Gastroesophageal Reflux Symptoms Research Articles

Modulation of tube feeding protocol to prevent aspiration pneumonia in gastroesophageal reflux

Background & AimsAspiration pneumonia, as an enteral tube feeding-related complication, interferes with nutritional administration, and gastroesophageal reflux (GER) is a well-known cause of this problem. One of the factors that induces GER and other abdominal symptoms is gastroparesis, which is a syndrome caused by delayed gastric emptying (DGE) without mechanical obstruction.High-viscosity formulas are reportedly effective in suppressing GER, and there are new formulas that further increase viscosity and change phase from liquid to semisolid in the stomach, which can be used even with small-diameter tubes such as nasogastric tubes. The management of gastroparesis is useful for preventing aspiration pneumonia. To achieve this, post-pyloric feeding has been recommended, but this needs additional skill and facilities. An elemental diet can hasten pyloric transit and decrease GER, but has less tolerability due to diarrhea. A new nutritional liquid formula containing ingredients fermented by lactic acid bacteria has been introduced and is expected to have rapid pyloric transit (similar to the elemental diet). Thus, this may be useful in the management of GER patients with gastroparesis.This retrospective study evaluated whether the modulation of nutritional formulas using the new materials contributes to the prevention of tube feeding-related complications such as aspiration pneumonia.MethodsIn patients with tube feeding-related complications, upper gastrointestinal series was performed to assess the gastrointestinal motility. In cases with abnormal motility, we made the modulation of formulas using the aforementioned new types. The effectiveness of the modulation was evaluated by the frequency of aspiration pneumonia, changes in nutritional status and the period of feeding interruption in one year.ResultsModulation of the tube feeding protocol significantly reduced the incidence of aspiration pneumonia. Tube feeding could be properly continued without any interruption and nutritional status could be recovered and maintained.ConclusionsModulation of the tube feeding protocol including the formulas based on gastrointestinal motility status can reduce tube feeding-related complications. Aspiration pneumonia, as an enteral tube feeding-related complication, interferes with nutritional administration, and gastroesophageal reflux (GER) is a well-known cause of this problem. One of the factors that induces GER and other abdominal symptoms is gastroparesis, which is a syndrome caused by delayed gastric emptying (DGE) without mechanical obstruction. High-viscosity formulas are reportedly effective in suppressing GER, and there are new formulas that further increase viscosity and change phase from liquid to semisolid in the stomach, which can be used even with small-diameter tubes such as nasogastric tubes. The management of gastroparesis is useful for preventing aspiration pneumonia. To achieve this, post-pyloric feeding has been recommended, but this needs additional skill and facilities. An elemental diet can hasten pyloric transit and decrease GER, but has less tolerability due to diarrhea. A new nutritional liquid formula containing ingredients fermented by lactic acid bacteria has been introduced and is expected to have rapid pyloric transit (similar to the elemental diet). Thus, this may be useful in the management of GER patients with gastroparesis. This retrospective study evaluated whether the modulation of nutritional formulas using the new materials contributes to the prevention of tube feeding-related complications such as aspiration pneumonia. In patients with tube feeding-related complications, upper gastrointestinal series was performed to assess the gastrointestinal motility. In cases with abnormal motility, we made the modulation of formulas using the aforementioned new types. The effectiveness of the modulation was evaluated by the frequency of aspiration pneumonia, changes in nutritional status and the period of feeding interruption in one year. Modulation of the tube feeding protocol significantly reduced the incidence of aspiration pneumonia. Tube feeding could be properly continued without any interruption and nutritional status could be recovered and maintained. Modulation of the tube feeding protocol including the formulas based on gastrointestinal motility status can reduce tube feeding-related complications.

Protocol of a randomized, double-blind, placebo-controlled study of the effect of probiotics on the gut microbiome of patients with gastro-oesophageal reflux disease treated with rabeprazole

