Gastroesophageal Reflux Disease In Population Research Articles

Impact of concomitant gastroesophageal reflux disease symptomology on prognosis and pulmonary function of chronic hypersensitivity pneumonitis.

Comorbid risk factors in chronic hypersensitivity pneumonitis (CHP) are poorly characterised. Gastroesophageal reflux disease (GERD) is linked to interstitial lung diseases like idiopathic pulmonary fibrosis (IPF), but its association and treatment in CHP is less understood. This study aims to understand the role and prevalence of GERD in CHP, plus the effect of GERD treatment on lung function and mortality. A tertiary referral centre panel was retrospectively reviewed for 214 patients diagnosed with CHP based on clinical history, bronchoalveolar lavage fluid analysis, imaging and histopathology. GERD diagnostic criteria included symptomology, acid suppressive therapy use and diagnostic testing. CHP patients with GERD (n = 89) and without GERD (n = 125) were compared via descriptive statistical analysis. Pulmonary function, GERD diagnosis plus treatment and other comorbidities were evaluated against CHP outcomes. Respective differences between diagnosis and study termination dates in the GERD population versus without GERD for functional vital capacity (FVC) were - 1 L vs - 2.5 L, diffusing capacity of the lungs for carbon monoxide (DLCO) were - 2 mL/min/mmHg versus - 1 mL/min/mmHg, per cent alive at the time of study 88% versus 81%, median date of survival 574.5 versus 850 and supplemental oxygen requirement 41% versus 37%. GERD prevalence was higher in CHP patients relative to the general population. No statistical significance was found between survival curves, oxygen requirement, smoking history, FVC, or DLCO. GERD could be a harmful comorbidity in CHP though may not necessarily affect survival or functional outcomes. This aligns with previous IPF studies, though remains controversial. Further research is needed regarding this association and treatment benefit.

Biochemical and Physiological Effects of Food-Induced Gastro-Esophageal Reflux Disease (GERD) in our Population. A Comparative Clinical Study

Background: Gastroesophageal reflux disease (GERD) can lead to significant medical complications such as esophageal ulcerations, peptic stenosis and esophageal adenocarcinoma. Aims and Objectives: The aims and objectives of current study was to evaluate the biochemical and physiological parameters associated with daily food which caused gastroesophageal reflux disease in population of Pakistan. Study Design: This was a comparative clinical study designed to investigate the effect of different dietary interventions on the symptoms of gastroesophageal reflux disease (GERD). Place and Duration: Current study was conducted medical units of Jinnah Hospital Lahore and Jinnah Hospital Karachi from June 2022 to February 2023 comparatively. Statistical analysis: Raw data was analyzed by using SPSS software (version 26.0). Descriptive statistics were used to summarize demographic and clinical characteristics of the study population. Methodology: A total of 100 adult patients with confirmed GERD diagnosis were randomized to either a standard GERD diet. The primary outcome measure was the change in GERD symptom severity, as assessed by the Gastroesophageal Reflux Disease Questionnaire (GERDQ) score after 12 weeks of dietary intervention. Secondary outcome measures included changes in esophageal inflammation, measured by endoscopy, and patient-reported improvement in quality of life. Practical Implications: Current study focuses on evaluation of the biochemical and physiological parameters associated with daily food which caused gastroesophageal reflux disease in population of Pakistan which will spread awareness among community for the prevention of GERD. Results: Demographic characteristics of the study population are presented in Table 1. The mean age of the patients was 48.7 years, and there were slightly more females (60%) than males (40%). The majority of patients (60%) reported a history of smoking, and 10% reported regular alcohol consumption. There was a significant (P≤0.05) difference between the two groups with respect to age, sex, smoking history and alcohol consumption. The findings of this study suggest that dietary interventions, particularly a modified Mediterranean diet, can significantly improve the symptoms and quality of life of patients with GERD. Conclusion: In conclusion, our study found that a modified Mediterranean diet may be more effective than a standard GERD diet in reducing the severity of GERD symptoms and improving quality of life in patients with GERD. This was evidenced by a significantly greater reduction in GERD score in Group B compared to Group A, as well as a higher proportion of patients reporting improved quality of life in Group B. In addition, the incidence of esophageal inflammation was lower in Group B, although this difference was not statistically significant. Keywords: dietary intervention, Mediterranean diet, symptom severity, quality of life, esophageal inflammation,

