Frequency Of Reflux Research Articles

Abstract B100: Association between ambient ultraviolet radiation and risk of esophageal cancer

Abstract Background and Aims: Ecological studies have suggested an inverse relationship between latitude and risks of some cancers. However, associations between solar ultraviolet radiation (UVR) exposure and esophageal cancer risk have not been fully explored. We therefore investigated the association between nevi, freckles and measures of ambient UVR over the life-course with risks of esophageal cancers. Methods: We compared estimated lifetime residential ambient UVR among Australian patients with esophageal cancer (330 esophageal adenocarcinoma (EAC), 386 esophago-gastric junction adenocarcinoma (EGJAC), and 279 esophageal squamous cell carcinoma (ESCC)), and 1471 population controls. We asked people where they had lived at different periods of their life, and assigned ambient UVR to each location based on measurements from NASA's Total Ozone Mapping Spectrometer database. Freckling and nevus burden were self-reported. We used multivariable logistic regression models to estimate the magnitude of associations between phenotype, ambient UVR and esophageal cancer risk. Results: Compared with population controls, patients with EAC and EGJAC were less likely to have high levels of estimated cumulative lifetime ambient UVR (EAC OR 0.59, 95% CI 0.35 – 0.99, EGJAC OR 0.55, 0.34 – 0.90). We found no association between UVR and risk of ESCC (OR 0.91, 0.51 – 1.64). The associations were independent of age, sex, BMI, education, state of recruitment, frequency of reflux, smoking status, alcohol consumption, and H.pylori serostatus. Cases with EAC were also significantly less likely to report high levels of nevi than controls. Conclusion: These data show an inverse association between ambient solar UVR at residential locations and risk of EAC and EGJAC, but not ESCC. Citation Format: Bich Tran, Robyn Lucas, Michael Kimlin, David Whiteman, Neale Rachel. Association between ambient ultraviolet radiation and risk of esophageal cancer. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B100.

Association Between Ambient Ultraviolet Radiation and Risk of Esophageal Cancer

Ecological studies have suggested an inverse relationship between latitude and risks of some cancers. However, associations between solar ultraviolet radiation (UVR) exposure and esophageal cancer risk have not been fully explored. We therefore investigated the association between nevi, freckles, and measures of ambient UVR over the life-course with risks of esophageal cancers. We compared estimated lifetime residential ambient UVR among Australian patients with esophageal cancer (330 esophageal adenocarcinoma (EAC), 386 esophago-gastric junction adenocarcinoma (EGJAC), and 279 esophageal squamous cell carcinoma (ESCC)), and 1471 population controls. We asked people where they had lived at different periods of their life, and assigned ambient UVR to each location based on measurements from NASA's Total Ozone Mapping Spectrometer database. Freckling and nevus burden were self-reported. We used multivariable logistic regression models to estimate the magnitude of associations between phenotype, ambient UVR, and esophageal cancer risk. Compared with population controls, patients with EAC and EGJAC were less likely to have high levels of estimated cumulative lifetime ambient UVR (EAC odds ratio (OR) 0.59, 95% confidence interval (CI) 0.35-0.99, EGJAC OR 0.55, 0.34-0.90). We found no association between UVR and risk of ESCC (OR 0.91, 0.51-1.64). The associations were independent of age, sex, body mass index, education, state of recruitment, frequency of reflux, smoking status, alcohol consumption, and H. pylori serostatus. Cases with EAC were also significantly less likely to report high levels of nevi than controls. These data show an inverse association between ambient solar UVR at residential locations and risk of EAC and EGJAC, but not ESCC.

