Gastroesophageal Reflux Disease Patients Research Articles

Gastroesophageal reflux in children: an updated review.

BackgroundGastroesophageal reflux is a common disorder in pediatrics. Clinicians should be familiar with the proper evaluation and management of this condition.ObjectiveTo provide an update on the current understanding, evaluation, and management of gastroesophageal reflux in children.MethodsA PubMed search was performed with Clinical Queries using the key term ‘gastroesophageal reflux’. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the English literature and the pediatric age group.ResultsRegurgitation is the most frequent symptom of gastroesophageal reflux and is present in nearly all cases. Gastroesophageal reflux occurs normally in infants, is often physiological, peaks at 4 months of age, and tends to resolve with time. Gastroesophageal reflux disease occurs when gastric contents reflux into the esophagus or oropharynx and produce troublesome symptom(s) and/or complication(s). A thorough clinical history and a thorough physical examination are usually adequate for diagnosis. When the diagnosis is ambiguous, diagnostic studies may be warranted. A combined esophageal pH monitoring and multichannel intraluminal esophageal electrical impedance device is the gold standard for the diagnosis of gastroesophageal reflux disease if the diagnosis is in doubt. In the majority of cases, no treatment is necessary for gastroesophageal reflux apart from reassurance of the benign nature of the condition. Treatment options for gastroesophageal reflux disease are discussed.ConclusionIn most cases, no treatment is necessary for gastroesophageal reflux apart from reassurance because the condition is benign and self-limiting. Thickened feedings, postural therapy, and lifestyle changes should be considered if the regurgitation is frequent and problematic. Pharmacotherapy should be considered in the treatment of more severe gastroesophageal reflux disease for patients who do not respond to conservative measures. Proton pump inhibitors are favored over H2-receptor antagonists because of their superior efficacy. Antireflux surgery is indicated for patients with significant gastroesophageal reflux disease who are resistant to medical therapy.

Clinical impact of gastroesophageal reflux disease in patients with subacute/chronic cough

BackgroundWhile gastroesophageal reflux disease (GERD) is one of the commonest causes of subacute/chronic cough along with cough-variant asthma (CVA) and rhinosinusitis, its clinical impact remains unknown. Therefore, we sought to investigate the impact of GERD in patients with subacute/chronic cough. MethodsBetween April 2012 and March 2018, a total of 312 patients presenting subacute or chronic cough lasting for ≥3 weeks [median cough duration, 4.9 (0.7–434) months] underwent diagnostic tests. GERD symptoms and cough-specific QoL were evaluated through the Frequency Scale for Symptoms of Gastroesophageal reflux (FSSG) and the Japanese version of the Leicester Cough Questionnaire (J-LCQ). According to the FSSG domains, patients with GERD were arbitrarily categorized into 3 groups; acid-reflux predominant, dysmotility predominant, and pauci-symptoms groups, respectively. ResultsThe average scores of J-LCQ was 12.5 (SD3.7). One hundred-forty three were diagnosed as having GERD-related cough based on classical reflux symptoms including heartburn and characteristic triggers of cough such as phonation, rinsing, lying, and eating. Most of them (89.8%) had other causative diseases including CVA. Cough lasted longer (p = 0.019) and required a longer time until alleviation (p = 0.003) in patients with GERD than in those without GERD. They also scored lower J-LCQ than counterpart group (p < 0.0001). In terms of symptom stratification, dysmotility predominant group showed significant more response to specific GERD treatments than the remnants (p = 0.002). ConclusionsThese results indicate that GERD is associated with the aggravation of other causes including CVA. Particularly, dysmotility symptoms may be potential therapeutic target for GERD-related cough.

The Effect of Zero Copayments on Medication Adherence in a Community Pharmacy Setting.

