Gastroesophageal Reflux In Patients Research Articles

Validated Clinical Score to Predict Gastroesophageal Reflux in Patients With Chronic Laryngeal Symptoms: COuGH RefluX

Background & AimsDiscerning whether laryngeal symptoms result from gastroesophageal reflux is clinically challenging and a reliable tool to stratify patients is needed. We aimed to develop and validate a model to predict likelihood of gastroesophageal reflux disease (GERD) among patients with chronic laryngeal symptoms. MethodsThis multicenter international study collected data from adults with chronic laryngeal symptoms that underwent objective testing (upper GI endoscopy and/or ambulatory reflux monitoring) between 3/2018-5/2023. The training phase identified a model with optimal receiver operating characteristic curves, and beta coefficients informed a weighted model. The validation phase assessed performance characteristics of the weighted model. Results856 adults, 304 in training cohort and 552 in the validation cohort, were included. In the training phase the optimal predictive model [AUC 0.68 (95% CI 0.62, 0.74)] - the COuGH RefluX score - consisted of Cough, Overweight/obesity, Globus, Hiatal Hernia, Regurgitation, and male seX with a lower threshold of 2.5 and upper threshold of 5.0 to predict proven GERD. In the validation phase, the COuGH RefluX score had an AUC of 0.67 (0.62, 0.71) with 79% sensitivity and 81% specificity for proven GERD. ConclusionsThe externally validated COuGH RefluX score is a clinically practical model to predict likelihood of proven GERD. The score classifies most patients with chronic laryngeal symptoms as low/high likelihood of proven GERD, with only 38% remaining as indeterminate. Thus, the COuGH RefluX score can guide diagnostic strategies and reduce inappropriate proton pump inhibitor use or testing for patients referred for evaluation of chronic laryngeal symptoms.

Radionuclide Diagnosis of Esophageal Dysmotility and Gastroesophageal Reflux in Patients with Systemic Sclerosis

Objective: to evaluate the possibilities of dynamic scintigraphy for the diagnosis of esophageal dysmotility (ED) and gastroesophageal reflux (GER) in patients with systemic sclerosis (SS).Material and methods. The study group included 77 patients with established SS of different disease duration (from several months to 30 years) who underwent Technephyt 99mTc dynamic esophageal scintigraphy using two-stage protocol. During the first stage, the esophageal transport function was evaluated; during the second stage, the presence and severity of GER were assessed. Scans were analyzed using visual assessment, quantitative estimation of time/activity curves, and a proposed three-point scale for evaluating ED and GER severity. The control group consisted of 19 practically healthy individuals who underwent a routine examination to exclude digestive system and gastrointestinal tract diseases, the algorithm of which included dynamic scintigraphy.Results. ED was found in 74 of 77 patients (96%). According to three-point scale, severe ED (3 points) was registrated in 41 (55%) patients, moderate ED (2 points) in 15 (21%), and mild ED in 18 (24%). GER was diagnosed in 35 of 77 cases (45%): mild GER in 13 (37%), moderate GER (2 points) in 22 (63%), and none of the patients was found to have severe GER (3 points). A significant relationship between the presence of GER and the severity of ED was not obtained, but a direct correlation was established between ED and GER severity.Conclusion. Most SS patients demonstrated ED of varying severity associated with mild and moderate GER in nearly 45% of the cases. The study results confirm the practical significance of dynamic scintigraphy for assessing the esophageal transport function and GER in SS patients.

Adequate timing of diagnostic tests for gastroesophageal reflux in children with esophageal atresia.

