Diagnosis Of Gastroesophageal Reflux Disease Research Articles

Reflux and Barrett's esophagus after sleeve gastrectomy: analysis of a statewide database.

Recent studies have suggested that sleeve gastrectomy (SG) is associated with the development of Barrett esophagus (BE) even in the absence of gastroesophageal reflux disease (GERD) symptoms. The aim of this study was to assess the rates of upper endoscopy and incidence of new BE diagnoses in patients undergoing SG. This was a claims-data study of patients who underwent SG between 2012 and 2017 while enrolled in a U.S. statewide database. Diagnostic claims data were used to identify pre- and postoperative rates of upper endoscopy, GERD, reflux esophagitis, and BE. Time-to-event analysis using a Kaplan-Meier approach was performed to estimate the cumulative postoperative incidence of these conditions. We identified 5562 patients who underwent SG between 2012 and 2017. Of these, 1972 patients (35.5%) had at least 1 diagnostic record of upper endoscopy. The preoperative incidences of a diagnosis of GERD, esophagitis, and BE were 54.9%, 14.6%, and .9%, respectively. The predicted postoperative incidences of GERD, esophagitis, and BE, respectively, were 18%, 25.4%, and 1.6% at 2 years and 32.1%, 85.0%, and 6.4% at 5 years. In this large statewide database, rates of esophagogastroduodenoscopy remained low after SG, but the incidence of a new postoperative esophagitis or BE diagnosis in patients who underwent esophagogastroduodenoscopy was higher than in the general population. Patients undergoing SG may have a disproportionately high risk of developing reflux complications including BE after surgery.

12. NEUROKININ A AND SUBSTANCE P SERUM CONCENTRATIONS CORRELATE WITH MOTILITY METRICS PREDISPOSING TO REFLUX, BUT NOT WITH ESOPHAGITIS PRESENCE IN GERD

Abstract Background Neurokinin A (NKA) and substance P (SP) may be responsible for airway hyper-reactivity and hypersensitization. Animal studies showed an increase of their blood concentration in response to acid installation into the esophagus, suggesting the presence of neurogenic inflammation in pathogenesis of asthma and chronic cough. Association between serum concentration of these cytokines and esophageal function testing parameters in patients with gastroesophageal reflux disease (GERD) is poorly studied. Aim of the study was to assess serum concentration of neurokinin A and substance P in patients with erosive esophagitis and non-erosive form of GERD and perform correlation analysis between concentrations of these substances and data of multichannel esophageal pH-impedance (MII-pH) and high-resolution esophageal manometry (HREM). Methods The data of examination of 88 subjects (31 with erosive esophagitis (EE); 57 with non-erosive form of GERD (NERD)) served as a source for the study. Diagnosis of GERD was established per Lyon criteria. Subjects with autoimmune disorders, receiving some medications able to affect esophageal motility were not eligible. Patients underwent HREM with the use of 36-channel solid-state catheters and MII-pH with 2-pH, 6-impedandce sensors. Serum concentrations of NKA and SP were measured with ELISA kits and biochemistry analyzer. Results Acid exposure time (AET), and number of high gastroesophageal refluxes were higher in EE compared to NERD, while number of refluxes and concentrations of NKA and SP were similar. Mean, minimal and residual lower esophageal sphincter resting pressures were lower in EE compared to NERD. There was direct correlation between serum concentration of SP and number of gastroesophageal refluxes (Spearman rank R = 0.26), AET (R = 0.25), and number of refluxes lasting >5 min (R = 0.35). NKA concentration correlated directly with number of refluxes >5 min long (R = 0.28), and inversely with levels of integrated relaxation pressure (R = –0.32), and contractile front velocity (R = –0.38). Conclusions In patients with GERD, serum concentrations of Neurokinin A and Substance P do not depend on the presence of esophagitis and probably are not caused by the influence of reflux content to sensory neurons of esophageal mucosa. Established correlations may support the involvement of Neurokinin A and Substance P in pathogenesis of gastroesophageal reflux disease.

Impact of concomitant gastroesophageal reflux disease symptomology on prognosis and pulmonary function of chronic hypersensitivity pneumonitis.

