Gastroesophageal Reflux Disease Research Articles

Prevalence and clinical features of gastroesophageal reflux disease in residents of the Makhachkala-Caspian agglomeration

Prevalence and clinical features of gastroesophageal reflux disease in residents of the Makhachkala-Caspian agglomeration

Evaluating the clinical efficacy of therapies in patients with symptoms of gastroesophageal reflux disease after phenotyping based on 24-h pH-impedance monitoring

Evaluating the clinical efficacy of therapies in patients with symptoms of gastroesophageal reflux disease after phenotyping based on 24-h pH-impedance monitoring

Persistent Gastroesophageal Reflux Disease After RYGB: What Shall we do Next?

Roux-en-Y gastric bypass (RYGB) is considered the weight loss procedure of choice for obese patients with gastroesophageal reflux disease (GORD). The long-term prevalence of GORD after RYGB for obesity is underestimated as many post-RYGB patients can still complain of severe reflux symptoms, refractory to medications. This is a narrative review using the patient, intervention, comparison, outcome and study strategy. The literature search was undertaken using PubMed, Medline, and Google Scholar databases with the following MeSH terms: Gastroesophageal reflux disease, GORD, Obesity, Gastric bypass, Roux-en-Y gastric bypass, complication, and fundoplication. Twelve original papers and case report studies on 57 patients who met the inclusion criteria were suitable for the present review. Reporting styles on successful treatment outcomes were heterogeneous. Treatment options for these patients are limited but include further surgical or endoscopic interventions. Careful follow-up and appropriate management are paramount for this population. There is significant paucity in the available evidence on managing GORD after RYGB. This narrative review provides a detailed overview of the underlying causes, discusses the various endoscopic and surgical therapy options, and suggests strategies to provide tailored and appropriate therapy for this complex group of patients.

Thirty-day outcome of patients who present with chest pain to the emergency department of a tertiary care hospital of Sri Lanka

Background: Patients present with chest pain causes significant burden to the workload in an emergency department (ED). Quick but thorough attention is needed for life threatening emergencies and to minimize unnecessary admissions. We assess the burden of chest pain and 30-day outcome of patients who present with chest pain to the ED. Methodology: Prospective observational study of all adult patients presented to ED over one month with the primary complain of chest pain were evaluated and followed for 30 days. Results: A total of 661 (20.3% of total admissions) patients (mean age 56.7±1 4.9 years, 51% males) were studied. Common causes for the chest pain included gastroesophageal reflux disease (GORD) (29%) and acute coronary syndrome (ACS) (25%). ACS patients included ST-elevation myocardial infarction (STEMI) (10%), Non-ST-elevation myocardial infarction (6.7%) and unstable angina (8.3%). Fifty patients (75% of the STEMI patients) were thrombolysed. Primary angioplasty facility was not available in the hospital during the study period. Five patients (3% of the ACS patients) had coronary revascularization during the follow-up period – 2 patients had angioplasty and 3 patients had coronary bypass surgery. In-hospital mortality was 2.7%. Thirty-day mortality was 3.2%. Thirty three percent of them continued to have recurrent chest pain despite thorough investigation and treatment. Conclusions: Chest pain carries a significant burden to the workload of a busy ED. The commonest causes for chest pain were ACS and GORD. A considerable number of patients continued to experienced chest pain despite investigations and treatment.

Gastroretentive Swellable and Floating Systems: An Innovative and Promising Strategy for Drug Delivery-A Comprehensive Review

Gastroretentive drug delivery systems (GRDDs) have emerged as an innovative and promising approach for enhancing the bioavailability and therapeutic efficacy of drugs with narrow absorption windows in the upper gastrointestinal tract (GIT). Among various GRDDs, swellable and floating systems have garnered significant attention due to their ability to prolong gastric residence time, improve drug dissolution, and facilitate sustained drug release (SDR). This comprehensive review provides a detailed exploration of the principles, mechanisms, and advancements in swellable and floating Gastroretentive systems. The key strategies, such as the use of hydrophilic polymers, gas-generating agents, and superporous hydrogels, are discussed. These systems offer benefits in treating conditions like peptic ulcers, gastroesophageal reflux disease, and infections, where prolonged localized drug action is desirable. A critical assessment of recent preclinical and clinical studies highlights the therapeutic potential of GRDDs in optimizing drug delivery for poorly soluble drugs and drugs with short half-lives. Challenges such as variability in gastric retention, potential toxicity of excipients, and patient-specific factors are also examined. It includes the outlining future trends in GRDDs, focusing on the incorporation of nanotechnology, 3D printing, and biocompatible materials to overcome existing limitations and further enhance therapeutic outcomes. This highlight of review article is initially introduction of GRDDs and their significance, mechanism and their classification of GRDDs, intermediately describe brief on swelling and floating GRDDs system with their application, lastly it describes the recent advances in patent, clinical trials and marketed products for GRDDs swellable and floating system. Keywords: Drug delivery; GRDDs; floating; swellable; gastroretentive; system; advance approach

