Gastroesophageal Reflux Index Research Articles

Comparison of direct effects of rice-thickened formula vs routine feeds on symptoms and gastroesophageal reflux indices: A crossover cohort study.

We compared the direct effects of routine vs rice-thickened formula on 24-h pH-impedance and symptom characteristics and then examined if dietary effects were modified by acid reflux index severity in infants. Forty infants under consideration for gastroesophageal reflux disease and therapies were evaluated at 43 ± 1 weeks postmenstrual age. Each infant was equally fed routine diet and thickened formula during evaluations. Postprandial sessions were analyzed for acid reflux index, reflux events, clearance times, distal baseline impedance, and symptoms. Thickened formula has no effect (P ≥ 0.05) on acid reflux events' characteristics or overall symptom frequency. However, refluxate height and frequency of weakly acidic events and cough were decreased (P < 0.05). Prolonged bolus clearance and a decrease in distal baseline impedance were noted with thickened feeds (vs routine feeds) when acid reflux index was >7 (P < 0.05). Our pH-impedance testing protocol identifies direct effects of potential therapies at the point of care. Acutely, thickened formula does not impact acid-specific reflux indices but decreases full-column reflux and cough reflexes. In those with an acid reflux index of >7, thickened formula prolongs the distal esophageal bolus clearance (the mechanisms of which are uncertain). Clinical trials are needed to clarify objective indications and therapeutic use of thickened formulas for infants with gastroesophageal reflux disease, along with short- and long-term side effects.

Semi-Solid Nutrients for Prevention of Enteral Tube Feeding-Related Complications in Japanese Population: A Systematic Review and Meta-Analysis.

The aim of this systematic review was to assess the best available evidence on semi-solid nutrients for prevention of complications associated with enteral tube feeding (ETF). PubMed (MEDLINE), EMBASE, Cochrane Central Register of Controlled Trial, Ichushi-web, and World Health Organization International Clinical Trials Registry Platform databases were searched for relevant articles. Randomized controlled trials (RCTs), cluster RCTs, and crossover trials comparing the effects of semi-solid nutrients with those of control interventions in patients on ETF were included in the review. The primary outcome was development of gastroesophageal reflux (GER). Eight RCTs and five crossover trials involving 889 study participants in total were examined via meta-analysis. The meta-analysis showed that semi-solid nutrients significantly decreased the risk of GER (risk ratio 0.39; 95% confidence interval (CI) 0.21 to 0.73) and the GER index (mean difference −2.93; 95% CI −5.18 to −0.68). Dwell time in the stomach was significantly shortened (standardized mean difference (SMD) −0.50; 95% CI −0.99 to −0.02), as was care time defined as the time needed to prepare and administer the nutrient solution (SMD −8.02; 95% CI −10.94 to −5.10). Semi-solid nutrients significantly decrease the risk of GER and the dwell time in the stomach in adult patients.

Correlation between severity of gastroesophageal reflux cough and degree of gastroesophageal reflux disease

Objective: To explore the correlation between the severity of gastroesophageal reflux cough and degree of gastroesophageal reflux. Methods: A cross-sectional investigation was carried out. Data of 174 cases of chronic cough were collected in Children's Hospital of Fuzhou from March 2009 to December 2016. The esophageal 24 hours pH value dynamic monitoring was used to detect gastric acid reflux index. Cases with abnomal results were divided into mild, moderate and severe groups according to severity of reflux and that of day and night cough symptoms, respectively. They were also divided into infant (1-3 years old), preschool (4-6 years old), and school age (>7 years old) groups according to age. Comparative analysis between groups by chi-square test and rank sum test were performed. Correlation analysis was used to analyze the correlation between cough severity and gastroesophageal reflux index. Results: A total of 174 patients with chronic cough, including 115 males and 59 females, aged from 1 to 15 years with an average age of (8.5±2.3) years, and (1.6±0.8) years of disease duration were enrolled. Among them, 129 cases (74.1%) were positive for esophageal reflux test and 45 cases (25.9%) with no obvious pathological gastroesophageal reflux. Patients with positive esophageal reflux test were divided into severe (n=37, 28.7%), moderate (n=23, 17.8%), and mild (n=69, 53.5%). There was no significant difference in the distribution of gastroesophageal reflux in each age group. (The proportions of mild, moderate and severe reflux in infants were 45.0% (9/20), 25.0% (5/20), and 30.0% (6/20), respectively. The proportions of mild, moderate and severe reflux in preschool children were 53.3% (32/60), 16.7% (10/60), 30.0% (18/60), respectively. The proportions of mild, moderate and severe reflux in school age children were 57.1% (28/49), 16.3% (8/49), 26.5% (13/49), respectively χ(2)=1.204, P=0.877). There was no correlation between age group and gastroesophageal reflux (r=-0.065, P=0.489).The severity of nighttime cough was positively correlated with percentages of distal esophagus pH≤4 in time, recumbent pH≤4 in time, and DeMeester score<14.72 (r=0.689, 0.621, and 0.707 respectively, all P<0.05). There was no statistically significant correlation between the severity of nighttime cough symptoms and percentage of standing pH≤4 in time (r=0.113, P>0.05). There were no statistically significant correlation between the severity of daytime cough and all gastroesophageal reflux markers (all P>0.05). Conclusion: The severity of nocturnal symptoms of gastroesophageal reflux cough is related to the degree of gastroesophageal reflux, to which clinical pediatricians should pay attention.