Comorbid risk factors in chronic hypersensitivity pneumonitis (CHP) are poorly characterised. Gastroesophageal reflux disease (GERD) is linked to interstitial lung diseases like idiopathic pulmonary fibrosis (IPF), but its association and treatment in CHP is less understood. This study aims to understand the role and prevalence of GERD in CHP, plus the effect of GERD treatment on lung function and mortality. A tertiary referral centre panel was retrospectively reviewed for 214 patients diagnosed with CHP based on clinical history, bronchoalveolar lavage fluid analysis, imaging and histopathology. GERD diagnostic criteria included symptomology, acid suppressive therapy use and diagnostic testing. CHP patients with GERD (n = 89) and without GERD (n = 125) were compared via descriptive statistical analysis. Pulmonary function, GERD diagnosis plus treatment and other comorbidities were evaluated against CHP outcomes. Respective differences between diagnosis and study termination dates in the GERD population versus without GERD for functional vital capacity (FVC) were - 1 L vs - 2.5 L, diffusing capacity of the lungs for carbon monoxide (DLCO) were - 2 mL/min/mmHg versus - 1 mL/min/mmHg, per cent alive at the time of study 88% versus 81%, median date of survival 574.5 versus 850 and supplemental oxygen requirement 41% versus 37%. GERD prevalence was higher in CHP patients relative to the general population. No statistical significance was found between survival curves, oxygen requirement, smoking history, FVC, or DLCO. GERD could be a harmful comorbidity in CHP though may not necessarily affect survival or functional outcomes. This aligns with previous IPF studies, though remains controversial. Further research is needed regarding this association and treatment benefit.

Prevalence and Risk Factors for Gastroesophageal Reflux Disease (GERD) Among Visitors to the Health Center of Imam Mohammad Ibn Saud Islamic University.

A considerable majority of people have gastroesophageal reflux disease (GERD), a common gastrointestinal ailment. Globally, the prevalence of GERD has been rising, and it is linked to several risk factors. In this study, the incidence of GERD in a sample of the population was examined, along with the associated factors that may have an impact on it. The Gastroesophageal Reflux Disease Questionnaire (GERD-Q) was included in a self-administered survey given to 490 participants in a cross-sectional study to help determine who was more likely to have GERD. The questionnaire collected data on demographic elements, health-related traits, and past GERD diagnoses. The findings revealed that 32.7% of the individuals had previously received a GERD diagnosis. Of the patients,17.1% had a GERD-Q score of 8 or above, which indicates a higher likelihood of having GERD. Participants who had previously been diagnosed with GERD had a noticeably greater incidence of GERD, and females had a higher incidence of GERD than males. The frequency of caffeine consumption was substantially correlated with the occurrence of GERD. Our study emphasizes the value of early GERD diagnosis and therapy to reduce problems and enhance the quality of life for those who are affected. According to our research, coffee use, gender, and prior GERD diagnoses are all linked to an increased risk of developing GERD. The GERD-Q is a trustworthy and proven tool for GERD diagnosis and might be used in clinical practice to recognize GERD patients and offer suitable treatment. Additional research is required to determine how additional risk variables affect the prevalence of GERD.

HIATAL HERNIA, PANORAMIC REVIEW OF DIAGNOSIS AND MANAGEMENT

Introduction: Hiatal hernia (HH) occurs frequently in the population, characterized by various non-specific symptoms, however most of these symptoms are found to be related to gastroesophageal reflux disease. A hiatal hernia is said to be a medical condition in which the upper portion of the stomach or other internal organ protrudes through an opening in the diaphragm. Objective: to detail current information related to hiatal hernia, description, etiology, classification, diagnosis, differential, prognosis, management and complications. Methodology: a total of 38 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 27 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: hiatal hernia, hiatal repair, diagnosis, management. Results: The incidence of symptomatic cases of hiatal hernia is related to the diagnosis of gastroesophageal reflux disease (GERD). The incidence of hiatal hernias increases with age. About 55%-60% of individuals over 50 years of age have a hiatal hernia. However, approximately 9% have symptoms and it depends on the type and competence of the lower esophageal sphincter (LES). The largest percentage of these hernias are type I sliding hiatal hernias. Type II, paraesophageal hernias, represent approximately 5% of hiatal hernias in which the LES remains stationary, with the stomach protruding superiorly to the diaphragm. There is also a high prevalence in women, attributable to increased intra-abdominal pressure during pregnancy. The estimated overall 30-day mortality rate in relation to antireflux surgery is approximately 0.19%. Conclusions: Hiatal hernia (HH) is relatively common in the general population. It is caused by increased intra-abdominal pressure, leading to protrusion of the stomach and other abdominal viscera into the mediastinum. Hiatal hernias can be congenital or acquired. The current anatomical classification of hiatal hernias consists of four types or categories, each with its different characteristics. Diagnosis of hiatal hernia can be challenging because of the change in the anatomy of the esophagogastric junction on swallowing, breathing and movement. The pre-surgical study of the individual supports the diagnosis and the exclusion of other pathologic entities to properly direct the surgical intervention. The success of hiatal hernia surgery can be measured by the improvement of symptoms, such as esophageal acid exposure, complications and the requirement for reoperation. Complications of surgery are usually mild and are not directly linked to the surgery itself. KEY WORDS: surgery, hernia, hiatus, diagnosis, management.

