Complications Of GERD Research Articles

Sex- and gender-specific differences in symptoms and health-related quality of life among patients with gastroesophageal reflux disease.

Gastroesophageal Reflux Disease (GERD) is a common chronic gastrointestinal disorder affecting both men and women. Nonerosive reflux disease generally affects more women, whereas GERD complications such as Barrett's esophagus (BE) or esophageal cancer affect more men. The aim of this study was to evaluate sex- and gender-specific symptoms and health-related quality of life (HRQoL) among men and women with GERD. Patients with clinical signs of reflux and completion of 24-hour pH-Impedance testing at the University Hospital Cologne were included into the study. Evaluation of symptoms and HRQoL included the following validated questionnaires: GERD-Health-Related Quality of Life (GERD HRQL), Gastrointestinal Quality of Life Index (GIQLI), and Hospital Anxiety and Depression Scale (HADS). In all, 509 women and 355 men with GERD were included. Men had a significantly higher DeMeester score (60.2 ± 62.6 vs. 43 ± 49.3, P < 0.001) and a higher incidence of BE (18.6 vs. 11.2%, P = 0.006). Women demonstrated significantly higher levels of anxiety (30.9 vs. 14.5%, P = 0.001), more severely impacting symptoms (45.3 ± 11.3 vs. 49.9 ± 12.3, P < 0.001), as well as physical (14.2 ± 5.7 vs. 16.7 ± 5.6, P < 0.001) and social dysfunction (13.3 ± 4.8 vs. 14.8 ± 4.3, P = 0.002). Women further reported a lower HRQoL (85.3 ± 22.7 vs. 92.9 ± 20.8, P < 0.001). Men and women differ on biological, psychological, and sociocultural levels.

Fundoplication in Pediatric Achalasia Patients Undergoing Heller’s Myotomy: A Systematic Review

Background: Achalasia is a rare motility disorder, with the incidence being the lowest among children. The disease is caused by the inability of the LOS to relax and the absence of normal peristalsis of esophagus. Heller’s myotomy has been known to be the gold standard management of achalasia, however, reports on postoperative GERD were established in the past. To control the reflux symptoms, fundoplication has been used as an addition to Heller’s myotomy. Unfortunately, there has been an inconclusive finding from available studies regarding the need for performing fundoplication. Hence, we aim to determine whether or not the addition of fundoplication to Heller myotomy in achalasia children resulted in better postoperative outcomes and fewer complications of GERD.&#x0D; Methods: A literature search was carried out in four databases: Medline, EMBASE, Pubmed, and Cochrane Library. The search was limited to publications from 2006 to 2019, English studies, and achalasia patients age 0-18 years old that underwent Heller’s myotomy. The exclusion of studies from the primary screening according to title and abstracts and secondary screening on the full text were done according to a priori protocol. Duplicate studies were also eliminated by using reference management software and manually.&#x0D; Results: A total of 446 studies were retrieved from the search. Preliminary screening based on the eligibility criteria resulted in 21 articles to be included in this review. A total of 410 patients were included in this study, in which 80 underwent HM alone and 330 experienced fundoplication as an adjunct to HM (HMF). There was a higher proportion of asymptomatic patients in the HM group (56.3%) compared to HMF (48.8%). Both groups had a similar rate of complications (HMF 12.1%, HM 10.0%). However, in terms of postoperative GERD, slightly better results were seen among HMF patients (9.7%) than HM (15%).&#x0D; Conclusion: Fundoplication did not result in better resolution of symptoms, as seen from its percentage of asymptomatic patients. Improvements in postoperative GERD were seen in HMF patients, however, it was deemed as insignificant. The findings suggest that there was a limited benefit in using fundoplication.

