GERD Patients Research Articles

Penerapan Teknologi Kesehatan pada Gaya Hidup dan Tingkat Stres Pasien Gastroesophageal Reflux Disease

This study aims to identify the influence of technology on GERD patients. The research method used is a literature review through electronic databases and websites, namely Scopus—Science Direct, PubMed, ProQuest, and Sage. The research results showed that of the 20 articles, there were articles that reported that lifestyles such as smoking, high BMI, lack of exercise, eating at night, not eating breakfast, and lack of sleep were risk factors for GERD. Apart from that, GERD is a psychosomatic disease, namely a disease that also originates from the mind, where stress, anxiety, and depression are also closely related to the incidence of GERD. Some articles also report that technology can help patients treat and control their diseases. In conclusion, using technology on the lifestyle and stress levels of gastroesophageal reflux disease patients can help patients treat their condition.
 
 Keywords: GERD, Technology, Lifestyle, Stress

Lap. Nissen fundoplication leads to better respiratory symptom control than Toupet in the long term of 20 years

IntroductionHaving performed anti-reflux surgery for thirty years, it was important to reexamine our patients in the long term to enlarge the body of evidence concerning classical and extraesophageal symptoms that are differently controlled by Nissen or Toupet fundoplication.ObjectivesWe report a cohort of 155 GERD patients who underwent fundoplication within a tailored approach between 1994 and 2000. Changes in the perioperative functional outcome, GERD symptoms, and quality of life are being analyzed 10 and 20 years after the operation.ResultsThe operation resulted in a superior quality of life compared to a patient cohort treated with PPI therapy. We found that both surgical methods (laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication) cure classical symptoms equally (heartburn, regurgitation, and dysphagia). GERD patients receiving a Toupet fundoplication seem more likely to suffer from extraesophageal GERD symptoms 10 and 20 years after surgery than patients with a Nissen fundoplication. On the other hand, some patients with Nissen fundoplication report dysphagia even 10 and 20 years after surgery.ConclusionBoth the laparoscopic Nissen and Toupet fundoplications provide excellent symptom control in the long term. Moreover, the Nissen fundoplication seems to be superior in controlling extraesophageal reflux symptoms, but at the expense of dysphagia. In summary, tailoring the operation based on symptoms seems advantageous.

480. ANTIREFLUX SURGERY’S LIFESPAN: 20 YEARS AFTER LAPAROSCOPIC FUNDOPLICATION

Abstract Background Laparoscopic Fundoplication (LF) is the surgical technique of choice for treating GERD, but only few studies report a follow-up beyond 15 years. The aim was to evaluate the results at least 20 years after laparoscopic fundoplication at a single national referral center for esophageal diseases. Methods We prospectively collected data on a cohort of consecutive patients who underwent LF between 1992–2001. Patients were divided into two groups: a GERD group (patients with pathological esophageal acid exposure and hiatal hernias <3 cm) and a large hiatal hernia (HH) group (patients having type I > 3 cm and types II-IV hiatal hernias). Patients were followed up for at least 20 years using endoscopy, barium-swallow, esophageal manometry, and pH monitoring. LF was defined failed in case of: GERD symptom recurrence (SS > 10); recurrence of esophagitis; HH recurrence or slipped-fundoplication; pathological pH-monitoring; BE progression or adenocarcinoma onset. Results The study population consisted of 142 patients: 112 in the GERD group and 30 in the HH group. The characteristics of patients are shown on Figure 1. Conversion to open surgery proved necessary in 8 patients (5.6%). At a median follow-up of 22 years, 80.4% of the GERD patients and 63.3% of the HH patients were failure-free. Revisional surgery was necessary in 14 (9.8%) patients (9 GERD and 5 HH patients); indications were dysphagia (5 cases), slipped fundoplication or hernia recurrence (6 cases), abnormal pH-monitoring or esophagitis resistant to medical therapy (2 cases), and telescoping (one case). Two decades after LARS, 87.6% of GERD patients and 76.7% of HH patients were satisfied with the procedure. Conclusions The present study concerns one of the largest populations of patients who had undergone LF to have been followed up for more than 20 years at a single center. The findings showed that laparoscopic antireflux surgery is effective and durable (for >20 years) in patients with uncomplicated GERD and, to a lesser extent, in those with a large hiatal hernia. The satisfaction rate more than 20 years after surgery almost reached 90% in the GERD group.

