GERD Patients Research Articles

Laparoscopic fundoplication improves esophageal motility in patients with GERD - A high-volume single-center controlled study in the era of high-resolution manometry and 24-hour pH-impedance

BackgroundMost of the existing literature demonstrates that Laparoscopic Fundoplication (LF) is safe in the setting of ineffective or weak peristalsis, however the effect of the wrap on esophageal motility is still debated. This study aimed to assess how a functioning and effective fundoplication could impact the esophageal motility in patients with GERD. MethodsWe analyzed prospectively collected data on patients who underwent laparoscopic Nissen (LN) or Toupet (LT) fundoplication for GERD at our Department between 2010-2022. Demographic and clinical characteristics were recorded. Patients were evaluated with the GerdQ questionnaire, barium swallow, endoscopy, high-resolution manometry (HRM) and 24-hour pH-Impedance (pH-MII) before and after surgery. The HRM were reviewed by 2 experts, following the criteria of the Chicago Classification v4.0. LF failure was objectively defined in case of abnormal postoperative pH-MII according to Lyon 2.0 criteria with/without an abnormal GerdQ. ResultsDuring the study period 124 (M:F=89:35) GERD patients were recruited. Fifty-eight patients underwent LN and 66 underwent LT. All procedures were completed laparoscopically, and the 90-day postoperative mortality was nil. At the postoperative pH-MII, we recorded a good outcome in 103 patients and a failure in 21 patients. There was a significant association between a successful LF and the normalization of esophageal motility (p<0.05). ConclusionOur data confirmed that LF is an effective treatment in patients with GERD independently from with an esophageal motility status. Moreover, our results indicate that LF could determine a normalization of motility abnormalities in patients with GERD.

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

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

Efficacy of rabeprazole for the treatment of gastroesophageal reflux disease in a 7-day non-interventional trial

To evaluate the efficacy of seven-day treatment with rabeprazole (Razo®) 20 mg once daily in patients with NERD and esophagitis based on monitoring the results of pH-impedancemetry of the stomach and esophagus and assessment of clinical symptoms. Thirty patients with typical GERD manifestations were examined. The study included patients who underwent pH-impedancemetry, endoscopic examination, and were prescribed treatment with rabeprazole at a dose of 20 mg once a day. Clinical monitoring was performed during three visits: before treatment, after 3 days, and after 7 days of treatment. Control pH-impedancemetry was performed after 7 days of therapy. The third visit was the endpoint of the study. After 7 days of treatment, the response rate for heartburn was 86.7% in the overall group of patients with GERD, 94.4% in those with NERD, and 75.0% in patients with esophagitis stage A and B. After 7 days of therapy with rabeprazole, we registered a significant decrease in the total number of refluxes (from 88 to 54; p<0.001), the number of acid refluxes (from 53 to 22; p<0.001), the DeMeester index (from 23.81 to 7.62; p<0.001), and AET (from 7.54 to 2.01; p<0.001) in the esophagus and an increase in the median daily pH (from 1.8 to 5.4; p<0.001) and the time with pH>4 in the stomach (from 2.57 hours and 10.7% up to 12.3 hours and 51.3%; p<0.001). 7-day therapy with rabeprazole was accompanied by a significant improvement in GERD patients in all parameters of quality of life. 100% of patients with GERD rated their satisfaction with therapy as "good" and "very good". As a result of 7-day therapy of patients with NERD and esophagitis with Razo® at a dose of 20 mg per day, an excellent clinical response was obtained, confirmed by a marked optimization of pH-impedancemetry parameters.

