Frequent Heartburn Research Articles

S559 Heartburn Frequency and Symptom Improvement Rates of Treated Episodes when Switching From Daily to On-Demand Vonoprazan Treatment for Non-erosive Reflux Disease

S559 Heartburn Frequency and Symptom Improvement Rates of Treated Episodes when Switching From Daily to On-Demand Vonoprazan Treatment for Non-erosive Reflux Disease

IL-8, TNF-α, and IL-17 in the Development of Erosive Esophagitis and Symptom Perception in Gastroesophageal Reflux Disease (GERD)

Background: The diverse clinical characteristics of erosive esophagitis (EE) and symptom perception in patients with gastroesophageal reflux disease (GERD) remain a major challenge in understanding their underlying pathogenesis. This study aimed to investigate the association between the levels of IL-8, TNF-α, and IL-17 in serum and the presence of erosive esophagitis and symptoms related to GERD. Method: We enrolled 65 subjects presenting with GERD symptoms. Based on the findings of upper endoscopy, the subjects were categorized into two groups: (1) erosive esophagitis (EE LA grades B-D) and (2) non-erosive esophagitis (normal-EE LA grade A). Symptom perception was assessed via GERD questionnaire (GERD-Q) and the frequency scale for the symptoms of GERD (FSSG). The enzyme-linked immunosorbent assay (ELISA) method was used to analyze serum levels of IL-8, TNF-α, and IL-17. Analysis of cytokine levels between different symptoms severity was performed using the Kruskal-Wallis H test. Results: Median serum IL-8 levels were significantly higher in the erosive esophagitis group compared to those with non-erosive esophagitis (20.2 (IQR 16.9–32.2) vs. 17.7 (IQR 15.2–19.6), p < 0.05). The study found a significant association between IL-8 levels and the presence of globus symptoms (median IL8 level 46.961 (38.622–92.644) in subjects with globus vs. 18.06 (16.68–20.49) in those without globus; p < 0.05). Similarly, TNF-α levels were associated with the frequency of regurgitation symptoms (H index = 10.748; dr = 3; p < 0.05). We observed a significant correlation between IL-17 levels and the frequency of heartburn and early satiety symptoms. Conclusions: IL-8 may play a role in the development of mucosal erosion in GERD. IL-8, TNF- α, and IL-17 might be involved in the development of globus symptoms, the frequency of regurgitation, and the frequency of heartburn and early satiety, respectively. The diverse symptom phenotypes observed in patients with GERD symptoms may be mediated by distinct profiles of proinflammatory cytokines.

Efficacy of a Food Supplement Containing Lactobacillus acidophilus LA14, Peptides, and a Multivitamin Complex in Improving Gastroesophageal Reflux Disease-Related Outcomes and Quality of Life of Subjects Showing Mild-to-Moderate Gastroesophageal Reflux Disease.

Dietary interventions represent an interesting alternative to pharmacological treatments for improving the quality of life (QoL) of subjects suffering from gastroesophageal reflux disease (GERD). This randomized, double-blind, placebo-controlled study aimed to evaluate the efficacy of a food supplement (FS) containing a probiotic strain, bioactive peptides, and vitamins in relieving heartburn/dyspeptic symptoms in subjects with mild-to-moderate GERD. Fifty-six adult participants were randomly assigned to receive the placebo or the active FS for 28 days. Subjects were asked to record daily the frequency and intensity of heartburn episodes and the intake of over- the-counter (OTC) medications. GERD-QoL and self-assessment questionnaires were also completed every two weeks and at the end of the treatment, respectively. FS was effective in achieving a progressive and significant reduction of heartburn frequency and severity, with an intergroup significant difference at the end of the treatment period. FS group also reported a reduction in the OTC medication intake, whereas placebo administration did not modify the OTC intake. Results from the QoL and self-assessment questionnaires showed that FS administration achieved a progressive and statistically significant intragroup and intergroup improvement in the QoL score and a higher positive response with respect to the placebo treatment.

Prevalence and risk factors of gastroesophageal reflux disease symptoms in Mazandaran, North of Iran: A Tabari cohort study.

