Gastroesophageal Reflux Disease Group Research Articles

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.

Correlation between obstructive sleep apnea hypopnea syndrome and gastroesophageal reflux disease

To discuss the occurrence correlation between obstructive sleep apnea hypopnea syndrome (OSAHS) and gastroesophageal reflux disease (GERD). Forty-three patients suspected of laryngopharyngeal reflux disease underwent combined multichannel intraluminal impedance and esophageal manometry (MII-EM), twenty-four-hour esophageal and pharyngeal pH and impedance monitoring and PSG. Subjects were grouped according to the detections. The difference of the measurement between groups were Compared. The possible relationship between the two diseases was analyzed. Fourteen of all the subjects can be diagnosed to have GERD (32.6%). Twenty-six can be diagnosed to have OSAHS (60.5%). There were 10 patients had OSAHS and GERD simultaneously, which took over 38.5% of the OSAHS group, and 71.4% of the GERD group. BMI (P = 0.000) and lower esophageal sphincter (LES) residual pressure (P = 0.021) were significantly different among the four groups OSAHS, GERD, OSAHS and GERD, and control (non-OSAHS and non-GERD), but no linear relationship between LES residual pressure and prevalence or severity of the two diseases was found. In OSAHS group, AHI were positively correlated with the following indictors: the DeMeester score (r = 0.45), acid exposure of the distal esophagus (r = 0.491). There seems to be no Linear correlation among reflux indicators, sleep indicators, and esophageal functional indicators in GERD group. Linear correlation was not found among reflux indicators, sleep indicators, and esophageal functional indicators in OSAHS and GERD group (P > 0.05). The incidence and the severity of GERD and OSAHS were related to each other. Reflux events may aggravate OSAHS. The two diseases may have some relationship on the esophageal function, especially on the regulation of the LES pressure.

Psychological Factors Influence the Symptoms of Gastroesophageal Reflux Disease

TO THE EDITOR: I read with interest the study by Lee et al1 regarding the relationship between existence of typical symptoms and psychological factors in patients with erosive esophagitis. The study was conducted by enrolling 29 symptomatic and 26 asymptomatic patients with erosive reflux disease (ERD). They used the Symptom Checklist-90-Revision (Korean version, SCL-90-R)2 to identify the presence of psychological symptoms. In the SCL-90-R, each of the items is rated on a 5-point scale of distress (0-4) ranging from not at to extremely. The 9 primary symptom dimensions are labeled as: somatization (SOM), obsessive-compulsive behavior (O-C), interpersonal sensitivity (I-S), depression, anxiety, hostility, phobic anxiety (PHOB), paranoid ideation and psychoticism (PSY). There are 3 global indices as well: the global severity index is a mean score of all 90 items; the positive symptom distress index; the positive symptom total, which represents the number of symptoms rated as ≥ 1. The authors demonstrated that symptomatic patients with ERD were more likely to have higher scores on psychological symptoms (SOM, O-C and PHOB) than asymptomatic patients with ERD. The authors should be congratulated for completing study, which supports the assumption that psychological factors influence the development of symptoms in patients with gastroesophageal reflux disease (GERD). Nevertheless, I would like to consider 2 concerns for the accurate understanding of the meaning of these results. First, the significant difference in the score of SOM, O-C and PHOB between them might be rather statistically different. In Lee's study,1 the mean values for SOM, O-C and PHOB were 52.37, 46.22 and 49.59, in symptomatic ERD group respectively. I wonder whether the scores of SOM, O-C and PHOB in symptomatic ERD are higher than those in general population. Nunez-Rodriguez and Miranda Sivelo3 conducted the study using the SCL-90-R to determine association between psychological factors and GERD. In the study, the scores of SOM, O-C, I-S, depression, anxiety, hostility, PHOB, paranoid ideation and PSY were 120/55, 79/60, 64/45, 81/72, 57/52, 42/45, 37/25, 55/47 and 40/21 in GERD group and Spanish healthy population, respectively. GERD subjects had higher scores compared to healthy controls on SOM, O-C, I-S, PHOB, and PSY. Thus Lee's study might be able to provide the SCL-90-R data of healthy controls to give us a better overview of association between psychological factors and GERD symptom. Second, it is unclear whether the psychological dimensions occurred before the reflux symptoms and played an important role in the development of GERD symptoms. The psychological diseases may be a consequence of reflux symptoms. If the authors reanalyze the SCL-90-R data before and after proton pump inhibitor treatment, it would be helpful in understanding whether the GERD symptoms are influenced by psychological factors or not.