Anti-LAN Antibodies: Clinical Implications and Case Presentation

Abstract Introduction/Objective The LAN system, originating from the 901 Series of High Incidence antigens, transitioned to a recognized System in 2012. The LAN antigen, situated on ABCB6, a multipass membrane protein associated with porphyrin transport, plays a crucial role in heme synthesis. Functionally, LAN acts as an ATP-binding cassette transporter on the red blood cell membrane. Comprising a single antigen, LAN exhibits elevated expression in various tissues including the heart, skeletal muscles, fetal liver, mitochondrial membrane, eye, and Golgi apparatus. Notably, LAN shows no specific association with any particular geographic or ethnic group. Resistant to Ficin/Papain, Trypsin, α-Chymotrypsin, and 0.2M DTT, LAN antibodies primarily consist of IgG and necessitate IAT for detection. While Anti-LAN has been implicated in Hemolytic Transfusion Reactions (HTRs), its involvement in Hemolytic Disease of the Fetus and Newborn (HDFN) remains infrequent. LAN-negative blood is exceedingly rare, often requiring Monocyte Monolayer Assay Testing (MMA) for clinical assessment. Methods/Case Report Case Presentation: An 81-year-old female with a medical history including seizure disorder, hypertension (HTN), hyperlipidemia (HLD), gastroesophageal reflux disease (GERD), small bowel obstruction, and high-grade de-differentiated metastatic retroperitoneal liposarcoma presented for preoperative evaluation. A type and screen ordered as part of outpatient preoperative assessments revealed a positive antibody screen. Further investigation traced the origin of the anti-LAN antibody to an external facility since 2017. Antibody identification indicated the reactivity of the patient’s plasma with all cells (1+ AHG in PEG), excluding the auto control. Utilizing rare frozen antisera anti-LAN, the patient was phenotyped for LAN, yielding a LAN-negative status. Subsequent testing with three rare frozen LAN-negative group O cells aimed to exclude clinically significant antibodies. Differential adsorption, employing a comprehensive baseline RBC phenotype record obtained from the external facility, ruled out anti-E, anti-K, and anti-Fyb, thereby confirming Anti-LAN specificity. Results (if a Case Study enter NA) NA Conclusion The exceptional rarity of LAN-negative blood underscores the high prevalence of reactivity to Anti-LAN antibodies, exceeding 99% in most populations. In select cases, autologous transfusion may emerge as a viable management strategy. Consequently, the patient’s surgical procedure has been deferred, with no immediate requirement for blood products.

Pain in the epigastral area: current aspects of differential diagnosis

Epigastric pain can have a variety of etiologies, including not only diseases of the upper gastrointestinal tract (GIT): gastroesophageal reflux disease, hiatal hernia, gastritis and duodenitis, gastric and/or duodenal ulcers, polyps and stomach cancer, functional dyspepsia, but also other gastrointestinal diseases, somatic diseases of other organs and systems, vascular pathology, infections and invasions, medications and a number of other reasons. More than 10 years have passed since the publication of our previous article on the issues of differential diagnosis of pain in the stomach. In the Elibrary.ru information base, both in the period of time preceding the publication and to this day, we have not found similar publications. This explains its placement in full or in fragments on specialized gastroenterological sites and guidelines for differential diagnosis in gastroenterology. Over the past 10 years, new consensuses and clinical recommendations have been published on diseases and conditions associated with epigastric pain, and the number of publications on other diseases and conditions that were previously considered very rare, but which today must be taken into account when carrying out differential diagnosis, has increased. Several foreign publications on the problem in recent years were found in the PubMed electronic database. In this regard, we consider it appropriate to consider the current aspects of the differential diagnosis of epigastric pain from the perspective of today. The list of diseases and conditions presented in the review, in which epigastric pain occurs in the clinical picture, indicates that the differential diagnosis of this syndrome is an interdisciplinary problem and is of interest not only to the gastroenterologist and therapist, but also to doctors of other specialties.