234. EFFECTS OF TRANSCUTANEOUS ELECTRICAL STIMULATION SYSTEM ON HEARTBURN, REGURGITATION AND ESOPHAGEAL ACID EXPOSURE IN GERD PATIENTS

Abstract Background Chronic PPI treatment in GERD is associated with high failure rate and concerns regarding PPI's side effects. In a previously published proof of concept study, a non-pharmacological, non-invasive transcutaneous, electrical stimulation system, reduced esophageal acid exposure in GERD patients unresponsive to standard dose PPI. However, in that study, a symptomatic response to electrical stimulation was not assessed. Aim To determine the effect of a transcutaneous electrical stimulation system (TESS) on symptoms (heartburn and regurgitation) and the percentage of esophageal acid exposure time in GERD patients. Methods Patients suffering from heartburn and regurgitation were recruited into this multicenter study. The first phase of this study was a one week, run-in period, off-PPI's, during which, patients completed symptoms diaries and demographic questionnaires. Thereafter, all patients underwent upper endoscopy with subsequently wireless esophageal pH capsule placement (off PPI). Based on pH analysis in the first 24-hours, (day 0) only those with increased acid exposure time (percent total time pH &amp;lt;4 above 6%) continued to the next phase. During phase two of the study, patients were treated for two weeks with TESS and documented their symptoms. Primary end points included the reduction of baseline (pretreatment) number of heartburn and regurgitation episodes as well as 24-hour percent total time pH &amp;lt;4 and/or DeMeester score by at least 50%. Results 26 GERD patients (16 male, aged 47±15 years, mean BMI 25±3 kg/m2) completed the study. At baseline, mean number of daily heartburn and regurgitation events was 2.41±0.36 and 1.38±0.35, respectively. Following TESS, mean number of daily heartburn and regurgitation events dropped to 0.69±0.16 and 0.31±0.19, respectively (p=0.01). At baseline, mean percent total time pH &amp;lt; 4 was 11.8±0.9. Following TESS, mean percent total time pH &amp;lt; 4 dropped to 7.3±0.8, 7.8±1.0, 6.7±1.1 and 5.0±0.7 for day 1, 2, 3 and 4, respectively (p=0.01). At baseline, mean DeMeester score was 31.4±2.1. Following TESS, mean DeMeester score dropped to 20.1±2.0, 20.4±2.5, 17.3±2.6 and 14.3±2.0 for day 1, 2, 3 and 4, respectively (p=0.01). Conclusions TESS is effective in reducing both symptoms (heartburn and regurgitation) and esophageal acid exposure time in GERD patients.

Outcomes of Transoral Incisionless Fundoplication (TIF 2.0): A Prospective, Multicenter Cohort Study in Academic and Community Practices (with video)

BACKGROUND AND AIMSTransoral incisionless fundoplication (TIF) is an established safe endoscopic technique for the management of GERD but with variable efficacy. In the last decade, the TIF technology and technique have been optimized and more widely accepted but data on outcomes outside clinical trials are limited. We tracked patient-reported and clinical outcomes of GERD patients after TIF 2.0. METHODSPatients with BMI < 35, hiatal hernia < 2cm, and confirmed GERD with typical and/or atypical symptoms from 9 academic and community medical centers were enrolled in a prospective registry and underwent after TIF 2.0 performed by gastroenterologists and surgeons. The primary outcomes were safety and clinical success (response in >2 of 4 endpoints). Secondary endpoints were symptom improvement, acid exposure time (AET), esophagitis healing, proton pump inhibitor (PPI) use, and satisfaction. Outcomes were assessed at last follow-up within 12 months. RESULTS85 patients underwent TIF 2.0, 81 were included in the outcomes analysis. Clinical success was achieved in 94%, GERD-HRQL scores improved in 89%, and elevated RSI score normalized in 85% of patients with elevated baseline. Patient satisfaction improved from 8% to 79% (p <0.0001). At baseline, 81% were taking at least daily PPI, while 80% were on no or occasional PPI after TIF 2.0 (p<0.0001). Esophageal AET was normal in 72%, greater with an optimized TIF 2.0 valve >300 degree circumference, >3cm length (94% vs 57%, p=0.007). There were no TIF 2.0-related serious adverse events. CONCLUSIONTIF 2.0 is a safe and effective endoscopic outpatient treatment option for select patients with GERD.

