Diagnosis Of Gastroesophageal Reflux Disease Research Articles

High Discovery Rate of Duodenal and Gastric Eosinophilia in Patients With Unexplained Moderate–Severe Abdominal Symptoms: A Prospective US Multisite Study

High Discovery Rate of Duodenal and Gastric Eosinophilia in Patients With Unexplained Moderate–Severe Abdominal Symptoms: A Prospective US Multisite Study

Surgical treatment for gastroesophageal reflux disease

Background: Gastroesophageal reflux disease (GERD) is one of the most common upper gastrointestinal diseases that affects 10% to 20% of the general population worldwide.Current Concepts: Proton pump inhibitors (PPIs), the main treatment for this disease, is used to control symptoms. In most cases, PPI is prescribed empirically, and may be ineffective in 30% to 40% of patients. Even in cases with a precise diagnosis of GERD following objective tests, PPI becomes less effective as the disease progresses over a long time period. Laparoscopic anti-reflux surgery can be a good option when PPI therapy becomes ineffective and dose increases are required. This surgery effectively abolishes all kinds of reflux by constructing a mechanical anti-reflux valve at the gastroesophageal junction. Before surgery, a precise diagnosis should be made following several objective tests, including esophagogastroduodenoscopy, pH monitoring, manometry, and esophagram. The degree of fundoplication should be tailored according to esophageal motility and disease severity.Discussion and Conclusion: Laparoscopic anti-reflux surgery may be particularly effective for GERD patients with hiatal hernia, mechanically defective lower esophageal sphincter, or weak acidic/nonacidic reflux.

Endoscopic Evaluation of De Novo Esophagitis and Barrett's Esophagus, 5 Years After Sleeve Gastrectomy.

Sleeve gastrectomy (SG) is the most common bariatric procedure worldwide. It has been reported that there is a strong association between SG and the development of gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE). This study was conducted to evaluate esophagogastroduodenoscopy (EGD) findings in patients with a history of SG with more than 5-year follow-up. This is a retrospective cohort study of prospectively maintained database. Inclusion criteria included patients who underwent SG between April 2015 and March 2016, aged 18 and above, BMI ≥ 40kg/m2. Patients with 5years of follow-up were invited to take part in the study and underwent EGD and biopsy. One hundred twenty-six patients were recruited with a mean age of 44.6 ± 11.1years. After a 5-year follow-up, there were 31 (29.5%) patients with reflux esophagitis. The grades of GERD were A, B, and C in 16 (15.2), 12 (11.4), and 3 (2.9%) patients, respectively. Incidence of BE was 5.7% after 5years from SG. There was a 16.6% lost to follow-up at 5years after SG. The diagnosis and severity of GERD and the search for BE justify endoscopic surveillance in all long-term post-sleeve patients, regardless of reflux symptoms.

Artificial intelligence facilitates measuring reflux episodes and postreflux swallow-induced peristaltic wave index from impedance-pH studies in patients with reflux disease.

Reflux episodes and postreflux swallow-induced peristaltic wave (PSPW) index are useful impedance parameters that can augment the diagnosis of gastroesophageal reflux disease (GERD). However, manual analysis of pH-impedance tracings is time consuming, resulting in limited use of these novel impedance metrics. This study aims to evaluate whether a supervised learning artificial intelligence (AI) model is useful to identify reflux episodes and PSPW index. Consecutive patients underwent 24-h impedance-pH monitoring were enrolled for analysis. Multiple AI and machine learning with a deep residual net model for image recognition were explored based on manual interpretation of reflux episodes and PSPW according to criteria from the Wingate Consensus. Intraclass correlation coefficients (ICCs) were used to measure the strength of inter-rater agreement of data between manual and AI interpretations. We analyzed 106 eligible patients with 7939 impedance events, of whom 38 patients with pathological acid exposure time (AET) and 68 patients with physiological AET. On the manual interpretation, patients with pathological AET had more reflux episodes and lower PSPW index than those with physiological AET. Overall accuracy of AI identification for reflux episodes and PSPW achieved 87% and 82%, respectively. Inter-rater agreements between AI and manual interpretations achieved excellent for individual numbers of reflux episodes and PSPW index (ICC=0.965 and ICC=0.921). AI has the potential to accurately and efficiently measure impedance metrics including reflux episodes and PSPW index. AI can be a reliable adjunct for measuring novel impedance metrics for GERD in the near future.

