Gastroesophageal Reflux Disease Questionnaire Research Articles

Study on the relationship of depression, anxiety, lifestyle and eating habits with the severity of reflux esophagitis

BackgroundThe etiology of reflux esophagitis (RE) is multi-factorial. This study analyzed the relationship of depression, anxiety, lifestyle and eating habits with RE and its severity and further explored the impact of anxiety and depression on patients’ symptoms and quality of life.MethodsFrom September 2016 to February 2018, a total of 689 subjects at Xuanwu Hospital Capital Medical University participated in this survey. They were divided into the RE group (patients diagnosed with RE on gastroscopy, n = 361) and the control group (healthy individuals without heartburn, regurgitation and other gastrointestinal symptoms, n = 328). The survey included general demographic information, lifestyle habits, eating habits, comorbidities, current medications, the gastroesophageal reflux disease (GERD) questionnaire (GerdQ), the Patient Health Questionnaire-9 depression scale and the General Anxiety Disorder-7 anxiety scale.ResultsThe mean age and sex ratio of the two groups were similar. Multivariate logistic regression analysis identified the following factors as related to the onset of RE (p < 0.05): low education level; drinking strong tea; preferences for sweets, noodles and acidic foods; sleeping on a low pillow; overeating; a short interval between dinner and sleep; anxiety; depression; constipation; history of hypertension; and use of oral calcium channel blockers. Ordinal logistic regression analysis revealed a positive correlation between sleeping on a low pillow and RE severity (p = 0.025). Depression had a positive correlation with the severity of symptoms (rs = 0.375, p < 0.001) and patients’ quality of life (rs = 0.306, p < 0.001), whereas anxiety showed no such association.ConclusionsMany lifestyle factors and eating habits were correlated with the onset of RE. Notably, sleeping on a low pillow was positively correlated with RE severity, and depression was positively related to the severity of symptoms and patients’ quality of life.

Predictive Factors of Gastroesophageal Reflux Disease Symptoms Following Open Sleeve Gastrectomy in Brazil Using Clinical Questionnaire.

To evaluate predictors of symptoms of gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) based on a clinical questionnaire. This is a cross-sectional study. We included all patients who underwent open SG between May 2013 and March 2017 in a single institution. Patients who could not be contacted or who did not want to participate were excluded. Clinical, demographic, and pre- and postoperative data were collected on medical records. Patients were contacted via telephone and inquired about GERD symptoms postoperatively. Symptoms were quantified using the GERD Questionnaire (GERDq). Patients were divided into three study groups according to GERDq score: asymptomatic (GERDq = 0), mildly symptomatic (GERDq ≤ 8), and severely symptomatic (GERDq > 8). Univariate analysis was performed using ANOVA, Kruskal-Wallis, Dunn, and chi-square tests. A logistic regression model was built for adjusted analysis of the data. One hundred eighty-nine patients were included. Mean age was 39.7 ± 10.71 years and 45.5% were female. Postoperative median follow-up period was 4.55 years (interquartile range 5.34-3.76). Mean GERDq score was 7.62 ± 10.17. Sixty-four patients were asymptomatic, 63 were mildly symptomatic, and 62 were severely symptomatic. The group of severely symptomatic patients showed a statistically lower preoperative weight when compared to the other groups (p = 0.049), but this association was not observed when analyzing preoperative BMI (p = 0.427). The other variables were not associated with postoperative GERD symptoms, both in univariate and adjusted analysis. No variables were statistically and clinically predictive of GERD occurrence or severity after SG. The pathophysiology of GERD is complex and further studies are needed to elucidate this condition.

Integrative Effects and Vagal Mechanisms of Transcutaneous Electrical Acustimulation on Gastroesophageal Motility in Patients With Gastroesophageal Reflux Disease

