Esophageal Reflux Disease Research Articles

The Role of Diet and Lifestyle Modifications in the Management of Esophageal Reflux Disease in local population

Background: Gastroesophageal reflux disease (GERD) is a very common medical complication connected with regurgitation of the gastric contents into the esophagus which caused heartburn and esophageal irritation. Objectives: The objective of this research was to assess practicality of diet and lifestyle changes in the management of GERD in local population. Pharmacotherapy remains the mainstay of management of GERD; however, diet and lifestyle changes have emerged as popular non-pharmacological interventions. Methodology: An observational study was conducted on 200 patients with GERD. Participants were divided into two groups: Group A received standard pharmacological treatment, while Group B received a structured diet and lifestyle modification program in addition to pharmacological management. Lifestyle changes included avoiding heartburn-triggering foods such as spicy meals, caffeine, and fatty foods, along with weight reduction, smoking cessation, and increased sleeping height. The effectiveness of the treatments was assessed based on symptom severity, endoscopic findings, and inflammatory biomarkers over 12 months. SPSS version 26.0 was used for statistical analysis, employing paired and independent t-tests for continuous variables and chi-square tests for categorical data. Results were considered significant at p ≤ 0.05. Results: Group B showed a significant reduction in symptom severity (35%) compared to Group A (20%) (p < 0.001). Endoscopy revealed better healing in Group B (70% vs. 50%, p = 0.02). Weight loss and smoking cessation positively influenced outcomes. Conclusion: Diet and lifestyle modifications, combined with medical management, positively impact GERD outcomes in the local population.

Dysfunction of the autonomic nervous system in gastro-esophageal reflux disease: Consequences for the cardiovascular system

ObjectiveThe pathophysiology of gastro esophageal reflux disease (GERD) implicates autonomic dysregulation of the lower esophageal sphincter tone. Our goal is to investigate whether this dysregulation of the autonomic nervous system (ANS) function observed in isolated GERD cases can affect other systems, such as cardiovascular regulation.Methods: Twenty-five participants were included in the study, 11 patients with isolated GERD and 14 controls. All patients and 7 controls responded to a COMposite Autonomic Symptoms Score 31 (COMPASS 31) questionnaire and underwent functional explorations including EMLA test, sympathetic skin response (SSR), 24-hour heart rate recording and ambulatory blood pressure measurement (ABPM). Seven additional controls underwent a 24-hour heart rate recording only. ResultsGERD patients (Age: mean 36.81±7.82; SR= 0.22) showed high clinically dysautonomic scores (COMPASS 31) (p = 0.015), increased Heart rate variability (HRV) parameters (daytime, nighttime, 24-hour SDNN (standard deviation of the RR interval (NN)), respectively p = 0.003, p < 0.001, p = 0.001; daytime and nighttime very low frequencies (VLF) respectively p = 0.03 and p = 0.007), impaired nocturnal dipping of blood pressure (3/11 patients) and high positivity of EMLA test (7/11, p = 0.037). These outcomes were strongly correlated with clinical dysautonomic assessment. No difference was observed between patients and controls regarding SSR. ConclusionOur data suggests a high parasympathetic tone amongst patients with GERD and a dysregulation of parasympathetic and sympathetic balance in the cardiovascular system with an impairment of the peripheral sympathetic fibers of cutaneous microcirculation, assessed by the EMLA test. GERD may be an inaugural symptom of autonomic neuropathy. Further functional exploration of peripheral small fibers seems to be necessary.

A Miasmatic Approach to Gastro Esophageal Reflux Disease and its Homoeopathic Management

A Miasmatic Approach to Gastro Esophageal Reflux Disease and its Homoeopathic Management

Socioeconomic traits and the risk of Barrett's esophagus and gastroesophageal reflux disease: A Mendelian randomization study.