Determinants Of Gastroesophageal Reflux Disease in Patients Visiting Tertiary Care Hospitals, Lahore

Gastroesophageal reflux disease is a persistent and widespread condition that affects people of all ages. It has multiple symptoms and has a remarkable effect on the lifestyle and work performance of the person. Objective: To assess the determinants of GERD in patients visiting tertiary care hospitals, Lahore. Methods: A cross-sectional study was conducted at The University of Lahore Teaching Hospital and Jinnah Hospital Lahore for 6 months. Non-probability convenient sampling technique was used to record data of 100 participants by utilizing a validated questionnaire. Results: The results revealed that 40% of males and 60% of females participated in the study. Their BMI showed that 44% of participants were overweight and 18% were obese. 61% of the participants developed GERD complications. Analysis of the questionnaire revealed that 66% of the participants had a basic knowledge of GERD. An important determinant identified was the sedentary lifestyle of 70% of the participants. Conclusion: The study concluded that GERD is found to be more prevalent in patients having obesity, diabetes, hypertension, heart disease, and kidney disease. It deduced that modifiable risk factors can determine the progression of the disease. In this regard, awareness and public health education campaigns would play a promising role in the reduction of disease.

Sistemik Skleroz’da Özofagus Tutulumu ve Gastroözofageal Reflü Hastalığı: Üçüncü Basamak Deneyimi

Aim: Esophagus is the most frequently involved gastrointestinal segment in systemic sclerosis (SS). Gastroesophageal reflux, which occurs with the motility disorder caused by esophageal involvement, has an important place in the course of the disease due to many local and systemic complications. In this study, we investigated the demographic features, endoscopic, manometric, and 24-hour pH monitoring findings of patients with SS.&#x0D; Materials and Methods: Twenty-six patients with SS who presented with dysphagia or heartburn complaints were identified. Patients' files, endoscopic, manometric, and 24-hour ph monitoring findings of the esophagus were examined.&#x0D; Results: All of the patients were symptomatic, 96.1% were women. 46.1% of them applied with the complaint of heartburn and 53.9% with the complaint of dysphagia. The frequency of esophagitis was found to be significantly higher (p = 0.005). Pathological reflux was detected in 90% of the patients who underwent 24-hour pH monitoring and it was significantly higher (p = 0.013).&#x0D; Conclusion: Esophageal involvement is a hallmark manifestation of SS and typically occurs secondary to heartburn and dysphagia.In our society, the incidence of GERD and GERD-related complications is high in SS patients with esophageal symptoms. It is important to refer these patients to experienced gastroenterology centers to be evaluated primarily by endoscopic and then other diagnostic methods.

Testing and validation of the Russian version of quality of life questionnaire in patients with GERD - GERD-HRQL

This study aimed to test the Russian version of GERD-HRQL in the focus group of patients with GERD, as well as to evaluate its psychometric properties reliability, validity and sensitivity. The total of 57 patients with GERD (mean age 45.812.4 years, 72% women, 68% patients with not erosive reflux disease, 84% had esophageal manifestations of GERD) were enrolled into the study. All the patients filled out the Russian version of GERD-HRQL and generic quality of life questionnaire RAND SF-36 during the routine visit to the gastroenterologist. According to the results of testing of GERD-HRQL, it was clear and easy to complete for patients and reflected the main concerns specific for GERD patients. The most frequent and bothersome symptoms/problems which interfered with quality of life in GERD patients were heartburn (100% of patients) and bloating (84% of patients). During the validation procedure, the high reliability and validity of the Russian version of GERD-HRQL were demonstrated. It was shown that the tool was sensitive both to changes over time and to clinically determined differences in patients status. The Total GERD-HRQL Score was significantly higher (worse quality of life) in the following groups: a) patients who had esophageal manifestations of GERB vs those without esophageal manifestations of GERB; b) patients with GERD complications vs those without GERD complications, c) patients with comorbidities of upper gastrointestinal tract vs without those comorbidities; d) patients with erosive esophagitis vs with non-erosive reflux disease (p0.05). The developed Russian version of the GERD-HRQL questionnaire proved to have high psychometric properties and may be used in the Russian population of GERD patients both in research studies and in a real clinical practice.

Extraesophageal syndrome of gastroesophageal reflux: relationships with lung disease and transplantation outcome.

Gastroesophageal reflux disease (GERD) is prevalent and may be associated with both esophageal and extraesophageal syndromes, which include various pulmonary conditions. GERD may lead to pulmonary complications through the "reflux" (aspiration) or "reflex" (refluxate-triggered, vagally mediated airway spasm) mechanisms. While GERD may cause or worsen pulmonary disorders, changes in respiratory mechanics due to lung disease may also increase reflux. Typical esophageal symptoms are frequently absent and objective assessment with reflux monitoring is often needed for diagnosis. Impedance monitoring should be considered in addition to traditional pH study due to the involvement of both acidic and weakly acidic/nonacidic reflux. Antireflux therapy may improve outcomes of some pulmonary complications of GERD, although careful selection of a candidate is paramount to successful outcomes. Further research is needed to identify the optimal testing strategy and patient phenotypes that would benefit from antireflux therapy to improve pulmonary outcomes.

