Duration Of Gastroesophageal Reflux Research Articles

A single-center experience of using milk scintigraphy in 251 pediatric patients: A retrospective study.

To report our experience with milk gastroesophageal scintigraphy and the management of gastroesophageal reflux (GER) in children. In 251 pediatric patients we recorded age, underlying disease, central nervous system (CNS) disorders, and GER management. GER management was classified based on treatment plans: grade 0, non-pharmacological treatment; grade 1, non-pharmacological but using a nasogastric tube; grade 2, pharmacological treatment; grade 3, transpyloric feeding; and grade 4, Nissen fundoplication surgery. Patients were included in classified groups with (grades 2, 3, and 4) and without (grades 0 and 1) GER treatment. We evaluated the GER height (classified based on the height of GER, grade 0; no GER, 1; GER in the lower esophagus, 2; GER in the upper esophagus), GER duration in the lower and upper esophagus, presence or absence of massive GER amounts in the lower and upper esophagus, and gastric emptying time. We compared milk scintigraphy results and patient characteristics between groups with (grades 2, 3, and 4) and without (grades 0 and 1) GER treatment. We treated 121 patients for GER. CNS disorders (presence/absence: 46/74 with vs 21/110 without treatment, P < .001). The GER height grade (1.7 ± 0.5 [range, 0-2] with vs 1.5 ± 0.7 [range, 0-2] without treatment, P = .002), massive GER amount (present/absent: 21/99 with vs 9/122 without treatment, P = .011), and duration of GER (seconds) (324.5 ± 508.3 [range, 0-1800] vs 125.0 ± 291.9 [range, 0-1750], P < .001) in the upper esophageal half differed significantly. Similarly massive GER amount (present/absent: 54/66 with vs 34/97 without treatment, P = .002) and GER duration (621.3 ± 601.0 [range, 0-1800] vs 349.8 ± 452.4 [range, 0-1800], P < .001) in the lower esophageal half differed significantly. Additionally, CNS disorders, age, and massive GER in the upper esophageal half differed significantly among grades 2 and 4 in treated patients (P < .05, P < .001, P < .05, respectively). Milk scintigraphy is useful for deciding whether GER treatment is indicated. However, the treatment plan needs to be decided based on each patient's condition.

Dose-Effect Relationship Between Gastric Cancer and Common Digestive Tract Symptoms and Diagnoses in Anhui, China.

BackgroundEarly prevention and diagnosis are key to reducing the huge burden of gastric cancer (GC). Nearly half of the population worldwide are suffering from some form of digestive tract conditions (symptoms/diagnoses, DTCs) but their relations with GC are not well understood. We aim to explore the relationships (especially dose–effect relationships) between GC and DTCs.MethodsThis study used data from a community-based case–control study in Anhui, China during 2016–2019 and performed multivariate conditional logistic regression modeling of the associations between GC and DTCs.ResultsA total of 2255 participants (451 cases and 1804 controls) completed the study. Statistically significant relations (P<0.05) were found between GC and the presence of gastroesophageal reflux [odds ratio (OR)=1.41], odynophagia (OR=1.87), stomach discomfort (OR=1.86), poor appetite (OR=2.01) and Helicobacter pylori (H. pylori) infection (OR=4.39). When the DTCs were divided into duration grades, all these ORs presented an increasing trend (P<0.05), being 1.89 to 2.45 for gastroesophageal reflux, 1.63 to 3.78 for stomach discomfort, 2.36 to 5.29 for poor appetite, and 3.95 to 10.03 for H. pylori infection. When the DTCs were divided into severity grades, the ORs also witnessed an increasing trend (P<0.05), being 1.69 to 2.52 for gastroesophageal reflux, 2.44 to 3.56 for stomach discomfort, and 2.22 to 2.75 for poor appetite. When the DTCs were divided into duration-severity grades, the ORs displayed a much steeper increasing trend, being 0.49 to 4.96 for gastroesophageal reflux, 1.50 to 6.33 for odynophagia, 0.47 to 3.32 for stomach discomfort, and 0.40 to 10.47 for poor appetite. In contrast, the ORs for the lower DTCs were generally tested without statistical significance.ConclusionThe study revealed consistent dose–effect associations between GC and duration of gastroesophageal reflux, stomach discomfort, poor appetite, and H. pylori infection; severity of gastroesophageal reflux, stomach discomfort and poor appetite; and duration-severity of gastroesophageal reflux, odynophagia, stomach discomfort and poor appetite. These should inform future prevention, diagnosis and further research in patients with GC.

