For The Symptoms Of GERD Research Articles

Effects of Proton Pump Inhibitors in Patients with Laryngopharyngeal Reflux Disease

The effect of proton pump inhibitors (PPIs) on the health-related quality of life (HRQoL) of patients with laryngopharyngeal reflux disease (LPRD) is not well known. Our aim was to assess the HRQoL before and after administration of a PPI in patients with LPRD. A total of 27 LPRD patients (14 women, 13 men; mean age 54 years) were enrolled. We determined the HRQoL using three different inquiry systems: 1) Frequency Scale for the Symptoms of GERD (FSSG); 2) the 36 item short form of the Medical Outcome Study Questionnaire (SF-36); and 3) the Gastrointestinal Symptom Rating Scale (GSRS). The HRQoL was determined at baseline and after eight weeks of treatment with lansoprazole at a dose of 30mg once daily or rabeprazole at a dose of 10mg once daily. After administration of the PPI, the FSSG, the SF-36 general health scale and mental health scale, GSRS reflux syndrome score, abdominal pain syndrome score and the indigestion syndrome score were significantly improved compared to baseline pretreatment scores (p<0.05). PPI therapy would be useful for the treatment of LPRD.

Elcatonin is effective for lower back pain and the symptoms of gastroesophageal reflux disease in elderly osteoporotic patients with kyphosis

Elderly osteoporotic patients with kyphosis tend to be frequently accompanied by the symptoms of gastroesophageal reflux disease (GERD) such as heartburn and acid reflux. Elcatonin, which is effective for lower back pain of osteoporosis, has a physiological action of reducing gastric acid. We examine whether or not this drug would alleviate GERD symptoms as well as lower back pain in patients with osteoporosis. Elcatonin was administrated at a dose of 20 units once weekly for 3 months. The visual analog scale (VAS) and the frequency scale for the symptoms of GERD (FSSG) were used to evaluate lower back pain and GERD symptoms, respectively. Both VAS and FSSG scores significantly decreased after 1, 2 and 3 months of elcatonin administration (at least P < 0.001). Even after the cessation of elcatonin, both scores remained significantly low for an extra 1 and 3 months, respectively. These beneficial effects were also observed in non-steroidal anti-inflammatory drug (NSAID) or GERD drug users. The present findings suggest that elcatonin could improve the symptoms of GERD as well as osteoporosis-invoked back pain in elderly patients with kyphosis, and that these effects are long-lasting and independent of NSAID or GERD drugs.

Quit smoking improves gastroesophageal reflux symptoms and quality of life

Background: Smoking is considered to be risk factors of gastroesophageal reflux disease (GERD). The present study aimed to reveal whether quit smoking improves GERD symptoms and QOL of patients. Methods: In this prospective study, 33 patients who participated in a 12-week quit smoking program filled out the Frequency Scale for the Symptoms of GERD (FSSG) questionnaire, and SF8 QOL questionnaire. Patients filled out the questionnaires at baseline and during the program at 2 weeks, 4 weeks, 8 weeks and 12 weeks. In the FSSG, the responses were scored and the reflux score (RS), dysmotility score (DS) and total score (TS) were calculated. Results: There were 22 males and 11 females. Their mean age was 54.8 ± 13.0 (mean ± SD) yr, BMI was 22.9 ± 4.0, and duration of smoking was 33.5 ± 12.5 years. Ten patients belonged to GERD subgroup (baselineFSSGscore ≥ 8). All patients were successful at quit smoking. Scores of TS/RS/DS are 8.6 ± 1.8 (mean ± SE)/4.2 ± 0.9/4.5 ± 0.9 at baseline, 4.7 ± 1.6**/2.5 ± 0.9**/2.3 ± 0.7** at 2 w, 5.7 ± 1.3**/2.6 ± 0.6*/3.0 ± 0.7* at 4 w, 4.5 ± 1.4*/2.2 ± 0.8*/2.3 ± 0.8* at 8 w and 3.7 ± 1.2**/1.7 ± 0.6**/2.0 ± 0.7** at 12 w, respectively (**p < 0.01, *p < 0.05 vs. baseline). Among GERD subgroup, Scores of TS/RS/DS are 18.0 ± 2.9/8.9 ± 1.6/9.1 ± 1.5 at baseline, 8.8 ± 3.0/5.1 ± 1.7/3.7 ± 1.6 at 2 w, 10.8 ± 2.9/5.4 ± 1.6/5.4 ± 1.5 at 4 w, 7.6 ± 2.9*/4.1 ± 1.6/3.5 ± 1.5* at 8 w and 7.1 ± 2.9*/3.2 ± 1.6*/3.9 ± 1.5* at 12w, respectively. Regarding QOL, physical component score has significantly improved at 2, 4, 8 and 12 w and mental component score at 4w, respectively. Conclusions: Quit smoking significantly improved not only GERD symptoms but also QOL, indicating that quit smoking might be an option in the treatment strategy of GERD symptoms.