Dental evaluation is helpful in the differentiation of functional heartburn and gastroesophageal reflux disease.

Heartburn is identically the key symptom of both, gastroesophageal reflux disease (GERD) and functional heartburn (FHB), making the differential diagnosis resource-intensive. Oral manifestations of GERD can be easily examined; therefore, their exploration might be a cheap, widely available, and useful tool in the differentiation of GERD and FHB. To evaluate the prevalence of dental erosions (DE) and periodontal diseases (PD) in patients with heartburn and their association with GERD and FHB. A total of 116 [M/F: 51/65, mean age: 54 (17-80) years] consecutive patients with heartburn were enrolled for detailed esophageal function and orodental examinations. Dental disorders were detected in 89% (103/116). Patients with PD + DE had significantly more often pathologic reflux (90.0% vs 27.8%; P < 0.05), higher esophagitis scores (1.8 vs 0.9; P < 0.05), and a significantly different mean impedance curve (P = 0.04) than those without any dental diseases. The opposite approach established that patients with GERD had significantly higher prevalence of DE and PD, especially if both were present (28.9% vs 2.0%; P < 0.01), more severe PD (1.5 vs 1.0; P < 0.01), and longer history of heartburn (15 years vs 9 years; P < 0.01) than those with FHB. The dental evaluation of patients with heartburn seems to be useful in the differential diagnosis of GERD and FHB. Among the studied parameters, the co-appearance of DE and PD seems to be the best predictor of GERD, whereas the absence of dental disorders was mostly observed in FHB.

The validity of I-Scan in diagnosis of gastroesophageal reflux disease

Background: The evaluation of patients with suspected gastroesophageal reflux disease (GERD) frequently represents a diagnostic dilemma. Confirmation of the presence of the esophogeal mucosal injury is one of the roles of endoscopy in GERD diagnosis. In this context, there are limitations of white light endoscopy (WLE) because of the inadequate visualization of the minute mucosal changes and the uncertainty in describing the severity of mucosal injury. I-SCAN technology helps in revealing fine details of the GI mucosa. Aim: to evaluate the diagnostic efficacy of I-SCAN technology as compared to white light endoscopy (WLE) in Egyptian patients suffering from GERD symptoms. Patients and methods: This study included adult patients with GERD questionnaire (Q) score ≥ 8 points. The distal esophagus was examined by WLE followed by I-SCAN 2 to evaluate the presence of mucosal injuries and to classify GERD severity according to the Los Angles (LA) classification &amp; its Japanese modification, respectively. Biopsies were taken from the lower esophageal mucosa as well as from the visible mucosal breaks and subjected to histopathologic examination. Results: Sixty patients were enrolled; 32 (53.3%) were females &amp; 28 (46.7%) were males. WLE showed erosive reflux disease (ERD) in 41 patients (68.3%); while 19 patients (31.7%) showed no mucosal breaks. As regard LA classification; 18 of the cases were classified as grade A (30%); 15 as grade B (25%); 7 as grade C (11.7%) and 1 as grade D (1.7%). Reexamination of distal esophagus by I-SCAN 2 showed minimal change esophagitis (MCE) (grade M) &amp; ERD in 57 patients (95%); while only 3 patients (5%) showed no mucosal changes (grade N). As regard the modified LA classification; 16 cases were classified as grade M (26.6%); 12 as grade A (20%); 21 as grade B (35%); 7 as grade C (11.7%) and 1 as grade D (1.7%). There was perfect agreement of WLE with I-SCAN 2 in LA grades B, C &amp; D. There was poor agreement of WLE with I-SCAN 2 in cases who had no mucosal breaks &amp; LA grade A cases on WLE (weighted Kappa was 0.11); as 16 cases were reclassified as grade M on I-SCAN 2 (had no mucosal breaks on WLE) and 6 cases were reclassified as class B on I-SCAN 2(were classified as grade A on WLE). As regard the histological proven reflux esophagitis (HPRE), it was present in 41 (68.3%) of the studied cases with statistically significant higher proportion of male gender. It was present in 28 (68.3%) of the patients who had ERD on WLE; 13(68.4%) of the patients who had no mucosal breaks on WLE; 38 (66.6%) of the cases who had grade M or ERD on I-SCAN 2 &amp; the three patients who had grade N on I-SCAN 2.GERD Q score ranged from 10 to 12 points with median of 11 points. It was significantly higher in patients with HPRE (11.4 ± 1.8 points) than those without (10.3 ± 1.3 points) (p= 0.026). GERD Q score strongly correlated with both the modified LA grade by I-SCAN 2 (p=0.03) and the histological severity score (p=0,016). On univariate &amp; multivariate analysis, male gender and GERD Q score &gt; 11points were significant predictors of HPRE (p &lt; .001). ROC analysis curve showed that GERD Q score at a cut-off &gt; 11points was a significant predictor of HPRE with a sensitivity of 47%, specificity of 85%, AUC of 66.7% and p = 0.015. Conclusion: I-SCAN technology may improve the diagnosis of the esophogeal mucosal injury in GERD patients. There was poor agreement of WLE with I-SCAN 2 in patients who had no mucosal breaks &amp; those with LA grade A on WLE. However, there was perfect agreement of WLE with I-SCAN 2 in patients with LA grades B, C&amp; D. GERD Q score had positive correlation with both the modified LA grade on I-SCAN 2 and the histological severity score. Male gender and GERD Q score &gt; 11points were significant predictors of histological proven reflux esophagitis.