Helicobacter pylori seroprevalence in children with sleep-disordered breathing

ObjectiveChronic Helicobacter pylori (HP) infection is considered to be a factor involved in obstructive sleep apnea syndrome (OSAS). This cross-sectional study examined the seroprevalence of HP in children with sleep-disordered breathing (SDB) in respect to OSAS severity and in reference to other common pediatric medical conditions. MethodsOvernight polysomnography with pH-metry (PSG) was performed at a Sleep Laboratory (in the years 2008–2011). OSAS severity was determined based on Obstructive Apnea Index (OAI). Subjects were classified into primary snoring group (OAI < 1/hours), mild - moderate OSAS (OAI: 1–5/hour), and severe OSAS (OAI: ≥5/hour). HP IgG was tested by an enzyme-linked immunosorbent assay in the SDB (n = 115) and reference (n = 387) groups [reference group consisted of 4 subgroups based on ICD-10 diagnoses encompassing conditions affecting the skin, respiratory system, food hypersensitivity, and gastrointestinal tract]. Analyses were performed by nonparametric statistical tests. ResultsHP seropositivity was 10.4% (12/115) in the SDB group and 11.6% (45/387) in the reference group. HP positive and negative subjects did not differ in PSG, acid gastro-esophageal reflux index nor in age, sex, nutritional status (BMI-z score), and hematological indices in the SDB group. Seropositivity was found in 16.7% of the primary snoring group, 10.2% of mild-moderate OSAS, and in 11.1% of severe OSAS (chi2 p = 0.832). ConclusionsChildren with SDB are not more predisposed to a chronic HP infection than children with other common chronic pediatric conditions. HP seropositivity does not influence OSAS severity but possible infection should none-the-less be considered on a case-by-case basis.

215 Characterization of gastroesophageal reflux with combined multichannel intraluminal impedance–pH (MII-pH) in a group of children with CF

Objectives Gastroesophageal reflux (GER) is an important patogenetic factor in CF. The aim of the study was to retrospectively analyze the extent of pathological GER in a group of children with signs or symptoms of gastroesophageal reflux disease (GERD). Methods MII-pH (MMS Ohmega) was performed in children who were suspected to have GERD. On the basis of the percentage of pH less than 4 and DeMeester index patients were separated in those having no pathological reflux and in those with GERD. Patients with GERD were treated with PPI and had another MII-pH performed after average 2 months of treatment. The same parameters, including baseline impedance were compared in both groups. Results 21 children (13 females (61.9%), median age 10.3±5.4 years, percentile of BMI 27.9 +/– 29.5; no differences between both groups) with CF who underwent MII-pH during last 5 years were identified. All had symptoms and signs suggestive of GERD. Pathological GER was measured in 14 pts (66.7%). There was no difference between baseline impedance of upper and lower 2 electrodes between both groups. The group with GERD had normalization of the percentage of pathological GER and DeMeester index after the treatment with PPI (omeprazole, 1 mg/kg/BW up to 40 mg in total). There was no difference in baseline impedance before and after the treatment. Conclusion GERD is very prevalent in symptomatic children with CF. Treatment with PPI is effective in usual dosages. In our (small) sample we could not find statistical difference in baseline impedance between GERD and non-GERD group, nor before and after the treatment with PPI in the group of children with CF and GERD.