Impaired esophageal and gastric motilities are known to contribute to symptoms of gastroesophageal reflux disease (GERD). However, there is a lack of GERD therapy, targeting both gastric and esophageal functions. This study was designed to investigate the effects of transcutaneous electrical acustimulation (TEA) on symptoms of GERD and gastroesophageal functions and possible mechanisms in patients with GERD. Thirty patients with GERD with ineffective esophageal motility were equally divided and randomized into a 4-week sham-TEA or 4-week TEA treatment. The GERD questionnaire (GerdQ), GERD health-related quality-of-life questionnaire, high-resolution esophageal manometry, a nutrient drink test, the electrogastrogram, and ECG were performed to assess the severity of reflux symptoms, low esophageal sphincter (LES) pressure, distal contractile integral (DCI), gastric accommodation, gastric slow waves (GSW), and autonomic functions, respectively. Compared with sham-TEA, the 4-week TEA treatment significantly decreased the GerdQ score (P = 0.011) and GERD health-related quality of life (P = 0.028) and improved nutrient drink-induced fullness (P < 0.001) and belching (P < 0.001) in patients with GERD. Although only acute TEA significantly enhanced LES pressure (P < 0.05), both acute and chronic TEA remarkedly increased DCI (P < 0.05) and reduced the incidence of ineffective esophageal contractions during wet swallows (P = 0.02). In addition, chronic TEA significantly increased gastric accommodation and the percentage of postprandial normal GSW compared with sham-TEA and baseline. Concurrently, TEA-enhanced vagal activity (P = 0.02) and the vagal activity positively correlated with LES pressure (r = 0.528; P = 0.003) and DCI (r = 0.522; P = 0.003). The TEA treatment performed in this study improves reflux-related symptoms, increases DCI, reduces the incidence of ineffective esophageal contractions during wet swallows, and improves gastric accommodation and slow waves. The improvement in GERD symptoms might be attributed to the integrative effects of TEA on these gastroesophageal functions mediated via the vagal mechanism.

Validation of the French version of the esophageal hypervigilance and anxiety scale

IntroductionAn esophageal hypervigilance and anxiety scale (EHAS) was developed in English to assess the psychological process in patients with esophageal disorders. The aim of the current study was to validate this scale in French. Patients and methodsPatients referred for esophageal high resolution manometry (HRM) were offered to fill out different questionnaires including EHAS, Eckart score and gastro-esophageal reflux disease-questionnaire (GERDQ) score. EHAS was translated in French by 2 French native speaker experts in esophageal motility. Patients were grouped according to the indications of HRM (dysphagia, reflux, other). The total EHAS score was calculated and compared between groups. The validation method used the assessment of internal consistency with Cronbach’s α and reliability with Guttman split-half reliability. ResultsAmong the 607 patients who accepted to fill out questionnaires, the EHAS questionnaire was completed and analyzable in 469 patients. The total score had an excellent internal consistency (Cronbach’s α = 0.91) and reliability (Guttman statistic = 0.86). EHAS score was not different between groups while Eckardt score was logically higher in patients with dysphagia than in others (p < 0.001) and GERDQ score was higher in patients with reflux than in those with dysphagia (p < 0.001). Despite different load on anxiety and hypervigilance scales, inter-item correlations and average scores did not differ between the original and the French EHAS. ConclusionEHAS is a valid questionnaire in French. It can be interpreted using the original EHAS score. Further studies are required to demonstrate the utility of this score in patients’ management.

Comparing Efficacy and Safety of Empirical vs. Guided Therapy for Non-cardiac Chest Pain: A Pragmatic Randomized Trial.

Background: Non-cardiac chest pain is common with two-thirds due to gastroesophageal reflux disease (GERD).Objective: To evaluate the effectiveness and safety of guided vs. empirical therapy in non-cardiac chest pain.Methods: Adults with normal angiogram or stress test were randomized into either a guided or empirical group. In the guided group, after the ambulatory pH-impedance test, if GERD then dexlansoprazole 30 mg/day for 8 weeks, but if functional or hypersensitive chest pain, then theophylline SR 250 mg/day for 4 weeks. In the empirical group, dexlansoprazole 60 mg/day was given for 2 weeks. The primary outcome was global chest pain visual analog score (VAS) and secondary outcomes were Quality of Life in Reflux and Dyspepsia (QOLRAD), GERD questionnaire (GERDQ), and pH parameters, all determined at baseline, 2nd and 8th weeks.Results: Of 200 screened patients, 132 were excluded, and of 68 randomized per-protocol, 33 were in the guided group and 35 in the empirical group. For between-group analysis, mean global pain scores were better with guided vs. empirical group at 8th week (P = 0.005) but not GERDQ or QOLRAD or any of pH measures (all P > 0.05). For within-group analysis, mean QOLRAD improved earliest at 8th week vs. baseline (P = 0.006) in the guided group and 2nd week vs. baseline (P = 0.011) in the empirical group but no differences were seen in other secondary outcomes (P > 0.05). No serious adverse events were reported.Conclusions: Guided approach may be preferred over short-term empirical therapy in symptom response, however QOLRAD, acid-related symptoms, or pH measures are not significantly different (trial registration ID no. NCT03319121).