Increased Risk for Persistent Intestinal Metaplasia in Patients With Barrett's Esophagus and Uncontrolled Reflux Exposure Before Radiofrequency Ablation

Radiofrequency ablation (RFA) is a safe alternative to esophagectomy for patients with dysplastic Barrett's esophagus (BE). Although some studies have indicated that RFA is effective at eradicating dysplasia, most have found that RFA is not as effective in eradicating intestinal metaplasia. We investigated whether uncontrolled reflux is associated with persistent intestinal metaplasia after RFA. Thirty-seven patients with BE underwent RFA, high-resolution manometry, and 24-hour impedance-pH testing; they received proton pump inhibitors twice daily. Patients returned every 2 months for repeat treatment or standard surveillance. Patients were classified as complete responders (CRs) if all intestinal metaplasia was eradicated in fewer than 3 ablation sessions. We analyzed clinical parameters to identify factors associated with a CR or incomplete responder (ICR). Among the 37 patients, 22 had a CR and 15 had an ICR. Mann-Whitney U tests revealed that length of BE, size of hiatal hernia, and frequency of reflux, but not acid reflux, differed between CRs and ICRs. CRs had fewer weakly acidic events than ICRs (29.5 vs 52; P < .05) and total reflux events (33.5 vs 60; P < .05), and a trend toward fewer weakly alkaline events (1.0 vs 5.0; P = .06). No other clinical or manometric features differed between groups. Uncontrolled, predominantly weakly acidic reflux despite twice-daily proton pump inhibitor therapy before RFA increases the incidence of persistent intestinal metaplasia after ablation in patients with BE. Length of BE and size of hiatal hernia also were associated with persistent intestinal metaplasia after RFA.

Sa1387 Prolonged Acid Exposure in Children With Cystic Fibrosis is Not Due to Increased Frequency of Acid Gastroesophageal Reflux but Rather to Delayed Chemical Clearance of Acid Gastroesophageal Reflux

Sa1387 Prolonged Acid Exposure in Children With Cystic Fibrosis is Not Due to Increased Frequency of Acid Gastroesophageal Reflux but Rather to Delayed Chemical Clearance of Acid Gastroesophageal Reflux

Mo1069 Effect of Oral Administration of a New Proton Pump Inhibitor E3710 on 24-h Intra-Gastric pH in Japanese Subjects

Background and Aims: Due to recurring nature of GERD, Most patients require long term maintenance therapy and continuous medication of proton pump inhibitor (PPI) is an adequate option for patients with erosive esophagitis. The aim of this study was to evaluate the efficacy and cost minimization analysis of omeprazole 10 mg once daily and rabeprazole 10 mg once daily for 24 weeks in the maintenance of remission Methods:This is randomized, open-label study enrolled 279 patients with erosive esophagitis A or B (LA classification) and typical GERD symptoms. Patients who showed complete endoscopic and symptomatic healing after 8 weeks PPI treatment were randomly allocated to maintenance treatment with omeprazole 10mg once daily or rabeprazole 10mg once daily for 42 weeks. The primary efficacy endpoint was the proportion of patients with symptomatic remission at 42 weeks. Secondary assessments included healing of reflux esophagitis, severity and frequency of reflux symptoms and cost-minimization analysis in the maintenance phase Results:At the end of 42 weeks of maintenance therapy, 96.4% of omeprazole treated and 95.1% of rabeprazole treated patients remained symptom free (P>0.05). Omeprazole and rabeprazole were also similarly efficacious in terms of endoscopic non-relapse rate for RE with 93.3% of patients on omeprazole and 97.5% of patients of rabeprazle. (P>0.05) Two drugs were also comparable with regard to severity and frequency of reflux symptoms duringmaintenance phase. (P>0.05) In the cost-minimization analysis, The mean total costs per patient for remaining symptom free within 6 months was 241,775 won in omeprazole and 287,115 won in rabeprazole, respectively.(as if 24 November 2011, 1 USD= 1,176.33 won) Conclusions:Omeprazole 10mg appeared to have a similar efficacy in maintaining symptomatic remission as rabeprazole 10 mg, but had a lower total cost per patient than rabeprazole 10mg.