Gastro-esophageal reflux disease (GERD) is a very common complaint. It is a major health concern and there is paucity of information about the epidemiology of the disease and its risk factors in Iran, especially Mazandaran province (North of Iran). This study aimed at investigating the prevalence of regurgitation and the factors associated with this condition in Tabari cohort study. This was a cross-sectional study that analyzed data from Tabari cohort study. Information including the presence and frequency of heartburn and regurgitation, demographic characteristics, socioeconomic status, occupational history, history of chronic illnesses, history of alcohol and cigarette consumption were recorded. The prevalence of GERD symptoms were 27.6% (20.4% in men, and 32.4% in women, p=0.0001). The frequency of typical symptoms was significantly higher in women than that in men. The risk of developing GERD symptoms were 1.7 times higher in women (p=0.0001). The highest prevalence of GERD symptoms was found in urban areas (41.8%, p=0.0001), in people with low educational levels (48%, p=0.0001), and in participants with history of depression symptoms (36.2%, p=0.0001). The prevalence of GERD symptoms was significantly high in individuals with higher BMI (29.5%, p=0.006), greater waist to hip ratio (29.1%, p=0.0001, p=0.0001), and high waist circumference (31.7%, p=0.0001). This study showed gender, region of residence, educational level, and depression symptoms as the main risk factors for developing GERD symptoms.

The effects of ginger supplementation on common gastrointestinal symptoms in patients with relapsing-remitting multiple sclerosis: a double-blind randomized placebo-controlled trial

BackgroundGastrointestinal (GI) symptoms affect more than 80% of individuals with relapsing-remitting multiple sclerosis (RRMS). Ginger is widely known for its GI relieving properties. Therefore, we investigated the effect of ginger supplementation on common GI symptoms in RRMS patients.MethodsThis study was a 12-week double-blind parallel randomized controlled trial with a 3-week run-in period. The intervention (n = 26) and control (n = 26) groups received 500 mg ginger and placebo (as corn) supplements 3 times a day along with main meals, respectively. At the beginning and end of the trial, the frequency and severity of constipation, dysphagia, abdominal pain, diarrhea, bloating, belching, flatulence, heartburn, anorexia, and nausea were assessed using the visual analogue scale ranging from 0 to 100 mm. Totally, 49 participants completed the study. However, data analysis was performed on all 52 participants based on the intention-to-treat principle.ResultsIn comparison with placebo, ginger supplementation resulted in significant or near-significant reductions in the frequency (-23.63 ± 5.36 vs. 14.81 ± 2.78, P < 0.001) and severity (-24.15 ± 5.10 vs. 11.39 ± 3.23, P < 0.001) of constipation, the frequency (-12.41 ± 3.75 vs. 3.75 ± 1.82, P < 0.001) and severity (-13.43 ± 4.91 vs. 6.88 ± 2.69, P = 0.001) of nausea, the frequency (-9.31 ± 4.44 vs. 1.56 ± 4.05, P = 0.098) and severity (-11.57 ± 5.09 vs. 3.97 ± 3.99, P = 0.047) of bloating, and the severity of abdominal pain (-5.69 ± 3.66 vs. 3.43 ± 3.26, P = 0.069).ConclusionGinger consumption can improve constipation, nausea, bloating, and abdominal pain in patients with RRMS.Trial RegistrationThis trial was prospectively registered at the Iranian Registry of Clinical Trials (www.irct.ir) under the registration number IRCT20180818040827N3 on 06/10/2021.

Frequency of functional esophageal disorders in patients with refractory reflux symptoms in Lima, Peru