Clinical Implications of the Gastroesophageal Reflux Disease Questionnaire and Reflux Symptom Index in Patients With Suspected Laryngopharyngeal Reflux Symptoms.

Background/AimsTo evaluate the usefulness of gastroesophageal reflux disease questionnaire (GerdQ) and reflux symptom index (RSI) for diagnosis of gastroesophageal reflux disease (GERD) in patients with suspected laryngopharyngeal reflux (LPR) symptoms (cough, hoarseness, globus, and throat pain).MethodsA total of 98 patients with LPR symptoms were incorporated from either gastroenterology or otorhinolaryngology clinic. Patient’s laryngoscopic findings were graded by reflux finding score (RFS), and RFS ≥ 7 was considered as positive LPR. Erosive esophagitis on endoscopy or abnormal results on ambulatory impedance-pH monitoring were used as diagnostic criteria for GERD. Esophageal motor function was evaluated using high-resolution esophageal manometry.ResultsNinety-three (94.9%) of the 98 subjects were diagnosed as LPR by RFS, but only 15 (15.3%) had GERD. For GerdQ, the cutoff value of 9 showed the highest area under curve (AUC) to diagnose GERD by receiver operating curve analysis (AUC = 0.565); the sensitivity, specificity, positive predictive value, and negative predictive value were unsatisfactory (50.0%, 70.7%, 22.6%, and 89.2%, respectively.) RSI also showed poor performance in diagnosing GERD; the cutoff value of 25 showed the highest yield (AUC = 0.581); the sensitivity, specificity, positive predictive value, and negative predictive value were 42.9%, 79.3%, 26.1%, and 89.0%, respectively. Ineffective esophageal motility was frequently observed (69 of 98, 70.4%), but there was no difference in esophageal motility parameters between GERD and non-GERD patients.ConclusionsIn patients with LPR symptoms, significant discrepancies are observed between laryngoscopic diagnosis and GERD. In this population, neither GerdQ nor RSI is useful in diagnosing GERD.

Dental Erosions: A Manifest of Gastroesophageal Reflux Disease (GERD)

Objective: To record the frequency of dental erosion (DE) in patients with Gastro esophageal Reflux Disease (GERD). Methodology: The research included a total of one hundred patients who had been diagnosed with gastro esophageal reflux disease. Duration of study was 3 months from July, 2022 to September, 2022. Patients who presented with a digestive system illness in which stomach acid splashed over the bottom of the esophagus met the criteria for a diagnosis of GERD, which we utilized to make the diagnosis. It manifested itself in the form of a strong burning feeling in the chest, which often occurred after meals and typically occurred many times each week. Endoscopy and the patients' medical histories were used to make the diagnosis. For the purpose of making a tooth erosion diagnosis, GERD patients were evaluated presenting in the Madinah teaching hospital Faisalabad. It was shown that individuals who suffered from GERD had a significantly higher incidence of tooth erosion. Results: In our study, 46(46%) cases were between 30-45 years of age while 54(n=54) were between 46-60 years of age, mean age was calculated as 46.14+11.85 years. Gender distribution shows that 51(51%) were male while 49(49%) were females. DE was recorded in 34(34%) while 66(66%) had no findings of the morbidity; we found no significant difference in age and gender. Conclusion: Patients with gastroesophageal reflux disease often have dental erosion as a presenting symptom (GERD). Screening individuals with GERD for tooth erosion is crucial for identifying and treating instances timely to enhance patients' quality of life. Keywords: Gastro esophageal Reflux Disease (GERD), Adults, Dental Erosion (DE)

56 Gastroesophageal reflux disease in children with neurological impairment: a population-based retrospective cohort study