Recent guidelines made recommendations for the management of gastroesophageal reflux in patients with esophageal atresia (EA). However, the timing for some diagnostic tests remained somehow unclear. This investigation studied the tests for gastroesophageal reflux in children aged one year old and children aged two or three. Patients with EA who underwent Multichannel Intraluminal Impedance-pH monitoring (MII-pH) and endoscopy-histology were studied retrospectively. Patients aged one when the test was performed were the YO group and patients aged two or three years old formed the OL group. Substantially impaired MII-pH was defined as total number of reflux episodes >105 or >85 (depending on age), or reflux index >10%. Substantially impaired endoscopy was defined as erosive esophagitis or Barrett's esophagus. Substantially impaired histology was defined as moderate-severe esophagitis or Barrett's esophagus. Conventional parameters and substantially impaired values of the tests were compared. Twenty-four patients were studied. Twenty-three MII-pH were performed (12 in YO and 11 in OL): percentages of abnormal conventional parameters of MII-pH were not significantly different in both groups. Twenty endoscopies with biopsies were performed (7 in YO and 13 in OL): percentages of esophagitis were not significantly different. Interestingly, 26.9% of all the tests performed in YO were substantially impaired vs. 10.8% of all the tests in OL (χ2=2.7; p=0.1). Considering the percentage of alarming results of diagnostic tests in the YO group it would be advisable that patients with EA undergo MII-pH and endoscopy-histology at one year of age.

Laryngopharyngeal Reflux Disease and Gastroesophageal Reflux Disease Can Mutually Influence

To investigate the mutually relationship between gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD). All included patients completed simultaneous 24-hour hypopharyngeal intraluminal multichannel impedance pH monitoring (24h-MII-pH), Reflux Symptom Index (RSI), and Reflux Finding Score (RFS). The LPRD diagnosis was based on the occurrence of ≥1 acid or non-acid hypopharyngeal proximal reflux episode(HRE), GERD was defined as a length of time >4.0% of the 24-hour recording spent below pH 4.0 or a DeMeester score >14.72. Patients with both positive LPRD and GERD were classified as LPRD & GERD group, patients with positive LPRD and negative GERD were classified as ILPRD group, patients with negative LPRD and positive GERD were classified as IGERD group, and patients with both negative LPRD and GERD were classified as N group. The differences in clinical characteristics of reflux between the groups were statistically analyzed. A total of 437 patients were included, including 248 (56.75%) in the ILPRD group, 98 (22.43%) in the LPRD & GERD group, 23 (5.26%) in the IGERD group, and 68 (15.56%) in the N group. There was no significant difference between the types of gastroesophageal reflux in patients with GERD. The number of weak acid/acid/gas/liquid HREs was significantly more in LPRD & GERD patients than in ILPRD patients (P < 0.01), and the number of distal acid reflux events and Longest distal acid clearance time were significantly higher in LPRD & GERD patients than in IGERD patients (P > 0.01). GERD and LPRD are not the same disease but can mutually influence. Combined GERD increased all types of laryngopharyngeal reflux events in patients with LPRD, whereas combined LPRD only increased acidic distal reflux events and acid clearance time in patients with GERD.

Phenotypic Characterization of Laryngospasm: The Utility of Laryngeal Neurophysiological Studies

To determine the existence of laryngeal neuropathy and the influence of gastroesophageal reflux in patients with episodic laryngospasm. Single -center, observational study with prospective clinical collection. Prospective analysis of 18 Spanish patients with episodic laryngospasm in a Spanish Public Center collected by otolaryngologist. The recruitment dates were from January 2019 to December 2019. Data collection of 18 patients with episodic laryngospasm. Clinical characteristics, laryngeal neurophysiological studies and reflux esophageal testing were analyzed. All patients have a trigger for the laryngospasms, being the most prevalent adopting the supine position (27.7%). EMG and ENG were pathological in 83.3 and 63.6 % respectively. Chronic bilateral denervation (increased amplitude and duration of potentials) with signs of reinnervation in the non-active chronic phase (large polyphasia), was the most prevalent finding. Evidence of gastroesophageal reflux either by pH meter, Gastroscopy or both was found in 38.8 % of patients. Neurophysiological studies have confirmed the existence of laryngeal neuropathy in the majority of patients with laryngospasm. A substantial percentage of patients (38.8%) with laryngospasm had objective GERD and improved with PPIs. Laryngeal EMG and ENG can establish a more accurate diagnostic for episodic laryngospams and may supports treatment with neuromodulators.

