Gastroesophageal Reflux Disease Group Research Articles

Increased risk of pulmonary tuberculosis in patients with gastroesophageal reflux disease.

Previous studies have suggested a close correlation between gastroesophageal reflux disease (GERD) and various respiratory disorders. However, the association between GERD and tuberculosis (TB) remains unexplored. Using data retrieved from Taiwan's National Health Insurance Research Database from 2000 to 2009, this longitudinal nationwide cohort study included a total of 63,930 patients with GERD and controls matched by age, sex and comorbidities. Risk factors associated with the development of pulmonary TB (PTB) were investigated. Active PTB was documented in 65 (0.20%) patients with GERD and 41 (0.13%) matched cohorts within 1 year of GERD diagnosis. The incidence rate of PTB in the GERD group and the matched cohort was respectively 24.1 and 15.2 cases per 10,000 person-years. In multivariate analysis, GERD was an independent risk factor for PTB (adjusted HR 1.63, 95%CI 1.10-2.40, P = 0.015). Among patients with GERD, independent predictors for PTB included older age, male sex, chronic obstructive pulmonary disease, asthma and exposure to proton pump inhibitors (PPIs). Patients with GERD have a significantly increased risk of PTB within 1 year of GERD diagnosis. Exposure to PPIs is an independent predictor for PTB among patients with GERD.

Dietary habits and gastroesophageal reflux disease in preschool children.

PurposeTo identify the relationship between dietary habits and childhood gastroesophageal reflux disease (GERD) in preschool children.MethodsWe performed a questionnaire study to analyze the relationship between dietary habits and GERD in 85 preschool children with GERD and 117 healthy children of the same age.ResultsIrregular and picky eating were more p–revalent in the GERD group than in the control group (odds ratio [OR], 4.14; 95% confidence interval [CI], 1.37–12.54 and OR, 4.96; 95% CI, 1.88–13.14, respectively). The snack preferences and the late night eating habits were significantly more prevalent in the GERD group than in the control group (OR, 3.83; 95% CI, 1.23–11.87 and OR, 9.51; 95% CI, 2.55–35.49, respectively). A preference for liquid foods was significantly more prevalent in the GERD group (OR, 9.51; 95% CI, 2.548–35.485). The dinner-to-bedtime interval was significantly shorter in the GERD group than in the control group (157.06±48.47 vs. 174.62±55.10, P=0.020). In addition, the time between dinner and bedtime was shorter than 3 hours in 47 children (55.3%) of the GERD group and 44 (37.6%) of the control group. This difference was statistical significance (P=0.015).ConclusionDietary habits such as picky and irregular eating, snack preference, a preference of liquid foods, late night eating, and a shorter dinner-to-bedtime interval had a significant correlation with GERD. Further large-scale studies are necessary to confirm our results.

喉頭専門外来を受診した咽喉頭異常感症例の検討

Globus sensation is a common symptom seen daily in ear-nose-throat (ENT) clinics. Globus is affected by multiple factors, and of these, gastroesophageal reflux disease (GERD), has been recognized as a relatively more manageable cause of globus than the other causes. However, we still commonly encounter globus patients with unclear backgrounds who require multiple diagnostic and therapeutic modalities. To provide an appropriate treatment approach and create favorable situations for these patients, we developed and applied an intramural algorithm to manage globus considering GERD, laryngeal allergy, and psychological problems as major factors of this pathology. Twenty-six patients with globus sensation who visited our voice clinic from June 2012 to March 2015 were enrolled in this study. All these patients had undergone general ENT examinations, including naso-pharyngo-laryngeal endoscopies and cervicothoracic computed tomographic scans. Upper gastrointestinal endoscopy revealed 2 cancers. Further study classified 23 patients into the GERD group and 1 patient into the allergy group. Proton pump inhibitor (PPI) therapy was successful in 11 patients of the GERD group (response rate, 47.2%). Improvement in subjective symptoms of globus were measured by the scores of questionnaires, including the F scale and Reflux Symptom Index. Significant improvement in these scores were observed 1 month after PPI prescription in the PPI-responder group in this study. Further assessment of medical history as well as the scores of questionnaires to measure the severity levels of depression (Self-rating Depression Scale) and anxiety (State-Trait Anxiety Inventory-Form JYZ, STAI) proved that relatively longer lasting symptoms (≥4 months) or relatively higher anxiety scores (STAI≥50 points) were predictive of PPI resistance. Our study results suggested that the pathology of globus is affected by multiple factors and that a multidisciplinary team approach is required for better management of this disease.