Abstract Background Children with neurological impairment (NI) are at increased risk of gastroesophageal reflux disease (GERD) and may be more susceptible to complications such as esophagitis and aspiration. Diagnosis is challenging due to communication impairments and frequent comorbidities, such as dysphagia, that present similarly to GERD. There is a risk of both under and over diagnosis with detrimental effects. Prior research has suggested the prevalence of GERD is as high as 75%. However, these studies examined subpopulations such as children presenting with symptoms or living in institutions, often many decades ago. Objectives Our aim was to determine the incidence and prevalence of GERD diagnosis and treatment in children with NI at a population level. Design/Methods This is a retrospective cohort study using provincial administrative data. Children with NI were identified by International Classification of Diseases (ICD-10) codes in the Discharge Abstract Database (DAD) between 2006 and 2018. GERD was defined as: (1) 1+ codes in DAD or National Ambulatory Care Reporting System; (2) 2+ specialist claims; (3) 1+ ASM prescription. Age, gender, complex chronic conditions (CCC) and technology assistance (TA) were covariates. ASM prescriptions and anti-reflux procedures were collected. Descriptive statistics included means with standard deviations and counts with proportions. Univariable and multivariable Poisson regressions calculated incidence rates and rate ratios for the presence of GERD and prescription of ASM. Results Among 10,309 children with NI, 2,772 (26.9%) met the GERD definition. The unadjusted incidence rate was 52.1 per 1000 person-years. Increasing numbers of CCCs were associated with a higher risk of GERD. Children with four or more CCCs had an incidence almost three times that of children with no CCCs. A gastrostomy tube incurred a five times higher rate of GERD. Overall, 2486 (23.7%) of the children were treated with ASMs of which 1535 (61.7%) met no other GERD criteria. The incidence rate was 16.9 prescriptions per year. Neonatal, respiratory and congenital CCCs were associated with higher rates of ASM prescribing. The prevalence of gastrojejunostomy tubes was 1.1% (n=121), surgical jejunostomy tubes was 0.7% (n=79) and fundoplication was 3.3% (n=351). Conclusion The incidence of GERD in children with NI is dramatically higher than in the general pediatric population, as is the use of ASM. Both disparities are heightened in children with gastrostomy tubes, perhaps due to increased severity of NI or relevant comorbidities. Regardless, GERD is clearly a significant clinical issue in this population that warrants additional study to determine optimal diagnosis and treatment practices.

Characteristics of gastroesophageal reflux disease in children with interstitial lung disease.

Childhood interstitial lung disease (chILD) is a rare group of respiratory tract disorders. One of the factors suggested to be associated with its etiopathogenesis is microaspiration related to gastroesophageal reflux disease (GERD). The aim of the present study was to determine the frequency and characteristics of GERD in children with chILD, with a particular focus on proximal GER episodes. This was a prospective cross-sectional study. Consecutive patients with chILD underwent 24-h multichannel intraluminal pH-impedance monitoring. Different types of gastroesophageal reflux episodes (GER) were recorded and compared with regard to the GERD diagnosis. Sixty-two children (median age of 1.22 years) were included. GERD was diagnosed in 20 (32.3%) of them. The GERD (+) and GERD (-) subgroups differed mainly in their esophageal exposure to acid content (2.9 vs. 1.0%, p = 0.02) and bolus exposure (3.0 vs. 1.4%, p < 0.0001), as well as total number of GER (72.5 vs. 42.0 p = 0.0004), acid GER (35.5 vs. 15.0 p = 0.004), and acid proximal GER (21.0 vs. 12.0 p = 0.02). There were no differences in the number of proximal GER comparing GERD (+) and GERD (-) subgroups. The frequency of GERD seems to be relatively high in the population of children with chILD used in this study. However, it has not demonstrated an association between proximal GER and GERD diagnosis in chILD, which casts uncertainty over the microaspiration theory proposed to link the two diseases. The latter conclusion, however, needs to be confirmed using more accurate aspiration assessment methods.

S442 Utilization of Diagnostic Testing and Indications for Long-Term Twice-Daily Proton Pump Inhibitor (PPI) Therapy for Gastroesophageal Reflux Disease (GERD) in a Large Healthcare System