Previous observational studies have shown that the prevalence of gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE) is associated with socioeconomic status. However, due to the methodological limitations of traditional observational studies, it is challenging to definitively establish causality. To explore the causal relationship between the prevalence of these conditions and socioeconomic status using Mendelian randomization (MR). We initially screened single nucleotide polymorphisms (SNPs) to serve as proxies for eight socioeconomic status phenotypes for univariate MR analysis. The inverse variance weighted (IVW) method was used as the primary analytical method to estimate the causal relationship between the eight socioeconomic status phenotypes and the risk of GERD and BE. We then collected combinations of SNPs as composite proxies for the eight socioeconomic phenotypes to perform multivariate MR (MVMR) analyses based on the IVW MVMR model. Furthermore, a two-step MR mediation analysis was used to examine the potential mediation of the associations by body mass index, major depressive disorder (MDD), smoking, alcohol consumption, and sleep duration. The study identified three socioeconomic statuses that had a significant impact on GERD. These included household income [odds ratio (OR): 0.46; 95% confidence interval (95%CI): 0.31-0.70], education attainment (OR: 0.23; 95%CI: 0.18-0.29), and the Townsend Deprivation Index at recruitment (OR: 1.57; 95%CI: 1.04-2.37). These factors were found to independently and predominantly influence the genetic causal effect of GERD. Furthermore, the mediating effect of educational attainment on GERD was found to be mediated by MDD (proportion mediated: 10.83%). Similarly, the effect of educational attainment on BE was mediated by MDD (proportion mediated: 10.58%) and the number of cigarettes smoked per day (proportion mediated: 3.50%). Additionally, the mediating effect of household income on GERD was observed to be mediated by sleep duration (proportion mediated: 9.75%). This MR study shed light on the link between socioeconomic status and GERD or BE, providing insights for the prevention of esophageal cancer and precancerous lesions.

Evaluation of the impact of oesophageal reflux disease on muscle fatigue.

Gastroesophageal reflux disease (GERD) is a gastrointestinal tract disorder associated with regurgitation of gastric acid into the oesophagus. It can present itself as non-erosive reflux condition or erosive esophagitis. Our main objective was to evaluate the impact of oesophageal reflux disease on muscle fatigue among patients. The prospective study design was adopted using surveys performed at the South West China Medical University. All patients who were subjected to screening endoscopy at the South West China Medical University were prospectively enrolled in the study. Our study was conducted according to ethical guidelines involving animal and human subjects. Our study used Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scale (HADS), and the Multidimensional Fatigue Inventory (MFI) questionnaires to perform data collection on the levels of fatigue, depression, daytime hypersomnolence and anxiety. In the (HADS, Anxiety (β = 0.657, p < .001) and Depression (β = 2.927, p < .001) exhibited significant positive associations with the predicted fatigue. The Epworth Sleepiness Scale (ESS) showed no significant difference between individuals with and without reflux esophagitis (p = 0.787, power = 0.071). However, a significant difference was observed based on the presence of GERD symptoms (p = 0.003, power = 0.789), with higher mean scores for those with GERD symptoms (6.1±3.5) compared to those without (4.9±2.9). In MFI, significant differences were observed between the two groups for General and Physical Fatigue (p = 0.040, power = 0.823), Mental Fatigue (p = 0.002, power = 0.767), and MFI Total Score (p = 0.002, power = 0.981). In conclusion, GERD symptoms exhibited stronger associations with fatigue and daytime sleepiness than endoscopic findings, emphasizing the impact of symptomatic experiences on well-being.

Esophageal carcinoma with SMARCA4 mutation: a narrative review for this rare entity.