The Prevalence and Clinical Features of Non-responsive Gastroesophageal Reflux Disease to Practical Proton Pump Inhibitor Dose in Korea: A Multicenter Study.

In Korea, there are no available multicenter data concerning the prevalence of or diagnostic approaches for non-responsive gastroesophageal reflux disease (GERD) which does not respond to practical dose of proton pump inhibitor (PPI) in Korea. The purpose of this study is to evaluate the prevalence and the symptom pattern of non-responsive GERD. A total of 12 hospitals who were members of a Korean GERD research group joined this study. We used the composite score (CS) as a reflux symptom scale which is a standardized questionnaire based on the frequency and severity of typical symptoms of GERD. We defined "non-responsive GERD" as follows: a subject with the erosive reflux disease (ERD) whose CS was not decreased by at least 50% after standard-dose PPIs for 8 weeks or a subject with non-erosive reflux disease (NERD) whose CS was not decreased by at least 50% after half-dose PPIs for 4 weeks. A total of 234 subjects were analyzed. Among them, 87 and 147 were confirmed to have ERD and NERD, respectively. The prevalence of non-responsive GERD was 26.9% (63/234). The rates of non-responsive GERD were not different between the ERD and NERD groups (25.3% vs. 27.9%, respectively, p=0.664). There were no differences between the non-responsive GERD and responsive GERD groups for sex (p=0.659), age (p=0.134), or BMI (p=0.209). However, the initial CS for epigastric pain and fullness were higher in the non-responsive GERD group (p=0.044, p=0.014, respectively). In conclusion, this multicenter Korean study showed that the rate of non-responsive GERD was substantially high up to 26%. In addition, the patients with the non-responsive GERD frequently showed dyspeptic symptoms such as epigastric pain and fullness.

Special features of sleep disorders and depressive disturbances in patients with isolated gastroesophageal reflux disease and in conjunction with coronary artery disease

Aim – to study the special features of sleep disorders and depression intensity in patients with gastroesophageal reflux disease (GERD) and GERD in conjunction with coronary artery disease (CAD) by the method of questionnaire and to compare results with clinical and functional manifestations of comorbidity. Methods. There were examined 65 patients with GERD and CAD (group 1) and 29 patients with GERD (group 2). Sleep disorders and depression were studied using questionnaires: subjective sleep characteristics (SSC), (Epworth Sleepiness Scale (ESS),Beck scale for depression (BSD). Results . Sleep disorders took place in 41 (61,54 %) patients from group 1 and 13 (44,83 %) patients from group 2. The mean point of SSC was 17,75±1,98 in group 1 opposite to18,59±1,12 in group 2 (p= 0,043). The mean point of ESS was 9,75±1,59 in group 1opposite to 9,24±1,18 in group 2, p=0,103. The mean point of BDS was 11,89±4,38 in group 1opposite to 8,86±1,30 in group 2, p= 0,004. In the group 1 it was established a correlation between SSC and patient’s age (r=- 0320; p=0,0075), BSD and age (r=0,371; p=0,0024), ESS and body mass index(r=0,291; p=0,0188). There were established correlations between duration of CAD and SSC (r=-0,315; p=0,011), CAD and ESS (r=0,273; p=0,0280), CAD and BSD (r=0,379; p=0,0018), GERD heaviness and SSC (p=0,0498), BSD and SSC (r= - 0,676; p=0,000) and between BSD and ESS (r=0,583; p=0,000) in group 1. In group 2 ESS correlated with age (r=0,379; p=0,0426). Conclusions . The conjunction of GERD and CAD can be considered as two mutually potential pathological processes that have a negative effect on such indicators as sleep and psycho-emotional status of patient

Associations of Circulating Gut Hormone and Adipocytokine Levels with the Spectrum of Gastroesophageal Reflux Disease