Endoscopic and histologic findings in patients referred for endoscopy by general practitioners in 2008-2013

Introduction. Patients with gastroesophageal reflux disease who did not improve with proton pomp inhibitors are at risk of serious diseases and should undergo endoscopy. Aim. The aim of the study was to present endoscopic and histopathologic findings in the esophagus in patients referred by a general practitioners to the Department of Gastrointestinal and General Surgery, Wroclaw Medical University in years 2008-2013 with initial diagnosis of GERD, in which the family doctor did not achieve the expected results of the empirical treatment with proton pump inhibitors. Material and methods. The clinical material included 122 patients (51 women and 71 men) aged 55.8 ± 14.1 referred for endoscopy by their general practitioners because of a lack of improvement after empirical treatment. Retrospective analysis of the endoscopic and histologic finding was performed. Results. The most prevalent diagnosis was hernia hiatus oesophagi (n = 41; 33.6%) and the least Barrett’s esophagus (n = 6; 4.9%). In men the most prevalent diagnosis was adenocarcinoma (n = 22; 31.0%) and in women hiatal hernia (n = 24; 47.1%). Near 60% patients were found to have histopathologic abnormalities. The most common finding was oesophageal cancer (n = 22; 18.0%) and the least dysplasia (n = 7; 5.7%). In men the most prevalent diagnosis was adenocarcinoma (n = 21; 29.6%) and in women esophagitis (n = 8; 11.3%) and Barrett’s esophagus (n = 8; 11.3%). Conclusions. 1. Near one quarter of patients with ineffective GERD symptoms treatment, who were referred for endoscopy by family practitioners, has serious endoscopic and histologic diagnosis. 2. Male gender and age above 52 years are risk factors for esophageal adenocarcinoma. 3. GERD complications are more common in men and benign complications prevail among women.

Hiatal Hernia is More Frequent than Expected in Bariatric Patients. Intraoperative Findings during Laparoscopic Sleeve Gastrectomy.

to assess the possible correlations between intraoperative presence of hiatal hernia (known or new discovered) and preoperative clinical, radiological and endoscopic data specific for GERD and HH. single institution Ponderas Academic Hospital, Center of Excellence in Bariatric and Metabolic Surgery. Material and Methods: The prospectively maintained database of the institution was retrospectively quired to identify all the patients who underwent primary Laparoscopic Sleeve Gastrectomy (LSG) without/with concomitant hiatal hernia (HH) repair between January 2015 to May 2016. Patient characteristics, co-morbidities, GERD symptoms, radiologic oral contrast study, endoscopy and operative details were analyzed. Results: six hundred ninety-five patients (260 male and 435 female) were identified meeting inclusion criteria (LSG +- HH repair). Mean age of patients was 41 +- 11.71years and average body mass index (BMI) was 41.96 +- 7.28 kg/m2. Preoperative upper gastrointestinal contrast series and endoscopy were performed for entire group study and demonstrated a hiatal hernia in 339 patients (48.78%). In all these cases, HH was repaired concomitantly with LSG. One hundred ninety-two patients (56.63%) were diagnosed with HH before operation and confirmed intraoperatively (Group A). The diagnosis of hiatal hernia was established intraoperatively for 147 patients (43.37%) - group B, using the surgical protocol for active identification of preoperative undiagnosed hiatal hernia - SPAIH. preoperative investigations such as EGD and barium X-ray oral study are suboptimal in diagnosing HH, therefore, in a significant number of patients, the presence of HH has been established using our surgical protocol - SPAIH. Crura approximation (HHR) concomitantly with laparoscopic sleeve gastrectomy is reproducible, may prevent the HH progression and possible GERD complications in the postoperative period of time.

Diagnosis and treatment of gastroesophageal reflux disease complicated by Barrett's esophagus.