Prescription medication copayments can be a financial burden to many patients. When patients cannot afford their medications, they may become nonadherent, and as a result, this can lead to an increase in chronic disease complications and healthcare costs. The objective of this study was to determine if zero copayments have an effect on medication adherence in a community pharmacy. This retrospective cohort study examined the prescription refill records of patients who filled specific generic medications for hypertension, hyperlipidemia, and gastroesophageal reflux disease (GERD) in 2016 at the NSU Clinic Pharmacy. The adherence rates of patients with zero copayments were compared to the adherence rates of patients with copayments greater than $0. Adherence was determined by calculating the proportion of days covered (PDC). Patients were considered adherent if their PDC was greater than or equal to 80%. GERD patients with no copayments had average PDC ratios of 87.4% and were statistically significantly more adherent than GERD patients with copayments, who had average PDC ratios of 76.7% (P = 0.042). Hyperlipidemia and hypertension patients with no copayments had average PDC ratios of 89.3% and 90.3%, respectively, and those with copayments had PDC ratios of 85.3% (P = 0.314) and 87.9% (P = 0.534). Overall, patients with $0 copayments had higher adherence rates than patients with copayments greater than $0. GERD patients with no copayments were significantly more adherent than GERD patients with copayments. However, no statistically significant difference was found between patients with or without copayments in the hyperlipidemia and hypertension cohorts. Further studies are recommended to analyze additional factors that may influence medication adherence.

Anti-reflux mucosectomy using a cap-assisted endoscopic mucosal resection method for refractory gastroesophageal disease: a prospective feasibility study

Endoscopic therapy of gastroesophageal reflux disease (GERD) overcomes the "treatment gap" for patients with refractory GERD, who are not willing to go into surgery. We propose an easy and efficient technique that is referred to as anti-reflux mucosectomy (ARMS) using cap-assisted endoscopic mucosal resection (EMR-C) which could be called ARMS-C. This study aimed to investigate the short-term outcomes of ARMS-C in GERD patients. From December 2016 to February 2018, we performed ARMS-C in 33 patients with pathologic reflux disease and esophageal hypersensitivity. ARMS-C involved endoscopic mucosal resection at the circumference of the esophagogastric junction (EGJ), resulting in narrowing of the hiatal opening after healing. The GERD symptoms, 24-h pH monitoring results, manometry, endoscopy, and EGJ distensibility were compared before and after the procedure. Six months after ARMS-C, 63% of patients discontinued the use of pump inhibitors (PPIs), while 30% patients reduced their PPI dose. The GERD questionnaire scores significantly decreased after ARMS-C, from 11.0 to 6.0 (P < 0.001). The median DeMeester score and acid exposure time based on pH monitoring also improved after ARMS-C. Furthermore, the median flap valve grade and EGJ distensibility decreased from 3.0 to 1.0 (P < 0.001) and from 19.0 to 13.9 (P < 0.001), respectively. Two patients were treated with balloon dilation due to stricture, but no other serious adverse events were encountered. ARMS-C may be an effective and safe treatment method for GERD in terms of short-term outcomes.

Oesophageal Adenocarcinoma after Surgery and Medication Against Gastro-Oesophageal Reflux Disease in a Nordic Cohort Study

Background: Gastro-oesophageal reflux disease (GORD) increases risk of oesophageal adenocarcinoma (OAC), but whether antireflux therapy prevents OAC is uncertain. We aimed to clarify this issue and assess potential differences after surgical and medical treatment. Methods: Multinational, population-based cohort study including individuals with GORD from the five Nordic countries in 1964-2014. The exposure was antireflux surgery or medication and the outcome was OAC. First, OAC risk after antireflux surgery and medication in the cohort was compared with the respective corresponding background population by calculating standardised incidence ratios (SIRs) with 95% confidence intervals (95%CIs). Second, multivariable Cox proportional hazards regression, providing hazard ratios (HRs) with 95%CIs, was used to compare antireflux surgery with medication in relation to OAC risk. Findings: Among 942,071 GORD patients, 48,863 underwent surgery and 893,208 received medication. Compared to the background population, OAC risk did not decrease following surgery (SIR=4.90 [95%CI 3.62-6.47] 1-<5 years and SIR=4.57 [95%CI 3.44-5.95] ≥15 years after surgery) or medication (SIR=2.37 [95%CI 2.17-2.59] 1-<5 years and SIR=3.07 [95%CI 2.65-3.54] ≥15 years after medication). Similarly, no decrease was found for patients with severe GORD over time after surgical (SIR=6.09 [95%CI 4.39-8.23] 1-<5 years and SIR=5.27 [95%CI 3.73-7.23] ≥15 years) or medical (SIR=3.61 [95%CI 3.19-4.07] 1-<5 years and SIR=3.82 [95%CI (3.19-4.55] ≥15 years) antireflux therapy. The HRs of OAC were stable over time over time after surgery compared with medication (HR=1.71 [95%CI 1.26-2.33] 1-<5 years and HR=1.69 [95%CI 1.24-2.30] ≥15 years after treatment), and remained stable over time after treatment in participants with severe GORD (HR=1.56 [95%CI 1.11-2.20] 1-<5 years and HR=1.57 [95%CI 1.08-2.26] ≥15 years after treatment). Interpretation: Medical and surgical treatment of GORD does not seem to reduce OAC risk. Funding: Nordic Cancer Union, Swedish Cancer Society and Swedish Research Council. Declaration of Interest: None. Ethical Approval: All required ethical and data permissions were retrieved from the relevant authorities within each country (The Danish Data Protection Agency; Population Register Centre, National Institute for Health and Welfare, Statistics Finland; The Icelandic Data Protection Authority, The National Bioethics Committee; Regional Ethics Committee, Norway; and Regional Ethics Committee, Sweden).