A Higher Manometric Esophageal Length to Height Ratio in Achalasia Explains the Lower Prevalence of Hiatal Hernia.

The evidence suggests that a shorter esophageal length (EL) in gastroesophageal reflux (GERD) patients is associated with the presence of hiatal hernia (HH). However, there are no reports of this association in patients with achalasia. The aim is to (1) determine the prevalence of hiatal hernia in achalasia patients, (2) compare achalasia EL with GERD patients and healthy volunteers (HV), (3) measure achalasia manometric esophageal length to height (MELH) ratio, and (4) determine if there are differences in symptoms between patients with and without hiatal hernia. This retrospective and cross-sectional study consist of 87 pre-surgical achalasia patients, 22 GERD patients, and 30 HV. High-resolution manometry (HRM), barium swallow, and upper endoscopy were performed to diagnose HH. The EL and MELH ratio were measured by HRM. Symptoms were assessed with Eckardt, Eating Assessment Tool, and GERD-health-related quality of life questionnaires. The HH in GERD's prevalence was 73% vs 3% in achalasia patients (P < 0.001). Achalasia patients had a longer esophagus and a higher MELH ratio than HV and GERD patients (P < 0.001). GERD patients had a lower MELH ratio than HV (P < 0.05). EAT-10 (P < 0.0001) and Eckardt (P < 0.05) scores were higher in achalasia without HH vs HH. The prevalence of HH in achalasia is significantly lower than in GERD. The longer EL and the higher MELH ratio in achalasia could explain the lower prevalence of HH. Despite the low prevalence of HH in achalasia patients, the surgeon should be encouraged not to rule out HH since the risk of postoperative reflux may increase if this condition is not identified and corrected.

Alterations of the salivary microbiota in gastroesophageal reflux disease

ObjectivesGastroesophageal reflux disease (GERD) is among the most prevalent gastrointestinal disorders. The oral microbiota plays an important role in human health and may be altered by the presence of GERD. Here, we aimed to investigate the alterations of salivary microbiota in GERD patients. MethodsWe collected clinical information and salivary samples from 60 individuals. All participants underwent combined pH/impedance monitoring measurement and submitted samples for salivary microbiota sequencing. According to acid exposure time and DeMeester score, participants were divided into two groups: GERD + (Group G) and GERD – (Group C). ResultsThere was no significant difference in alpha diversity between study groups. Regarding beta diversity, principal coordinate analysis plots indicated that the microbiota composition data of the participants were grouped within partial overlapping clusters. The statistical analysis of the distance matrices was performed using the Adonis test (p = 0.017). Based on linear discriminant analysis effect size, the relative abundances of the phylum Bacteroidetes, class Bacteroidia, order Bacteroidales, family Prevotellaceae, and genus unidentified_Prevotellaceae were enriched in Group G. Compared with Group C, the phylum Actinobacteria, classes unidentified_Actinobacteria and Bacilli, orders Micrococcales and Lactobacillales, families Micrococcaceae and Streptococcaceae, and genuses Rothia and Streptococcus were decreased in Group G. At the genus level, the abundances of Streptococcus and Rothia were negatively correlated with DeMeester score and acid exposure time. ConclusionsThis study revealed alterations of the salivary microbiota in GERD patients, suggesting that acid reflux changes the oral ecosystem.

Gastroesophageal Reflux Characteristics in Supragastric Belching Patients With Positive Versus Negative pH Monitoring: An Evidence of Secondary Gastroesophageal Reflux Disease From Excessive Belching.

A high prevalence of GERD has been reported in patients with supragastric belching. We aim to evaluate reflux characteristics and explore the temporal relationship between supragastric belches (SGBs) and reflux episodes in GERD patients with excessive belching. Twenty-four hour esophageal pH-impedance monitoring was analyzed. Reflux episodes were classified into: refluxes preceded by SGBs, followed by SGBs, and lone refluxes. Reflux characteristics were compared between patients with pH-positive (pH+) and pH-negative(pH-). Forty-six patients (34 Female, age 47 ± 13 years) were included. Fifteen patients (32.6%) had pH+. Almost half (48.1 ± 21.0%) of refluxes were preceded by SGBs. The number of SGBs significantly correlated with the number of reflux episodes preceded by SGBs (r = 0.43, P < 0.05) and % time pH < 4 at the distal esophagus (r = 0.41, P < 0.05). Patients with pH+ had significantly more SGBs and reflux episodes preceded by SGBs/day than pH- patients (P < 0.05). The difference in the number of refluxes between pH+ and pH- patients was caused by reflux episodes preceded by SGBs, but not lone refluxes and refluxes followed by SGBs. The proportion of SGBs followed by reflux/total SGBs was similar between patients with pH+ and pH- (P > 0.05). Reflux episodes preceded by SGBs and followed by SGBs extended more proximal and had longer bolus and acid contact time than lone refluxes (P < 0.05). In patients with GERD and SGB, the number of SGBs positively correlates with the number of reflux episodes preceded by SGBs. Identifying and managing SGB may be beneficial and more likely to improve GERD.

