Gastroesophageal Reflux Research Articles

Evaluating the reflux suppression properties of Gaviscon Infant powder with different milk formulations using an in vitro model of the infant stomach

Gastroesophageal reflux (GER) is common in babies and infants and is characterized by effortless regurgitation (with or without vomiting), which is a common symptom of other infant conditions, including cow’s milk protein allergy (CMPA). Various milk formulations are commercially available to help manage GER and CMPA symptoms (extensively hydrolyzed [eHF], partially hydrolyzed [pHF], and amino-acid formulas [AAF]). We aimed to understand if an alginate product (Gaviscon Infant powder) worked as intended in the presence of different milk formulations. A previously evaluated artificial infant stomach model simulated an internal pressure-inducing reflux event (five reflux events performed at 5 min intervals). Suppression activity of Gaviscon Infant combined with eHF, pHF, and AAF was assessed by measuring the height that the refluxate event traveled up a tube mimicking the infant esophagus, alongside a benchmark unhydrolyzed formulation (uHF) with Gaviscon Infant and a negative control without Gaviscon Infant. Each experiment was repeated six times per formulation in a random order. Gaviscon Infant combined with each milk formulation produced a lower height of refluxate versus the negative control. When formulations combined with Gaviscon Infant were grouped by category (eHF, pHF, AAF), two or more products from each category showed a lower refluxate height than the benchmark (uHF). There was a significant difference in median refluxate height (p = 0.0011 in Wilcoxon rank sum test) when comparing Gaviscon Infant combined with eHF against Gaviscon Infant combined with pHF, AAF, or uHF (benchmark). Refluxate height did not change significantly between events one and five for each milk formulation combined with Gaviscon Infant. In an artificial infant stomach model, Gaviscon Infant combined with different milk formulations (uHF, eHF, pHF, AAF) produced a lower refluxate height compared with a negative control (uHF without Gaviscon Infant), suggesting that Gaviscon Infant suppresses reflux as intended when used with different milk formulations.

Gastroesophageal reflux disease following sleeve gastrectomy: an overview and practical guide

Gastroesophageal reflux disease following sleeve gastrectomy: an overview and practical guide

Bariatric surgery and relevant comorbidities: a systematic review and meta-analysis.

Obesity is a growing epidemic in the United States, and with this, has come an increasing volume of metabolic surgery operations. The ideal management of obesity-associated medical conditions surrounding these operations is yet to be determined. This review sought to investigate the routine use of intraoperative cholangiogram (IOC) with cholecystectomy during or after a bypass-type operation, the ideal management of post-sleeve gastrectomy gastroesophageal reflux disease (GERD), and the optimal bariatric operation in patients with known inflammatory bowel disease (IBD). Using medical literature databases, searches were performed for randomized controlled trials (RCTs) and non-randomized comparative studies from 1990 to 2022. Each study was screened by two independent reviewers from the SAGES Guidelines Committee for eligibility. Data were extracted while assessing the risk of bias using the Cochrane Risk of Bias 2.0 Tool and the Newcastle-Ottawa Scale for RCTs and cohort studies, respectively. A meta-analysis was performed using random effects. Routine use of IOC was associated with a significantly decreased rate of common bile duct injury and a trend towards decreased intraoperative complications, perioperative complications, and mortality. The rates of reoperation, postoperative pancreatitis, cholangitis, and choledocholithiasis were low in the routine use of the IOC group, but no non-routine use studies evaluated these outcomes. After sleeve gastrectomy, GERD-specific quality of life was significantly higher in the surgically treated group compared to the medically treated group. Bypass-type operations had worse outcomes of IBD sequelae than sleeve gastrectomy, including pain, patient perception, and fistula formation. Sleeve patients had lower mortality and fewer short- and long-term complications. Low-quality data limited the conclusions that were drawn; however, trends were observed favoring the routine use of IOC during cholecystectomy for patients with bypass-type anatomy, surgical treatment of GERD post-sleeve gastrectomy, and sleeve gastrectomy in IBD patients. Future research proposals are suggested to further answer the questions posed.

Is as-needed treatment with a proton pump inhibitor (PPI) as effective as daily treatment for symptom control in gastroesophageal reflux disease (GERD), nonerosive reflux disease (NERD), or mild erosive reflux disease (ERD)?

