Frequent Heartburn Research Articles

The effectiveness of esomeprazole 40 mg in patients with persistent symptoms of gastro-oesophageal reflux disease following treatment with a full dose proton pump inhibitor

Background:Some patients with gastro-oesophageal reflux disease (GORD) remain symptomatic despite proton pump inhibitor (PPI) treatment. There is a need to determine the most appropriate management of these patients.Aims:To assess the effectiveness of esomeprazole 40 mg in GORD symptoms persisting in patients receiving a full daily dose PPI.Methods:In this multi-centre open label study patients who had received full daily dose PPI for 8 weeks, but were still experiencing persistent GORD symptoms, were treated with esomeprazole 40 mg for 8 weeks (n = 99). The primary outcome variable was the change in the frequency of heartburn. Patient-reported outcomes were also assessed using the Reflux Disease Questionnaire (RDQ) and the GORD Impact Scale (GIS).Results:The mean frequency of heartburn was reduced by 78% from 4.4 days a week to 1 day a week at the end of the 8-week treatment period (p < 0.0001). Other GORD symptoms were also significantly reduced following of treatment with esomeprazole (all p < 0.0001). All RDQ dimensions and the level of symptom control as measured by the GIS also showed significant improvement at 8 weeks.Conclusions:In patients with persistent GORD symptoms despite full dose daily PPI therapy, esomeprazole 40 mg significantly improved the frequency and severity of all GORD symptoms.

Nationwide epidemiological study on gastroesophageal reflux disease and sleep disorders in the Japanese population

To elucidate the relationship between gastroesophageal reflux disease and sleep disorders in the Japanese population, we conducted a nationwide survey on the prevalence of heartburn, the cardinal symptom of the disease, and sleep disorders. Questionnaires regarding the frequency of heartburn and sleep disorders were distributed and endoscopic findings were assessed among patients who visited 35 participating institutions from March through September 2005, with a target sample size of 100 consecutive endoscopy patients per institution. A total of 2426 patients were included in the analysis population. The prevalence of gastroesophageal reflux disease in patients was 26.5% (n = 644). Mean sleeping time was 6.5 +/- 1.2 h, and 48.3% (n = 1172) of all patients reported experiencing sleep disorders. Sleep disorders were significantly more prevalent among patients with heartburn, at 56.3% (615/1093 patients, P < 0.0001), with the number of sleep disorder events increasing with the frequency of heartburn. Conversely, those with sleep disorders reported experiencing heartburn at a significantly higher rate (approximately 75%). However, sleep disorders occurred in only 51.6% (197/382) of patients with reflux esophagitis, showing no significant difference compared with those without reflux esophagitis. No definite tendency was seen in relation to the severity of reflux esophagitis. In Japanese people, patients with heartburn had a significantly higher prevalence of sleep disorders than those without heartburn.

Upper Gastrointestinal Symptoms and Associated Disorders in Morbidly Obese Patients: A Prospective Study

To prospectively evaluate the frequency of upper gastrointestinal symptoms and associated disorders in morbidly obese patients with endoscopy and histology prior to their gastric bypass surgery in comparison with age- and sex-matched nonobese control subjects. All patients who were scheduled to undergo laparoscopic gastric bypass for treatment of morbid obesity (body mass index, BMI > 40 kg/m(2)) during a 1-year period (n = 101) were included in the study. Age- and sex-matched nonobese patients who were seen in the medical clinics during the study period were enrolled as control subjects. The demographic data, total body weight, body mass index, and gastrointestinal symptoms were recorded, and the results of upper endoscopy and histology were tabulated. Endoscopic documentation of hiatal hernia, esophagitis, gastritis, gastric polyps, and peptic ulcer disease was also noted along with the histologic findings of the mucosal biopsies from the upper gastrointestinal tract. The prevalence of heartburn as a symptom was significantly higher (P < 0.05) in the morbidly obese patients (32.6%) compared with in the control group (18.8%). Endoscopically, the prevalence of hiatal hernia was also significantly higher (P < 0.05) in the morbidly obese group (38.6%) compared with in the control group (13.8%). Similarly the frequency of endoscopically and histologically identified gastritis was significantly higher (P < 0.01) in the morbidly obese patient group. However, the frequency of histologically identified Helicobacter pylori was not statistically different in the two groups. These observations suggest a significant increase in the frequency of heartburn, hiatal hernia, and histologically identified gastritis in morbidly obese patients.