Complacency in GERD an Imminent Disaster

Gastroesophageal reflux disease is one of the most common gastrointestinal disorders which is mainly characterized by problems with esophageal peristalsis, which is responsible for propelling food from the esophagus into the stomach or dysfunctional or weaker lower esophageal sphincter, which prevents the reflux to stomach contents.Typical symptoms involve heartburn, regurgitation of food, a sore taste in the mouth, and sometimes atypical symptoms like chest pain, signs of dental erosion and even breathlessness at night. There is also a trend of testing for helicobacter pylori in GERD patients which is absolutely not recommended at all as there is no evidence that eradication therapy will ease the symptoms.Instead, it has contributed to widespread antimicrobial resistance with physicians using them, which is otherwise a futile exercise. There is no need to try different proton pump inhibitors for a long time when there is no improvement in symptoms.The physicians in general practice should rather be generous in referring such patients on time to gastroenterology experts, as the treatment needs to be multidisciplinary and one should not be silent on sinister signs and symptoms if they are present. Endoscopy is already a safer option to screen such patients, which will suffice for the reassurance of the patients.

The association between GERD patients’ knowledge and development of complications in Makkah

The association between GERD patients’ knowledge and development of complications in Makkah

Comparing Gastroesophageal Reflux Disease (GERD) and Non-GERD Patients Based on Knowledge Level of Acute Myocardial Infarction Symptoms, Risk Factors and Immediate Action Taken in Eastern Province, Saudi Arabia.

A major cause of death globally is cardiovascular disease (CVD). Chest pain, nausea, vomiting, and heartburn are common symptoms of acute myocardial infarction (AMI). Chest pain is also the main symptom of gastroesophageal reflux disease (GERD). Therefore, the differential diagnosis of chest pain can become more challenging when GERD and AMI coincide. This study evaluated and compared the knowledge of the signs, symptoms, and immediate action that must be taken regarding AMI among GERD and non-GERD patients. An observational cross-sectional study using an online questionnaire was created and published between October and November 2022 to collect data from Saudi males and females 18 or older willing to participate in the study. Participants who were not Saudi had declined to complete the survey or had not fully completed it was excluded. The questionnaire contained three sections; after collecting informed consent, it made inquiries regarding respondents' GERD status, demographic information, and knowledge and attitudes regarding GERD. This study included 691 responses from 300 non-GERD participants and 391 GERD participants. The study showed a high level of awareness (75.5%) of GERD, with significant differences in the level of awareness according to marital status, education levels, and occupation status. There was no significant difference in the level of awareness according to gender and GERD diagnosis, where the p-value > 0.05. The most common source of information about AMI was the Internet, followed by health care professionals. The most commonly known symptoms of AMI were sudden pain or discomfort in the chest, followed by a sudden shortness of breath. Additionally, there was no significant association between the diagnosis of GERD and known risk factors. The association between GERD and other diseases (chi-square = 46.94, p-value 0.01). Obesity and smoking were the two main risk factors for heart attacks. This study demonstrated thatthere was no significant difference between GERD and non-GERD participants regarding the knowledge and awareness level of AMI. Moreover, it showed that there was a lack of general knowledge and awareness of AMI in Saudi Arabia.The authors recommend initiating more awareness programs in Saudi Arabia to inform people about AMI and cardiovascular disease. More research is required to determine whether other patients are aware of AMI.

Anxiety correlates with excessive air swallowing and PPI refractoriness in patients with concomitant symptoms of GERD and functional dyspepsia.