Washed microbiota transplantation reduces proton pump inhibitor dependency in nonerosive reflux disease

BACKGROUNDThe pathogenesis of gastroesophageal reflux disease (GERD) is closely associated with the intestinal bacteria composition and their metabolites.AIMTo investigate whether washed microbiota transplantation (WMT) improves symptoms of nonerosive reflux disease (NERD) with proton pump inhibitor (PPI) dependency.METHODSPatients with recurrent NERD and PPI dependency at the First Affiliated Hospital of Guangdong Pharmaceutical University from 2017 to 2018 were included and divided into a WMT or PPI group treated with PPI with/without WMT. The endpoint was NERD symptom frequency evaluated 1 mo after WMT using reflux disease questionnaire (RDQ) and GERD questionnaire (GERDQ) scores, remission time, PPI dose, and the examination of intestinal mucosal barrier function.RESULTSIn the WMT (n = 15) and PPI (n = 12) groups, the total remission rate at 1 mo after treatment was 93.3% vs 41.7%. Compared with the PPI group, the WMT group showed better results in GERDQ (P = 0.004) and RDQ (P = 0.003) and in remission months (8 vs 2, P = 0.002). The PPI dose was reduced to some extent for 80% of patients in the WMT group and 33.3% in the PPI group. In 24 patients, intestinal mucosal barrier function was examined before treatment, and changes in the degree of damage were observed in 13 of these patients after treatment. Only one of the 15 patients had minor side effects, including a mushy stool two or three times a day, which resolved on their own after 1 wk.CONCLUSIONThis study is the first to demonstrate that WMT may be safe and effective for relieving NERD symptoms and reducing PPI dependency and recurrence.

Association between gastroesophageal reflux disease-questionnaire factors and gastroesophageal reflux disease incidence at Kardinah general hospital inpatient wards

Background: Gastroesophageal reflux disease (GERD) is a condition where an acid reflux into the esophagus with can resulted some symptoms. GERD is one of the most common disease in around the world. The most common symptom is heartburn, with its various risk factors. Diagnosing GERD based on the clinical examination or more advanced examination. One simple tool to help diagnosing is GERD questionnaire (GERD-Q). This study aims to find out the association of GERD-Q factors to GERD incidence at Kardinah inpatient wards. Methods: This study is cross sectional design, with the subjects are all patients in the inpatient wards, and asked with the Indonesian version of GERD-Q plus other questions. All data will be assessed with chi Square test. Results: Total of 84 respondents are in this study, where the relationship of each factors with GERD incidence are: gender (p value: 0.191), surgery (p value: 0.428), spicy foods consumption (p value: 0.920), fatty foods consumption (p value: 0.916), sour foods consumption (p value: 0.557), and irregular eating habit (p value: 0.023).Conclusions: Irregular eating habit is significantly associated with GERD incidence.

Prevalence and clinical significance of esophageal motility disorders in patients with laryngopharyngeal reflux symptoms

Esophageal motor dysfunction may underlie impaired bolus/refluxate clearance in laryngopharyngeal reflux (LPR). However, the prevalence of esophageal dysmotility and its correlation with reflux parameters and symptoms in LPR is not well established. The aim of this study was to evaluate the prevalence of coexisting esophageal dysmotility among patients with suspected LPR. This was a retrospective cohort study of 194 consecutive patients with LPR symptoms referred for high-resolution manometry (HRM) and combined hypopharyngeal-esophageal multichannel intraluminal impedance and pH testing at a tertiary center in March 2018 to August 2019. Validated symptom surveys were prospectively collected at time of testing, including Reflux Symptom Index, Gastroesophageal Reflux Disease Questionnaire, dominant symptom intensity, and 12-Item Short-Form Health Survey. HRM findings were categorized using Chicago Classification v3.0. Abnormal findings on HRM were identified in 84 (43.3%) patients, with ineffective esophageal motility (n=60, 30.9%) as the most common diagnosis. A disorder of esophagogastric junction outflow or a major disorder of peristalsis was identified in 26 (13.4%) patients, including 2 (1%) with achalasia and 7 (3.6%) with jackhammer esophagus. Reflux burden (distal, proximal, or pharyngeal) on combined hypopharyngeal-esophageal multichannel intraluminal impedance and pH testing did not differ across HRM findings. Patients reporting esophageal symptoms were more likely to have a primary motility disorder (odds ratio 2.34, P=0.04). However, no significant differences in Reflux Symptom Index, Gastroesophageal Reflux Disease Questionnaire, or 12-Item Short-Form Health Survey were noted across HRM diagnoses. Esophageal motility disorders are prevalent among patients with LPR symptoms, including up to one in seven with esophagogastric junction outflow or major peristaltic disorder. Patients with abnormal motility more likely report esophageal symptoms. Clinicians should be aware of these coexisting conditions, particularly in those with refractory symptoms.