Peculiarities of heart rate variability in children with gastroesophageal reflux disease

Introduction. According to modern literature gastroesophageal reflux disease (GERD) is multifactorial illness. One of the most important risk factors for this disease is considered a violation of autonomic nervous system balance. The study of heart rate variability (HRV) in recent times is used as the most informative noninvasive method for quantitative assessment of autonomic regulation of heart rate.The aim of research. Determining the characteristics of autonomic regulation in children with gastroesophageal reflux disease.Materials and methods. The study involved 77 children with chronic gastroduodenal pathology (aged 9 to 17 years). The main group consisted of 54 children with GERD (Group 1 - 46 children with GERD with esophagitis, Group 2 - GERD without esophagitis), comparison group comprised 23 children without clinical and endoscopic manifestations of the esophagus pathology. The following methods were conducted: clinical and medical history, fibroesofagogastroduodenoscopy, intragastric pH-metry, pH monitoring in the esophagus, Holter cardiac monitoring, variational statistics, correlation analysis.Results. 34.8% of children with GERD with esophagitis had sympathicotonia (p&lt;0.05), 43.5% - vagotonia and 21.7% - eytoniya (p&lt;0,05). In 29.0% of children with GERD without esophagitis sympathicotonia was registered and the same number - vagotonia, eytoniya - in 42.0%. During the diurnal cycle predominance of sympathetic activity in children with GERD is observed, more girls with esophagitis and the presence of UCTD (undifferentiated connective tissue dysplasia) symptoms. Girls with esophagitis had lower time analysis indices of HRV at day time relative to boys of the same group. The predominance of sympathetic activity in girls confirmed by significantly lower rates of pNN50 (p&lt;0.05). Tension-time index at day time was significantly higher in girls with esophagitis than in boys, which also indicated the predominancy of sympathetic tone (74,4 ± 34,6 vs conv 34,2 ± 14,1, p&lt;0, 05). At night time in girls of group 1 values of HRV were significantly lower relative to boys (p &lt;0.05. The stress index was significantly higher at night in girls with esophagitis (53,9 ± 33,7 vs conv 15,9 ± 8,6 cu in boys, p&lt;0.05).For children with esophagitis with symptoms of UCTD increased activity of the sympathetic (autonomic nervous system) ANS level is characteristic. If children without UCTD SDNNi values were within 82,5 ± 12,6 ms and 94,1 ± 20,7 ms, respectively at day and at night time, than in the presence of UCTD manifestations these figures were reduced by 1.4-fold (p&lt;0.05). Similar changes were characteristic for rMSSD and pNN50. SI analysis showed significant stress adaptation capabilities in children with esophagitis associated with UCTD.Children with acid reflux indicators of reflecting parasympathetic activity, were almost 1.5 times lower than in children with alkaline GER (gastroesophageal reflux), but did not differ significantly from that of children with mixed GER. Thus, in children with acid GER indexes of SDNNi and rMSSD were within 62,2 ± 12,6 ms (p&lt;0.05) and 38,4 ± 13,2 ms (p&lt;0.05) at day time 72 9 ± 20,9 ms (p &lt;0.05) and 56,9 ± 19,9 ms (p &lt;0.05) at night time respectively, relative to children with alkaline GER (SDNNi amounted to 90,9 ± 32,6 ms and rMSSD - 64,0 ± 32,2 ms at day time and SDNNi - 101,6 ± 27,7 ms and rMSSD - 91,8 ± 39,2 ms at night time). Distinction of children with acid GER was significantly lower CI (circadian index) indicators, that is indicating exhaustion of adaptive reserves in these children.Was established negative correlation of medium strength between the number GER lasting more than 5 minutes and the time performance analysis of HRV (at day time r = -0,57; p &lt;0.05; at night time r = -0,56; p &lt;0.05). The more stress of sympathetic division of ANS, the bigger number of long-term GER.Conclusion. Thus, according to the analysis of HRV in children with GERD derangements of rhythmicity and intensity of fluctuations of the sympathetic and parasympathetic parts of the ANS identify. It was noted that the prevailing of sympathetic link of ANS is more typical for girls and in the presence of UCTD symptoms.