Mo1066 A Multi-Center, Randomized, Double Blinded, Phase 4 Clinical Trial to Assess the Efficacy and Cost Effectiveness of Omeprazole Compare to Rabeprazole in the Maintenance Therapy of Patients With Gastroesophageal Reflux Disease

Background and Aims: Due to recurring nature of GERD, Most patients require long term maintenance therapy and continuous medication of proton pump inhibitor (PPI) is an adequate option for patients with erosive esophagitis. The aim of this study was to evaluate the efficacy and cost minimization analysis of omeprazole 10 mg once daily and rabeprazole 10 mg once daily for 24 weeks in the maintenance of remission Methods:This is randomized, open-label study enrolled 279 patients with erosive esophagitis A or B (LA classification) and typical GERD symptoms. Patients who showed complete endoscopic and symptomatic healing after 8 weeks PPI treatment were randomly allocated to maintenance treatment with omeprazole 10mg once daily or rabeprazole 10mg once daily for 42 weeks. The primary efficacy endpoint was the proportion of patients with symptomatic remission at 42 weeks. Secondary assessments included healing of reflux esophagitis, severity and frequency of reflux symptoms and cost-minimization analysis in the maintenance phase Results:At the end of 42 weeks of maintenance therapy, 96.4% of omeprazole treated and 95.1% of rabeprazole treated patients remained symptom free (P>0.05). Omeprazole and rabeprazole were also similarly efficacious in terms of endoscopic non-relapse rate for RE with 93.3% of patients on omeprazole and 97.5% of patients of rabeprazle. (P>0.05) Two drugs were also comparable with regard to severity and frequency of reflux symptoms duringmaintenance phase. (P>0.05) In the cost-minimization analysis, The mean total costs per patient for remaining symptom free within 6 months was 241,775 won in omeprazole and 287,115 won in rabeprazole, respectively.(as if 24 November 2011, 1 USD= 1,176.33 won) Conclusions:Omeprazole 10mg appeared to have a similar efficacy in maintaining symptomatic remission as rabeprazole 10 mg, but had a lower total cost per patient than rabeprazole 10mg.

Evaluation and Outcome of Antenatal Hydronephrosis:A Prospective Study

Antenatal hydronephrosis (AHN), defined as dilatation of renal pelvis and/or calyces, is the most frequently detected antenatal abnormality. However, postnatal management of AHN is controversial. The purpose of this study was to describe the clinical outcomes of infants with AHN and to contribute to the definition of the postnatal evaluation of these patients. One hundred and thirty-six infants with AHN were prospectively followed up to 18 months. Patients were divided into two groups according to the degree of sonographic hydronephrosis (HN) on days 5–7: group I (n = 87, 64%) included patients who had grades 1 and 2 (64%) and group II (n = 49, 36%) included patients who had grade 3 and above HN. The grade of HN was found to be correlated with the increased risk of urologic pathologies. Frequency of vesicoureteral reflux was found to be significantly lower in patients with mild HN (6%) as compared to patients with severe AHN (29%) (p = 0.005). In addition, the risk of urinary tract infection increases with increasing grades of HN (10% vs. 29%, p = 0.006). The frequency of spontaneous resolution in patients with mild AHN (64%) was also significantly higher than in patients with severe HN (29%) (p < 0.001). The degree of AHN can be used for making decision about further diagnostic imaging and treatment. Our results strongly suggest that low-grade HN is a relatively self-limited condition and needs minimal investigation. In contrast, the outcome of more severe degrees of AHN needs clarification.

Supragastric belches are the main determinants of troublesome belching symptoms in patients with gastro‐oesophageal reflux disease

Patients with gastro-oesophageal reflux disease (GERD) frequently report excessive belching but it is not known what determines the severity of these complaints. To determine what causes troublesome belching symptoms in GERD patients. We included 90 consecutive patients who were referred for ambulatory 24-h pH-impedance measurement as part of the analysis of reflux symptoms. Overall severity of belching was reported by the patients using a 3-point scale. Furthermore, each belch perceived during the ambulatory measurement was reported by the patients using a symptom diary. No significant differences in frequency of gastric belches or combined liquid reflux and gastric belches were observed. However, the number of supragastric belches was significantly higher in patients with severe belching complaints compared to patients with moderate and none to mild complaints. Moreover, the number of supragastric belches which coincided with a liquid reflux episode was significantly higher in patients with severe complaints than in those with moderate and none to mild complaints. Per-patient analysis showed that belches coinciding with a liquid reflux event were more often symptomatic than isolated belches. The type of belch determines the burden of belching complaints in patients with GERD. Supragastric belches, not gastric belches determine the severity of belching complaints.

