Gastroesophageal Reflux Disease Patients Research Articles

Topical Protection of Esophageal Mucosa as a New Treatment of GERD.

Among the various factors implicated in the pathogenesis of gastroesophageal reflux disease (GERD), visceral hypersensitivity and mucosal resistance have been recently re-evaluated in relation to the increasing phenomenon of proton pump inhibitor failure, particularly in patients with nonerosive reflux disease (NERD). Intensive research has allowed us to understand that noxious substances contained in the refluxate are able to interact with esophageal epithelium and to induce the elicitation of symptoms. The frequent evidence of microscopic esophagitis able to increase the permeability of the mucosa, the proximity of sensory afferent nerve fibers to the esophageal lumen favoring the higher sensitivity to noxious substances and the possible activation of inflammatory pathways interacting with sensory nerve endings are pathophysiological alterations confirming that mucosal resistance is impaired in GERD patients. Accordingly, the reinforcement of protective mechanisms of esophageal mucosa by topical therapies has become a novel treatment target. Alginate, the combination of hyaluronic acid+chondroitin sulphate and Poliprotect have been shown to adhere to esophageal mucosa and to have good protective properties. Several placebo-controlled clinical trials have shown that these compounds, given alone or as add-on therapy for short periods, enable to relieve symptoms and to improve the quality of life in NERD patients. Further studies are needed to confirm the above results and to find new mucosal protectants in order to improve the management of NERD patients.

The Impact of Circadian Preferences on Quality of Life in Patients With Gastroesophageal Reflux Disease: An Evaluation Using the SF-36.

Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder that negatively impacts individuals' quality of life. This study investigates the effect of circadian preferences on the quality of life in patients with GERD. A total of 152 participants (80 patients diagnosed with GERD and 72 healthy controls) were included in the study. Participants' circadian preferences were assessed using the morningness-eveningness questionnaire (MEQ), quality of life was evaluated with the SF-36 scale, and the severity of GERD symptoms was measured using the gastroesophageal reflux disease quality of life scale (GERD-QOL). The study's findings indicate that the quality of life and circadian preferences of GERD patients differ significantly from those of the control group. Correlation analyses revealed a positive relationship between SF-36 and MEQ, but no direct relationship was found between GERD-QOL and SF-36 or MEQ. Mediation analyses demonstrated that the effect of GERD-QOL on SF-36 is entirely mediated by circadian preferences. These results highlight the significant impact of circadian preferences on the quality of life in GERD patients, suggesting that individuals with an evening chronotype may have lower quality of life. Our study contributes to the literature as one of the first to suggest that circadian preferences should be considered in the management of GERD.

Correlation Between Gastroesophageal Reflux Disease and Small Intestinal Bacterial Overgrowth: Analysis of Intestinal Microbiome and Metabolic Characteristics.

Our study examines the relationship between gastroesophageal reflux disease (GERD) and small intestinal bacterial overgrowth (SIBO), focusing on the potential impact of acid-suppressive drugs. We also explore changes in gut microbiota and metabolism in patients with both conditions. This study included patients from the Department of Gastroenterology, Beijing Shijitan Hospital, between February 2021 and November 2023. All patients underwent assessments including questionnaires, hydrogen and methane breath tests, and gastroscopy. GERD was diagnosed using the GERD-Q scale and gastroscopy, while SIBO was diagnosed via breath tests. We analyzed the correlation between GERD and SIBO, identified risk factors for SIBO, and examined the gut microbiota using 16S rRNA sequencing to explore the relationship between GERD and SIBO. The retrospective study included 394 patients.148 with GERD and 287 with positive SIBO results. Among these, 270had a positive methane (CH4) breath test and 97had a positive hydrogen (H2) breath test. GERD was more common in patients with positive SIBO (P = 0.007), and the link between CH4 breath tests and GERD was stronger than that with H2 breath tests (P = 0.020). Logistic regression showed GERD is an independent risk factor for SIBO. Short-term, low-dose acid-suppressive drugs did not affect SIBO development. 16S rRNA sequencing of fecal microbiota from 24 patients showed dominant microbiota in SIBO-positive GERD patients included bacteroides uniformis and bacteroides stercoris. Patients with both GERD and SIBO had differential metabolites, mainly associated with ATP-Binding Cassette transporters (ABC transporters). GERD is strongly linked to SIBO, especially in patients with a positive CH4 breath test. The gut microbiota in GERD and SIBO patients differs from healthy individuals, with bacteroides uniformis as a key marker. Metabolic changes are mainly related to ABC transporter metabolites.