Effect of laparoscopic angle of His reconstruction in the treatment of patients with gastroesophageal reflux disease and hiatal hernia.

Effect of laparoscopic angle of His reconstruction in the treatment of patients with gastroesophageal reflux disease and hiatal hernia.

Modulation of tube feeding protocol to prevent aspiration pneumonia in gastroesophageal reflux

Background & AimsAspiration pneumonia, as an enteral tube feeding-related complication, interferes with nutritional administration, and gastroesophageal reflux (GER) is a well-known cause of this problem. One of the factors that induces GER and other abdominal symptoms is gastroparesis, which is a syndrome caused by delayed gastric emptying (DGE) without mechanical obstruction.High-viscosity formulas are reportedly effective in suppressing GER, and there are new formulas that further increase viscosity and change phase from liquid to semisolid in the stomach, which can be used even with small-diameter tubes such as nasogastric tubes. The management of gastroparesis is useful for preventing aspiration pneumonia. To achieve this, post-pyloric feeding has been recommended, but this needs additional skill and facilities. An elemental diet can hasten pyloric transit and decrease GER, but has less tolerability due to diarrhea. A new nutritional liquid formula containing ingredients fermented by lactic acid bacteria has been introduced and is expected to have rapid pyloric transit (similar to the elemental diet). Thus, this may be useful in the management of GER patients with gastroparesis.This retrospective study evaluated whether the modulation of nutritional formulas using the new materials contributes to the prevention of tube feeding-related complications such as aspiration pneumonia.MethodsIn patients with tube feeding-related complications, upper gastrointestinal series was performed to assess the gastrointestinal motility. In cases with abnormal motility, we made the modulation of formulas using the aforementioned new types. The effectiveness of the modulation was evaluated by the frequency of aspiration pneumonia, changes in nutritional status and the period of feeding interruption in one year.ResultsModulation of the tube feeding protocol significantly reduced the incidence of aspiration pneumonia. Tube feeding could be properly continued without any interruption and nutritional status could be recovered and maintained.ConclusionsModulation of the tube feeding protocol including the formulas based on gastrointestinal motility status can reduce tube feeding-related complications. Aspiration pneumonia, as an enteral tube feeding-related complication, interferes with nutritional administration, and gastroesophageal reflux (GER) is a well-known cause of this problem. One of the factors that induces GER and other abdominal symptoms is gastroparesis, which is a syndrome caused by delayed gastric emptying (DGE) without mechanical obstruction. High-viscosity formulas are reportedly effective in suppressing GER, and there are new formulas that further increase viscosity and change phase from liquid to semisolid in the stomach, which can be used even with small-diameter tubes such as nasogastric tubes. The management of gastroparesis is useful for preventing aspiration pneumonia. To achieve this, post-pyloric feeding has been recommended, but this needs additional skill and facilities. An elemental diet can hasten pyloric transit and decrease GER, but has less tolerability due to diarrhea. A new nutritional liquid formula containing ingredients fermented by lactic acid bacteria has been introduced and is expected to have rapid pyloric transit (similar to the elemental diet). Thus, this may be useful in the management of GER patients with gastroparesis. This retrospective study evaluated whether the modulation of nutritional formulas using the new materials contributes to the prevention of tube feeding-related complications such as aspiration pneumonia. In patients with tube feeding-related complications, upper gastrointestinal series was performed to assess the gastrointestinal motility. In cases with abnormal motility, we made the modulation of formulas using the aforementioned new types. The effectiveness of the modulation was evaluated by the frequency of aspiration pneumonia, changes in nutritional status and the period of feeding interruption in one year. Modulation of the tube feeding protocol significantly reduced the incidence of aspiration pneumonia. Tube feeding could be properly continued without any interruption and nutritional status could be recovered and maintained. Modulation of the tube feeding protocol including the formulas based on gastrointestinal motility status can reduce tube feeding-related complications.