Distress in Infants and Young Children: Don't Blame Acid Reflux.

The role of gastroesophageal reflux (GER) causing distress in infants is controversial but acid inhibitors are often empirically prescribed. We evaluated the relation between distress assessed by the Face, Legs, Activity, Cry, Consolability (FLACC) scale and GER in infants. We analyzed multiple intraluminal impedance-pH (MII-pH) monitoring tracings of infants with persistent unexplained fussiness or distress. Symptoms occurring during investigation were scored by parents using the FLACC scale and were grouped as "distress" episodes. We recruited 62 children (ages 15 days to 23 months, median age 3.5 months). During MII-pH, 452 episodes of distress were registered: 217 (48%) were temporally associated with GER and 235 (52%) were not, with no difference in the median value of FLACC between the 2 groups. Infants with abnormal acid exposure index had a significantly lower FLACC compared with the group with acid reflux index <7% (P < 0.001). When associated with symptoms, GER occurred significantly more often before than simultaneously or after an episode of distress (P = 0.001). Age, proximal extension, and duration of GER did not correlate with FLACC scores. Episodes of distress associated with nonacid reflux presented a significant higher FLACC compared with the ones with acid content (FLACC 6 vs 5, P = 0.011). In infants, episodes of distress do not significantly correlate with GER. No difference in infant distress was noted between proximal and distal GER. Non-acid reflux is perceived at least as painful than acid GER. Our results stress that acid inhibitors should not be started in infants presenting distress unless a clear association with acid GER is demonstrated.

Intra-Esophageal pH Monitoring on Two Consecutive Days in Patients With Gastroesophageal Reflux Symptoms.

BackgroundThe best method to measure the frequency and duration of gastroesophageal reflux is 24-h pH or 24-h pH/impedance monitoring. However, the detection of reflux can vary when measured on different days. Our aim was to evaluate the possibility that the severity of gastroesophageal reflux is different even under similar conditions on two consecutive days.MethodsWe performed a 48-h pH monitoring in 12 subjects, aged 25 - 63 years, who complaint of heartburn and regurgitation, ten with esophagitis and two with non-erosive disease. The pH measurement was conducted at 5 cm from the lower esophageal sphincter. The patients stayed at the Clinical Investigation Ward of the hospital for 48 h. On each day, they consumed a 2,000 calorie diet. The results obtained on the first day were compared with those on the second day.ResultsMean reflux index in the upright position was different between the two days. Results of the pH-monitoring within the 2 h after the meal revealed differences in the number of acidic reflux and reflux index episodes. Three patients had abnormal DeMeester score on one day and normal score on the other day. Considering the upper limit of 6.0% of the test duration with esophageal pH < 4 as indicative of gastroesophageal reflux disease, two patients showed abnormal results on one day and normal results on the other day.ConclusionsThe 24-h pH monitoring, performed on two consecutive days under similar conditions, can lead to different diagnosis of gastroesophageal reflux disease in symptomatic patients.

