Effects Of Antireflux Therapy Research Articles

Effect of anti-reflux therapy on pulmonary function in idiopathic pulmonary fibrosis: a systematic review and meta-analysis.

BackgroundCurrent guideline conditionally recommends regular use of anti-reflux medication in idiopathic pulmonary fibrosis (IPF). However, the effect of anti-reflux therapy in this group remains controversial. We systematically reviewed literatures to evaluate whether anti-reflux therapy could ameliorate pulmonary function in IPF.MethodsWe performed electronic search in PubMed, Embase and CENTRAL (Cochrane Central Register of Controlled Trials) to identify original articles published in English language. We included randomized controlled trials (RCTs) and observational studies regarding anti-reflux therapy on pulmonary function in IPF. Qualitative and quantitative analyses were conducted. In quantitative analysis, the inverse-variance method with fixed-effect model was used to analyze pooled data.ResultsFifteen studies (2 RCTs and 13 observational studies) including 3,891 patients with IPF were included. Pooled analysis suggested that anti-reflux therapy did not improve forced vital capacity (FVC)% predicted [mean difference (MD) =0.88, 95% confidence interval (CI): −0.22 to 1.98, P=0.12, I2 =0%, 8 studies, n=3,076], diffusing capacity of the lung for carbon monoxide (DLCO) % predicted (MD =0.75, 95% CI: −0.13 to 1.62, P=0.10, I2 =0%, 8 studies, n=3,073), and FVC decline (MD =0.02, 95% CI: −0.01 to 0.04, P=0.29, I2 =17%, 5 studies, n=1,586) in IPF.DiscussionAnti-reflux therapy may not ameliorate pulmonary function in IPF. However, adequately powered studies are warranted to validate the present findings.

ASSESSMENT OF THE IMPACT OF ANTIREFLUX THERAPY ON THE COURSE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The aim: To examine the effect of antireflux therapy on the course of COPD. Materials and methods: Under observation were 60 patients who were hospitalized in the «Transcarpathian Regional Clinical Hospital named after Andrei Novak» with a diagnosis of COPD II gr B in combination with GERD and 36 patients diagnosed with GERD who were treated on an outpatient basis. To study the effectiveness of antireflux therapy and its impact on the course of COPD, patients are divided into 2 groups: 1 group (main) (n = 60) – patients with COPD in combination with GERD, group 2 (control) (n = 36) – patients with isolated GERD. Patients with positive Helicobacter pylori status received antihelicobacter therapy. Patients in group 1 were divided into subgroups: 1a (n = 34) – COPD in combination with esophageal manifestations of GERD and 1b (n = 26) – COPD in combination with extraesophageal manifestations of GERD. Group 1a received complex therapy, which consisted of basic therapy of COPD in combination with antireflux and with rebapimide, group 1b – only basic therapy of COPD in combination with antireflux. Results: After treatment, the clinical signs of GERD significantly decreased in all patients receiving complex therapy, improved the course of respiratory symptoms of COPD. After treatment, patients showed a clinically significant reduction in systemic inflammation, which is best seen in the group with the use of rabipimide. Conclusions: Comprehensive treatment of combined pathology with the use of antireflux therapy has a positive effect not only on the clinical symptoms of the disease, but also on the indicators of external respiratory function in patients with combined COPD and GERD.

СТРЕС І ГАСТРОЕЗОФАГЕАЛЬНА РЕФЛЮКСНА ХВОРОБА

Gastroesophageal reflux disease (GERD) is one of the commonest conditions managed by clinicians. Regurgitation and heartburn are considered the cardinal symptoms of GERD. In recent decades, an increasing association has been noted between stress and GERD and our knowledge about the pathophysiology of this relationship is constantly evolving. Both acute and chronic stress can accentuate GERD related symptoms. Subjects exposed to chronic life stressors are more likely to complaint of GERD symptoms. Current data suggests that acute stress exacerbates GERD symptoms by enhancing the perceptual responses to intra-esophageal acid stimulivia central mechanisms without increasing the amount of acid reflux. This process is likely mediated by an increase in esophageal mucosal permeability. Treatment with proton pump inhibitors attenuates the effect of acute stress on esophageal perception thresholds for pain. However, the effect of anti-reflux therapy in patients experiencing chronic stress remains to be elucidated.