Modified inspiratory muscle training (m-IMT) as promising treatment for gastro-oesophageal reflux disease (GERD)

BackgroundGastro-oesophageal reflux disease (GERD) is one of the most common diseases, but is still a challenge to cure. Different medical treatments are used, first of all Proton pump inhibitors (PPIs), however these are sometimes ineffective and long-term intake can lead to underestimated complications. Recently, some studies investigated the role of inspiratory muscle training (IMT) in the medical treatment of GERD. It seems that IMT is able to increase the pressure generated by the lower oesophageal sphincter (LES), reduce spontaneous releases of LES, acid exposure, use of PPIs, and improve symptoms and quality of life for GERD patients. ObjectiveThe aim of this study was to evaluate the effectiveness of IMT in association with myofunctional therapy exercises of swallowing set by Daniel Garliner (m-IMT) on the symptoms of patients with non-erosive gastro-oesophageal reflux disease (NERD). MethodsTwenty-one adult patients with NERD were enrolled from May to December 2017 and performed m-IMT over a period of 4 weeks. Before and after treatment, all the patients completed the following questionnaires: GERD oesophageal symptomatology (GERDQ), extra-oesophageal GERD symptomatology (RSI), quality of life (GERD-Health Related Quality of Life Questionnaire (GERD-HRQL), and underwent laryngeal endoscopy. ResultsNineteen patients completed m-IMT. GERDQ (from 8.36±3.94 to 1.7±3.41; p<.05), RSI (from to 21.68±10.26 to 6.93±8.37; p<.05) and GERDHRQL (from 25.68±16.03 to 8.4±11.06; p<.05) the questionnaire scores significantly reduced after treatment. In addition, the laryngeal endoscopy score greatly improved (from 14.24±4.15 to 7.4±1.77; p<.05). Conclusionsm-IMT is a low cost therapy without side effects. It could be useful in association with PPI or alone for selected GERD cases and for mild NERD forms, in association with diet. Further studies are required to prove the effects of m-IMT on GERD symptoms and decide the best treatment schedule.

Gastroesophageal reflux disease and Barrett esophagus: an overview of evidence-based guidelines.

Gastroesophageal reflux disease is an extremely common condition worldwide, with the published prevalence rates varying from 2.5% in China to 51.2% in Greece. Its economic and morbidity burden is vast, and optimizing care for this condition carries huge financial and patient‑related benefits. The disease can be complicated by progression to Barrett esophagus (BE), a precancerous condition that affects approximately 2% of the population and remains undiagnosed in many individuals. The National Institute of Clinical Excellence has produced guidelines on cost‑effective management of gastroesophageal reflux disease in patients in the United Kingdom, and the Benign Barrett's and Cancer Taskforce consensus was the largest international review of evidence known on the management of benign BE complications. This paper is a review of these guidelines with updates on new evidence. Areas for future development involve risk‑stratifying patients to surveillance, chemoprevention agents, and genetic biomarkers to help decide who will be at highest risk of malignant progression. Evidence supports the safety of proton pump inhibitors for symptom control in the medium term (ie, 9 years) and reducing the risk of progression of BE, while surgical options are cost‑effective treatments for certain patients. Barrett esophagus surveillance should be directed towards high‑risk groups, while those at lower risk may benefit from chemoprevention strategies.