The influence of dietary and lifestyle factors on GERD-related dental erosion: A literature review

Background: Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal disorder commonly associated with dental erosion. GERD-related dental erosion is influenced by various factors, including dietary habits and lifestyle choices. Purpose: This article aims to review the influence of dietary and lifestyle factors on GERD-related dental erosion based on a literature review. Methods: This study employed a literature review methodology, analyzing articles published between 2019 and 2024. Data sources were obtained from databases such as PubMed, Google Scholar, ScienceDirect, and Elsevier. A total of 8 articles met the inclusion criteria and were analyzed further. Results: Studies indicate that the consumption of acidic foods and beverages, such as citrus fruits and carbonated drinks, exacerbates dental erosion in GERD patients. Lifestyle factors, such as late-night eating and caffeine consumption, were also found to increase the risk of dental erosion. Conversely, the consumption of milk was associated with a reduction in the severity of erosion. GERD also affects the salivary profile, including lowering the pH and buffering capacity of saliva, thereby increasing the risk of enamel demineralization. Conclusion: Dietary and lifestyle factors play a significant role in increasing the risk of GERD-related dental erosion. A holistic management approach, including dietary modifications, lifestyle changes, and regular dental health monitoring, is necessary to reduce the impact of GERD on dental health.

Efficacy of endoscopic radiofrequency ablation for proton pump inhibitor-dependent gastroesophageal reflux disease: Multicenter prospective cohort study.

To evaluate the effects of endoscopic radiofrequency ablation (RFA) on proton pump inhibitor (PPI)-dependent gastroesophageal reflux disease (GERD) in a Chinese population, and to explore the factors associated with favorable efficacy. A multicenter, single-armed prospective cohort study was conducted. PPI-dependent GERD patients were enrolled and underwent RFA. The primary outcome was improvement of GERD health-related quality of life (GERD-HRQL). Secondary outcomes were symptom improvement, satisfaction, PPI use, and the indicators of 24-h pH-impedance monitoring. A nomogram to predict complete remission was constructed. In total, 66 patients were included. The GERD-HRQL score was significantly reduced at the 3 month (mean difference, 14.7 [12.6-16.9]), 6 month (mean difference, 15.9 [13.8-18.1]), 12 month (mean difference, 16.7 [14.4-18.9]), 24 month (mean difference, 18.4 [16.2-20.1]), 36 month (mean difference, 18.2 [16.3-20.4]), and 48 month follow-up (mean difference, 16.1 [14.2-18.3]), all P < 0.001. The esophageal and extra-esophageal symptom scores were all significantly decreased. The proportion of satisfaction and no PPI use were significantly higher. With regard to the indicators of 24-h pH-impedance monitoring, acid exposure time (AET), and DeMeester score, but not lower esophageal sphincter (LES) pressure, decreased significantly at the 12 month follow-up. A nomogram based on age, body mass index (BMI), baseline AET, and LES pressure was then constructed and showed good discrimination in the prediction of complete remission following RFA. This study demonstrated that RFA improved life quality as well as symptoms in PPI-dependent GERD patients in a Chinese population. Younger age, higher BMI, lower baseline AET, and higher baseline LES pressure indicate favorable efficacy of RFA.