Exploring the Incidence and Associated Risk Factors of Barrett's Esophagus in African Americans: A Retrospective Study.

The prevalence of Barrett's esophagus (BE) in African Americans (AA) is uncertain. However, several potential risk factors, includes family history, male sex, ethnicity, chronic heartburn and acid reflux, age over 60, current or past smoking, and obesity are associated with BE. The aim of this study is to determine the incidence of BE in AA patients who underwent Esophageal Gastro Endoscopy (EGD). Medical and demographic data of 1,253 AA patients with various symptoms, including BE, Esophageal adenocarcinoma (EAC), esophageal squamous adenocarcinoma (SCC), hiatal hernia, H. pylori infection, Gastro-Esophageal Reflux Disease (GERD), Gastritis, and esophagitis, were collected from January 2004 to December 2014 at Howard University Hospital. Among the 1,253 patients, the median age was 61 and 49% were male out of the total. The frequencies of EAC (p= 0.05), and SCC (p= 0.002) were significantly high in males, along with SCC frequency significantly increased with older age (p<0.001). Furthermore, esophageal polyps with hiatal hernia (p=0.008) and H. pylori (p=<0.001) were found to be associated with esophagitis, and its presence may contribute to the development of BE. The findings highlighted the high prevalence of GERD symptoms and pathologic gastritis along with EAC was less common than SCC and both types of esophageal cancer were associated with male gender and older age whereas, H. pylori infection was identified as a risk factor for pathologic gastritis in AA. Overall data emphasize the need for extensive research, increased awareness, diagnosis, and management of GERD, gastritis, and related conditions to uncover the underlying mechanisms and factors contributing to these conditions in the AA population.

Extended Wireless pH Monitoring Significantly Increases Gastroesophageal Reflux Disease Diagnoses in Patients With a Normal pH Impedance Study.

Extended wireless pH monitoring (WPM) is used to investigate gastroesophageal reflux disease (GERD) as subsequent or alternative investigation to 24-hour catheter-based studies. However, false negative catheter studies may occur in patients with intermittent reflux or due to catheter-induced discomfort or altered behavior. We aim to investigate the diagnostic yield of WPM after a negative 24-hour multichannel intraluminal impedance pH (MII-pH) monitoring study and to determine predictors of GERD on WPM given a negative MII-pH. Consecutive adult patients (> 18 years) who underwent WPM for further investigation of suspected GERD following a negative 24-hour MII-pH and upper endoscopy between January 2010 and December 2019 were retrospectively included. Clinical data, endoscopy, MII-pH, and WPM results were retrieved. Fisher's exact test, Wilcoxon rank sum test, or Student's t test were used to compare data. Logistic regression analysis was used to investigate predictors of positive WMP. One hundred and eighty-one consecutive patients underwent WPM following a negative MII-pH study. On average and worst day analysis, 33.7% (61/181) and 34.2% (62/181) of the patients negative for GERD on MII-pH were given a diagnosis of GERD following WPM, respectively. On a stepwise multiple logistic regression analysis, the basal respiratory minimum pressure of the lower esophageal sphincter was a significant predictor of GERD with OR = 0.95 (0.90-1.00, P = 0.041). WPM increases GERD diagnostic yield in patients with a negative MII-pH selected for further testing based on clinical suspicion. Further studies are needed to assess the role of WPM as a first line investigation in patients with GERD symptoms.