BackgroundFor patients with gastro-oesophageal reflux symptoms, the preferred treatment is proton pump inhibitor (PPI) administration for approximately 8 weeks. However, long-term use of PPIs can cause gut microbiome (GM) disturbances. This study is designed to evaluate the effect of probiotics combined with a PPI on the GM and gastrointestinal symptoms of patients with gastro-oesophageal reflux disease (GERD).MethodThis is a randomized, double-blind, placebo-controlled trial. A total of 120 eligible patients with GERD will be randomized into the experimental group or the control group. The treatment includes two phases: the initial treatment period lasts 8 weeks (weeks 1–8), and the maintenance treatment period lasts 4 weeks (weeks 9–12). During the initial treatment period, the experimental group will take rabeprazole and LiHuo probiotics, and the control group will take rabeprazole and a probiotic placebo; during the maintenance treatment period, the experimental group will take LiHuo probiotics, and the control group will take a probiotic placebo. The primary measure is the change in the GM. The secondary measures are the Reflux Disease Questionnaire (RDQ) score, Gastrointestinal Symptom Rating Scale (GSRS) score, faecal metabolome (FM), body mass index, Los Angeles grade of oesophagitis, adverse event (AE) rate and treatment compliance. Each outcome indicator will be assessed at day 0 (before administration), day 28 and/or 56 (during administration), and day 84 (end of administration) to reveal intragroup differences. AEs will be monitored to assess the safety of LiHuo probiotics.DiscussionThis will be the first trial to use the intestinal flora metagene method to analyse the effects of probiotics on patients with GERD receiving long-term PPI treatment. The goal is to provide evidence for the use of probiotics to reduce intestinal flora disorders and other symptoms of gastrointestinal discomfort in patients with GERD who have used PPIs for a long period.Trial registrationChinese Clinical Trial Registry (ChiCTR) (NO. ChiCTR2000038409). Registered on November 22, 2020, http://www.chictr.org.cn/showproj.aspx?proj=56358.

Predictors of Long-Term Outcomes, Recurrent Dysphagia, and Gastroesophageal Reflux After Per-oral Endoscopic Myotomy in Esophageal Motility Disorders

BackgroundThere is limited data on long-term outcomes of per-oral endoscopic myotomy (POEM). In this study, we aim to evaluate the efficacy of POEM in patients who completed a minimum follow-up of 5 years. MethodsData of patients who underwent POEM and completed ≥ 5-year follow-up were analyzed, retrospectively. Primary outcome of study was clinical success (Eckardt ≤ 3) at ≥ 5 years after POEM. Secondary outcomes included predictors of dysphagia and symptomatic gastroesophageal reflux disease (GERD) on long-term follow-up. ResultsThree hundred nineteen patients (males 182, mean age 40.5±14.2 years) completed a median of 73-(60–89) month follow-up. Esophageal motility disorders included idiopathic achalasia (type I 26.6%, type II 60.8%, type III 5.6%) and Jackhammer esophagus or distal esophageal spasm (2.8%). POEM was technically successful in 307 (96.2%) patients. Long-term success was 92.6% (overall), 92.1% (type I), 94.7% (type II), 87.5% (type III), and 75% (Jackhammer esophagus/distal esophageal spasm). Symptomatic GERD and reflux esophagitis were detected in 28.9% and 35.3% patients, respectively. On multivariate analysis, young age and female gender were independent risk factors for recurrent dysphagia (p = 0.037) and symptomatic GERD after POEM (p = 0.025), respectively. Lower post-POEM lower esophageal sphincter pressure was an independent predictor for reflux esophagitis (p = 0.016). ConclusionPOEM is an effective and durable treatment for achalasia and non-achalasia spastic motility disorders. Young patients and females may be at higher risk for recurrent dysphagia and symptomatic GERD, respectively.

Predictors of histopathological esophagitis in infants and adolescents with esophageal atresia within a national follow-up programme.

PurposeEsophageal atresia (EA) is a congenital anomaly of the foregut. Although the survival has improved over the years there is a significant gastrointestinal morbidity affecting physical function and health-related quality of life. The aims of the study were to identify and evaluate predictors of histopathological esophagitis in infants and adolescents with EA.MethodsSingle centre, cross-sectional study including one and 15-year-old patients operated for EA that participated in the national follow-up programme between 2012 and 2020 according to a pre-established protocol including upper endoscopy with oesophageal biopsies and 24h-pH-test. Data was collected from patients’ medical records and pH-analysis software. Regression models were used to identify predictors of histopathological oesophagitis. Possible predictors were abnormal reflux index, endoscopic esophagitis, hiatal hernia, symptoms of gastroesophageal reflux (GER) and age.Results65 patients were included, 47 children and 18 adolescents. All children were treated with PPI during their first year of life. Symptoms of GER were reported by 13 (31.7%) of the infant’s caregivers, 34 of the children (72.3%) had abnormal reflux index and 32 (68.1%) had histopathological esophagitis. The corresponding numbers for adolescents were 8 (50%), 15 (83.3%) and 10 (55.6%). We found no significant associations between histopathological esophagitis and endoscopic esophagitis, symptoms of GER, hiatus hernia or age group. Abnormal reflux index was an independent predictor of histopathological esophagitis. Seven patients with normal reflux index had histopathological esophagitis, all grade I.ConclusionsWe found a high prevalence of histopathological esophagitis despite PPI treatment in accordance with recommendations. No significant difference between the two age groups was seen. Abnormal reflux index was an independent predictor of histopathological esophagitis. However, we cannot recommend the use of pH-metry as a substitute for esophageal biopsies; future studies are needed to elucidate if esophageal biopsies might be postponed in infants with normal reflux index.