A diagnostic and therapeutic algorithm for complicated GERD was developed. To describe the changes in the esophagus with reflux esophagitis, the Los Angeles classification was used. Intestinal metaplasia of the epithelium in the lower third of the esophagus was assessed using videoendoscopy, chromoscopy, and biopsy. Quality of life was assessed with the Gastro-Intestinal Quality of Life Index. The used methods were modeling, clinical, analytical, comparative, standardized, and questionnaire-based. Results and their discussion. Among the complications of GERD, Barrett's esophagus was diagnosed in 9 (19.6 %), peptic ulcer in the esophagus in 10 (21.7 %), peptic stricture of the esophagus in 4 (8.7 %), esophageal-gastric bleeding in 23 (50.0 %), including Malory-Weiss syndrome in 18, and erosive ulcerous bleeding in 5 people. Hiatal hernia was diagnosed in 171 (87.7 %) patients (sliding in 157 (91.8%), paraesophageal hernia in 2 (1.2%), and mixed hernia in 12 (7.0%) cases). One hundred ninety-five patients underwent laparoscopic surgery. Nissen fundoplication was conducted in 176 (90.2%) patients, Toupet fundoplication in 14 (7.2%), and Dor fundoplication in 5 (2.6%). It was established that the use of the diagnostic and treatment algorithm promoted systematization and objectification of changes in complicated GERD, contributed to early diagnosis, helped in choosing treatment, and improved quality of life. Argon coagulation and use of PPIs for 8-12 weeks before surgery led to the regeneration of the mucous membrane in the esophagus. The developed diagnostic and therapeutic algorithm facilitated systematization and objectification of changes in complicated GERD, contributed to early diagnosis, helped in choosing treatment, and improved quality of life.

IDENTIFICATION OF UNDERLYING CAUSES OF CHRONIC UNSPECIFIC UPPER GASTROINTESTINAL-RELATED SYMPTOMS IN CHILDREN, A PILOT STUDY.

Upper gastrointestinal tract (GIT) symptoms are not disease specific and of limited value in the differentiation of GIT disorders. The present study aimed to determine the etiology of chronic unspecific symptoms in children and to test the need for upper endoscopy in diagnosis. This is a prospective study for 30 Egyptian children presented with chronic upper GIT symptoms for at least 2 months. History regarding severity and frequency of GIT symptoms were asked for. Children with known disorder that explains presenting symptoms were excluded. Upper GIT endoscopy wa performed and 5 biopsies were obtained for pathological examination and for Hpylori testing. The results showed that children age ranged between 2.5-18 years with mean ± SD of 13.6 ± 3.4 and 63.3% were females. The main complaints were epigastric pain in 43.3%, hematemesis in 30% and vomiting in 26.7%. Motility disorders were diagnosed in 66.7% children; in the form of GERD in 63.3% and achalasia in one. Complication of GERD in the form of erosive esophagitis was present in 15.8% children, while Barrett's esophagus was not observed. H. pylori infection was diagnosed in 80% histologically. Eosinophilic esophagitis was not detected.

AB0335 Investigation of the Association between Gastroesophageal Reflux Disease and Clinical Factors in Patients with Rheumatoid Arthritis

BackgroundGastroesophageal reflux disease (GERD) is caused by the abnormal reflux of the gastric contents into the esophagus. Many risk factors are considered as a cause of GERD. Nonsteroidal anti-inflammatory drugs...

Long-Term Follow-up of Barrett’s Epithelium: Medical Versus Antireflux Surgical Therapy

BackgroundBarrett’s esophagus (BE) is the most serious complication of GERD. In BE patients, this observational study compares the effects of antireflux surgery versus antisecretory medical therapy. MethodsOverall, 89 BE patients (long BE = 45; short BE = 44) were considered: 45 patients underwent antireflux surgery and 44 underwent medical therapy. At both initial and follow-up endoscopy, symptoms were assessed using a detailed questionnaire; BE phenotypic changes [intestinal metaplasia (IM) presence/type, Cdx2 expression] were assessed by histology (H&E), histochemistry (HID), and immunohistochemistry. Surgical failures were defined as follows: (1) abnormal 24-h pH monitoring results after surgery, (2) endoscopically evident recurrent esophagitis, and (3) recurrent hiatal hernia or slipped fundoplication on endoscopy or barium swallow. ResultsReversion of IM was observed in 12/44 SSBE and 0/45 LSBE patients (p < 0.01). Reversion was more frequently observed after effective antireflux surgery than after medical treatment (p = 0.04). In patients with no further evidence of IM after therapy, Cdx2 expression was also absent (p = 0.02). The extent of IM was reduced, and the IM phenotype improved in SSBE patients after surgery. ConclusionsPatients with short BE (but not those with long BE) may benefit from surgically reducing the esophagus’ exposure to GE reflux; among these patients, successful surgery carries a higher IM reversion rate than medical treatment.