Surgical Management of Gastroesophageal Reflux in Patients With Obesity

With the growing prevalence of obesity and its association with gastro-esophageal reflux disease (GERD), the thoracic, foregut, and bariatric surgeons will be ever more commonly facing the challenge to treat GERD in patients with obesity, albeit having the opportunity to treat GERD and obesity simultaneously. In this review, we outline the outcomes of laparoscopic antireflux surgery (LARS) in patients with Class 1, 2, and 3 obesity, as well as GERD outcomes of Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG). We also discuss the revisional surgical options for patients with obesity and failed LARS, or with GERD after LRYGB and LSG.

500 THE PATHOLOGICAL GASTROESOPHAGEAL REFLUX IN PATIENTS WITH CYSTIC FIBROSIS

Abstract The presence of gastroesophageal reflux in patients after lung transplantation rises the risk of posttransplantant complications. The aim of our study was to evaluate the severity of gastroesophageal reflux (GER) in patients with cystic fibrosis before lung transplantation. Methods 14 patients with cystic fibrosis, who refferred to our Centre, were included in this study, mean age 28,86 ± 2,5 (6 males and 8 females). The diagnosis of cystic fibrosis was established at the age of 1–5 y.o. according to clinic, sweet test and genetic tests. All patients were performed upper endoscopy, X-ray, esophageal manometry and 24 h impedance monitoring. PPI treatment was excluded for 7 days before monitoring. Pathologic GER was established when total number of refluxes in distal esophagus was more than 75, the total number of refluxes in proximal esophagus was more than 20% of those in the distal part. Results According to endoscopy, none of patients had erosions of the esophagus. Five patients had ineffective motility and one—diffuse esophageal spazm. 56% of patients had pathologic number of refluxes in distal esophagus. 80% subjects had pathologic refluxes in proximal esophagus. The mean number of total refluxes in distal part was 54,93 ± 5,7, in proximal part—27,64 ± 2,6 (it is 40% of those in distal part). The distribution of acid and non-acid refluxes in patients with pathologic refluxes was 2:1. We didn’t reveal any correlation between number of refluxes, ineffective motility and gastric emptying. Conclusion despite normal upper endoscopy, 56% of patients with cystic fibrosis have pathologic gastroesophageal reflux. Besides, the study showed high propagation of GER to proximal esophagus in 80% of subjects, which may play role in posttransplantation period.

794 DOES TRACHEOSTOMY PREDISPOSE GASTROESOPHAGEAL REFLUX?

Lung diseases have a strong relationship with gastroesophageal reflux disease (GERD). It has been previously demonstrated that conditions such as tracheal stenosis, asthma and even lung transplantation may worsen with reflux and these patients have few symptoms of GERD. With the COVID-19 pandemic, the number of people who needed mechanical ventilation and tracheostomy increased. Our objective was to demonstrate the prevalence of gastro-oesophageal reflux in patients with tracheostomy and describe its characteristics.MethodsEsophageal manometry and 24 h pH-metry was performed in 137 consecutive patients with a tracheostomy already in a chronic phase, independent of symptoms. Inquire on respiratory and digestive symptoms was also carried out at the time of the examination. Prevalence of gastroesophageal reflux was identified in this population and description of the groups with reflux and without it, as well as comparison between them.ResultsOf the 137 patients, 49 were male, the average age was 40.94 ± 17.3 and the body mass index was 26.3 ± 4.85. The prevalence of gastroesophageal reflux was 45.2%. Baseline characteristics were similar between the groups with and without reflux. In the reflux group, the mean DeMeester score was 36.5 ± 20.8 and the presence of lower sphincter hypotonia was found in only 31% of the patients and was not correlated with reflux between the groups (p = 0.285). Regarding the symptoms, 48% had heartburn symptoms and only 30% had a combination of typical symptoms (heartburn + regurgitation).ConclusionThe presence of tracheostomy is related to an increased prevalence of reflux, even without typical symptoms most of the time. The mechanism for this is still unknown, perhaps the altered respiratory dynamics has a role. These patients should be investigated with functional exams if they develop any condition that may be affected by reflux.