Long-term disease-specific quality of life after laparoscopic Nissen fundoplication in patients with borderline GERD

BackgroundHistorically, DeMeester score over 14.7 has been used to diagnose GERD. The 2022 American Gastroenterological Association clinical guidelines define GERD based on acid exposure time (AET) instead of DeMeester score. We aim to compare outcomes after laparoscopic Nissen fundoplication (LNF) in patients based on differing GERD diagnostic criteria.MethodsPatients who underwent first-time LNF between 2009 and 2017 were identified. Demographics, objective GERD evaluation, and outcomes were maintained in an IRB-approved database. Disease-specific quality of life was assessed with a survey (GERD-HRQL) with higher values representing more symptomatic disease. Descriptive statistics, Fischer’s exact test and logistic regression were used to analyze the data, p-value < 0.05.Results225 patients were stratified into two groups: borderline GERD (AET 4–6%, n = 25.11%) and GERD (AET ≥ 6%, n = 200.89%). The mean age was 50.1 ± 13.4 years and 169 (75%) were female. Baseline GERD-HRQL was lower in the borderline group (24.3 vs 30.0, p = 0.031). Short-term (5 weeks [IQR 4, 8]), medium-term (14 months [IQR 7.25, 31]) and long-term (6.75 years [IQR 5.5, 8]) follow-up was performed. GERD-HRQL scores did not differ between borderline and GERD patients at short-(6.0 vs 7.1, p = 0.630), medium-(12.0 vs 12.1, p = 0.818), or long-term follow-up (10.0 vs 9.0, p = 0.757). The absolute long-term improvement in GERD-HRQL was −12.3 (p = 0.022) vs. −21.3 (p < 0.001). At long-term follow-up there was no difference in PPI use (50% vs 47%, p = 0.852), satisfaction (58% vs 76%, p = 0.187), willingness to repeat the procedure given the benefit of hindsight (75% vs 85%, p = 0.386), or need for reoperation (14% vs 13%, p = 0.910).ConclusionBoth patients with borderline GERD and GERD achieve GERD-HRQL improvements at 7 years following laparoscopic Nissen fundoplication and demonstrate similar long-term PPI usage and satisfaction with surgical results. Borderline GERD patients have lower GERD-HRQL at baseline, and thus have smaller improvements in their QOL scores. Anti-reflux surgery should be considered for patients with a diagnosis of borderline GERD refractory to medical therapy.

Enhanced Risk of Gastroesophageal Reflux Disease and Esophageal Complications in the Ulcerative Colitis Population.

Background: Although heartburn and reflux are frequently reported in ulcerative colitis [UC], the correlation between UC and gastroesophageal reflux disease [GERD], and its complications, esophageal stricture and Barrett's esophagus [BE], is not well understood. This study aims to examine the prevalence and associated risk of GERD and its complications within the UC population. Methods: We analyzed the National Inpatient Sample (NIS) dataset, consisting of 7,159,694 patients, comparing GERD patients with and without UC to those without GERD. We assessed the degree of colonic involvement in UC and the occurrence of esophageal complications. Bivariate analyses were conducted using the chi-squared test or Fisher exact test (two-tailed). Results: A higher prevalence of GERD (23.0% vs. 16.5%) and GERD phenotypes, such as non-erosive reflux disease (NERD) (22.3% vs. 16%) and erosive esophagitis (EE) (1.2% vs. 0.6%), was found in UC patients (p < 0.01), including pancolitis, proctitis, proctosigmoiditis, left-sided colitis, and indetermined UC (with undefined colonic involvement). UC patients were more likely to develop GERD (1.421), NERD (1.407), and EE (1.681) (p < 0.01). A higher prevalence of esophageal stricture (16.9 vs. 11.4 per 10,000 patients) and BE without dysplasia (94.5 vs. 39.3 per 10,000 patients) was found in UC (p < 0.05). The odds of developing BE without dysplasia were higher (1.892) in patients with UC (p < 0.01), including ulcerative pancolitis, proctitis, and indeterminate UC (OR of 1.657, 3.328, and 1.996, respectively) (p < 0.05). Conclusions: Our study demonstrates an increased risk of developing GERD and its complications in UC. This highlights the importance of vigilant monitoring and early intervention to minimize associated GERD-related risks in patients with UC.