ObjectiveThe pathogenesis of gastroesophageal reflux disease (GERD) is complex and poorly understood. We aim to investigate the association of various circulating peptide hormones with heterogenous manifestations of GERD.MethodsOne hundred and four patients that had experienced typical GERD symptoms (heartburn and/or acid regurgitation) for at least 3 episodes per week in the past 3 months were enrolled. All patients received a baseline assessment of symptom severity and frequency with the Reflux Disease Questionnaire and an upper endoscopy to classify GERD into erosive esophagitis (EE, n = 67), non-erosive esophagitis (NE, n = 37), and Barrett’s esophagus (BE, n = 8). Fifty asymptomatic subjects with an endoscopically normal esophagus were recruited as the control group. Complete anthropometric measures and blood biochemistry were obtained and fasting serum levels of adipocytokines (adiponectin and leptin) and gut hormones (ghrelin and peptide YY (PYY)) were determined by enzyme-linked immunosorbent assay in all subjects.ResultsAll circulating peptide hormone levels were not statistically different between the GERD and control groups. However, GERD patients appeared to have lower PYY levels [median (25th-75th percentile), 80.1 (49.8–108.3) vs. 99.4 (65.8–131.9) pg/ml, p = 0.057] compared with control subjects. Among the GERD patients, ghrelin levels were inversely associated with the frequency and severity of acid regurgitation. In male GERD patients, EE was associated with significantly higher PYY levels [107.0 (55.0–120.8) vs. 32.8 (28.7–84.5) pg/ml, p = 0.026] but lower adiponectin levels [6.7 (5.6–9.3) vs. 9.9 (9.6–10.6) μg/ml, p = 0.034] than NE. Patients with BE had significantly lower adiponectin levels [6.0 (5.1–9.2) vs. 9.2 (7.1–11.2) μg/ml, p = 0.026] than those without BE.ConclusionsHumoral derangement of circulating peptide hormones might participate in inflammation and symptom perception in patients suffering from GERD. Further studies to clarify the exact role of these hormones in the pathogenesis of GERD are warranted.

The Gastric Refluxate in Patients With Gastroesophageal Reflux Disease (GERD) Has a Protective Effect on Periodontal Microbiota

Introduction: Gastroesophageal reflux disease (GERD) is a common condition and among the most common conditions encountered in GI practice with up to 44% of otherwise healthy Americans suffer from heartburn symptoms at least once a month. Oral manifestations of GERD include halitosis, abnormal taste, mouth ulcerations and dental erosions. Periodontitis results from an interaction between periodontal pathogens, oral microbiota and host immune responses. The relationship between GERD, periodontal microbiota and periodontitis has not been previously performed. Accordingly the aims of the present study is to assess the relationship between GERD and periodontal hygiene using gingival indices and clinical attachment loss as outcome variables while controlling for principle confounding variables in patients with GERD compared to a control group without GERD. Methods: This prospective study was IRB-approved and patients being seen for either GERD or non-GERD conditions in the Gastroenterology Clinic were referred to be seen in the periodontal clinic in a blinded fashion. Subjects were recruited into the GERD arm with a diagnosis of GERD and the presence and frequency of typical GERD symptoms (heartburn, regurgitation, chest pain, and dysphagia) and/or atypical GERD symptoms (coughing, wheezing, hoarseness, and asthma). Subjects in either the GERD or Control arm Eligible were referred to the VAGLAHS Periodontal clinic, where a questionnaire was completed and a comprehensive dental examination was conducted by experienced examiners. Results: 56 patients were enrolled (32 with GERD and 24-aged matched controls). No significant difference between the 2 groups in reference to age, gender, race, income, education level, frequency of dental visits, professional fluoride treatments, fluoridated water history, occupational hazards, alcohol intake, smoking, diabetes, and citrus or soda intake. The GERD group had a statistically significant higher mean erosion index of 0.506 compared to 0.120 of the control group (p-value < 0.01). The highest erosion index in both groups was observed in the upper anterior sextant (test = 0.87, control = 0.34). However, the GERD group had a statistically significant lower mean gingival index of 1.076 compared to 1.385 of the control group (p < 0.01). There was a statistically significant negative correlation between lower gingival index and having a diagnosis of GERD. The GERD group had a statistically significant lower mean plaque index of 0.962 compared to 1.263 of the control group (p-value= 0.01). Conclusion: GERD patients demonstrated more erosion than non-GERD patients. However, GERD patients have less periodontal pathology compared to control subjects. These results suggest for the first time that acidic reflux in patients with GERD have a protective effect on the periodontal microbiota. The role of chronic PPI therapy on periodontal hygiene and microbiota has yet to be explored.

