Gastroesophageal Reflux Research Articles

A biosensor based on carbon dots-protein interactions for specific and sensitive detection of pepsin in saliva

Salivary pepsin has emerged as a promising biomarker for rapid screening and diagnosis of gastroesophageal reflux disease (GERD). Pepsin mainly exists in strongly acidic environments and exhibits its highest activity. However, the poor stability of most fluorescent sensors in strong acidic environments brings a significant challenge for pepsin detection. Herein, an innovative biosensor was developed for the highly specific and sensitive detection of pepsin on the basis of green-emitting ionic liquid-based carbon dots (G-IL-CDs) conjugated with whey proteins (WPs). The G-IL-CDs exhibited aggregation-induced fluorescence enhancement when interacting with WP, and the fluorescence intensity decreased after incubation with pepsin due to the disruption of the aggregation structure. This strategy is highly selective for pepsin due to the strongly acidic environment in which other proteases are inactivated. Under optimal experimental conditions, this biosensor successfully detected pepsin in real human saliva with a satisfying recovery. Furthermore, this study not only developed a CDs-based sensor for detecting pepsin but also laid a solid theoretical foundation for the future development of novel biosensors combining CDs and proteins.

Using impedance planimetry (EndoFLIP) to determine ideal distensibility ranges for esophageal motility disorders

ObjectiveUse of impedance planimetry (EndoFLIP) has shown distensibility index ranges associated with improved patient-reported outcomes after antireflux surgery. Questions remain whether the previously described ideal distensibility index range can be used for patients with esophageal motility disorders. We hypothesized that patients with esophageal motility disorders would have a different ideal distensibility range for optimal outcomes. MethodsA retrospective review of a prospectively maintained gastroesophageal database was performed for all patients undergoing Toupet and Nissen fundoplication and impedance planimetry. Demographic data, perioperative outcomes, and quality-of-life indicators (Reflux Symptom Index, Gastroesophageal Reflux Disease-Health Related Quality of Life Questionnaire, and gas/bloat and dysphagia scores) were analyzed and compared between patients by use of the χ2 and Wilcoxon rank-sum tests. ResultsFrom 2015 to 2024, 475 patients underwent laparoscopic fundoplication and impedance planimetry evaluation. Of those, 160 had a final distensibility index score in the ideal range, 165 with a final distensibility index score <2.5, and 150 with a final distensibility index >3.6. In the ideal-range cohort, there were no statistically significant differences between those with normal and abnormal motility in regards to outcomes or quality of life indicators. In the low distensibility index cohort, patients with abnormal motility had worse Gastroesophageal Reflux Disease-Health Related Quality of Life Questionnaire, gas/bloat, and dysphagia scores at 1 year postoperatively compared with those with normal motility. More patients in the low distensibility index cohort required dilations postoperatively, and more patients in the high distensibility index cohort had recurrences compared with those in the ideal range cohort. ConclusionThe previously described ideal distensibility index range of 2.5–3.6 for patients undergoing laparoscopic fundoplication may be used for patients with certain esophageal motility disorders.

Impact of Obesity on Outcome for Inflammatory Bowel Disease Patients From 2008 Through 2020.