Comparison of patients of chronic laryngitis with and without troublesome reflux symptoms

Little is known about the difference between patients of chronic laryngitis with and without troublesome reflux symptoms. The aim of this study was to compare the clinical characteristics and response to acid suppression between patients of chronic laryngitis with and without troublesome reflux symptoms. Consecutive patients with chronic laryngitis were enrolled. The frequency and severity of reflux and laryngeal symptoms were scored. All the patients underwent laryngoscopy, esophagogastroduodenoscopy and 24-h multichannel intraluminal impedance and pH monitoring before receiving rabeprazole 10 mg b.i.d. for 3 months. Mild typical reflux symptoms (heartburn or regurgitation) occurring ≥ 2 days/week or moderate/severe symptoms occurring ≥ 1 day/week were defined as troublesome reflux symptoms. Compared to patients without troublesome reflux symptoms, those with troublesome reflux symptoms were older and had more episodes of acid and liquid gastroesophageal reflux (GER) and acid and weakly acidic laryngopharyngeal reflux (LPR). They also had higher percentages of both bolus exposure time and acid exposure time of GER and LPR. Patients with troublesome reflux symptoms responded to acid suppression more often at 12 weeks (67.3% vs 20.9%, P < 0.001) and more rapidly (40.8% vs 14.0%, 3 weeks after the start of acid suppression; P = 0.004) compared to those without. Difference in reflux profile of GER and LPR between patients with and without troublesome reflux symptoms could partly explain the discrepancy of response to acid suppression among patients with chronic laryngitis. Acid suppression therapy may provide limited therapeutic benefits to patients of chronic laryngitis without troublesome reflux symptoms.

Twice-daily proton pump inhibitor therapy does not decrease the frequency of reflux episodes during nocturnal recumbency in patients with refractory GERD: analysis of 200 patients using multichannel intraluminal impedance-pH testing

Over half of patients with gastroesophageal reflux disease (GERD) report nocturnal symptoms. Proton pump inhibitors (PPIs) are the main medications used to treat GERD. Multichannel intraluminal impedance with pH (MII-pH) monitoring is the most sensitive method for detection and characterization of GERD. The aim of this study was to assess and compare reflux frequency in patients with refractory GERD symptoms on and off PPI therapy during the nocturnal recumbent period, as assessed by MII-pH testing. We analyzed 24-hour MII-pH studies performed in 200 patients monitored either on twice-daily (n = 100) or off (n = 100) PPI therapy. Demographic analysis of the on-therapy group revealed a mean age of 52 years (24-78 years) with 37% males, and the off-therapy group revealed a mean age of 49 years (18-84 years) with 40% males. All studies were interpreted to assess and characterize the number of acid and nonacid reflux episodes in the nocturnal recumbent period identified by each patient on an overnight recorder (Zephyr, Sandhill Scientific, Inc., Highlands Ranch, CO, USA). The nocturnal recumbent period was the period documented by patients during which they lie in the recumbent period at night to sleep with average periods lasting 456 and 453 minutes for patients on and off PPI therapy. There were more mean recumbent reflux episodes in the on-therapy group in comparison with the off-therapy group (3.76 mean reflux episodes [mre] per patient in the recumbent vs. 2.82 mre); the difference was not statistically significant (P = 0.187). When the reflux events are classified into acid and non-acid reflux episodes, the relative occurrence of acid reflux events is less in the on-therapy group (P = 0.047), while the off-therapy group have fewer nonacid reflux episodes (P = 0.003). PPIs decrease the acidity of esophageal refluxate but do not decrease the relative frequency of reflux episodes in the recumbent position in patients with refractory GERD despite twice-a-day treatment with PPI therapy. The explanation for the finding of numerically increased, although not statistically significant, amount of reflux episodes in the PPI treatment group in this study, and previous studies is unclear and warrants further evaluation.

