Erosive Gastroesophageal Reflux Disease Research Articles

A pilot study comparing the initial clinical response to different proton pump inhibitors within first week in treating erosive esophagitis

AbstractGastroesophageal reflux disease (GERD) characterized by heartburn and/or acid regurgitation symptoms is one of the most common gastrointestinal disorders. The rapid onset of proton pump inhibitors (PPIs) to improve annoying symptom is an essential need in treating GERD. There was no report about the short‐term clinical effects comparing lansoprazole 30 mg to rabeprazole 20 mg. This pilot study was designed to compare the initial one‐week clinical response of the two drugs in GERD with erosive esophagitis. Total 44 patients with GERD were enrolled in this study and randomized into two groups. The patients had the symptoms of acid regurgitation, heartburn, or feeling of acidity in the stomach and erosive esophagitis proven by endoscopy. They respectively received once‐daily dose of lansoprazole 30 mg (n = 23) and rabeprazole 20 mg (n = 21) for treatment of GERD. The primary end point was complete symptom resolution (CSR). The CSR rate was evaluated by questionnaire including acid regurgitation, heartburn sensation and epigastric pain at day 1, 3 and 7. Two patients in the arm of rabeprazole had poor compliance of drugs and were excluded from analysis. The final patient numbers were 23 in the arm of lansoprazole and 19 in rabeprazole. The baseline characteristics of two groups were similar in age, gender, body mass index (BMI), Helicobacter pylori infection, GERD severity, smoking, alcohol, coffee, spicy, sweet food and laboratory data. The ingestion of tea was the only one variable with significant difference between the two groups (65.2% and 31.58%, p = .03). At day 1, 3 and 7, the CSR rate of lansoprazole and rabeprazole were 21.74% and 26.32% (p = 1.000), 34.78% and 31.58% (p = .827), 47.83% and 47.37% (p = .976), respectively. The other clinical factors, including age, gender, BMI, Helicobacter pylori infection, smoking, alcohol, coffee, tea, spicy, sweet food and laboratory data, have also no significant influence on CSR rates at day 1, 3, 7. However, the patients with GERD C and D had significantly higher CSR rate than patients with GERD A and B at day 1 and 7 (CSR rate at day 1: 50.00% vs. 15.63, p = .040; day 3: 60.00% vs. 25.00%, p = .059; day 7: 90.00% vs. 34.38%, p = .003). In multivariate regression analysis, the patients with GERD C and D still had significantly higher CSR rate than patients with GERD A and B at day 7 (Odds ratio: 28.27, 95% CI: 2.10–380.03, p = .012). The CSR rates between lansoprazole group and rabeprazole group at day 1, 3, 7 were not significantly different, so the difference of PPIs did not play the role on the initial clinical response within 1 week for the erosive GERD patients. However, the patients with more severe erosive GERD on endoscopy had higher CSR rate at day 7.

Cytokine-determined mechanisms of the pathomorphological realization of gastroesophageal reflux disease against the background of autoimmune thyroiditis in young persons

The aim: to study the features of proinflammatory cytokine status and pathomorphological realization of gastroesophageal reflux disease (GERD) against the background of autoimmune thyroiditis (AIT) in young people.
 Materials and methods. Examinations involved 120 patients with GERD and AIT and 45 people with isolated GERD. The control group consisted of 20 volunteers matched by age, gender, and social status. All patients underwent esophagogastroduodenoscopy, histological study, comparative morphometry of the esophageal mucosa, and determination of proinflammatory cytokines’ levels: interleukin‑1β (IL‑1β), IL‑18, tumor necrosis factor‑α (TNF‑α).
 Results. The frequency of erosive GERD in the examined groups of patients did not statistically differ. At the same time, analysis of the structure of erosive GERD forms revealed a significant redistribution of esophagitis grades towards its enhancement in patients with comorbid pathology. The histological study showed that in patients with nonerosive GERD and AIT all the studied morphometric parameters had significantly deeper changes and exceeded similar indicators of the group with isolated GERD: epithelium total thickness 319.3±9.1 µm against 286.1±8.2 µm (p <0.01), epithelium basal layer thickness 79.6±3.2 µm versus 49.7±2.1 µm (p <0.01), connective tissue papillae height 224.8±7.3 µm against 172.7±4.6 µm (p <0.01), intercellular space 1.55±0.11 µm versus 1.12±0.09 µm (p <0.01). The presence of concomitant AIT was associated with a significant redistribution towards increased degrees of hyperplasia of the basal layer of the epithelium, elongation of the papillae, and leukocyte infiltration. The comorbidity of GERD and AIT in young people was associated with significant increase in the blood serum levels of proinflammatory cytokines in compared to isolated GERD: IL‑1β — 29.6 pg/ml versus 17.7 pg/ml (p <0.01), IL‑18—1763.4 pg/ml versus 614.6 pg/ml (p <0.01), TNF‑α — 7.6 pg/ml versus 5.2 pg/ml (p <0.01). Correlation analysis of the cytokine content and expressivity of certain morphometric parameters of the esophageal mucosa revealed the direct correlations.
 Conclusions. GERD and euthyroid AIT comorbidity in the student population is accompanied by significant redistribution of esophagitis grades towards its aggravation. The presence of concomitant AIT in patients with non‑erosive GERD leads to the significant intensification of the degree of epithelium basal layer hyperplasia, connective tissue papillae elongation, and polymorphic cellular inflammatory infiltration in comparison with isolated GERD, while these deviations demonstrate direct correlations with the levels of IL‑1β, IL‑18, and TNF‑α.