The study of oral liquid microcrystallization in children with gastro-esophageal reflux disease

Background and aim.Patients with disabilities have a higher prevalence of caries and dental erosions than general population. This particularity may be assessed by the study of microcrystallization of saliva. We investigated the oral liquid microcrystallization in children with gastroesophageal reflux disease (GERD), a condition associated with dental erosions.Material and methods.54 children have been clinically examined: 27 children suffering from GERD with ages between 13 and 15, were included in the study group, and 27 healthy children - the control group. The study of crystallographic changes of the oral liquid was performed using the method developed by Shatohina, Razumov SN, Shabalin VN (2006) with the scanning electron microscope VEGA TESCAN TS 5130 MM.ResultsThe degree of microcrystalization of the oral liquid in children with GERD was considerably reduced, (1.73±0.11 points) and was lower than in children in the control group (3.22±0.16 points) (p<0.01, RR=2). The degree of microcrystallization of oral liquid in children with GERD was 1.86 times lower than in healthy children. This was correlated with the duration of gastroesophageal reflux.ConclusionThe study of structural particularities of dehydrated droplet of oral liquid in children with GERD has elucidated a number of markers of the changes produced in the oral cavity. These can be used in the screening research in prevention of caries and dental erosions.

Low Plasma Adiponectin Is Associated with Barrettʼs Esophagus, Controlling for Reflux Symptoms

Purpose: Gastroesophageal reflux (GER), male gender, and abdominal obesity are associated with Barrett's esophagus (BE), the accepted precursor of esophageal adenocarcinoma. The assumption has been that the risk abdominal obesity is mediated by a mechanical predilection for GER. We postulated that abdominal obesity is a marker for a more basic mechanism mediated by a secreted factor. Adiponectin is a peptide secreted by adipocytes, and blood levels are inversely associated with abdominal obesity. Adiponectin inhibits inflammation, and low levels have been found to be associated with cancers of the colon, uterus, and breast. We aimed to observe whether blood levels of adiponectin are associated with the risk for BE, controlling for GER. Methods: We performed a case-control study of plasma levels of adiponectin in cases of BE compared with control subjects without BE undergoing elective upper endoscopy for clinical indications. Controls were matched to cases on age, veteran/civilian status, and month of enrollment. Results: Conditional logistic regression from 40 matched pairs showed that cases were more likely than controls to have GER for at least 5 years (OR = 3.8; 95% CI = 1.2, 11.3) and to be male (OR = 29.0; 95% CI = 0.5, 1670). Cases had larger abdominal circumference (for each increment of 10 cm, OR = 1.6; 95% CI = 1.1, 2.3) and higher waist to hip ratios (for each increment of 0.1, OR = 3.2; 95% CI = 1.5, 6.7). For each 10ng/mL decrement in adiponectin the odds of BE increased five-fold (OR = 5.0; 95% CI = 1.2, 20.0). The effect of adiponectin deficiency was similar when controlling for GER duration (OR = 4.4; 95% CI = 1.04, 18.5), and was partially confounded by waist to hip ratio (OR = 1.6; 95% CI = 0.5, 5.3). Unconditional logistic regression from 31 male cases and 20 male controls, controlling for the matching variables, showed that each 10ng/mL decrement in adiponectin trended toward increasing the odds of BE (OR = 2.3; 95% CI = 0.7, 6.9). Conclusions: Low adiponectin blood levels are associated with BE, controlling for GER symptoms. Rather than simply a mechanical effect of obesity promoting GER, the risk of abdominal obesity might be mediated by adiponectin deficiency. Adiponectin deficiency might also mediate the effect of gender on the risk of BE.

Barrett esophagus: Will effective treatment prevent the risk of progression to esophageal adenocarcinoma?

Barrett esophagus is a complication of long-standing gastroesophageal reflux disease (GERD) and is the well-recognized premalignant condition for the majority of esophageal and gastroesophageal junction adenocarcinomas. Although duration of gastroesophageal reflux (GER), male sex, and, possibly, a strong family history are directly related to risk of Barrett esophagus, the role of screening in those with GERD and surveillance in those with confirmed Barrett syndrome remains controversial. Acid suppression with proton pump inhibitor (PPI) therapy plays a pivotal role in the management of symptoms in persons with chronic GER and Barrett esophagus. Although there is no conclusive evidence for the role of PPIs in regression of Barrett epithelium or prevention of dysplasia, longer-term studies that titrate the dose to normalization of esophageal pH may proffer different data in the future. Although highly touted in the literature, surgical and endoscopic ablation therapies are limited by several factors, including high rates of symptom recurrence, persistently abnormal pH values, need for repeat surgery, and, in the case of endoscopic therapy, residual Barrett metaplasia that can progress to high-grade dysplasia or cancer. These invasive interventions should only be considered after consultation with a gastroenterologist. Cancer chemoprevention strategies are just emerging, and their roles as direct chemoprotectants remain to be determined.