Cytomegalovirus esophagitis associated with gastroesophageal reflux disease in an immunocompetent patient: case report

Cytomegalovirus infection has a wide variability of clinical presentations depending on the patient's immunity, ranging from asymptomatic infections in immunocompetent individuals to infections with significant morbidity and mortality in immunocompromised patients. We originally described a clinical case of severe cytomegalovirus esophagitis, confirmed by blood polymerase chain reaction (PCR) test and esophageal biopsy, in a young immunocompetent patient with a long-standing diagnosis of gastroesophageal reflux disease. Clinical improvement occurred only after the initiation of specific treatment with ganciclovir, providing a negative viral load. This report reinforces the importance of ruling out the etiology of cytomegalovirus infection in severe ulcerative esophagitis, even in immunocompetent individuals.

Ligamentum teres cardiopexy for post vertical sleeve gastrectomy gastroesophageal reflux.

Vertical sleeve gastrectomy (VSG) evolved in the early 2000s into the standalone weight loss procedure we see today. While numerous studies highlight VSG's durability for weight loss, and improvements co-morbidities such as type 2 diabetes mellitus and cardiovascular disease, patients with gastroesophageal reflux disease (GERD) have been counseled against VSG due to the concern for worsening reflux symptoms. When considering anti-reflux procedures, VSG patients are unable to undergo traditional fundoplication due to lack of gastric cardia redundancy. Magnetic sphincter augmentation lacks long-term safety data and endoscopic approaches have undetermined longitudinal benefits. Until recently, the only option for patients with a history of VSG with medically refractory GERD has been conversion to roux en Y gastric bypass (RNYGB), however, this poses other risks including marginal ulcers, internal hernias, hypoglycemia, dumping syndrome, and nutritional deficiencies. Given the risks associated with conversion to RNYGB, we have adopted the ligamentum teres cardiopexy as an option for patients with intractable GERD following VSG. A retrospective chart review was conducted of patients who had prior laparoscopicor robotic VSG and subsequently GERD symptoms refectory to pharmacological management who underwent ligamentum teres cardiopexy between 2017 and 2022. Pre-operative GERD disease burden, intraoperative cardiopexy characteristics, post-operative GERD symptomatology and changes in H2 blocker or PPI requirements were reviewed. Of the study's 60 patients the median age was 50years old, and 86% were female. All patients had a diagnosis of GERD through pre-operative assessments and were taking antisecretory medication. Of the 36 patients who have completed their one year follow up, 81% of patients had either a decrease in dosage or cessation of the antisecretory medication at one year following ligamentum teres cardiopexy. Ligamentum teres cardiopexy is a viable alternative to RNYGB in patients with a prior vertical sleeve gastrectomy with medical refractory GERD.

Association of Neighborhood Socioeconomic Deprivation With Utilization and Costs of Anterior Cervical Discectomy and Fusion.

A retrospective analysis. The aim of our study was to analyze the association of Area Deprivation Index (ADI) with the utilization and costs of elective anterior cervical discectomy and fusion (ACDF) surgery. ADI, a comprehensive neighborhood-level measure of socioeconomic disadvantage, has been shown to be associated with worse perioperative outcomes in a variety of surgical settings. The Maryland Health Services Cost Review Commission Database was queried to identify patients who underwent primary elective ACDF between 2013 and 2020 in the state. Patients were stratified into tertiles by ADI, from least disadvantaged (ADI1) to most disadvantaged (ADI3). The primary endpoints were ACDF utilization rates per 100,000 adults and episode-of-care total costs. Univariable and multivariable regression analyses were performed. A total of 13,362 patients (4984 inpatient and 8378 outpatient) underwent primary ACDF during the study period. In our study, there were 2,401 (17.97%) patients residing in ADI1 neighborhoods (least deprived), 5974 (44.71%) in ADI2, and 4987 (37.32%) in ADI3 (most deprived). Factors associated with increased surgical utilization were increasing ADI, outpatient surgical setting, non-Hispanic ethnicity, current tobacco use, and diagnoses of obesity and gastroesophageal reflux disease. Factors associated with lower surgical utilization were: non-white race, rurality, Medicare/Medicaid insurance status, and diagnoses of cervical disk herniation or myelopathy. Factors associated with higher costs of care were increasing ADI, older age, Black/African American race, Medicare or Medicaid insurance, former tobacco use, and diagnoses of ischemic heart disease and cervical myelopathy. Factors associated with lower costs of care were outpatient surgical setting, female sex, and diagnoses of gastroesophageal reflux disease and cervical disk herniation. Neighborhood socioeconomic deprivation is associated with increased episode-of-care costs in patients undergoing ACDF surgery. Interestingly, we found greater utilization of ACDF surgery among patients with higher ADI. 3.