Top 4 Research Studies of the month for Italian Primary Care Physicians: December 2023.

This monthly article provides a collection of summaries of the most relevant studies identified as POEMs (patient-oriented evidence that matters) for Italian primary care physicians. 1) According to a high-quality network meta-analysis, oral isotretinoin is the most effective therapy for decreasing the number of inflammatory and non-inflammatory skin lesions in patients with acne vulgaris. 2) Non-steroidal anti-inflammatory drug (Nsaid) use is associated with a small increase (0.004%) in the risk of venous thromboembolism. Combining Nsaid use with a medium-risk hormonal contraceptive increases the risk to 0.011%; the addition of a high-risk hormonal contraceptive increases the risk to 0.023%. 3) For adults who wish to quit smoking, nicotine delivery via e-cigarettes, plus counseling, may be more effective than other means of nicotine replacement, or counseling alone for long-term smoking cessation. 4) We can reassure our patients that nonerosive gastroesophageal reflux disease (Gerd) does not increase the likelihood of esophageal cancer. Erosive Gerd, however, is associated with a doubled - but still low - risk of developing cancer, with the likelihood increasing over time.

INDEX ASSESSMENT OF THE CONDITION OF PERIODONTAL TISSUES IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE

Introduction. Significant prevalence of periodontal diseases, tendency to progress with the subsequent loss of teeth, onset at a young age, decrease in the quality of life of patients and significant financial costs determine the relevance of this medical and social problem. The problem of gastroesophageal reflux disease (GERD) is being increasingly paid attention by researchers and doctors due to the high prevalence and variety of its clinical manifestations. One of the atypical (extraordinary) syndromes of gastroesophageal reflux disease is dental. The purpose of the research was to assess the condition of periodontal tissues in patients with gastroesophageal reflux disease. Materials and methods. For the study, 65 patients with GERD were selected who had been hospitalized to the gastroenterology department of Ternopil City Hospital No. 2. In total, the sample included 34 (52.31 %) men and 31 (47.69 %) women. To identify inflammatory changes in the gum mucosa, the papillary-marginal-alveolar index (PMA) and the complex periodontal index (CPI) according to P.O. Leus (1989) were used. Statistical processing of the data obtained during the study was carried out using the licensed Microsoft Excel 2016 and Statsoft Statistica 12 statistical analysis packages. Results. As a result of our study, we found that only 18.5 % of patients suffering from GERD had clinically healthy gums. 9.2 % of patients showed signs of mild gingivitis (PMA index values were within 20 %). According to the RMA index, 33.8 % of patients in the main group were diagnosed with moderate gingivitis (values ranged from 25–50 %). In 38.5 %, manifestations of severe gingivitis were visualized (the PMA index value was more than 51 %). We have found that in patients with GERD, the manifestations of inflammatory phenomena in periodontal tissues increase with age and their severity increases. According to the data obtained when determining the CPI index, 11.2 % of patients with erosive lesions of the esophagus were diagnosed with moderate periodontal tissue damage (CPI value was (2.9 ± 0.1)). In 44.4 % of patients with the erosive form of GERD, mild periodontal tissue damage was visualized (CPI = (1.6 ± 0.1)). All patients with periodontitis secondary to erosive GERD were elderly (45–59 years, according to WHO). Only 44.4 % of patients with the erosive form of GERD and 100.0 % of patients with non-erosive GERD had no inflammation of periodontal tissue (the average CPI value did not exceed 1.0). Conclusions. Based on the studies described above, we can come to the conclusion that inflammatory processes in the tissues of the periodontal complex and oral mucosa in patients suffering from gastroesophageal reflux disease are interconnected processes that aggravate each other.