Gastroesophageal reflux disease (GERD) is a clinical condition in which gastric reflux causes symptoms or damage to the esophageal mucosa. It is managed with proton pump inhibitors, however, up to 45% of patients with suspected GERD are refractory to treatment. It is necessary to establish a true GERD diagnosis by means of a digestive endoscopy, which does not show lesions in approximately 70% of patients. In this scenario, it is necessary to perform an esophageal pH-impedance measurement, a procedure that allows to determine whether exposure to gastric acid is pathological. Of this group, patients with pathological acid exposure are diagnosed as true non-erosive reflux disease (NERD). If, in addition to not presenting esophageal lesions, they have a physiological exposure to gastric acid, they suffer from esophageal hypersensitivity or functional heartburn, which are functional disorders. These require a different approach from that of GERD or NERD, as the symptoms are not due to pathological exposure to gastric acid. The aim was to calculate the frequency of esophageal hypersensitivity and functional heartburn in patients with suspected NERD. This was a cross-sectional study. Data was collected by reviewing pH-impedance and manometry reports, 166 patients were selected. The frequency for functional disorders was 86.15%, being 46.9% for functional heartburn and 39.2% for esophageal hypersensitivity. The frequency of functional disorders was higher than that reported in previous studies. In conclusion, age, psychological conditions, dietary, cultural, ethnic or lifestyle factors inherent to our environment might play important roles in the development of functional disorders.

Gastroesophageal reflux disease in conditions of chronic stress. Review with own observation

It is known that 20 to 42% of patients receiving a proton pump inhibitor for the treatment of gastroesophageal reflux disease do not respond satisfactorily to it. This condition is called refractory gastroesophageal reflux disease. To achieve a therapeutic effect, it is advised to use H2‑receptor antagonists, alginates, baclofen or antidepressant therapy in complex treatment. Recent years, solutions containing sodium alginate have been widely used. These drugs reduce the severity and frequency of heartburn when used postprandially as adjunctive therapy to proton pump inhibitors in patients with gastroesophageal reflux disease. The alginates, available in the US and European markets, differ, with the latter containing higher concentrations of alginate, possibly contributing to higher efficiency. This is supported by some researchers reporting rapid efficacy for both postprandial and nocturnal symptoms in patients with refractory gastroesophageal reflux disease. Given the absence of significant side effects, it is advised to use alginates as an addition to proton pump inhibitors, taking into account the availability, as well as the preferences of the doctor and patient.&#x0D; The article presents modern scientific data on a widespread Gastroenterological disease — GERD in the context of the impact of stress factor on its course. The analysis was performed of the recent investigations, aimed at the study of the mechanisms of traumatic effect of psychosocial and psychoemotional stress on the functional activity of the upper gastrointestinal tract. The results of the study of the role of anxiety‑phobic and depressive disorders because of prolonged exposure to stressors were analyzed. The author presented data of his own research, which clearly demonstrated a significant increase of frequency and level of anxiety and depression under wartime stress. It has been established that combination of gastroesophageal reflux disease with anxiety and depression exacerbates the clinical manifestations of the disease and reduces the effectiveness of treatment, which requires an individual approach to the choice of therapeutic measures. It is advisable to use antacids and alginic acid preparations, as well as methods of psychological correction, along with proton pump inhibitors or instead of them.

Effect of Proton Pump Inhibitor Treatment in "PPI Non-responsive" Patients with Eosinophilic Esophagitis.

Some eosinophilic esophagitis (EoE) patients can have a decline in eosinophil count after proton pump inhibitor (PPI) treatment without achieving histologic response, but little is known about this group. We aimed to determine the effect of PPIs on reducing esophageal eosinophilia in patients deemed non-responsive to PPI therapy. We analyzed prospectively collected cohort data from newly diagnosed adults with EoE who were histologic non-responders (≥15 eos/hpf) to PPI-only therapy. Symptoms, endoscopic histologic features were assessed before and after PPI. Pre- and post-PPI treatment esophageal biopsies were read by pathologists to determine peak eosinophil counts and other histologic findings. Of 125 patients, peak eosinophil counts were 102.1 ± 69.8 and 102.9 ± 101.1 (p=0.93) before and after PPI treatment, respectively, but lamina propria fibrosis decreased from 97% to 41% (p<0.001). Heartburn frequency also decreased (19% to 11%; p=0.006), though endoscopic findings did not change. There were 75 patients (60%) who had some decrease in eosinophil counts, with 30 patients (24%) having ≥50% decrease in counts. When comparing the ≥50% and <50% decrease groups, differences in endoscopic features were identified, but the ≥50% group had improvement in eosinophil degranulation, microabscesses, spongiosis, and basal cell hyperplasia. Peak eosinophil counts did not decrease overall after PPI treatment, but symptoms of heartburn improved. Approximately a quarter had ≥50% decrease in eosinophil counts, with associated decreases in other histologic findings. Further research may consider what role PPIs have in this subset of non-responders or in combination therapies.