A Thickened Formula Does Not Reduce Apneas Related to Gastroesophageal Reflux in Preterm Infants

Background: Apnea of prematurity (AOP) occurs frequently in preterm infants and a variable proportion of AOP can be induced by gastroesophageal reflux (GER). Conservative treatment, including dietary modifications, should be the first-line approach for both GER and GER-related apneas in this population. Objectives: To evaluate the efficacy of a starch-thickened preterm formula (PF) in reducing the frequency of apneas related to GER. Methods: Preterm infants with AOP were studied by combined impedance and pH monitoring and polysomnography. The 6-hour study period included two feeds, one of a commercially available PF and one of the same formula thickened with amylopectin (TPF). GER indexes, apneas and GER-related apneas detected after TPF and PF feeds were compared by Wilcoxon signed-rank test. Results: 24 infants were studied. During 140 h of registration, 289 apneas (147 after TPF and 142 after PF; p = 0.876), and 861 GER episodes (400 after TPF and 461 after PF; p = 0.465) were recorded. No difference in the number of AOP was found between TPF and PF. A significant reduction in acid exposure was found after TPF; there was no influence on non-acid GER indexes. The frequency of GER-related apneas did not differ between TPF and PF. Conclusions: A formula thickened with amylopectin did not reduce the number of AOP or GER-related apneas. It reduced acid GER features but had no effect on non-acid GER indexes. Future research should focus on exploring different conservative strategies to treat GER-related apneas in preterm infants.

Impedance-pH monitoring and conventional pH monitoring are complementary methods to detect association between gastroesophageal reflux and apnea-related symptoms in preterm infants and neonates

Objective: To investigate the usefulness of Multichannel intraluminal impedance-pH (MII-pH) monitoring as compared with conventional pH monitoring for detecting Gastroesophageal reflux (GER) episodes and apnea-related symptom association in preterm infants and neonates. Methods: Twenty-three infants (16 preterm and 7 term infants) in hospital, who underwent 24-h MII-pH monitoring, were studied retrospectively. GER indices and apnea-related symptom association were measured by both MII-pH and conventional pH based analysis. Results: Of the total 998 GER episodes assessed by MII-pH monitoring, 407 (40.8%) were acidic and 590 (59.1%) were weakly acidic. A total of 1689 GER episodes were detected by conventional pH based analysis and 270 (16%) were related to retrograde bolus movement. A total of 313 apnea-related symptoms were reported. Five patients had a positive symptom association: 3 by MII-pH, 1 by both MII-pH and conventional pH, 1 only by conventional pH. Conclusions: Addition of MII-pH monitoring to conventional pH monitoring improves the diagnostic yield of symptom association analysis in preterm infants and neonates with apnea-related symptoms. Conventional pH monitoring is still important in the era of impedance measurement.

Obstructive hypopnea and gastroesophageal reflux as factors associated with residual obstructive sleep apnea syndrome