Lansoprazole plus levosulpiride versus esomeprazole in participants with gastroesophageal reflux disease and erosive esophagitis: a double blinded randomized control trial.

The aim was to compare the efficacy and safety of lansoprazole plus levosulpiride over esomeprazole. This randomized control trial recruited 1000 participants having symptomatic gastroesophageal reflux disease (GERD) and erosive esophagitis and they were blindly randomized into two groups in a 1:1 ratio with appropriate concealment. Group 1 was given lansoprazole plus levosulpiride combination twice daily whereas group 2 was prescribed only esomeprazole twice daily. The primary efficacy endpoint was the healing of erosive esophagitis and GERD at week 49. Secondary assessments included improvement in quality of life. Participants' quality of life was assessed before starting the treatment and post-treatment using a short-form health survey questionnaire (SF-36). The lansoprazole plus levosulpiride group had significantly lower rates of positive postintervention GERD and erosive esophagitis status, and higher rates of sustained resolution of heartburn compared to the esomeprazole alone group. However, the lansoprazole plus levosulpiride group also had a higher risk of nausea. Lansoprazole plus levosulpiride is a more effective and safe treatment for GERD than esomeprazole alone. Participants in the lansoprazole plus levosulpiride group showed a significantly higher rate of sustained resolution of GERD, lower rates of postintervention GERD and erosive esophagitis status, and a higher incidence of nausea compared to the esomeprazole alone group. Although quality of life worsened in both groups, adverse effects did not significantly differ. These findings strongly support the use of lansoprazole plus levosulpiride as a preferred treatment option for GERD and erosive esophagitis, which could have significant clinical implications for managing this common condition.

Non-erosive gastro-oesophageal reflux disease and incidence of oesophageal adenocarcinoma in three Nordic countries: population based cohort study

ObjectiveTo assess the incidence rate of oesophageal adenocarcinoma among patients with non-erosive gastro-oesophageal reflux disease compared with the general population.DesignPopulation based cohort study.SettingAll patients in hospital and specialised outpatient healthcare...

Overlap of some forms of functional pathology of organs of digestion in children

Introduction. In the adult population, a high prevalence of the gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) can vary from 3 to 79%. As for children, there are a few works on the overlap between functional dyspepsia and IBS, GERD and functional constipation. 
 Aim. To determine the prevalence of overlap of the GERD syndrome with irritable bowel syndrome and functional dyspepsia in school-age children. 
 Materials and methods. The study included ninety eight cases including 71 boy and 27 girls, aged of 7 to 17 years (mean age 11.4 ± 2.1 years) suffered from erosive GERD. The comparison group consisted of 30 patients (11 boys and 19 girls), of mean age of 12.7 ± 1.8 years without erosive GERD). The criterion for inclusion in the main group was the presence of erosive changes in the esophagus according to fibrogastroduodenoscopy, in the comparison group the — manifestation of heartburn, with occurrence, at least twice a week over the past three months and the absence of erosive changes in the esophagus according to fibrogastroduodenoscopy. The exclusion criterion was the presence of organic pathology with sides of the upper (peptic ulcer, etc.) and lower parts of the digestive tract (ulcerative colitis, Crohn’s disease, etc.) 
 Results. Every fourth GERD patient (25.8%) has an overlap with functional bowel diseases, while GERD is more often combined with IBS with diarrhea (15.6%) than IBS with constipation/functional constipation (10.2%). Overlap of IBS with postprandial distress syndrome is much less common — only in 7.0% of children. 
 Conclusion. School-age GERD children are characterized by frequent overlap with functional bowel diseases, the frequency of which reaches 25.8%. The combination of all three diseases (IBS, GERD and postprandial distress syndrome) was observed in 2.3% of cases. These patterns are typical for patients with both erosive and non-erosive forms of GERD.