Lifestyle modification in the treatment of refractory gastroesophageal reflux disease and non-alcoholic fatty liver disease. A clinical case

The article presents a clinical case of refractory gastroesophageal reflux disease (GERD) in a female patient with non-alcoholic fatty liver disease and morbid obesity. A 38-year-old woman came to the clinic with complaints of heartburn up to 5–6 times a day, other manifestations of pain and dyspeptic syndromes. Morbid obesity, refractory GERD with erosive esophagitis, and hepatic steatosis were diagnosed during follow-up examination. A set of treatment measures was developed, which included lifestyle modification, proton pump inhibitors and ursodeoxycholic acid preparations. During the observation period of 16 months, a gradual decrease in body weight was accompanied by a decrease in the frequency of heartburn. As a result, the patient lost 49kg. During the control instrumental examination, a positive trend was observed in terms of sonographic and endoscopic indicators, as well as a decrease in liver stiffness according to elastography data. A review of the literature on the correlation between obesity, steatosis and reflux disease is given. Conclusion. Obesity and related fatty liver disease can be additional factors for the development of refractory GERD, and a significant reduction in body weight leads to both resolution of reflux disease and improvement of parameters characterizing the structural state of the liver.

Heartburn relief with bicarbonate-rich mineral water: results of the randomised, placebo-controlled phase-III trial STOMACH STILL

ObjectiveWe assessed whether the bicarbonate-rich mineral water Staatl. Fachingen STILL is superior over conventional mineral water in relieving heartburn.DesignMulticentre, double-blind, randomised, placebo-controlled trial STOMACH STILL in adult patients with frequent...

Dyspeptic Symptoms in Type 2 Diabetes Patients

Background: Nearly half of the patients with diabetes experience diabetic gastroparesis. Some diabetic patients present with complaints of epigastric pain, vomiting, nausea, or postprandial fullness, however only a few have severe symptoms. Objective: To determine the frequency of dyspepsia among T2DM patients. Methods: This cross-sectional study was performed in Ziauddin Hospital Kemari Branch, Karachi, Pakistan after acquiring ethical approval from the hospital ethics committee. Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ) was used to identify the presence of dyspepsia. Based on the sum of the frequency of symptoms, a cut-off value of 4 and above was used for the presence of dyspepsia. Results: A total of 368 patients were included in the study with a median age of 68.6 ± 14.2 years. The majority were females (62.8%). The mean duration of diabetes was 15 ± 10.4 years. The frequency of indigestion, heartburn, regurgitation, and nausea was 35.3%, 30.7%, 31.5%, and 11.4% respectively. Out of 368, 168 (45.7%) patients were found to have dyspepsia. The risk of dyspepsia was significantly lower among younger age, male gender, and patients having controlled glycemic status, patients doing physical activity twice a week, taking all three meals on time, and always having their breakfast early. The odds of having dyspepsia were higher among those who are currently and formerly addicted to alcohol, current and former smokers, having comorbidity, consuming &lt;8 glasses of water per day, and those who were always or sometimes sleeping within two hours of having dinner. Conclusion: This study analyzed that dyspeptic symptoms including indigestion, heartburn, and regurgitation were common in T2DM patients, and about half of these patients had dyspepsia which was common among patients with poor glycemic control and those with unhealthy lifestyles.

The Effects of Modifying Amount and Type of Dietary Carbohydrate on Esophageal Acid Exposure Time and Esophageal Reflux Symptoms: A Randomized Controlled Trial.