Anxiety may exacerbate GERD and FD symptoms perception and reduce quality of life. As many as 50% of patients with GERD symptoms have incomplete relief with PPI therapy, and psychological factors may influence PPI responsiveness. The potential relationship between anxiety, excessive air swallowing, and PPI responsiveness was evaluated. GERD patients with concomitant FD were prospectively evaluated. Validated structured questionnaires were used to evaluate anxiety, GERD, and FD symptoms. All patients were treated, within the previous year, with at least 8 weeks of standard dose PPI therapy. One hundred sixty-one patients were included. Frequency of non-responders in patients with moderate/severe anxiety was significantly higher compared to patients with mild anxiety (62.7% vs. 37.3%, p < 0.01). Patients with moderate/severe anxiety displayed a significantly higher mean FD symptoms score value compared to patients with mild anxiety. A significantly higher mean number of air swallows were observed in patients with moderate/severe anxiety. At ROC analysis, air swallows and mixed reflux episodes were significantly associated with the presence of PPI refractoriness (AUC: 0.725, 95% CI: 0.645-0.805 and 0.768, 0.692-0.843). According to univariate analysis, an abnormal number of air swallows, mixed reflux episodes and presence of moderate/severe anxiety was significantly associated with PPI refractoriness. Our results, if confirmed in in a larger, prospective clinical and therapeutic study, demonstrate the usefulness of an up-front evaluation with anxiety questionnaire and esophageal testing in patients with a broad spectrum of upper gastrointestinal symptoms who fail to respond to PPI treatment, supporting the option of alternative treatment modalities.

On-therapy impedance-pH monitoring can efficiently characterize PPI-refractory GERD and support treatment escalation.

On-therapy impedance-pH monitoring is recommended in patients with documented GERD and PPI-refractory heartburn in order to establish whether the unremitting symptom is reflux-related or not. To define on-PPI cut-offs of impedance-pH metrics allowing proper interpretation of on-therapy impedance-pH monitoring. Blinded expert review of impedance-pH tracings performed during double-dosage PPI, prospectively collected from 150 GERD patients with PPI-refractory heartburn and 45 GERD patients with PPI-responsive heartburn but persisting extra-esophageal symptoms. Acid exposure time (AET), number of total refluxes (TRs), post-reflux swallow-induced peristaltic wave (PSPW) index, and mean nocturnal baseline impedance (MNBI) were assessed. On-PPI cut-offs were defined and evaluated with ROC analysis and the area under curve (AUC). All the four impedance-pH metrics significantly differed between PPI-refractory and PPI-responsive heartburn cases. At ROC analysis, AUC was 0.73 for AET, 0.75 for TRs, 0.81 for PSPW index, and 0.71 for MNBI; best cut-offs were ≥1.7% for AET, ≥45 for TRs, ≤36% for PSPW index, and ≤ 1847 Ω for MNBI; AUC of such cut-offs was 0.66, 0.71, 0.73, and 0.68, respectively. Analysis of PSPW index and MNBI added to assessment of AET and TRs significantly increased the yield of on-therapy impedance-pH monitoring in the PPI-refractory cohort (97% vs. 83%, p < 0.0001). Notably, suboptimal acid suppression as shown by AET ≥1.7% was detected in 43% of 150 PPI-refractory cases. We have defined on-PPI cut-offs of impedance-pH metrics by which comprehensive assessment of impedance-pH tracings, including analysis of PSPW index and MNBI can efficiently characterize PPI-refractory GERD and support treatment escalation.

Proton pump inhibitors as treatment of laryngeal disorders among patients with gastroesophageal reflux disease: a single-arm (pre and post) quasi-experimental study