Concomitant Infection of Helicobacter pylori and Intestinal Parasites: Burden, Sociodemographic and Clinical Characteristics in Hospitalized Children and Adolescents in Northern Lebanon

Background Helicobacter pylori and intestinal parasites are well-known for their high prevalence in children, especially in developing countries. However, their concomitant infections are poorly documented. In this study, we aimed to evaluate the association between intestinal parasites and H. pylori among hospitalized children and adolescents with upper gastrointestinal complaints in Northern Lebanon. Methods A cross-sectional study was conducted involving 297 hospitalized pediatric patients, aged between 1 and 15 years, who presented with gastrointestinal symptoms. The socio-demographic, lifestyle, and gastrointestinal characteristics of all participants were analyzed. Fresh stool samples were collected and screened for the presence of intestinal parasites and H. pylori infections. Results 6.4% of the patients were positive for intestinal parasitic infections, 5.4% were positive for H. pylori infection, and 11.8% were co-infected. The results of the Chi-square test showed that H. pylori infection is significantly associated with parasitic infection but not with a particular species. The most frequent coinfection was H. pylori-Entamoeba histolytica (77.1%). Moreover, H. pylori infection was associated with overcrowding and infrequent washing of vegetables before eating. The prevalence of co-infections increased in patients of mothers with a primary educational level or less. In regards to clinical characteristics, our findings showed a statistically significant relationship between i) gastric reflux and H. pylori, and ii) severe diarrhea and parasitic infection. Conclusion Our data highlighted the association between H. pylori and intestinal parasitic infections. Thus, H. pylori detection could be taken into consideration while screening for parasitic infections in children and adolescents.

Causal association between gastrointestinal diseases and coronary artery disease: a bidirectional Mendelian randomization study.

Coronary artery disease (CAD) has been a dominating reason of mortality globally due to its complexity of etiology. A variety of gastrointestinal disorders (GDs) have been accounted to be related to CAD. Thus, this study aims to determine their causal relationship by two-sample Mendelian randomization (MR) analysis. Single-nucleotide polymorphisms (SNPs) relevant to 22 GDs were employed as instrumental variables from the genome-wide association summary (GWAS) datasets. Genetic associations with CAD and HF were acquired from UK Biobank, FinnGen, and other GWAS studies. We conducted a univariable MR (UVMR) analysis followed by a meta-analysis. A multivariable MR (MVMR) analysis was then performed with smoking and body mass index (BMI) as justifications. Also, a bi-directional MR analysis was leveraged to verify the reverse causal correlations. Generally, UVMR analyses separately observed the causal effects of GDs on CAD and HF. Genetic liability to gastroesophageal reflux disease displayed a positive association with both CAD (OR=1.19; 95%CI: 1.01-1.41) and HF (OR=1.22; 95%CI: 1.00-1.49) risk; genetic liability to celiac disease separately attributed to CAD (OR=1.02; 95%CI: 1.01-1.03) and HF (OR=1.01; 95%CI: 1.00-1.02), which also maintained after MVMR analysis. Besides, we observed mutually causal associations between CAD and celiac disease. Our work suggested that genetic susceptibility to some GDs might causally increase the risk of CAD and HF, emphasizing the importance of preventing CAD in patients with GDs.