Post-reflux swallow-induced peristaltic wave index and mean nocturnal baseline impedance predict proton pump inhibitor response in patients with reflux hypersensitivity.

Post-reflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI) have been shown to influence proton pump inhibitor (PPI) response in GERD patients. However, currently, little data concerning these variables in patients with reflux hypersensitivity (RH) are available. In this study, we aimed to evaluate, in RH patients, the prevalence of PPI responders and nonresponders and investigate the predictive value of impedance-pH variables, including PSPW and MNBI, on responses to PPI. A total of 108 RH patients who met ROME IV criteria were prospectively recruited from June 2018 to December 2022. The prevalence of PPI responders/nonresponders was calculated, and impedance-pH variables were compared between the response and nonresponse groups. Multiple logistic regression was used to investigate predictors for PPI response. Among 108 patients with RH, 60 patients (55.56%) were the PPI responders, and 48 (44.44%) were the nonresponders. Compared with the nonresponders, the PPI responders had a lower PSPW index (47.05±4.43 vs 51.33±3.50, P=0.004) and a decreased value of MNBI (1866.68±390.62 vs 2181.14±338.42, P=0.017). Multivariate logistic regression revealed that only the pathologic PSPW index (OR: 2.064) and MNBI (OR: 1.800) significantly influenced PPI response. Nearly half of RH patients were PPI nonresponders. Impedance-pH monitoring was more valuable than pH-only monitoring in associating PPI response to reflux in RH patients owing to the appraisal of the PSPW index and MNBI.

Unraveling the causality between gastroesophageal reflux disease and increased cancer risk: evidence from the UK Biobank and GWAS consortia

BackgroundGastroesophageal reflux disease (GERD) is a common condition characterized by the reflux of stomach contents into the esophagus. Despite its widespread prevalence worldwide, the causal link between GERD and various cancer risks has not been fully established, and past medical research has often underestimated or overlooked this relationship.MethodsThis study performed Mendelian randomization (MR) to investigate the causal relationship between GERD and 19 different cancers. We leveraged data from 129,080 GERD patients and 473,524 controls, along with cancer-related data, obtained from the UK Biobank and various Genome-Wide Association Studies (GWAS) consortia. Single nucleotide polymorphisms (SNPs) associated with GERD were used as instrumental variables, utilizing methods such as inverse variance weighting, weighted median, and MR-Egger to address potential pleiotropy and confounding factors.ResultsGERD was significantly associated with higher risks of nine types of cancer. Even after adjusting for all known risk factors—including smoking, alcohol consumption, major depression, and body mass index (BMI)—these associations remained significant, with higher risks for most cancers. For example, the adjusted risk for overall lung cancer was (OR, 1.23; 95% CI: 1.14–1.33), for lung adenocarcinoma was (OR, 1.18; 95% CI: 1.03–1.36), for lung squamous cell carcinoma was (OR, 1.35; 95% CI: 1.19–1.53), and for oral cavity and pharyngeal cancer was (OR, 1.73; 95% CI: 1.22–2.44). Especially noteworthy, the risk for esophageal cancer increased to (OR, 2.57; 95% CI: 1.23–5.37). Mediation analyses further highlighted GERD as a significant mediator in the relationships between BMI, smoking, major depression, and cancer risks.ConclusionsThis study identifies a significant causal relationship between GERD and increased cancer risk, highlighting its role in cancer development and underscoring the necessity of incorporating GERD management into cancer prevention strategies.