Characteristics of non-erosive gastroesophageal reflux disease refractory to proton pump inhibitor therapy

To investigate whether potent acid inhibition is effective in non-erosive reflux disease (NERD) refractory to standard rabeprazole (RPZ) treatment. We treated 10 Japanese patients with NERD resistant to standard dosages of RPZ: 10 mg or 20 mg od, 20 mg bid, or 10 mg qid for 14 d. All patients completed a frequency scale for symptoms of gastroesophageal reflux disease questionnaire frequency scale for the symptoms of GERD (FSSG); and underwent 24 h pH monitoring on day 14. With increased dosages and frequency of administration of RPZ, median intragastric pH significantly increased, and FSSG scores significantly decreased. With RPZ 10 mg qid, potent acid inhibition was attained throughout 24 h. However, five subjects were refractory to RPZ 10 mg qid, although the median intragastric pH in these subjects (6.6, range: 6.2-7.1) was similar to that in the remaining five responsive subjects (6.5, range: 5.3-7.3). With baseline RPZ 10 mg od, FSSG scores in responsive patients improved by > 30%, whereas there was no significant decrease in the resistant group. NERD patients whose FSSG score fails to decrease by > 30% after treatment with RPZ 10 mg od for 14 d are refractory to higher dosage.

Effect of rabeprazole treatment on health-related quality of life and symptoms in patients with reflux esophagitis: a prospective multicenter observational study in Japan

Despite many reports from Western nations describing endoscopic and symptomatic improvements in patients with reflux esophagitis (RE) using proton pump inhibitors (PPI), PPI effects on the health-related quality of life (HRQOL), particularly for a dose duration of less than 8 weeks, have not been sufficiently clarified in Japanese RE patients. RE patients (n = 9,029) in general practice settings took rabeprazole once daily for 8 weeks. HRQOL, using the 8-item Short-Form Health Survey (SF-8™), and symptoms, using a frequency scale for the symptoms of gastroesophageal reflux disease (GERD), were evaluated at the initiation of therapy (0 W), week 4 (4 W), and week 8 (8 W). Endoscopy was performed at 0 and 8 W where possible. In efficacy analysis (n = 6,839), the mean ± SD values for the physical component summary of the SF-8™ at 0, 4, and 8 W were 45.005 ± 7.534, 48.517 ± 6.336, and 49.328 ± 6.207, respectively, while those for the mental component summary were 46.465 ± 7.743, 49.460 ± 6.470, and 50.388 ± 6.049, respectively. Significant improvements, compared to 0 W, were observed in eight domains and two summary scores at 4 W (P < 0.001), and further QOL score elevations were seen by 8 W. Regarding symptoms, the mean total frequency scale for the symptoms of GERD (FSSG) scores at 0, 4, and 8 W were 16.4 ± 9.8, 7.8 ± 7.4, and 6.0 ± 6.8, respectively. Significant improvements, compared to 0 W, were seen in the total, reflux, and dysmotility scores and in the scores for all 12 items at 4 W (P < 0.001). The score for the HRQOL of RE patients before rabeprazole therapy was below 50 points (the national mean for the general Japanese population), indicating harmed QOL. Rabeprazole markedly improved the HRQOL at 4 W, with recovery to the national mean by 8 W. Symptoms had also improved significantly at 4 W, with further improvements observed at 8 W.