English

Reflux esophagitis is a common gastrointestinal disorder that affects the quality of life in patients. Esophagitis is a chronic disease that leads to inflammation of the esophagus. Ghrelin is a 28-amino acid peptide that has several endocrine and metabolic effects. The aim of this study was to investigate the effect of ghrelin on the esophagitis. Eighteen wistar rats were divided into three groups of six. Midline laparatomy was performed in the control group. In the gastroesophageal reflux disease (GERD) and GERD+Ghrelin groups, esophagitis was induced by method of Omura. Rats in GERD+Ghrelin group received 4 i.p. injections of 25 ng/g body weight ghrelin. The amount of gastric acid secretion and esophageal blood flow were measured. Gastric acid in GERD+Ghrelin group increased significantly when compared to control and GERD groups. The epithelium thickness and papillae of lamina properia length in GERD group increased significantly compared to the control group. The difference in papillae of lamina properia length between GERD and GERD+Ghrelin was statistically significant. Esophageal blood flow in GERD+Ghrelin group increased significantly in comparison with GERD group. Treatment with ghrelin could reduce esophageal mucosal damage followed by chronic exposure of acid and other gastric contents. Key words: Reflux esophagitis, ghrelin, blood flow, gastric acid, mucosal damage, rat.

Overlap of gastroesophageal reflux disease and functional bowel disorders in the general Chinese rural population.

This study aimed to investigate the prevalence of the overlap between gastroesophageal reflux disease (GERD) and functional bowel disorders (FBD) in the general population in rural areas in China. A population-based cross-sectional study was conducted in six villages in Nanmazhuang area in Lankao County (Henan Province, China) from December 2010 to October 2011. The GERD questionnaire (GerdQ) and Rome III criteria were used for the diagnosis of GERD and FBD and to determine the prevalence of GERD-FBD overlap. The response rate to the questionnaires of the patients was 91.5%. In all, 2950 of 3700 residents with a mean age of 42.4 ± 16.8 years were included. Among them, 4.8% were diagnosed with GERD and 4.6% with FBD. The proportion of respondents with FBD was significantly higher in the GERD group than that in the non-GERD group (25.53% vs 3.60%, P < 0.05). The prevalence of GERD in the FBD group was significantly higher than that in the non-FBD group (26.28% vs 3.73%, P < 0.05). The prevalence of GERD-FBD overlap in the general rural population was 1.22%. Logistic regression analysis indicated that anxiety was an independent predictor for the GERD-FBD overlap in GERD and FBD (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02-1.09 and OR 1.06, 95% CI 1.02-1.10, respectively). GERD-FBD overlap is more common than expected by chance in the general rural population, and anxiety is significantly related to the overlap.

215 Characterization of gastroesophageal reflux with combined multichannel intraluminal impedance–pH (MII-pH) in a group of children with CF

Objectives Gastroesophageal reflux (GER) is an important patogenetic factor in CF. The aim of the study was to retrospectively analyze the extent of pathological GER in a group of children with signs or symptoms of gastroesophageal reflux disease (GERD). Methods MII-pH (MMS Ohmega) was performed in children who were suspected to have GERD. On the basis of the percentage of pH less than 4 and DeMeester index patients were separated in those having no pathological reflux and in those with GERD. Patients with GERD were treated with PPI and had another MII-pH performed after average 2 months of treatment. The same parameters, including baseline impedance were compared in both groups. Results 21 children (13 females (61.9%), median age 10.3±5.4 years, percentile of BMI 27.9 +/– 29.5; no differences between both groups) with CF who underwent MII-pH during last 5 years were identified. All had symptoms and signs suggestive of GERD. Pathological GER was measured in 14 pts (66.7%). There was no difference between baseline impedance of upper and lower 2 electrodes between both groups. The group with GERD had normalization of the percentage of pathological GER and DeMeester index after the treatment with PPI (omeprazole, 1 mg/kg/BW up to 40 mg in total). There was no difference in baseline impedance before and after the treatment. Conclusion GERD is very prevalent in symptomatic children with CF. Treatment with PPI is effective in usual dosages. In our (small) sample we could not find statistical difference in baseline impedance between GERD and non-GERD group, nor before and after the treatment with PPI in the group of children with CF and GERD.