Antireflux surgery for prevention of chronic lung allograft dysfunction (CLAD) onset after lung transplantation: The earlier the better before CLAD onset? A single-center series of 284 patients

BackgroundGERD is highly prevalent after lung transplantation (LTx), and suspected to favor the development of chronic lung allograft disease (CLAD), almost of BOS phenotype. The preventive effect of anti-reflux surgery (ARS) on BOS/CLAD onset in patients with GERD still remains debated. We compared the outcome (freedom from CLAD and graft survival) of patients with GERD with or without performed ARS (GERD-ARS and GERD-noARS groups) and those without GERD (noGERD group) in our LTx cohort. MethodsData from 284 LTx recipients with available post-LTx pHmetry findings were reviewed (2001-2014). We focused on the outcome of 244 patients without CLAD at the date of pHmetry. ResultsAmong 244 stable patients at the date of pHmetry, 78 patients did not have GERD and 166 patients had GERD [41 with and 125 without ARS performed]). The mean DeMeester score was higher in the GERD-ARS group than GERD-noARS group (p=0.03). An increase of DSAs MFI values was observed only in GERD after LTx (M6 vs day 0, p<0.0001; M12 vs day 0, p=0.003).Freedom from CLAD at 3 years post-pHmetry/ARS was higher for GERD-ARS patients as compared to GERD-noARS patients (p=0.002). Additionally, ARS was independently associated with a subsequent decreased risk of CLAD onset at 3 years in GERD patients (GERD-ARS versus GERD-noARS, p=0.02 [Cox models]). ARS was safe in this series, with no surgery-related deaths. ConclusionOur results suggested a preventive effect of ARS on CLAD onset in stable selected patients with GERD, with a beneficial medium-term effect. IRB approval numberIRB00012437

A pilot study comparing the initial clinical response to different proton pump inhibitors within first week in treating erosive esophagitis

AbstractGastroesophageal reflux disease (GERD) characterized by heartburn and/or acid regurgitation symptoms is one of the most common gastrointestinal disorders. The rapid onset of proton pump inhibitors (PPIs) to improve annoying symptom is an essential need in treating GERD. There was no report about the short‐term clinical effects comparing lansoprazole 30 mg to rabeprazole 20 mg. This pilot study was designed to compare the initial one‐week clinical response of the two drugs in GERD with erosive esophagitis. Total 44 patients with GERD were enrolled in this study and randomized into two groups. The patients had the symptoms of acid regurgitation, heartburn, or feeling of acidity in the stomach and erosive esophagitis proven by endoscopy. They respectively received once‐daily dose of lansoprazole 30 mg (n = 23) and rabeprazole 20 mg (n = 21) for treatment of GERD. The primary end point was complete symptom resolution (CSR). The CSR rate was evaluated by questionnaire including acid regurgitation, heartburn sensation and epigastric pain at day 1, 3 and 7. Two patients in the arm of rabeprazole had poor compliance of drugs and were excluded from analysis. The final patient numbers were 23 in the arm of lansoprazole and 19 in rabeprazole. The baseline characteristics of two groups were similar in age, gender, body mass index (BMI), Helicobacter pylori infection, GERD severity, smoking, alcohol, coffee, spicy, sweet food and laboratory data. The ingestion of tea was the only one variable with significant difference between the two groups (65.2% and 31.58%, p = .03). At day 1, 3 and 7, the CSR rate of lansoprazole and rabeprazole were 21.74% and 26.32% (p = 1.000), 34.78% and 31.58% (p = .827), 47.83% and 47.37% (p = .976), respectively. The other clinical factors, including age, gender, BMI, Helicobacter pylori infection, smoking, alcohol, coffee, tea, spicy, sweet food and laboratory data, have also no significant influence on CSR rates at day 1, 3, 7. However, the patients with GERD C and D had significantly higher CSR rate than patients with GERD A and B at day 1 and 7 (CSR rate at day 1: 50.00% vs. 15.63, p = .040; day 3: 60.00% vs. 25.00%, p = .059; day 7: 90.00% vs. 34.38%, p = .003). In multivariate regression analysis, the patients with GERD C and D still had significantly higher CSR rate than patients with GERD A and B at day 7 (Odds ratio: 28.27, 95% CI: 2.10–380.03, p = .012). The CSR rates between lansoprazole group and rabeprazole group at day 1, 3, 7 were not significantly different, so the difference of PPIs did not play the role on the initial clinical response within 1 week for the erosive GERD patients. However, the patients with more severe erosive GERD on endoscopy had higher CSR rate at day 7.