Gastroesophageal reflux disease: 2021 guideline updates and clinical pearls.

In 2021, the American College of Gastroenterology updated its diagnosis and treatment guideline for gastroesophageal reflux disease (GERD). This article provides a summary of noteworthy changes to the guideline and describes clinical pearls that are pertinent to the diagnosis and treatment of GERD in primary care.

Effect of aging and obesity on esophageal mucosal integrity as measured by baseline impedance.

Low mean nocturnal baseline impedance (MNBI) values support gastroesophageal reflux disease (GERD) diagnosis. Recent data denote that age and obesity may affect MNBI. We aimed to evaluate diagnostic MNBI cutoffs as also the effect of aging and body mass index (BMI) on MNBI. In total 311 patients (M/F: 139/172, mean age: 47 ± 13) referred for typical GERD symptoms that have undertaken both high-resolution manometry (HRM) and pH-Impedance studies off PPI were evaluated. MNBI at 3, 5, and 17 cm over lower esophageal sphincter (LES) were evaluated. GERD was diagnosed if acid exposure time (AET) >6%. Mean BMI was 26.6 ± 5.9 kg/cm2 . GERD was diagnosed in 39.2% and 13.5% had inconclusive GERD. MNBI was correlated to patients' age, BMI, AET, and the length of LES-CD separation and at 3 cm also to the total number of reflux and LES hypotension. In the multivariate analysis MNBI at 3 and 5 cm was independently correlated only to age, BMI, and AET. Patients with definite GERD showed lower MNBI at 3 cm compared with inconclusive GERD though both showed lower values when compared with GERD absence. At 3 cm MNBI ability for diagnosing GERD was good (0.815, p < 0.001 95% CI: 0.766-0.863) with an optimal cutoff point of 1281 Ohm. According to our study findings age and BMI affect independently lower esophageal MNBI values in patients evaluated for GERD. MNBI significantly aids toward GERD diagnosis though in a real-life setting MNBI values much lower than the one previously proposed should be used.

The role of a nurse in the stage-by-stage diagnosis of gastroesophageal reflux disease

Complete and high-quality work of a primary care physician is impossible without the participation of highly qualified nursing staff, including in the diagnosis of gastroesophageal reflux disease (GERD). Considering the importance of the problem, we have developed criteria for the stage-by-stage diagnosis of GERD, taking into account the work of the polyclinic and hospitals. The examinations were carried out as follows: 4 stages of diagnosis, starting from the primary level and ending with a specialized center. At the first stage, doctors, with the active participation of polyclinic nurses, assessed subjective complaints and the clinical picture of the disease. At the second stage, the patient first undergoes diagnostic esophagogastroscopy with chromoscopy and biopsy of visually altered areas of the esophageal mucosa, then ultrasound examination after filling the stomach with liquid. At the third stage, the patient is examined in a specialized gastroenterological center, where a number of additional studies are carried out for the patient. Further, patients with the results of all examinations and medical reports are sent to the thoracic surgery center (the fourth stage), where patients are selected for surgical treatment. Currently, the implementation of this scheme in practical healthcare and the active participation of nursing staff in identifying patients with GERD symptoms has significantly increased the diagnosis of GERD at early stages and timely treatment.

The clinical application value of salivary pepsin in the diagnosis of gastroesophageal reflux diseases.