Endoscopic management of gastroesophageal reflux disease: Panacea for proton pump inhibitors dependent/refractory patients.

Endoscopic therapies in proton pump inhibitors (PPI) dependent/refractory gastroesophageal reflux disease (GERD) are increasingly indicated in patients who are not suitable or willing for chronic medical therapy and surgical fundoplication. Currently available endoluminal anti-reflux procedures include radiofrequency therapy (Stretta), suturing/plication and mucosal ablation/resection techniques at the gastroesophageal junction. Meticulous work up and patient selection results in a favorable outcome with these endoscopic therapies, especially the quality of life and partially the PPI independence. Stretta can be considered in patients with PPI refractory GERD and might have a role in patients with reflux hypersensitivity and functional heartburn. Endoscopic fundoplication using the Esophyx device and the GERD-X device have strong evidence (multiple randomized controlled trials) in patients with small hiatus hernia and high volume reflux episodes. Mucosal resection/ablation techniques like anti-reflux mucosectomy and anti-reflux mucosal ablation have shown promising results but need long term follow-up studies to prove their efficacy. The subset of PPI dependent GERD population will benefit from endoscopic therapies and the future of endoscopic management of GERD looks promising.

The Risk of Acute Myocardial Infarction in Patients With Gastroesophageal Reflux Disease.

Background/AimsA number of inflammatory mediators have been documented to be elevated in gastroesophageal reflux disease (GERD). Similar inflammatory mediators are involved in coronary artery disease. Thus, the aim of the study is to determine if GERD is a risk factor for developing acute myocardial infarction (AMI).MethodsWe used Explorys, a private cloud-based data store to which a number of health care systems feed information. We identified a cohort of GERD patients who have undergone an esophagogastroduodenoscopy compared to those without GERD. Incidence of AMI was studied after statistically controlling for known AMI risk factors.ResultsTotal of 200 400 patients were included in the GERD group and 386 800 patients in non-GERD group. The primary event of AMI occurred in 17 200 patients in the GERD group (8.6%) vs 24 300 in non-GERD group (6.3%). Using logistic regression analysis and controlling for 6 major risk factors which included male gender (OR, 1.09; 95% CI, 1.07-1.11; P < 0.001), hypertension (OR, 6.53; 95% CI, 6.21-6.88; P < 0.001), hyperlipidemia (OR, 3.08; 95% CI, 2.96-3.20; P < 0.001), diabetes mellitus (OR, 1.72; 95% CI, 1.69-1.76; P < 0.001), obesity (OR, 1.02; 95% CI, 1.00-1.04; P = 0.044), and smoking (OR, 1.38; 95% CI, 1.35-1.41; P < 0.001). The odds of developing AMI in the GERD population was 1.11 (95% CI, 1.08-1.13; P < 0.001). GERD had higher odds of developing AMI than male gender or obesity in our study.ConclusionsThis study demonstrated that GERD is a risk factor for AMI, higher than male gender and obesity. However, the increased risk may be clinically insignificant.

A Systematic Review and Meta-Analysis of the Effect of Roux-en-Y Gastric Bypass on Barrett's Esophagus.