Nocturnal asthma and gastroesophageal reflux

Bronchial asthma is a complex disease involving various cyclic environmental and chronobiologic factors. In patients with asthma, nocturnal gastroesophageal reflux (GER) has been associated with triggering and worsening bronchoconstriction. There are data to suggest that the prevalence of GER is higher in patients with asthma than in the general population and that GER is directly associated with asthma severity. However, the role of GER in asthma remains controversial; some studies suggest that reflux does not mediate nocturnal asthma symptoms. This article reports the results from a study conducted in 7 adult patients affected by nocturnal asthma and moderate to severe GER disease. The relation between GER and asthma was tested by continuously and simultaneously monitoring respiratory resistances and esophageal pH. The study demonstrated a significant correlation between lower respiratory resistances and spontaneous GER. More specifically, both long (more than 5 minutes’ duration) and short (5 minutes’ or less duration) GER episodes elicited bronchoconstriction in patients with asthma who had moderate to severe GER disease. The severity and duration of bronchoconstriction were related to the duration of GER.

VALIDATION AND MODIFICATION OF THE pH METRY-ANALYSIS PROTOCOL WITH THE pH INDEPENDENT IMPEDANCE TECHNIQUE

131 pH monitoring is considered the goldstandard in diagnosing gastroesophageal reflux (GER). However, it does not in fact measure reflux, but only pH values. Thus the parameters to define GER pH-wise were derived empirically. These parameters were evaluated for their validity of reflux recognition and modified using the intraesophageal impedance technique (IMP), a pH-independent method for the registration of bolus movement. Methods: Simultaneous pH-IMP-measurements were performed in 50 infants. Using the standardized ESPGAN protocol for the analysis of pH metry data, the parameters sampling rate (SR), cutoff value (CV: GER registration, if pH < CV), minimal GER duration (MD) and latency time (LT, i.e. time after end of GER, wherein pH-drops < CV are considered the same episode) were varied. A new parameter, pre-latency time (preLT, i.e. time before beginning of GER, wherein pH-drops < CV are neglected), was introduced. By software aided analysis the optimal set of parameters regarding sensitivity and positive prediction was determined. Results: During a total measuring time of 310 hours 1856 reflux episodes were identified by IMP and considered the reference data. 306 GER with pH < 4 should have been identified by pH metry. With the standard parameters (SR 15/min, CV pH 4, MD 15s, LT 30s) 307 GER were detected by pH metry: 145 true GER (sensitivity 47.4%) and 162 falsely identified episodes(positive prediction 47.2%). Using the best parameter set (SR 60/min, CV pH 4, MD 5s, LT 30s, preLT 3s) 150 true (sensitivity 49.0%) and 154 false (positive prediction 49.3%) GER were detected. Conclusions: The diagnostic potential of pH metry, its sensitivity and positive prediction in identifying acid reflux was validated with IMP as the reference. The empirically derived parameters for the analysis of pH metry data proved to be valuable using standard hard- and software. By increasing sampling rate, decreasing minimal GER duration and with the introduction of a new parameter, the pre-latency time, sensitivity and positive prediction could be slightly increased. However, due to its nonacidity, the major amount of GER is concealed to pH metry and only detected by the impedance technique.