Potential roles of gastroesophageal reflux in patients with superficial esophageal squamous cell carcinoma without major causative risk factors.

Cigarette smoking, alcohol consumption, and Lugol-voiding lesions (LVLs) are the major causative risk factors of esophageal squamous cell carcinoma (ESCC); however, reports on ESCC cases unrelated to these risk factors are very limited. Here, we investigated the clinicopathological features and etiology of such cases. We retrospectively analyzed 704 consecutive superficial ESCC tumors of 512 patients who were treated with endoscopic submucosal dissection. The enrolled patients were divided into two groups-the very low-risk (VLR)-group and risk (R)-group-based on the presence of the abovementioned risks. Clinical, endoscopic, and pathological characteristics and genetic findings were assessed in both groups. The VLR-group consisted of 21 (4.1%) patients, who were characteristically female. Patients in the VLR-group presented gastroesophageal reflux disease (GERD), hiatal hernia, and non-open-type atrophic gastritis, and were negative for Helicobacter pylori. We found unique endoscopic features-frequently observed in the posterior wall of the middle thoracic esophagus-with a linear shape that closely resembled the erosion-like form of GERD. Additionally, histopathological examination showed that these tumors presented atypical nuclei limited to the basal and parabasal layer, sequential to the surrounding changes that presented pathological chronic inflammation of esophagitis. Evaluation of somatic mutations in cancer-related genes using next-generation sequencing revealed that the positive carcinogenic potential (TP53 mutation) of the tumors was relatively frequent in the VLR-group. Our study suggests that ESCC without major causative factors is related to GERD, with no remarkable oncogenic difference.

Necrosis esofágica aguda en pacientes post trasplante hepático. Un túnel oscuro desde el hígado al esófago

Acute esophageal necrosis is a rare entity endoscopically described as a black appearance of esophageal mucosa, generally of circumferential distribution that extends proximally from the gastroesophageal junction, and affects a variable length of this organ. It has a multifactorial etiology that includes a combination of ischemic mucosal esophageal vascular compromise associated with gastroesophageal reflux in patients with multiple comorbidities. Clinical management focuses on general support measures and treatment of the underlying illness and comorbidities. Although this pathology usually tends to a restitution-ad-integrum in 7-10 days, these patients have a high mortality rate more related to their clinical conditions and not due to this entity itself. Therefore, early diagnosis is crucial to initiate proper treatment. We present two cases of AEN in patients who underwent orthotopic liver transplantation.

Effect of continuous positive airway pressure on gastroesophageal reflux in patients withobstructive sleep apnea: a meta-analysis.

Gastroesophageal reflux disease (GERD) often occurs inpatients with obstructive sleep apnea (OSA). Although continuous positive airway pressure (CPAP) is considered to be the preferred treatment for OSA, the effectof CPAP therapy on reflux events remains controversial. In this study, we utilized meta-analysis to investigate whether or notCPAP treatment reduces the incidence of reflux. Two independent reviewers obtained the data sources from the database of PubMed, Elsevier, Cochrane library, and CNKIusing search terms, and then filtered the target articles based on the inclusion and exclusion criteria. RevMan (version 5.3) and STATA (version 12.0) were used for data synthesis. The effect of CPAP treatment on GERD was studied by calculating the weighted mean difference (WMD) and standard deviation (SD) before and after CPAP treatment. Ten studies involving a total of 272 participants were included in this study. The results showed that the total of WMD before and after CPAP was - 17.68 (95% CI - 30.67 to - 4.69) for percentage time pH < 4, - 24.66 (95% CI - 36.15 to - 13.18) for the longest reflux duration, - 27.53 (95% CI - 49.53 to - 5.52) for number of reflux events, - 49.76 (95% CI - 60.18 to - 39.35) for DeMeester score, - 1.85 (95% CI - 3.00 to - 0.71) for reflux diseases questionnaire (RDQ) score, and - 8.95 (95% CI - 16.00 to - 1.89) for reflux symptom index (RSI). The subgroup analysis demonstrated that the improvement of reflux symptoms was more obvious with the extension of treatment time. This meta-analysis showed that CPAP treatment significantly reduces the incidence of reflux events inpatients with OSA.