Association between gastroesophageal reflux disease and tinnitus in a nationwide population-based cohort study

Gastroesophageal Reflux Disease (GERD) is characterized by the regurgitation of stomach contents. Recent research indicates that acid reflux may disrupt the homeostasis of the middle and inner ear through the Eustachian tube. Given this context, we hypothesized that an association between GERD and tinnitus may exist due to the imbalance of the middle and inner ear caused by acid reflux. To explore this connection, we conducted a retrospective cohort study involving 669,159 patients registered in the National Health Insurance Service-National Sample Cohort (2012–2019) in South Korea. Our data showed that GERD and tinnitus are highly associated. Nevertheless, the use of proton pump inhibitor medication in GERD patients did not show a significant decrease in the onset of tinnitus.

Expert opinion on the prescription practice of a combination of rabeprazole and domperidone for managing nighttime heartburn in GERD among Indian patients

The synergistic effect of Rabeprazole and Domperidone suggested a more comprehensive treatment strategy, targeting both acid suppression and motility enhancement in GERD management in several clinical studies. However, studies regarding their prescription practices of this combination is scarce. This study aimed to gather comprehensive insights into various aspects of gastroesophageal reflux disease (GERD) management in Indian settings.This cross-sectional study was conducted from June 2023 to December 2023 using a 24-item structured questionnaire distributed via email and online platforms. Clinicians completed the survey independently, with the option to skip questions and provided written informed consent. The questionnaire covered GERD management aspects, including patient demographics, clinical challenges, treatment preferences, efficacy of treatment combinations, patient adherence, use of guidelines, comorbidities, risk factors and patient education methods.According to 39% of clinicians, 31-40 GERD patients per month report nighttime heart burn, while another 39% reported it as 21-30 cases monthly. Majority of the clinicians (95.65%) preferred rabeprazole for its longer action in managing nighttime heartburn in GERD. According to 96% and 89% of the clinicians, respectively, the combination of rabeprazole and domperidone was favored for managing nighttime heartburn and was more effective than other PPI combinations. Nearly 93% stated that this combination provides the fastest relief. The recommendation for taking the combination once a day was made by 67% of clinicians and 59% reported that their patients felt relieved within 1-2 weeks. Helirab D was preferred due to its advanced release profile 2 (ARP2) technology by 50% of clinicians.There was a strong clinical preference for using a combination of rabeprazole and domperidone to manage nighttime heartburn in patients with GERD. This combination seems to have advantages in terms of effectiveness, quick onset of action and relief for patients. The once-daily dosing schedule and formulation technology (ARP2) may be contributing factors to its popularity among clinicians.

Endoscopic cardiac mucosal ligation: a novel minimally invasive procedure for gastroesophageal reflux disease

Background Our objective in this study was to evaluate the short-term clinical efficacy and safety of endoscopic cardiac mucosal ligation, a novel endoscopic procedure, in the treatment of gastroesophageal reflux disease (GERD). Methods Patients diagnosed with refractory GERD or recurrent patients due to drug withdrawal admitted to our hospital were recruited in this clinical trial. All GERD patients were treated with endoscopic cardiac mucosal ligation. Postoperatively, all patients received subsequent follow-ups for approximately four months to evaluate the efficacy and safety of this endoscopic procedure. Results A total of 13 GERD patients were enrolled. Endoscopic cardiac mucosal ligation was successfully performed in all cases. Postoperatively, relevant symptoms were significantly alleviated in 10 patients (76.9%). The average Gastroesophageal Reflux Disease Questionnaire (GERD-Q) score in all participants significantly decreased from preoperative 10.0 ± 3.5 to postoperative 7.8 ± 2.9 (p = .022). The average GERD symptom questionnaire score was 27.0 ± 12.0 prior to surgery, which significantly decreased to 18.3 ± 7.5 postoperatively (p = .032). No severe postoperative complications were observed during subsequent follow-ups. Conclusions Endoscopic cardiac mucosal ligation might be a novel effective and safe endoscopic procedure for GERD.

Diagnosis and treatment of patients with gastroesophageal reflux disease - a systematic review of cost-effectiveness and economic burden.