The incidence and prevalence of obesity have been rising in the U.S. It is known to affect the course and treatment of a variety of gastrointestinal disorders. It has been proposed to particularly worsen the symptoms of inflammatory bowel disease (IBD) and put patients at risk of treatment failure. Our study seeks to understand better the impact of obesity on morbidity, mortality, hospital length of stay (LOS), and charges in patients with IBD. The National Inpatient Sample (NIS) from 2008 to 2020 was used to identify patients over 18 diagnosed with IBD using the International Classification of Disease (ICD) 9 and 10 codes. Records were weighted per the NIS algorithm to produce accurate population estimates. Patients were classified by obesity status and then analyzed for baseline characteristics such as age, gender, race, insurance status, and various comorbidities. Various primary outcomes were analyzed. Outcomes were compared between groups, and odds ratios (ORs) were calculated using weighted logistic regression. ORswere adjusted for common co-founders. A weighted total of 2,105,418 patients admitted for IBD were included in this study. Of these, 170,475 were obese, and 1,934,943 were not obese. Obese patients were older, more complex (Charlson comorbidity index [CCI] 2.03 vs. 1.53), and more likely to be female (p<0.01) than non-obese patients. Compared to non-obese patients, IBD patients with obesity had a higher prevalence of coronary artery disease (11.35% vs. 7.87%), hyperlipidemia (29.27% vs. 15.09%), hypertension (45.38% vs. 25.60%), diabetes mellitus type 2 (27.15% vs. 9.38%), congestive heart failure (4.58% vs. 2.35%), gastroesophageal reflux disease (30.73% vs. 17.98%), and CCI (2.03% vs. 1.53%). Obese IBD patients had slightly higher odds of shock (OR 1.228, p<0.05), acute myocardial infarction (AMI, OR 1.692, p<0.01), acute kidney injury (AKI, OR 1.187, p<0.01), and chronic steroid treatment (OR 1.149, p<0.01). Conversely, obese IBD patients had lower odds of intestinal fistula (OR 0.837, CI 0.77-0.91, p<0.001). Obesity poses a diverse set of complications in IBD patients. Our study found that obese patients admitted with IBD had significantly higher odds of shock, AKI, and chronic steroid treatment. Interestingly, these patients were less likely to develop intestinal fistulas. These findings suggest further research into how obesity affects the disease course.

S590 Comparative Outcomes of Gastroesophageal Reflux Disease, Nonerosive Reflux Disease, and Erosive Esophagitis in Patients Undergoing Roux-en-Y Gastric Bypass versus Sleeve Gastrectomy for Weight Loss

S590 Comparative Outcomes of Gastroesophageal Reflux Disease, Nonerosive Reflux Disease, and Erosive Esophagitis in Patients Undergoing Roux-en-Y Gastric Bypass versus Sleeve Gastrectomy for Weight Loss

S1651 Long-Term Clinical Outcomes After Endoscopic Stapling System Therapy of Patients With Gastroesophageal Reflux Disease (GERD)

S1651 Long-Term Clinical Outcomes After Endoscopic Stapling System Therapy of Patients With Gastroesophageal Reflux Disease (GERD)

Nissen sleeve gastrectomy: 5-year follow-up results

BackgroundNissen sleeve gastrectomy is a new bariatric procedurebased on the combination of two well-known surgical techniques (vertical sleeve gastrectomy and Nissen fundoplication). It was conceived as a means of preventing the major drawback of the sleeve gastrectomy (SG), the gastroesophageal reflux disease (GERD), while preserving the advantages of SG in terms of weight loss and remission of obesity-related comorbidities. ObjectivesThe objectives of this study are to present the long-term (5 years) follow-up results on weight loss, evolution of GERD and other comorbidities and the complication rate of the Nissen sleeve gastrectomy. SettingMontpellier University Hospital, France. MethodsThis is a prospective analysis of patients who underwent Nissen sleeve gastrectomy as a first-line bariatric procedure between January 2018 and February 2019. A subgroup analysis of patients with no further surgery during follow-up was also performed. ResultsA total of 144 patients underwent a Nissen sleeve gastrectomy: After adjusting for exclusion criteria, 133 patients comprised the initial study population, 81.9% of whom had complete follow-up for weight and GERD clinical symptom outcomes at 5 years. The mean total weight loss (TWL%) was 22 (± 12.3)% and the mean excess weight loss percentage (EWL%) was 59.4% (± 34.2)%. Of the 63 patients with preoperative clinical symptoms of GERD, we observed an 85.5% 5-year clinical remission rate; however only 25 patients had a gastroscopy at 5 years. The cumulative short- and long-term reoperation rate was 8.1% and the mortality rate was zero. ConclusionsThe Nissen sleeve gastrectomy achieves a satisfactory long-term TWL% and a significant improvement in comorbidities, particularly regarding the incidence of GERD. The rate of complications requiring surgical reoperation is low.