Significant decline in the prevalence of Barrett's esophagus among patients with gastroesophageal reflux disease.

Barrett's esophagus (BE), a premalignant condition for the development of esophageal adenocarcinoma (EAC), is a consequence of chronic gastroesophageal reflux disease (GERD). Although the incidence of EAC is increasing, a similar trend for BE is not clear. We aimed to evaluate the prevalence of newly diagnosed BE over time in a cohort of patients presenting with GERD symptoms. Information was prospectively collected between 1998 and 2015 for patients presenting to the endoscopy unit at a tertiary referral center for their index upper endoscopy for evaluation of GERD symptoms. Patients were asked to complete a validated GERD questionnaire that documents the onset of GERD symptoms (heartburn and acid regurgitation) and grades the frequency and severity of symptoms experienced. Demographic information, body mass index (BMI), and use of aspirin, nonsteroidal anti-inflammatory drugs, acid suppression therapy if any, smoking, family history, and endoscopic findings: erosive esophagitis, BE, and hiatal hernia were recorded. Patients evaluated during 1998-2003 (control) were compared with those presented in subsequent years (3-year cohorts) using chi-square test, and a multivariable logistic regression model was used to evaluate independent predictors. A total of 1109 patients were included in the analysis: mean age 56.9years (standard deviation [SD] 12.8), 83% Caucasian, 93% male, and mean BMI 29.8 (SD 5.5). Overall, 226 (20.3%) patients were diagnosed with BE, with a mean BE length of 2.1cm (SD 2.6). There was a significant decrease in the prevalence of BE over time from 24.3% in 1998-2003 to 13.5% in 2013-2015 (P = 0.002). During the same time period, a significant increasing trend in proton pump inhibitor (PPI) (41.7%; 1998-2003 vs. 80.2%; 2013-2015) (P < 0.001) and aspirin (ASA) use (23.7%; 1998-2003 vs. 25.9%; 2013-2015) (P = 0.034) was noted. There was also a significant reduction in cigarette smoking. In a multivariable logistic regression model for predicting the presence of newly diagnosed BE, there was a significant effect of timeframe even after adjusting for confounding variables. The results of our study indicate that there has been a steady and significant decline in the prevalence of BE in GERD patients over the last 2 decades. During this same time period, there has been an accompanying increase in the use of PPI, aspirin therapy, and a reduction in smoking, all modifiable risk factors potentially contributing to the decreasing prevalence of BE. Whether this decreasing prevalence of BE will lead to a reduction in EAC remains to be seen.

Yetişkin Nüfuslarda Gastroözofageal Reflü, Laringofaringeal Reflü ve Uyku Kalitesi

Objective: This study was conducted to determine the interrelationships of gastroesophageal reflux, laryngopharyngeal reflux and sleep quality in adults. Sleep quality in adults is important for health protection in terms of physiological and psychological and increasing performance. Recent studies have emphasized a strong association between sleep disorders and gastrointestinal disorders. Material and Methods: This cross-sectional study was carried out with 400 individuals who are >18 years old who were registered family health centers from east, west, north, and south of Elazığ province between April and June 2018. A Personal Information Form, Gastroesophageal Reflux Disease Questionnaire, Reflux Symptom Index, and the Pittsburgh Sleep Quality Index were used as data collection tools. Results: The results of simple linear regression indicate that Pittsburgh Sleep Quality Index global score was associated with Gastroesophageal Reflux Disease Questionnaire, Reflux Symptom Index, age, gender, educational status, marital status, working status, monthly income perception, health perception and the person living together. By the multiple regression analysis, Reflux Symptom Index, Gastroesophageal Reflux Disease Questionnaire, the employment status and being widow are the most correlated variables on the Pittsburgh Sleep Quality Index global score and explained 27% of the total variance. Conclusion: In addition to being a significant relationship between reflux and sleep quality, it can be asserted that some sociodemographic variables besides reflux is the important parameters required while evaluating the sleep-related problems.