Obesity is associated with a twofold risk of gastroesophageal reflux disease (GERD) and thrice the risk of Barrett's esophagus (BE). Roux-en-Y gastric bypass (RYGB) leads to weight loss and improvement of GERD in population with obesity, but its effect on BE is less clear. Bibliographic databases were searched systematically for relevant articles till January 31, 2019. Studies evaluating the effect of RYGB on BE with preoperative and postoperative endoscopy and biopsy were included. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool. Meta-analysis was conducted using Mantel-Haenszel, random effects model and presented as risk difference (RD) or odds ratio (OR) with 95% confidence intervals. Eight studies with 10,779 patients undergoing RYGB reported on 117 patients with BE with follow-up of > 1year. Significant regression of BE after RYGB was observed (RD - 0.56.95% c.i. - 0.69 to - 0.43; P < 0.001). Subgroup analysis showed regression of both short-segment BE [ssBE] (RD - 0.51.95% c.i. - 0.68 to - 0.33; P < 0.001) and long-segment BE [lsBE] (RD - 0.46.95% c.i. - 0.71 to - 0.21; P < 0.001). RYGB also caused improvement in GERD in patients of BE (RD - 0.93, 95% c.i. - 1.04 to - 0.81; P < 0.001). RYGB was strongly associated with regression of BE compared with progression (OR 31.2.95% c.i. 11.37 to 85.63; P < 0.001). RYGB leads to significant improvement of BE at > 1year after surgery in terms of regression and resolution of the associated GERD. Both ssBE and lsBE improve after RYGB significantly.

Impact of concomitant dyspepsia and irritable bowel syndrome on symptom burden in patients with gastroesophageal reflux disease

Patients with gastroesophageal reflux disease (GERD) frequently report symptoms like dyspepsia or/and irritable bowel syndrome (IBS). The aim of the study was to investigate the impact of symptom overlap on GERD symptom burden. We also investigate whether GERD overlapping dyspepsia or/and IBS would have different clinical and psychological features as compared with GERD alone. A total of 2752 subjects were screened from a health check-up population. We compared the clinical and psychological factors among subjects with GERD alone and with overlap of two or all three diseases. All participants underwent an evaluation with questionnaires including Reflux Disease Questionnaire score, Pittsburgh Sleep Quality Index, Taiwanese Depression Questionnaire, and State-Trait Anxiety Inventory before receiving endoscopic exam. Among the GERD population, we identified 26 with IBS (GERD-IBS), 60 with dyspepsia (GERD-D), and 25 subjects with overlap of all three conditions (GERD-D-IBS). GERD-D and GERD-D-IBS subjects had more severe GERD symptoms as compared subjects with GERD alone (p<0.001). Subjects with overlapping dyspepsia or/and IBS showed a significant increase in the severity of depression and poorer sleep quality than subjects with GERD alone. Notably, anxiety scores did not differ significantly between subjects with overlapping diseases and GERD alone. Our study demonstrates that disease overlap in GERD population is associated with greater symptom burden, higher depression and poorer sleep quality, but not with anxiety. This study highlights the importance of identifying overlapping conditions as a therapeutic strategy for better management of GERD.

Overlap of Dyspepsia in Patients with Gastroesophageal Reflux Disease: Impact of Clinical, Metabolic, and Psychosocial Characteristics

Gastroesophageal reflux disease (GERD) and dyspepsia are highly prevalent in the general population with significant symptom overlap, while the interaction between both remains poorly understood. To examine whether GERD overlapping dyspepsia would have an impact on clinical and psychological features as compared with GERD alone. We performed a cross-sectional study in a GERD cohort (n=868) that was previously recruited from a population-based GERD survey (n=2752). We compared the clinical and psychological factors between patients with and without dyspeptic symptoms "epigastric pain or burning." All participants were evaluated with Reflux Disease Questionnaire score, Pittsburgh Sleep Quality Index score, Taiwanese Depression Questionnaire score, and State-Trait Anxiety Inventory score. Endoscopic findings were classified according to the Los Angeles classification. Among the GERD population, 107 subjects had overlapping "epigastric pain or burning" (GERD-D), and 761 did not have these symptoms (GERD alone). GERD-D subjects had more severe GERD symptoms and were more often associated with irritable bowel syndrome (IBS) (OR 3.54, 95% CI 1.92-6.52) as compared subjects with GERD alone. In addition, GERD-D subjects had lower quality of sleep (OR 1.11, 95% CI 1.01-1.21), higher depression (OR 1.06, 95% CI 1.02-1.10), lower blood pressure (OR 0.45, 95% CI 0.22-0.95), and higher serum total cholesterol levels (OR 2.78, 95% CI 1.36-5.67) than GERD alone. GERD-D subjects are characterized with worsening clinical symptoms as well as higher psychosocial, IBS, and metabolic comorbidities, but less erosive esophagitis. Our results indicate that clinical awareness of such overlapping condition would help optimize the management of GERD in clinical practice.