Objective The mechanism of persisting obstructive sleep apnea (OSA) after adenotonsillectomy is not fully explained. The purpose of this study was to evaluate factors associated with residual OSA. The primary outcome measures were metabolic tests and polysomnographic respiratory indices in children with residual disease compared with children who were diagnosed with OSA but were untreated. Secondary outcome measures were acid gastroesophageal reflux indices recorded parallel to the sleep study. Methods In the one-year study consecutive series of patients with sleep disordered breathing hospitalized in a tertiary pediatric center were evaluated. Following the study protocol a sleep interview, physical examination, metabolic blood tests (serum leptin and the homeostasis model assessment index for insulin resistance, HOMA-IR) and an overnight polysomnography with pH-metry recording were performed. Children diagnosed with OSA were analyzed in two groups: I – residual OSA (after surgery), II – non-residual OSA (newly diagnosed). Logistic regression analysis was applied to obtain significant risk factors for prediction of OSA. Results Fifty-seven children (mean age ± SE, 6.9 ± 0.5 years; 66.7% boys) met the inclusion criteria and were enrolled in the study as residual ( n = 19) or non-residual OSA ( n = 38). The groups differed significantly in mean oxygen saturation, SpO 2 (94.3% vs. 96.2%; p = 0.018 respectively), in the Apnea Hypopnea Index, (20.6/h vs. 9.1/h; p < 0.03), the number of respiratory arousals with desaturation (2.2/h vs. 0.8/h; p < 0.03); mean intraluminal esophageal pH (5.36 vs. 5.86; p = 0.007) and the Reflux Index (9.61% vs. 4.35%; p = 0.003). The groups did not differ in total sleep time, tonsil size, BMI z-score and blood metabolic indices. Logistic regression analysis showed that residual OSA was significantly predicted by two polygraphic findings: the obstructive hypopnea index (OR 1.15; 95% CI 1.02–1.28; p = 0.014) and by the Reflux Index (OR 1.01; 95% CI 1.00–1.34; p = 0.042). Conclusions 1. Obstructive hypopneas, rather than obstructive apneas, persist after adenotonsillar surgery resulting in residual OSA. 2. Children with residual OSA are at higher risk of acid gastroesophageal reflux and should be evaluated for gastroesophageal reflux disease.

Protein Content and Fortification of Human Milk Influence Gastroesophageal Reflux in Preterm Infants

: Preterm human milk (HM) may provide insufficient energy and nutrients and thus may need to be fortified. Our aim was to determine whether fat content, protein content, and osmolality of HM before and after fortification may affect gastroesophageal reflux (GER) in symptomatic preterm infants. : Gastroesophageal reflux was evaluated in 17 symptomatic preterm newborns fed naïve and fortified HM by combined pH/intraluminal-impedance monitoring (pH-MII). Human milk fat and protein content was analysed by a near-infrared reflectance analysis. Human milk osmolality was tested before and after fortification. Gastroesophageal reflux indexes measured before and after fortification were compared and were also related to HM fat and protein content and osmolality before and after fortification. : An inverse correlation was found between naïve HM protein content and acid reflux index (RIpH: P = 0.041, rho =-0.501). After fortification, osmolality often exceeded the values recommended for infant feeds; furthermore, a statistically significant (P < 0.05) increase in nonacid reflux indexes was observed. : Protein content of naïve HM may influence acid GER in preterm infants. A standard fortification of HM may worsen nonacid GER indexes and, due to the extreme variability in HM composition, may overcome both recommended protein intake and HM osmolality. Thus, an individualised fortification, based on the analysis of the composition of naïve HM, could optimise both nutrient intake and feeding tolerance.

Acid gastroesophageal reflux and intensity of symptoms in children with gastroesophageal reflux disease. Comparison of primary gastroesophageal reflux and gastroesophageal reflux secondary to food allergy

The ability to differentiate between primary and secondary causes of gastroesophageal reflux (GER) is extremely important during the diagnostic procedure. At the same time, the quality of symptoms and the intensity of the course of gastroesophageal reflux disease (GERD) should be estimated. Acid GER is assessed using 24-hour esophageal pH monitoring; the results of this diagnostic test should always be interpreted alongside the clinical picture. To establish the interdependence between the intensity of the clinical symptoms and the acid reflux index in children with primary GER and GER secondary to cow's milk protein allergy (CMA) and/or other food allergies (FA). A total of 138 children of various ages with symptoms of GERD were included in the study. The diagnostic procedure included 24-hour pH monitoring of the esophagus with a 2-channel probe (distal and proximal lead). For this purpose, ESPGAN diagnostic criteria were implemented. The type and intensity of typical manifestations of GERD were assessed with the help of our own scoring system. This diagnostic and therapeutic algorithm which includes an oral food challenge test, was applied to 138 children in order to differentiate primary GER from GER secondary to CMA/FA. Primary GERD was diagnosed in 76 patients (55.1%) with a mean age: x=25.20 months+/-27.28 (group 1) and GERD secondary to CMA/FA was confirmed in 62 children (44.9%) with a mean age: x=21.53 months+/-17.79 (group 2). The most important pH-metric parameter analyzed in study groups 1 and 2 was the GER index: total and supine. An assessment of the intensity of symptoms and a comparative analysis of intensity was evaluated against the GER index: total and supine. Among study group 1, the following gradation of symptoms was found: in 31 children (40.8%)-degree 3, in 33 children (43.4%)-degree 4, and in 12 children (15.8%)-degree 5, whereas among the patients in group 2:25 (40.3%) were in degree 3, 27 (43.6%) were in degree 4, and 10 (16.1%) were in degree 5. It was estimated that the higher the GER result in both total and supine positions (for both leads), the higher the level of symptoms noted. This interdependence was demonstrated for both groups. In seeking to determine any etiopathogenetic connection between primary GER or GER secondary to CMA/FA and their clinical consequences, 24-hour esophageal pH monitoring with a 2-channel probe is recommended, since it provides for better clinical control of GERD and its appropriate treatment.