Extraesophageal gastroesophageal reflux disease (GERD) symptoms are not more frequently associated with proximal esophageal reflux than typical GERD symptoms

Extraesophageal (EE) symptoms such as cough and throat clearing are common in patients referred for reflux testing, but are less commonly associated with gastroesophageal reflux disease (GERD). Patients with reflux associated EE symptoms often lack typical GERD symptoms of heartburn and regurgitation. Our aim was to compare the frequency of proximal esophageal reflux between esophageal (typical) symptoms and EE (atypical) symptoms. Combined multichannel intraluminal impedance-pH (MII-pH) tracings were blinded by an investigator so that symptom markers were relabeled with a number without disclosure of symptom type. We selected 40 patients with at least five reflux-related symptom events for one of four symptoms (heartburn, regurgitation, cough, or throat clearing). A blinded investigator analyzed all 200 reflux episodes, reporting the proximal esophageal extent of the reflux for all symptoms. The percentage of symptom-related reflux extending proximally to 17 cm above the LES was similar among all four symptom types. At least 50% of all symptoms were associated with proximal esophageal reflux to 17 cm, with regurgitation having the highest frequency at 60%. Our data indicate that EE symptoms are not more frequently associated with proximal esophageal reflux than typical esophageal symptoms.

What is the best reconstruction method after distal gastrectomy for gastric cancer?

We performed this prospective randomized study to evaluate what is the best reconstruction method after distal gastrectomy for gastric cancer. One hundred fifty-nine patients who underwent laparoscopy-assisted or open gastrectomy for gastric cancer were analyzed from March 2006 to August 2007. Billroth I (B-I) anastomosis, Billroth II (B-II) with Braun anastomosis, and Roux-en-Y (R-Y) anastomosis were applied randomly. Additionally, the patients were divided into two groups based on treatment type: laparoscopic and open operation. Endoscopy and hepatobiliary scans were performed to investigate gastric stasis and enterogastric reflux. The Gastrointestinal Quality of Life Index (GIQLI) was used to evaluate postoperative quality of life, and the hematologic test was used to assess nutritional aspect. Endoscopy revealed that reflux after the R-Y anastomosis procedure was significantly less frequent than after the other anastomosis types at 12 months. Comparison of the GIQLI and the nutritional parameters between the reconstruction types revealed that there were no differences, but a significantly higher GIQLI score was observed in the laparoscopic group immediately following the procedure (P = 0.042). R-Y anastomosis is superior to B-I and B-II with Braun anastomosis in terms of frequency of bile reflux, despite the fact that there is no difference in the postoperative quality-of-life index and nutritional status between reconstructive procedures. The laparoscopic approach is the better option than open surgery in terms of QOL in the immediate postoperative period.