534 WHICH IS THE BEST SURGICAL MANAGEMENT OF GASTROESOPHAGEAL REFLUX DISEASE (GERD) IN PATIENTS WITH SYSTEMIC SCLEROSIS WITH PULMONARY INVOLVEMENT?

Abstract Systemic sclerosis (scleroderma) is frequently associated with both gastroesophageal reflux disease (GERD) and simultaneous esophageal dysmotility (ED). Antireflux surgery have to considerate the individual esophageal dysmotility degree of each patient. They need GERD treatment as a priority to help control worsening lung function, in patients developing pulmonary fibrosis or in lung transplantation patients. Another issue is the possibility that fundoplications in this patients can cause esophageal stasis, an event that can also disrupt lung function. Methods 113 patients were referred for surgical treatment of GERD, related with pulmonary impairment. SS patients are the most critical, once the ED may be an obstacle to fundoplication. We divided this patients in three groups regarding the esophageal function. A- Partial fundoplication—without important affection of ED, checked by manometry, confirmed with a complete emptying of esophagus in barium swallow test. B- Laparoscopic gastric bypass for treatment of GERD (RYGBP)—aperistalsis or atonic esophageal body, with normal esophageal empty at barium test. C- Esophagectomy—Atonic esophageal body with important delayed emptying of esophagus in barium swallow test. Results We could follow up 4 patients in group A, 3 patients in group B and 2 patients in group C. Median follow-up was 75, 30 and 18 months for Groups A,B and C respectively. All 3 patients in the RYGB group resolved all the symptoms including heartburn and regurgitation, with a sensitive improve in lung function. Only 1 patients in the fundoplication group reported symptom improvement or resolution. The Patients at Group C have no complain of Dysphagia but referred regurgitation and difficulty feedingtill first year. Conclusion Laparoscopic RYGB as an anti-reflux procedure is safe and may provide an alternative to fundoplication in the treatment of GERD for systemic sclerosis patients with esophageal dysmotility. Both reflux control and dysphagia rates were improved in the RYGBP group compared with fundoplication and esophagectomy.. This finding suggests that RYGBP may be an option for the primary manage- ment of scleroderma-associated gastroesophageal reflux in patients without importnat impairing of esophageal emptying.

Impaired Mucosal Integrity in Proximal Esophagus Is Involved in Development of Proton Pump Inhibitor-Refractory Nonerosive Reflux Disease

Background and Objective: Weakly acidic reflux reaching to the proximal esophagus is closely related to the perception of gastroesophageal reflux in patients with nonerosive reflux disease despite treatment with a proton pump inhibitor (PPI). However, little is known about the involvement of the patients’ mucosal integrity of the proximal esophagus. Methods: We recruited 15 symptomatic nonerosive gastroesophageal reflux disease (GERD) patients with a positive symptom index despite PPI treatment and 11 healthy asymptomatic volunteers as controls. The biopsy specimens obtained from the proximal and distal esophagus were applied to a mini-Ussing chamber system to measure transepithelial electrical resistance (TEER) against a pH 4 weak acid. The esophageal biopsy samples were subjected to quantitative real-time PCR and immunohistochemical analysis. Results: In the proximal esophagus, the weak acid exposure reduced the TEER in the PPI-refractory patients compared to that in the controls. The frequency of the reflux extending to the proximal esophagus had a significant correlation with the reduction in the proximal esophageal TEER in the patients. The reduced TEER in the proximal esophagus was accompanied by an increase in IL-8 and IL-1β mRNA and a decrease in occludin mRNA levels. The proximal esophageal mucosa in the patients presented infiltration of CD3-positive lymphocytes and an increased expression of solute carrier organic anion transporter family member 2A1 (SLCO2A1), a passage gate of reflux symptom-evoking molecules. Conclusions: The reflux perception is related to an impairment of the proximal esophageal mucosal integrity in patients with nonerosive reflux disease despite PPI.