Peptest is a noninvasive and convenient diagnostic kit for gastroesophageal reflux disease (GERD). We aimed to explore the application value of Peptest in the diagnosis of GERD. Patients suspected of GERD all completed 24 h pH-impedance monitoring (24 h MII-pH) and then took proton pump inhibitor (PPI) 2 weeks. The postprandial, post-symptom and random salivary samples were taken. Receiver operating characteristic analysis was used to identify the best cutoff value of Peptest, to differentiate GERD patients from non-GERD patients and the optimal sampling time of Peptest was analyzed. Reflux characteristics and esophageal motility between Peptest (+) group and Peptest (-) group were compared in negative 24 h MII-pH patients. Peptest concentration were compared among non-reflux, distal reflux, and proximal reflux groups according to 24 h MII-pH curve. The area under the curve of post-symptom Peptest was highest in three time points and the diagnostic specificity was 81.0% and sensitivity was 53.3% with the diagnostic value of 86 ng/mL. Compared with negative Peptest group, distal mean nocturnal baseline impedance was significantly lower, gastroesophageal junction contractile integral was substantially lower in positive Peptest group in negative 24 h MII-pH patients. The concentration of post-symptom and postprandial Peptest increased gradually in the non-reflux, distal reflux, and proximal reflux groups. Peptest has a relatively low diagnostic value for GERD. Post-symptom Peptset is the best sampling time with the optimal value of 86 ng/mL and may have auxiliary diagnostic value for negative 24 h MII-pH patients. Peptest may assist 24 h MII-pH in monitoring proximal reflux.

Acid exposure time better predicts outcomes following anti-reflux surgery than DeMeester score.

Criteria to diagnose gastroesophageal reflux disease (GERD) vary. The American Gastroenterology Association (AGA) 2022 Expert Review on GERD focuses on acid exposure time (AET) rather than DeMeester score from ambulatory pH testing (BRAVO). We aim to review outcomes following anti-reflux surgery (ARS) at our institution, grouped by differing criteria for the diagnosis of GERD. A retrospective review of a prospective gastroesophageal quality database was performed for all patients undergoing evaluation for ARS with preoperative BRAVO ≥ 48h. Group comparisons were made using two-tailed Wilcoxon rank-sum and Fisher's exact tests and two-tailed statistical significance of p < 0.05. Between 2010 and 2022, 253 patients underwent an evaluation for ARS with BRAVO testing. Most patients (86.9%) met our institution's historical criteria: LA C/D esophagitis, Barrett's, or DeMeester ≥ 14.72 on 1+ days. Fewer patients (67.2%) met new AGA criteria: LA B/C/D esophagitis, Barrett's, or AET ≥ 6% on 2+ days. Sixty-one patients (24%) met historical criteria only, with significantly lower BMI, ASA, less hiatal hernias, and less DeMeester and AET-positive days, a less severe GERD phenotype. There were no differences between groups in perioperative outcomes or % symptom resolution. Objective GERD outcomes (need for dilation, esophagitis, and postop BRAVO) were equivalent between groups. Patient-reported quality of life scores, including GERD-HRQL, RSI, and Dysphagia Score did not differ between groups from preop through 1year postop. Those who met our historical criteria only reported significantly worse RSI scores (p = 0.03) and worse GERD-HRQL scores at 2years postop, though not statistically significant (p = 0.07). Updated AGA GERD guidelines exclude a portion of patients who historically would have been diagnosed with and surgically treated for GERD. This cohort appears to have a less severe GERD phenotype but equivalent outcomes up to 1year, with more atypical GERD symptoms at 2years postop. AET may better define who should be offered ARS than DeMeester score.

Postoperative outcomes for sleeve gastrectomy patients with positive pH-defined GERD.

Gastroesophageal reflux disease (GERD) is a possible side effect of sleeve gastrectomy (SG). However, procedure selection for patients with GERD and risk factors for morbidity after bypass surgeries is complex. For patients with a preoperative GERD diagnosis, literature related to worsening postoperative symptoms is discordant. This study evaluated the effects of SG on patients with pre-operative GERD confirmed through pH testing. University Hospital, United States. This was a single-center case-series. SG patients with preoperative pH testing were compared based on DeMeester scoring. Preoperative demographics, endoscopy results, need for conversion surgery, and changes in gastrointestinal quality of life (GIQLI) scores were compared. Two-sample independent t-tests assuming unequal variances were used for statistical analysis. Twenty SG patients had preoperative pH testing. Nine patients were GERD positive; median DeMeester score 26.7 (22.1-31.15). Eleven patients were GERD negative, with a median DeMeester score of 9.0 (4.5-13.1). The two groups had similar median BMI, preoperative endoscopic findings and use of GERD medications. Concurrent hiatal hernia repair was performed in 22% of GERD positive vs. 36% of GERD negative patients, (p = 0.512). Two patients in the GERD positive cohort required conversion to gastric bypass (22%), while none in the GERD negative cohort did. No significant postoperative differences were noted in GIQLI, heartburn, or regurgitation symptoms. Objective pH testing may allow the differentiation of patients who would be higher risk for need for conversion to gastric bypass. For patients with mild symptoms, but negative pH testing, SG may represent a durable option.