This study aims to review the existing knowledge on the cost-effectiveness and item costs related to the diagnosis and treatment of gastroesophageal reflux disease (GERD) patients at different stages. The study adhered to the PRISMA guidelines. The systematic search involved several steps: finding and identifying relevant articles, filtering them according to the set criteria, and examining the final number of selected articles to obtain the primary information. The number of articles published between 2013 and September 2024 in the Web of Science and PubMed databases was considered. The CHEERS checklist was used for the risk of bias assessment. Ultimately, 36 studies were included. Regarding the cost-effectiveness of GERD treatment, Proton pump inhibitors (PPIs) appeared to be the dominant solution for non-refractory patients. However, this might change with the adoption of the novel drug vonoprazan, which is more effective and cheaper. With advancements in emerging technologies, new diagnostic and screening approaches such as Endosheath, Cytosponge, and combined multichannel intraluminal impedance and pH monitoring catheters should be considered, with potential implications for optimal GERD management strategies. The new diagnostic methods are reliable, safe, and more comfortable than standard procedures. PPIs are commonly used as the first line of treatment for GERD. Surgery, such as magnetic sphincter augmentation or laparoscopic fundoplication, is only recommended for patients with treatment-resistant GERD or severe symptoms. Advances in emerging technologies for diagnostics and screening may lead to a shift in the entire GERD treatment model, offering less invasive options and potentially improving patients' quality of life.

Esophageal chest pain resembles heartburn in reflux metrics and response to proton pump inhibitor therapy.

Gastro-esophageal reflux disease (GERD) is the most common cause for noncardiac chest pain (NCCP), with an estimated prevalence rate ranging between 30% and 60%. Heartburn and NCCP may share common mechanisms. To assess whether particular patterns of impedance-pH variables characterize patients with dominant heartburn, regurgitation, or NCCP and their ability to predict proton pump inhibitor (PPI) response for each symptom, GERD patients, evaluated with high-resolution manometry (HRM) and impedance-pH, were included. In total, 109 NCCP, 68 heartburn, and 64 regurgitation patients were included. Pathological reflux episodes were observed in 28%, 19%, and 56% (p < 0.001). Pathological mean nocturnal baseline impedance (MNBI) values were observed in 55%, 53%, and 34% (p < 0.05). Hypomotility was more frequent in NCCP compared to heartburn patients (p < 0.05). When comparing NCCP with heartburn, hypomotility was associated with NCCP perception (OR: 2.34, 95% CI: 1.23-4.43; p < 0.01). When comparing NCCP with regurgitation, >80 refluxes and type 2/3 esophagogastric junction (EGJ) were associated with regurgitation perception (OR: 0.31, 95% CI: 0.16-0.59; p < 0.001, and OR: 0.5, 95% CI: 0.27-0.93; p < 0.05), while pathological MNBI was associated with NCCP perception (OR: 2.34, 95% CI: 1.23-4.43; p < 0.01). 45.5% NCCP patients, 45.6% with heartburn, and 36% with regurgitation responded to PPIs (p < 0.05). At multivariate analysis, pathological MNBI or PSPW index were associated with PPI responsiveness in patients with NCCP or heartburn, while in patients with regurgitation, pathological MNBI was associated with PPI responsiveness and a reflux number >80 to PPI refractoriness. We highlight the usefulness of an accurate clinical and functional evaluation of GERD patients, allowing to discriminate particular characteristics in patients with dominant heartburn, NCCP, or regurgitation, which may benefit of distinct therapeutic strategies.

Association Between Gastroesophageal Reflux Disease and Periodontitis: A Longitudinal Follow-Up Study from the Korean National Health Screening Cohort.