Salivary parameters and teeth erosions in patients with gastroesophageal reflux disease

In the gastroesophageal reflux disease (GERD), a highly prevalent digestive disorder, gastric content may return to the esophagus and reach the mouth, thus leading to a small number of carious lesions and high incidence of dental erosion. Since saliva plays a major role in oral homeostasis, evaluating salivary parameters is necessary in attempting to explain such outcome. This study aimed at analyzing salivary parameters (salivary flow, pH and buffering capacity), bacterial count, caries index and dental erosion in patients with GERD. Sixty patients were studied, and of these, 30 had GERD (group 1), and 30 were controls (group 2). Gastroesophageal reflux disease diagnosis confirmation was achieved by means of endoscopy, manometry and pH metric esophageal monitoring. The above mentioned salivary parameters were evaluated in patients from groups 1 and 2. The number of erosions in patients with GERD (group 1) was larger than in controls (P<0.001). The number of carious teeth was smaller in group 1 than in group 2 (P<0.001). Salivary flow (non-stimulated and stimulated) and pH did not show differences between the 2 groups (P = 0.49; P = 0.80 and P = 0.85, respectively). Salivary buffering capacity in patients with GERD showed lower values in controls (P = 0.018). The number of bacteria (Lactobacilli and Streptococci) was smaller in patients with gastroesophageal reflux disease than in controls (P = 0.0067 and P = 0.0017, respectively). It was concluded that the large number of erosions must be a result of GERD patients reduced salivary buffering capacity. The reduced number of caries of patients in group 1 can be explained by the low prevalence of bacteria (Lactobacilli and Streptococci), observed in the saliva of patients with chronic reflux.

Clinically distinct characteristics in patients younger than 40 years old with non‐cardiac chest pain

Little is known about non-cardiac chest pain (NCCP) in young patients. We aimed to examine the proportion of gastroesophageal reflux disease (GERD) in young patients with NCCP compared to the average-aged NCCP patients and to evaluate their symptomatic characteristics and the clinical efficacy of a 2-week proton pump inhibitor (PPI) trial. Ninety-six patients with NCCP≥1/week were classified into the young-aged (≤ 40 years, n =38) and the average-aged groups (>40 years, n=58). Typical reflux symptoms were assessed. The patients were defined into a GERD group and non-GERD group according to reflux esophagitis on esophagogastroduodenoscopy and/or pathologic acid exposure on 24-h esophageal pH monitoring. Then the patients were treated with 30mg of lansoprazole bid for 14 days. Nine patients (23%) in the young-aged group and 22 patients (38%) in average-aged group were diagnosed with GERD-related NCCP (P=0.144). The proportion of typical reflux symptoms was higher in the GERD group compared with the non-GERD group in both age groups. A PPI test improved symptoms in the GERD group irrespective of age, but this improvement was not observed in non-GERD group. In young NCCP patients, the prevalence of GERD was relatively low compared to average-aged NCCP, but the difference was insignificant. The PPI test was very effective in diagnosing GERD in the NCCP patients in both age groups. Therefore, in young NCCP patients, if there is a negative response to a 2-week PPI trial, the possibility of extra-esophageal disease origin needs to be considered.

Increase of Epidermal Growth Factor Receptor Expression in Progression of GERD, Barrett, and Adenocarcinoma of Esophagus

Gastroesophageal reflux disease (GERD) is a pathology with a wide range of clinical and endoscopic manifestations. Epidermal growth factor receptor (EGFR), found in the epithelium of the digestive tract, plays an important role in epithelial repair and shows increased expression in different neoplasms, including esophageal tumors. The purpose of this study was to evaluate EGFR expression using immunohistochemistry in esophageal biopsies obtained from patients with GERD, Barrett's esophagus, and adenocarcinoma of the esophagus. EGFR expression was immunohistochemically determined in biopsies from 194 patients with symptoms suggestive of GERD or adenocarcinoma of the esophagus, seen at two Brazilian university hospitals between January 2003 and December 2008. Based on histopathological analysis, patients were divided into three groups: GERD, Barrett's esophagus and adenocarcinoma of the esophagus. EGFR expression was considered positive when staining was detected in the membrane. Mean age was 55.25 years (range 30-90). Patients with GERD (n = 127) accounted for 65.5% of the sample, compared with 12.4% (n = 24) of patients with Barrett's esophagus and 22.2% (n = 43) of patients with esophageal adenocarcinoma. Immunohistochemical analysis was positive for EGFR in 19.1% of the patients (37/194), divided as follows: 8.7% (11/127) in the GERD group, 25% (6/24) in the Barrett's esophagus group, and 46.5% (20/43) in the esophageal adenocarcinoma group. Statistical analysis revealed significant differences between the three groups (p = 0.0001). GERD patients showed lower levels of EGFR expression than patients with Barrett's esophagus or patients with adenocarcinoma of the esophagus, suggesting a direct relationship between EGFR expression and disease progression.