Esophageal carcinoma with switch/sucrose nonfermenting (SWI/SNF)-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4 (SMARCA4) mutation is a rare variant of malignant esophageal epithelial neoplasm, which is characterized by the loss of SMARCA4/BRG1 protein on immunohistochemistry or alterations in the SMARCA4 gene on sequencing. Only a few case series and case reports of esophageal carcinoma with SMARCA4 mutations have been published in the English literature; the rarity of the disease poses significant diagnostic challenges for surgical pathologists and could potentially lead to delayed or suboptimal patient care. Herein, we reviewed the available literature on esophageal carcinoma with SMARCA4 mutations to discuss its epidemiology, clinical presentation, pathological and molecular features, diagnostic challenges, treatment, and prognosis. The PubMed, Scopus, Ovid, and Google Scholar databases were extensively reviewed. The references included in the articles were cross-examined to identify any missing articles. We searched for all published literature on esophageal carcinoma with SMARCA4 mutations from inception of the databases to date. Esophageal carcinoma with SMARCA4 mutations is most common in middle-aged and older men. Barrett esophagus and gastroesophageal reflux disease (GERD) are the most associated risk factors. Dysphagia was the most common initial clinical presentation. Esophagogastroduodenoscopy (EGD) is the preferred diagnostic modality. Microscopically, the tumor cells exhibited epithelioid features mixed with variable components of rhabdoid and glandular differentiation. The tumor cells showed variable immunoreactivity for cytokeratin and sometimes weakly expressed neuroendocrine or B-lymphocyte markers (Pax5), which are potential diagnostic pitfalls. Melanoma marker tests showed negative results. The SMARCB1/INI1 protein remains intact, and a definitive diagnosis necessitates the presence of either SMARCA4/BRG1 protein loss or SMARCA4 gene mutations. Esophageal carcinoma with SMARCA4 mutations shows overly aggressive behavior and presents with advanced stages of disease; most patients succumb to the disease within 1 year of initial diagnosis. Esophageal carcinoma with SMARCA4 mutation is an overly aggressive disease, and further research on the affected molecular pathway may help improve its prognosis.

Esophageal lesions in children with symptoms of dyspepsia

Introduction. Symptoms of gastro esophageal reflux disease are noticed in 2–7% of children. Manifestations of this disease may be limited to symptoms (e.g., heartburn, regurgitation) or have more complicate complex, such as erosive esophagitis, esophageal strictures or Barrett’s esophagus.&#x0D; Study purpose. To study the prevalence of esophagitis in school-age children with symptoms of dyspepsia. &#x0D; Materials and methods. The retrospective study included 7–18 years 2935 children patients aged with symptoms of dyspepsia. The presence of endoscopic signs of distal catarrhal esophagitis and erosions (epithelialized and non-epithelialized) was assessed; in the case of non-epithelialized erosions, the stage of esophagitis according to the Los Angeles classification was taken into account (1998).&#x0D; Results. The prevalence of endoscopic signs of esophagitis among 7 to 17 years 11 months children with symptoms of dyspepsia was 1858/2935 (63.3%). Changes in the type of epithelialized erosions of the esophagus were detected in 593/2935 (20.2%), non-epithelialized erosions in 222/2935 (7.6%) children. Overall, erosive changes in the esophagus were noted in 815/2935 (27.8%) children with symptoms of dyspepsia. Erosive changes in the esophagus are more often observed in boys. The proportion of child­ren with erosive esophagitis is the same in all age groups. Among patients with non-epithelialized erosions, according to the Los Angeles classification stage A was established in 149/222 (67.1%), stage B — in 63/222 (28.4%), stage C — in 8/222 (3.5%), in 2/222 (0.9%) single ulcers of the esophagus were identified&#x0D; Conclusion. There is a high prevalence of esophagitis in school-age children with symptoms of dyspepsia, the frequency of erosive esophagitis, taking into account epithelialized and non-epithelialized erosions, was 27.8%, the frequency of non-epithelialized erosions — 7.6%.

Romheld's Gastrocardiac Syndrome, diagnosing a complex of cardiologic and gastroenterologic symptoms

&#x0D; In clinical practice among cardiac patients, symptoms of palpitations diagnosed as premature beats or episodes of atrial fibrillation (AF) are very frequently reported. One of the most common diseases in the field of gastroenterology is gastroesophageal reflux disease (GERD) . However, it may happen that the coincidence of the above-mentioned disease entities may predispose to the development of arrhythmias. &#x0D; &#x0D; &#x0D; In this article we describe the case of a 65-year-old man, without previously diagnosed diseases, in whom a clear association of arrhythmias with gastrointestinal complaints was observed. &#x0D; &#x0D; &#x0D; The presence of a burning sensation in the lower sternal region and typical symptoms resulting from esophagitis aggravated by triggers allows us to suspect esophageal reflux disease. Diagnostic tests performed for concomitant cardiac diseases did not reveal an organic cause of the arrhythmia. The recurrent course of symptoms observed in the present case and the analysis of the cause-effect course made us to diagnose gastrointestinal syndrome, also referred to as Romheld's Syndrome.&#x0D;