The specific features of progress of exudative otitis media in infants with gastroesophageal reflux disease

The article considers the efficacy of antireflux therapy in the treatment of exudative otitis media in the infants with gastroesophageal reflux. The authors have analyzed the efficacy of the tympanic cavity shunting in children with exudative otitis media against the background of gastroesophageal reflux disease, in the absence of the effect of antireflux therapy.

Ineffective Esophageal Motility Is Independently Associated with Higher Reflux Symptom Index (RSI) Score in Subjects with Suspected Laryngopharyngeal Reflux

Introduction: Evaluation and management of suspected laryngopharyngeal reflux (LPR) symptoms is challenging, and the effectiveness of anti-reflux therapy has been varied. Esophageal dysmotility may also play a role in LPR symptoms. The association between esophageal dysmotility on high-resolution manometry (HRM) and objective measures of LPR symptoms such as the reflux symptom index (RSI) is not known. A better understanding of the HRM patterns found in patients with suspected LPR may further our understanding of this clinical presentation, particularly when reflux assessment alone fails to establish a diagnosis. We aimed to examine the association between abnormal HRM findings in patients with suspected LPR and RSI. Methods: This was a retrospective study of all patients with suspected LPR who underwent HRM and multichannel intraluminal impedance and pH study (MII-pH) at a tertiary center in 3/2015-5/2016. All patients completed the reflux symptom index (RSI) questionnaire within 3 months of testing. Chart review was performed to collect data on demographics, medical history, clinical symptoms, and prior PPI use. Abnormal HRM findings were categorized using Chicago Classification v3.0. The associations between RSI score and HRM findings were evaluated using student's t-test for univariate analysis and general linear regression for multivariate analysis. Results: 47 patients (mean age = 55.6±13.7, 74.5% female) met criteria for inclusion. On univariate analysis, the mean total RSI score was significantly higher among patients with ineffective esophageal motility (IEM), defined as failed or weak swallows ≥50%, compared to those with normal motility (27.8 vs 19.8, p=0.03). No association between other HRM findings and RSI scores was found. On multivariate analysis, after controlling for age, gender, PPI use, and bolus exposure (measured on MII-pH), IEM remained independently associated with a higher total RSI score (β coefficient: 8.36, p=0.04). No association was found between parameters on MII-pH testing alone and RSI score. Conclusion: IEM is independently associated with a higher total RSI score among patients with LPR symptoms, even after controlling for abnormal reflux on MII-pH. Esophageal dysmotility may contribute to LPR symptoms and should be routinely considered in the work-up of suspected LPR.

The Effect of Antireflux Therapy on Phonomicrosurgical Outcomes: A Preliminary Retrospective Study

Currently, no clinical standards exist with regard to antireflux medications in the perioperative period for patients undergoing surgery for benign vocal fold lesions. The present study sought to determine the clinical yield of these medications on operative outcomes in patients who underwent surgical treatment for benign vocal fold lesions. Retrospective, outcomes study. Medical records were reviewed from a single surgeon database between January 2011 and June 2012 toquantify outcomes in patients taking antireflux medications compared with subjects not taking medications at the time of surgery. Voice Handicap Index (VHI)-10 and Reflux Symptom Index (RSI) scores were the primary dependent variables. The t test analyses were conducted to compare VHI-10 and RSI scores. Additional multivariate regression analyses were conducted to evaluate medication effects on VHI and RSI, adjusting for potential confounds. A total of 51 patients met inclusion criteria. Of these patients, 12 (23.5%) were using antireflux medication(s) at the time of surgery and 39 (76.5%) were not. The mean shifts in VHI-10 and RSI after surgery for the antireflux therapy (ART) group were -14.75 and -7.5, respectively. For the non-antireflux therapy (non-ART) group, mean ΔVHI-10 and ΔRSI values were -9.87 and -5.05, respectively. Both t test and regression analyses confirmed no statistical difference between the ART and non-ART groups for both ΔVHI-10 and ΔRSI. Additional regression analysis revealed a positive correlation between preoperative RSI score and ΔRSI score. Antireflux medications did not significantly alter postoperative outcomes in this preliminary cohort of patients.