Comparison of Distribution of Intraesophageal pH During Nighttime Recumbency Among Patients With Gastroesophageal Reflux Disease

Nighttime reflux has been demonstrated to be associated with a more aggressive presentation of gastroesophageal reflux disease (GERD). However, it has remained unknown until now if the difference in nighttime reflux between the different GERD groups is related to the distribution of intraesophageal pH level or duration of acid exposure. To compare distribution of intraesophageal pH during nighttime between patients with erosive esophagitis (EE) versus those with nonerosive reflux disease (NERD). Patients with heartburn symptoms at least 3 times per week were included in this study. Patients were not receiving any antireflux treatment. All patients underwent an upper endoscopy to determine if esophageal inflammation was present or absent. Subsequently, patients underwent ambulatory 24-hour esophageal pH monitoring. Only those with NERD and EE were included in this study. Nighttime period was defined as the time from the moment patients entered the bed to fall asleep and until they woke up the next morning. Distribution of intraesophageal pH during nighttime was generated using a special computer program that analyzed all registered pH measurements. Nineteen patients were found to have NERD and 31 EE. Time in bed was not different between the 2 groups. The mean number of acid reflux events, mean reflux time pH<4, and mean % total time pH<4 during nighttime were significantly lower in the NERD group as compared with the EE group (13.05±4.6, 19.7±7.09, 3.6±1.2% vs. 25.44±4.4, 29.3±7.97, 5.3±1.5%, respectively, all P<0.05). Symptom index for EE was 43.8% versus 21% for NERD, P<0.05. Overall, the distribution of intraesophageal pH during nighttime was similar between NERD and EE patients for all pH ranges. Patients with EE demonstrated a significantly higher nighttime esophageal acid exposure as compared with NERD, but the overall distribution of the acid exposure was similar between the 2 groups. This suggests that duration rather than intensity of nighttime intraesophageal acid exposure accounts for the difference between EE and NERD.

Atypical Symptoms Are Related to Typical Symptoms Rather Than Histologic and Endoscopic Esophagitis

Atypical Symptoms Are Related to Typical Symptoms Rather Than Histologic and Endoscopic Esophagitis

Analysis of Intersegmental Trough and Proximal Latency of Smooth Muscle Contraction Using High-resolution Esophageal Manometry

Intersegmental troughs (ISTs) between striated and smooth muscle contraction segments on high-resolution manometry (HRM) have been linked to hypomotility disorders. We investigated the relationship between ISTs, latency of initiation of smooth muscle contraction, and motor patterns in symptomatic patients and normal controls. HRM Clouse plots were analyzed in 199 participants (47.2±1.2 y, 112F/87M), categorized into 110 participants with gastroesophageal reflux disease (GERD), 74 symptomatic participants without GERD, and 15 healthy controls. IST length was measured in centimeters and percentage esophageal length, designated extended when ≥20% esophageal length on >30% swallows. Proximal latency was measured as the time interval between onset of skeletal and smooth muscle contraction segments, and designated prolonged when ≥4s in ≥50% of swallows. ISTs of any length were noted in 74.6% swallows and in 92.5% of participants, with a similar frequency across the 3 groups. ISTs and proximal latency were both longer in the GERD group, especially when Barrett esophagus was present, compared with non-GERD patients or controls (P≤0.03 across groups); extended IST and prolonged proximal latency followed similar trends. On multivariate logistic regression, extended IST predicted GERD [odds ratio (OR), 2.30; 95% confidence intervals (CI) 1.18-4.47], as did lower esophageal sphincter pressure <5 mm Hg (OR, 3.79-3.96; 95% CI 1.77-8.49), after controlling for age and sex; prolonged proximal latency predicted both GERD (OR, 2.03; 95% CI 1.01-4.12) and Barrett esophagus (OR 1.91, 95% CI 1.24-2.94). Measurement of IST and proximal latency add value to HRM analysis, and may be markers of esophageal hypomotility.