S643 Assessing Risk of Gastroesophageal Reflux Disease and its Complications in Patients Starting Tirzepatide

S643 Assessing Risk of Gastroesophageal Reflux Disease and its Complications in Patients Starting Tirzepatide

S601 Distensibility Index Using EndoFlip in the Assessment of Gastroesophageal Reflux Disease With Esophagitis

S601 Distensibility Index Using EndoFlip in the Assessment of Gastroesophageal Reflux Disease With Esophagitis

S705 The Efficacy of Antireflux Mucosectomy (ARMS) and Antireflux Mucosal Ablation (ARMA) for Gastroesophageal Reflux Disease (GERD) by 24-Hour pH Monitoring: Systematic Review and Meta-Analysis

S705 The Efficacy of Antireflux Mucosectomy (ARMS) and Antireflux Mucosal Ablation (ARMA) for Gastroesophageal Reflux Disease (GERD) by 24-Hour pH Monitoring: Systematic Review and Meta-Analysis

In vitro and in vivo evaluation of a novel wired transmission pH-combined photographic catheter for ambulatory gastroesophageal reflux monitoring (with videos).

Twenty-four-hour pH-impedance monitoring is an important diagnostic approach for gastroesophageal reflux disease (GERD). Reflux monitoring results cannot be synchronized with ambulatory motility imaging of the esophageal sphincter. We have designed a novel wired transmission pH-combined photographic catheter (WT-CPC) for the synchronous acquisition of reflux image and pH. Different patterns of reflux events were simulated to perform in a porcine gastroesophageal reflux model in vitro. The live porcine model of gastroesophageal reflux was established in three Bama pigs. Monitoring was conducted with the WT-CPC and pH-impedance catheter simultaneously. Measurements included the number and proportion of reflux events, as well as acid exposure time (AET). The detection rates of WT-CPC for distal and horizontal acid reflux events were significantly higher compared to those of pH-impedance catheters (100% vs. 14.29%, 100% vs. 57.14%, P < 0.05). There was no significant difference between the two methods in proximal acid reflux events (P = 0.217). Regarding mixed reflux events, WT-CPC exhibited higher detection rates for distal events than pH-impedance catheter (100% vs. 42.86%, P < 0.05). However, there was no significant difference between the two methods for proximal reflux events (P > 0.05). Both methods showed similar results for horizontal reflux events. A porcine gastroesophageal reflux model was successfully established and utilized for reflux monitoring. A total of 28 episodes of reflux were detected within 6.5min. The detection rate achieved by WT-CPC for reflux events was significantly higher than that obtained by pH-impedance (100% vs. 78.57%, P = 0.023). The WT-CPC has demonstrated reflux monitoring capabilities in an isolated reflux organ model. It also showed good operability and performance in the porcine model. The WT-CPC holds promising potential to provide valuable diagnostic evidence for GERD.

Effectiveness of Changing Drug Classes in Patients With Refractory Laryngopharyngeal Reflux Disease.

To investigate the effectiveness of drug class changes in patients with refractory laryngopharyngeal reflux disease (LPRD). Retrospective case series with prospective data. Multicenter study. The data of patients treated for a refractory LPRD from September 2017 to December 2023 were collected. The effectiveness of drug class changes was assessed through the reflux symptom score (RSS) change. Signs were evaluated with the Reflux Sign Assessment. The RSS reduction was used to categorize the therapeutic responses as mild (20%-40% RSS reduction), moderate (40.1%-60% RSS reduction), high (60.1%-80%), and complete (>80%). Among the 334 medical records, 74 (22.2%) patients had refractory LPRD defined as no RSS change in the pre- to 3-month posttreatment. The mean age was 52.6 ± 15.5 years. Changing drug class was associated with significant 3- to 6-month posttreatment reductions of RSS and RSA. Thirty patients (39%) did not experience symptom reduction after changing drugs. Changing alginate to magaldrate and magaldrate to alginate was associated with the highest responder rate (76.9%). Changing PPI and alginate/magaldrate molecules led to a response rate of 62.5%. In patients initially treated with a combination of PPI and alginate or magaldrate, changing PPI without changing alginate/magaldrate led to a 37.5% response rate. The baseline RSS was predictive of the 3- and 6-month RSS (therapeutic response). Changing drug class, especially alginate-to-magaldrate, may be an effective therapeutic approach for patients with a refractory LPRD.