AGE, BODY MASS INDEX AND SEVERITY OF PRIMARY CHRONIC VENOUS DISEASE

The aim of this cross-sectional prospective study was investigate whether there is a correlation between age, BMI and severity of chronic venous disease (CVD), evaluated clinically (CEAP classification) and anatomically (extent of the epifascial venous reflux). 213 patients, 65 males (30.5%, mean age 45.1 ± 13.9 years) and 148 females (69.5%, mean age 47.5 ± 13.5 years) were divided into three age categories: 18-40 years (40.8%), 41-74 years (56.3%) and ≥75years (2.8%). BMI was classified as normal weight (18.5 - <25 kg/m(2)), overweight (25 - <30 kg/m(2)) and obesity (≥30 kg/m(2)). Clinical examination of the lower limbs assessed presence and severity of venous signs as included in the CEAP classification. BMI was calculated. Anatomical extent of CVD was described as the number of segments of the superficial and perforating veins with documented reflux by duplex imaging. Median age increased the number of insufficient venous segments (1 insufficient venous segment - median age 41.0 years, 5 insufficient venous segments - median age 51.0 years). The frequency of reflux in the superficial and perforating veins significantly increased with age (p<0.05). A statistically significant correlation was also found between age and the CEAP classification (p<0.01). This was more significant than the correlation between age and number of insufficient venous segments. In the whole group and in women the Spearman's correlation analysis revealed only a weak positive correlation between BMI and reflux in the superficial veins (r=0.145 respectively r=0.264) (p<0.05). No correlation was found in men (r=0.091). Weak positive correlation between BMI and stage of venous insufficiency (CEAP classification) was demonstrated for the whole group of patients (r=0.229, p<0.01), for women (r=0.293, p<0.05) and for men (r=0.245, p<0.01). Multiple linear regression showed age (p<0.0001) and BMI (p=0.049) as significant predictors of clinical grade according to the CEAP classification and the CEAP clinical class (p<0.0001) as a significant predictor of extent of the epifascial venous reflux. The study confirmed the relationship between age, clinical (CEAP clinical class) and pathophysiological (extent of the venous reflux) severity of CVD Older age means an increased number of insufficient venous segments and increased risk of the clinical progression of CVD from varicose veins to chronic venous insufficiency (C(3)-C(6), trophic skin changes and venous ulcers). Our results support the BMI, in term of frequency of venous reflux, as a risk factor in the whole group of patients but only in women but not in men. Multiple linear regression showed BMI together with age as significant predictors of clinical grade of CVD (p<0.05) according to the CEAP classification. As regards the influence of BMI on clinical severity/grade of CVD (CEAP), the results of our study support BMI as an important risk factor.

The Efficacy of the Upright Position on Gastro-Esophageal Reflux and Reflux-Related Respiratory Symptoms in Infants With Chronic Respiratory Symptoms

PurposeGastro-esophageal reflux (GER), particularly non-acid reflux, is common in infants and is a known cause of chronic respiratory symptoms in infancy. Recent guidelines recommended empirical acid suppression therapy and the head-up position in patients with suspected GER. However, the efficacy of the upright position in relieving GER and reflux-related respiratory symptoms in infants is unclear. We conducted this study to investigate the efficacy of the upright position on GER and reflux-related respiratory symptoms in infants with chronic respiratory symptoms.MethodsThirty-two infants (21 male; median age, 5 months; range, 0 to 19 months) with unexplained chronic respiratory symptoms underwent multi-channel intraluminal esophageal impedance and pH monitoring. We retrospectively compared the frequencies of GER and reflux-related symptoms according to body position.ResultsA mean of 3.30 episodes of reflux per hour was detected. Overall, refluxes were more frequent during the postprandial period than the emptying period (3.77 vs. 2.79 episodes/hour, respectively; P=0.01). Although there was no significant difference in the total refluxes per hour between the upright and recumbent positions (6.12 vs. 3.77 episodes, P=0.10), reflux-related respiratory symptoms per reflux were significantly fewer in infants kept in an upright position than in a recumbent position during the postprandial period (3.07% vs. 14.75%, P=0.016). Non-acid reflux was the predominant type of reflux in infants, regardless of body position or meal time.ConclusionsThe upright position may reduce reflux-related respiratory symptoms, rather than reflux frequency. Thus, it may be a useful non-pharmacological treatment for infantile GER disease resistant to acid suppressants.

Nephromegaly is a Significant Risk Factor for Renal Scarring in Children With First Febrile Urinary Tract Infections