Efficacy and Gastrin Levels in Gastroesophageal Reflux Disease Patients Treated with Esomeprazole Following a Potassium: Competitive Acid Blocker

Background：Changing a drug from a potassium‒competitive acid blocker（P‒CAB） to a proton pump inhibitor（PPI）is one of the treatment options for long‒term management of gastroesophageal reflux disease（GERD）. GERD symptoms and serum gastrin levels were investigated in reflux esophagitis（RE）patients who switched from potassium‒competitive acid blocker to esomeprazole. Methods：Esomeprazole 20 mg was orally administered to RE patients who had been treated with vonoprazan 20 mg once daily for more than 4 weeks. Primary endpoint was changes in the total scores at Week 4 based on the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease（FSSG）questionnaire. The secondary endpoints were changes in the reflux scores, motility scores, and total scores evaluated based on the FSSG questionnaire, changes in serum gastrin levels, and tolerability.Results：In 25 patients with mean age of 60.5 years, median FSSG total score demonstrated a significant decrease both at Week 2（p＜0.05）and Week 4（p＜0.01）. Median FSSG reflux score demonstrated a significant decrease both at Week 2（p＜0.01）and Week 4（p＜0.001）. Median FSSG motility scores showed no statistical significance at any time. Median serum gastrin level significantly decreased from 755 pg/mL at baseline to 309 pg/mL at Week 4（p＜0.01）.Conclusion：Treatment with esomeprazole in patients with GERD was suggested to be a useful option both in management of GERD symptom and serum gastrin level.

Sensitivity and specificity of combination of Hull airway reflux questionnaire and gastroesophageal reflux disease questionnaire in identifying patients with gastroesophageal reflux-induced chronic cough.

BackgroundThere is a need to find a simple, non-invasive and effective diagnostic tool for diagnosing gastroesophageal reflux-induced chronic cough (GERC) in clinic. This study aimed to evaluate the predictive diagnostic value of Hull airway reflux questionnaire (HARQ) and its combination with gastroesophageal reflux disease questionnaire (GerdQ) for GERC.MethodsChronic cough patients were enrolled and the diagnosis of GERC was established according to the chronic cough diagnosis and treatment process. The diagnostic value of HARQ and GerdQ alone or the combination of HARQ and GerdQ was analyzed.ResultsA total of 402 patients with chronic cough were eventually enrolled, including 166 GERC patients. When the HARQ score was used to predict the diagnosis of GERC, the area under the ROC curve was 0.796. The sensitivity and specificity were 77.19% and 77.06%, respectively. When the GerdQ was used to predict the diagnosis of GERC, the area under the ROC curve was 0.763. The sensitivity and specificity were 70.18% and 76.15%, respectively. When HARQ combined with GerdQ were used to predict the diagnosis of GERC, the area under the ROC curve was 0.848. The sensitivity and specificity were 77.19% and 79.82%, respectively.ConclusionsHARQ used to evaluate the cough hypersensitivity has a certain predictive diagnostic value for GERC. The diagnosis of GERC should be considered when the HARQ score is ≥24. The predictive diagnostic value of the combination of HARQ and GerdQ is significantly higher, which makes the diagnosis of GERC simpler, quicker and more effective.

Assessment of gastroesophageal reflux disease, musculoskeletal symptoms and quality of life in dentists

Background and aimGastroesophageal reflux disease (GERD) has been associated with sick leave, decreased work productivity and poor quality of life. Another possible cause for the development of GERD is the relationship with maintaining the posture in flexion of the spine. The aim of this study was: (1) to compare gastro esophageal reflux with musculoskeletal disorders and quality of life of dentists, (2) to evaluate the association between gastro esophageal reflux such as time in the profession, time working while sitting, musculoskeletal disorders and quality of life of dentists. Methods83 dentists (23 males and 60 females; average age 39.3 years old) participated in the study, who were evaluated for their time in the profession, sitting time, musculoskeletal disorders, quality of life (SF-12v2) and the GERD symptoms using the Frequency Scale for Symptoms of GERD (FSSG) questionnaire. ResultsThe results showed that the majority were female (72.3%) and sendentary (74.7%). A difference was found between the level of GERD with musculoskeletal disorders (p < 0.05) and quality of life (p < 0.05). An association was also found between GERD and working time (p < 0.01), sitting working time (p < 0.05), headache (p < 0.01) and quality of life (p < 0, 01). ConclusionThis study showed that there was an association with working time, sitting time, musculoskeletal disorders, quality of life and GERD in dentists.