Quality of Life in Children and Adolescents with Gastroesophageal Reflux Disease

Objective: Children with gastroesophageal reflux disease (GERD) have significant co-morbidity. This study aimed to evaluate the health-related quality of life (HRQoL) in these children and adolescents by self and parent questionnaires. In addition, we also investigated the impact of gastroesophageal reflux symptoms on HRQoL. Material and Methods: The study included 93 patients with GERD and 59 age and sex-matched healthy controls. We asked the children and their parents to complete the validated Turkish version of KINDer Lebensqualitätsfragebogen-Children Quality of Life Questionnaire (self-report and parent report, respectively) for assessing HRQoL. The patients have additionally completed a gastroesophageal reflux symptom questionnaire. Results: The patients and their parents scored significantly lower on the general health perception (p=0.004) than the healthy controls. Especially physical well-being and emotional well-being subscales were negatively affected (p=0.000, and p=0.002, respectively). The most common symptoms in the patients were epigastric pain (70.9%), abdominal distention (64.5%), halitosis (58%), and regurgitation (50.6%). Epigastric pain significantly negatively affected the total HRQoL score in the patients (p= 0.003). The patients with GERD scored significantly higher than their parents in physical well-being (p=0.000) and family (p=0.000) subscale scores. The patients with GERD evaluated their quality of life more negatively in self-esteem (p=0.000) and school domains (p=0.001) than did their parents. Conclusion: GERD has a significant negative impact on HRQoL in children. The most affected domains are physical well-being and emotional well-being. Epigastric pain is associated with worse HRQoL scores.

High rate of de novo esophagitis 5 years after sleeve gastrectomy: aprospective multicenter study in Spain.

Major concerns years after the sleeve gastrectomy (SG) include weight regain, development of hiatal hernia (HH) and gastroesophageal reflux disease, with esophagitis and Barrett's esophagus (BE). Both problems could be related, and the incidence of asymptomatic patients is troubling. To study the incidence of reflux symptoms, esophagitis, BE, HH, and asymptomatic pathology and their relationship with weight regain in patients 5 years after undergoing SG at different bariatric centers in Spain. Public and private hospitals with bariatric surgery units. Prospective, multicenter, nonrandomized study involving 13 Spanish hospitals with a cumulative experience of 4,500 patients having undergone the SG procedure and patients who had been subjected to the procedure at least 5 years previously along with preoperative gastroscopy. The clinical history, preoperative gastroscopy, and technical details of the SG were recorded. A specific clinical questionnaire was given that recorded the intake volume, perception of satiety, and gastroesophageal reflux (GER) symptoms. Gastroscopy, pH-metry, and manometry studies were carried out, and the data were analyzed statistically. The study has been authorized by the official Spanish ethics committee CEI/CEIm Hospital Universitario Gran Canaria Dr Negrín (code 2019-216-1). One hundred and five patients who underwent SG and who had with at least 5 years of follow-up were included. All procedures were performed laparoscopically. The mean age of patients was 51.1 years, and 70.5% were women. The mean characteristics of the SG procedure were a 37.2F probe, at 4.6 cm from the pylorus, and a crura closure was performed in 5 cases. There were no major complications (Clavien-Dindo grade >3) or deaths. The average preoperative body mass index was 46.3 kg/m2, the minimum reached was 20.6 kg/m2, whereas the average after 5 years was of 34.5 kg/m2. GER, HH, and esophagitis symptoms went from 17.1%, 28.6%, and 5.7%, respectively, before the SG to 76%, 30.5%, and 31.4%, respectively, 5 years after the procedure. Symptoms persisted over the years in 37.1% of cases and presented de novo in 52.8% of cases. Fifty-three percent of manometries (n = 27, total 51) and 64% of pH-metries (n = 32, total 53; DeMeester average score was 65) were pathologic 5 years after the procedure. Concerning gastroscopies, 5 years after the procedure, HH was found in 33 patients (30.5% of total) and esophagitis in 32 patients (31.4% of total). Eighty patients (76%) had GER symptoms, and 25 patients (24%) were asymptomatic. Only 1 patient (.9%) developed BE. Our study has confirmed a high rate of both persistent and de novo esophagitis and hiatal hernia, many of which were asymptomatic, 5 years after SG had been performed. Weight regain and a striking increase in gastric capacity are risk factors indicative of esophagitis, even when patients are asymptomatic. We consider a control gastroscopy and the preventive use of proton pump inhibitors necessary in these cases regardless of symptoms. We recommend that a control gastroscopy should be performed in all cases regardless of symptoms 5 years after SG. Further studies are needed to validate these recommendations.