Diagnosis and initial management of Gastroesophageal complications

Chronic esophageal exposure to reflux of gastroduodenal contents can result in complications of GERD including esophageal stricture, Barrett's oesophagus or extraesophageal symptoms such as laryngitis, chronic cough or asthma. Endoscopy is the main diagnostic tool for patients with chronic reflux presenting with dysphagia to visualise esophageal mucosa and identify the underlying pathology. Barrett's oesophagus should be suspected in those with chronic reflux disease. Patients with Barrett's oesophagus should undergo surveillance endoscopy in order to risk stratify to dysplasia or adenocarcinoma. New endoscopic ablative therapies in patients with Barrett's oesophagus and high grade dysplasia are promising new treatment modality for those who may not be candidates for definitive intervention. Given poor sensitivity of diagnostic tests in extraesophageal reflux, empiric therapy with proton pump patients is the initial recommended approach. Diagnostic testing with esophagogastroduodenoscopy and ambulatory pH and impedance monitoring is usually reserved for those unresponsive to acid suppressive therapy. Many uncertainties remain in this group of patients including which patient subgroups might benefit from acid suppressive therapy. Future outcome studies are needed to assess the role of impedance/pH monitoring in this group of patients and to determine who might symptomatically benefit from medical or surgical intervention.

Treatment of GERD complications (Barrett’s, peptic stricture) and extra-oesophageal syndromes

Apart from typical reflux symptoms and oesophagitis, the clinical presentation of GERD can be dominated by mucosal complications of reflux (Barrett's oesophagus, oesophageal adenocarcinoma, Peptic structure) or by extra-oesophageal syndromes, most notably asthma, laryngitis, or chronic cough. Managing these entities is much less straightforward than with oesophagitis. With respect to adenocarcinoma, metaplasia and dysplasia are recognised precursors, but the potential of these lesions to evolve to cancer has not been shown to lessen as a result of treatment, medical or surgical. Consequently, management focuses on strategies to identify and eliminate high-grade dysplasia and intramucosal cancer, lesions that are potentially curable by endoscopic ablation or surgical resection. With respect to the extra-oesophageal GERD syndromes, these are increasingly recognised as multifactorial conditions with reflux as an exacerbating factor. Treatment trials have been generally disappointing and the clinical challenge remains in accurately identifying afflicted patients who might benefit from more intensive medical or surgical reflux treatment.

W1848 Acute Upper Gastro-Intertinal Bleeding (AUGIB) Is a Serious Complication of GERD, with Different Clinical Features from Bleeding Peptic Ulcers (PUD)

W1848 Acute Upper Gastro-Intertinal Bleeding (AUGIB) Is a Serious Complication of GERD, with Different Clinical Features from Bleeding Peptic Ulcers (PUD)

Laparoskopische Therapie der Refluxkrankheit

Laparoscopic fundoplication became the gold standard in the surgical therapy of GERD. In comparison with open procedures, laparoscopic antireflux surgery has a lower morbidity rate, a better early and late postoperative outcome and is more cost-effective. Antireflux surgery can be performed after a critical evalutation of the patient including gastroscopy, biopsy, 24h-pH-manometry and after a long lasting conservative medical treatment. Indications for antireflux surgery are given by a failed medical treatment, an insufficient compliance, complications of GERD, i.e. stenosis, Barrett-esophagus and atypical reflux symptoms like chronic cough, hoarseness or thoracic pain with presence of a pathological pH-monitoring. Laparoscopic 360 degrees Nissen-fundoplication with crurorrhaphy is our standard procedure, whereas the 270 degrees Toupet technique in our tailored approach is the technique of choice for esophageal motility disorders. Results of antireflux surgery published in literature are discussed and compared with our own ten years experience with 124 cases of laparoscopic fundoplication.