Extraesophageal Manifestations of Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a common disease, affecting approx 40 million people in the United States alone. In fact, even this huge number is only an estimate, which is based on population surveys of the prevalence of frequent heartburn (the cardinal symptom of GERD) in the population. The GERD population would likely be even larger if the estimate encompassed individuals with extraesophageal manifestations of GERD, as well as heartburn sufferers. Extraesophageal manifestations of GERD, encompassing a spectrum of pulmonary and otolaryngologic disorders, may be the primary (or only) manifestation of GERD in some individuals. The implicated syndromes include posterior laryngitis, asthma, chronic cough, recurrent pneumonitis, chronic hoarseness, chest pain, pharyngitis, sinusitis, and dental disease.

PPI-Refractory GERD: an Intriguing, Probably Overestimated, Phenomenon.

Proton-pump inhibitors (PPIs) are still a cornerstone of pharmacologic treatment for gastroesophageal reflux disease (GERD) because of their unquestionable efficacy in reducing the acid component of refluxate. However, their extensive use in the general population has revealed a subset of patients who are unsatisfied with these agents. These patients are considered unresponsive to PPIs, and this emerging phenomenon, defined as refractoriness to PPIs, may have a prevalence ranging from 10 to 40 % [1, 2]. Several drug-related variables, such as daily dosage and duration of therapy, clearly may be responsible for these numbers, and recently, it was proposed that the term PPI refractory be used only for patients unresponsive to a 12-week twice-daily course of PPI therapy [3•]. However, the greatest factor influencing PPI response likely is the type of patient to whom the drug is prescribed. It is now well established that the mechanisms underlying the symptoms in patients with GERD are related not only to esophageal acid exposure, especially in those without mucosal erosions (i.e., with nonerosive reflux disease (NERD)) who have a possibly normal but still symptomatic acid reflux (i.e., hypersensitive esophagus (HE)). In all these patients, who represent a large proportion of the GERD population, another very important mechanism for symptom occurrence is enhanced esophageal sensitivity, which also may be associated with central sensitization. We can speculate that the two mechanisms—acid exposure and hypersensitivity—each might play a different role throughout the spectrum of GERD phenotypes. Acid exposure is a predominant factor in patients with erosive disease but is less important in those without mucosal lesions; on the contrary, hypersensitivity is the major mechanism in patients without lesions and with normal reflux (Fig. 1). Despite this heterogeneous pathogenesis, however, we treat our GERD patients with drugs—PPIs—characterized by a very selective mechanism of action, i.e., the inhibition of acid secretion. It thus is reasonable to expect that the efficacy of this therapy is related directly and proportionally to the role of acid exposure in the individual patient, and this is exactly what occurs in clinical practice. A recently published paper [4••] provides an elegant summary of PPI efficacy in patients with different manifestations of GERD. The authors analyzed randomized controlled trials and evaluated the placebo effect and therapeutic gain for each patient category. Their data clearly indicate that the greatest PPI success—75 % or more—occurred in patients with esophagitis or typical reflux symptoms, such as heartburn or reflux-induced chest pain. On the contrary, patients with regurgitation as their main symptom or with laryngeal manifestations such as hoarseness or chronic cough showed a poor response to PPIs, with * Fabio Baldi fa.baldi@libero.it; fabio.baldi@unibo.it

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.