A multi-level investigation of the genetic relationship between gastroesophageal reflux disease and lung cancer.

Observational studies have revealed a potential association between gastroesophageal reflux disease (GERD) and lung cancer (LC), but the genetic role in their comorbidity have not been fully elucidated. This study aimed to comprehensively dissect the genetic link underlying GERD and LC. Using large-scale genome-wide association study (GWAS) data, we investigated shared genetic architecture between GERD and LC. Our analyses encompassed genetic correlation, cross-trait meta-analysis, transcriptome-wide association studies (TWASs), and the evaluation of the causality though a bidirectional Mendelian randomization (MR) analysis with sufficient sensitivities. We identified a significant genome-wide genetic correlation between GERD and overall LC (rg =0.33, P=1.58×10-14), as well as across other subtype-specific LC (rg ranging from 0.19 to 0.39). After separating the whole genome into approximately 2,353 independent regions, 5 specific regions demonstrated significant local genetic correlation, with most significant region located at 9q33.3. Cross-trait meta-analysis revealed 22 pleiotropic loci between GERD and LC, including 3 novel loci (rs537160, rs10156445, and rs17391694). TWASs discovered a total of 49 genes shared in multiple tissues, such as lung tissues, esophagus muscularis, esophagus mucosa, and esophagus gastroesophageal junction. MR analysis suggested a significantly causal relationship between GERD and overall LC [odds ratio (OR) =1.34, 95% confidence interval (CI): 1.19-1.51], as well as other subtype-specific LC (OR ranging from 1.25 to 1.76). No evidence supports a significant causal effect of LC on GERD. Our findings suggest intrinsic genetic correlation underlying GERD and LC, which provides valuable insights for screening and management of LC in individuals with GERD.

Comprehensive analysis of nizatidine: Pharmacodynamics and pharmacokinetics in anti-ulcer treatment

Ulcers are characterized histologically as lesions that penetrate through the muscularis mucosae into the submucosal layer, affecting any segment of the gastrointestinal (GI) tract mucosa. They often arise due to excessive acid production from peptic secretions. Nizatidine (NZT) is a potent H2-receptor antagonist used to reduce basal, nocturnal, and stimulated gastric acid secretion. This medication is commonly prescribed for conditions such as gastroesophageal reflux disease, peptic ulcers, and duodenal ulcers. As a member of the histamine H2 receptor antagonist class introduced before proton pump inhibitors, Nizatidine is noted for its effectiveness comparable to ranitidine. However, Nizatidine is distinguished by its thiazole ring, in contrast to the furan ring found in ranitidine. When administered orally, Nizatidine, especially in combination with antacids, enhances drug delivery to parietal cell receptors, improving the overall bioavailability of the medication and its ability to suppress acid secretion. Nizatidine is primarily absorbed in the proximal small intestine, exhibiting about 70% absolute bioavailability. Its lower absorption from the colon and a short biological half-life (ranging from 1 to 1.6 hours) suggest the potential benefits of developing sustained-release formulations such as floating gels to prolong its therapeutic effects. Clinical studies indicate that Nizatidine, in doses of 300 mg at bedtime or 150 mg twice daily, shows superior efficacy compared to other H2-receptor antagonists for managing duodenal and gastric ulcers as well as gastroesophageal reflux disease.