Frequency Scale for the Symptoms of GERD Score for Gastroesophageal Reflux Disease in Koja Hospital

Background: The frequency scale for the symptoms of GERD (FSSG) was a specific questionnaire to gastroesophageal reflux disease (GERD), which has been validated against the endoscopic findings in Japan. The high score FSSG is one of the factors related to failure of proton pump inhibitor (PPI) mono therapy. The purpose of this study is to determine FSSG score in patients with GERD at Koja hospital, in order to predict the need for combination therapy of PPI with pro- kinetic drug or PPI only. Method: Dyspeptic patients which had have heartburn and/or regurgitation were collected in the period of March until July 2010. The FSSG score was obtain containing 12 questions which consisted of seven questions for reflux symptoms and five questions for dysmotility/dyspeptic symptoms. Results: There were 129 patients, 51 (39.5%) males and 78 (60.5%) females, mostly in the age group of < 40 years (55.8%), body mass index of most patients (66.6%) were normal, only 12.4% were overweight. FSSG score revealed the mean of total score of 17.6 ± 6.9. From 129 dyspepsia patients who complained heartburn and or regurgitation, obtained 121 (94%) met criteria for GERD with cutoff eight. The mean of reflux score was 7.4 ± 4.6 while the mean of dyspeptic/dysmotility score was 10.1 ± 4. Thus from 129 patients studied, the symptoms of dyspeptic/dysmotility more dominant than symptoms of reflux Conclusion: GERD patients in Koja hospital have a high mean FSSG score, whereas dysmotility symptoms was proved to be more dominant than acid reflux Keywords: GERD, FSSG, dyspeptic/dysmotility score, reflux score

Gastroesophageal Reflux Disease in Indonesia

Gastroesophageal reflux disease (GERD) is one of the problems in gastroenterology which causes major disturbance in the quality of life and daily activity. GERD can be divided into erosive and non-erosive type. GERD develops by many factors i.e. anatomical and physiological disorder, hereditary or acquired factors, genetic, diet, certain drugs, and obesity. The principle pathophysiology of GERD is an imbalance between aggressive factors and defensive factors. The aggressive factors include gastric acid, pepsin, bile acid reflux, and trypsin. The defensive factors include hypotensive lower esophageal sphincter (LES), transient lower esophageal sphincter relaxations (TLESR), hiatal hernia, disrupted saliva production, esophageal peristaltic disorder. The complications of GERD divided into esophageal and extra esophageal complications. The complications in the esophagus which can be found are bleeding, stricture, perforation, Barret’s esophagus and esophageal cancer. The complications in the extra esophagus are sore throat, tonsillo-pharyngitis, sinusitis, laryngitis, dental caries, pneumonia, asthma bronchiale, etc. Studies in Indonesia reveal that GERD is increasing recently. Syam et al. reported that the prevalence of GERD in Cipto Mangunkusumo hospital was increasing from 5.7% in 1997 to 25.18% in 2002. From the extrapolated statistic, the prevalence of GERD in Indonesia can be predicted as 7,153,588 patients from 238,452,952 populations. In this edition we have two studies on GERD. The first study studied the frequency scale for the symptoms of GERD score for GERD in Koja hospital Jakarta. Ndraha found that the most frequent characteristic of GERD was female patient, age less than 40 years old, normal body mass index (BMI). The frequency scale for the symptoms of GERD (FSSG) revealed the mean of total score was 17.6 ± 6.9. GERD patients have a high mean FSSG score, whereas dysmotility was more dominant than acid reflux. The second study studied obesity as a risk factor of erosive GERD in Cipto Mangunkusumo hospital Jakarta. Sijabat et al. found from their study that the most frequent characteristic of GERD was grade A esophagitis, female patients and mean age 48.61 ± 8.64 years old. There was a correlation between obesity or abdominal obesity and erosive GERD. The prevalence of GERD in Indonesia is increasing and this data is inline with the reports from other countries in ASIA and USA. The management of GERD is performed in keeping with Indonesian and Asia Pacific consensus, life-style modification and administering the acid suppression agents (proton pump inhibitor, H2-receptor antagonist, etc), prokinetic agents.