A preliminary test of gastroesophageal reflux disease questionnaire serving as auxiliary diagnosis of gastroesophageal reflux disease in infants and young children

Objective To preliminarily test the value of gastroesophageal reflux disease questionnaire(GERD-Q) in auxiliary diagnosis of gastroesophageal reflux disease(GERD) in infants and young children. Methods From January 2011 to February 2014, 148 infants and 87 young children with suspected GERD symptoms were enrolled in the outpatient and inpatient departments of Wuhan Women and Children's Medical Care Center.The diagnosis of GERD were made through 24 h esophageal pH monitoring and upper gastrointestinal hysterosalpingography.Those with any examinations being positive were brought into GERD group, and the others into the control group.All cases had been surveyed with GERD-Q.Using SPSS17.0 statistical software, the ratio was compared with chi-square test, and the difference of the scores between groups with t test. Results In infants(1 to 11 months), the individual symptom scores(ISS) of the 6 symptoms in the GERD group(n=111) were all higher than those in the control group(37 cases)(P<0.05), and the composite and symptom scores(CSS)[(131.43±66.56) scores] in the GERD group was higher than that[(33.70±40.03) scores] in the control group(t=8.42, P<0.05). In young children(1 to 3 years old), the ISS in the GERD group(55 cases) were all higher than those in the control group(32 cases), and the CSS[(98.58±66.75)scores] in the GERD group was also higher than that[(28.50±35.95)scores] in the control group(t=5.49, P<0.05). Conclusions There is a good correlation for age-specific GERD-Q to distinguish GERD symptoms in infants and young children, which is suitable for the assessment of GERD. Key words: Gastroesophageal reflux disease; Questionnaire; Auxiliary diagnosis; Infants and young children

Gastroesophageal Reflux Disease Is a Risk Factor for Severity of Organizing Pneumonia

Background: The link between organizing pneumonia (OP) and gastroesophageal reflux disease (GERD) is not well known. There is little evidence in the literature to establish a causal link between GERD and OP. Objectives: The aim of the study was to assess the hypothesis that OP is more severe when it is associated with GERD and that it leads to more frequent relapses. Methods: In a retrospective study on 44 patients suffering from OP, we compared the clinical, radiological and histological characteristics of 2 groups, 1 composed of patients with GERD (n = 20) and the other of patients without GERD (n = 24). Results: The GERD group was distinguished by a higher number of patients with migratory alveolar opacities on chest radiography and thoracic computerized tomography (14/20 vs. 9/24; p = 0.03 and 18/20 vs. 13/24; p = 0.01), greater hypoxemia [60 (42-80) vs. 70 (51-112) mm Hg; p = 0.03], greater bronchoalveolar lavage cellularity [0.255 (0.1-1.8) vs. 0.150 (0.05-0.4) g/l; p = 0.035] and more frequent relapses (14/20 vs. 9/24; p = 0.03). Conclusions: OP associated with GERD is more severe and results in more frequent relapses. Microinhalation of gastric secretions might induce lung inflammation leading to OP and relapse. We suggest that typical symptoms of GERD such as pyrosis should be investigated in OP.

Relationship between acid pocket and acid reflux in gastroesophageal reflux disease