BackgroundLaryngopharyngeal reflux is a silent cause of laryngeal disorders which was documented in the last decade by many studies. This study aimed to evaluate the prevalence of laryngeal reflux in GERD cases and to evaluate the effect of GERD treatment on these laryngeal disorders.MethodologyIn this single-arm (pre and post) quasi-experimental study, eighty patients with GERD were examined for laryngeal disorders by rigid laryngoscopy and assessed by the Reflux Finding Score (RFS). Complaints of patients were evaluated using the 9-item Reflux Symptom Index (RSI) questionnaire. Patients received medical treatment of GERD in the form of proton pump inhibitors (PPIs) only, and they were reassessed after 3 months for improvement in their symptoms and signs using RSI and RFS systems to compare patient complaints and findings in the laryngeal endoscopy pre- and post-treatment.ResultsAmong 80 confirmed GERD cases, 70 (87.5%) suffered from laryngeal disorders. Throat clearing and postnasal drip were the most prevalent symptoms, and ventricular obliteration and erythema, vocal fold and diffuse laryngeal edema, and posterior commissure hypertrophy were the most detected signs. Significant improvement in both symptoms and signs after 3 months of PPI therapy was clearly observed. The resistance rate among our studied patients was reported to be 22.4%.ConclusionGERD can be considered as an inducer or cause of laryngeal disorders, with a significant direct proportional relationship between the severity of GERD and both the RSI and RFS. PPI greatly improves laryngeal disorders among GERD patients with a high response rate (77.6%).

Effects of caffeine and peppermint consumption on GERD patients in Saudi Arabia

Effects of caffeine and peppermint consumption on GERD patients in Saudi Arabia

Burning mouth syndrome and Reflux Disease: relationship and clinical implications.

An association between reflux and burning mouth syndrome (BMS) has been proposed. Aims of this study were: 1) to investigate the frequency of BMS in a sample of GERD patients; 2) to measure G17, in a sample of BMS patients; 3) to assess the efficacy of different therapeutical schedules for GERD in BMS patients. We divided the study in 3 main steps. In step one, we analyzed 500 consecutive GERD patients' type and frequency of extraesophageal manifestations including BMS. In step two, we collected 124 consecutive BMS patients' symptoms and G17. In step three, we evaluate the efficacy of 3 different drugs on BMS. In step one, 204 patients complained heartburn; 31 globus pharyngeus; 52 chronic cough; 54 pharyngitis; 31 postnasal drip; 56 burning mouth symptoms; 34 noncardiac chest pain; 17 asthma and 21 sleep apnea. In step two, 29 patients had G17 ≤ 1 pg/L; 64 patients between 1 and 3; and 31 patients ≥ 3. In step three, 49 patients reported slight benefit with PPI, 75 no benefit. 61 patients reported slight benefit with sodium alginate and sodium bicarbonate, 63 no benefit. 23 reported an almost complete remission with HYCHSA, 26 slight benefit, 33 no benefit. Prevalence of BMS in GERD patients was similar to that reported for chronic chough and pharyngitis. Low levels of G17 were found in the majority of BMS patients. Finally, we observed a greater benefit from barrier drugs therapy than from PPI therapy in BMS patients. (www.actabiomedica.it).

S423 Association Between Defective Secondary Peristalsis Detected by Functional Lumen Imaging Probe Topography (FLIP) and GERD

Introduction: Esophageal secondary peristalsis is a defense mechanism against GERD by clearance of refluxate. When absent or defective, it may lead to increased esophageal acid exposure time (AET). Functional lumen imaging probe topography (FLIP) allows assessment of secondary peristalsis induced by volumetric distension. Aim: evaluate the association between secondary peristalsis and GERD. Methods: We included patients with esophageal symptoms who underwent FLIP topography and reflux monitoring (wireless pH or catheter-based pH-impedance) while off PPI ≥7 days, high-resolution esophageal manometry (HRM) findings (LES pressure, ineffective esophageal motility , absent contractility) were added for secondary analysis when available. Exclusion criteria: achalasia, prior gastroesophageal surgery, Botox injection within 6 months of FLIP and reflux study. Abnormal AET on reflux monitoring was defined as % time pH< 4 greater than 4%. FLIP was performed with a 16 cm balloon during propofol-sedated endoscopy; peristaltic response was assessed at 30-40-50-60 ml and classified as repetitive antegrade contractions (RACs), borderline contractile response, repetitive retrograde contractions (RRCs), impaired, absent, and spastic reactive. EGJ distensibility index (DI) was calculated at 60ml. Secondary peristalsis was considered intact if RACs seen at any volume, impaired otherwise. Those with borderline contractility but no RACs were excluded from analysis.. We assessed the association between FLIP and HRM findings and GERD by t test and chi square. Results: 37 patients included (23, 62% female), mean age 58.45 years, mean BMI 25.7. GERD present in 15 (40.5%). Mean esophageal AET was lower in patients with versus without intact peristalsis but significance not reached (5.8% vs 3.0%, p=0.058). The proportion of patients with GERD was lower in patients with peristalsis versus without intact peristalsis but significance not reached (25% vs 40%, p=0.18). There was no association between GERD and DI or any HRM measures. Conclusion: Our data suggests that defective secondary peristalsis is more frequent in GERD patients and is thus and important contributing factor to reflux. Lack of significance may be due to small sample size and type II error, but a larger number of patients is needed to clarify this and data collection is ongoing.