24-hour esophageal pH-monitoring in children suspected of gastroesophageal reflux disease: Analysis of intraesophageal pH monitoring values recorded in distal and proximal channel at diagnosis

To assess values of 24-h esophageal pH-monitoring parameters with dual-channel probe (distal and proximal channel) in children suspected of gastroesophageal reflux disease (GERD). 264 children suspected of gastroesophageal reflux (GER) were enrolled in a study (mean age c=20.78+/-17.23 mo). The outcomes of this study, immunoallerrgological tests and positive result of oral food challenge test with a potentially noxious nutrient, enabled to qualify children into particular study groups. 32 (12.1%) infants (group 1) had physiological GER diagnosed. Pathological acid GER was confirmed in 138 (52.3%) children. Primary GER was diagnosed in 76 (28.8%) children (group 2) and GER secondary to allergy to cow milk protein and/or other food (CMA/FA) in 62 (23.5%) children (group 3). 32 (12.1%) of them had CMA/FA (group 4-reference group), and in remaining 62 (23.5%) children neither GER nor CMA/FA was confirmed (group 5). Mean values of pH monitoring parameters measured in distal and proximal channel were analyzed in individual groups. This analysis showed statistically significant differentiation of mean values in the case of: number of episodes of acid GER, episodes of acid GER lasting >5 min, duration of the longest episode of acid GER in both channels, acid GER index total and supine in proximal channel. Statistically significant differences of mean values among examined groups, especially between group 2 and 3 in the case of total acid GER index (only distal channel) were confirmed. 24-h esophageal pH monitoring confirmed pathological acid GER in 52.3% of children with typical and atypical symptoms of GERD. The similar pH-monitoring values obtained in group 2 and 3 confirm the necessity of implementation of differential diagnosis for primary vs secondary cause of GER.

Clinical analysis of gastroesophageal reflux after PEG

It is difficult to predict whether or not gastroesophageal reflux (GER), such as aspiration or vomiting, will occur after PEG. To identify factors that would support the prediction of aspiration after PEG. Case-control study. Patients who underwent PEG from February 1998 to June 2005 in our hospital. The study included 178 patients. Endoscopic observation was carried out during PEG tube placement and at PEG tube replacement to determine the presence of hiatus hernia and/or reflux esophagitis. Gastric emptying and GER index (GERI) were measured by using a radioisotope technique. The patients were divided into 2 groups: the non-GER (NGER) group (n = 108), who had no symptoms of GER, and the GER group (n = 70), who showed these symptoms. No significant differences were observed between the groups in age, sex, morbidity, the presence of reflux esophagitis at PEG tube placement, gastric emptying, or serum albumin levels. The presence of a hiatus hernia (P = .028) and reflux esophagitis grading Los Angeles classification C or D (P = .008) were significantly more frequent in the GER group compared with the NGER group. The GERI was also significantly higher in the GER group than in the NGER group (P < .0001). The presence of hiatus hernia, severe reflux esophagitis, and a high GERI might be predictive factors of aspiration or vomiting after PEG tube placement.