INTRODUCTION:This is the first randomized controlled diet intervention trial to investigate both the amount and type of carbohydrate on symptomatic gastroesophageal reflux disease (GERD).METHODS:Ninety-eight veterans with symptomatic GERD were randomly assigned to high total/high simple, high total/low simple, low total/high simple, or low total/low simple carbohydrate diet for 9 weeks. The primary outcomes were esophageal acid exposure time (AET) and total number of reflux episodes derived from 24-hour ambulatory pH monitoring. Secondary outcomes were esophageal reflux symptoms rated using the Gastroesophageal Reflux Disease Questionnaire (GERDQ) and GERD Symptom Assessment Scale (GSAS).RESULTS:Half of the subjects were White and half African American (mean age, 60.0 ± 12.5 years; mean body mass index, 32.7 ± 5.4 kg/m2). There was a significant main effect of diet treatment on AET (P = 0.001) and on the total number of reflux episodes (P = 0.003). The change in AET in the high total/low simple group (−4.3% ± 3.8%) differed significantly from the high total/high simple control group (+3.1% ± 3.7%), (P = 0.04). The reduction in simple sugar intake averaged 62 g less per day. Subjects' ratings of symptoms improved in all carbohydrate modification groups, including significant reductions in heartburn frequency, heartburn severity, acid taste in the mouth, lump/pain in the throat or chest, and sleep disturbance.DISCUSSION:A modification of dietary carbohydrate intake that targeted a substantial reduction in the intakes of simple sugars improved pH monitoring outcomes and symptoms of GERD that profoundly affect daily life. These findings provide a feasible and clinically applicable contribution to the limited objective data existing for efficacious dietary recommendations in the routine treatment and management of GERD.

Long‐term outcomes after esophagectomy for end‐stage achalasia: A bridge to a better quality of life?

AbstractObjectiveWe sought to evaluate the outcomes of patients with end‐stage achalasia (ESA) who underwent esophagectomy.MethodsAll patients who underwent esophagectomy for ESA and replied to a QoL‐centred questionnaire from 2002 to 2015 were included.ResultsOverall, 14 patients underwent esophagectomy for ESA, 12 (85.7%) patients completed the questionnaire and were included in the study. Patients were referred for esophagectomy after 18.5 median years (IQR1‐3 13.5–35.25) since presentation of symptoms. Heller's myotomy was previously performed in eight patients (66.7%). Major postoperative complications occurred in 2 (16.7%) patients. No patients required reoperation, and there was no postoperative mortality. At a median follow‐up of 84 months (IQR1‐3 60–84 months), satisfaction in postoperative symptom control was reported in 10 (83.3%) patients. Patients reported significant improvements in frequency of dysphagia (p &lt; .001), regurgitation (p = .004), heartburn (p = .034), cough (p = .003), and odynophagia (p = .001). Specifically, incidence of dysphagia for liquid food was reduced from 100% to 16.7% (p &lt; .001), for semisolid food from 81.8% to 16.7% (p = .003), and for solid food from 100% to 41.7% (p = .005).ConclusionsIn select patients suffering from long‐standing ESA, esophagectomy is feasible and is associated with good perioperative and long‐term outcomes.

The impact of low-fat and full-fat dairy foods on symptoms of gastroesophageal reflux disease: an exploratory analysis based on a randomized controlled trial.

Gastroesophageal reflux disease (GERD) is a widely prevalent condition. High consumption of dairy foods and dietary fat are associated with worse GERD symptoms. However, existing data are inconsistent and mostly based on observational studies. The purpose of this exploratory analysis of a randomized controlled trial was to investigate the impact of low-fat and full-fat dairy food consumption on GERD symptoms. Seventy-two participants with metabolic syndrome completed a 4-week wash-in diet during which dairy intake was limited to three servings of nonfat milk per week. Participants were then randomized to either continue the limited dairy diet or switch to a diet containing 3.3 servings per day of either low-fat or full-fat milk, yogurt and cheese for 12weeks. Here, we report intervention effects on the frequency of acid reflux, and the frequency and severity of heartburn, exploratory endpoints assessed by a questionnaire administered before and after the 12-week intervention. In the per-protocol analysis (n = 63), there was no differential intervention effect on a cumulative heartburn score (p = 0.443 for the time by diet interaction in the overall repeated measures analysis of variance). Similarly, the intervention groups did not differentially affect the odds of experiencing acid regurgitation (p = 0.651). The intent-to-treat analyses (n = 72) yielded similar results. Our exploratory analyses suggest that, in men and women with the metabolic syndrome, increasing the consumption of either low-fat or full-fat dairy foods to at least three servings per day does not affect common symptoms of GERD, heartburn and acid regurgitation compared to a diet limited in dairy. ClinicalTrials.gov Identifier: NCT02663544, registered on January 26, 2016.