Introduction: For symptoms potentially associated with GERD, guidance recommends de-prescribing long-term PPI therapy based on symptoms if possible, particularly in the absence of objective diagnostic findings. We assessed the utilization and yield of diagnostic evaluation (upper endoscopy (EGD) and/or reflux monitoring) among patients with GERD diagnoses receiving long-term twice-daily PPI therapy. Methods: From a healthcare system database, adults with GERD diagnoses (per ICD coding) who received prescriptions for twice-daily PPI for at least 90 days from 2018-2021 were identified. CPT analyses were performed to identify the proportions who underwent EGD and reflux monitoring. Characteristics of patients who underwent diagnostic testing were compared to those who did not. Further, those with objective EGD findings potentially warranting long-term PPI (such as erosive or eosinophilic esophagitis, peptic stricture, Barrett’s esophagus, ulcer) were compared to those without such findings on EGD. Factors significant on univariate analysis were included in multivariate models to identify predictors of A) undergoing diagnostic evaluation, and B) having positive EGD findings. Results: 5565 patients (57.7±0.2 yrs; 67.4% female; BMI 31.3±0.1) met inclusion criteria. 2696 (47.7%) had upper endoscopy, 491 (8.7%) had reflux monitoring, and 2735 (48.4%) had either upper endoscopy or reflux monitoring performed. Factors associated with diagnostic testing included younger age, female gender, and non-white race (Table, Figure A). Among those who underwent EGD, 42.2% had endoscopic findings potentially warranting long-term PPI (37.7% for females vs 52.2% for males; 34.7% for non-white patients vs 47.3% for white patients). Factors associated with the presence of EGD findings included older age, male gender, and white race (Figure B). Conclusion: Among patients receiving prescriptions for long-term, twice-daily PPI for GERD diagnoses, over half did not have procedural diagnostic evaluation documented per CPT analysis, suggesting providers may rely on patient symptom reporting to guide long-term PPI prescriptions. Of those with documented EGD, less than half had objective findings to potentially corroborate the need for long-term, twice-daily PPI. These findings warrant further investigation into potential disparities in care around long-term PPI prescribing patterns based on symptoms and symptom response versus diagnostic evidence.Figure 1.: Forest Plots for Multivariate Analysis of Factors Associated with A) Diagnostic Evaluation (Upper Endoscopy and/or Ambulatory Reflux Monitoring) among Patients with GERD Diagnoses Prescribed Twice-Daily Long-Term PPI Therapy; and B) Objective Endoscopic Findings Potentially Warranting Twice-Daily Long-Term PPI Therapy. Odds Ratios are Depicted with Bars Representing Associated 95% Confidence Intervals; Values Not Crossing the Dashed Line at 1 are Significant. Odds ratios for smoking status variables are in reference to no smoking history. Table 1. - Comparisons Between Patients who Underwent Diagnostic Evaluation (with Upper Endoscopy and/or Ambulatory Reflux Monitoring) and Those Patients Who did Not Undergo Diagnostic Evaluation Evaluated (n=2735) Not Evaluated (n=2920) p Values Age (years) 57.1±0.3 58.3±0.3 0.005* Body Mass Index 31.0±0.1 31.6±0.2 0.006* Gender (female) 1898 (69.4%) 1916 (65.6%) 0.002* Race (data missing = 97) White 1681 (62.4%) 1998 (69.8%) < 0.001* Black 838 (31.1%) 672 (23.5%) Asian 62 (2.3%) 77 (2.7%) Other 115 (4.3%) 115 (4.0%) Ethnicity (data missing =109) Non-Hispanic 2505 (93.1%) 2663 (93.3%) 0.71 Hispanic or Latino 187 (7.0%) 191 (6.7%) Married (data missing =58) Married 1526 (56.2%) 1658 (57.5%) 0.32 Not Married 1189 (43.8%) 1224 (42.5%) Smoking Status (data missing = 5) Current 279 (10.2%) 390 (13.4%) < 0.001* Former 974 (35.6%) 945 (32.4%) Never 1481 (54.2%) 1581 (54.2%)

S506 Evaluating the Diagnostic Accuracy of GerdQ for Diagnosis of Gastroesophageal Reflux Disease: A Meta-Analysis

S506 Evaluating the Diagnostic Accuracy of GerdQ for Diagnosis of Gastroesophageal Reflux Disease: A Meta-Analysis

149. LOCAL INFLAMMATORY RESPONSE TO GASTROESOPHAGEAL REFLUX: ASSOCIATION OF GENE EXPRESSION OF INFLAMMATORY CYTOKINES WITH MULTICHANNEL INTRALUMINAL PH-IMPEDANCE DATA