The index of failure of the antireflux function of the cardia (IFAFC), as a criterion for the effectiveness of its videolaparoscopic correction for gastroesophageal reflux disease (gerd) in pthe index of failure of the antireflux function of the cardia after video-laparoscopic correction in gerd patients with hiatal hernia

The purpose of the study was to create an index based on the total results of special research methods that characterizes the antireflux function of the cardia in the long term after its video-laparoscopic correction in GERD patients with hiatal hernia (HH). Long-term results of video-laparoscopic antireflux intervention in 213 patients with GERD and HH were analyzed. Based on the results of a remote survey and instrumental examination, the patients were divided into three groups. The first group consisted of the patients who had symptoms of GERD, but the presence of pathological gastroesophageal reflux was not confirmed by instrumental methods (122 patients, 57.3 %); the second group included the patients with recurrent GERD (19 patients, 8.9 %); the third group (72 patients, 33.8 %) consisted of the patients without GERD symptoms or its recurrence. To assess the antireflux function of the cardia in the long term after its video-laparoscopic correction, the index of failure of the antireflux function of the cardia (IFAFC) was developed based on the generalized results of instrumental research methods. Before surgery in all groups of the patients, the IFAFC did not have a statistically significant difference and indicated a very significant severity of signs of failure of the antireflux function of the cardia (0.70±0.06, 0.74±0.05, and 0.70±0.06, respectively; р&gt;0.05). In the long term after surgery, the patients with false-positive GERD symptoms showed an improvement in the IFAFC by 87.14 % (p&lt;0.001), the patients without symptoms of GERD and its recurrence — by 92.86 % (p&lt;0.001), and the patients with recurrent GERD — by 16.22 % (p&lt;0.05). The IFAFC allows assessing the results of the antireflux surgery. In the absence of recurrent GERD, the IFAFC is 0.05±0.01; in patients with recurrent GERD, it is 0.62±0.07. The IFAFC equal to 0.09±0.07 is typical for patients at risk with false-positive symptoms of GERD without confirmation of its relapse by special studies. These patients require follow-up.

Comparison of efficacy of daily and alternate day maintenance treatment of GERD with Vonoprazan 10-mg using Gastroesophageal Reflux Disease Symptom Assessment Scale.

To compare efficacy of 10-mg of vonoprazan daily & on alternate days by Gastroesophageal Reflux Disease Symptom Assessment Scale (GSAS). This prospective interventional cohort was done at Department of Medicine/Gastroenterology Dow Medical College, Karachi, Pakistan during the period August 2022 & January 2023. Potential participants fulfilling inclusion and exclusion criteria were asked to fill out GSAS questionnaires after their written consent. Patients were allocated in to two groups using random tables. Group-A was given Tab Vonoprazan 10-mg daily for two weeks. Group-B was given Tab Vonoprazan 10-mg on alternate day. GSAS was scored by totaling scores across symptoms and then they are divided by the total number of non-missing symptom scores. Both groups were assessed week-0 & week-2. Only 90 proformas that were completely filled were included, Group-A had 30 males and 15 females while Group-B had 29 males and 16 females. No significant difference in score was found in GSAS score at week-0 except that in item 'gurgling' while at week two there was no significant difference between any of the items. Total GSAS score were significantly lower at Week-2 than at week-0 (p = <.001). Vonoprazan of 10-mg on alternate day is equally effective as 10-mg daily in maintenance of GERD patients at two weeks.