The yield of solid swallows in high resolution esophageal manometry among patients with dysphagia and gastro-esophageal reflux symptoms.

Swallowing disorders are frequently reported esophageal symptoms and represent a common cause for referrals to gastroenterology consultations. Esophageal high-resolution manometry (HRM) is considered the gold standard modality for the evaluation of esophageal peristalsis and esophageal sphincter. The standard protocol of HRM includes water swallows only, that may not assess appropriately esophageal function and symptoms. Hence, we investigated the diagnostic yield of combining solid food swallows (SFS) to standard HRM. We conducted a retrospective study at the Unit of Gastroenterology of EMMS Nazareth Hospital, Israel. Patients who underwent manometry mainly due to dysphagia or reflux symptoms between November 2019 and November 2020 were enrolled. All patients underwent routine HRM and completed ten 5 mL water swallows and 5 bread swallows. Analysis and reports were done by an expert gastroenterologist, based on the Chicago Classification version 3. Overall, 99 patients (45.5% men, mean age 52.1±16 years) who underwent HRM were included. The addition of solid swallows to the test changed manometry results in 43 patients (43.4%) (P<0.005). Furthermore, SFS improved the contractility in 26/42 cases of ineffective and/or absent motility (61%) (P<0.005). Finally, SFS aggravated symptoms in 44 patients (44.6% more aggravation than in liquid only) (P<0.005). Combining SFS to HRM can improve the diagnostic yield of the study. Adding solid swallows is of special value in cases of ineffective esophageal motility but induces a high rate of symptoms aggravation.

Real-world prevalence of endoscopic findings in patients with gastroesophageal reflux symptoms: a cross-sectional study.

Background and study aims Data regarding endoscopic findings and symptom correlation in patients with gastroesophageal reflux disease (GERD) symptoms are largely limited to single-center experiences. We performed a nationwide study to examine the association between patient-reported GERD symptoms and clinically relevant endoscopic findings. Patients and methods Using the National Endoscopic Database, we retrospectively identified all esophagogastroduodenoscopies (EGDs) performed for GERD symptoms from 2000 to 2014. Patients were categorized into three symptom groups: 1) typical reflux only (R); 2) airway only (A); and 3) both R and A (R + A). Outcomes were the point prevalence of endoscopic findings in relation to patient-reported GERD symptom groups. Statistical analyses were performed using R. Results A total of 167,459 EGDs were included: 96.8 % for R symptoms, 1.4 % for A symptoms, and 1.8 % for R + A symptoms. Of the patients, 13.4 % had reflux esophagitis (RE), 9.0 % Barrett’s esophagus (BE), and 45.4 % hiatal hernia (HH). The R + A group had a significantly higher point prevalence of RE (21.6 % vs. 13.3 % and 12 %; P < 0.005) and HH (56.9 % vs. 45.3 % and 38.3 %; P < 0.005) compared to the R or A groups, respectively. The R group had a significantly higher point prevalence of BE compared to the A or R + A groups, respectively (9.1 % vs. 6.1 % and 6.1 %, P < 0.005). Conclusions On a national level, patients experiencing R + A GERD symptoms appear more likely to have RE and HH, while those with only R symptoms appear more likely to have BE. These real-world data may help guide how providers and institutions approach acid-suppression therapy, set thresholds for recommending EGD, and develop management algorithms.