Quality by design approach for the formulation of bilayer tablets of domperidone and itopride in gastro esophageal reflux disease

In the current work, a bilayer tablet of itopride gastroretentive and domperidone immediate release formulation was developed showing the synergistic effect of gastric motility in gastroesophageal reflux disease, through antidopaminergic and antiacetylcholine stearic activities. A bilayer tablet of domperidone and itopride was optimized using quality by design and its product performance was analyzed. Itopride was designed to be gastroretentive and remains in the stomach for a longer period, providing sustained release. The domperidone layer was optimized by an empirical hit and trial method, while the itopride layer was optimized using the Box Behnken experimental design. Three independent variables were considered as hydroxypropyl methyl cellulose K 100 M, xanthum gum, and Carbomer 974 with dependent variables like floating lag time, swellable index, and percentage drug release at 24 hours. Quality target product profile and critical quality attributes were studied which helps in an effective way to develop bilayer tablets. The excipients were chosen based on the time taken by medicaments to be released and the quantity was optimized according to Handbook of Pharmaceutical Excipient. From the optimization processes, DF5 and IH2 were selected as optimized composition for the formulation of domperidone and itopride layer of bilayer tablet respectively. The bilayer tablets were formulated in 16 × 8.26 mm oblong plain biconcave die and punch. The in-vitro drug release of domperidone was 99.39% in 30 minutes and itopride was 27.50%, 53.45%, and 93.65% at 4, 16, and 24 hours respectively.

Gasteric Emptying Study With Milk: Analysis in Children of Pakistan

Gastro esophageal reflux (GER) is a widespread physiological phenomenon in children. In some children GER may be described as pathological and contribute to respiratory problems such as bronchial asthma and upper respiratory tract. The main objective of this study was to evaluate the presence of Gastro esophageal reflux disease (GERD) in children. Thirty children (up to 6 months of age) suspected with GERD were included in this study. The gastric emptying (SPECT) study was conducted according to predetermine protocol. All patients underwent Tc-99m DTPA gastric imaging for 30 minutes for children. The study was analyzed qualitatively i.e. visual analysis and quantitatively i.e. time activity curve (TAC) and Reflux index percentage (RI %) analysis for the presence of GER. The detection rate of GER in our study was 33% in children. This shows poor diagnoses of physicians because most of the children suffering from vomiting problems were diagnosed GERD but actually they were suffering from asthma and tonsillitis. The diagnosis and treatment of GER is mandatory in children asthma and tonsillitis. Gastric SPECT represents a significant advance in the diagnosis and quantitation of GER. It is one of the simplest radionuclide investigations which can be conducted with least patient inconvenience at a considerable low radiation burden. It can detect GERD with great accuracy even after physiologic neutral pH meal.

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

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

OGBN P33 The Missing LINX® - Reconstituting the Hill Valve

Abstract Background Magnetic sphincter augmentation (MSA) with LINX® is an increasingly utilised procedure as an effective and safe alternative for fundoplication in the management of gastro oesophageal reflux disease (GORD). Our aim was to evaluate the post-operative LINX® endoscopic appearances in maintaining the competence of the Hills valve. Here we present a retrospective review of endoscopic assessment post insertion of LINX® Reflux Management System. Methods Patients who underwent magnetic sphincter augmentation with LINX® between December 2012 and December 2022 at a single district general hospital were recruited for a retrospective case analysis. Photographs taken at the time of endoscopy were assessed to evaluate the gastroesophageal flap valve using the Hill classification. Results Of 186 patients who underwent MSA, 40 underwent endoscopy post-operatively and of these 35 had photographs suitable for evaluation. There were various indications for endoscopy including dysphagia (13), dyspepsia (9), abdominal pain (7), laryngopharyngeal reflux (2), odynophagia (2), Barrett’s surveillance (1) and food bolus (1). Median time from LINX® to endoscopy was 2.5 years. 33 out of 35 patients (94.2%) were found to have Hills Grade I. One patient (2.8%) had Hills Grade II and one patient (2.8%) had a recurrence of their hiatus hernia, Hills Grade IV. Conclusions Endoscopy is a useful modality to assess symptomatic patients after MSA with LINX®. This study has confirmed reconstitution of the Hills valve on endoscopic assessment in 94.2% of patients. This supports LINX® as an effective and robust solution in the management of GORD.