Editor's Summary and Q&A: Gastroesophageal reflux symptoms in adults with skeletal Class III malocclusion examined by questionnaires

Introduction Patients with masticatory dysfunction have a higher incidence of gastrointestinal disorders including gastroesophageal reflux disease (GERD). Masticatory function is significantly lower in patients with skeletal Class III malocclusion than in those with normal occlusion. However, GERD symptoms in patients with skeletal Class III malocclusion are still unknown. The purpose of this study was to examine GERD symptoms and masticatory functions in patients with skeletal Class III malocclusion. Methods Nineteen adult patients with severe skeletal Class III malocclusion (Class III group) and 20 adults with normal occlusion (control group) participated in this study. The results of the Carlsson-Dent self-administered questionnaire (QUEST) and the frequency scale for the symptoms of GERD (FSSG) were compared between the 2 groups, along with occlusal contact area, maximal voluntary bite force, and salivary flow rate. Results The QUEST and FSSG scores were significantly higher in the Class III group. Occlusal contact area and maximal voluntary bite force were significantly smaller in the Class III group. There was no significant difference in the salivary flow rates between the groups. Conclusions GERD symptoms were observed more often in patients with skeletal Class III malocclusion than in normal subjects as determined by the questionnaires. Patients with masticatory dysfunction have a higher incidence of gastrointestinal disorders including gastroesophageal reflux disease (GERD). Masticatory function is significantly lower in patients with skeletal Class III malocclusion than in those with normal occlusion. However, GERD symptoms in patients with skeletal Class III malocclusion are still unknown. The purpose of this study was to examine GERD symptoms and masticatory functions in patients with skeletal Class III malocclusion. Nineteen adult patients with severe skeletal Class III malocclusion (Class III group) and 20 adults with normal occlusion (control group) participated in this study. The results of the Carlsson-Dent self-administered questionnaire (QUEST) and the frequency scale for the symptoms of GERD (FSSG) were compared between the 2 groups, along with occlusal contact area, maximal voluntary bite force, and salivary flow rate. The QUEST and FSSG scores were significantly higher in the Class III group. Occlusal contact area and maximal voluntary bite force were significantly smaller in the Class III group. There was no significant difference in the salivary flow rates between the groups. GERD symptoms were observed more often in patients with skeletal Class III malocclusion than in normal subjects as determined by the questionnaires.

Gastroesophageal reflux symptoms in adults with skeletal Class III malocclusion examined by questionnaires

Patients with masticatory dysfunction have a higher incidence of gastrointestinal disorders including gastroesophageal reflux disease (GERD). Masticatory function is significantly lower in patients with skeletal Class III malocclusion than in those with normal occlusion. However, GERD symptoms in patients with skeletal Class III malocclusion are still unknown. The purpose of this study was to examine GERD symptoms and masticatory functions in patients with skeletal Class III malocclusion. Nineteen adult patients with severe skeletal Class III malocclusion (Class III group) and 20 adults with normal occlusion (control group) participated in this study. The results of the Carlsson-Dent self-administered questionnaire (QUEST) and the frequency scale for the symptoms of GERD (FSSG) were compared between the 2 groups, along with occlusal contact area, maximal voluntary bite force, and salivary flow rate. The QUEST and FSSG scores were significantly higher in the Class III group. Occlusal contact area and maximal voluntary bite force were significantly smaller in the Class III group. There was no significant difference in the salivary flow rates between the groups. GERD symptoms were observed more often in patients with skeletal Class III malocclusion than in normal subjects as determined by the questionnaires.