The management of periprosthetic leakage in the presence of supra-oesophageal reflux after prosthetic voice rehabilitation

The objective of the study was to investigate the influence of anti-reflux medications on the management of periprosthetic leakage in laryngectomised patients with prosthetic voice rehabilitation. Sixty patients underwent laryngectomy and prosthetic voice rehabilitation. In a prospective non-randomised study, we examined the patients clinically and assessed the presence of reflux disease using 24-h dual-probe pH monitoring before and 6 months after oral anti-reflux treatment with proton pump inhibitors (PPIs). The severity of reflux, the effectiveness of anti-reflux therapy, and the clinical success of treatment were evaluated. Reflux parameters before and after anti-reflux therapy as well as the severity and incidence of periprosthetic leakage before and after PPI therapy were the main outcome measures. The absolute number of reflux events was 162.2 (±144.3) before treatment and 63.1 (±87.9) after treatment with PPIs (p = 0.031). The reflex area index score decreased from 327.1 (±419.3) without PPIs to 123.8 (±249.7) with PPIs (p = 0.0228). The mean DeMeester score was 108.3 (±85.4) before treatment and 47.4 (±61.7) after 6 months of treatment (p = 0.0557). The relative risk of periprosthetic leakage decreased to 0.5 after anti-reflux treatment. In 19 patients, leakage problems were successfully managed by rigorous treatment with PPIs. No further surgical procedures were required in these cases. Rigorous anti-reflux treatment leads to an improvement in parameters that can be assessed objectively by 24-h dual-probe pH monitoring. In the majority of patients, the symptoms associated with periprosthetic leakage can be improved or cured.

Effect of Acid Suppression on Molecular Predictors for Esophageal Cancer

Gastroesophageal reflux disease is a risk factor for the development of Barrett's esophagus and esophageal adenocarcinoma. The effect of antireflux therapy on the incidence of esophageal adenocarcinoma is unknown. Acid exposure in vitro induces hyperproliferation via a cyclooxygenase-2 (COX-2) dependent mechanism. Epidemiologic and animal studies suggest that COX inhibitors decrease the incidence of esophageal adenocarcinoma. To study the differential effect of complete compared with incomplete acid suppression on proliferation, apoptosis, and COX-2. Fifty-one patients with Barrett's esophagus who underwent pH monitoring were divided into two groups according to their DeMeester score: 32 acid-suppressed patients (group 1) and 19 patients with abnormally high acid exposure (group 2). Slides from biopsies taken 3 months before and 4 and 12 months after pH monitoring were stained for Mcm2, COX-2, c-myc, and cleaved caspase-3 (marker of apoptosis). There was no evidence of a difference between the two groups in terms of age, gender ratio, medication, dysplasia status, and the expression levels of any marker before pH monitoring. In group 1, Mcm2 expression decreased in the luminal surface and throughout the tissue 12 months after monitoring when compared with the two previous time points (P < 0.05). The levels of COX-2 increased overtime (P < 0.01 in group 1, not significant in group 2). There was no correlation between Mcm2 and COX-2 expression. Acid suppression had no effect on c-myc or apoptosis. Long-term acid suppression reduces proliferation in Barrett's esophagus samples but has no advantageous effect on c-myc, apoptosis, or COX-2.

Paroxysmal Laryngospasm: A Typical but Underrecognized Supraesophageal Manifestation of Gastroesophageal Reflux?