PREVALENCE AND ASSOCIATED FACTORS OF PEPTIC ULCER DISEASE AMONG DYSPEPTIC PATIENTS AT ENDOSCOPY UNIT IN KABUL, AFGHANISTAN

Introduction: Dyspepsia is a medical term utilized to describe a cluster of symptoms related to the digestive system, particularly in the upper gastrointestinal tract. The most prevalent causes of dyspepsia encompass gastro esophageal reflux disease (GERD), peptic ulcer disease (PUD), and non-ulcer dyspepsia (NUD). A peptic ulcer is a sore or erosion that forms in the lining of the stomach, upper part of the small intestine, or lower part esophagus.&#x0D; Materials and Methods: The study incorporated 500 dyspeptic patients who underwent upper gastrointestinal endoscopic assessments. This hospital-based analytical cross-sectional study was conducted at the endoscopy unit of different hospitals, spanning from January 1, 2023, to September 30, 2023.&#x0D; Results: The findings revealed that out of 500 dyspeptic patients, 45 (9%) exhibited positive results for peptic ulcer, while 455 (91%) displayed non-peptic ulcer conditions. The correlation between dyspepsia and peptic ulcer was statistically significant (χ2= 73, P= 0.01). Gender-specific prevalence indicated that 17 (37.7%) males and 28 (62.2%) females exhibited peptic ulcers. When stratified by age, the prevalence was 20 (44.4%) for individuals aged 18-40, 10 (22.2%) for those aged 41-52, and 15 (33.3%) for those above 52 years. Notably, significant differences were observed among age groups (χ2= 85, P= 0.04). Peptic ulcer prevalence was 16 (35.55%) for urban residents and 29 (64.44%) for rural residents. In the context of smoking habits, 30 (66.6%) of smokers exhibited peptic ulcers, compared to 15 (33.3%) of non-smokers. The association between smoking and peptic ulcers was statistically significant (χ2= 101, P= 0.02). Additionally, 28 (62.2%) of individuals with H. pylori infections displayed peptic ulcers, in contrast to 17(37.7%) without the infection. The association between H. pylori infection and peptic ulcers was statistically significant (χ2= 85, P= 0.05). Regarding NSAID use, 29 (64.4%) of participants who used NSAIDs and 16 (35.5%) who did not use NSAIDs showed peptic ulcer prevalence. The highest prevalence was among individuals using NSAIDs for pain relief. The association between NSAID use and peptic ulcers was statistically significant (χ2= 100, P= 0.05).&#x0D; Discussion: These results highlight the significance of addressing these risk factors in the management and prevention of peptic ulcer disease.

A prospective study of extraesophageal reflux and potential microaspiration in patients hospitalized with COVID-19 in Jordan