Gastrointestinal adverse events associated with immune checkpoint inhibitors: a pharmacovigilance analysis of the EudraVigilance and VigiAccess databases

ABSTRACT Background This study aimed to provide an overview of gastrointestinal (GI) adverse events associated with immune checkpoint inhibitors (ICIs) using two pharmacovigilance databases, EudraVigilance and VigiAccess. Research design and methods Data was collected from the date of ICI’s marketing authorization until 30 November 2023. Reporting odds ratio (ROR) was used as a measure of ADR reporting disproportionality for signal detection. Results Overall, across both databases, EudraVigilance and VigiAccess, a total of 76,606 ADR reports were analyzed. In EudraVigilance, colitis (12,581) and diarrhea (12,108) were the most reported GI adverse events, with similar findings in VigiAccess. Furthermore, in both databases, the most ADR reports were associated with nivolumab and pembrolizumab. Durvalumab (ROR: 3.96, 95%CI :3.65–4.28), ipilimumab (ROR: 1.95, 95%CI: 1.89–2.01), nivolumab (ROR: 1.05, 95%CI: 1.02–1.07), and atezolizumab (ROR: 1.04, 95%CI: 1.01–1.07) demonstrated higher risks of GI events compared to other ICIs. EudraVigilance analysis identified dysphagia, ascites, hematochezia, and gastroesophageal reflux disease as potential signals associated with ICI therapy. Majority of ADR reports (87.2%) comprised serious GI adverse events, a portion of which was associated with fatal outcomes (14.5%). Atezolizumab (14.9%) and pembrolizumab (11.9%) were linked to a higher incidence of fatal outcomes compared to other ICIs. Conclusion The differential risk profiles of ICIs-associated-GI adverse events underscore the importance of personalized therapy in oncology.

Vonoprazan (Voquezna) for nonerosive GERD.

The potassium-competitive acid blocker vonoprazan (Voquezna – Phathom), which was approved earlier for treatment of erosive esophagitis, has now been approved by the FDA for relief of heartburn associated with nonerosive gastroesophageal reflux disease (GERD) in adults.1 Vonoprazan is also available copackaged with amoxicillin (Voquezna Dual Pak) and with amoxicillin and clarithromycin (Voquezna Triple Pak) for treatment of Helicobacter pylori infection.

Chinese expert consensus on the etiological diagnosis of adult bronchiectasis

Bronchiectasis is a highly heterogeneous chronic airway disease for which accurate etiological diagnosis is crucial for effective management. A group of experts from the China Bronchiectasis Alliance and the Infection Assembly of the Chinese Thoracic Society conducted a comprehensive review of recent research into the etiology of bronchiectasis. Using the widely accepted Delphi methodology, the experts reached a consensus on the etiological diagnosis of bronchiectasis through multiple rounds of discussion and revision. The consensus is divided into four sections: the definition and classification of the etiology of bronchiectasis, the etiological diagnostic procedures for bronchiectasis, the treatable causes of bronchiectasis, and other causes of bronchiectasis. The ultimate goal of this consensus is to improve the diagnostic accuracy and optimize the management of bronchiectasis in China. The main recommendations of Section 1 focused on chest thin-section computed tomography (CT) for the diagnosis of bronchiectasis and the etiological classification. The main recommendations of Section 2 focused on the medical history collection for bronchiectasis and the etiological diagnostic protocol for bronchiectasis. The main recommendations of Section 3 focused on the recommendations of the diagnosis of bronchiectasis secondary to COPD, the diagnosis of bronchiectasis due to asthma, diffuse pan-bronchiolitis, allergic bronchopulmonary aspergillosis, connective tissue disease (CTD)-related bronchiectasis or gastroesophageal reflux disease (GERD)-related bronchiectasis. The main recommendations of Section 4 focused on suspected primary ciliary dyskinesia (PCD)-associated bronchiectasis, cystic fibrosis and the diagnosis of congenital airway malformations.

Sliding hiatus hernia (intrathoracic sleeve migration) post-laparoscopic sleeve gastrectomy: A case series and review of literature.