Malignant Melanoma Disguised as Biliary Obstruction

In melanoma, symptomatic involvement of the small bowel is exceedingly rare. When melanoma spreads to the gastrointestinal tract, the prognosis worsens significantly. We present the case of a 70-year-old woman with secondary malignant melanoma of the gastrointestinal tract. Our patient, who had been treated for a stage I melanoma 4 years prior, presented with symptoms of frequent constipation, heartburn, and nausea. A biopsy of the masses on her back and axilla showed malignant melanoma. Computed tomography showed marked dilation of the common bile duct. Endoscopic retrograde cholangiopancreatography was unsuccessful owing to malignant infiltration of the ampulla. Biliary drainage via percutaneous port placement and immunotherapy were initiated.

Do obesity and diabetes increase the frequency and risk of bile reflux gastritis post-cholecystectomy?

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt; Biliary gastropathy is a disease characterized by upper abdominal pain, frequent heartburn, nausea, and vomiting of bile. It is caused by the backward flow of duodenal fluid into the stomach and esophagus.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Aim:&lt;/b&gt; A retrospective cohort study was performed to estimate the prevalence and risk factors of bile reflux gastritis secondary to cholecystectomy and to evaluate the endoscopic and histopathologic changes in gastric mucosa caused by bile reflux gastritis.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Materials and methods:&lt;/b&gt; The study involved 64 patients with epigastric pain and/or dyspeptic symptoms during the period from January 2018 to December 2020 who presented to Zagazig University Hospitals. The subjects were divided into two groups: the control group (CG), with 30 subjects who had never undergone any biliary interventions, and the post-cholecystectomy group (PCG), consisting of 34 patients who had undergone cholecystectomy.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; The prevalence of bile reflux gastritis was 16.7% in the CG and 61.8% in the PCG. In both groups, diabetes, obesity, increased gastric bilirubin, and increased gastric pH were risk factors for bile reflux gastritis (r = 0.28, 0.48, 0.78, and 0.57, respectively). However, there were no correlations between age, sex, epigastric pain, heartburn, vomiting, and the presence of bile reflux gastritis.&lt;/br&gt; &lt;br&gt;&lt;b&gt;Discussion:&lt;/b&gt; Bile reflux gastritis is a common complication following cholecystectomy and is more common among obese and diabetic patients.&lt;/br&gt.

Эозинофильный гастрит у ребенка. Как заподозрить? Критерии диагностики

Study Objective: to investigate the association of dyspepsia and heartburn in school-age children. Study Design: A continuous epidemiological screening of heartburn and dyspepsia in school-age children was carried out using a single- point (transverse) method. Material and Methods. A total of 328 children were examined (163 boys and 165 girls, mean age 12.4 years). Heartburn was determined according to the recommendations of the international pediatric consensus on gastroesophageal reflux disease. Dyspepsia was diagnosed in accordance with the pediatric section of the Rome IV criteria. Study Results. The prevalence of dyspepsia syndrome was 14.0%, heartburn — 10.4%. Increasing age in children was a risk factor for dyspepsia. The frequency of heartburn was registered in 39.1% of patients with dyspepsia and only in 5.7% of those without dyspepsia (p &lt; 0.001). The prevalence of overlap syndrome of dyspepsia and heartburn in school-age children was 5.5%. Conclusion. The association of heartburn and dyspepsia in school-age children is a real problem that requires the attention of practitioners. Keywords: gastroesophageal reflux disease, dyspepsia, overlap syndrome, children.

Helicobacter pylori infection and related factors among pregnant women at Debre Tabor General Hospital, Northwest Ethiopia, 2021: Anemia highly related with H. pylori.