Effect of hiatal hernia and esophagogastric junction morphology on esophageal motility: Evidence from high-resolution manometry studies.

High-resolution Manometry (HRM) is the most sensitive and specific test available for clinical assessment of hiatal hernia (HH), a common condition defined as the separation between the Lower Esophageal Sphincter (LES) and crural diaphragm (CD). While the link between HH and Gastroesophageal Reflux Disease (GERD) is established, the potential association of HH with esophageal dysmotility, independently from GERD, is uncertain. This study aimed to analyze if HH, with or without GERD, can associate with esophageal motility disorders. Consecutive patients without previous esophageal surgery who underwent HRM between 2018 and 2022 were enrolled. All patients with symptoms suggestive of GERD underwent impedance-pH testing off-therapy. HH was defined as a separation >1 cm between LES and CD, and esophagogastric junction (EGJ) morphology was classified as: Type I, when there was no separation between LES and CD; Type II, in case of minimal separation (>1 and <3 cm); Type III, when ≥3 cm of separation was present. Demographic and clinical characteristics were collected at baseline, including Age, Gender, Alcohol-, Coffee- and Smoke-habits, GERD diagnosis and symptoms' duration. Two cohorts of patients, with and without HH, were retrospectively individuated, and their association with Ineffective Peristalsis, Hypercontractile Esophagus and Outflow Obstruction was analyzed with univariate and multivariate Logistic regressions using the statistical software R. 848 consecutive patients were enrolled, and 295 cases of HH (34.8%), subdivided into 199 (23.5%) Type II- and 96 (11.3%) Type III-EGJ patients, were identified. Ineffective peristalsis was diagnosed in 162 (19.1%) subjects, Hypercontractile esophagus in 32 (3.8%), and Outflow Obstruction in 91 (10.7%), while GERD was present in 375 (44.2%) patients. HH was significantly associated with Ineffective Peristalsis (p < 0.001) and GERD (p < 0.001). Furthermore, HH resulted to be a risk factor for Ineffective peristalsis (OR 2.0, 95% CI 1.4-2.8, p < 0.001) both when the analysis was conducted in all the 848 subjects, independently from GERD, and when it was carried out in patients without GERD (OR 2.3, 95% CI 1.02-5.3, p = 0.04). The risk for Ineffective Peristalsis increased 1.3 times for every centimeter of HH. No statistically significant association was found between HH and Outflow obstruction or Hypercontractile Esophagus. An increasing separation between the LES and CD may lead to a gradual and significant elevation in the risk of Ineffective Peristalsis. Interestingly, this association with HH is true in patients with and in those without GERD, suggesting that the anatomical alteration seems to play a major role in motility change.

IL-8, TNF-α, and IL-17 in the Development of Erosive Esophagitis and Symptom Perception in Gastroesophageal Reflux Disease (GERD)

Background: The diverse clinical characteristics of erosive esophagitis (EE) and symptom perception in patients with gastroesophageal reflux disease (GERD) remain a major challenge in understanding their underlying pathogenesis. This study aimed to investigate the association between the levels of IL-8, TNF-α, and IL-17 in serum and the presence of erosive esophagitis and symptoms related to GERD. Method: We enrolled 65 subjects presenting with GERD symptoms. Based on the findings of upper endoscopy, the subjects were categorized into two groups: (1) erosive esophagitis (EE LA grades B-D) and (2) non-erosive esophagitis (normal-EE LA grade A). Symptom perception was assessed via GERD questionnaire (GERD-Q) and the frequency scale for the symptoms of GERD (FSSG). The enzyme-linked immunosorbent assay (ELISA) method was used to analyze serum levels of IL-8, TNF-α, and IL-17. Analysis of cytokine levels between different symptoms severity was performed using the Kruskal-Wallis H test. Results: Median serum IL-8 levels were significantly higher in the erosive esophagitis group compared to those with non-erosive esophagitis (20.2 (IQR 16.9–32.2) vs. 17.7 (IQR 15.2–19.6), p &lt; 0.05). The study found a significant association between IL-8 levels and the presence of globus symptoms (median IL8 level 46.961 (38.622–92.644) in subjects with globus vs. 18.06 (16.68–20.49) in those without globus; p &lt; 0.05). Similarly, TNF-α levels were associated with the frequency of regurgitation symptoms (H index = 10.748; dr = 3; p &lt; 0.05). We observed a significant correlation between IL-17 levels and the frequency of heartburn and early satiety symptoms. Conclusions: IL-8 may play a role in the development of mucosal erosion in GERD. IL-8, TNF- α, and IL-17 might be involved in the development of globus symptoms, the frequency of regurgitation, and the frequency of heartburn and early satiety, respectively. The diverse symptom phenotypes observed in patients with GERD symptoms may be mediated by distinct profiles of proinflammatory cytokines.