Study on esophageal motor function against reflux after esophagogastric anastomosis with mucosal valve

To find an effective operative procedure against reflux after esophagogastric anastomosis with mucosal valve. Four hundred and sixty-four patients with esophageal or cardiac cancer were randomly divided into three groups according to anastomosis modes. Group A underwent esophagogastric anastomosis with mucosal valve (175 cases), group B with mechanical stapler (151 cases) and group C one layer anastomosis with handcraft suture (138 cases). The gastroesophageal reflux index (GERI) was examined by isotope,and 24 h esophageal pH was also monitored. The esophageal motor function was compared among three groups. The reflux rates were 0, 33.3%, and 6.7% in group A, B, C respectively. The esophageal motor function and the 24 h esophageal pH monitoring indicated that the various indexes were approaching to the normal level in group A, but the various indexes in group B and C were significantly different from the normal values (P< 0.05). The esophagogastric anastomosis with mucosal valve has better antireflux effect and can prevent the reflux esophagitis after esophageal or cardiac cancer eradication.

Gastric Emptying and Gastroesophageal Reflux in Patients Fed via Percutaneous Endoscopic Gastrostomy: Effects of Erythromycin

Abstract: Percutaneous endoscopic gastrostomy (PEG) has been suggested to affect gastric emptying. The aims of this prospective study were to examine the effects of erythromycin, known to act as a motilin agonist, on gastroesophageal motility in nine patients fed via PEG tubes and nine fed via nasogastric tubes. The gastric emptying time and gastroesophageal reflux index were simultaneously measured in each patient after the intravenous administration of erythromycin (200 mg) or a placebo on different days, using a radioisotopic method. The alteration of gastric emptying time produced by intravenous erythromycin in the PEG group was smaller than that in the nasogastric group (p&lt;0.05). However, gastroesophageal reflux indices in the two groups were similar. We conclude that PEG may impair gastric emptying subclinically without affecting gastroesophageal reflux.

Effect of isosorbide dinitrate on gastroesophageal reflux in healthy volunteers and patients with Chagas' disease

The effect of isosorbide dinitrate (ISD) on gastroesophageal reflux and gastric emptying during the 24-min period following a liquid meal was studied in healthy volunteers, Chagas' disease patients with normal esophageal motility (CD-1 group), and Chagas' disease patients with esophageal dysmotility (CD-2 group) with dynamic scintigraphy. At random, on two separate days, the subjects received 5 mg isosorbide dinitrate or an identical-appearing placebo tablet, by the sublingual route, and ingested a liquid test meal containing [99mTc]phytate colloid before scintigraphic studies were performed. Gastroesophageal reflux episodes were more frequent (P = 0.016) and gastroesophageal reflux indexes were greater (P < 0.010) after isosorbide dinitrate than after placebo in CD-2 group (N = 15) but not in healthy volunteers (N = 14) or CD-1 group (N = 9); six of seven CD-2 patients presenting with gastroesophageal reflux after isosorbide dinitrate had abnormal clearance of refluxate. Gastric emptying was similar in healthy volunteers (N = 13), CD-1 patients (N = 6), and CD-2 patients (N = 13), and no effect of isosorbide dinitrate on it was detected in any of the groups. In separate studies, 5 mg isosorbide dinitrate reduced the lower esophageal pressure (P < 0.01) in seven CD-2 patients. These results indicate that ISD increases the tendency towards GER in CD-2 patients, but not in healthy volunteers or CD-1 patients. This effect is probably related to an exceedingly intense relaxation of the LES caused by ISD in CD-2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Radionuclide detection of gastroesophageal reflux in children suffering from recurrent lower respiratory tract infection

Radionuclide gastro-esophageal scintigraphy was performed on 25 control and 183 children suffering from recurrent lower respiratory tract infection. Gastro-esophageal reflux (GER) of varying grades was observed in 135 patients. The severity of clinical symptoms in the patients was found to be directly related to the severity of reflux observed in the radionuclide study. In some patients an attempt was also made to quantitate GER by calculating the Gastro-esophageal reflux index. The results of the scintigraphic study were correlated with the results of the other commonly used and more conventional Barium swallow and fluoroscopy study. Gastro-esophageal scintigraphy was found to be much superior in terms of sensitivity, specificity and accuracy in detecting GER. It was also possible to objectively evaluate and monitor response to treatment following conservative or corrective surgical therapy using the radionuclide technique. The results of the study demonstrated a remarkably high incidence of GER in the patients. Whether GER is the cause of recurrent lower respiratory tract infection or not is difficult to establish firmly. But within the preview of the study the association seems to be very strong and cannot be easily ignored.