Is as-needed treatment with a proton pump inhibitor (PPI) as effective as daily treatment for symptom control in gastroesophageal reflux disease (GERD), nonerosive reflux disease (NERD), or mild erosive reflux disease (ERD)?

Robotic-assisted reoperative benign foregut surgery

Foregut disorders including gastroesophageal reflux disease (GERD), hiatal hernia (HH), and achalasia are often treated operatively including anti-reflux surgery (ARS), fundoplication, and Heller myotomy (HM). Minimally invasive surgery has become the preferred technique to treat these disorders. These operations have an inherent risk of failure requiring reoperation. These redo operations are more difficult because adhesions and destruction of tissue planes impair visualization during dissection of the hiatus and the gastroesophageal junction (GEJ). Conventional laparoscopic techniques have been described for redo foregut surgery with good results. Surgical robotic systems provide an alternative minimally invasive approach that improves visualization, dexterity, and surgeon ergonomics in many operations. The robot can be used safely and effectively for redo foregut surgery. In this review, we discuss the robotic surgical technique for reoperative foregut surgery and discuss the approach to individual foregut diseases.

Retrospective Cohort Study of Gastric Bypass Versus Sleeve Gastrectomy in Gastroesophageal Reflux Disease Patients: Procedure Use and Racial Disparity.

Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are common bariatric procedures, with GERD being a frequent obesity-associated disease among individuals undergoing these surgeries. RYGB is recommended for patients with GERD due to the increased control of GERD symptoms. This study examines RYGB and SG use in this population and factors influencing procedure choice. This study analyzed 2016-2022 data from the MBSAQIP database comprising patients with GERD who underwent SG or RYGB. Statistical analysis included univariate and multivariable logistic regression to identify factors associated with procedure receipt. RYGB rates are rising annually but remain lower than SG for GERD. Compared to White individuals, Hispanics are 14% less likely, and African Americans are 19% less likely, to receive RYGB. The study notes a research gap in choosing RYGB or SG for patients with GERD, despite consensus favoring RYGB. It highlights a disparity between recommendations and practice, with GERD predicting the use of RYGB but SG being more prevalent in this population overall. The analysis links race to procedure choice, showing African American and Hispanic patients are less likely to undergo RYGB, indicating potential disparities in access and decision-making.

Histology of the Upper Gastrointestinal Tract, Morphometry and Lymphocyte Subpopulations of the Duodenal Mucosa: Insights from Healthy Individuals

The upper oesophagogastrointestinal (UEGI) tract histology, intestinal morphometry and lymphocyte subpopulations of healthy people is scarcely known. In research studies of inflammation involving the UEGI tract, there is a lack of adequate healthy controls. Aims: To evaluate the histology of the UEGI tract and the duodenal lymphocyte subpopulations of healthy volunteers and patients with gastroesophageal reflux disease (GERD), the latter to assess if it could replace healthy subjects. Healthy individuals were excluded if they had symptoms, comorbidities, pregnancy, toxics, medications or abnormal blood analysis. Subjects in both groups with abnormal duodenal intraepithelial lymphocyte (IEL) counts were also excluded. A total of 280 subjects were assessed, and 37 were included (23 healthy and 14 with GERD). The GERD group showed a higher IEL count (median [IQR]: 19.5 [17–22]) than healthy group: (15 [12–18]), p = 0.004. Eosinophils, mast cells and intestinal morphometry were similar in both groups. In the lamina propria, CD4+ T cells decreased (p = 0.008), and CD8+ T cells increased (p = 0.014). The total innate lymphoid cells (ILC) and CD3− cells decreased (p = 0.007) in GERD group compared to healthy controls. At the intraepithelial level, NKT cells increased (p = 0.036) and ILC3 decreased (p = 0.049) in the GERD group. This is the first study to comprehensively map the histology, morphometry and duodenal subpopulations of healthy volunteers to help define a “gold standard” of normality. The differences found between both groups suggest that, whenever possible, healthy subjects should be included in research studies. Alternatively, we can consider a well-defined homogenous group with GERD to serve as the control group.