Intrathoracic sleeve migration (ITSM) is a complication that uncommonly occurs post-sleeve gastrectomy, with an incidence rate anecdotally ranging from 5% to 45%. Its treatment has established difficulties by bariatric surgeons worldwide. Sixteen cases were shown in this case series that commonly encountered the symptoms of weight gain, gastro-oesophageal reflux disease (GERD), epigastric pain, globus sensation, nausea and vomiting as their initial complaints before their diagnosis. Moreover, these symptoms began a few years after the gastric sleeve. The confirmatory results through gastrografin and computed tomography abdomen were performed where relevant findings of Grade I or II GERD, sliding hiatal hernia and post-sleeve anatomy were appreciated. In literature, the most common modality used to treat ITSM was the conversion to Roux-en-Y bypass. However, other treatment modalities were also utilised for the cases presented due to the different patients' preferences, including mini-gastric bypass and laparoscopic hiatal hernia repair with/without posterior cruroplasty and buttress plication with the falciform ligament. In addition, anchoring to pre-pancreatic fascia post-gastric sleeve has been shown to prevent such presentations further in the future. Postoperatively, all patients were stable with no complications acutely or after 3 months follow-up. Hence, this concludes that despite Roux-en-Y being considered the golden standard treatment of ITSM, laparoscopic hiatal hernia repair with cruroplasty and plication reflects an equivalent, cost-effective and valuable alternative to treating relevant patients.

The Link Between Metabolic Dysfunction-Associated Steatotic Liver Disease and Gastroesophageal Reflux Disease.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly nonalcoholic fatty liver disease (NAFLD), and gastroesophageal reflux disease (GERD) are prevalent chronic conditions with escalating global incidence. This study delves into the intricate interplay between MASLD and GERD. The primary objective is to comprehensively explore the association between MASLD and GERD, investigating how various factors contribute to the coexistence and potential exacerbation of these conditions. We conducted a literature search in PubMed and Google Scholar of only human studies over the past 10 years. The search included systematic review, meta-analysis, editorial, and cross-sectional studies of patients with MASLD and GERD. The prevalence of GERD in patients with MASLD was higher, with various risk factors coming into play. Obesity was identified as an independent risk factor for both GERD and MASLD. However, obese patients predominantly had higher disease progression. Lifestyle factors like physical activity and dietary modifications emerge as promising strategies to mitigate risk.

Endoscopic Sleeve Gastroplasty for the Treatment of Obesity: A Single-Centre Experience and Literature Review.

In the world, obesity is constantly increasing, and so are the types of medical and surgical therapies. However, to cope with the increase in costs associated with surgical procedures and certain complications, such as gastroesophageal reflux disease, the number of bariatric endoscopic (BE) procedures has been increasing in recent years. Endoscopic sleeve gastroplasty (ESG) is one of the most rapidly increasing BEprocedures, given its benefits in terms of patient quality of life and reduced costs. In fact, it is a procedure characterised by minimal postoperative complications and is applicable to different types of bariatric patients. However, the number of studies on BE is not comparable to that on bariatric surgery. We analyzed the results of 84 ESG performed in our centre and compared them with those presented in the literature. We evaluated 36-Item Short Form Health Survey (SF-36)to 0, six and 13 months, signs and symptoms of patients undergoing ESG on the first and second postoperative day (POD), in terms of abdominal pain, nausea and vomiting. We found a reduction of these outcomes from POD 1 to POD 2. Finally, we measured total body weight loss percentage (TBWL%) and excess weight loss percentage (EWL%) at three, six and 12 months both in patients undergoing bariatric surgery for the first time (specifically, ESG) and in patients previously undergoing bariatric surgery and then undergoing ESG. Using the SF-36 score, we observedan improvement in the physical (mean score from 46.4 at time 0 to 53.6 at 12 months from the ESG) and mental (mean score from 37 at time 0 to 39.9 at 12 months from the ESG) status of the patients.Furthermore, we observed a 0 to 12-month increase in TBWL% and EWL% from the ESG procedure. Furthermore, we observed an increase in TBWL% and EWL% at three, six and 12 months both in patients undergoing bariatric surgery for the first time (specifically ESG) and in patients previously undergoing bariatric surgery and then undergoing ESG. ESG was an effective, reversible, and repeatable surgical procedure for bariatric patients.

Secondhand smoke is associated with peptic ulcer disease and gastroesophageal reflux disease in non-smokers in a large Taiwanese population study.