Examination on Factors Affecting Symptom Change after Drug Withdrawal in Patients with Mild Erosive Gastroesophageal Reflux Disease Undergoing Symptom-Controlled Maintenance Therapy with Acid-Secretion Inhibition Drugs

Introduction: In patients with gastroesophageal reflux disease (GERD) on maintenance therapy with acid-suppressive drugs, it is not clear what background factors allow patients to discontinue the drugs. The aims of this study were to examine the relationship of the changes in the frequency and severity of gastrointestinal symptoms after discontinuation of acid-secretion inhibitors for erosive GERD (eGERD) with possible patient background factors and to identify factors that influence these changes. Methods: This is a multicenter, open-label, interventional, exploratory study. eGERD patients with mild mucosal injury whose symptoms were under control and who were on maintenance therapy with acid-suppressive drugs were withdrawn from the drug treatment for 4 weeks. We examined the relationship of patient backgrounds (sex, age, body mass index, alcohol consumption, smoking habits), esophageal hiatal hernia, Helicobacter pylori infection, pepsinogen I and II concentrations and I/II ratios, blood gastrin levels before and after drug discontinuation with total score change in Frequency Scale for the Symptoms of GERD (FSSG). Results: Of the 92 patients whose symptoms could be assessed before and after drug withdrawal, 66 patients (71.7% of the total) had FSSG <8 and no symptom relapse after the withdrawal. Furthermore, patient background factors that may be related to symptom relapse/non-relapse were examined, but no related factors were detected. The maintenance medications before discontinuation in the above 92 patients were a proton pump inhibitor (PPI) and vonoprazan (VPZ, a potassium ion competitive acid blocker). Since PPI and VPZ were administered to about the same number of patients, though incidentally, we additionally examined the relationship between patient background factors and symptom relapse/non-relapse by treatment group. As a result, no relevant background factors were detected in both groups. Although there were no significant differences between the two groups, the severity and frequency of symptom recurrence in the VPZ group tended to be higher than in the PPI group. Conclusions: Consideration of background factors is unlikely to be required in the discontinuation of maintenance therapy for eGERD. There was no significant difference in the extent of disease or frequency of recurrence during the discontinuation period, regardless of whether the drug before discontinuation was a PPI or VPZ.

Efficacy of esophagus protection in complex treatment of erosive gastroesophageal reflux disease: a systematic review and meta-analysis of controlled trials

To review the data about the efficacy of esophagus protective agent based on the fixed combination of hyaluronic acid and chondroitin sulfate dissolved in the bioadhesive carrier (poloxamer 407) in the complex therapy of patients with erosive gastroesophageal reflux disease (GERD). A search in MEDLINE/PubMed, EMBASE, Cochrane, and Russian Science Citation Index of Scientific Electronic Library electronic databases was performed. Relevant original controlled studies of a fixed combination of hyaluronic acid and chondroitin sulfate as an esophagus protective agent in a population of patients with erosive GERD were included. The final analysis included three studies that enrolled 181 patients with erosive GERD. All the studies had a uniform design with the assessment of the primary endpoints (complete epithelialization of esophageal erosions and complete resolution of heartburn) 28 days after the start of therapy. Meta-analysis of the three controlled trials has demonstrated that combination therapy with proton pump inhibitors (PPIs) and esophagus protective agents is significantly more effective than PPI monotherapy for complete epithelialization of esophageal erosions at 28 days of treatment (relative risk 1.267, 95% confidence interval 1.082-1.483, p=0.003; I2=21.19%), but did not differ for complete resolution of heartburn on the day 28 of treatment (relative risk 1.638, 95% confidence interval 0.660-4.067, p=0.287; I2=92.59%). Combined therapy with PPI and Alfasoxx is significantly more effective than PPI monotherapy for the epithelialization of esophageal erosions in patients with erosive GERD.