An observational study to assess reasons for lack of control among patients of bronchial asthma attending a tertiary care centre in India

Background: Bronchial asthma is a common chronic respiratory ailment affecting both children and adults. Lack of control among asthmatics leads to adverse outcomes and increased health care costs. Studies from India evaluating level of control and reasons for inadequate control are lacking. Objective was to assess level of control and reasons for partly/poorly controlled asthma.Methods: Consecutive patients of bronchial asthma (&gt;8 weeks on treatment) presenting to a tertiary care centre and consenting for participation in the study were enrolled. Control was assessed used global initiative for asthma (GINA) guidelines and patients categorised into poor, partly or well control.1 Enrolled patients were assessed by a questionnaire to record their demographic details including body mass index (BMI), duration of disease, smoking status, environmental smoke exposure/biomass fuel exposure, adherence to therapy, technique of inhaled medication and anxiety/depression, co morbidities including allergic rhinitis, gastro-oesophageal reflux (GER) symptoms, obstructive sleep apnoea (OSA) and allergic bronchopulmonary aspergillosis were also assessed.Results: 150 consecutive patients, 58% females and 42% males with mean age of 40.03±14.77 years were enrolled. 19.3% of patients were well controlled while 50.7% were poorly and 30% were partly controlled. On comparing well controlled versus uncontrolled asthma (poor and partly controlled) adherence, device technique of inhaled medication, depression scores and eosinophilia showed a significant association. On application of logistic regression model, depression scores, inhaler adherence and device technique were associated with level of control.Conclusions: Asthma is partly/poorly controlled in majority of asthmatics. Psychiatric co-morbidities, adherence to therapy and correct device technique are major reasons for partly/poorly controlled asthma. Addressing these modifiable factors can improve level of control among asthmatics.

Modified Peroral Endoscopic Myotomy Technique for Type II Achalasia: A Multicenter Retrospective Study.

Aim This retrospective study is aimed at evaluating the outcomes of a modified peroral endoscopic myotomy (POEM) technique in patients with type II achalasia. Methods We performed a modified POEM procedure, which involved a shorter (total myotomy length = 4 cm), full-thickness myotomy, on 31 patients with type II achalasia. Clinical success rates, technical success rates, pre- and postoperative esophageal manometry results, complications, and reflux-related adverse events were evaluated. Results The clinical success (Eckardt score ≤ 3) rates were 100% and 88.9% within 2 years and beyond 2 years postoperatively, respectively. The median lower esophageal sphincter pressures (LESP) decreased from 31.6 (26.7-49.7) mmHg preoperatively to 13.4 (10.5-21.6) and 11.8 (7.4-16.7) mmHg (P < 0.001) at 6 and 12 months postoperatively, respectively. The median integrated relaxation pressure (IRP) decreased from 27.8 (20.6-37.5) mmHg preoperatively to 12.9 (11.3-23.4) and 11.6 (9.6-16.8) mmHg (P < 0.001) at 6 and 12 months after POEM, respectively. Only one case (3.2%) of mucosal injury, four (12.9%) cases of reflux esophagitis, and two (6.5%) cases of gastroesophageal reflux symptoms were reported. Conclusions The modified POEM technique showed excellent outcomes in patients with type II achalasia.

Sleep Positional Therapy for Nocturnal Gastroesophageal Reflux: A Double-Blind, Randomized, Sham-Controlled Trial

Experimental studies have suggested that sleep position plays a role in the occurrence of nocturnal gastroesophageal reflux and the left lateral decubitus position is most favorable. The aim of this study was to evaluate the effect of a novel electronic sleep positional therapy wearable device on sleep position and nocturnal reflux symptoms. We performed a double-blind, randomized, sham-controlled trial in patients with nocturnal symptoms of gastroesophageal reflux. Patients were advised to sleep in the left lateral decubitus position and were assigned randomly (1:1) to an electronic sleep positional therapy wearable device, programmed to either produce a vibration when in the right lateral position (intervention) or only during the first 20 minutes (sham). The primary outcome was treatment success, defined as a 50% or more reduction in the nocturnal reflux score. Secondary outcomes included change in sleep position and reflux symptoms. One hundred patients were randomized. In the intention-to-treat analysis, the rate of treatment success was 44% in the intervention group (22 of 50) vs 24% in the sham group (12 of 50) (risk difference, 20%; 95% CI, 1.8%-38.2%; P= .03). Treatment led to a significant avoidance of sleeping in the right lateral decubitus position (intervention 2.2% vs sham 23.5%; P= .000) and increased time sleeping in the left lateral decubitus position (intervention 60.9% vs sham 38.5%; P= .000). More reflux-free nights were observed in the intervention group (intervention 9 nights [interquartile range, 6-11 nights] vs sham 6 nights [interquartile range, 3-9 nights]; P= .01). Sleep positional therapy using an electronic wearable device promotes sleeping in the left lateral decubitus position and effectively alleviates nocturnal reflux symptoms compared with sham treatment (https://www.trialregister.nl, NL8655).