Review article: the patient with gastro‐oesophageal reflux disease – lifestyle advice and medication

SummaryGastro‐oesophageal reflux disease (GERD) is a highly prevalent disorder in all Western countries. Interestingly, prevalence rates appear to be increasing in these countries, with a remarkable increase of GERD‐related lethal and nonlethal complications. However, these complications are rare on a global scale. This review aims to summarize the current concepts of genetic, lifestyle and environmental factors that need to be considered whilst caring for patients with these disorders. GERD is defined by the augmented exposure of oesophageal mucosa to acidic content, and is associated with specific symptoms or mucosal lesions. A number of factors may contribute to the manifestation of GERD. Although recent studies emphasize the role of genetic factors, there are many other risk factors that play a pivotal role in the development of GERD and GERD complications. Some nutritional factors are believed to aggravate acidic reflux either by delaying gastric emptying or diminishing the pressure of the lower oesophageal sphincters. Patients are often advised to sleep with their heads elevated, but this advice is not easy to follow and has not been proven effective with regard to long‐term outcome. Other lifestyle modifications include changes to the patient's diet, which are important but not frequently sufficient. Thus, medication is usually necessary for symptom control. Proton pump inhibitors are now mainstream treatment for the reduction of acid secretion in patients with severe manifestations and 4‐week healing rates are approaching 90%.

Comparison of interobserver agreement for different scoring systems for reflux esophagitis: impact of level of experience

Background The Savary-Miller, the Los Angeles, and the MUSE (metaplasia, ulcer, stricture, erosion) scoring systems have been developed to assess esophageal lesions related to GERD. Interobserver agreement for these systems was compared, with particular reference to the experience of the endoscopist. Methods By using videoendoscopes, videotapes were made of the gastroesophageal junction of 60 patients who presented with symptoms suggestive of GERD. The Savary-Miller, the Los Angeles, and the MUSE systems were used to score all video clips by 9 endoscopists who were subgrouped by level of experience (3 levels, 3 endoscopists per level). Agreement was assessed by using weighted kappa statistics (κ). Results The Savary-Miller scoring system revealed moderate agreement for the experienced group (κ = 0.41) but performed poorly when applied by inexperienced raters (κ = 0.16). The Los Angeles system was most reproducible in all subgroups, irrespective of the level of experience (κ = 0.49 to 0.65). The MUSE scoring system was highly similar to the Los Angeles scoring system with respect to erosions and, in addition, allowed assessment of complications of GERD. Conclusions The Los Angeles and the MUSE scoring systems are most reliable for the assessment of erosions caused by GERD. Because of low reliability, use of the Savary-Miller scoring system is not recommended. For all scoring systems, interobserver agreement varies with the level of experience in the performance of upper endoscopy.

The epidemiology of gastroesophageal reflux disease: what we know and what we need to know

GERD is a common and costly disorder. Despite its prevalence, the epidemiology and natural history of GERD are incompletely understood. Until now, most studies have been of short duration and utilized convenience samples of patients presenting for upper endoscopy. There remain several obstacles, enumerated above, that need to be overcome to better study the epidemiology of GERD. Large scale, prospective data collection with standardized terminology and longitudinal follow-up will allow a clearer picture of the incidence, prevalence, natural history, and complications of GERD. This in turn should lead to timely, cost-effective diagnosis and management of this disorder.

Critical review of the epidemiology of gastroesophageal reflux disease with specific comparisons to asthma and breast cancer

GERD is one of the most common GI disorders. Despite its frequent occurrence, the absence of a consistent definition and an easily used diagnostic gold standard make it difficult to ascertain the true epidemiology of this condition. Recent work to validate a short symptom questionnaire to reliably diagnose GERD will be a major methodological improvement facilitating the analysis of large populations to better define its epidemiology. When these methods are available, a number of questions need to be addressed (Table 4). These include elucidating the epidemiology of erosive and nonerosive reflux disease, defining the epidemiology of GERD among minority populations, determining the natural history of erosive and nonerosive reflux disease, and identifying potential risk factors contributing to the development of GERD. The answers to these questions should improve our understanding of GERD, allowing us to better identify and treat individuals and populations at risk with the ultimate goal of improving quality of life in addition to preventing the development of GERD complications such as adenocarcinoma.