Esophagoprotective therapy in patients with erosive esophagitis

To evaluate the advantages of using combined therapy of proton-pump inhibitors (PPIs) and esophagoprotector in comparison with basic therapy of PPIs for 4 weeks based on the results of changes in the endoscopic picture.To compare the effectiveness of 4-week PPI therapy and 4-week combination therapy with PPI and esophagoprotector Alfasoxx (sodium hyaluronate, chondroitin sulfate, poloxomer 407) in patients with erosive esophagitis (EE) of any degree according to the Los Angeles Endoscopic Classification. 81 patients with EE AC according to the Los Angeles endoscopic classification (1994) was enrolled in the study on the basis of the clinic of Peter the Great, Mechnikov North-Western State Medical University. By computer randomization, patients were divided into the control group 40 patients (pantoprazole 40 mg 1 time per day) and the intervention group 41 patients (pantoprazole 40 mg 1 time per day + Alfasoxx 1 sachet qid). The therapy was carried out for 4 weeks. In all patients before and after therapy, the frequency and severity of the main symptoms of gastroesophageal reflux disease (GERD) were assessed, esophagogastroduodenoscopy was performed. The advantage of combination therapy over standard PPI monotherapy in patients with EE was revealed. According to the results of the control endoscopy, healing of erosions of the esophageal mucosa was observed in 39 out of 41 (95.1%) patients in the intervention group and 32 out of 39 (82.1%) in the control group. The proportion of patients who showed an improvement in the endoscopic picture before and after treatment for 4 weeks by at least 1 level according to the Los Angeles classification was significantly higher in the comparison group 41 patients (100%), while in the control group 33 patients (85%); p0.009. After treatment, the combination therapy group had a lower incidence (p0.01) and severity of heartburn (p0.01). The same results are demonstrated by combination therapy regarding the symptom belching of air: in the study group after treatment, this symptom occurred less frequently (p=0.014), its severity was significantly less than in the control group (p0.01). There was a statistically significant decrease in the need for on-demand antacid therapy in the study group. In this study involving 81 patients with erosive GERD, the benefits of combination therapy were demonstrated. The addition of Alfasoxx medical device to PPI therapy increases the clinical and endoscopic efficacy of therapy. This positive effect is associated with the esophagoprotective properties of the drug, based on unique pharmacodynamic characteristics. Combination therapy for GERD is preferred in patients with EE. Studies have shown the expediency of using Alfasoxx in case of insufficient effectiveness of classical acid-suppressive therapy for GERD.

The association between helicobacter pylori infection and erosive gastroesophageal reflux disease; a cross-sectional study

BackgroundThe association between H. pylori (Helicobacter pylori) infection and gastroesophageal reflux disease (GERD) is a complex and confusing subject. The aim of this study was to evaluate the association between helicobacter pylori infection and erosive gastroesophageal reflux disease.MethodIn a cross-sectional study, all patients referred for endoscopy due to dyspepsia were enrolled. The diagnosis of erosive GERD was made by endoscopy. Patients with normal esophagus were selected as comparison group. Random gastric biopsies were taken from all participants to diagnose H. pylori infection.ResultIn total, 1916 patients were included in this study, of whom 45.6% had GERD. The mean age (SD) was 42.95 (16.32). Overall, 1442 (75.3%) patients were positive for H. pylori infection. The frequency of H. pylori infection in mild GERD patients was higher than the severe GERD, but this difference was not significant (P = 0.214). Except for sociodemographic status (P < 0.001), other variables including gender, age, ethnicity, body mass index (BMI), smoking, and presence of hiatus hernia in patients had no significant association with the frequency of H. pylori infection. According to Robust Poisson regression models analysis, the association of H. pylori (PR 1.026; 95% CI 0.990–1.064; P = 0.158) and sociodemographic status were not significantly different between the two groups. But smoking, increased BMI, older age, presence of hiatus hernia, and peptic ulcer diseases were significantly associated with GERD compared with the non-GERD group.ConclusionIn our results, there was no association between H. pylori infection and erosive GERD. Further studies are recommended.

A study for every second day administration of vonoprazan for maintenance treatment of erosive GERD (ESD von GERD): a multicenter randomized cross-over study.

Vonoprazan is a potassium competitive acid blocker used to treat erosive gastroesophageal reflux disease (GERD) with stronger, more stable acid-suppressing effects than proton pump inhibitors (PPIs). This study clarified the usefulness and superiority of vonoprazan administered every second day over PPIs in the maintenance therapy of erosive GERD. This is a prospective, multicenter, open-label, two-period randomized cross-over study. Patients were randomized to either the vonoprazan-lansoprazole (VP-LZ) group, who were given vonoprazan 10mg for the first 4weeks and then lansoprazole 15mg for the next 4weeks both administered once every second day, or the lansoprazole-vonoprazan (LZ-VP) group, who were treated in reverse. GERD symptoms were compared using symptom diaries, the frequency scale for symptoms of GERD (FSSG), and the gastrointestinal symptom rating scale (GSRS). We enrolled 122 patients between December 2017 and May 2019. Symptoms were well controlled in vonoprazan administration and lansoprazole administration were 93.6% and 82.1%, respectively, with a significant difference on McNemar's test (P = 0.003). During the second 4weeks, 94.4% and 76.7% of patients in the VP-LZ and LZ-VP groups, respectively, were well controlled following for ≥ 6 consecutive days a week (P = 0.009). During the first 4weeks, 96.7% and 80.0% of patients were well controlled with < 1 weekly in the VP-LZ and LZ-VP groups, respectively, during the first 4weeks (P = 0.007). GERD symptoms, assessed via FSSG and GSRS, significantly decreased with vonoprazan administration once every second day. Vonoprazan administered once every second day could be an effective alternative to PPIs in the maintenance treatment of erosive GERD (UMIN000030393).