Objective To explore the relationship between acid pocket and acid reflux in gastroesophageal reflux disease (GERD).Methods From March 2011 to January 2012,29 patients with GERD were enrolled and nine healthy individuals were set as control.All objects of this study accepted esophageal manometry test,acid pocket test,test of the occurrence time of acid pocket and ambulatory 24 hours pH monitoring.The t-test was performed for comparison between two groups.The relationship between the incidence of GERD and acid pocket was analyzed by Logistic regression analysis.Pearson correlation analysis was used for correlation analysis.Results The percentage of acid pocket in GERD group and control group was 58.6％ (17/29) and 5/9,respectively,and the difference was not statistically significantly (P＞0.05).The duration time of acid pocket was (56.3±44.7) minutes in GERD group which was longer than that of control group ((16.0±8.2) minutes) and the difference was statistically significant (t=1.970,P＜0.01).There was no statistical significance in the average pH value of acid pocket between GERD group with acid pocket (2.8 ± 1.3) and that of control group with acid pocket (1.9±0.5,P＞0.05).The duration time of acid pocket was correlated with the longest reflux time in GERD group with acid pocket (r=0.550,P＜0.01).The peak velocity of esophageal motility in GERD group ((3.3±0.6) cm/s) was lower than that of control group ((5.0±4.1) cm/s) and the difference was statistically significant (t=-1.354,P＜0.05).The peak velocity of esophageal motility in GERD group with acid pocket ((3.2±0.6) cm/s) was lower than that of control group with acid pocket ((7.2± 6.3) cm/s) and the difference was statistically significant (t=-2.693,P＜0.05).Conclusions The duration time of acid pocket in GERD is correlated with the time of acid reflux.Esophageal dysmotility may be related with the pathogenesis of GERD and the occurrence of acid pocket. Key words: Acid pocket; Gastroesophageal reflux disease; Esophageal motility disorders

Association between gastroesophageal reflux disease after pneumatic balloon dilatation and clinical course in patients with achalasia.

Background/AimsThe occurrence of gastroesophageal reflux disease (GERD) is known to be associated with lower post-treatment lower esophageal sphincter pressure in patients with achalasia. This study aimed to elucidate whether GERD after pneumatic balloon dilatation (PD) has a prognostic role and to investigate how the clinical course of GERD is.MethodsA total of 79 consecutive patients who were first diagnosed with primary achalasia and underwent PD as an initial treatment were included in this retrospective study. Single PD was performed using a 3.0 cm balloon. The patients were divided into two groups: 1) who developed GERD after PD (GERD group) and 2) who did not develop GERD after PD (non-GERD group). GERD was defined as pathological acid exposure, reflux esophagitis or typical reflux symptoms.ResultsTwenty one patients (26.6%) developed GERD after PD during follow-up. There were no significant differences between the two groups in demographic or clinical factors including pre- and post-treatment manometric results. All patients in GERD group were well responsive to maintenance proton pump inhibitor therapy including on demand therapy or did not require maintenance. During a median follow-up of 17.8 months (interquartile range, 7.1–42.7 months), achalasia recurred in 15 patients (19.0%). However, the incidence of recurrence did not differ according to the occurrence of GERD after PD.ConclusionsGERD often occurs after even a single PD for achalasia. However, GERD after PD is well responsive to PPI therapy. Our data suggest that GERD after PD during follow-up does not appear to have a prognostic role.

Association Between Non-erosive Reflux Disease and High Risk of Obstructive Sleep Apnea in Korean Population.

Background/AimsObstructive sleep apnea is becoming more important in gastroesophageal reflux disease (GERD) patients. This study investigated the prevalence of high risk for obstructive sleep apnea in GERD patients in comparison with that in healthy controls using the Berlin Questionnaire. We also investigated the risk factors for obstructive sleep apnea in GERD patients.MethodsWe enrolled 1,007 subjects: 776 healthy controls, 115 individuals with erosive reflux disease, and 116 with non-erosive reflux disease. GERD was diagnosed and classified using endoscopy and a reflux questionnaire. The Berlin Questionnaire was used to evaluate obstructive sleep apnea.ResultsMore patients in the GERD group (28.2%) had higher risk for obstructive sleep apnea than healthy controls (20.4%, P = 0.036). More patients with non-erosive disease (32.8%) had higher risk for obstructive sleep apnea (OSA) than patients with erosive disease (20.9%) and controls (20.4%, P = 0.010). On multivariate analysis, non-erosive disease was a high risk factor for obstructive sleep apnea (odds ratio [OR], 1.82; P = 0.011). Age ≥ 55 years (OR, 1.83; P < 0.001) and a high body mass index (≥ 25 kg/m2) (OR, 2.76; P < 0.001) were also identified as risk factors. Nocturnal GERD was related to high risk for OSA in non-erosive disease patients (OR, 2.97; P = 0.019), but not in erosive disease patients.ConclusionsHigh risk for OSA is more prevalent in GERD patients than in controls. Non-erosive reflux disease, age ≥ 55, and a high BMI are associated with high risk for OSA.