Gastroesophageal reflux disease (GERD) and periodontitis are common conditions in older adults that can lead to serious complications, gaining public health attention. Although GERD and periodontitis share common risk factors, such as age, lifestyle habits, and socioeconomic status, large-scale studies examining their specific relationship are limited. This study aimed to assess the association between GERD and the likelihood of developing periodontitis using a national validated cohort data from Korea. Data were drawn from the Korean National Health Insurance Service Health Screening Cohort (2004-2019) using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnostic codes. The study included 16,744 GERD patients and 66,976 matched controls (matched 1:4 by age, sex, income, and residence). Cox proportional hazard models estimated hazard ratios (HRs) for periodontitis, adjusting for various factors, with subgroup analyses based on age, income, and other covariates. The overall incidence of periodontitis was similar between the GERD and control groups, with no significant difference in the adjusted hazard ratios (aHR = 1.00, 95% CI 0.99-1.02, p = 0.625). However, subgroup analyses in the GERD group showed a slightly increased likelihood of periodontitis in individuals over 60 years old (aHR = 1.03, 95% CI 1.00-1.06, p = 0.050) and those in lower-income brackets (aHR = 1.03, 95% CI 1.01-1.06, p = 0.023). In summary, while GERD was not associated with an increased overall probability of periodontitis, age and socioeconomic factors may influence the likelihood of periodontitis development in certain GERD patients. These findings may highlight the need for targeted preventive strategies and closer oral health monitoring in older and lower-income populations with GERD.

Multidisciplinary management of gastroesophageal reflux disease: an italian retrospective study

Abstract Background Millions of individuals are affected by gastroesophageal reflux disease (GERD) that causes significant discomfort negatively affecting patients’ overall quality of life. For a collaborative approach of continuous improvement in public health we wanted to know the real-world perspectives in the multidisciplinary and multimodal management pathway. Methods We aimed to interview a sample of gastroenterologists (GE), primary care physicians (GP), and otolaryngologists (ENT) to investigate the management of the intake and treatment of patients reporting symptoms of GERD. Symptoms were divided into typical and extraesophageal, and their severity and impact on quality of life was explored with the GERD Impact Scale (GSI) and Reflux Symptom Index (RSI). Results A total of 6211 patients were analyzed of whom with typical symptoms were 53.5%, while those with extraesophageal symptoms were 46.5%. The latter were more frequently reported by ENT patients (53.6%, p &amp;lt; 0.0001). GSI was highest in patients followed by GE (9 points) and GP (9 points) than ENT specialists (8 points), while the RSI was higher in the ENT group (14.3 ± 6.93) than in the groups of GP and GE, respectively (10.36 ± 6.36 and 10.81 ± 7.30, p &amp;lt; 0.0001). Chest pain had the greatest negative impact on quality of life (p &amp;lt; 0.0001). Of the 3,025 patients who used (proton pump inhibitors) PPIs, non-responders had a lower GSI when treated with a combination of adjunctive drug treatments and bioadhesive compounds, compared with single-component drugs. Conclusions The multidisciplinary and multimodal approach to the management pathway of GERD patients reveals variations in patient profiles by physician specialty, directing toward more appropriate and targeted treatments. In addition, the combination of adjunctive drug treatments and bioadhesive compounds appears to be effective in the management of patients refractory to PPIs. Key messages • The presentation of GERD symptoms is different in accordance with the physician’s speciality: the patients with GERD referred to a gastroenterologist had more severe disease and poorer quality of life. • The combination of adjunctive pharmacological treatments and bioadhesive compounds seems to be effective in the management of PPI refractory patients.

A cost-effectiveness analysis of RefluxStop against relevant therapeutic alternatives for chronic gastroesophageal reflux disease in Sweden

ABSTRACT Introduction The standard treatment for gastroesophageal reflux disease (GERD) is proton pump inhibitors (PPIs). In selected cases, Nissen fundoplication is offered as a surgical treatment option, but alternative endoscopic and minimally invasive surgical alternatives are emerging. RefluxStop is a new technology for the treatment of GERD. Research design and methods A cost-effectiveness analysis of RefluxStop in comparison to PPI therapy and Nissen fundoplication in the Swedish healthcare setting was conducted using a Markov model and available comprehensive population and clinical trial-based long-term data. Benefits were measured in quality-adjusted life-years (QALYs). Uncertainty was determined by deterministic and probabilistic sensitivity analyses. Results The base case incremental cost-effectiveness ratios (ICERs) for RefluxStop in comparison to PPIs and Nissen fundoplications were SEK 48,152 (€ 4,531) and SEK 62,966 (€ 5,925) per QALY gained, respectively. At a cost-effectiveness threshold of SEK 500,000 per QALY gained, RefluxStop has a high likelihood of being cost-effective, with probabilities of 96% and 100% against Nissen fundoplication and PPIs, respectively. The results of the model remained robust with sensitivity analysis. Conclusions RefluxStop may offer a highly cost-effective long-term treatment alternative for chronic GERD patients over lifelong PPI therapy, but also in comparison with laparoscopic Nissen fundoplication.