691 The Role of PPARγ Modulation in the Growth Inhibition of Hepatocellular Carcinoma Cells

Background: It has been reported that weakly acidic pharyngeal gas reflux is significantly increased in patients with reflux laryngitis. However, the diagnosis of reflux laryngitis is controversial. Therefore, we studied patients with chronic cough who responded to fulldose PPI therapy, in whom 24-hr pharyngoesophageal impedance and pH monitoring was performed. Methods: Ten patients with chronic cough responding to PPIs (CC)(24-74 yrs; 3F), 10 with GERD (GE)(20-73; 2F), and 10 healthy controls (C)(22-72; 4F) underwent ambulatory 24-hr concurrent pharyngoesophageal impedance and pH monitoring. Three types of new impedance/pH catheters (ZAI-S62C12E-14E, Sandhill Scientific Inc., CO) were used to detect esophagopharyngeal reflux with a Sleuth GER monitoring system. The subjects ate ad libitum and were instructed to record events such as coughing by using an event marker. Weakly acidic reflux was defined as a pH drop of more than 1 unit with a nadir pH > 4. The symptom association probability (SAP) method was used to analyze the relation between gastroesophageal reflux and cough. In 6 CC patients, 24-hr monitoring was repeated on treatment after 8 weeks full-dose PPI therapy. Symptoms were evaluated using Frequency scale for the symptoms of GERD (FSSG). Results: Weakly acidic pharyngeal gas reflux events were observed in 8 out of 10 CC patients, and were significantly increased in the CC versus GE or C groups (p<0.05). Acidic and weakly acidic esophagaopharyngeal reflux (EPR) events were only observed in CC patients and were always induced by swallowing and occurred during acid liquid or mixed reflux events in the proximal esophagus. Swallow-induced acidic and weakly acidic EPR was significantly increased in the CC versus GE or C groups (p<0.05). Among 10 CC patients, 9 had weakly acidic and/or acidic EPR events, while only one had pure non-acidic EPR events. This patient and 2 other CC patients showed a positive association between gastroesophageal reflux and cough on SAP analysis. In 6 CC patients, PPIs abolished swallow-induced weakly acidic and/or acidic reflux, while weakly acidic pharyngeal gas reflux events decreased significantly and symptoms improved significantly compared with before therapy (p<0.05). Conclusion: Most patients with chronic cough responding to PPIs had minor acidic gas reflux and/or swallow-induced weakly acidic and/or acidic reflux in the pharynx. A direct effect of acidic mist or acidic liquid refluxing into the pharynx was suggested to be the cause of their chronic cough. In some patients, symptoms may arise indirectly from gastroesophageal reflux via a vago-vagal reflex.

M1915 Efficacy of Addition of Prokinetics for Proton Pump Inhibitor (PPI)-Resistant Non-Erosive Reflux Disease (NERD) Patients: Significance of Frequency Scale for the Symptoms of GERD(FSSG) On Decision of Treatment Strategy

M1915 Efficacy of Addition of Prokinetics for Proton Pump Inhibitor (PPI)-Resistant Non-Erosive Reflux Disease (NERD) Patients: Significance of Frequency Scale for the Symptoms of GERD(FSSG) On Decision of Treatment Strategy

咽喉頭異常感症に対するＦスケール問診票と咽喉頭異常感スコアの検討

(Purpose) Gastroesophageal reflux disease (GERD) has been known to induce globus pharyngeus. The frequency scale for the symptoms of GERD (FSSG) is a simplified questionnaire for GERD evaluation. To clarify the relationship between an abnormal sensation in the throat and GERD, the value of such an abnormal sensation was compared with the FSSG score in patients with globus pharyngeus. (Methods) The subjects comprised 130 globus pharyngeus patients who visited our outpatient department between May 2005 and March 2007. They were all evaluated using the FSSG and questionnaire for the presence of an abnormal sensation in the throat. The patients showing an FSSG score above 8 were diagnosed with GERD. The rate of GERD patients among those presenting with globus pharyngeus, and the correlation between the FSSG score and the value of an abnormal sensation in the throat were reviewed. Twenty-two patients with GERD were administered sodium rabeprazole (proton pump inhibitor: PPI) at a dosage of 10 mg daily for 2 weeks. Their symptoms were evaluated using the questionaire both before and after treatment. (Results) Sixty-seven of the 130 (52%) patients showed an FSSG score above 8, and, therefore, were diagnosed with GERD. Although the dyspeptic symptom score of the FSSG showed a weak correlation with the value of an abnormal sensation in the throat, the total FSSG score demonstrated no significant correlation with either. Treatment with PPI was associated with a significant improvement in the FSSG score but not in the value of an abnormal sensation in the throat. The acid reflux-related symptom score of the FSSG showed a more significant improvement than the dyspeptic symptom score after PPI treatment. (Conclusion) The FSSG was therefore found to be useful for the evaluation and treatment of globus pharyngeus patients. Factors other than acid reflux, such as dyspepsia, may also have some relationship with the cause of an abnormal sensation in the throat in GERD patients.