Validation of the Polish version of the Functional Oral Intake Scale against flexible endoscopic evaluation of swallowing and the International Dysphagia Diet Standardization Initiative Functional Diet Scale

IntroductionThe Functional Oral Intake Scale (FOIS) is a widely used instrument for assessing oral intake in dysphagic patients. Despite its frequent use, a validated version for the Polish population has been lacking.MethodsThis study aimed to validate the Polish adaptation of FOIS (FOIS-PL) by examining its concordance with Fiberoptic Endoscopic Evaluation of Swallowing (FEES) outcomes and the International Dysphagia Diet Standardization Initiative Functional Diet Scale (IDDSI-FDS) scores across patients with diverse clinical profiles. The primary outcome measures included the Penetration-Aspiration Scale (PAS) score from FEES, pharyngeal residue quantification, and IDDSI-FDS scores. A total of 302 participants with varying clinical conditions were recruited. The cohort included individuals with head and neck malignancies, cerebrovascular incidents, neuromuscular disorders, and other dysphagia aetiologies.ResultsPatients with gastroesophageal reflux disease and those post-thyroidectomy consistently exhibited oral food intake with a FOIS-PL score of ≥5. A strong inverse correlation was found between FOIS-PL scores and PAS scores (rho = −0.739; p < 0.001), indicating that reduced oral intake was associated with increased penetration or aspiration risk. Significant differences in FOIS-PL scores were evident across patient subgroups stratified by PAS severity (PAS ≤ 2, PAS 3–5, PAS > 5) and IDDSI levels. Lower FOIS-PL scores corresponded with more impaired swallowing safety (PAS > 5). The median FOISPL score was 5 for individuals with pharyngeal residue and 6 for those without (p < 0.001). Inter-rater reliability between evaluations conducted by a dietitian (FOIS I) and a speech-language pathologist (FOIS II) demonstrated high consistency (tau = 0.995; p < 0.001). Convergent validity was supported by strong correlations between FOIS-PL and IDDSI-FDS scores (FOIS I vs. IDDSI-FDS I: tau = 0.819; p < 0.001; FOIS II vs. IDDSI-FDS II: tau = 0.815; p < 0.001).ConclusionThe Polish version of the Functional Oral Intake Scale (FOIS-PL) is a valid and reliable tool for assessing oral intake in dysphagia. The findings demonstrate high accuracy, reliability, and validity, supporting its use across diverse clinical conditions.

Research on Neuroimmune Gastrointestinal Diseases Based on Artificial Intelligence: Molecular Dynamics Analysis of Caffeine and DRD3 Protein.

The aim of this study was to develop a clinical application model for the rational use of caffeine. Caffeine is related to the incidence of neuro immune gastrointestinal diseases. Coffee consumption needs to be optimized in order to reduce the incidence rate. By using KEEG analysis to explore potential molecular signaling pathways involved in the progression of neurological immune gastrointestinal diseases, and analyzing the details of this signaling Pathway using molecular simulation results, which can support AI system for doctor. The research team designed a controlled experiment to analyze the differences in reward and reinforcement of Brain pleasure/addiction and dopamine related signaling pathways function between multiple groups of people with different coffee drinking habits and a blank control group. The study team used molecular dynamics methods to investigate the signaling route that links coffee with the binding of dopamine receptor D3.AI is used to predict the prevalence of gastric reflux disease. Human experiments have shown a correlation between caffeine intake and gastroesophageal reflux disease. AI algorithm results can provide clinical support, and molecular simulation results are consistent with human experimental results. Caffeine and DRD3 protein have a stable interaction system. The research team elucidated the intermolecular interaction between caffeine and DRD3, and AI algorithms can predict the likelihood of disease occurrence, providing a new strategy for clinical practice. This study has passed ethical approval at Chifeng Cancer Hospital, and the ethical documents for this study have been submitted to the World Health Organization for filing.

Evaluation of comorbidity burden on disease progression and mortality in patients with interstitial pneumonia with autoimmune features: A retrospective cohort study.