Acid Sensitization of Esophageal Mucosal Afferents

Sensitization of esophageal chemoreceptors, either directly by intermittent acid exposure or indirectly through esophagitis-associated inflammatory mediators, is likely to be the mechanism underlying the perception of heartburn. To compare basal esophageal sensitivity with electrical stimulation and acid, and to compare the degree of acid-induced sensitization in controls and in patient groups across the entire spectrum of gastroesophageal reflux disease: erosive oesophagitis (EO), nonerosive reflux disease (NERD), and functional heartburn (FH). Esophageal sensory and pain thresholds to electrical stimulation were measured before, 30, and 60 minutes after an intraesophageal infusion of saline or HCl. Patients received a 30-minute infusion of 0.15 M HCl and controls were randomized to receive either HCl (n = 11) or saline (n = 10). After electrical sensory threshold testing, participants received another 30-minute infusion of HCl to determine whether sensitivity to acid is increased by prior acid exposure All patient groups had higher basal sensory thresholds than healthy controls (controls, 13 ± 1.4 mA; FH, 20 ± 5.1 mA; NERD, 21 ± 5.1 mA; EO, 23 ± 5.4 mA; P < 0.05). Acute esophageal acid exposure reduced sensory thresholds to electrical stimulation in FH and NERD patients (P < 0.05). The level of acid sensitivity during the first HCl infusion was comparable between all patient groups and controls. The secondary infusion caused increased discomfort in all participants (P < 0.01). This acid-induced sensitization to HCl was significantly elevated in the patient groups ( P < 0.05). (1) Esophageal acid infusion sensitizes it to subsequent electrical and chemical stimulation. (2) The acid-related sensitization is greater in gastroesophageal reflux disease than in controls and may influence in part symptom perception in this population. (3) Acid-related sensitization within the gastroesophageal reflux disease population is not dependant on mucosal inflammation.

LINX™ Reflux Management System: magnetic sphincter augmentation in the treatment of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD), commonly manifested by heartburn or regurgitation, is a chronic, progressive condition in which failed sphincter function allows the contents of the stomach to reflux into the esophagus, the airways and the mouth. Chronic GERD affects 10% of Western society. The majority of patients receive adequate relief from proton pump inhibitors, but up to 40% have incomplete relief of symptoms that cannot be addressed by increasing the dose of medications. The laparoscopic Nissen fundoplication is the surgical gold standard; however, the level of technical difficulty and its side effects have limited its use to less than 1% of the GERD population. These factors have contributed to the propensity of patients to persist with medical therapy, even when inadequate to control symptoms and complications of the disease. Consequently, a significant gap in the treatment continuum for GERD remains evident in current clinical practice. The LINX™ Reflux Management System (Torax Medical) is designed to provide a permanent solution to GERD by augmenting the physiologic function of the sphincter barrier with a simple and reproducible laparoscopic procedure that does not alter gastric anatomy and can be easily reversed if necessary.

Su1082 GERDQ is Superior Tool for the Evaluation of GERD Symptoms and Unmet Medical Needs to the Carlsson-Dent Questionnaire - a Large Scale Survey -