Global Transcriptomic Analysis of Topical Sodium Alginate Protection against Peptic Damage in an In Vitro Model of Treatment-Resistant Gastroesophageal Reflux Disease.

Breakthrough symptoms are thought to occur in roughly half of all gastroesophageal reflux disease (GERD) patients despite maximal acid suppression (proton pump inhibitor, PPI) therapy. Topical alginates have recently been shown to enhance mucosal defense against acid-pepsin insult during GERD. We aimed to examine potential alginate protection of transcriptomic changes in a cell culture model of PPI-recalcitrant GERD. Immortalized normal-derived human esophageal epithelial cells underwent pretreatment with commercial alginate-based anti-reflux medications (Gaviscon Advance or Gaviscon Double Action), a matched-viscosity placebo control, or pH 7.4 buffer (sham) alone for 1 min, followed by exposure to pH 6.0 + pepsin or buffer alone for 3 min. RNA sequencing was conducted, and Ingenuity Pathway Analysis was performed with a false discovery rate of ≤0.01 and absolute fold-change of ≥1.3. Pepsin-acid exposure disrupted gene expressions associated with epithelial barrier function, chromatin structure, carcinogenesis, and inflammation. Alginate formulations demonstrated protection by mitigating these changes and promoting extracellular matrix repair, downregulating proto-oncogenes, and enhancing tumor suppressor expression. These data suggest molecular mechanisms by which alginates provide topical protection against injury during weakly acidic reflux and support a potential role for alginates in the prevention of GERD-related carcinogenesis.

Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-Types of GERD

Abstract Background Gastroesophageal reflux disease (GERD) is a prevalent condition characterized by the troublesome reflux of stomach contents into the esophagus, significantly impacting the quality of life. Pepsin, a protease originating from the stomach, has been implicated in the pathogenesis of GERD and can serve as a potential biomarker for objective assessment. Patients and Methods In this cross-sectional observational study, 45 patients with GERD and 45 healthy volunteers as a control group were examined. Clinical evaluations, laboratory tests, and salivary pepsin measurements were conducted, and esophagogastroduodenoscopy was performed. Results The study revealed a statistically significant increase in body mass index (BMI) among GERD patients (32.2 ± 3.9 kg/m²) compared to the control group (27.8 ± 2.4 kg/m²). Smoking was identified as a significant risk factor for GERD, with 44.5% of GERD patients being smokers compared to 24.4% in the control group. Salivary pepsin levels were significantly higher in GERD patients (108.5 ± 46.6 ng/ml) compared to the control group (24.4 ± 9.9 ng/ml). Additionally, a significant correlation was observed between salivary pepsin levels and the Los Angeles classification of GERD severity. Conclusion This study indicates that obesity negatively impacts esophageal function and smoking is a significant risk factor for GERD. Salivary pepsin levels are significantly elevated in GERD patients and show a strong correlation with GERD severity as classified by the Los Angeles classification system. Salivary pepsin holds promise as a non-invasive biomarker for GERD diagnosis and monitoring.

Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-Types of GERD

Abstract Background Gastroesophageal reflux disease (GERD) is a prevalent condition characterized by the troublesome reflux of stomach contents into the esophagus, significantly impacting the quality of life. Pepsin, a protease originating from the stomach, has been implicated in the pathogenesis of GERD and can serve as a potential biomarker for objective assessment. Patients and Methods In this cross-sectional observational study, 45 patients with GERD and 45 healthy volunteers as a control group were examined. Clinical evaluations, laboratory tests, and salivary pepsin measurements were conducted, and esophagogastroduodenoscopy was performed. Results The study revealed a statistically significant increase in body mass index (BMI) among GERD patients (32.2 ± 3.9 kg/m²) compared to the control group (27.8 ± 2.4 kg/m²). Smoking was identified as a significant risk factor for GERD, with 44.5% of GERD patients being smokers compared to 24.4% in the control group. Salivary pepsin levels were significantly higher in GERD patients (108.5 ± 46.6 ng/ml) compared to the control group (24.4 ± 9.9 ng/ml). Additionally, a significant correlation was observed between salivary pepsin levels and the Los Angeles classification of GERD severity. Conclusion This study indicates that obesity negatively impacts esophageal function and smoking is a significant risk factor for GERD. Salivary pepsin levels are significantly elevated in GERD patients and show a strong correlation with GERD severity as classified by the Los Angeles classification system. Salivary pepsin holds promise as a non-invasive biomarker for GERD diagnosis and monitoring.

Laparoscopic Toupet Fundoplication as a First Line Surgical Treatment of GERD versus Nissen Fundoplication a Retrospective Comparative Study

Abstract Background Gastroesophageal reflux disease (GERD) is a frequent clinical condition characterized by the reflux of gastric constituents into the esophagus or oropharynx via the lower esophageal sphincter (LES), producing discomfort and/or harm to esophageal tissue serious enough to disturb a patient's life. Acid reflux into the esophagus may cause esophagitis, tracheobronchitis, stricture, Barrett’s esophagus and even esophageal cancer. Aim of the Work to evaluate the surgical results of a partial 270 degree wrap (Toupet) versus a total 360 degree wrap (Nissen) in patients with gastroesophageal reflux disease (GERD) in accordance with symptom alleviation, and postoperative complications like dysphagia and gas bloat disorder. Patients and Methods This study is a retrospective cohort study. It was conducted at (the General surgery department), Ain Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. The study period Between January 2023 and November 2023. Results In this retrospective cohort study comparing Toupet versus Nissen fundoplication in GERD patients, baseline characteristics including age, BMI, and gender distribution were similar between groups (p &amp;gt; 0.05). Prevalence of hypertension and diabetes mellitus did not significantly differ between the two groups (p &amp;gt; 0.05). These findings suggest comparable baseline characteristics and comorbidity distributions among GERD patients undergoing either Toupet or Nissen fundoplication procedures. The study was conducted on patients with no significant differences in UGI endoscopy grades (p = 0.442), reflux severity during GG meal testing (p = 0.540), or LES pressure (p = 0.204) preoperatively. The study found a significant difference in operative time (p = 0.011) but not in hospitalization duration (p = 0.854), indicating shorter operative time for Nissen Fundoplication. No significant differences were observed in dysphagia (p = 0.080), heartburn (p = 0.388), regurgitation (p = 0.247), or gas bloat (p = 0.723), though trends suggested potential variations, requiring larger samples for confirmation. Conclusion This retrospective comparative study assessing the outcomes of Toupet and Nissen fundoplication procedures as first-line surgical treatments for GERD revealed several notable findings. While the Nissen procedure demonstrated a shorter operative time compared to the Toupet procedure, both interventions exhibited similar hospitalization durations. Moreover, there were comparable rates of postoperative complications including dysphagia, heartburn, regurgitation, and gas bloat between the two groups, although trends suggesting potential differences were observed in dysphagia and heartburn occurrences. These results suggest that while both procedures are effective in managing GERD, Toupet can be considerd as an effective alternative procedure for patients with GERD with advantage of lower postoperative complications such as dysphagia and gas bloat.