Prevalence of Symptoms and Use of Medication for Gastroesophageal Reflux in an Australian Community

Gastroesophageal reflux disease is common in Western societies, although the prevalence of reflux symptoms in the community is not well described. In this study we determined the prevalence of symptoms of gastroesophageal reflux and other "esophageal" symptoms, and the consumption of medication for reflux in an Australian community. A population sample designed to accurately reflect the characteristics of the population aged 15 years or older in the State of South Australia was studied. Demographic data; symptoms specific to reflux, dysphagia, and abdominal bloating; and the consumption of antireflux medication were determined in a face-to-face interview. The frequency and severity of heartburn and dysphagia were assessed with analog scales. A total of 2,973 people (age range: 15-95 years) were interviewed between September and December 2006. Approximately half experienced the symptom of heartburn; 21.2% experienced heartburn at least once a month, and 12.4% described frequent symptoms of heartburn (at least a few times each week). Of those with heartburn, 25.0% graded it as moderate or severe, 10.9% reported some dysphagia for solid foods, and 6.9% reported dysphagia for liquids. 3.7% described dysphagia for solids at least once a month. Abdominal bloating was reported by 48.2%. 16.9% were taking medications for reflux symptoms (10.1% proton pump inhibitors, 1.2% H2-receptor antagonists, 2.1% simple antacids, 3.4% alternative medications). Heartburn was more common in individuals who consumed medication. There were significant associations between heartburn and bloating, and between heartburn and dysphagia. Symptoms of gastroesophageal reflux and the use of medications to treat such symptoms are very common in the community of South Australia. Nearly 1 in 7 people over the age of 15 consume medication for the treatment of symptoms of reflux.

Gastro-oesophageal reflux disease and irritable bowel syndrome: a significant association in an Iranian population

Gastro-oesophageal reflux disease and irritable bowel syndrome are common diseases, which may be related. To assess the association between gastro-oesophageal reflux disease and irritable bowel syndrome in a country with high prevalence of Helicobacter pylori. This study was designed as cross-sectional and population-based in Tehran province, Iran. The participants were interviewed by using a valid and reliable questionnaire. Gastro-oesophageal reflux disease was defined by weekly or more frequent heartburn and/or acid regurgitation. Irritable bowel syndrome was diagnosed according to the Rome III. The association between these two disorders was calculated using a statistical model that allows the odds ratio (OR) to be measured. A total of 6526 individuals were selected randomly, the response rate was 87.8%. Among the respondents, 178 (3.1%) participants reported both the diseases. The OR of having gastro-oesophageal reflux disease and irritable bowel syndrome together was estimated to be 16.55 (95% confidence interval: 12.85-21.33) indicating significant association between the two diseases. Thirty-four percent of patients with gastro-oesophageal reflux disease and 61.5% with irritable bowel syndrome suffered from both diseases. Sex did not have a significant effect on the OR of coexistence. Older participants were statistically more prone to the coexistence of two diseases. The association between gastro-oesophageal reflux disease and irritable bowel syndrome was significantly higher in our community compared with others. Their association occurs predominantly in older participants. Further studies for understanding of the pathophysiological mechanisms behind these two diseases are required.

Validation of a Four-Graded Scale for Severity of Heartburn in Patients with Symptoms of Gastroesophageal Reflux Disease