Abstract Expression of inflammatory cytokines’ genes may take part in pathophysiology of different forms of gastroesophageal reflux disease (GERD). Aim: to explore the expression of inflammatory cytokines’ genes in esophageal mucosa in patients with erosive esophagitis and non-erosive forms of gastroesophageal reflux disease and its association with data of esophageal multichannel intraluminal pH-impedance measurements. This was a single-center prospective study. Esophageal mucosa samples were taken from lower part of the esophagus during endoscopy. Expression of IL-1β, IL-10, IL-18, TNFA, TLR4, GATA3, CD68, beta-2 macroglobulin genes in esophageal mucosa was assessed with ImmunoQuantex assays. Multichannel intraluminal esophageal pH-impedance (MII-pH) studies performed to all the participants. Diagnosis of GERD was confirmed by the results of MII-pH data. Patients were allocated to erosive esophagitis (EE) or non-erosive GERD groups (NERD). Non-symptomatic subjects with normal endoscopy and MII-pH results served as a control. Spearman rank correlation was used to asses association of genes expression and results of MII-pH. Data of 60 patients with GERD and 10 subjects of the control group were available for the analysis. Higher expression of IL-18 (5.89 ± 0.4 vs 5.28 ± 1.1, p = 0.04) and GATA3 (2.92 ± 0.86 vs 2.23 ± 0.96, p = 0.03) genes was found in EE group compared to NERD. Expression of IL-1β, IL-18, TNFA, and TLR4 genes was lower (P &amp;lt; 0.05) in the control group compared to EE and NERD. Esophageal acid exposure correlated with the expression of IL-1β (R = 0.29), IL-18 (R = 0.31), TNFA (R = 0.35), GATA3 (R = 0.34), TLR4 (R = 0.29), CD68 (R = 0.37) genes. Mean esophageal рН correlated inversely with the expressions of IL-18, TNFA, GATA3, TLR4, CD68 genes. In patients with erosive esophagitis, local expression of interleukin 18 and GATA3 transcription factor genes was higher compared to subjects with non-erosive form of gastroesophageal reflux disease. Esophageal acid exposure correlated directly with expression of IL-1β, IL-18, TNFA, TLR4, CD68 and B2M genes. Inverse correlation revealed between expression of IL-18, TNFA, GATA3, TLR4 CD68 genes and mean esophageal pH.

Local inflammatory response to gastroesophageal reflux: Association of gene expression of inflammatory cytokines with esophageal multichannel intraluminal impedance-pH data.

BACKGROUNDGene expression of inflammatory cytokines may take part in the pathophysiology of different forms of gastroesophageal reflux disease (GERD).AIMTo explore gene expression of inflammatory cytokines in esophageal mucosa in patients with erosive esophagitis (EE) and non-erosive forms of GERD (NERD) and its association with data of esophageal multichannel intraluminal impedance-pH (MII-pH) measurements.METHODSThis was a single-center prospective study. Esophageal mucosa samples were taken from the lower part of the esophagus during endoscopy. Expression of interleukin (IL)-1β, IL-10, IL-18, tumor necrosis factor α (TNFA), toll-like receptor 4 (TLR4), GATA binding protein 3 (GATA3), differentiation cluster 68 (CD68) and β-2 microglobulin genes in esophageal mucosa was assessed with ImmunoQuantex assays. MII-pH measurements were performed on all the participants. Diagnosis of GERD was confirmed by the results of the MII-pH data. Based on the endoscopy, patients were allocated to the groups of EE and NERD. The control group consisted of non-symptomatic subjects with normal endoscopy and MII-pH results. We used nonparametric statistics to compare the differences between the groups. Association of expression of the mentioned genes with the results of the MII-pH data was assessed with Spearman’s rank method.RESULTSData from 60 patients with GERD and 10 subjects of the control group were available for the analysis. Higher expression of IL-18 (5.89 ± 0.4 vs 5.28 ± 1.1, P = 0.04) and GATA3 (2.92 ± 0.86 vs 2.23 ± 0.96, P = 0.03) was found in the EE group compared to NERD. Expression of IL-1β, IL-18, TNFA, and TLR4 was lower (P < 0.05) in the control group compared to EE and NERD. Esophageal acid exposure correlated with the expression of IL-1β (Spearman’s rank r = 0.29), IL-18 (r = 0.31), TNFA (r = 0.35), GATA3 (r = 0.34), TLR4 (r = 0.29), and CD68 (r = 0.37). Mean esophageal рН correlated inversely with the expression of IL-18, TNFA, GATA3, TLR4, and CD68. No association of gene expression with the number of gastroesophageal refluxes was found.CONCLUSIONIn patients with EE, local expression of IL-18 and GATA3 was higher compared to subjects with NERD. Esophageal acid exposure correlated directly with expression of IL-1β, IL-18, TNFA, TLR4, CD68, and β-2 microglobulin genes. Inverse correlation was revealed between expression of IL-18, TNFA, GATA3, TLR4, and CD68 and mean esophageal pH.