Analysis of the Association between Eosinophilic Esophagitis and MASLD: Retrospective, Observational, Cohort Analysis of the National Inpatient Sample 2016-2020.

Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory condition. Associated pathologies for EoE are similar to those with metabolic-dysfunction-associated steatotic liver disease (MASLD). This study assesses whether an association exists between MASLD and EoE. We used National Inpatient Sample (NIS) 2020 data to identify adult patients. ICD-10 codes were used to identify patients with MASLD and EoE. The relationship between MASLD and EoE was assessed by multivariate analysis after adjusting for confounding factors, such as patient demographics, hospital characteristics, Charlson comorbidity index, obesity, obstructive sleep apnea (OSA), diabetes, hypertension (HTN), hyperlipidemia (HLD), inflammatory bowel disease (IBD), celiac disease (CD), gastroesophageal reflux disease (GERD), smoking, alcohol use, and irritable bowel syndrome (IBS). Out of 26 million patients, 4,820 had a diagnosis of EoE. The majority of the patients were between 18 and 44 years of age (47.82%), male (54.05%), had private insurance (50.1%), and were in the highest income quartile (29.25%). A higher incidence of MASLD was noted in the EoE group than those without (6.1% vs.2.9%, p<0.001). After adjusting for confounding factors, MASLD had 2.38 times higher odds of having EoE (95% CI-1.82-3.11, p<0.001). Other factors noted to be associated with higher odds of EoE included younger age, Caucasian race, IBS, GERD, IBD, and CD. Our study reports a novel finding that MASLD and EoE are associated. Future prospective studies are needed to confirm and understand the clinical significance of this relationship and how one disease affects the other.

Predictors of Poor Quality of Life in Patients with Gastroesophageal Reflux Disease Undergoing Sleeve Gastrectomy.

Background-Gastroesophageal reflux disease (GERD) is commonly diagnosed in patients with severe obesity. The outcomes of patients with preoperative GERD after sleeve gastrectomy (SG) are unclear, and some surgeons consider GERD a contraindication for SG. Methods-A retrospective analysis of a tertiary university hospital database was conducted. All patients with preoperative GERD undergoing SG between January 2012 and January 2020 and having at least two years of follow-up were included in the analysis. A validated GERD-associated quality of life questionnaire (GERD-HRQL) was completed by all patients. Results-During the study period, 116/1985 patients (5.8%) were diagnosed with GERD before SG. In total, 55 patients were available for a two-year follow-up and were included in the analysis. Median follow-up was 40 months (range 24-156 months). Mean total weight loss (TWL) was 24.0% ± 12.0%. On follow-up, 43 patients (78.1%) reported having GERD symptoms. In patients who underwent postoperative endoscopy, less than a third had esophagitis. The mean GERD-HRQL score was 25.2 ± 10.9. On univariable analysis, patients with poor GERD-HRQL had lower BMI at baseline (41.5 ± 12.4 vs. 44.9 ± 10.0 kg/m2, p = 0.03), were less commonly smokers at baseline (8.1% vs. 33.3%, p = 0.02), and had lower TWL at the end of the follow-up (22.2% ± 10.4% vs. 28.9% ± 13.7%, p = 0.05). On multivariable analysis, smoking status at baseline and TWL at last follow-up were independent predictors of better GERD-HRQL. Conclusions-In conclusion, most GERD patients after SG have a relatively high GERD-HRQL score, most patients still have GERD symptoms during the follow-up, and approximately a third of patients have endoscopic signs of esophagitis. There was an association between patients with higher TWL and smoking at baseline and better GERD-HRQL outcomes. The latter is potentially due to smoking cessation.