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lung infection has represented a global challenge. Intriguingly, it has been shown that the alveolar lung epithelium expresses little Angiotensin Converting Enzyme receptor protein (ACE2), the entry receptor for SARS-CoV-2. Upper airway establishment of infection and translocation to the lung is well documented but other anatomical niches may be relevant to potentially serious lung infection. ACE2 is heavily expressed in the gastrointestinal tract and gastrointestinal symptoms support a clinical diagnosis of Coronavirus disease 2019 (COVID-19). This suggests a research question and the need to gather patient data exploring potential aerodigestive links in SARS-CoV-2 tranlocation and infection which may be relevant in the peripheral lung. This recognizes anatomical proximity and concepts of bi-directional movement between the Gastrointestinal and lung systems in normal physiology and disease. We have therefore explored the potential for gastro oesophageal reflux disease (GORD) micro aspiration and aeorodigestive pathophysiology in a novel prospective investigation of patients hospitalized with COVID-19.MethodsThis is a prospective descriptive cohort study of 210 patients who were hospitalized with a confirmed diagnosis of COVID-19. The cohort was divided into three groups of patients based on symptom severity and radiological results. The Reflux Symptom Index (RSI) was used to evaluate the presence and severity of GOR. An RSI greater than 13 is considered to be abnormal. Patients’ saliva samples were tested using enzyme-linked immunosorbent assay (ELISA) to determine the level of salivary pepsin among the cohort of patients.ResultsA total of 210 patients with COVID-19 were enrolled in the study with 55.2% (116/210) classified as mildly ill, 31.9% (67/210) moderately ill and 12.9% (27/210) as severely ill. 34% (72/210) of the patients had an RSI score of over 13 and a median salivary pepsin value of 54 ± 29 ng/ml which suggested an incidence of extraesophageal reflux (EOR) in around a third of patients. The presence of respiratory comorbid conditions, an RSI score of over 13 and a salivary pepsin level of > 76ng/ml increased the risk of developing a more severe COVID-19 infection.ConclusionThe study showed a high prevalence of EOR among the study cohort and provide the first prospective evidence suggesting the potential for aerodigestive pathophysiology including microaspiration in COVID-19 disease. We believe that the results of our study support the need for more extensive research.

The Effect of Adding Pyloroplasty to Nissen Fundoplication in Improving the Outcome in Patients with Delayed Gastric Emptying Associating Gastro Esophageal Reflux Disease: A Meta-Analysis

Abstract Background An important consideration for patients with GERD is the possibility of underlying gastroparesis defined as delayed gastric emptying in the absence of mechanical obstruction. The addition of a pyloroplasty to nissen fundoplication in patients with GERD is said to improve bloating symptoms and promote faster gastric emptying. Aim of the Work The aim of this meta-analysis study is to identify the effect of adding pyloroplasty to Nissen Fundoplication in improving the outcome in patients with delayed gastric emptying associating Gastro esophageal reflux disease. Patients and Methods Types of studies used Published studies about the effect of adding pyloroplasty to Nissen Fundoplication in improving the outcome in patients with delayed gastric emptying associating Gastro esophageal reflux disease (carried out in the period between 2000 – 2020). The published English-language literature was searched in the databases PUBMED (US National Library of Medicine, Bethesda, Maryland) (2000 to present), EMBASE (Reed Elsevier PLC, Amsterdam, Netherlands) (2000 to present), as well as Google Scholar and Science direct. The search terms was employed: “Pyloroplasty” and “Delayed gastric emptying” or “gastroparesis” and “Nissen’s fundoplication”. Results A total of four studies reported there was statistically significant decrease in the T1/2 postoperative (90.62 ± 15.64) than preoperative (192.42 ± 28.10) with p-value &amp;lt;0.001. The change from pre to postoperative t ½ with a total sample size of 164 patients. The overall effect estimates noted a significant reduction in the t ½ by 116.5 (95% CI 85.9 – 146.9) minutes. The pooled effect estimates showed significant heterogeneity (p = 0.016; I2 =71%). A total of four studies reported the rate of symptomatic improvement with a total sample size of 164 patients. The overall effect estimates noted a symptomatic improvement rate by 84% (95% CI 78.6 – 89.7%). The pooled effect estimates showed no significant heterogeneity (p = 0.66; I2 =0%). Conclusion Laparoscopic pyloroplasty with Nissen’s fundoplication is an effective procedure and might be considered as a first-line treatment for selected cases of gastroparesis. We report an 84% symptomatic improvement rate and 71% improvement rate for gastric emptying times measured by scintigraphy. The procedure can be performed with a minimally invasive technique with low morbidity and no mortality. The laparoscopic approach does not preclude subsequent procedures when required.