Cardiomyotomy associated with antireflux surgery in the treatment of achalasia

AbstractThe purpose of this report was to evaluate the efficacy of cardiomyotomy combined with fundoplication in the treatment of achalasia. Results obtained in 15 patients are compared with those collected in 19 asymptomatic patients treated by the classical Heller operation (12 patients), or by cardiomyotomy combined with suture of phrenoesophageal ligament to the underside of the diaphragm (7 patients). The preventive action of fundoplication on reflux esophagitis and especially the effect of surgery on esophageal emptying are particularly examined, using two rigorous isotopic tests. It is demonstrated that even asymptomatic patients have, after cardiomyotomy without antireflux maneuvers, a very high risk of esophagitis. The statistical comparison using the gastroesophageal reflux index between patients treated by Heller cardiomyotomy and normals wasp &lt;0.001 to the classical Heller, and 0.01 &lt;p &lt;0.05 to the group treated by cardiomyotomy plus abdominal fixation of the cardia. By contrast, the combination of a fundoplication to the myotomy provided a very high antireflux efficacy (p &gt;0.1), and maintained the improvement of the esophageal emptying.

Gastroesophageal scintigraphy to assess the severity of gastroesophageal reflux disease.

Thirty-six (36) patients with symptomatic gastroesophageal reflux were studied. Symptoms of heartburn, regurgitation and dysphagia were scored as to their severity and compared to quantitative tests of gastroesophageal reflux. Patients were studied with the acid reflux test, fiberoptic endoscopy, esophageal mucosal biopsy with a pinch forceps, esophageal manometry and radioisotopic gastroesophageal scintigraphy. Symptoms were scored according to an arbitrary grading system as mild, moderate, or severe. There were significant correlations between symptoms scores and both the degree of endoscopic esophagitis and the gastroesophageal reflux indices as measured by the radioisotopic scintiscan, but not with the degree of histologic esophagitis or lower esophageal sphincter pressure. Review of the findings suggests the following profile for patients who might require antireflux surgery: severe symptoms, presence of endoscopic esophagitis; resting lower esophageal sphincter pressure below 10 mmHg; and gastroesophageal reflux index above 10%.

Guanosine triphosphate (GTP)-dependent stimulation of rabbit gallbladder mucosal adenylate cyclase by prostaglandins

ASSESSING THE CLINICAL SEVERITY OF REFLUX ESOPHAGITIS. R.Menin,L.Malmud,R.Peterson,K.Phaosawasdi, and R.Fisher, Temple University Hospital, Philadelphia, Pennsylvania. Data which correlate the severity of reflux symptoms with the results of diagnostic tests in patients with esophagitis are not available. The need for such data is emphasized by the recent enthusiasm for anti-reflux surgery. The purpose of this study was to rate symptom severity and correlate symptom scores with the results obtained from diagnostic tests. Thirty-six patients with esophagitis were evaluated by endoscopy, mucosal biopsy with pinch forceps, esophageal manometry and gastroesophageal scintiscanning. Heartburn, regurgitation and dysphagia were rated numerically, and the severity of esophagitis was classified clinically as mild, moderate or severe based on symptom scores. Endoscopic esophagitis correlated with symptoms. Symptom scores were 3.750.4, 3.4+0.4 (P>.OS), 5.7kO.4 (Pc.01) and 7.0+_0.5 (Pc.001) respectively, in normal and mild, moderate and severe endoscopic esophagitis. All patients with moderate or severe symptoms had endoscopic esophagitis. Symptoms did not correlate with the severity of histologic esophagitis or with resting LES pressures (r,O.Z). However, LES pressure was below 10 mmHg in 23 of 27 patients with moderate or severs symptoms. Biopsy specimens could not be interpreted in 19% of patients. Symptoms correlated significantly with gastroesophageal reflux indices (r,0.7). Reflux indices were a'bove lo/ in all patients with severe symptoms. In those selected for anti-reflux surgery, endoscopic esophagitis was present in 83%, LES pressure was less than 10 mmHg in 75% and the gastroesophageal reflux index was greater than 10% in 92%. Conclusion: In patients with esophagitis, the severity of symptoms correlates with the severity of endoscopic esophagitis and the quantity of reflux, but not with LES pressure or histologic esophagitis. Analyses of these results might assist the clinician to determine which of his patients might require surgical treatment.