The Lyon Consensus Criteria for GERD Diagnosis in a Greek Population: The Clinical Impact and Changes in GERD Diagnosis in a Real-World, Retrospective Study.

(1) Introduction/aim: Gastroesophageal reflux disease (GERD) affects 8–33% globally. The gold standard examination technique in diagnosing GERD is 24 h pHmetry ± impedance. Recently, new diagnostic criteria were introduced by the Lyon Consensus for GERD diagnosis. Our aim was to investigate the diagnostic yield of pHmetry + impedance using the Lyon Consensus criteria in a real-world study. (2) Patients and methods: Our study included 249 consecutive patients (M/F: 120/129, mean age 50 ± 15 years) who underwent 24 h pH+ impedance monitoring in our department, during a 5-year period. Epidemiological, endoscopic, clinical, and 24 h pH+ impedance data were retrospectively collected. (3) Results: Typical GERD symptoms were reported by 140/249 (56.2%) patients, whereas 99/249 (39.6%) patients reported various extraesophageal symptoms. Endoscopic findings supportive of GERD based on the Lyon Consensus were present in 42/185 (22.7%). An AET value of >6% was observed in 60/249 (24.1%). GERD diagnosis according to the Lyon Consensus criteria was set in 63/249 (25.3%) patients; a rate significantly lower than that observed by implementing the older criteria (32.1%), p < 0.001. In the multivariate analysis, the existence of endoscopic findings supportive of GERD diagnosis as defined by the Lyon Consensus (p = 0.036), a De Meester score of over 14.7, and the presence of typical GERD symptoms were correlated to GERD diagnosis (p < 0.001, respectively) using the criteria defined for pH–impedance monitoring. (4) Conclusions: Changes in the diagnostic criteria concerning the 24 h pH–impedance monitoring of GERD based on the Lyon Consensus led to a conclusive GERD diagnosis in approximately 25% of the patients. This rate of GERD diagnosis is reduced in comparison to the one confirmed with the use of previously established criteria.

Prevalence, Predictors, and Management of Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy: a Multicenter Cohort Study

One of the most popular bariatric procedures is laparoscopic sleeve gastrectomy (LSG), which can either cause or worsen gastroesophageal reflux disease (GERD). Therefore, the goal of this study was to examine the prevalence, predictors, and management of GERD symptoms after LSG. From January 2017 to January 2022, we looked at patients who had a primary LSG and developed GERD. Before LSG, all patients underwent a barium meal and upper endoscopy. After LSG, barium meal, endoscopy, esophageal manometry, and 24-h pH measurements were performed for selected patients. The diagnosis of GERD is based on the GERD-HRQL questionnaire and upper endoscopy. The study included 1537 patients (62.5% women and 37.5% men) with a mean age of 34.4years. The mean % TWL was 40.7% during a mean follow-up period of 15.9months. A total of 379 patients (24.7%) experienced postoperative GERD, of whom 328 (21.3%) had postoperative de novo GERD symptoms, 25 (1.6%) had worsened preoperative GERD, and 26 (1.7%) had the same preoperative GERD symptoms. Antral preservation and gastropexy were protective factors against the development of GERD after LSG. LSG was converted to LRYGB in 15.8% of the patients with GERD. The response to medical treatment was observed in 300 (79.2%) patients with GERD. Post-LSG GERD presented in 379 patients (24.7%). Antral preservation and gastropexy were protective factors for the development of postoperative GERD after LSG. Medical treatment was the main line of treatment for GERD. ClinicalTrials.gov ID: NCT05416645.