Combined Partial Toupet Fundoplication With Laparoscopic Sleeve Gastrectomy for Patients With Morbid Obesity and Symptomatic GERD: Preliminary Results of the T-sleeve Technique.

The aim of this study to reveal preliminary results of our Toupet-sleeve technique in morbid obese patients with symptomatic gastroesophageal reflux disease (GERD) and compare their outcomes with laparoscopic sleeve gastrectomy (LSG) patients' outcomes. The study included 103 patients who underwent primary LSG between March 2018 and October 2020 and 18 patients who underwent partial T-sleeve. Patients were stratified into 2 groups according to the surgical technique. All of the patients had preoperative symptomatic GERD. Patients were reevaluated with regard to GERD symptoms and weight loss in the postoperative period. Two groups' data were compared. The mean age of the patients was 39.2±10.2 years (63% female), and the mean body mass index was 43.2±6.4 kg/m2. The median operative time was 93 minutes (75 to 110 min) in group A (primary LSG) and 110 minutes (90 to 120 min) in group B (partial T-sleeve). The mean body mass index decreased to 28±4.5 kg/m2 in group A and 25.8±3.5 kg/m2 in group B at 12 months after the surgery. At the 12th month, the patients were reevaluated for GERD symptoms. Reflux symptoms were found to be resolved in 62% of the patients (n=64) in group A, while 32% of the patients (n=39) had persistent GERD symptoms. In group B, all of the patients had discontinued proton pump inhibitors postoperatively, and GERD symptoms were completely resolved in 94% of these patients (n=17). The present study showed that T-sleeve provides a very good weight loss and reflux control in patients with symptomatic GERD with morbid obesity in the short-term period. This technique can be proposed in some cases as a primary treatment modality. High numbers of patients and longer follow-up are needed.

Tratamiento Quirúrgico de la Enfermedad por Reflujo Gastro Esofágico y de las Hernias del Hiato Esofágico

Gastroesophageal reflux disease (GERD) is a chronic and recurrent condition that is linked to the retrograde passage of gastric contents, with or without duodenal contents, towards the esophagus and adjacent organs, with or without tissue damage (1).It is characterized by its chronicity and recurrence, as well as by being a benign pathology, but which adversely affects the quality of life of patients (2, 3, 4). The clinical presentation is highly variable, with typical symptoms being heartburn and regurgitation. Respiratory, otorhinolaryngological and chest pain are recognized as atypical symptoms betweenothers. In its evolution, it can develop complications such as esophagitis of variable degree with ulcerationand stricture, Barret's esophagus, and adenocarcinoma of the esophagus. GERD is a common disease, but with different prevalences in different countries. According to the international study DIGEST (Domestic / International Gastroentero-logy Surveillance Study) 7, 7% of the population refers symptoms of gastroesophageal reflux (5). Approximately 20% of North American adults have gastroesophageal reflux symptoms such as heartburn and acid regurgitations at least once a week (6, 7). In Uruguay, the estimated prevalence in the urban population was 4, 69, while for the populationhospital was 11.66%, using the GERD (Gastro-esophageal reflux disease Questionnaire) (8) The treatment of gastroesophageal reflux disease has undergone significant changes in the last two decades, motivated by a better study and knowledge of its aspects pathophysiological, in the use of proton pump inhibitors and in the development of laparoscopic surgery since the 1990s.

Antacids revisited: review on contemporary facts and relevance for self-management.

Heartburn and acid regurgitation are the typical symptoms of gastroesophageal reflux. Despite the availability of several treatment options, antacids remain the mainstay treatment for gastroesophageal reflux-related symptoms based on their efficacy, safety, and over-the-counter availability. Antacids are generally recommended for adults and children at least 12 years old, and the FDA recommends antacids as the first-line treatment for heartburn in pregnancy. This narrative review summarizes the mechanism, features, and limitations related to different antacid ingredients and techniques available to study the acid neutralization and buffering capacity of antacid formulations. Using supporting clinical evidence for different antacid ingredients, it also discusses the importance of antacids as OTC medicines and first-line therapies for heartburn, particularly in the era of the COVID-19 pandemic, in which reliance on self-care has increased. The review will also assist pharmacists and other healthcare professionals in helping individuals with heartburn to make informed self-care decisions and educating them to ensure that antacids are used in an optimal, safe, and effective manner.

A Narrative Review on Efficacy and Safety of Proton Pump Inhibitors in Children.