Interstitial pneumonia with autoimmune features (IPAF) is a subset of interstitial lung disease that manifests with features of autoimmunity while not meeting classification criteria for a defined rheumatic disease. Comorbidity burden is an important prognostic indicator in various rheumatic and interstitial lung diseases, but few studies have commented on comorbidities in this population. This study was conducted to evaluate the association of individual comorbidities, the Charlson Comorbidity Index (CCI), and the Rheumatic Disease Comorbidity Index (RDCI) with lung disease progression and transplant/mortality outcomes in patients with IPAF. In a retrospective study, we evaluated the prevalence and severity of comorbidities in an institutional cohort of patients with IPAF. Using Cox regression, we correlated the association of individual comorbidities and comorbidity indices with time to lung disease progression (relative forced vital capacity decline of 10% or more) and with time to lung transplant/death. We compared the performance of CCI and RDCI in predicting outcomes. History of cerebrovascular accident (CVA) or cardiovascular disease (CVD), moderate-severe chronic kidney disease, and fracture was associated with a faster onset of lung disease progression, while a history of gastroesophageal reflux was protective. History of CVA/CVD, diabetes mellitus, and lymphoma were associated with a faster onset of lung transplant/death. Both CCI and RDCI were associated with shorter time to lung disease progression and lung transplant/death in unadjusted analyses. However, only CCI was associated with shorter time to lung transplant/death in analyses adjusted for age, sex, pulmonary function, and radiographic pattern of lung lesion. CCI and RDCI may be useful tools in assessing prognosis in patients with IPAF in terms of both lung disease progression and mortality. Prospective studies are needed to further evaluate the performance of CCI and RDCI and the impact of optimizing comorbid conditions that may mitigate poor outcomes among patients with IPAF.

Assessing Safety Concerns in Omeprazole Use: An Observational Study of Potentially Inappropriate Prescriptions and Patient Adherence in a Spanish Community Pharmacy

Introduction: Omeprazole is commonly prescribed for conditions associated with excess gastric acid, including gastroesophageal reflux and Helicobacter pylori infection. Spain ranks highest among Organization for Economic Co-operation and Development (OECD) countries in omeprazole consumption (measured in doses per 1000 inhabitants per day, DHD), indicating potential overuse and misuse. Community pharmacists are pivotal in collaborating with healthcare professionals to address safety risks and improve patient outcomes. Objective: This study aims to profile omeprazole users to inform pharmaceutical care (PC) strategies that address patient-specific needs and improve treatment safety. Methods: We conducted an observational, cross-sectional study (CEIm Code FCF-OME-2023-01) involving 100 omeprazole users at a community pharmacy in Barcelona from November 2023 to May 2024. Data were collected via clinical interviews using a Data Collection Questionnaire. Results: Among the omeprazole users, 49% were male, 51% female, and 56% were over the age of 65. A significant proportion (71%) exhibited long-term omeprazole use, and 30% were polymedicated (taking five or more medications). Notably, 52% of patients reported no history of gastric symptoms. Additionally, 22% reported using omeprazole occasionally, following short-term, on-demand treatment regimens, while 78% adhered to a chronic daily dosing schedule. Among these patients, 29.5% demonstrated poor treatment adherence. The analysis of medication-related problems (MRPs) among the 78 patients using omeprazole daily and chronically revealed that the most prevalent MRPs were “unnecessary medication”, “lack of adherence”, “wrong administration”, “drug interactions”, and “lack of knowledge regarding medication use”. Based on STOPP criteria, 45% of users were candidates for deprescribing or dose adjustment. Conclusions: The high incidence of MRPs among omeprazole users highlights the need for enhanced pharmaceutical care (PC). Proactive pharmacist interventions, including deprescribing, dose adjustments, and prescriber collaboration, can reduce adverse medication outcomes and promote safer omeprazole use.

Sleep and respiratory infections.