Relationship of the frequency scale for symptoms of gastroesophageal reflux disease with endoscopic findings of cardiac sphincter morphology

Kusano et al. developed a questionnaire for the evaluation of gastroesophageal reflux disease (GERD), the frequency scale for the symptoms of GERD (FSSG). The FSSG is now widely used in Japan. We investigated the relationship between FSSG results and cardiac sphincter endoscopic findings. The subjects were 470 patients who responded to the FSSG before undergoing endoscopy. From the FSSG results, we calculated the total, acid reflux, and dysmotility scores. Endoscopic findings were assessed in terms of the anatomic-functional-pathological (AFP) classification as the A factor, or degree and type of hiatal hernia, and the valve factor, or laxity of the cardiac sphincter. The degree of esophagitis was assessed using the modified Los Angeles classification. We investigated correlations between each score and the anatomy of the cardia. With either definition of esophagitis (grade M or greater, or grade A or greater), the total and acid reflux scores were both significantly higher in the group with reflux esophagitis than in the group without reflux esophagitis. Examination of the relationship between FSSG scores and the A factor revealed no significant differences in the total, acid reflux, or dysmotility scores whether a hiatal hernia was present or absent. Similarly, examination of the valve factor showed no significant difference in any scores between V0 and V1 versus V1 and V2, indicating no correlation between cardiac sphincter laxity and FSSG scores. The FSSG was useful in determining whether reflux esophagitis is present, but it did not predict the anatomy of the cardia.

Frequency scale for symptoms of gastroesophageal reflux disease predicts the need for addition of prokinetics to proton pump inhibitor therapy

Proton pump inhibitor (PPI) monotherapy cannot cure all cases of gastroesophageal reflux disease (GERD), and combination therapy with prokinetics and PPI achieves symptomatic improvement for some GERD patients. Few studies have been performed to predict the need for prokinetics. Subjects were 163 patients (64 male, mean age 53.1 +/- 16.6 years) with GERD symptoms. They were evaluated using the frequency scale for the symptoms of GERD (FSSG), a GERD-specific questionnaire developed in Japan(1) and endoscopy. They were administered with rabeprazole 10 mg daily. At 12 and 24 weeks of treatment, subjects were offered a choice of four treatment regimens according to their degree of satisfaction (1, no need for further treatment; 2, opt for continued PPI treatment; 3, step-down to H2RA; 4, dissatisfied with present treatment, so opt for combination treatment with prokinetics, mosapride 5 mg tid). The choice of treatment after 12 weeks of treatment placed 79.1% of subjects in the satisfied group (1, 21; 2, 98; 3, 10). After 24 weeks, 98.2% of subjects were in the satisfied group. Pretreatment FSSG scores were significantly higher in the dissatisfied group (4, 17.4 +/- 1.4) than in the satisfied group (1, 12.3 +/- 1.3; 2, 12.8 +/- 0.8; 3, 10.2 +/- 1.8) (P < 0.05). The satisfaction rate with these treatment regimens was 98.2% at 24 weeks, suggesting that combination therapy with prokinetics was effective for patients dissatisfied with PPI monotherapy. The FSSG is a useful predictor of the necessity for combination therapy.

咽喉頭異常感に対する問診表Fスケールの有用性の検討

咽喉頭異常感に対する問診表Fスケールの有用性の検討