Incidence of Gastroesophageal Reflux with Whey‐ and Casein‐Based Formulas in Infants and in Children with Severe Neurological Impairment

SummaryTen exclusively gastrostomy‐fed, neurologically impaired children (4.5‐14.5 years old) with gastroesophageal reflux were randomly assigned to receive feedings with either a casein‐ or a whey‐based formula for 48 h each and then crossed over to the other formula. One 24‐h pH probe study each was performed while being fed casein‐ and whey‐based formula, respectively. There was a significant reduction in episodes and duration of gastroesophageal reflux while consuming the whey‐based formula (p &lt; 0.05). Whey‐based feedings should be considered an additional tool in conjunction with other antireflux measures to treat gastroesophageal reflux more effectively in children with severe neurological impairment. A similar study was also conducted involving 14 infants (3‐12 months old) with documented gastroesophageal reflux using 24‐h pH probe monitoring while consuming a casein‐based formula. The formula was changed to a whey‐based formula and the pH probe study repeated within 3‐5 days. Four infants showed improvement and the rest showed either deterioration (1/14) or comparable results (9/14). The reduction in the mean number of episodes or duration of gastroesophageal reflux with the whey‐formula was not significantly different from that with the casein‐based formula (p &gt; 0.05). Based on these findings, generalized recommendations for the use of whey‐based formula in infants with gastroesophageal reflux cannot be made.

Gastroesophageal reflux incidence and respiratory dysfunction during sleep in infants: treatment with cisapride.

We studied the effects of positional treatment and cisapride (a new prokinetic agent) on the incidence and duration of gastroesophageal reflux in 22 infants (4-26 weeks old) in asleep, awake, fasted, and postcibal periods. In addition to gastroesophageal reflux (assessed by 24-h continuous esophageal pH monitoring), all infants presented with a disrupted irregular sleep pattern ("respiratory dysfunction") (assessed by a simultaneously performed cardiopneumogram). Reflux was particularly prominent during the sleep and fasted periods. Investigations (cardiopneumogram and esophageal pH monitoring) in the study population were repeated under treatment conditions (cisapride) after 13-16 days. All pH monitoring data with regard to the total investigation time decreased significantly (p less than 0.001). The treatment-related differences were largest in the asleep and fasted periods, but treatment data were not completely within normal ranges (established in age-matched asymptomatic infants), as they were for the awake periods. Associated symptoms of gastroesophageal reflux (belching, cough, nocturnal wheezing, irritability, and restlessness at night) were evaluated before and during treatment by history. A combination of positional treatment and cisapride seemed effective (objectivated by pH monitoring data and clinical improvement); cisapride did not cause adverse reactions. The disrupted sleep pattern improved significantly or disappeared (p less than 0.001) in all infants. These data suggest that in a number of young infants, gastroesophageal reflux may be associated with a disturbed, irregular sleep of poor quality, which is characterized by a typical breathing pattern (multiple, irregularly repeated, short apneas).

Gastroesophageal Reflux Incidence and Respiratory Dysfunction During Sleep in Infants

We studied the effects of positional treatment and cisapride (a new prokinetic agent) on the incidence and duration of gastroesophageal reflux in 22 infants (4–26 weeks old) in asleep, awake, fasted, and postcibal periods. In addition to gastroesophageal reflux (assessed by 24‐h continuous esophageal pH monitoring), all infants presented with a disrupted irregular sleep pattern (“respiratory dysfunction”) (assessed by a simultaneously performed cardiopneumogram). Reflux was particularly prominent during the sleep and fasted periods. Investigations (cardiopneumogram and esophageal pH monitoring) in the study population were repeated under treatment conditions (cisapride) after 13–16 days. All pH monitoring data with regard to the total investigation time decreased significantly (p &lt; 0.001). The treatment‐related differences were largest in the asleep and fasted periods, but treatment data were not completely within normal ranges (established in age‐matched asymptomatic infants), as they were for the awake periods. Associated symptoms of gastroesophageal reflux (belching, cough, nocturnal wheezing, irritability, and restlessness at night) were evaluated before and during treatment by history. A combination of positional treatment and cisapride seemed effective (objectivated by pH monitoring data and clinical improvement); cisapride did not cause adverse reactions. The disrupted sleep pattern improved significantly or disappeared (p &lt; 0.001) in all infants. These data suggest that in a number of young infants, gastroesophageal reflux may be associated with a disturbed, irregular sleep of poor quality, which is characterized by a typical breathing pattern (multiple, irregularly repeated, short apneas).