Erosive Gastroesophageal reflux disease – are we missing pulmonary symptoms?

Background: Gastroesophageal reflux disease (GERD) is a common condition that affects about 20- 30% of the adult population, presenting with a broad spectrum of symptoms and varying degrees of severity and frequency. Extra esophageal manifestations like respiratory symptoms are being increasingly recognized. There are only very few studies on the prevalence of pulmonary symptoms in patients with erosive gastroesophageal reflux disease. Aim: The objective of the study was to determine the frequency of pulmonary symptoms in patients with erosive gastroesophageal reflux disease, Materials and Methods: This was a cross-sectional study done on 100 patients diagnosed based on upper gastrointestinal endoscopy findings. Patients were first interviewed about GERD symptoms using the GERD Health-Related Quality of Life questionnaire. Then the respiratory symptoms are assessed. Demographic details are recorded in a proforma. Pulmonary function tests were done on all the patients. Upper GI endoscopic findings are graded according to Los Angeles (LA) grading from A to D Results: The prevalence of pulmonary symptoms was 60%. The most prevalent symptom was a cough, then followed by dyspnoea on exertion, chest pain, wheezing, and snoring. There was a significant association found between LA grading and pulmonary symptoms like wheezing, cough, chest pain, and hoarseness of voice. No significant association was found between GERD duration and pulmonary symptoms. There was a statistically significant association found between LA grading and pulmonary function test. No association was found between quality of life scoring and pulmonary symptoms. Conclusion: There was a high prevalence of pulmonary symptoms in patients with erosive gastroesophageal reflux disease. Erosive GERD can affect pulmonary function according to severity. There was no association between prolonged GERD and pulmonary symptoms.

PATHOMORPHOLOGICAL FEATURES OF GASTROESOPHAGEAL REFLUX DISEASE REALIZATION IN YOUNG PEOPLE WITH AUTOIMMUNE THYROIDITIS

The aim: To evaluate the pathomorphological features of the esophageal mucous membrane in young people with GERD and autoimmune thyroiditis. Materials and methods: 120 patients with GERD and AIT and 45 people with isolated GERD matched for age, gender and social status were examined. Esophagogastroduodenoscopy, histological study and comparative morphometry of the esophageal mucosa were performed. Results: The frequency of erosive GERD in the examined groups of patients did not statistically differ. At the same time, integral analysis of the structure of erosive forms of GERD revealed statistically significant redistribution of grades of esophagitis towards its enhancement in patients with comorbid pathology. The histological study showed that in patients with GERD and AIT all the morphometric parameters studied had a significantly more severe course and exceeded similar indicators of the group with isolated GERD: epithelium total thickness, epithelium basal layer thickness, connective tissue papillae height, intercellular space. The analysis of morphological changes frequency showed that epithelium basal layer hyperplasia, dystrophic changes and epithelial edema, elongation of papillae and dilation of intercellular space were significantly more frequent in the group with comorbid pathology. Conclusions: GERD and euthyroid AIT comorbidity in the student population is accompanied by a statistically significant redistribution of esophagitis grades towards its aggravation. The presence of concomitant euthyroid AIT in patients with non-erosive GERD leads to statistically more pronounced disorganization of esophageal mucosal epithelium.

GASTROESOPHAGEAL REFLUX DISEASE: A PRACTICAL APPROACH.

Gastroesophageal reflux disease (GERD) presents typical manifestations such as heartburn and/or regurgitation as well as atypical manifestations such as throat symptoms, laryngitis, hoarseness, chronic cough, asthma, and sleep alterations. There are two phenotypes of the disease: erosive GERD, when erosions are identified by upper digestive endoscopy, and non-erosive GERD, when the esophageal mucosa presents a normal endoscopic aspect. Relevant clinical findings are usually absent in the physical examination, but it should be highlighted that obesity is an important aggravating factor of reflux. The treatment is established based on clinical findings and, according to the clinical situation, on complementary exams such as upper digestive endoscopy. In dubious cases where a precise diagnosis is required, the indicated test is esophageal pHmetry or impedance-pHmetry. Clinical treatment is divided into behavioral/dietary measures and pharmacological measures. Most patients benefit from clinical treatment, but surgical treatment may be indicated in the presence of a larger hiatal hernia and complications of the disease.