Background: With an increasing prevalence of gastroesophageal reflux disease (GERD), primary care physicians are now faced with the challenge of making an accurate diagnosis of GERD and effectively managing it to provide patient satisfaction. Attention has recently focused on a simple and valid tool to support GERD management, called GerdQ, which is a patient-centered tool that has been devised for health care professionals (Aliment. Pharm. Ther. 30:1030, 2009). The present study is designed to validate the efficacy of the Japanese version of GerdQ compared with that of the classical Carlsson-Dent questionnaire (CDQ) onGERDmanagement.Methods:With approval from the ethics committee of Keio University (No.2010-319), web-based questionnaires comprising the Japanese versions of GerdQ and CDQ, including questions for demographic information, including the history of treatment with antisecretory agents and compliance with the prescribed medicines that were scored on a 5-point patients' satisfaction scale, were sent to 1,630 subjects with a history of heartburn and/or regurgitation. Of the 1,630 subjects, 1,024 (men 479; women 545) completed the above questionnaires after providing informed consent. Results: After the exclusion of subjects with peptic ulcer (n = 30) or malignancy (n = 131), 863 subjects (391 men, 43.1 ± 8.5 years; 472 women, 39.4 ± 9.7 years) were ultimately included in the analysis. The CDQ scores were significantly correlated with GerdQ scores (r = 0.34, p < 0.001). Based on the diagnostic criteria of the frequency of reflux symptoms as being more than once a week, subjects were further allocated to GERD (men 173; women 189) and non-GERD (men 218; women 283) groups. Among the GERD group, age-dependent aggravation of scores more strongly correlated with GerdQ than CDQ (trend: p = 0.01 for men; p < 0.001 for women). Among subjects prescribed medicines (n = 67), the score on the patient satisfaction was more significantly correlated with GerdQ score (p = 0.03) than with CDQ score, suggesting the superiority of GerdQ over CDQ for evaluating a patient's satisfaction level with regard to disease management. Among the prescribed population, 34 subjects (49%) used over-the-counter (OTC) drugs to control their GERD symptoms in addition to the prescribed medicine. Although the GerdQ scores of subjects taking the prescribed medicines was significantly higher than those not taking prescriptions (p = 0.03), no trend in CDQ score was noted. Conclusion: GerdQ more reliably reflected the severity of GERD symptoms than CDQ among GERD population. Compared with the CDQ, GerdQ more reflected patient satisfaction levels with the prescribed medicines, suggesting that it might be a potentially useful tool for the evaluation of unmet medical needs for GERD treatment as indicated by the need for OTC medication.

Frequency scale symptoms for gastroesophageal reflux disease (Frequency Scale for Symptoms of GERD) predicts need for addition of prokinetics to proton pump inhibitor therapy

Frequency scale symptoms for gastroesophageal reflux disease (Frequency Scale for Symptoms of GERD) predicts need for addition of prokinetics to proton pump inhibitor therapy

Time trends in cost of caring for people with gastroesophageal reflux disease

OBJECTIVE: Increasing acceptance of the many permutations of gastroesophageal reflux disease (GERD) has led to diverse study of the disease and its effects. The goal of this study was to estimate medical care costs attributable to a defined GERD population over time. Methods: A retrospective cohort control design was used. All participants were identified from the database of a managed care organization serving 300,000 people in the northeastern United States. The index population (n = 600) was defined as anyone who obtained medical services during 1997 or 1998, for any International Classification of Diseases (ninth revision, Clinical Modification) codes suggestive of GERD, and/or anyone who received at least one prescription and one refill for antisecretory or GERD medications during at least two 3-month periods in 1997 or 1998. A matched cohort (n = 600) without any diagnosis of GERD was randomly selected as a control group. Both populations were observed restrospectively from January 1, 1990 through December 31, 1998. Results: The cost of treating GERD averaged around $510 per year, about 15% of all medical costs for those with GERD. Treating people with GERD was about 2-fold more costly than treating those without GERD, a marginal cost of $1500 to $2000 per annum. Conclusion: Although GERD is a low-cost disease to treat, the cost of treating people with GERD is subtantially greater than that for a comparable population without GERD. Two explanations may account for the large difference of costs between the study populations. First, the GERD group may be sicker than the control group. Disease severity variables and diagnoses associated with GERD were more commonly diagnosed in the GERD group. Second, an additional disease that is not treated appropriately increases the cost of treatment geometrically for all diseases.