Objectives To evaluate the reliability, responsiveness, and validity of a four-graded symptom severity scale (none, mild, moderate, severe) and an eight-graded frequency scale (number of days with symptoms during past week) for assessment of heartburn severity and frequency in patients with symptoms of heartburn but without esophagitis. Methods Data were taken from two 4-week clinical trials comparing esomeprazole 20 mg and/or 40 mg to omeprazole 20 mg. Both scales were analyzed in terms of mean scores and treatment success rates, after dichotomization to “treatment success” variables. Results Heartburn severity reliability was higher when assessed by patient diary cards than by the investigator (intraclass correlation coefficients were 0.79 and 0.59, respectively; corresponding figures for heartburn frequency were 0.77 and 0.78). There was good agreement between investigator and diary card assessments for the dichotomized variables “complete resolution” and “adequate relief” from heartburn. High correlation between investigator- and diary card-assessed heartburn severity and frequency was apparent. Responsiveness was high, as shown by comparing 4-week treatment success rates to the patients' perception of treatment effect according to the Overall Treatment Effect questionnaire. Construct validity was good (kappa values approximately 0.70 for agreement between complete resolution and the dichotomized Gastrointestinal Symptom Rating Scale [GSRS] Heartburn item). Correlations between heartburn severity and frequency and the GSRS Heartburn item were similarly high. Conclusion The four-graded heartburn severity and eight-graded frequency scales are reliable, responsive, and valid when used in clinical trials of patients with symptoms of gastroesophageal reflux disease, irrespective of the type of assessment (investigator assessment or patient diary cards).

Does Concomitant Anterior Fundoplication Promote Dysphagia after Laparoscopic Heller Myotomy?

Concerns for gastroesophageal reflux after laparoscopic Heller myotomy for achalasia justify considerations of concomitant anterior fundoplication. This study was undertaken to determine if concomitant anterior fundoplication reduces symptoms of reflux after myotomy without promoting dysphagia. From 1992 to 2004, 182 patients underwent laparoscopic Heller myotomy without fundoplication. After a prospective randomized trial justified its concomitant application, anterior fundoplication was undertaken with laparoscopic Heller myotomy in 171 patients from 2004 to 2007. All patients have been prospectively followed. Pre and postoperatively, patients scored the frequency and severity of symptoms of achalasia (including dysphagia, choking, vomiting, regurgitation, chest pain, and heartburn) using a Likert Scale (0 = never/not bothersome to 10 = always/very bothersome). Before myotomy, symptoms of achalasia were frequent and severe for all patients. After myotomy, the frequency and severity of all symptoms of achalasia significantly decreased for all patients (P < 0.001, Wilcoxon matched pairs test). Notably, relative to patients undergoing laparoscopic Heller myotomy alone, concomitant anterior fundoplication led to significantly less frequent and severe heartburn after myotomy (P < 0.05, Mann-Whitney Test) and to less frequent and severe dysphagia and choking (P < 0.05, Mann-Whitney Test). Laparoscopic Heller myotomy reduces the frequency and severity of symptoms of achalasia. Concomitant anterior fundoplication decreases the frequency and severity of heartburn and dysphagia after laparoscopic Heller myotomy. Concomitant anterior fundoplication promotes salutary relief in the frequency and severity of symptoms after myotomy and is warranted.

Are upper gastrointestinal symptoms associated with exacerbations of COPD?