A blood-based circulating microbial metagenomic panel for early diagnosis and prognosis of oesophageal adenocarcinoma.

Emerging evidence indicates the potential clinical significance of specific microbial signatures as diagnostic and prognostic biomarkers, in multiple cancers. However, to date, no studies have systematically interrogated circulating metagenome profiling in oesophageal adenocarcinoma (EAC) patients, particularly as novel non-invasive, early detection, surveillance and prognostic classifiers. Metagenome sequencing was performed on 81 serum specimens collected across EAC spectrum, with sequencing reads classified using Bracken and MetaPhlAn3. Followed by the Linear Discriminant Analysis effect size (LEfSe) method to identify microbial profiles between groups. Logistic regression and Kaplan-Meier analyses were used to build classifiers. A significant loss of alpha and beta diversity was identified in serum specimens from EAC patients. We observed a shift in microbial taxa between each group-at the phylum, genus, and species level-with Lactobacillus sakei as the most prominent species in gastroesophageal reflux (GERD) vs other patient groups. Interestingly, LEfSe analysis identified a complete loss of Lactobacillus (L. Sakei and L. Curvatus), Collinsella stercoris and Bacteroides stercoris but conversely a significant increase in Escherichia coli in patients with EAC. Finally, we developed a metagenome panel that discriminated EAC from GERD patients with an AUC value of 0.89 (95% CI: 0.78-0.95; P < 0.001) and this panel in conjunction with the TNM stage was a robust predictor of overall survival (≥24 months; AUC = 0.84 (95% CI: 0.66-0.92; P = 0.006)). This study firstly describes unique blood-based microbial profiles in patients across EAC carcinogenesis, that are further utilised to establish a novel circulating diagnostic and prognostic metagenomic signature for EAC. Accumulating data indicates the clinical relevance of specific microbial signatures as diagnostic and prognostic biomarkers, in multiple cancers. However, to date, no studies have systematically interrogated circulating metagenome profiling in patients with oesophageal adenocarcinoma (EAC). Herein, we performed metagenome sequencing in serum specimens from EAC patients 81 collected across EAC spectrum and observed a significant loss of alpha and beta diversity, with a shift in microbial taxa between each group-at the phylum, genus, and species level-with Lactobacillus sakei as the most prominent species in gastroesophageal reflux (GERD) vs other patient groups. Interestingly, LEfSe analysis identified a complete loss of Lactobacillus (L. Sakei and L. Curvatus), Collinsella stercoris and Bacteroides stercoris but conversely a significant increase in Escherichia coli in patients with EAC. Finally, we developed a metagenome panel that discriminated EAC from GERD patients with an AUC value of 0.89 and this panel, in conjunction with the TNM stage, was a robust predictor of overall survival. This study for the first time describes unique blood-based microbial profiles in patients across EAC carcinogenesis, that are further utilised to establish a novel circulating diagnostic and prognostic metagenomic signature for EAC.

CORRELATION BETWEEN SYMPTOMS AND REFLUX IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE.

Esophageal symptoms of gastroesophageal reflux are the same in functional heartburn, non-erosive disease, and erosive disease. Their patient-perceived intensity may be related to gastroesophageal reflux intensity. To evaluate whether the symptoms in GERD patients are related to the intensity of gastroesophageal acid reflux. To test this hypothesis, 68 patients with heartburn (18 with functional heartburn, 28 with non-erosive reflux disease, and 22 with erosive reflux disease) had their symptoms evaluated by the Velanovich score (which mainly focuses on heartburn) and the Eating Assessment Tool (EAT-10) (which focuses on dysphagia). They were submitted to esophageal endoscopy and then, on another day, they answered the Velanovich and EAT-10 questionnaires and underwent manometry and 24-hour pHmetry (measured 5 cm proximal to the upper border of the lower esophageal sphincter). The Velanovich score was higher in patients with non-erosive and erosive diseases than in those with functional heartburn. The mean EAT-10 score did not differ between functional heartburn, erosive, and non-erosive gastroesophageal reflux disease. Considering the threshold of ≥5 to define dysphagia, 4 (22%) patients with functional heartburn, 12 (43%) with non-erosive disease, and 9 (41%) with erosive disease had dysphagia (P=0.18). There was: a) a moderate correlation between the Velanovich and DeMeester score and between Velanovich score and the percentage of acid exposure time (AET); b) a weak correlation between EAT-10 and DeMeester score and between EAT-10 and acid exposure time. There is a moderate positive correlation between heartburn and gastroesophageal reflux measurement. Dysphagia has a weak positive correlation with reflux measurement.