A Cross-Sectional Survey on the Dispensing Practice and its Determinants from the Retailers’ Perspective in Rural Areas of Gazipur

Being the de facto primary healthcare contacts in rural Bangladesh, retail pharmacy shops (RPSs) influence the medication usage by the people. Therefore, identifying dispensing activities of RPSs can be a key indicator of medicine use. The aim of the current study is to explore the drug dispensing practice of retail pharmacists in the rural areas of Gazipur district. A cross-sectional study was designed to find out drug dispensing practice of analgesic, antipyretic, Gastro Esophageal Reflux Disease (GERD), sedative &amp; hypnotic, ED and multivitamin drugs, assess determinants impacting the practice, and acceptance level of retailers’ suggestions. Forty seven RPSs were selected by random sampling out of 92 in rural areas of Gazipur Sadar from the list of registered allopathic RPSs by the Directorate General Drug Administration (DGDA). Dispensers were interviewed with structured validated questionnaire and data was analyzed using ‘Microsoft Office Excel 2016’. Diclofen, Napa extra, Rivotril, Seclo, Niagra and Filwel Gold were reported to be as the highest dispensed brands at that time. The lowest dispensed brands were found to be Apeclo, Zerin, Relaxen, Procap, Adegra and Biovit Gold. Among determinants impacting dispensing practice, ‘prescriber’s choice’ dominated most in Multivitamin (94%), Sedative &amp; Hypnotic (87%), and Analgesic (77%) groups. ‘Dispenser’s choice’ emerged as a primary determinant in the ED drug group (62%) which is alarming. Moreover, an unlicensed foreign brand, Senegra was found to be dispensed in many drugstores. Buyer’s choice (self-medication) was more remarkable in Antipyretic (38%) and GERD drugs (21%). Although only a few of the reported drugs were over-the-counter (OTC), almost all drugs were being dispensed without prescriptions. As per retailers’ perception, buyers did not seem to be much affected by medicine price (72%) indicating that studied drugs’ price is affordable. A total of 66% dispensers were found to suggest an alternative brand in the absence of a sought brand (brand-substitution) implying to the fact that untrained dispensers may potentially influence drug choice and 77% claimed that buyers usually accept their suggestions which is of no surprise considering the reality of our medication buy-sale practice. Retailers’ perspective might be a great tool to understand drug usage scenario on the ground. Effective regulatory and social initiatives can be devised accordingly to strengthen the rational dispensing and use of medicine. Dhaka Univ. J. Pharm. Sci. 22(1): 55-63, 2023 (June)

Corrosion mitigation on orthodontic wire made of SS 18/8 alloy using esomeprazole tablet (Esiloc-40 mg) in artificial saliva

The corrosion inhibition of orthodontic wire made of SS 18/8 alloy in artificial saliva, with and without the presence of tablet esomeprazole − 40 mg has been investigated by electrochemical analysis. Polarisation study indicates that in the presence of the mentioned tablet, polarisation resistance (Rp) value increases and corrosion current (Icorr) decreases. That is, the corrosion resistance of SS 18/8 alloy in artificial saliva increases. AC impedance spectroscopy reveals that charge transfer resistance value (Rct) value increases and double layer capacitance value (Cdl) decreases. The open circuit potential (OCP) values for the inhibited system are more negative than that of the uninhibited blank system. The vibration peaks obtained from the FTIR spectra indicates the presence of functional group in esomeprazole pill and these characteristic peaks are slightly shifted in the analyzed scratched film from the surface of the orthodontic wire after immersion. AFM micrograph image of the polished specimen sample immersed in artificial saliva (AS) with esomeprazole tablet solution shows lesser degree of surface deterioration than those for SS 18/8 specimen immersed only in artificial saliva. From the present work, it is reported that people clipped with orthodontic wire made of SS 18/8 alloy need not worry about orthodontic corrosion for taking esomeprazole tablet for the treatment of gastro esophageal reflux disease and other medicinal purpose.