Demographics and Clinical and Endoscopic Characteristics of Patients with Helicobacter pylori Infection and Gastroesophageal Reflux Disease: A Case-Control Study.

Background The correlation between Helicobacter pylori (H. pylori) and gastroesophageal reflux disease (GERD) is complex. Some studies showed a protective role of H. pylori infection against GERD. This study was aimed at assessing the role of H. pylori infection in GERD utilizing a large cohort of patients diagnosed with GERD. Methods and Materials All patients who underwent gastroscopy for an indication of GERD during the study period between 2015 and 2017 at the EMMS Nazareth Hospital were considered eligible for the study and therefore were included. H. pylori infection was determined by the rapid urease test or histology. Severity of esophagitis was assessed using the Los Angeles classification. Univariate analysis was performed to figure out differences between patients according to H. pylori infection status. Multivariate regression analysis was conducted to illustrate the predictors of positivity for H. pylori infection. Results 2,508 GERD patients were included with a median age of 49.42 ± 17.96 years. H. pylori infection was detected in 299 (11.9%) patients. GERD patients with H. pylori infection were found to be younger (48.83 ± 17.42 years versus 44.57 ± 17.69 years, p < 0.001), have the tendency to smoke more (1406 (63.6%) versus 266 (89.0%), p < 0.001), and use more proton pump inhibitors or PPIs (1314 (59.5%) versus 242 (80.9%), p < 0.001). In multivariate regression analysis, age (OR 0.987, p < 0.001), smoking status (OR 0.190, p < 0.001), use of ASA/NSAIDs (OR 1.652, p = 0.004), and use of statins (OR 0.499 (95%CI 0.295-0.846), p = 0.010) were found significant among H. pylori-positive individuals. H. pylori-positive subjects have less severe esophagitis and more hiatus hernia. Conclusion Patients with GERD and H. pylori infection were significantly younger, tended to smoke more, and used more PPIs and had significantly lower grades of esophagitis compared to noninfected ones.

Sa1205 – Predicting Factors of Recurrence in Patients of Gastroesophageal Reflux Disease: A Prospective Follow-Up Analysis

Sa1205 – Predicting Factors of Recurrence in Patients of Gastroesophageal Reflux Disease: A Prospective Follow-Up Analysis

Клинико-эндоскопические аспекты гастроэзофагеальной рефлюксной болезни у пациентов с ревматологической патологией

Клинико-эндоскопические аспекты гастроэзофагеальной рефлюксной болезни у пациентов с ревматологической патологией

Tu1209 – Clinical, Manometric and Psychological Profile of Patients with Excessive Belching. A Comparative Analysis with Gastroesophageal Reflux Disease Patients

Tu1209 – Clinical, Manometric and Psychological Profile of Patients with Excessive Belching. A Comparative Analysis with Gastroesophageal Reflux Disease Patients

Sa1203 – Acute Effect of Curcuminoid on Reflux Physiology: A Randomized Cross-Over Trial in Gastroesophageal Reflux Disease (GERD) Patients

Sa1203 – Acute Effect of Curcuminoid on Reflux Physiology: A Randomized Cross-Over Trial in Gastroesophageal Reflux Disease (GERD) Patients

PGI8 BUDGET IMPACT ANALYSIS OF LINX REFLUX MANAGEMENT SYSTEM FOR THE TREATMENT OF MEDICATION-REFRACTORY MECHANICAL GASTROESOPHAGEAL REFLUX DISEASE: A U.S. PAYER PERSPECTIVE