Gastroesophageal reflux disease in residents of the Trans-Baikal Territory

Aim. To study the prevalence of gastroesophageal reflux disease (GERD) symptoms and lesions of the esophageal mucosa in residents of Zabaikalsky krai, taking into account ethnicity.&#x0D; Methods. The first stage: 371 residents of Zabaikalsky krai over 18 years old, were door-to-door interviewed by using the GERD questionnaire (GerdQ). The respondents with 8 or more points were classified as having GERD symptoms. Additionally, we collected passport data, smoking status, alcohol and coffee consumption, anthropometric data and social status. The second stage: we analyzed 2130 upper gastrointestinal (GI) endoscopy reports from Regional Clinical Hospital in Chita.&#x0D; Results. 48 (12.9%) of 371 respondents had GERD symptoms. 135 (36.4%) respondents were Buryats, and 236 (63.6%) were non-Buryats, with the latter more often had GerdQ total score of 8 or more [38 (16.1%) non-Buryats and 10 (7.4%) Buryats, p=0.009]. The average age of non-Buryats respondents with GERD symptoms was 53.417.47 years and exceeded that in the group without symptoms (46.219.2 years), p=0.035. The age of Buryats with and without GERD symptoms did not differ (42.6711.52 and 37.8915.54 years, respectively, р=0.087). The prevalence of obesity, smoking, alcohol and coffee consumption of respondents with and without GERD symptoms, both among Buryats and non-Buryats was the same. Of the 2130 patients who underwent endoscopy, 164 (7.8%) had morphological changes in the esophagus, 105 (4.9%) had erosive esophagitis (EE). Catarrhal and erosive changes in the esophagus were detected in 156 non-Buryats (91 men and 66 women) (7.7%), while EE was diagnosed in 97 (4.8%) patients. 6.5% (5 women and 3 men) Buryats had the esophagus pathology, which caused by erosion. It was found that in non-Buryats group EE develop more often in male respondents (p=0.0019). Only non-Buryats had catarrhal changes in the esophagus (37.8%, 59 people), p=0.0312. At the same time, the incidence of complicated disease course in groups with EE was the same (p=0.8934).&#x0D; Conclusion. About 13% of residents of Zabaikalsky krai have weekly symptoms of GERD, male of a non-Buryat ethnic group are more likely to develop erosive esophagitis than women; the incidence of complications of esophagitis is the same in Buryats and non-Buryats respondents groups.

Semi-embedded valve anastomosis a new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction

BackgroundThere is a high probability of gastroesophageal reflux after laparoscopic proximal gastrectomy for adenocarcinoma of the oesophagogastric junction (AEG). Various anti-reflux anastomotic methods are emerging in clinical practice; however, none of them have been widely accepted. We have innovated a new type of anti-reflux anastomotic method, named semi-embedded valve anastomosis. The aim of this study was to explore the feasibility and anti-reflux effect of the new anastomotic method.MethodsThe clinical data of 28 patients with Siewert II AEG who were treated by semi-embedded valve anastomosis were collected. The key point of the operation is to reconstruct a simulated valve and form an anti-reflux barrier similar to the physiological mechanism. The gastroesophageal reflux disease questionnaire (GerdQ) and classification of gastroesophageal reflux under electron microscopy were used to evaluate gastroesophageal reflux after the operation.ResultsThe mean operative duration was 164.3 ± 19.0 min, the median intraoperative haemorrhage volume was 65 ml, the average number of lymph nodes dissected was 23 ± 2.6, the time for valve construction was 15.8 ± 3.2 min, the time for anastomotic reconstruction was 35.4 ± 4.8 min, the median time to first flatus was 3 d, and the median hospitalization duration was 12 d. There was one case of postoperative anastomotic stenosis. The GerdQ score [median (range)] was as follows: 2 (0–6), preoperation; 0 (0–8), 1 month postoperation; 2 (0–12), 3 months postoperation; and 3 (0–12), 6 months postoperation. The Wilcoxon signed-rank sum test was carried out at different times after the operation and the day before the operation, and the differences were not significant. There was one case of grade B gastroesophageal reflux according to the Los Angeles classification system among the gastrofibroscopic re-examination reports of 28 cases.ConclusionSemi-embedded valve anastomosis is safe and feasible after proximal gastrectomy for Siewert II AEG and has good anti-reflux effects.

S0392 Spastic Esophageal Changes Detected on Functional Lumen Imaging Probe Topography Are Associated With Lower Acid Exposure in Patients With Suspected Gastroesophageal Reflux Disease