Laryngeal Granuloma in Experimental Rats With Gastroesophageal Reflux Disease and Mechanically Injured Vocal Cord Mucosa

This study was undertaken to elucidate the mechanisms underlying laryngeal granuloma formation in a rat model of gastroesophageal reflux disease (GERD) with mechanically injured vocal cord mucosa. The rat model of GERD was surgically created by tying the pyloric sphincter and ligating the transitional region between the forestomach and the glandular portion (limiting ridge). The control rats received only a midline incision. In all the animals, a plastic bar was inserted into the trachea, and moved vertically thrice in 3 seconds to cause mechanical injury of the vocal cord mucosa. The rats were sacrificed 2 weeks postsurgically, and their pharynx and larynx were observed histologically. Granulomas were observed in the vocal cord mucosa of the GERD group (3 of 5 animals); they presented a similar pathological structure to that of human laryngeal granulomas. In contrast, only abrasions and blisters were observed on the vocal cord mucosa in the control group (all 5 animals). The development of laryngeal granuloma may involve both mechanical injury and gastric acid reflux.

Specific Movement of Esophagus During Transient Lower Esophageal Sphincter Relaxation in Gastroesophageal Reflux Disease

Background/AimsTransient lower esophageal sphincter relaxation (TLESR) is the main mechanism of gastroesophageal reflux disease (GERD). The aim of this study was to investigate the characteristics of transient lower esophageal sphincter movement in patients with or without gastroesophageal reflux by high-resolution manometry (HRM).MethodsFrom June 2010 to July 2010, we enrolled 9 patients with GERD (GERD group) and 9 subjects without GERD (control group), prospectively. The manometry test was performed in a semi-recumbent position for 120 minutes following ingestion of a standardized, mixed liquid and solid meal. HRM was used to identify the frequency and duration of TLESR, esophageal shortening length from incomplete TLESR, upper esophageal sphincter (UES) response, and the related esophageal motor responses during TLESR.ResultsTLESR occurred in 33 in the GERD group and 34 in the control group after 120 minutes following food ingestion. Duration of TLESR and length of esophageal shortening did not differ between 2 groups. UES pressure increase during TLESR was mostly detected in patients with GERD, and UES relaxation was observed frequently in the control group during TLESR. TLESR-related motor responses terminating in TLESR were predominantly observed in the control group.ConclusionsIncreased UES pressure was noted frequently in the GERD group, suggesting a mechanism for preventing harmful reflux, which may be composed mainly of fluid on the larynx or pharynx. However, patients with GERD lacked the related motor responses terminating in TLESR to promote esophageal emptying of refluxate.

Tu1772 Comparison of Proximal and Distal Impedance Episodes in Patients With Classic Versus Extra-Esophageal Symptoms of GERD

Background: Patients are frequently referred for evaluation of extraesophageal (EXT) symptoms (cough, hoarseness, globus sensation) presumably related to gastroesophageal reflux disease (GERD). 24 hour pH/impedance is the most sensitive test for the diagnosis of GERD, however limited data exist in examining the relationship between distal and proximal impedance episodes in patients with EXT symptoms versus classic reflux symptoms. Aim: To compare the number and percentage of proximal impedance episodes in patients with EXT symptoms to those with classic GERD symptoms undergoing 24 hour pH/impedance testing. Patients & Methods: A retrospective review of adult patients undergoing esophageal manometry and 24 hour pH/impedance studies off acid suppressing therapy between 20062011 was performed. Indications for these studies included typical GERD symptoms (heartburn and regurgitation) or atypical symptoms (cough, asthma, hoarseness or globus sensation). GERD was defined using the validated Johnson-DeMeester (JD) score. The results of the esophageal manometry and 24 hour pH/impedance studies between the classic GERD and EXT groups were compared using Chi squared test and students independent t-test. Continuous data is expressed as means (sd). Results: A total of 220 patients were included in the analysis [172 GERD vs. 48 EXT]. GERD and EXT groups were similar in race and gender, however GERD patients were younger than EXT patients [46 (13) years vs. 50 (8) years, p = 0.048]. There was no significant difference between GERD and EXT in the mean number of proximal impedance episodes [33 (22) vs. 28 (22), p = 0.188], the percentage of proximal impedance episodes migrating from the distal esophagus [55 (20) % vs. 50 (17) %, p=0.178), or the mean number of distal impedance episodes [57 (33) vs. 49 (34), p = 0.157]. There was no significant difference between GERD and EXT with regards to mean lower esophageal sphincter pressures [13.3 (11) mmHg vs. 15.3 (7.8) mmHg, p = 0.251] or mean esophageal amplitude [95.4 (44.6) mmHg vs. 84.9 (41.0) mmHg, p=0.146]. Based on 24 hour pH monitoring there was no significant difference between the classic GERD and EXT groups in the JD scores [22.6 (33) vs 17.8 (22), p = 0.358] or percent total time pH ,4 [4.6 (5.3) vs. 4.2 (5.3), p = 0.642]. There was a significant correlation between the number of proximal and distal episodes between the two groups (R = 0.724, p , 0.001). Conclusion: Patients with EXT symptoms are similar to classic GERD patients in the number proximal impedance reflux episodes and percentage of distal episodes migrating to the proximal esophagus. Furthermore, both groups have a similar degree of acid reflux.