In the U.S., the prevalence of gastroesophageal reflux disease (GERD) ranges from 18-27%, with an annual economic burden of $15-20 billion. While proton pump inhibitors are the first-line treatment, up to 44% of GERD patients are refractory to medication. Treatment of medication-refractory GERD may involve surgery with laparoscopic Nissen Fundoplication (LNF), a non-reversible procedure with adverse side-effects. Removable magnetic sphincter augmentation devices such as the LINX Reflux Management System are an alternative surgical option that have demonstrated clinical benefits for medication-refractory patients with some lower esophageal sphincter function; however, economic data are limited. The objective of this study is to assess the economic impact of introducing LINX into current practice from a U.S. payer perspective. A budget impact model comparing two treatment practices over a 1-year time-horizon was developed: 1) current practice, which included patients who are medically managed but refractory to their medication or those who receive LNF; and 2) future practice, which included patients managed with current practice or those who receive LINX. Resources included those related to the index procedure, reoperations, readmissions, and general healthcare use (healthcare visits, diagnostic tests, and medications). Eligible patient population, market share, and resource use were estimated using market research, published literature, and a survey of 99 clinicians. Costs were informed from Medicare payments in 2018. One percent of a hypothetical commercial insurance population of one million members were eligible for treatment, specifically those with medication-refractory mechanical GERD. The base-case analysis estimated use of LINX could save $48,116 (i.e., $5.01 per patient), primarily driven by avoided inpatient procedures and reoperations with LINX. Analyses predicted approximate budget neutrality with alternative plausible future scenarios. Results of the analysis predicted the introduction of LINX may lead to favorable budget impact for payers. Future analyses will benefit from inclusion of middle-ground treatments and longer time-horizons.

PGI15 ONE-YEAR RESOURCE USE FOR MEDICATION-REFRACTORY GASTROESOPHAGEAL REFLUX DISEASE PATIENTS TREATED WITH LAPAROSCOPIC NISSEN FUNDOPLICATION OR LINX REFLUX MANAGEMENT SYSTEM: A SURVEY OF 99 U.S. CLINICIANS

Gastroesophageal reflux disease (GERD) is a common condition, with a large proportion of patient’s refractory to medical management (rMM). Treatment options for rMM has been limited to laparoscopic Nissen Fundoplication (LNF) which has been associated with several complications. Technologies such as the LINX Reflux Management System (MSA) have emerged with demonstrated clinical benefits, however, resource use data are limited. This study sought to compare the 1-year resource use with MSA and LNF through a clinician survey. A survey was developed to capture resources with MSA and LNF use including pre-op/post-op/ongoing- diagnostics, intra/post-operative resources (ie, consumables, drugs, lab tests, etc.), readmissions, re-operations, and follow-up visits. Survey development utilized published literature and input from key opinion leaders. The survey was administered to two U.S. clinical stakeholder types: GIs and surgeons that refer patients and perform GERD procedures. Participants were recruited through large physician and surgeon databases to identify qualified respondents. Inclusion in the study required participants to be expertly familiar with MSA and LNF procedures. Administration of the survey was conducted via an online survey instrument. A total of 99 clinicians completed the survey (50 GIs and 49 surgeons). In general, responses were similar between clinicians, though differences were reported in consumables and follow-up tests. Key benefits anticipated with the MSA compared to LNF included reductions in procedural consumables, intra-/post-operative drugs, readmission rates, physician/outpatient visits, and 1-year follow-up tests. A larger proportion of MSA procedures were expected to be performed in an outpatient setting. Resources anticipated to be similar between MSA and LNF included diagnostic tests performed prior to the procedure. According to the survey, treatment of GERD patients who are unresponsive to medical therapy with MSA is anticipated to result in reduced overall hospital resource use compared to LNF. In adopting MSA, this finding may have important economic implications for hospitals.

Transoral incisionless fundoplication with EsophyX for gastroesophageal reflux disease: clinical efficacy is maintained up to 10 years.

Background Transoral incisionless fundoplication with EsophyX is reported to be effective in patients with gastroesophageal reflux disease in short-medium term follow-up. Aim To examine clinical outcomes up to 10 years. Methods In total, 51 procedures were performed in 50 patients. All entered a yearly clinical follow-up schedule including gastroesophageal reflux disease health-related quality-of-life questionnaires, heartburn and regurgitation scores, and daily proton pump inhibitor consumption. Results The procedure was successfully performed in 49/50 patients. Severe complications occurred in 2/51 procedures. The remaining 49 patients were re-evaluated at 2 and 3 years, 41 after 5 years, 30 after 7 years, and 14 after 10 years. Eight patients were lost to follow-up between 3 and 5 years. Seven patients who were unresponsive to endoscopic fundoplication underwent surgical fundoplication. The mean scores at 2 years were significantly lower than before the procedure and did not change substantially during the follow-up. The rates of patients who had stopped or halved antisecretive therapy 2, 3, 5, 7, and 10 years after the procedure were 86.7 %, 84.4 %, 73.5 %, 83.3 %, and 91.7 %, respectively. Conclusions Transoral incisionless fundoplication with EsophyX is an effective therapeutic option for symptomatic gastroesophageal reflux disease patients, with Hill grades I – II or hiatal hernia < 2 cm, who refuse life-long medical therapy or surgery.