Active smokers are known to be at an increased risk of both gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD), however the role of passive smoking remains unclear. In this study, we aimed to examine whether secondhand smoke (SHS) is associated with PUD and GERD. In this population-based study, we conducted a large-scale analysis with 88,297 never-smokers (male: 18,595; female: 69,702; mean age 50.1 ± 11.0 years) from the Taiwan Biobank. The exposure group was comprised of those who had been exposed to SHS, and the no exposure group as those without SHS exposure. According to the frequency of exposure, we further divided the participants into "no exposure," "<1 h per week," and "≥1 h per week" groups. A cutoff point of 1 h per week was chosen according to the median exposure time in our participants. Associations between SHS and SHS frequency with PUD and GERD were assessed. Of the 88,297 enrolled participants, 11,909 (13.5%) had PUD and 76,388 (86.5%) did not. In addition, 11,758 (13.3%) had GERD and 76,539 (86.7%) did not. Multivariable analysis showed a significant association between SHS with PUD (odds ratio [OR] = 1.166; 95% confidence interval [CI] = 1.084-1.254; p < 0.001), and GERD (OR = 1.131; 95% CI = 1.053-1.216; p = 0.001). Furthermore, those exposed to SHS ≥ 1 h per week (vs. no exposure) were associated with higher risks of PUD (OR = 1.232; 95% CI = 1.121-1.355; p < 0.001) and GERD (OR = 1.200; 95% CI = 1.093-1.319; p < 0.001). SHS was significantly associated with PUD and GERD. Furthermore, exposure to SHS ≥ 1 h per week (vs. no exposure) was associated with a 1.23-fold higher risk of PUD and 1.20-fold higher risk of GERD. This study represents the largest population-based investigation to explore the association between SHS with PUD and GERD in Taiwanese never-smokers.

TikTok and Bilibili as health information sources on gastroesophageal reflux disease: an assessment of content and its quality.

Gastroesophageal reflux disease (GERD) is a global chronic disease. Short video platforms make it easy for patients with GERD to obtain medical information. However, the quality of information from these videos remains uncertain. This study aimed to systematically assess videos related to GERD on TikTok and Bilibili. We conducted a search and gathered 241 Chinese videos related to GERD and recorded the essential information. Two independent evaluators assessed each video based on the completeness of six components of the GERD guidelines, and assessed the quality and reliability of the information in the videos using recognition tools. Finally, videos from different sources were compared. The uploaders of most videos were medical professionals (86.7%, n = 209). The content was mainly about symptoms and treatment. The quality of the videos information varied depending on the sources. Among videos posted on Bilibili, those posted by medical professionals had a lower content score for definition (P < 0.001). Videos produced by non-gastroenterologists had the highest mean modified DISCERN. (The DISCERN scoring tool was initially created for assessing written publications, but nowadays, it is frequently leveraged for appraising various health-related videos. Details can be found in the text) quality of the videos information was acceptable; however, the content varied significantly depending on the type of source used. Videos with broad content should be carefully screened to meet more needs.

BariClip: Outcomes and Complications from a Single-Center Experience.

Laparoscopic BariClip gastroplasty (LBCG) is a new reversible bariatric procedure designed to replicate the restrictive effects of laparoscopic sleeve gastrectomy (LSG) by placing a clip vertically on the stomach. This technique achieves gastric lumen restriction without the need for resection, ensuring organ preservation and reversibility. However, concerns have arisen regarding potential complications such as gastroesophageal reflux disease (GERD), slippage, or erosion of the stomach. The aim of the study is to evaluate the outcomes and complications of LBCG. This is a monocentric retrospective study. We analyzed 149 patients who underwent LBCG procedure between July 2021 and November 2023. A minimum follow-up period of 6months was observed for all patients, recording clinically relevant GERD through GERD-Q score questionnaires. Weight loss was monitored through body mass index (BMI) and % total weight loss (%TWL), registered during follow-up visits. Overall, 149 patients were eligible for this study. Overall complication rate was 8% (12/149). The average BMI went from 40 ± 4.37kg/m2 to 28 ± 4.29kg/m2 (p < 0.05) in 6months, while the mean %TWL was 22.6% after at least 6months of follow-up. Clinically relevant GERD went from 18.1% (27/149) to 10.7% (16/149), p = 0.1262. As expected, also the PPI usage was not altered significantly (17.8% vs 16.4%), p = 0.8714. LBCG remains an experimental procedure that must be approached with caution. Nonetheless, the potential of LBCG to reproduce the effects of LSG while reducing GERD makes it a promising new reversible option for the treatment of morbid obesity.

Global Transcriptomic Analysis of Topical Sodium Alginate Protection against Peptic Damage in an In Vitro Model of Treatment-Resistant Gastroesophageal Reflux Disease.