Repair of Type C Tracheo-esophageal Fistula/Esophageal Atresia With or Without Trans Anastomotic Tube: A Pilot Randomized Controlled Trial

BackgroundThe use of trans anastomotic feeding tube (TAFT) during the repair of Esophageal atresia/Tracheo-esophageal fistula (EA/TEF) aims to enhance outcomes by enabling early feeding, reducing the requirement for parenteral nutrition, and reducing complications such as anastomotic leak by stenting the anastomosis. However, TAFT's benefits and drawbacks are debated due to conflicting reports. Thus, we conducted a prospective pilot randomized control trial to elucidate the impact of TAFT on postoperative outcomes and the potential benefits of avoidance of TAFT. MethodsWe performed a single-center randomized controlled trial in 53 neonates diagnosed with Type C EA/TEF who were operated on from January 2022 to June 2023. The patients were randomized into TAFT (n = 30) and non-TAFT (n = 23) groups. The patients were followed up for a minimum of 6 months following discharge. The primary objective of the study was to compare the rate of anastomotic leaks following primary repair of EA/TEF in both groups. Secondary objectives included early postoperative outcomes such as the occurrence of anastomotic stricture, time taken to initiate feeding, the time required to reach full feeding, the incidence of brief resolved unexplained events (BRUE) or acute life-threatening events (ALTE), the incidence of gastroesophageal reflux (GER), somatic growth, and all-cause mortality within 30 days post-surgery. ResultThe study demonstrated that TAFT placement was associated with a higher incidence of anastomotic leaks (20 % vs 0, p = 0.03). However, there was no difference in the 30-day mortality between both groups. Although the rate of anastomotic strictures and GER was higher in the TAFT group (54.5 % vs 27.8 %, p = 0.08 and 25 % vs 57.1 %, p = 0.076), it did not reach statistical significance. Avoiding TAFT resulted in earlier initiation of enteral feeding (18 vs 22 days, p = 0.002), shorter time to achieve full feeds (15 vs 21 days, p = 0.03), reduced duration of TPN (3 vs 10 days; p = 0.001), improved weight gain at the 2-week follow-up (27.5 vs. 24.4 g/kg/day, p-value = 0.037) and lesser incidence of ALTE/BRUE (11.1 % vs 48 %, p = 0.01) at 6 months. ConclusionWhile previous research has covered TAFT's impact on complications such as anastomotic leak, stricture, use of TPN and enteral feed, prospective randomized studies remain limited, and the impact on GER, somatic growth, and occurrence of ALTE/BRUE is still unexplored. This study evaluated the short-term outcomes of EA/TEF in a resource-challenged setting, shedding light on the potential benefits of repair without TAFT such as reduction in the rate of anastomotic leak, earlier feeding, reduced GER, better somatic growth and reduced incidence of ALTE/BRUE. Level of EvidenceLevel II (Treatment study/Randomized controlled trial).

Distal esophageal spasm and gastroesophageal reflux disease: re-examining the association.