Screening for Barrett's Esophagus: Balancing Clinical Value and Cost-effectiveness.

In predisposed individuals with long standing gastroesophageal reflux disease (GERD), esophageal squamous mucosa can transform into columnar mucosa with intestinal metaplasia, commonly called Barrett’s esophagus (BE). Barrett’s mucosa can develop dysplasia, which can be a precursor for esophageal adenocarcinoma (EAC). However, most EAC cases are identified when esophageal symptoms develop, without prior BE or GERD diagnoses. While several gastrointestinal societies have published BE screening guidelines, these vary, and many recommendations are not based on high quality evidence. These guidelines are concordant in recommending targeted screening of predisposed individuals (eg, long standing GERD symptoms with age > 50 years, male sex, Caucasian race, obesity, and family history of BE or EAC), and against population based screening, or screening of GERD patients without risk factors. Targeted endoscopic screening programs provide earlier diagnosis of high grade dysplasia and EAC, and offer potential for endoscopic therapy, which can improve prognosis and outcome. On the other hand, endoscopic screening of the general population, unselected GERD patients, patients with significant comorbidities or patients with limited life expectancy is not cost-effective. New screening modalities, some of which do not require endoscopy, have the potential to reduce costs and expand access to screening for BE.

Laparoscopic Nissen fundoplication in the management of gastroesophageal reflux disease: a single centre experience

Background: Laparoscopic Nissen fundoplication is currently the surgical treatment of choice for gastro-esophageal reflux disease (GERD) in properly selected patients.Methods: Laparoscopic Nissen fundoplication was performed in 36 patients of GERD, Government Medical College over a period of 2 years. Pre-operative evaluation included baseline investigations and clinical assessment by using GERD Questionnaire and specific investigations i.e., barium esophagram, esophago-gastroduodenoscopy, esophageal manometry and 24 hour ambulatory pH monitoring of the esophagus. All patients underwent laparoscopic Nissen Fundoplication. Patients were evaluated at three months after surgery with symptom scoring questionnaire.Results: Mean age of patients in our study was 38 years and most common symptoms were heartburn and regurgitation. Four patients (11%) developed complications. The conversion rate to laparotomy was 2.7% (1 patient). Average symptom scores decreased from 10/18 to 0/18 after fundoplication (&lt;0.0001) and all the eight patients who underwent postoperative endoscopy had normal results.Conclusions: Laparoscopic Nissen’s fundoplication is a safe and effective procedure for GERD, having an acceptable hospital stay with consistently improved short term symptomatic and endoscopic results.

History of gastroesophageal reflux disease in patients with suspected coronary artery disease.

It is well known that patients with gastroesophageal reflux disease (GERD) experience GERD-related chest pain, but little is known about the relationship between GERD and coronary artery disease (CAD). We evaluated medical history of GERD in patients with suspected CAD and its association with types of CAD. We enrolled 236 patients who underwent coronary angiography (CAG). We assessed past medical history of each patient, making note of esophageal or stomach diseases such as GERD including reflux esophagitis and non-erosive reflux disease. The patients were divided into the following three subgroups based on the CAG results. Group I, patients with o-CAD (> 50% stenosis with ischemic findings, n = 141); Group II, patients with vasospastic angina (VSA, with positive spasm provocation test without organic coronary stenosis, n = 52); and Group III, patients without organic coronary stenosis or VSA (n = 43). Group I included more men than women (p < 0.001) and the frequencies of smoking, lipid disorders, and diabetes mellitus in this group were higher than those in the other groups (p < 0.01). The frequency of medical history of GERD was significantly higher in Group II (21%) than in Group I (3%) or Group III (7%, p < 0.0001). Logistic regression analysis showed that a medical history of GERD (OR 7.8; p < 0.01) was one of the factors associated with the presence of VSA. Our findings showed that a medical history of GERD was frequently observed in approximately one-fifth of patients with VSA, indicating that VSA may be present in patients with chest pain and a medical history of GERD.