Is the Proton Pump Inhibitor Test Helpful in Patients with Laryngeal Symptoms?

The association of gastroesophageal reflux disease (GERD) and laryngeal symptoms is not clear. We aimed to examine the symptomatic and endoscopic relations between GERD and laryngeal symptoms and also to evaluate the response to a 2-week proton pump inhibitor (PPI) trial. Seventy-two patients experiencing persistent laryngeal symptoms ≥ 2/week were enrolled. The laryngeal symptoms using the 1-week laryngeal symptom score (LSS) and the typical reflux symptoms including heartburn and acid regurgitation were assessed. Transnasal-esophagogastroduodenoscopy (TN-EGD) and ambulatory 24-h esophageal pH monitoring were performed. The patients were classified into a GERD group and a non-GERD group. The GERD group was defined as the cases of the presence of typical reflux symptoms and/or reflux esophagitis and/or pathologic acid exposure. Patients were treated with 30 mg of lansoprazole bid for 14 days. Thirty-nine patients (54 %) were diagnosed with GERD on the basis of typical reflux symptoms, EGD, and/or pH testing. There was no significant association between the LSS and the presence of typical reflux symptoms. Also, the presence of laryngitis was not significantly related to reflux esophagitis. The 2-week PPI trial showed no significant difference in the improvement in laryngeal symptoms between the GERD and non-GERD groups. There was no significant symptomatic and endoscopic association between GERD and laryngeal symptoms. Therefore, GERD does not appear to be the sole cause of these symptoms. Additionally, a 2-week PPI trial is not long enough to be a diagnostic tool in patients with laryngeal symptoms.

Varying marginal ulcer rates in patients undergoing laparoscopic Roux-en-Y gastric bypass for morbid obesity versus gastroesophageal reflux disease: Is the acid pocket to blame?

BackgroundNissen fundoplication failure rates are increased in obese patients; however, conversion to laparoscopic Roux-en-Y gastric bypass (LRYGB) can resolve or improve gastroesophageal reflux disease (GERD) symptoms. Acid pockets near the gastroesophageal junction may influence these surgical outcomes. Our objective was to compare the outcomes for patients who underwent LRYGB for morbid obesity (MO) versus GERD. MethodsA retrospective review of our institution’s bariatric database was completed. Statistical analysis included t test and χ2 test. ResultsLRYGBs were performed from 2001–2011 for MO and 2009–2010 for GERD. Eighty-three percent of patients in the GERD group had undergone previous antireflux surgery. The median time from initial presentation to LRYGB was significantly shorter in the GERD versus the MO group (105 days versus 241 days; P = .009). There was an increased rate of marginal ulcers in the GERD group compared with the MO group, at 50% versus 4.5%, respectively (P = .001). Stomal stenosis was also increased in the GERD group compared with the MO group, at 8.3% and .7%, respectively (P = .091). There were no in-hospital or 30-day mortalities. ConclusionPatients undergoing LRYGB for GERD had a shorter interval to surgery and an increased rate of marginal ulcers compared with those undergoing LRYGB for MO. Operative time was longest among patients in the GERD group. The acid pocket may explain the increased ulcer rate in the GERD population. Use of a smaller sized pouch may improve this outcome.