Proton pump inhibitors (PPIs) are among the most prescribed drugs worldwide and include omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole. Their use in pediatrics is approved for children older than 1 year, for the short-term treatment of symptomatic gastroesophageal reflux disease (GERD), healing of erosive esophagitis, treatment of peptic ulcer disease, and eradication of Helicobacter pylori. PPIs are also considered the standard of care for pediatric eosinophilic esophagitis. Despite the strict range of indications, the use of this class of molecules has increased in all pediatric age ranges. The long-term gastric acid suppression in children has been linked to increased risks of gastrointestinal and lower respiratory tract infections, bone fractures, and allergy. This study aims to provide a comprehensive overview of the mechanism of actions, use (and misuse) in infants and children, and safety of PPIs.

Diagnostic and therapeutic management in gastroesophageal reflux disease: consensus of the Polish Society of Gastroenterology

The paper was prepared by an expert group appointed by the Polish Society of Gastroenterology with an aim to update and systematize the knowledge about diagnosis and treatment of gastroesophageal reflux disease (GERD). Based on the previously published guidelines of international societies, expert consensuses, and recently published good quality data, we formulated 74 statements regarding the definition, diagnosis and treatment of GERD and assessed the level of acceptance of these statements and the reliability of the data. We discussed in details the possibilities and limitations of the available diagnostic methods and therapies, with particular emphasis on the diversity of gastroesophageal reflux symptoms and complications including Barrett's esophagus. Practical principles regarding interpretation of the diagnostic tests are presented. In addition, we discussed the indications for surgical treatment as well as the situations in which surgical treatment is not indicated with emphasis on the importance of preoperative diagnostics. The role of add-on therapy and indications for maintenance treatment are defined.

S148: Long-term patient-reported outcomes of laparoscopic magnetic sphincter augmentation versus Nissen fundoplication: a 5-year follow-up study.

Laparoscopic magnetic sphincter augmentation (MSA) has emerged as an alternative to laparoscopic Nissen fundoplication (LNF) for the management of symptomatic gastroesophageal reflux disease (GERD). While short-term outcomes of MSA compare favorably to those of LNF, direct comparisons of long-term outcomes are lacking. We hypothesized that the long-term patient-reported outcomes of MSA would be similar to those achieved with LNF. We tested this hypothesis in a retrospective cohort undergoing primary LNF or MSA between March 2013 and July 2015. The primary outcome was GERD-Health Related Quality of Life (GERD-HRQL) score at long-term follow-up relative to baseline. Secondary outcomes included dysphagia and bloating scores, proton-pump inhibitor (PPI) cessation, reoperations, and overall satisfaction with surgery. 70 patients (25 MSA, 45 LNF) met criteria for study inclusion. MSA patients had lower baseline BMI (median: 27.1 [IQR: 22.7-29.9] versus 30.4 [26.4-32.8], p = 0.02), lower total GERD-HRQL (26 [19-32] versus 34 [25-40], p = 0.02), and dysphagia (2 [0-3] versus 3 [1-4], p = 0.02) scores. Median follow-up interval exceeded 5 years (MSA: 68 [65-74]; LNF: 65months [62-69]). Total GERD-HRQL improved from 26 to 9 after MSA (p < 0.001) and from 34 to 7.5 after LNF (p < 0.01); these scores did not differ between groups (p = 0.68). Dysphagia (MSA: 1 [0-2]; LNF: 0 [0-2], p = 0.96) and bloating (MSA: 1.5 [0.5-3.0]; LNF: 3.0 [1.0-4.0], p = 0.08) scores did not show any statistically significant differences. Device removal was performed in 4 (16%) MSA patients and reoperation in 3 (7%) LNF patients. Eighty-nine percent of LNF patients reported satisfaction with the procedure, compared to 70% of MSA patients (p = 0.09). MSA appears to offer similar long-term improvement in disease-specific quality of life as LNF. For MSA, there was a trend toward reduced long-term bloating compared to LNF, but need for reoperation and device removal may be associated with patient dissatisfaction.