Results of 24-hour esophageal impedance-pH monitoring in 141 patients with gastroesophageal reflux disease

Objective To analyze the relationship between body type, age, gender, esophageal motility function, lower esophageal sphincter pressure (LESP) and clinical classification and type of reflux contents of patients with gastroesophageal reflux disease (GERD). Methods From September 2015 to July 2016, at Beijing Tongren Hospital of China Capital Medical University, the results of 24-hour esophageal impedance-pH monitoring of 141 patients with GERD were retrospectively analyzed. The differences of reflux contents were compared in patients with GERD among different body type, age, gender, esophageal motility function, LESP and clinical classification. Mann-Whitney test was performed for comparison between groups. Results Acid reflux was more common in obese patients (body mass index more than 23.9 kg/m2) compared with patients with normal body type (body mass index from 18.5 to 23.9 kg/m2) (18.5, 7.0 to 45.3 vs. 10.0, 2.0 to 32.0), and the difference was statistically significant (Z=-2.320, P=0.020). Patients under 65 years old had more numbers of weak acid reflux, non-acid reflux and gas reflux than patients over 65 years old (58.5, 32.8 to 95.0 vs. 40.0, 24.0 to 71.0; 19.5, 6.0 to 47.5 vs. 8.0, 3.0 to 19.0; 46.0, 23.8 to 79.3 vs. 35.0, 11.0 to 56.0), and the differences were statistically significant (Z=-2.690, -3.286 and -2.091, all P 0.05). Patients with reflux esophagitis(RE)and /or Barrett′s esophagus (BE) had more weak acid reflux, non-acid reflux and gas reflux compared with patients with non-erosive reflux disease (NERD) (61.0, 31.3 to 102.5 vs. 44.0, 24.5 to 66.5; 18.0, 8.0 to 36.5 vs. 8.0, 2.0 to 22.0; 49.5, 27.5 to 86.5 vs. 26.0, 11.0 to 47.0), and the differences were statistically significant (Z=-2.585, -2.942 and -3.278, all P<0.05). Patients with lower esophageal sphincter (LES) relaxation were more likely to have weak acid reflux than patients with normal LES function (57.0, 32.3 to 87.0 vs. 40.0, 21.0 to 73.0), the difference was statistically significant (Z=-2.065, P=0.039). Conclusion Body type, age, gender, LESP and clinical classification are related to type of reflux contents in GERD patients, while esophageal peristalsis is irrelevant. Key words: Gastroesophageal reflux; 24-hour esophageal impedance pH monitoring; Patterns of reflux episodes

Studies of salivary pepsin in patients with gastro-oesophageal reflux disease.

Gastro-oesophageal reflux disease (GERD) is difficult to diagnose without invasive testing. Peptest (RD Biomed, Hull, UK) is a recently marketed diagnostic tool which aims to quantify salivary pepsin as a marker of reflux, providing a rapid alternative to invasive procedures. To evaluate optimal timing for sampling, and to evaluate the accuracy of Peptest against an independent measure. Thirty diagnosed GERD patients (12 female, mean age 49 [range 20-72]) and 20 asymptomatic subjects (14 female, mean age 56 [range 21-56]) were subject to diurnal saliva sampling, with additional samples for 60 minutes following self-reported reflux symptoms and triggering of a proximal reflux alarm. Saliva samples were split and were analysed by both Peptest and ELISA with operators for each blinded to sample identity. Salivary pepsin was detectable in most patients and most volunteers. Peptest scores were significantly lower for patients than controls (P<0.005). ELISA scores showed no difference between patients and controls. There was no effect of diurnal sampling time (P=0.75) or time after symptoms (P=0.76) on Peptest readout. There was no correlation between Peptest and Pepsin ELISA (P=0.55); Bland-Altman analysis suggested no agreement between the tests (P=0.414). Receiver-operator curve suggests that neither Peptest (P=0.3328) nor pepsin (P=0.4476) is useful for predicting GERD. Salivary pepsin is not a reliable tool for the diagnosis of GERD.