Distal esophageal spasm (DES) is a rare motility disorder presenting with dysphagia or chest pain. Although studies suggest a link between DES and gastroesophageal reflux disease (GERD), data supporting a distinct GERD-related phenotype are limited. This study aims to investigate demographic, symptomatic, and physiologic differences between DES subjects with and without GERD. A retrospective cohort analysis of DES patients determined by high resolution manometry (HRM) was conducted between February 2020 and January 2023. Demographics, medications, symptoms, and quantitative reflux testing data were collected. DES subjects with reflux (R-DES) were defined by presence of Los Angeles Grade B/C/D esophagitis, Barrett's metaplasia, or abnormal pH testing. DES subjects without reflux (NR-DES) had normal parameters. Statistical analysis employed two-sided or Wilcoxon Rank-Sum, Chi-squared, or Fisher's exact tests, and multivariate logistic regression. Of 69 DES subjects, 32 (46.3%) had GERD. R-DES and NR-DES patients had similar demographic variables except for higher BMI in R-DES (30.41 vs. 26.88, P= 0.01). R-DES and NR-DES shared similar symptom profiles (heartburn P= 0.67, dysphagia P= 0.448, chest pain P= 0.32). Proton pump inhibitor use was similar between groups (78.1% vs. 91.9%, P= 0.202). HRM metrics were comparable except for basal LES tone (20.7mmHg vs. 32.99mmHg, P= 0.03) and median IRP 11.82mmHg versus 17.20mmHg, P= 0.017). This study found no distinguishing clinical or physiologic differences between DES patients with and without GERD, challenging the historical emphasis of GERD in DES pathogenesis. The impact of GERD management on the natural history of DES remains uncertain.

Does reflux symptom index and reflux finding score have clinical utility in the diagnosis of laryngopharyngeal reflux disease?

BackgroundReflux symptom index(RSI) and reflux finding score (RFS) are widely used scoring systems used to diagnose laryngopharyngeal reflux disease(LPRD). However many patients do visit the outpatient department with minimal symptoms not sufficient to fit the criteria described by Belafsky et al. for diagnosing LPRD. Most of these patients are provisionally diagnosed and treated for LPRD. Reflux symptom index(RSI) and reflux finding score (RFS) are widely used scoring systems used to diagnose(LPRD) (Belafsky PC et al., J Voice 16(2):274–7, 2002, Belafsky PC et al, Laryngoscope 111(8):1313–7, 2001).RSI has nine questions that the patient must grade from 0 to 5. An abnormal score is greater than 13. Laryngopharyngeal reflux (LPR) may or may not be diagnosed using the RSI and RFS especially when patients present with minimum symptoms not sufficient to score more than 13 and 7 respectively. These patients may miss the diagnosis and have to be treated empirically. Pepsin’s presence in the saliva is indicative of reflux as pepsin is a gastric enzyme (NICE advice on Peptest for diagnosing gastro-oesophageal reflux, 2015, Wood JM et al., J Laryngol Otol 125(12):1218–24, 2011). Patients with minimum symptoms may be missed if diagnosis relies only on RSI AND RFS. The present study aims to see the correlation of pepsin-proven LPRD and RSI and RFS.MethodsThis is a prospective study, 49 patients with symptoms suggestive of LPRD who tested positive for the pepsin test were further analysed for RSI and RFS. A cut-off value of > 25 ng/mL was considered diagnostic of LPRD (Dhillon VK et al., Curr Gastroenterol Rep 18(8):44, 2016).ResultThe average RSI and RFS were respectively 10 and 4. The mean age of the patients in the study was 39 years and the mean weight was 60 kg. The association between RSI and PEPSIN detection is considered to be not statistically significant. Chi-squared equals 0.086 with 1 degree of freedom. The two-tailed P value equals 0.7698. Chi-squared equals 0.233 with 1 degree of freedom. The two-tailed P value equals 0.6295. The association between RFS and PEPSIN detection is considered to be not statistically significant.In terms of correlation analysis, neither the RSI nor the RFS had Pearson’s correlation coefficient that was statistically significant.ConclusionSince salivary pepsin detection and the RSI do not have any significant correlation, the RSI is not a valid diagnostic method for LPR and should not be used exclusively.Level of evidence4.