Sleep disorders that involve circadian rhythm disruption and sleep-disordered breathing (SDB) such as obstructive sleep apnea (OSA) are closely linked to respiratory infections. SDB leads to a proinflammatory state due to intermittent hypoxia, sleep fragmentation, increased oxidative stress, and elevation of inflammatory mediators such as tumor necrosis factor (TNF), interleukin-6 (IL-6), and C-reactive protein (CRP). Furthermore, inflammatory mediator levels correlate with SDB severity, especially in people with OSA. Nocturnal microaspiration, gastroesophageal reflux, and associated comorbidities (e.g. obesity) increase the risk of community-acquired pneumonia, viral infections such as SARS-CoV-2, respiratory complications, and death. OSA has been associated with post-COVID syndrome. It also increases the risk of postoperative complications in both adults and children. Circadian rhythm disorders such as insomnia predispose to immune disorders and increase the risk of infection. Chronic conditions such as bronchiectasis, with or without concomitant cystic fibrosis, can lead to structural sleep changes and increase the risk of OSA due to chronic cough, arousals, aspirations, hypoxia, upper airway edema, and overexpression of proinflammatory cytokines. The protective effect of treatment for sleep disorders against respiratory infection is currently unknown. However, in people presenting with respiratory infection, it is important to test for SDB to prevent complications.

Combination therapy of gastroesophageal reflux disease in comorbidity with functional dyspepsia

It has been shown that in patients with GERD and functional dyspepsia, the use of proton pump inhibitors leads to a decrease in heartburn and pain behind the sternum. However, symptoms such as regurgitation, belching, feeling of early satiety and heaviness after eating were stopped ineffectively. The inclusion in the treatment complex of the prokinetic domperidone at a dose of 10 mg 3 times a day contributed to a more effective regression of symptoms of impaired motility of the esophagus and stomach.

Association between Helicobacter pylori, reflux and chronic rhinosinusitis: a systematic review.

The prevalence, role, and clinical relevance of Helicobacter Pylori (HP) in sinonasal tissues of patients with chronic rhinosinusitis remain unclear. To investigate the prevalence and clinical relevance of Helicobacter Pylori (HP) in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and without nasal polyps (CRSSNP). Three investigators conducted a PubMed, Scopus, and Cochrane Library systematic review of the prevalence and clinical relevance of HP infection in CRS patients through the PRISMA framework. A bias analysis was conducted to identify potential heterogeneity and biases across studies. Of the 42 identified studies, 20 met the inclusion criteria, accounting for 741 CRS patients and 368 controls. HP was detected in 37.1% (n = 127/342) of polyps of CRSwNP patients with the polymerase chain reaction (PCR) and 32.7% (n = 37/113) of polyp tissue with the immunohistochemistry (IHC). Controls reported a nasal PCR and IHC detection rates of 14.8% (n = 36/243) and 3.6% (n = 3/84), respectively. The HP rate did not differ between CRSwNP and CRSsNP. Among patients with CRS, the enzyme-linked immunosorbent assay testing detected blood HP antigens in 48.7% (n = 74/152) of CRS patients and 41.6% (n = 37/89) of controls. The detection of HP in polyps was associated with the severity of gastroesophageal reflux disease (GERD). There was an important heterogeneity between studies for the inclusion criteria, methods of HP detection, and reflux outcomes. Helicobacter Pylori can be detected in one-third of sinonasal tissues from patients with CRS and can be considered a biomarker of GERD. The potential role of HP in the development of CRS remains unclear. The heterogeneity between studies limits the drawing of valid conclusions.

Mucosal integrity of the larynx and hypopharynx and the response to proton pump inhibitors in patients with laryngopharyngeal reflux.

To evaluate whether impairment of integrity of laryngeal and hypopharyngeal mucosa in laryngopharyngeal reflux (LPR) could be related to response to proton pump inhibitors (PPIs). Chronic hoarseness with Reflux Finding Score (RFS) > = 7 was evaluated using the Reflux Disease Questionnaire (RDQ) and Reflux Symptoms Index (RSI). Upper endoscopy was performed and samples of the laryngeal posterior commissure were collected to evaluate ex vivo laryngeal mucosal integrity by transepithelial resistance (TER) using Ussing chamber. In vivo, hypopharyngeal integrity was measured using intraluminal impedance. Clinical responders scored < 13 and had a drop of at least 50% in the initial RSI after 8 weeks of pantoprazole. Eighteen patients completed the protocol, Esophagitis was detected in 28% of the patients, and one patient presented acid exposure above 6%. After treatment, 66.67% responded to PPI. Laryngeal basal TER and TER drops after the weakly acidid challenge showed no difference between PPI responders and non-responders. Hypopharyngeal basal impedance was similar between the groups. After acid exposure test, there was a lower impedance in non-responders. In laryngopharyngeal reflux, hypopharyngeal mucosal integrity was lower in PPI non-responders. These preliminary results suggest that the weaker laryngopharyngeal mucosa in refractory LPR may require new therapies aimed at improving barrier function. N/A.