Role of Ayurveda Modalities in the Management of Urdhwag Amlapitta (Gastro Esophageal Reflux Disease): A Critical Review

For long time various types of communicable diseases were biggest killer diseases globally. But now a days trend become changing towards increased prevalence of chronic diseases due to changing their diet pattern, lifestyle and behavioral pattern. In these chronic diseases Gastro Esophageal Reflux Disease (GERD) is the Gastro-intestinal disorder defined by recurrent troublesome heart-burn and regurgitation. Patient with GERD can be medicated empirically with Antacids and proton pump Inhibitor’s but in most of the cases patient do not respond to such treatment absolutely and several adverse effects arises after prolonged use. Ayurvedic texts classifies the broad spectrum of Amlapitta into Urdhwag and Adhog Amlapitta in which GERD shows similarity with Urdhwag Amlapitta on the basis of causes and symptoms. Aim and Objectives: The current review article illustrates the mode of action of Ayurvedic procedures (Shodhana Chikitsa) and formulations (Shamana Chikitsa) which is safe and effective for GERD (Urdhwag Amlapitta) Material and Methods: Ayurvedic texts referred are Charak Samhita, Yog Ratnakar, Bhaisjya ratnavali and contemporary modern texts and published manuscripts. Discussion: Detailed protocol treatment for Amlapitta in the form of Shodhana and Shamana Chikitsa discussed in terms of drugs and diet, should be applied considering the association of Dosha. Conclusion: This review article will helpful to Ayurveda scholars, academicians, clinicians and researchers for the future prospect to plan the research work on same topics.

EFFECTIVENESS OF VIDEO ASSISTED TEACHING MODULE (VATM) ON KNOWLEDGE OF OLDER ADULTS REGARDING PREVENTION OF SELECTED GASTROINTESTINAL DISORDERS OF GERIATRICS IN A SELECTED OLD AGE HOME AT TIRUNELVELI

Ageing is accompanied by several changes in the gastrointestinal (GI) system and older adults frequently present with GI problems. Ageing is a time of numerous illnesses and common disability. The most common health problems seen in all the elderly people are gastrointestinal disorders such as Gastro esophageal reflux disease, constipation, dyspepsia and peptic ulcer. A quantitative approach with pre experimental - one group pre and post test research design was used to conduct the study.

Homoeopathy in Treatment of Gastro Intestinal Disorders - A Retrospective Study

Introduction: Acid peptic disorder (APD) is a condition which includes peptic ulcer and gastro esophageal reflux disease (GERD). The highest prevalence rate of gastric disorders had been found out between ages 45-50. Dyspepsia is a term used for reduced digestion or indigestion. GERD is referred to as condition where there is regurgitation of stomach contents to the esophagus. Around 58.7% of peoples are having acid regurgitation or heart burn yearly once and 19.8% weekly once. Worldwide functional gastrointestinal disorder are commonest now a days, Irritable Bowel Syndrome (IBS) is also one among them having frequent pain abdomen and altered bowel habits without any structural gut abnormalities. Homoeopathy is a system which is based on individualization, and has principles of “Like cures like” and law of nature. &#x0D; Materials and methods: A retrospective study had been conducted with those patients who had attended the gastroenterology OPD of NHRIMH, Kottayam, Kerala, for a period of 1 year (from January 2022 to December 2022). Data had been collected from the case records and it had been found that around 899 patients had visited for the symptoms like nausea, vomiting, abdominal pain, altered bowel movements (diarrhea and constipation), bleeding per rectum, dysuria and hesitancy in urination,etc for the past 1 year. Aim of the study is to find out the most frequent age group, diseases affected and to know the frequently indicated remedies in treating gastroenterology disorders. &#x0D; Results: 899 patients visited in the defined period with a highest number of patients (212) were from &#x0D; the age group of 51-60, female patients were more than male patients, 758 old patients and 141 new patients. 214 pateints had diagnosed as gastritis which is the highest frequency noted. The most frequently indicated remedies were Nuxvomica in 161 patients and Suphur in 118 patients. &#x0D; Conclusion:It is concluded from the study that gastritis is the most common condition among patients visiting the above OPD in the defined period and Nux vomica, Sulphur and Lycopodium were the most common indicated and prescribed remedies.