INTRODUCTION: Hypercontractile and spastic motility changes are hypothesized to be an esophageal response to gastroesophageal reflux disease (GERD). The functional lumen imaging probe (FLIP) measures distension induced esophageal contractility. We aim to compare symptoms, acid exposure, and reflux events as related to esophageal motility pattern on FLIP in patients with presumed GERD. METHODS: We prospectively collected data on all patients who underwent FLIP and BravoTM placement during upper endoscopy for evaluation of proton-pump inhibitor (PPI) refractory symptoms presumed to be related to GERD between January 2019 and March 2020. A total of 23 patients were included. Patients with a history of anti-reflux surgery, primary symptoms of dysphagia or a diagnosis of achalasia were excluded. Patients were characterized based on FLIP motility criteria as having either 1) Normal or diminished contractility or 2) Spastic contractility (if FLIP showed esophagogastric junction outflow obstruction or repetitive retrograde contractions). Total and maximal single-day acid exposure % and number of reflux events were compared. Presence of heartburn as the reported primary symptom and GERD questionnaire (GERDQ) scores were also compared. Mann-Whitney test was used to compare continuous variables; Fisher’s exact test was used to compare categorical variables. RESULTS: Normal/diminished and spastic contractility were noted in 14 (61%) and 9 (39%) respectively. Maximal single-day acid exposure % time (4.5% vs 9.2%, P value: 0.02), average acid exposure % time (2.7% vs 6.8%, P value: 0.02) and number of reflux events (24 vs 47.5 events, P value: 0.04) were lower in the spastic contractility group (Figure 1). GERDQ score was 7.5 in the spastic motility group vs 10 in the normal/diminished motility group (P value: 0.8). Seven out of 14 (50%) of the normal/diminished motility group had heartburn in comparison to only 1 out of 9 (11%) in the spastic motility group (P value: 0.08) (Table 1). The most common symptoms in the spastic motility group were non-cardiac chest pain and laryngeal symptoms. CONCLUSION: Spastic motility findings are detected on FLIP in a high proportion of patients with PPI-refractory esophageal symptoms in the absence of dysphagia. Spastic motility on FLIP is associated with less measured acid exposure and a different symptom profile with less heartburn. Studies evaluating resolution of spastic changes and symptoms over time with PPI therapy could confirm this group as a GERD-spectrum entity.Table 1.: Patient characteristicsFigure 1.: BravoTM metrics and Gastroesophageal reflux disease questionnaire (GERDQ) score results in the normal/diminished motility and spastic motility groups are shown. Maximal single-day acid exposure % time and number of reflux events are shown. Group median values are displayed as black bars.

Application of a novel straight leg raise test during high-resolution manometry can predict esophageal contractile reserve in patients with gastroesophageal reflux disease.

Increased intra-abdominal pressure from abdominal compression augments esophageal peristalsis during high-resolution manometry (HRM), and straight leg raise (SLR) while supine increases intra-abdominal pressure. We determined if water swallows performed during SLR can mimic contraction reserve seen with multiple rapid swallows (MRS). Consecutive patients evaluated for GERD symptoms completed validated GERD questionnaires, esophageal HRM, and upper endoscopy. Distal contractile integral (DCI) was analyzed during single water swallows (10×5mL), MRS (5×2mL), and during SLR (5x5mL). Peristaltic breaks were measured using software tools with a 20mmHg isobaric contour. Univariate correlational analyses were performed to compare esophageal motor patterns and DCI values during single water swallows, MRS, and SLR. Of 103 study patients (mean age: 46.7±12.3years, 56.3% female), 50 (48.5%) had ineffective esophageal motility (IEM). Contraction reserve was observed on MRS in 62% with IEM, and 35.8% with normal motility (p=0.008). DCI was significantly higher during SLR compared to mean single swallow DCI in both IEM and normal motility patients (p<0.001 for each comparison). In IEM patients, SLR significantly reduced swallows with peristaltic breaks (6.1±3.7 vs 3.6±3.6; p<0.001) and shortened the length of the largest break (4.8±3.4 vs 3.0±3.0cm; p<0.001). DCI response following MRS correlated with DCI with swallows during SLR, with a correlational coefficient (Pearson's r) of 0.70 (p<0.001). Swallowing against the resistance of increased intra-abdominal pressure from SLR improves esophageal body peristaltic performance and predicts esophageal body contraction reserve.

Lack of Correlation Between Subjective and Objective Measures of Gastroesophageal Reflux Disease: Call for a Novel Validated Assessment Tool