Gastro-oesophageal reflux disease in children with neurological impairment: a retrospective cohort study

ObjectivesTo determine the incidence and prevalence of gastro-oesophageal reflux disease (GERD) diagnosis and treatment in children with neurological impairment (NI) along with relationship to key variables.DesignThis is a population-based retrospective...

Диагностика и лечение гастроэзофагеальной рефлюксной болезни: анализ современных рекомендаций

The article summarizes the data of international and Russian recommendations for the treatment and diagnosis of one of the most common diseases of the XXI century – gastroesophageal reflux disease (GERD), provides indications for the use of instrumental methods and refined criteria for the diagnosis of GERD, describes the principles of treatment, including the refractory form of GERD. Special emphasis is placed on the importance of esophageal manometry and reflux monitoring before antireflux surgery. Indications for antireflux operations are listed

Impact of hiatal hernia repair technique on patient-reported gastroesophageal reflux symptoms following laparoscopic sleeve gastrectomy.

Repairing a hiatal hernia at the time of laparoscopic sleeve gastrectomy (SG) can reduce or even prevent gastroesophageal reflux disease (GERD) symptoms in the post-operative period. Several different hiatal hernia repair techniques have been described but their impact on GERD symptoms after SG is unclear. Surgeons (n = 74) participating in a statewide quality collaborative were surveyed on their typical technique for repair of hiatal hernias during SG. Options included posterior repair with mesh (PRM), posterior repair (PR), and anterior repair (AR). Patients who underwent SG with concurrent hiatal hernia repair (n = 7883) were compared according to their surgeon's reported technique. Patient characteristics, baseline and 1-year GERD health-related quality of life surveys, weight loss and 30-day risk-adjusted complications were analyzed. The most common technique reported by surgeons for hiatal hernia repair was PR (n = 64, 85.3%), followed by PRM (n = 7, 9.3%) and AR (n = 4, 5.3%). Patients who underwent SG by surgeons who perform AR had lower rates of baseline GERD diagnosis (AR 55.3%, PR 59.5%, PRM 64.8%, p < 0.01), but were more likely to experience worsening GERD symptoms at 1 year (AR 29.8%, PR 28.7%, PRM 28.2%, p < 0.0001), despite similar weight loss (AR 29.8%, PR 28.7%, PRM 28.2%, p = 0.08). Satisfaction with GERD symptoms at 1 year was high (AR 73.2%, PR 76.3%, PRM 75.7%, p = 0.43), and risk-adjusted 30-day outcomes were similar among all groups. Patients undergoing SG with concurrent hiatal hernia repair by surgeons who typically perform an AR were more likely to report worsening GERD at 1 year despite excellent weight loss. Surgeons who typically performed an AR had nearly one-half of their patients report increased GERD severity after surgery despite similar weight loss. While GERD symptom control may be multifactorial, technical approach to hiatal hernia repair at the time of SG may play a role and a posterior repair is recommended.

A case of tracheal tumor with unusual bronchoscopic presentation: A case report

Primary tumor of the trachea and bronchial tree is rare. Primary tracheobronchial malignancies make up about 0.1% of all pulmonary tumors. The survival rate depends on several factors which include the malignant potential of the tumor, the patient’s comorbidities, and the location of the tumor. The index case is a 60-year-old woman who had 7 months history of globus with an associated history of central chest discomfort and cough of 3 months duration. There was a positive history of dysphagia to solid meals, odynophagia, dyspepsia, nausea, excessive belching, bloating, and regurgitation. These symptoms led to the diagnosis of gastroesophageal reflux disease. However, the persistent symptom of globus and worsening cough necessitated her referral to the chest clinic. Chest radiograph revealed opacity in the left upper lobe. Chest computerized tomographic scan showed a solitary, lobulated, and calcified soft-tissue mass in the apicoposterior segment of the left upper lobe with loss of volume. Bronchoscopy showed multiple planes of non-glistering submucosa lesions which were biopsied. The histology report revealed invasive adenocarcinoma of the airway. The surgical resection of tumors with stents was done and she was discharged home 2 weeks later. However, the patient refused adjunct chemotherapy. She is alive and well with complete resolution of symptoms. Early presentation, availability of investigative tools, and prompt treatment may improve survival in cases of trachea tumors as seen in the index case. A high index of suspicion is also needed to make a prompt diagnosis of trachea tumors, especially in patients presenting with globus.