Small Extracellular Vesicles Engineered Using Click Chemistry to Express Chimeric Antigen Receptors Show Enhanced Efficacy in Acute Liver Failure.

Acetaminophen (APAP) overdose can cause severe liver injury and life-threatening conditions that may lead to multiple organ failure without proper treatment. N-acetylcysteine (NAC) is the accepted and prescribed treatment for detoxification in cases of APAP overdose. Nonetheless, in acute liver failure (ALF), particularly when the ingestion is substantial, NAC may not fully restore liver function. NAC administration in ALF has limitations and potential adverse effects, including nausea, vomiting, diarrhoea, flatus, gastroesophageal reflux, and anaphylactoid reactions. Mesenchymal stromal cell (MSC)-based therapies using paracrine activity show promise for treating ALF, with preclinical studies demonstrating improvement. Recently, MSC-derived extracellular vesicles (EVs) have emerged as a new therapeutic option for liver injury. MSC-derived EVs can contain various therapeutic cargos depending on the cell of origin, participate in physiological processes, and respond to abnormalities. However, most therapeutic EVs lack a distinct orientation upon entering the body, resulting in a lack of targeting specificity. Therefore, enhancing the precision of natural EV delivery systems is urgently needed. Thus, we developed an advanced targeting technique to deliver modified EVs within the body. Our strategy aims to employ bioorthogonal click chemistry to attach a targeting molecule to the surface of small extracellular vesicles (sEVs), creating exogenous chimeric antigen receptor-modified sEVs (CAR-sEVs) for the treatment. First, we engineered azido-modified sEVs (N3-sEVs) through metabolic glycoengineering by treating MSCs with the azide-containing monosaccharide N-azidoacetyl-mannosamine (Ac4ManNAz). Next, we conjugated N3-sEVs with a dibenzocyclooctyne (DBCO)-tagged single-chain variable fragment (DBCO-scFv) that targets the asialoglycoprotein receptor (ASGR1), thus producing CAR-sEVs for precise liver targeting. The efficacy of CAR-sEV therapy in ALF models by targeting ASGR1 was validated. MSC-derived CAR-sEVs reduced serum liver enzymes, mitigated liver damage, and promoted hepatocyte proliferation in APAP-induced injury. Overall, CAR-sEVs exhibited enhanced hepatocyte specificity and efficacy in ameliorating liver injury, highlighting the significant advancements achievable with cell-free targeted therapy.

Novel risk loci encompassing genes influencing STAT3, GPCR, and oxidative stress signaling are associated with co-morbid GERD and COPD.

Chronic obstructive pulmonary disease (COPD) is a leading cause of death globally. Gastroesophageal reflux disease (GERD) is a common comorbidity in COPD associated with worse pulmonary symptoms, reduced quality of life, and increased exacerbations and hospitalizations. GERD treatment in COPD is associated with a lower risk of exacerbations and mortality; however, it is not clear whether these findings can be attributed to aging populations where both diseases are likely to co-occur or reflect shared etiology. To test for the influence of common etiology in both diseases, we aimed to identify shared genetic etiology between GERD and COPD. We performed the first whole-genome sequence association analysis of comorbid GERD and COPD in 12,438 multi-ancestry participants. The co-heritability of GERD and COPD was 39.7% (h2 = 0.397, SE = 0.074) and we identified several ancestry-independent loci associated with co-morbid GERD and COPD (within LINC02493 and FRYL) known to be involved in oxidative stress and G protein-coupled receptor (GPCR) signaling mechanisms. We found several loci associated with co-morbid GERD and COPD previously associated with GERD or COPD individually, including HCG17, which plays a role in oxidative stress mechanisms. Gene set enrichment identified GPCR signaling pathways in co-morbid GERD and COPD loci. Rare variants in ZFP42, encoding key regulators of the IL6/STAT3 pathway, have been previously implicated with GI disorders and were associated with co-morbid GERD and COPD. We identified common genetic etiology for GERD in COPD which begins to provide a mechanistic foundation for the potential therapeutic utility of STAT3, oxidation, and GPCR signaling pathway modulators in both GERD and COPD.