Dear Editor: Upper gastrointestinal (GI) symptoms are common in the general population and they are usually divided into dyspepsia and gastro-oesophageal reflux disease (GERD) (1). Previous studies have reported a high prevalence of GERD in respiratory disorders (2, 3). In contrast to asthma, the prevalence and the exact association between upper GI and respiratory symptoms is not well recognised in the setting of chronic obstructive pulmonary disease (COPD) (4-6). Recently, we have evaluated prospectively 79 consecutive patients (64 men, mean age 73 ± 11 years) with known history of COPD established with pulmonary function tests. At the day of evaluation, demographic and clinical data including smoking and alcohol status, coffee consumption, coexistent diseases/medication and body mass index were recorded. In each patient, the frequency and severity (using a scale from zero to four) of GERD symptoms (heartburn and/or regurgitation) as well as dyspepsia symptoms (such as nausea, hunger pain in the stomach and/or stomach ache) during the previous year were evaluated. In addition, the number of COPD exacerbations (defined as episodes of worsening dyspnoea, cough, wheezing, increased inhaler/antibiotics use or admission to the hospital because of respiratory symptoms) during the last year were also assessed. Multivariable linear regression analysis was used to identify the independent risk factors associated with the number of exacerbations of COPD. In our cohort, 45 (57%) patients reported at least one monthly episode of GERD symptoms (heartburn and/or regurgitation). Thirty-two (40.5%) and 36 (46%) patients had heartburn and regurgitation during the last year respectively. In addition, 56 (71%) patients had one or more episodes of dyspepsia per month. Exacerbations of COPD occurred at a median of three (range 0–14) times in the previous year. Forty-seven patients [60%, group 1: 42 men, 71 ± 10 years, forced expiratory volume in 1 s (FEV1): 1.3 ± 0.42 l] had ≤ 3, and 32 (40%, group 2: 22 men, 75 ± 9 years, FEV1: 1.4 ± 0.35 l) had > 3 exacerbations of COPD. In the univariate analysis, group 1, compared with group 2 patients, had less frequent regurgitation (p < 0.001), heartburn (p = 0.05), stomachache (p = 0.002) and nausea (p = 0.002) and used less frequently oxygen therapy (p = 0.05). Medications (e.g. proton pump inhibitors, non-steroidal anti-inflammatory drugs) and pulmonary function tests [forced vital capacity, FEV1, FEV1 (%) and peak expiratory flow (PEF)] were not significantly different between the two groups of patients. In addition, none of the patients was under theophylline therapy, while administration of inhaled corticosteroids was not significantly different between the two groups (78% vs. 81%, p > 0.05). The independent factors associated with > 3 exacerbations of COPD were regurgitation (p < 0.001) and nausea (p = 0.05) (Table 1). Interestingly, patients with ≥ 1 episodes of nausea per month, compared with those without nausea, had significantly lower PEF (45 ± 18 vs. 72 ± 26, respectively, p = 0.01). Severity of GERD symptoms was not significantly associated with exacerbations of COPD. It is estimated that GERD symptoms once or more per month occur in 40% of general adult population (5). In accordance with previous studies (5, 7), we found that our COPD patients had higher prevalence of GERD symptoms per month (57%). On the other hand, frequent exacerbations of respiratory symptoms may have a negative impact on lung function and their prevention should be a major target in COPD (8). Although the exact relationship between COPD and GERD is not well established (5, 7), we found that the number of COPD exacerbations was significantly associated with GERD symptoms (regurgitation). Thus, similar to asthma, GERD may exacerbate COPD symptoms and/or vice versa. In addition, for the first time, we evaluated dyspepsia symptoms and we found that nausea was also significantly associated with exacerbations of COPD and it was recorded significantly more frequently in patients with advanced COPD (as detected by PEF). We believe that these findings may have important preventive and therapeutic implications and may further elucidate the mechanisms, which are implicated in pathogenesis and exacerbations of COPD/GERD symptoms.

Clinical, Radiological, and Manometric Profile in 145 Patients with Untreated Achalasia

Esophageal achalasia is characterized by the absence of esophageal peristalsis and by a dysfunctional lower esophageal sphincter (LES). Descriptions of clinical, radiological, and manometric findings in patients with achalasia usually have been based on small numbers of patients. This study was designed to determine in patients with untreated achalasia: (1) clinical presentation; (2) how often a diagnosis of gastroesophageal reflux disease (GERD) was erroneously made based on the presence of heartburn; (3) manometric profile; (4) relationship between chest pain and the manometric finding of vigorous achalasia. Between 1990 and 2004, a diagnosis of esophageal achalasia was established in 145 patients. None of them had been previously treated (no previous endoscopic or surgical treatment). We evaluated the demographic and clinical characteristics, as well as the results of the endoscopy, barium swallow, esophageal manometry, and ambulatory pH monitoring. We also compared the clinical and the manometric profile of patients with classic and patients with vigorous achalasia. Most patients with untreated achalasia had dysphagia (94%). Regurgitation was present in 76% and heartburn in 52%. Chest pain (41%) and weight loss (35%) were less common. Acid-suppressing medications had been prescribed to 65 patients (45%) who complained of heartburn on the assumption that GERD was present. The LES was hypertensive in 43% of patients only. There was no significant difference in the prevalence, severity, and duration of chest pain in patients with classic and with vigorous achalasia. These results show that in patients with untreated achalasia: (1) dysphagia was the most frequent complaint, but regurgitation and heartburn were frequently present; (2) a diagnosis of GERD based on the presence of heartburn was highly unreliable; (3) the LES was hypertensive in less than half of patients; and (4) the prevalence, severity, and duration of chest pain did not correlate with the manometric finding of vigorous achalasia.