Review of Impact of Proton Pump Inhibitors on GERD Patients

Review of Impact of Proton Pump Inhibitors on GERD Patients

GERD: latest update on acid-suppressant drugs

GERD is a very familiar diagnosis among health care providers due to its massive spread, and its symptoms can affect the quality of life for a respectable slice of its patients. Therefore, what can only be described as a logical consequence, a pursuit of a treatment that can both relieve symptoms and have minimal side effects is still ongoing to cover the large demographic affected by GERD. In the following review, analysis will be made of GERD, including possible regulatory activity, of certain drugs to the already discussed pathways involved in GERD patients.

Polypharmacy and pattern of medication use among patients with gastroesophageal reflux disease: results from Pars Cohort study

BackgroundGastroesophageal Reflux Disease (GERD) is a common chronic condition. Its chronic nature may affect the pattern of medication use. This study aimed to investigate the prevalence, associated factors, and patterns of polypharmacy and medication use among GERD patients in southwestern Iran.MethodsWe used data from the Pars Cohort Study. We classified drugs using the Anatomical Therapeutic Chemical classification system. The Lexicomp® database was used to assess potential drug-drug interactions. Multivariable Poisson regression was applied. Adjusted prevalence ratio (PR) and its 95% confidence interval (CI) were estimated.ResultsA total of 9262 participants were included. Among 2,325 patients with GERD, age-standardized prevalence of polypharmacy was 9.5% (95% CI: 7.5%, 11.6%) in males, and 19.3% (95% CI: 17.2%, 21.4%) in females. The PR of experiencing Polypharmacy by GERD patients compared to non-GERD patients was 1.82 (95% CI: 1.61, 2.05%). Multimorbidity (PR: 3.33; CI: 2.66, 4.15), gender (PR: 1.68; CI: 1.30, 2.18), and metabolic syndrome (PR: 1.77; CI: 1.45, 2.15) were associated with polypharmacy among GERD patients. Drugs for acid-related disorders were the most common used drugs among men, women and elders. We found that 13.9%, 4.2%, and 1.1% of GERD patients had type C, D and X drug interactions, respectively.ConclusionGERD is correlated with a higher prevalence of polypharmacy. Among GERD patients, females, those with multi-morbidities, and those with metabolic syndrome may be affected more by polypharmacy. Considering the fairly high rate of interactions identified, a review of the medication list is essential when approaching GERD patients, and physicians must check for medications that may worsen GERD.

Identification of novel immune cell signature in gastroesophageal reflux disease: altered mucosal mast cells and dendritic cell profile.

Heartburn pathogenesis in GERD remains incompletely understood. We aimed to identify differences in the immune cell signature and sensory mucosal markers between reflux phenotypes and healthy asymptomatic subjects. Thirty-seven patients with heartburn symptoms were phenotyped endoscopically and with objective reflux studies into erosive reflux disease (ERD) (N=10), nonerosive reflux disease (NERD) (N=9), functional heartburn (FH) (N=9), and Barrett's esophagus (BO) (N=9). Bulk mRNA-sequencing(RNA-seq) was conducted on RNA extracted from endoscopic biopsies, and immune cell deconvolution analysis was performed using CIBERSORT. RNA-seq findings were validated by immunofluorescent staining for CD1a, nerve growth factor (NGF), and mast cell tryptase in corresponding patient biopsies. Transcriptomic analysis detected higher mast cell abundance in BO, ERD, and NERD compared to healthy controls (p<0.05), with decreased dendritic cell infiltration in BO, ERD, and NERD patients compared to healthy controls and FH patients. CD1a-positive dendritic cell infiltration was significantly higher in the healthy esophageal mucosa at protein level compared to BO (p=0.0005), ERD (p=0.0004), and FH patients (p=0.0096). Moreover, NGF co-expression on mast cells in GERD patients was significantly higher than in healthy controls (p=0.0094). The mucosa in patients with GERD had a significant increase in NGF expression on mast cells, suggesting an upregulation of signalling for neuronal sprouting in GERD. Moreover, decreased dendritic cell abundance in GERD esophageal mucosa may play a role in reduced oral tolerance and development of subsequent immune responses which may participate in esophageal sensitivity.