We determined whether nephromegaly on ultrasound can be used to identify patients with urinary tract infection at increased risk for renal scarring, and we investigated the effect of vesicoureteral reflux on renal scarring. We enrolled hospitalized patients with a first febrile urinary tract infection. All patients underwent renal ultrasound and most patients underwent voiding cystourethrography. Renal scarring was assessed using (99m)technetium dimercapto-succinic acid renal scintigraphy at least 6 months after treatment. Children with recurrent urinary tract infections before scintigraphy were excluded from the study. A total of 545 children (80 with and 465 without nephromegaly) were enrolled. Infection was more severe in patients with than without nephromegaly. The incidence of renal scarring was significantly higher in patients with nephromegaly (90% vs 32%, p <0.001), in kidneys with nephromegaly (80.5% vs 18.7%, p <0.001) and in kidneys with vesicoureteral reflux (41.5% vs 22.2%, p <0.001). Kidneys with nephromegaly had a greater incidence of reflux. The finding of nephromegaly is associated with a greatly increased likelihood of renal scarring in patients with vesicoureteral reflux. Our results indicate that ultrasound diagnosis of nephromegaly at onset is associated with a high incidence of renal scarring, and identification of nephromegaly at onset and vesicoureteral reflux are significant risk factors for renal scarring in children with a first febrile urinary tract infection. Nephromegaly is associated with an increased frequency of vesicoureteral reflux and increased likelihood of renal scarring in patients with reflux.

Effect of Sex on Symptoms Associated With Gastroesophageal Reflux

Previous research suggests that females have a poorer outcome than do males after surgery for gastroesophageal reflux. To evaluate reflux and esophageal symptoms in males and females in a community sample and in patients undergoing antireflux surgery. Face-to-face interview. A South Australian community. Random sample of 2973 individuals from the community and 2153 patients presenting for antireflux surgery. In a random sample of 2973 individuals from the community, the prevalence of reflux and other esophageal symptoms was determined and compared with symptoms in 2153 patients presenting for antireflux surgery. Identical questions were used to assess frequency and severity of heartburn and dysphagia and medication use. Analog scales assessed heartburn and dysphagia (0 indicating no symptoms and 10, severe symptoms). Outcomes for males vs females were compared across both groups. In the community, females were more likely to report heartburn, and when reported, symptom severity was higher. The prevalence of dysphagia was similar for males and females, although females reported higher dysphagia scores for solid foods. A similar proportion of males and females took antireflux medications. Females presenting for antireflux surgery were, on average, 7 years older than males, had a higher body mass index, and had higher heartburn and dysphagia symptom scores. At endoscopy, men were more likely to have ulcerative esophagitis and Barrett esophagus, and at surgery they were less likely to have a hiatal hernia. Significant differences were noted between males and females in the frequency and severity of gastroesophageal reflux-associated symptoms in the community and in patients presenting for surgery. These might reflect differences in symptom perception, which explain previously reported better outcomes in men undergoing antireflux surgery.

Percutaneous Endoscopic Gastrostomy Prevents Gastroesophageal Reflux in Patients with Nasogastric Tube Feeding: A Prospective Study with 24-Hour pH Monitoring

Background/AimsPercutaneous endoscopic gastrostomy (PEG) has been widely used for patients with swallowing dysfunction. However, its beneficial effects in the treatment of gastroesophageal reflux (GER) are controversial. The aim of this study was to evaluate the effect of PEG on the prevention of GER in patients with nasogastric tube (NGT) feeding.MethodsContinuous 24-hour pH monitoring was performed prospectively in 21 patients receiving NGT feeding before and 7.3±2.2 days after PEG placement to compare the severity of GER.ResultsWe studied 21 patients with a mean age of 59.8±14.1 years. The mean duration of NGT placement was 5.8±5.4 months. The causes of swallowing dysfunction included cerebral infarction, cerebral hemorrhage and other central nervous system (CNS) lesions. When all of the patients were considered, there were no significant differences in reflux parameters after PEG placement compared to before PEG placement. However, all seven patients who had preexisting GER showed significant improvement (p<0.05) of the reflux parameters, including the frequency of acid reflux, duration of acid reflux, total time with a pH below 4.0 and the fraction of time with a pH below 4.0, after PEG placement.ConclusionsPEG might prevent GER in patients receiving NGT feeding, especially in those patients with GER.