Thirty-five consecutive adult patients with paroxysmal laryngospasm (LS) and with unimpaired vocal fold mobility were prospectively studied for coexisting gastroesophageal reflux disease (GERD). Nineteen patients reported frequent (>3 episodes a week) LS episodes (FLS patients) and 16 patients reported occasional LS episodes (OLS patients). All patients underwent an extensive otorhinolaryngological (ORL) examination, upper gastrointestinal (GI) endoscopy, ambulatory 24-hr dual-channel esophageal pH monitoring, and esophageal manometry. In addition, a subset of LS patients also underwent ambulatory duodenogastroesophageal reflux (DGER) monitoring. Patients with daily LS used the symptom marker during pH monitoring indicating separate LS episodes. All FLS patients and 14 OLS patients (87%) had a diagnosis of GERD. Only 10 patients (29%) experienced heartburn and/or regurgitation. Compared to OLS patients, FLS patients generally had more severe GERD as indicated by a higher prevalence of a hiatus hernia, higher distal and proximal esophageal acid exposure times, and higher values of DGER. In six FLS patients, 21 LS episodes (91%) occurred simultaneously with acid reflux, indicating a causal association between LS and GER. On antireflux therapy consisting of omeprazole, 20 mg bid, or lansoprazole, 30 mg oid, and lifestyle measures, LS ceased completely in all patients within 6 weeks. The present study not only demonstrates the role of GER in the pathogenesis of LS and the effectiveness of antireflux therapy, but also suggests that LS in adult patients with unimpaired vocal fold mobility might be considered a typical, although most frequently unrecognized, supraesophageal manifestation of GER.

Gastroesophageal reflux and asthma: can the paradox be explained?

The reported effects of asthma on gastroesophageal reflux (GER), effects of GER on asthma and the effects of antireflux therapy on asthma are conflicting. The purpose of this paper is to review the evidence for a relationship between the two conditions. A search of the MEDLINE 1966 to 1999 database, combining the terms GER and asthma, was used to identify studies of the effects of acid perfusion of the esophagus, the physiological equivalent of GER and the effects of both medical and surgical antireflux therapy on asthma. Bibliographies of the identified papers were also reviewed. The collected evidence suggests that GER causes asthma symptoms but has minimal effects on pulmonary function. Both medical and surgical antireflux therapy can improve asthma symptoms and asthma medication requirements without improving pulmonary function. The paradox of GER causing symptoms without affecting pulmonary function may be because of the retrosternal discomfort that accompanies GER increases minute ventilation and respiratory sensation. Despite an extensive body of literature, many questions remain about the relationship between GER and asthma. A review of the data suggests a strong association between the two conditions, and that GER worsens asthma symptoms without affecting pulmonary function. Asymptomatic GER does not worsen asthma. Antireflux therapy may have a role in asthma patients with symptomatic GER, possibly being most beneficial for those with reflux-associated respiratory symptoms. Unfortunately, many studies contain flaws such as a lack of controls and small sample sizes. Further properly designed controlled trials, including ones that measure the effects of GER and antireflux therapy on quality of life, are needed to understand better the role of GER in asthma.

Does Medical Antireflux Therapy Improve Asthma in Asthmatics With Gastroesophageal Reflux?: A Critical Review of the Literature

Identify and critically review the peer-reviewed, English-language studies of the effects of medical antireflux therapy in asthmatics with gastroesophageal reflux (GER). Using the 1966 to 1996 MEDLINE database, asthma was combined with GER to identify all studies of the effects of medical antireflux therapy on asthma control. The articles' bibliographies were also reviewed. Studies were graded according to Sackett's criteria and grouped by levels of evidence. A total of 242 citations were found; 171 were published in English. Twelve studies of the effects of medical antireflux therapy on asthma control, with a total of 326 treated patients, were identified. Eight studies were placebo-controlled, three were open studies, and one used an untreated control. Eight studies treated 20 or fewer patients. Reflux symptoms either did not improve or the effects of antireflux therapy on them were not reported in four studies. The combined data from the controlled medical antireflux studies showed that: (1) asthma symptoms improved in 69% of the subjects; (2) asthma medication use was reduced in 62% of the subjects; (3) evening peak expiratory flow (PEF), but not PEF at other times, improved in 26% of the subjects; and (4) spirometry did not improve in any of the placebo-controlled antireflux studies. Analysis of the combined data suggests that medical antireflux therapy improves asthma symptoms, may reduce asthma medication use, but has minimal or no effect on lung function.

The relationship between GERD and OSAS and effects of anti-reflux therapy

The relationship between GERD and OSAS and effects of anti-reflux therapy