Diagnostic accuracy of gastroesophageal reflux disease questionnaire for gastroesophageal reflux disease: A systematic review and meta-analysis.

The use of a symptom-based gastroesophageal reflux disease (GERD) questionnaire (GerdQ) for GERD diagnosis has gained interest due to its greater efficacy and ease of use than other available questionnaires. However, different guidelines have given inconsistent recommendations regarding using GerdQ as a diagnostic test. This meta-analysis summarized the diagnostic accuracy of GerdQ for diagnosing GERD. Studies published up to April 12, 2023, and indexed in MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Library were searched. Diagnostic test accuracy studies comparing GerdQ with upper endoscopy and/or pH-metry for GERD diagnosis in adult patients with symptoms suggestive of GERD were included. The study quality was assessed using the QUADAS-2 tool. Meta-analysis using bivariate (Reitsma) analysis was done to summarize the overall sensitivity, specificity, likelihood ratios (LRs), and diagnostic odds ratio (DOR). The summary receiver operating characteristics (SROC) curve was visualized, and the area under the ROC (AUC) was calculated. A total of 13 studies with 11,166 participants were included in the meta-analysis. The pooled sensitivity, specificity, positive LR, negative LR, and DOR for GerdQ (cut-off value of ≥8) were 66.9% (95% CI 56.4%-73.1%), 65.2% (95% CI 56.4%-73.1%), 1.93 (95% CI 1.55-2.42), 0.51 (95% CI 0.38-0.66), and 3.89 (95% CI 2.44-5.89), respectively. The overall AUC from the SROC was 0.705. The subgroup analysis showed similar pooled sensitivity, specificity, and DOR between Asian and non-Asian studies. GerdQ had moderate sensitivity and specificity for GERD diagnosis. GerdQ can still be recommended as a diagnostic tool for GERD, especially when the PPI test is unavailable or contraindicated.

Twenty-four-hour pH metry alone is inferior to additional impedance monitoring in the diagnosis of gastroesophageal reflux disease, particularly in presence of reduced gastric acid secretion.

Current gold standard for the diagnosis of gastroesophageal reflux disease (GERD) is 24-hour pH metry though it fails to detect non-acidic reflux. The sensitivity of 24-hour pH metry alone (both catheter-based and Bravo capsule) is questionable, especially if gastric acid secretion is low due to reduced parietal cell mass, Helicobacter pylori-induced gastric atrophy and antisecretory therapy. Accordingly, we analyzed the diagnostic ability of 24-hour pH metry as compared to impedance monitoring in relation to the gastric pH without antisecretory therapy. A retrospective analysis of prospectively collected data from 150 patients with suspected GERD undergoing a 24-hour pH impedance study was done. Among 150 patients with symptoms suggestive of GERD, 106 (70.6%) had confirmed GERD diagnosed either by 24-hour pH metry alone (10 [9.4%]), impedance monitoring alone (49 [46.2%]) or both (47 [44.3%]). Abnormal reflux of acidic and non-acidic gastric contents was detected by 24-hour pH metry and 24-hour impedance monitoring in 57/106 (53.7%) and 96/106 (90.5%) of patients, respectively (p < .00001). Patients with GERD diagnosed by 24-hour impedance monitoring had a higher mean gastric pH (2.9 [median 1.3, IQR 5.3]) than those diagnosed by 24-hour pH metry (2.1 [median 1.4, IQR 2.6]) or both (1.6 [median 1.2, IQR 2.1]) (p = 0.001). Twenty-four-hour impedance monitoring detects GERD more often than 24-hour pH metry. Patients with higher mean gastric pH leading to non-acidic reflux were more often diagnosed by 24-hour impedance monitoring than 24-hour pH metry. Thus, 24-hour pH metry alone is inferior to additional impedance monitoring in the diagnosis of GERD, particularly in presence of reduced gastric acid secretion.