Combined oral contraceptives are associated with increased risk of developing gastroparesis in pre-menopausal women.

Females are disproportionately affected by gastroparesis. Sex hormones play a significant role. The aim of this study was to investigate the effects of combined oral contraceptives (COC) on the development of gastroparesis and its related symptoms, medication use, and diagnostic testing in pre-menopausal women. A population-based cohort study was conducted utilizing the TriNetX platform. The study group included pre-menopausal women. The effect of developing gastroparesis at least 30 days after initiating COC was assessed by comparing it to pre-menopausal women not on contraceptive therapy. A 1:1 propensity score matching was performed to adjust for age, race, ethnicity, body mass index, and diabetes mellitus. Exclusion criteria included upper gut and bariatric surgery, functional dyspepsia, cyclic vomiting syndrome, gastro-esophageal reflux disease, irritable bowel syndrome, cannabis dependence and opiate use. Odds ratios with 95 % confidence intervals were calculated. P-value <0.05 was considered statistically significant. After propensity matching, 1,370,274 patients were included in the study for each cohort. A total of 1,050 pre-menopausal women developed gastroparesis at least 30 days after being prescribed COC compared to 815 pre-menopausal women not prescribed COC (OR 1.29 [1.176-1.412] p-value<0.0001). These associations persisted in sensitivity analysis over 5 years (OR 1.31 [1.097-1.575] p-value=0.0029). COC were associated with increased gastrointestinal symptoms including early satiety (OR 2.31 [2.08-2.577] p-value<0.0001) and prokinetic medications including metoclopramide (OR 1.30 [1.285-1.316] p-value<0.0001). Gastrointestinal diagnostic tests including esophagogastroduodenoscopy (OR 1.611 [1.561-1.663] p-value<0.0001) and gastric emptying scintigraphy (OR 1.89 [1.717-2.085] p-value<0.0001) were more likely to be performed in pre-menopausal women who were prescribed COC. COC is associated with an increased risk of developing gastroparesis, which persists over time. Furthermore, COC is associated with developing gastrointestinal symptoms, increased prokinetic usage, and diagnostic testing.

568 Gastroesophageal reflux disease and the role of aldosterone: a cross-sectional study

568 Gastroesophageal reflux disease and the role of aldosterone: a cross-sectional study

Management of GERD Adherence to Mediterranean-Like Dietary Pattern in Association with Gastroesophageal Reflux Disease in Adolescents

Background: Gastroesophageal reflux disease (GERD) is a common esophageal disorder affecting adolescents. Recent studies have indicated that the risk of GERD may be influenced by different dietary patterns. This study aimed to examine the relationship between an adherence to Mediterranean-like dietary pattern and GERD in a large group of adolescents from central Iran. Methods: This cross-sectional study involved 5141 adolescents aged 13-14 years. Dietary intake was assessed using a food frequency method which included in a reliable and valid Global Asthma Network (GAN) core questionnaire. GERD symp­toms and the frequency of their occurrence over the last week were assessed using a validated GERD questionnaire. A binary logistic regression was used to evaluate the relationship between adherence to Mediterranean-like dietary pattern and GERD and its related symptoms. Results: The results showed that after controlling for potential confounding variables including age, sex, watching TV and computer, and BMI, the adolescents in the highest adherence to the Mediterranean style diet (MedDiet) score had lower odds of GERD [odds ratio (OR)=0.53; 95% CI 0.35-0.80, Ptrend=0.005)], sense of reflux (OR=0.45; 95% CI 0.26-0.77, Ptrend=0.01) and poor sleep (OR=0.54; 95% CI 0.31-0.96, Ptrend=0.02) compared with those in the lowest adherence. No significant association found between MedDiet and other GERD symptoms. Conclusions: This study found a negative relationship between following a MedDiet and having GERD among Iranian adolescents. Following the MedDiet may be a useful strategy to prevent GERD in adolescents.