Evaluation of the effectiveness of the antireflux mechanism of the modified technique of laparoscopic longitudinal gastrectomy with the formation of a three-chamber gastric sleeve in patients with morbid obesity

INTRODUCTION. The issues of prevention of postoperative gastroesophageal reflux in patients undergone laparoscopic sleeve gastrectomy (LSG) is the most relevant, due to the increase in the number of these surgical interventions and patients who note manifestations of gastroesophageal reflux disease (GERD) in the long-term period after surgery. The OBJECTIVES was to evaluate the effectiveness of the antireflux mechanism of our proposed modified method of laparoscopic longitudinal gastrectomy with the formation of a three-chamber gastric «sleeve». METHODS AND MATERIALS. The study was based on the data from clinical examination of patients with morbid obesity, who were operated on in the NHI «Railway Clinical Hospital» at the Rostov-Glavnyi station in 2008-2019. We made comparisons of the clinical manifestations of GERD before and after surgery in patients who underwent LSG using classic and modified technique. RESULTS. As a result of the study, we were able to identify that a year after both types of operations, patients showed an increase in GERD symptoms. And in 47 % of all operated, GERD appeared de novo. However, we managed to fix the difference between the frequency of occurrence of reflux in the studied groups. Thus, a year after the operation, in the control group, the clinical manifestations of reflux increased by 25 %, both in qualitative and quantitative indicators. While in the study group, these manifestations were increased by 13.5 %. CONCLUSION. The use of the antireflux surgery of prostate cancer proposed by us in patients with morbid obesity significantly improves their quality of life with symptoms of GERD and can be used in patients with existing GERD symptoms before surgery and without them.

Effect of sleeve gastrectomy on gastroesophageal reflux in patients with metabolic syndrome.

To investigate the incidence of gastroesophageal reflux disease (GERD) after sleeve gastrectomy and the effect of sleeve gastrectomy in treating the symptom of gastroesophageal reflux in patients with metabolic syndrome. We retrospectively analyzed 60 patients with metabolic syndrome who received laparoscopy sleeve gastrectomy in the Department of Bariatric and Metabolic Surgery, Third Xiangya Hospital of Central South University from April 2018 to May 2019, and assessed the changes of symptoms before and after surgery. The study included 31 men and 29 women. The age of these patients was 16-46 (29.17±7.23) years, ranging from 16 to 46 years. The weight and body mass index (BMI) of the patients decreased from (116.02±31.96) kg and (39.67±8.90) kg/m2 to (98.32±25.22) kg and (34.4±7.85) kg/m2 at 1 month after the surgery, respectively. The number of patients with gastroesophageal reflux was 37(61.67%) before the surgery, and 18(30.00%) at 1 month after the surgery, respectively. The number of asymptomatic patients before the surgery while had gastroesophageal reflux symptoms within 1 month after the surgery was 4(6.67%). Among the 37 patients, 6(16.62%) had persisted or worsen symptoms with gastroesophageal reflux symptoms before the surgery, 23(62.16%) had no symptoms, and 8 patients (21.62%) showed improvement of gastroesophageal reflux 1 month after the surgery. Some scores of the GERD-Health-Related Quality of Life Scale (such as reflux after dinner) were significantly lower after the surgury than those before the surgery (P<0.05). The symptoms of GERD are effectively improved after surgery. Sleeve gastrectomy is a feasible, safe and effective treatment for obesity with GERD.