Association between gastroesophageal reflux disease and coronary atherosclerosis.

Background and aimGastroesophageal reflux disease (GERD) typically presents with symptoms of heartburn and acid regurgitation but occasionally manifests as atypical chest pain. Coronary artery disease (CAD) and GERD share some risk factors, such as smoking and obesity. The aims of this study were to evaluate the association between GERD and coronary atherosclerosis and to assess the risk factors for coronary atherosclerosis in GERD patients.MethodsA total of 16616 subjects who underwent upper gastrointestinal endoscopy from 2003 to 2017 and a cardiac computed tomography (CT) scan within one year were included in this study. Coronary atherosclerosis was evaluated by the coronary artery calcium score (CACS). The severity of GERD was evaluated based on endoscopic findings using the Los Angeles classification.ResultsThe proportion of high CACSs (≥100) increased significantly in subjects with severe GERD (p = 0.008). However, the presence of a high CACS did not increase the risk of GERD (OR = 1.007, 95% CI 0.857–1.182), nor did that of GERD increase the risk of a high CACS (OR = 1.018, 95% CI 0.865–1.198). The risk factors for a high CACS in GERD patients included age (OR = 1.087, 95% CI 1.066–1.109), male sex (OR = 5.645, 95% CI 2.561–12.446), hypertension (OR = 1.800, 95% CI 1.325–2.446), and hypercholesterolemia (OR = 1.684, 95% CI 1.213–2.338).ConclusionsAlthough the presence of a high CACS did not increase the risk of GERD or vice versa, the proportion of high CACSs was significantly higher in subjects with severe GERD. Therefore, it might be helpful to assess the CACS in GERD patients with multiple risk factors.

Understanding Compliance, Practice Patterns, and Barriers Among Gastroenterologists and Primary Care Providers Is Crucial for Developing Strategies to Improve Screening for Barrett’s Esophagus

Understanding Compliance, Practice Patterns, and Barriers Among Gastroenterologists and Primary Care Providers Is Crucial for Developing Strategies to Improve Screening for Barrett’s Esophagus

The Impact of Ineffective Esophageal Motility on Patients Undergoing Magnetic Sphincter Augmentation.

To evaluate and characterize outcomes of MSA in patients with IEM. MSA improves patients with gastroesophageal reflux and normal motility. However, many patients have IEM, which could impact the outcomes of MSA and discourage use. An international, multi-institutional case control study of IEM patients undergoing MSA matched to normal patients was performed. Primary outcomes were new onset dysphagia and need for postoperative interventions. A total of 105 IEM patients underwent MSA with matching controls. At 1 year after MSA: GERD-Health Related Quality of Life was similar; DeMeester scores in IEM patients improved to 15.7 and 8.5 in controls ( P = 0.021); and normalization of the DeMeester score for IEM = 61.7% and controls = 73.1% ( P = 0.079).In IEM patients, 10/12 (83%) with preop dysphagia had resolution; 11/66 (17%) had new onset dysphagia and 55/66 (83%) never had dysphagia. Comparatively, in non-IEM patients, 22/24 (92%) had dysphagia resolve; 2/24 (8%) had persistent dysphagia; 7/69 (10%) had new onset dysphagia, and 62/69 (90%) never had dysphagia.Overall, 19 (18%) IEM patients were dilated after MSA, whereas 12 (11%) non-IEM patients underwent dilation ( P = 0.151). Nine (9%) patients in both groups had their device explanted. Patients with IEM undergoing MSA demonstrate improved quality of life and reduction in acid exposure. Key differences in IEM patients include lower rates of objective GERD resolution, lower resolution of existing dysphagia, higher rates of new onset dysphagia and need for dilation. GERD patients with IEM should be counselled about these possibilities.