Esophageal function following livaditis repair of long gap esophageal atresia

Proximal pouch esophagomyotomy (Livaditis) allows for repair of long gap esophageal atresia (EA). Postoperative esophageal functional studies in these patients are lacking. Six such infants were followed for up to 42 months. Esophageal function was assessed clinically and by barium swallow, manometry, 24 hr pH monitoring, esophagoscopy, and biopsy. Operative complications included two minor anastomotic leaks and two asymptomatic diverticula at the myotomy site. All patients had dysmotility on barium swallow. Gastroesophageal reflux (GER) was seen in four. Manometry showed a variable aperistaltic segment in each infant but lower esophageal sphincter pressures and relaxation were retained. Twenty-four hour pH monitoring showed an increase in frequency and duration of GER. All four patients biopsied had esophagitis. Five of the six patients showed normal growth velocity. Livaditis modified repair of EA was not associated with significant surgical complications. Esophageal motility showed abnormalities similar to those reported after the standard repair of EA. Myotomy did not adversely affect the esophageal function.

Influence of Acute Mental Stress on the Frequency and Duration of Gastroesophageal Reflux in Normal Volunteers

Six fasted healthy male volunteers (mean age 21.7 years) were studied. A pH probe was inserted with the tip 5cm proximal to the gastroesophageal junction and recording begun 15 mins after completion of a standard meal. pH was recorded by computerized data logger which sampled every 6s. Subjects were stressed intermittently by a dichotic Listening task in which they attempted to track recorded word Usts heard simultaneously in different ears. Mean frequency and duration of reflux episodes was determined from two 30-min stress and control periods. Alterations in heart rate, systolic and diastolic blood pressure confirmed the effectiveness of the stressor. Mean ( ± SEM) duration of reflux per 30-min stress period ( l . l ±0.53 mins) was not significantly different to mean duration per 30-min control period (l.5 ±0.53 mins). The mean numberof reflux episodes per 30-min stress period (2.3 ± 1.1) did not differ significantly from the mean number of episodes per 30-min control period (2.8± 1.1). T herefore, in normal volunteers acute predictable emotio nal stress does not influence the frequency or duration of postprandial gastroesophageal reflux.

The Effects of Gaviscon and Metoclopramide in Gastroesophageal Reflux in Children

SummaryOral metoclopramide (0.5 mg/kg/24 h) and a liquid alginic acid‐antacid compound were administered to infants and children with gastroesophageal reflux (GER) in a double‐blind randomized controlled trial. The effect of medication was measured with 24‐h intraesophageal pH monitoring. Neither metoclopramide nor the alginic acid‐antacid compound decreased the frequency or duration of gastroesophageal reflux.

Postcibal gastroesophageal reflux in children

The effect of eating on childhood gastroesophageal reflux (GER) is unclear. Twenty-eight asymptomatic children and 28 children with symptoms of GER were fed apple juice or milk-formula and observed for 3 hr postcibal. Distal esophageal pH was monitored continuously during this interval and used to quantitate the frequency and duration of GER. A period of frequent GER occurred for up to 2 hr after apple juice feedings in asymptomatic children, whereas symptomatic patients had frequent GER for longer periods. Compared to apple juice feedings, milk-formula feedings resulted in a decreased esophageal acidity for the first 2 hr. However, the type of feeding did not affect GER seen in asymptomatic children more than 2 hr postcibal. The frequency and duration of postcibal GER were not reduced by the upright position in either group. Effective medical treatment of symptomatic children did not eliminate the frequent GER within 2 hr of apple juice feedings, whereas the Nissen fundoplication usually eliminated all GER. The absence of GER episodes following apple juice correlated with the inability of most children to burp or vomit following antireflux surgery. Therefore, frequent GER for up to 2 hr after clear liquid meals is probably physiologic in children. The effective control of vomiting by medical or surgical therapy correlated best with a decrease in GER more than 2 hr postcibal.