Gastroesophageal reflux disease and autoimmune thyroiditis: features of pathomorphological manifestation in young people

The aim of the work. To study the effect of concomitant autoimmune thyroiditis (AIT) on the pathomorphological features of lesions of the esophageal mucosa in young patients with gastroesophageal reflux disease (GERD).&#x0D; Material and research methods. The study included 165 individuals. The contingent of the surveyed was students of Kharkov higher educational institutions. The main group consisted of 120 patients with a combined course of GERD and AIT, the comparison group included 65 individuals with an isolated GERD. The morphological form of the GERD was revealed during esophagogastroduodenoscopy (“Fuginon” system). A histomorphological study of the obtained biopsy material from the mucous membrane of the esophagus was carried out. Samples were studied on an Olympus BX-41 microscope. Morphometric study of the esophageal mucosa was performed using the Olympus DP-Soft.&#x0D; Research results. Histological examination of biopsy specimens revealed that the main pathomorphological signs of GERD in both groups were hyperplasia of the basal zone, lengthening of epithelial papillae, leukocyte infiltration, intercellular edema, expansion of the intercellular space, dystrophic changes, submucous fibrosis, the presence of severe inflammatory infiltration in the submucosal layer. Presence of concomitant AIT was associated with a statistically higher frequency of occurrence of certain signs: hyperplasia of the basal layer of the epithelium, elongation of the papillae, epithelial edema, expansion of the intercellular space, dystrophic changes in the epithelium (p&lt;0.05).&#x0D; Conclusions. The presence of concomitant AIT in young patients with GERD does not affect the incidence of erosive GERD, but is associated with a significant increase in the severity of erosive esophagitis. The comorbid course of GERD and AIT in the student population is accompanied by a significant increase in the incidence and statistically significant intensification of the severity of hyperplasia of the basal layer of the epithelium, elongation of connective tissue papillae and leukocyte infiltration compared with isolated GERD

Factors affecting the treatment outcomes of laparoscopic fundoplication for erosive reflux esophagitis: findings of esophageal pathological function tests.

To identify the factors that affect laparoscopic fundoplication (LF) treatment efficacy in patients with erosive gastroesophageal reflux disease (e-GERD) esophagitis, based on the findings of multichannel intraluminal impedance pH (MII-pH) and high-resolution manometry (HRM). The subjects were 102 patients with e-GERD diagnosed by endoscopy, who underwent LF as the initial surgery. To analyze the findings of MII-pH and HRM, the patients were divided into two groups: a cured group (CR), comprised of patients whose esophagitis was cured postoperatively; and a recurrence group (RE), comprised of patients who suffered recurrent esophagitis. There were 96 patients in the CR group and 6 in the RE group. MII-pH indicated that the acid reflux time, the longest reflux time, and the number of refluxes longer than 5min, were significantly higher in the RE group than in the CR group (p = 0.0028, p = 0.0008, p = 0.012, respectively). The HRM indicated that only the distal contractile integral (DCI) was significantly lower in the RE group (p = 0.0109). The results of this study indicate that esophageal clearance may affect the treatment outcome of LF. Based on the findings of MII-pH, the longest reflux time and the number of refluxes longer than 5min were important factors influencing the therapeutic effect, whereas based on the HRM, the DCI value was most important.

Эффективность комбинированной терапии больных эрозивной гастроэзофагеальной рефлюксной болезнью