The Association Between Gastroesophageal Reflux Disease and Non-Small Cell Lung Cancer: A Retrospective Case-Control Study.

BackgroundLung cancer is a leading cause of mortality in the USA. Non-small cell lung cancer (NSCLC) contributes to 85% of all lung cancers. It is the most prevalent subtype amongst non-smokers, and its incidence has risen in the last 20 years. In addition, gastroesophageal reflux disease (GERD) has been associated with several lung pathologies, namely idiopathic pulmonary fibrosis and asthma. We aimed to investigate the association between GERD and NSCLC by performing a retrospective, multicenter, case-control study. This is the first study of this nature to be carried out in the USA.MethodsData were retrieved from 17 Northwell health care facilities in the New York area between the years 2010 and 2018. Inclusion criteria were patients > 18 years of age with NSCLC (large cell, adenocarcinoma, and squamous cell). They were appropriately matched with controls based on age, gender, weight, comorbidities, and medication use. Our exposure group had a diagnosis of GERD based on the International Classification of Diseases, Ninth/10th Revision (ICD 9/10) codes and endoscopic, in addition to histological evidence if present. We excluded patients with secondary lung cancers, esophageal adenocarcinoma, other primary malignancies, Barrett’s esophagus, and smokers. Logistic regression was conducted to determine the adjusted odds ratio (OR) and corresponding 95% confidence interval (CI) for the association between NSCLC and GERD.ResultsA total of 1,083 subjects were included in our study: 543 (50%) patients were diagnosed with NSCLC. In this population, GERD was twice as prevalent compared to controls (20.4% vs. 11.6%, P < 0.001). Multivariate analysis demonstrated that GERD was associated with a higher risk of NSCLC compared to matched controls (OR = 1.86, 95% CI = 1.26 - 2.73). In addition, GERD patients treated with either antihistamines or proton pump inhibitors did not demonstrate an overall reduced risk of NSCLC (OR = 1.01, 95% CI = 0.48 - 2.12).ConclusionsOur study demonstrates that GERD is associated with a higher risk of NSCLC, irrespective of GERD treatment. We postulate that GERD patients suffer from chronic micro-aspirations leading to a prolonged inflammatory state within the lung parenchyma, triggering specific proliferative signaling pathways that may lead to malignant transformation.

Gastroesophageal reflux after sleeve gastrectomy. Fact or fiction?

BackgroundOne of the most controversial issues surrounding laparoscopic sleeve gastrectomy is the development of gastroesophageal reflux disease following surgery. The aim of the study was to evaluate the occurrence of gastroesophageal reflux disease after laparoscopic sleeve gastrectomy and to analyze patients’ weight loss, comorbidities, and quality of life after surgery. MethodsThe clinical records of 52 patients submitted to laparoscopic sleeve gastrectomy between January and November 2018, with 3 years of follow-up, were retrospectively reviewed. At the end of the follow-up period, the patients underwent screening endoscopy, and those with postoperative esophagitis were submitted to endoscopic biopsies and pH-impedance monitoring (MII-pH). The presence of gastroesophageal reflux disease symptoms was assessed using the modified clinical DeMesteer score questionnaire. The Bariatric Analysis and Reporting Outcome System score and 36-Item Short Form Health Survey were used to assess the postoperative quality of life. ResultsIn the preoperative work-up, only 7.6% of patients had signs of esophagitis at esophagogastroduodenoscopy, whilst at 3-year follow-up, 50% of them had endoscopic signs of gastroesophageal reflux disease. Twenty-one out of 26 patients with signs of esophagitis agreed to undergo MII-pH. The median DeMesteer score questionnaire was 4.5, with only 4 patients (19%) exhibiting a value greater than the pH cut-off value (14.72), indicative of gastroesophageal reflux disease. MII-pH data analysis showed the presence of gastroesophageal reflux disease in 5 patients. An excellent outcome on the Bariatric Analysis and Reporting Outcome System score was reported in 50% of patients, and all 8 domains from the 36-Item Short Form Health Survey improved significantly. ConclusionThis study showed an improvement in these patients’ quality of life and the limited refluxogenic nature of laparoscopic sleeve gastrectomy at 3-year follow-up when diagnosis of gastroesophageal reflux disease is based on the Lyon consensus.