Potassium-Competitive Acid Blocker sebagai Alternatif Penghambat Pompa Proton untuk Mengatasi Gejala Gastroesophageal Reflux Disease: Sebuah Laporan Kasus Berbasis Bukti

Gastric acid suppression is one of the main pillars of gastroesophageal reflux disease (GERD) treatment. Proton pump inhibitor (PPI) is the most used drug for suppressing gastric acid in GERD patients currently. Potassium- acid competitive acid blocker (PCAB) is a new class of drug which can be used as an alternative drug for suppressing gastric acid, so hypothetically, this drug could be an alternative of PPI for relieving GERD symptoms. However, the ability of PCAB for relieving GERD symptoms was not established, so this study was aimed to elucidate the ability of PCAB as an alternative drug of PPI for relieving GERD symptoms. Comprehensive literature searching was conducted in several databases such as PubMed, Embase, Cochrane, EBSCO, and Proquest with keywords “GERD”, “PCAB”, “PPI” dan “symptoms” on September 16-20, 2023. Early literature searching comprised 229 articles then selected based on clinical question and eligibility criteria to get 3 articles to be appraised critically. Vonoprazan, one of PCAB, was using as the main therapy in all of selected studies. Two randomized control trial (RCT) studies showed the non-inferiority of vonoprazan compared to PPI for relieving GERD symptoms. On the other hand, one systematic review and meta-analysis study showed that vonoprazan was superior than PPI for relieving GERD symptoms. This evidence-based case report (EBCR) shows that vonoprazan is non-inferior, even superior, compared to PPI for relieving GERD symptoms. Further, extensive, and larger researches is still needed to support this evidence and the using of PCAB as main and routine treatment for GERD patients.

Shanghai consensus on the diagnosis and treatment of gastroesophageal reflux disease in patients undergoing sleeve gastrectomy(2024 edition)

Morbid obesity and its accompanying diseases have become one of the most serious public health problems warranting global effort and bariatric and metabolic surgery is still the most effective method for long-term weight control. Among all bariatric and metabolic procedures, sleeve gastrectomy is currently the most widely used, but it is not a perfect procedure. One of the most serious issues that this surgical procedure faces is the possibility of worsening existing or developing de novo gastroesophageal reflux disease after surgery. Moreover, there is currently a lack of high-level clinical trial evidence on the diagnosis and treatment of gastroesophageal reflux disease in patients undergoing sleeve gastrectomy. Therefore, initiated by four domestic bariatric and metabolic surgery centers, 41 experts with rich experience in bariatric and metabolic surgery and diagnosis and treatment of gastroesophageal reflux disease from China, Japan, and South Korea reached a consensus on the diagnosis and treatment of gastroesophageal reflux disease in sleeve gastrectomy patients using the Delphi method. There are a total of 59 consultation questions in this consensus, of which 44 have reached a consensus. We hope that this consensus can not only serve as a reference for clinical diagnosis and treatment, but also provide more possible directions for future high-quality clinical research.

Reflux, eosinophilic esophagitis, and celiac disease - the blurred lines.

Gastroesophageal reflux disease (GERD) is a commonly recognized cause of dysphagia. Conversely, eosinophilic esophagitis (EoE) and celiac disease are rarer and often overlooked as dysphagia culprits. Overlap between these conditions complicates diagnosis and delays appropriate treatment. This review aims to clarify the distinctive dysphagia characteristics in each condition, explore potential overlaps, and offer guidance on differentiation. Recent studies have advanced our understanding of dysphagia mechanisms in GERD, EoE, and celiac disease, particularly in characterizing disordered motility and dysphagia's natural history. While upper endoscopy, biopsies, and manometry remain crucial in dysphagia assessment, novel diagnostic tools are emerging. New insights highlight the significance of cytokine-induced mucosal injury in all three conditions, revealing potential connections where mucosal damage in one disorder may contribute to the development of others. GERD, EoE, and celiac disease can coexist and present with similar symptoms. Distinguishing between them often entails upper endoscopy, esophageal biopsies, pH testing, and celiac serologies. EoE should be considered when GERD patients fail proton pump inhibitor therapy or when celiac patients have persistent esophageal symptoms despite a gluten-free diet. Consider celiac disease if dysphagia accompanies iron deficiency anemia, malabsorptive diarrhea, or osteoporosis. Recognizing the potential overlap between these conditions is crucial for guiding clinical evaluation and therapy.