Introduction:Infection with Helicobacter pylori is one of the most frequent chronic bacterial illnesses in humans. Pregnant mothers are the populations most vulnerable to H. pylori infection. The objective of this study was to assess the prevalence of H. pylori infection and associated factors among pregnant mothers having antenatal care at Debre Tabor General Hospital, Debre Tabor, Ethiopia, 2021.Methods and materials:Institutional based cross-sectional study design was conducted on 290 pregnant women. The stool antigen test is used to detect the active presence of the H. pylori antigen in the feces. Bivariate and multivariable logistic regression analyses were carried out to assess potential factors responsible for H. pylori infection. Variables associated with the prevalence of H. pylori infection with (p-value < 0.05) were considered statistically significant.Results:The prevalence of H. pylori infection was 17.9%, with 95% (CI: 13.4%–22.3%). In all, 65.4% of H. pylori infection positive mothers had gastrointestinal problems and developed symptoms like abdominal cramp and diarrhea 1 (1.92%), loss of appetite 10 (19.23%), hiccups 9 (17.31%), abdominal pain which worsens when the stomach is empty 19 (36.54%), indigestion, and frequent heart burn 13 (25%) during the present pregnancy. Lesser frequency of handwashing practice AOR = 3.09, 95% CI (1.14–8.34), use of soap for handwashing AOR = 0.44, 95% CI (0.19–0.98), eating unwashed vegetables and fruits AOR = 2.279, 95% CI (1.03–5.04), and not being anemic AOR = 0.268, 95% CI (0.10– 0.71), were significantly associated with H. pylori infection.Conclusions:This study shows that the prevalence of H. pylori infection among pregnant women was low compared with that of the general population. Although in the lower prevalence, the level of anemia was strongly associated with the prevalence of H. pylori infection. This implies that H. pylori infection is a public health problem.

S398 Functional Heartburn and Esophageal Hypersensitivity Frequency in Patients With Refractory Gastroesophageal Reflux Symptoms: Using the Roma IV Consensus and a Series of Diagnostic Procedures in Lima, Peru

S398 Functional Heartburn and Esophageal Hypersensitivity Frequency in Patients With Refractory Gastroesophageal Reflux Symptoms: Using the Roma IV Consensus and a Series of Diagnostic Procedures in Lima, Peru

Drug-induced esophagitis: pathogenetic mechanisms of development and modern approaches to the treatment

The incidence of drug‑induced esophagitis is 3.9 cases per 100 thousand population per year. The risk factors of its development include polypharmacy in the treatment of elderly patients and patients’ polymorbidity, supine position during and within 30 minutes after taking the drug, insufficient water intake at administration of medicinal products, intake of large tablets and/or drugs in a gelatin capsule, presence of the comorbid esophageal pathology. Drug‑induced esophageal lesions appear due to both direct toxic actions of preparations and their effects on nervous system. Pathogenesis of the drug‑induced esophagitis presents the direct irritant effect and a violation of the cytoprotective barrier of the esophageal mucosa, which is especially pronounced with prolonged contact of irritants and can lead to damage to the esophageal epithelium.&#x0D; Clinical symptoms of the drug‑induced esophagitis are varied and nonspecific: chest pain, heartburn, odynophagia, dysphagia, weight loss. Endoscopy is the gold standard of diagnosis, it allows revealing the esophageal lesions (erosions, bleedings, ulcers) as well as residual fragments of drugs. The diagnosis of drug‑induced esophageal lesions is often underestimated as they are often masked with gastroesophageal reflux disease and its phenotypes. The authors present data on the efficacious use of Hyalera preparation (combination of hyaluronic acid and alginate) at the drug‑induced esophagitis. The drug provides protective, anti‑inflammatory, anti‑edematous and reparative effects on the eophageal and stomach mucosa. Hyaluronic acid and alginate have a synergistic effect, reducing the severity and frequency of heartburn, regurgitation, chest pain, protecting the esophageal mucosa, relieving symptoms of the disease and improving the quality of life of patients. Hyalera proved to be an effective agent to remove symptoms of reflux‑esophagitis, caused by administration of medicinal products.&#x0D;