Real-time MRI for dynamic assessment of gastroesophageal reflux disease: Comparison to pH-metry and impedance

PurposeTo evaluate the diagnostic potential of real-time MRI for dynamic assessment of gastroesophageal reflux in patients with GERD (gastroesophageal reflux disease)-like symptoms compared to pH-metry and impedance. MethodsPatients who underwent real-time MRI and pH-metry between 2015–2018 were included in this retrospective study. Real-time MRI at 3 T was achieved by undersampled radial FLASH acquisitions with iterative image reconstruction by NLINV. Real-time MRI visualized transit of pineapple juice through the gastroesophageal junction and during Valsalva maneuver. MRI results were compared to 24 h pH-metry to assess acidic reflux (following Lyon Consensus guidelines) and to impedance to assess non-acidic reflux. A standard 2 × 2 table was chosen to calculate diagnostic performance. Results91/93 eligible patients fulfilled inclusion criteria (male n = 49; female n = 42; median age 55 y). All MRI studies were successfully completed without adverse events at a mean examination time of 15 min. On real-time MRI, reflux was evident in 60 patients (66 %). pH-metry revealed reflux in 41 patients (45 %), and impedance in 54 patients (59 %). Compared to pH-metry and impedance, real-time MRI sensitivity was 0.78 (95 % CI: 0.66-0.87), specificity 0.67 (95 % CI: 0.45-0.84) and PPV 0.87 (95 % CI: 0.75-0.94). ConclusionReal-time MRI is an imaging method for assessment of gastroesophageal reflux in patients with GERD-like symptoms. Considering its high positive predictive value, real-time MRI can accurately identify patients in which further invasive testing with pH-metry and impedance might be considered.

Pharmacotherapy and adjunctive treatment for idiopathic pulmonary fibrosis (IPF).

Idiopathic pulmonary fibrosis (IPF) is an advancing and fatal lung disease with increasing incidence and prevalence. Nintedanib and pirfenidone were approved by the FDA for the treatment of IPF in 2014 based on positive phase 3 trials, and both of these antifibrotic drugs are conditionally recommended in the 2015 ATS/ERS/JRS/ALAT Clinical Practice Guideline. Although an improvement over previously suggested therapies, their capacity to reduce, but not completely arrest or improve, lung function over time presents an opportunity for novel or add-on pharmacologic agents. The purpose of this review is to deliver a brief overview of the results of phase 3/4 IPF trials with pirfenidone and nintedanib, as well as highlight encouraging results of phase 1/2 trials with novel therapies. Long-term studies indicate that pirfenidone and nintedanib are effective IPF treatments, with acceptable safety and tolerability. The combination of pirfenidone and nintedanib appear safe. Promising results have recently been made public for several phase 2 trials with novel targets, including the autotaxin-lysophosphatidic acid (ATX/LPA) pathway, connective tissue growth factor (CTGF), pentraxin-2, G protein-coupled receptor agonists/antagonists, αvβ6 integrin, and galectin-3. Results of treatments directed at gastro-esophageal reflux in patients with IPF have also been published. Currently, monotherapy with pirfenidone or nintedanib is the mainstay of pharmacological treatment for IPF. Innovative therapies along with combinations of pharmacological agents hold great promise for the future.

Managing End-Stage Renal Disease: An Alphabetized Mnemonic Strategy

End-stage renal disease (ESRD) is a complex condition that requires knowledge and expertise for its effective management. Nurse practitioners continuously strive to provide adequate and safe care based on rigorous research. The objective of this article is to provide a structured and applicable approach to managing ESRD that is up-to-date and evidence based. To achieve this objective, we created an alphabetized mnemonic and synthesized our discussion to address Anemia, Bone health, Cardiovascular issues, vitamin D deficiency, Electrolytes imbalances, Fluid overload, and Gastroesophageal reflux in patients with ESRD.