Background. Objective measures including the DeMeester score, lower esophageal sphincter (LES) pressure, acid exposure time, and body mass index (BMI) are used to determine gastroesophageal reflux disease (GERD) severity and eligibility for various antireflux surgical procedures. The GERD Health-Related Quality of Life (GERD-HRQL) survey is widely used to evaluate patients' subjective severity of symptoms and GERD-related quality of life. The purpose of this project was to identify whether or not the subjective measure (GERD-HRQL) correlated with objective measures (DeMeester score, LES, acid exposure time, and BMI) of GERD severity. Methods. A retrospective review of the medical records of patients who underwent antireflux surgery from 2013-2018 was completed. Patients' GERD severity was measured preoperatively and postoperatively using the GERD-HRQL. Statistical analysis included the calculation of Spearman correlation coefficients, Wilcoxon rank sum, sign, and chi-square tests. Results. 151 patients were included in the study; 64% were female. The mean age and BMI were 54.6 ± 14.6years and 30.1 ± 4.1kg/m2, respectively. The mean preoperative DeMeester score was 43.1 ± 36.1, LES pressure was 19.9 ± 18.4mmHg, and acid exposure time was 11.4 ± 9.6. Mean GERD-HRQL scores decreased from 27.3 ± 9.2 preoperative to 5.3 ± 4.5 postoperative; P < .0001. Preoperative GERD-HRQL scores were not correlated with the DeMeester score (r = .11; P = .389), LES pressure (r = -.20; P = .089), acid exposure time (r = .05; P = .755), BMI (r = .10; P = .329), or age (r = -.16; P = .118). Conclusions. Total GERD-HRQL scores significantly decreased from pre- to postoperative. There was no correlation between subjective and objective GERD scoring. These data indicate the need for both physiologic evaluation and subjective assessment of patient symptoms during preoperative workup. There is a need for a contemporary, validated GERD questionnaire that correlates with objective pH testing.

The diagnostic utility of the frequency scale for the symptoms of gastroesophageal reflux disease questionnaire (FSSG) for patients with subacute/chronic cough

Background The frequency scale for the symptoms of GERD (FSSG) questionnaire, which originally consists of acid-reflux and dysmotility symptom domains, is a succinct questionnaire to evaluate gastroesophageal reflux disease (GERD) symptoms. Objectives To evaluate the utility of subjective questionnaire of GERD for the diagnosis of GERD-related cough by using FSSG questionnaire. Methods We recruited 256 patients with subacute/chronic cough between April 2012 and March 2018, who were analyzed using FSSG questionnaire and blood eosinophil counts. GERD-related cough was inferred through the presence of classic reflux symptoms including heartburn and/or typical coughing trigger (e.g. phonation, rising, lying, eating, and intake of certain food). The diagnosis was confirmed by response to specific treatments for GERD. Receiver operating characteristic curve analysis was performed to determine the cutoff score for the diagnosis. Results One-hundred ten patients (43%) were diagnosed as having GERD-related cough. FSSG questionnaire was relevant for diagnosing GERD-related cough, with the area under the curve (AUC) of 0.70 (p < 0.0001, cutoff score 7 points, sensitivity 75%, specificity 62%). When limited to patients with blood eosinophils of ≤150/μL or those with sputum eosinophils of ≤3%, sensitivity and specificity of the diagnosis was increased, respectively (sensitivity and specificity; 79% and 65% for blood eosinophils and 82% and 68% for sputum eosinophils. p < 0.0001, AUC 0.74 for both). Conclusions The subjective questionnaire of GERD (FSSG) would be helpful in diagnosing GERD-related cough, particularly in patients with low blood or sputum eosinophil counts.

Outcomes of anterior versus posterior peroral endoscopic myotomy 2 years post-procedure: prospective follow-up results from a randomized clinical trial.

Peroral endoscopic myotomy (POEM) is considered a primary treatment modality for achalasia. It can be performed using either the anterior or posterior approach. A previous randomized clinical trial (RCT) showed that the posterior approach was noninferior to the anterior approach at 1 year post-POEM in terms of clinical success, rate of adverse event, and risk of gastroesophageal reflux disease (GERD). The aim of this post-RCT study was to compare outcomes at ≥ 2 years post-POEM. Patients who previously completed the 1-year follow-up were contacted and their Eckardt, dysphagia, and GERD questionnaire (GERDQ) scores and frequency of proton pump inhibitor use were recorded. Clinical success was defined as an Eckardt score < 3. 150 patients were initially randomized and 138 completed the 1-year follow-up. Of the 138, 111 (anterior group 54, posterior group 57) also completed ≥ 2 years of follow-up, with an overall clinical success decrease from 89 % to 82 %. At ≥ 2 years post-POEM, clinical success was achieved in 46/54 (85 %) and 45/57 (79 %) in the anterior and posterior groups, respectively (P = 0.43). A similar decrease in clinical success was noted in both groups at ≥ 2 years (anterior: 90 % to 85 %; posterior 89 % to 79 %; P = 0.47). GERDQ score was 6 (interquartile range 6 - 8; P = 0.08) in both treatment groups. The anterior and posterior POEM techniques remained equally effective at 2 years and decreases in efficacy were similar between the two approaches over time. GERD outcomes were also similar in both groups during medium-term follow-up.