OGBN O03 Quality of life of patients with gastroesophageal reflux disease: findings from a systematic literature review

Abstract Background Gastroesophageal reflux disease (GERD), affecting over a billion people worldwide, is associated with significant impairment and productivity loss. Understanding the quality of life among GERD patients may provide important clinical relevance to treatment management and highlight the patient perspective. The aim of this study was to conduct a systematic review of GERD and quality of life, including any potential effects on treatment management. Methods MEDLINE, Embase, and the Cochrane Library were searched for randomized controlled trials, case-control, and cohort studies published in English from 2013 to 2023. Eligible studies included adult GERD patients with quality of life data from a disease-specific or generic instrument. Data analysis contained a narrative synthesis of pre- and post-procedural total scores. Results Eight trials and 34 observational studies were included. The disease-specific instruments GERD Health-Related Quality of Life (GERD-HRQL) (n = 35) and Gastrointestinal Quality of Life Index (GIQLI) (n = 4) had baseline mean scores ranging from 13.3 to 37.1 and 72.0 to 96.3, which changed to 1.3 to 31.6 and 94.8 to 119.8 post-treatment, respectively. Besides the Reflux Symptom Index (RSI) (n = 3), EQ-5D, Psychological General Well-Being (PGWB), SF-36, and GastroEsophageal Reflux Symptom Score (GERSS) were only used by single studies to evaluate the quality of life among GERD patients. In general, these results indicated an improvement post-treatment. Conclusions As a general finding, patients with GERD have poor quality of life and active treatment seems to influence and improve GERD patients’ quality of life, considering the pre-post results of GERD-HRQL and GIQLI scores. As expected, generic quality of life instruments are seldom used.

Diagnosis and Treatment of GastroEsophageal Reflux Disease at the Primary Health Care Clinics in Korea

The prevalence of GERD and treatment costs are continuously rising in Korea, and the importance of primary health care clinics where the most treatment of actual patients is conducted is increasing. In this study, the diagnosis of GERD, selection of therapeutic drugs, and treatment methods in primary health care clininics were investigated through a large-scale multi-dimensional surveys. From January 2015 to December 2018, the study data of 18,010 patients with GERD were retrospectively investigated based on eletronic medical record at 542 primary health care clinics in Korea. Among all GERD patients, endoscopy was used for diagnosis in 16.11% of cases, and the most frequently performed in gastroenterology department (28.85%). The average BMI and the proportion of patients in stages 1 to 3 of obesity were highest in the ERD group, and the majority of the severity of ERD group was mild. Symptoms of the patients with GERD were mainly heartburn, gastric acid reflux, and chest pain. Drug treatment was performed in most of the patients with GERD, and PPI was the main drug, and Esomeprazol was prescribed the most among the main ingredients, and the ratio of PPI alone was high. The rate of symptom improvement after GERD treatment was slightly higher in the ERD group (75.91%) and the NERD group (74.36%) than in the GERD diagnosed without endoscopy group (63.89%). In domestic primary health care clinics, the majority were diagnosed with GERD without endoscopy on the basis of symptoms. The most preferred treatment for GERD was PPI, which was prescribed alone in the majority.

S613 Treatment of Bile Reflux Phenotype Improved Response to Treatment in PPI Refractory GERD Patients

S613 Treatment of Bile Reflux Phenotype Improved Response to Treatment in PPI Refractory GERD Patients