Breakthrough symptoms are thought to occur in roughly half of all gastroesophageal reflux disease (GERD) patients despite maximal acid suppression (proton pump inhibitor, PPI) therapy. Topical alginates have recently been shown to enhance mucosal defense against acid-pepsin insult during GERD. We aimed to examine potential alginate protection of transcriptomic changes in a cell culture model of PPI-recalcitrant GERD. Immortalized normal-derived human esophageal epithelial cells underwent pretreatment with commercial alginate-based anti-reflux medications (Gaviscon Advance or Gaviscon Double Action), a matched-viscosity placebo control, or pH 7.4 buffer (sham) alone for 1 min, followed by exposure to pH 6.0 + pepsin or buffer alone for 3 min. RNA sequencing was conducted, and Ingenuity Pathway Analysis was performed with a false discovery rate of ≤0.01 and absolute fold-change of ≥1.3. Pepsin-acid exposure disrupted gene expressions associated with epithelial barrier function, chromatin structure, carcinogenesis, and inflammation. Alginate formulations demonstrated protection by mitigating these changes and promoting extracellular matrix repair, downregulating proto-oncogenes, and enhancing tumor suppressor expression. These data suggest molecular mechanisms by which alginates provide topical protection against injury during weakly acidic reflux and support a potential role for alginates in the prevention of GERD-related carcinogenesis.

8355 Pheochromocytoma In The Elderly: A Mini Case Series

Abstract Disclosure: S. Nabi: None. A. Golash: None. P. Panwar: None. G. Powner: None. C. Schiteanu: None. C. George: None. M. Vallabhaneni: None. B.G. Issa: None. A. Clark: None. D. Bailey: None. J. Waldron: None. F.W. Hanna: None. Diagnosis and management of pheochromocytoma in the older population is challenging due to the co-morbidities and general age-related frailty. We present a mini case series of four patients aged 72 to 86 years who presented to our tertiary referral center at the University Hospitals of North Midlands UK, between 2019 and 2022.The case series documents the challenges of managing pheochromocytoma in this population, emphasizing how close monitoring, regular follow ups and collaboration between different members of the multidisciplinary team helped to achieve the desirable outcomes in these cases. Case 1: Adrenal incidentaloma in 84-year-old female. Background of hypertension and diabetes mellitus. History of occasional palpitations. Investigations showed raised plasma and urinary metanephrines. MIBG scan confirmed pheochromocytoma and after adequate alpha and beta blockade underwent successful laparoscopic surgery. No intra or post operative complications and showed good recovery. Discharged on the 5th day post operative. Case 2: 82-year female under cardiology with non-ST elevation myocardial infarction. Background of hypertension, chronic kidney disease and gastroesophageal reflux disease. Initial presentation with shortness of breath, sweating and swelling lower limbs. Normal coronary arteries on angiography, so investigated for possible excess catecholamine production. Had significantly raised 24-hour urinary normetadrenaline. Paraaortic paraganglioma confirmed on MIBG SPECT scan. Initially opted for medical treatment however quality of life worsened over the next year and eventually underwent robot assisted excision. Procedure was uneventful with good post-operative recovery. Was able to go home 2 days after the procedure. Case 3: 72-year-old female referred with right adrenal incidentaloma. Background of hypertension, diabetes mellitus, hypothyroidism, asthma, arthritis and Ca breast treated 10 years ago. Results showed raised plasma metanephrines, subsequently, MIBG scan revealed a 3 cm right adrenal nodule with increased uptake. Full alpha and beta blockade achieved before she underwent surgical treatment with no complications. Discharged on the 3rd day post op. Case 4: An 80-year-old male was referred with left adrenal incidentaloma. History of diabetes, chronic kidney disease, ischemic heart disease and heart failure, recent myocardial infarction and atrial fibrillation. Biochemical and radiological investigations confirmed pheochromocytoma. He was started on alpha blockade that proved difficult to achieve due to underlying co-morbidities. The patient needed close monitoring by the endocrine team and was finally established on adequate alpha and beta blockade. Due to significant risks associated with the procedure, the patient decided not to proceed with the surgery and opted for medical management. Remains under active follow up. Presentation: 6/2/2024