Helicobacter pylori infection and the risks of Barrett's oesophagus: A population‐based case–control study

Infection with Helicobacter pylori is associated with significantly reduced risks of oesophageal adenocarcinoma; however, few studies have examined the association between H. pylori and Barrett's oesophagus (BO), the precursor lesion. We explored the relationship between H. pylori infection and BO and sought to identify potential modifiers. We compared the prevalence of positive H. pylori serology among 217 adults with simple BO (without dysplasia), 95 with dysplastic BO and 398 population controls sourced from the metropolitan Brisbane area. We determined H. pylori serostatus using enzyme-linked immunosorbent assay. To estimate relative risks, we calculated odds ratios (OR) and 95% confidence intervals (CI) using multivariable logistic regression in the entire sample and stratified by factors known to cause BO. The prevalence of H. pylori seropositivity was 12%, 3%, and 18%, respectively, among patients with simple BO, dysplastic BO and population controls. BO patients were significantly less likely to have antibodies for H. pylori (Simple BO: OR = 0.51, 95% CI: 0.30-0.86; Dysplastic BO: OR = 0.10, 95% CI: 0.03-0.33) than population controls. For simple BO, the association was diminished after adjustment for frequency of gastro-oesophageal reflux (GOR) symptoms. Adjustment for frequency of GOR symptoms did not substantially alter the observed effect for dysplastic BO. Although there was some variation in the magnitude of risk estimates across strata of age, sex, GOR symptoms and use of proton pump inhibitors or H2-receptor antagonists, the differences were uniformly nonsignificant. Helicobacter pylori infection is inversely associated with BO, and our findings suggest that decreased acid load is not the only mechanism underlying the H. pylori protective effect.

Symptom Association in Ambulatory Gastro-Esophageal Reflux Monitoring: A Systematic Analysis

Introduction The diagnosis of gastro-oesophageal reflux disease (GORD) by ambulatory reflux monitoring is based on oesophageal acid exposure time (AET) or temporal association of reflux events with patient symptoms. Several key issues required for reflux-symptom association, such as the most appropriate pH threshold and time window, have not been defined and current statistical analysis has important limitations: Symptom Index (SI) is a measure of an effect size, not of confidence. Symptom Association Probability (SAP) is a measure of confidence but not of size and applies the Fisher exact test inappropriately (dividing time into fixed intervals does not produce independent counts). This study presents a systematic assessment of symptom association in ambulatory gastro-oesophageal reflux monitoring data. Methods Acid reflux (pH) and symptom data were acquired by wireless pH recording (Bravo, Given Imaging). 163 consecutive patients presenting with predominantly typical reflux symptoms (heartburn, regurgitation) studied 2006–2009 with duration >3.7 days were studied (636 days). Data were exported in XML format, and analyzed by custom written program. A systematic analysis was performed. Results (1) Symptom markers A finite-state algorithm was developed to equalise patient responses, removing redundant markers in one pass with reflux detection. (2) pH threshold: Setting pH thresholds for reflux detection is not physiological and a weighted S-shaped (‘dose response9) curve could be more appropriate. This was assessed varying the centre and steepness of the curve to maximise association with SI and SAP. A steep S-curve almost indistinguishable to a threshold was found: maximum correlation SI pH threshold 4.5, correlation 0.55; SAP pH threshold 4.4, correlation 0.34. (3) time window: The frequency of reflux associated symptom markers was above baseline only during minute 1. The association in minute 2 was no higher than chance. (4) Over time (day 1–4) SI was stable; however SAP increased progressively. Both parameters increased with the frequency of reflux events. CI for SI were computed by assuming a binomial distribution (Agresti-Coull method). Conclusion A novel approach to symptom association of ambulatory reflux monitoring data is presented. Confounding due to redundant symptom markers is removed by a finite-state algorithm. Acid threshold of pH 4.5 and a time window of 1 min provided optimal correlation with SI. Computing SI with CI provides a statistically valid, single parameter that describes both size of effect and likelihood of association between reflux events and symptoms.

Symptom association in ambulatory gastro-oesophageal reflux monitoring: a systematic analysis

IntroductionThe diagnosis of gastro-oesophageal reflux disease (GORD) by ambulatory reflux monitoring is based on oesophageal acid exposure time (AET) or temporal association of reflux events with patient symptoms. Several key...