Investigation of the effect of gastroesophageal reflux disease on dental erosion and oral tissue alterations

Aim: This study aimed to investigate the relationship between gastroesophageal reflux disease (GERD) and dental erosion and the alterations in oral tissues. Materials and Methods: In this study, the GERD group consisted of 50 individuals with gastroesophageal reflux symptoms, and the control group consisted of 50 healthy individuals. The prevalence of teeth wears and caries was evaluated using the Smith and Knight tooth wear index (TWI) and the decayed, missing, and filled teeth index (DMFT), respectively. Oral complaints were also evaluated. Stimulated saliva samples were collected, and the salivary buffering capacity, pH and flow rate values were measured. Results: In the GERD group, wear was observed in the palatal surface of the maxillary teeth, whereas no wear was observed in the control group (p&amp;lt;0.05). Although the incisal surfaces of the maxillary anterior teeth and the occlusal surfaces of the maxillary/mandibular posterior teeth were observed as eroded in both groups, the values in the patient group were significantly higher compared with those of controls (p&amp;lt;0.05). In the GERD group, complaints of inflammatory mouth sensitivity, tongue sensitivity, nonspecific itching and burning, halitosis, dry mouth, tooth sensitivity, erythema in the soft/hard palatinal mucosa/uvula were significantly more frequent than the control group (p&amp;lt;0.05, for each). The groups were similar with respect to DMFT (p=0.480). The salivary flow rate, pH and buffering capacity values were found to be significantly lower in the GERD group (p&amp;lt;0.05, for each). Conclusion: The results showed that patients with GERD had wear in palatal surfaces of maxillary teeth. Moreover, these patients also complained more commonly from oral tissue alterations and had lower salivary flow rate, pH, and buffering capacity. Hence dentists should consider GERD as a potential risk factor for oral health.

GASTROESOPHAGEAL SYMPTOMS AFTER LAPAROSCOPIC GASTRIC BYPASS: MISTAKES IN PERFORMING THE PROCEDURE?

ABSTRACT - BACKGROUND:Laparoscopic Roux-en-Y gastric bypass (LGB) is the recommended procedure for morbidly obese patients with gastroesophageal reflux disease (GERD). However, there have been reported gastroesophageal reflux symptoms or esophagitis after LGB. Few functional esophageal studies have been reported to date.AIM: To evaluate the anatomic and physiologic factors contributing to the appearance of these problems in patients who underwent LGB.METHODS: This prospective study included 38 patients with postoperative gastroesophageal reflux symptoms submitted to LGB. They were subjected to clinical, endoscopic, radiologic, manometric, and 24-h pH-monitoring evaluations.RESULTS: Eighteen (47.4%) of 38 patients presented with heartburn or regurgitation, 7 presented with pain, and 4 presented with dysphagia. Erosive esophagitis was observed in 11 (28.9%) patients, and Barrett’s esophagus (5.7%) and jejunitis (10.5%) were also observed. Hiatal hernia was the most frequent finding observed in 15 (39.5%) patients, and most (10.5%) of these patients appeared with concomitant anastomotic strictures. A long blind jejunal loop was detected in one (2.6%) patient. Nearly 75% of the patients had hypotensive lower esophageal sphincter (9.61±4.05 mmHg), 17.4% had hypomotility of the esophageal body, and 64.7% had pathologic acid reflux (% time pH <4=6.98±5.5; DeMeester’s score=32.4±21.15).CONCLUSION: Although rare, it is possible to observe gastroesophageal reflux and other important postoperative symptoms after LGB, which are associated with anatomic and physiologic abnormalities at the esophagogastric junction and proximal gastric pouch.

Metabolic Dysfunction-Associated Fatty Liver Disease Increases the Risk of Gastroesophageal Reflux Symptoms.

ObjectiveThe present study aimed to explore the relationship between metabolic dysfunction-associated fatty liver disease (MAFLD) and gastroesophageal reflux symptoms (GERS).MethodsThe present study was a cross-sectional observational study. The study population was 3002 subjects from a single hospital who underwent a health checkup from September 1, 2019, to December 31, 2020. The diagnosis of MAFLD was based on the diagnosis of fatty liver in the subject by ultrasound or computed tomography (CT) and the presence of one of the following conditions: overweight or obesity (body mass index [BMI] ≥ 23), type 2 diabetes mellitus, and metabolic abnormalities. The subjects were divided into the GERS group (n = 305) and the non-GERS group (n = 2697) based on the presence or absence of GERS, based on the GerdQ score.ResultsThe prevalence of MAFLD was significantly higher in the GERS group than in the non-GERS group (p = 0.001). In the univariate analysis of risk factors for GERS, MAFLD was identified as a risk factor for GERS (OR 1.5; 95% CI 1.176–1.913; p = 0.001). With adjustment of confounding factors such as BMI, waist circumference, lipid levels, and blood pressure, the correlation between MAFLD and GERS was attenuated but still significant (OR 1.408; 95% CI 1.085–1.826; p = 0.010).ConclusionMAFLD might be an independent risk factor for GERS.