Aim: to evaluate the efficacy and safety of combined therapy with a proton pump inhibitor (PPI) and an esophagoprotector to relieve the symptoms of reflux esophagitis, improve the life quality of patients and achieve faster and complete disease remission. Patients and Methods: a randomized study included 60 patients, including 33 men (mean age 40.96±13.44 years) and 27 women (mean age 48.29±12.69 years) with a duration of gastroesophageal reflux disease (GERD) of 21.85±15.48 months and C/D stage of reflux esophagitis. Depending on the prescribed treatment, the patients were divided into 2 groups of 30 subjects. Patients of the main group received complex therapy: PPI pantoprazole 40 mg once per day and esophagoprotector based on hyaluronic acid, chondroitin sulfate and poloxamer 407. In the comparison group, only pantoprazole was prescribed at the same dosage. The duration of the treatment course in both groups was 4 weeks. Before and after treatment, the presence and severity of complaints were assessed on the Likert scale, life quality according to the SF-36 questionnaire and endoscopic examination data. Results: after the end of the therapy course, a statistically significant decrease in the severity of epigastric burning, regurgitation, substernal pain, gaseous eructation, odynophagia and dysphagia was found both in the main group (in all cases p&lt;0.05, Wilcoxon Matched Pairs Test) and the comparison group (in all cases p&lt;0,05, Wilcoxon Matched Pairs Test). The use of combination therapy made it possible to achieve a more significant improvement in the life quality of patients in all indicators versus PPI monotherapy. In addition, 3 (10%) patients of the main group achieved endoscopic remission, while there were no such patients in the comparison group. The use of esophagoprotector in addition to PPI made it possible to reach the primary and secondary endpoints significantly more commonly versus during monotherapy. Conclusion: the obtained data indicate the high efficiency and safety of PPI therapy in combination with esophagoprotector for relieving the disease symptoms and improving the life quality of patients, faster and complete remission of reflux esophagitis by additional restoration of the esophageal mucosa resistance. Esophagoprotector as a component of complex therapy together with PPI allows achieving clinical and endoscopic disease remission in patients with erosive esophagitis in shorter terms. KEYWORDS: gastroesophageal reflux disease, esophageal mucosa resistance, esophagoprotection, proton pump inhibitor, quality of life. FOR CITATION: Matoshina I.V., Livzan M.A., Fedorin M.M., Lapteva I.V. Efficacy of combined therapy in patients with erosive gastroesophageal reflux disease. Russian Medical Inquiry. 2021;5(6):366–372 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-366-372.

New technology minimally invasive for the treatment of gastro-esophageal reflux disease: LINX

: Gastroesophageal reflux disease (GERD) is a common disorder worldwide (10–30% of adults); lifestyle modifications and PPI therapy (the gold-standard medical treatment for GERD) work in many patients with GERD but in 30–40% of them symptoms persist. Anti-reflux surgery is indicated, with moderate level of evidence, in PPI-resistant GERD patients and with low level of evidence in erosive GERD patients on long term PPI treatment. LINX Reflux Management System (Torax Medical, Maple Grove, MN) is a device for magnetic sphincter augmentation (MSA) and is gaining interest as a valuable surgical alternative approach in patients with GERD, compared to laparoscopic Nissen fundoplication (LNF) which is nowadays the gold-standard surgical technique. In this brief review of current literature in order to compare LINX to the gold-standard surgical procedure for GERD, we analyzed two reviews and three meta-analyses. Each Authors confirmed the efficacy and safety of both techniques. LINX seems to have shorter operative time, shorter length of stay and fewer complications of gas and bloating, if compared to standard surgical procedure. In all analyzed studies the presence of hiatal hernia (HH) larger than 3 cm was often an exclusion criterion for LINX. No RCTs are currently available in literature in order to compare LNF vs. LINX and future researches are needed.

Expression of FFAR3 and FFAR4 Is Increased in Gastroesophageal Reflux Disease.

Background: The negative impact of a high-fat diet on the course of gastroesophageal reflux disease (GERD) has been previously reported. Free fatty acid receptors (FFARs) may be mediators of this phenomenon. The aim of this study was to characterize the role of FFARs in the course of nonerosive (NERD) and erosive (ERD) reflux disease. Methods: Collectively, 73 patients (62 with GERD and 11 healthy controls (HCs)) were recruited to the study. Esophageal biopsies were drawn from the lower third of the esophagus and kept for further experiments. Quantitative, real-time polymerase chain reaction was used to assess the expression of FFAR1, FFAR2, FFAR3, and FFAR4 in biopsies. Histological evaluation of dilated intracellular spaces (DISs) was also performed. Results: FFAR3 exhibited the highest expression, and FFAR4 exhibited the lowest expression in all esophageal samples. Higher relative expression of FFAR1 and FFAR2 and significantly higher expression of FFAR3 (p = 0.04) was noted in patients with GERD compared to respective HCs. Patients with nonerosive GERD (NERD) presented higher expression of all FFARs compared to patients with erosive GERD (ERD) and respective HCs. Interestingly, in patients with ERD, the expression of FFAR3 was lower than in HCs. Significant, weak, positive correlation was found for FFAR3 and FFAR4 expression and DIS scores (r = 0.36, p < 0.05 for FFAR 3, and r = 0.39, p < 0.05 for FFAR4). Conclusions: In this study, we show that FFARs may play a role in GERD pathogenesis, particularly in the NERD type. It may be assumed that FFARs, in particular FFAR3 and FFAR4, may have diagnostic and therapeutic potential in GERD.