start of the study. Before and after the treatment in both groups, the severity of GERD symptoms was assessed using the GerdQ questionnaire, as well as osteopathic status was estimated. In addition, we studied the relationship between the structure of dominant somatic dysfunctions (SD) and some indicators of the state of the esophagus and stomach, measured as part of an EGD examination: the cardia of the esophagus and stomach (closes, closes incompletely), transcardial migration of the stomach folds during calm breathing (yes, no), Hiss angle (acute, smoothed), the arch of the stomach during calm breathing (shifts, shifts to a limited extent), the shape of the arch of the stomach (normal, fl attened), the contents of the stomach (usual, with an admixture of bile). Results. The use of an osteopathic correction course for patients with a non-erosive form of GERD is accompanied by a statistically signifi cant (p&lt;0,05) decrease in the severity of symptoms of the disease, assessed by the GerdQ questionnaire. The achieved indicators (the severity of symptoms of the disease, assessed using the GerdQ questionnaire) do not statistically signifi cantly differ from those achieved using standard drug therapy. The course of osteopathic correction is accompanied by a statistically signifi cant (p&lt;0,05) decrease in the severity of biomechanical disorders of the thoracic region. A signifi cant correlation was established between the presence of dominant SD in the thoracic region and the presence of some features of the esophagus and stomach state (incomplete closure of the cardia of the esophagus and stomach, transcardial migration of the stomach folds during quiet breathing, a fl attened Hiss angle, a limited displacement of the gastric fornix during quiet breathing, a fl attened shape of the gastric fornix). Conclusion. The obtained results allow to consider the possibility of using osteopathic correction as a monotherapy for patients with non-erosive GERD. However, it is recommended to continue research in this direction on a larger sample size and using instrumental methods of examination in dynamics.

The Relationship of Body Mass Index with Gastroesophageal Reflux Disease based on Gastroesophageal Reflux Disease Questionnaire Score in Dinas Bina Marga and Bina Konstruksi of North Sumatera

Abstract. Introduction: Gastroesophageal Reflux Disease (GERD) is a pathological condition due to the reflux of stomach contents back into the esophagus that causing symptoms. In Indonesia, there is no clear prevalence of the incidence of GERD. Some risk factors that can cause GERD are age, sex, race, family history, economic status, increased body mass index (BMI) to obesity and smoking. BMI is the most useful and practical indicator for measuring body fat. It is known that an increased BMI can increase the risk for the occurrence of GERD. Objective: Knowing the relationship between BMI and GERD based on the GERD-Q score at the Dinas Bina Marga dan Bina Konstruksi of North Sumatra province. Methods: This research is an analatic study using cross-sectional method. Sampling using simple random sampling. The sample of this study using Gastroesophageal Reflux Disease Questionnaire (GERD-Q) for GERD diagnosis tool and measurement of weight and height to get BMI. Results: The analysis results obtained by Kendalls Tau-b correlation test and found p = 0.773 (p &lt; 0.005). Conclusion: There was no significant relationship between BMI and GERD based on GERD-Q scores on employees of the Dinas Bina Marga dan Bina Konstruksi of North Sumatera. Keywords: Body Mass Index, GERD, GERD-Q

Chicago Classification v4.0 Stratifies Acid Burden and Abnormal Impedance-pH Variables Better Than Chicago Classification v3.0 Chicago Classification v4.0 and GERD.

Gastroesophageal reflux disease (GERD) severity increases with esophageal body hypomotility, but the impact of Chicago Classification (CC) v4.0 criteria on GERD diagnosis is incompletely understood. In patients with GERD evaluated with high-resolution manometry and pH-impedance monitoring, CCv3.0 and CCv4.0 diagnoses were compared. In 247 patients, hypomotility diagnosis decreased from 45.3% (CCv3.0) to 30.0% (CCv4.0, P < 0.001). In contrast, within patients with ineffective esophageal motility, proportions with pathological acid exposure increased from 38% (CCv3.0) to 88% (CCv4.0); baseline impedance and esophageal clearance demonstrated similar findings ( P < 0.05 for each comparison). CCv4.0 hypomotility criteria are more specific in supporting GERD evidence compared with CCv3.0.