Effect of Heartburn on Life Expectancy

Effect of Heartburn on Life Expectancy

Inverse association between gastroesophageal reflux and blood pressure: Results of a large community based study

BackgroundIn a cross-sectional community based study, as part of a randomised controlled trial of eradication of Helicobacter pylori infection, the association between blood pressure and symptoms of gastro-oesophageal reflux was examined.MethodsLinear regression was used to examine the association between systolic and diastolic blood pressure and the frequency of heartburn and acid regurgitation in 4,902 of 10,537 participants aged 20–59 years.ResultsIn multivariable analyses, adjusted mean systolic blood pressure was 4.2 (95% confidence interval 1.5 to 7.0) mm Hg lower in participants with daily acid regurgitation compared to those with less frequent symptoms. Similarly, for diastolic blood pressure, a reduction of 2.1 (0.0 to 4.3) mm Hg wasobserved.ConclusionPeople who experience daily symptoms of gastro-oesophageal reflux have lower blood pressure than people with less frequent or no symptoms. It is possible that factors influencing nitric oxide concentrations both at the lower oesophageal sphincter and within the vasculature may be involved. This hypothesis requires confirmation.Trials registration numberISRCTN44816925

Gastroesophageal Reflux Disease (GERD): Is There More to the Story?

Gastroesophageal reflux disease (GERD) affects both men and women worldwide, with the most common symptom of GERD being frequent heartburn. If left untreated, more serious diseases including esophagitis and/or esophageal cancer may result. GERD has been commonly held to be the result of gastric acid refluxing into the esophagus. Recent work, however, has shown that there are acid-producing cells in the upper aerodigestive tract. In addition, acid-producing bacteria located within the upper gastrointestinal tract and oral cavity may also be a contributing factor in the onset of GERD. Proton pump inhibitors (PPIs) are commonly prescribed for treating GERD; these drugs are designed to stop the production of gastric acid by shutting down the H(+)/K(+)-ATPase enzyme located in parietal cells. PPI treatment is systemic and therefore significantly different than traditional antacids. Although a popular treatment choice, PPIs exhibit substantial interpatient variability and commonly fail to provide a complete cure to the disease. Recent studies have shown that H(+)/K(+)-ATPases are expressed in tissues outside the stomach, and the effects of PPIs in these nongastric tissues have not been fully explored. Likewise, acid-producing bacteria containing proton pumps are present in both the oral cavity and esophagus, and PPI use may also adversely affect these bacteria. The use of PPI therapy is further complicated by the two philosophical approaches to treating this disease: to treat only symptoms or to treat continuously. The latter approach frequently results in unwanted side effects which may be due to the PPIs acting on nongastric tissues or the microbes which colonize the upper aerodigestive tract.

T2016 Novel Integration of Video and pH/Impedance Recording Coupled with Cardiorespiratory Monitoring for Evaluation of Pediatric Gastroesophageal Reflux Disease

for diagnostic work-up in a usual clinical care setting and the clinical predictors of response/ non-response. This abstract summarizes the interim analysis after recruitment of 100 patients. METHODS: One hundred patients referred for endoscopic assessment of suspected GERD within a single metropolitan area health service were recruited; 82 consecutive patients from the Royal Adelaide Hospital (RAH) and 28 from the Lyell McEwen Health Centre (LMH). Symptoms and psychological co-morbidities were assessed utilizing the Bowel Disease Questionnaire, the Hospital Anxiety and Depression Scale and the Nepean Dyspepsia Index. Questionnaires were mailed to the patients. Data on endoscopic findings at referral using the Los Angeles (LA) classification were included. As this was an observational study, routine clinical management by the referring GP was not altered. RESULTS: 68 patients were on proton pump inhibitor (PPI) therapy while 31 patients did not receive the treatment. In 58 patients endoscopy revealed no visible esophagitis. The frequency of heartburn was significantly associated with the presence of hiatal hernia but the frequency of reflux symptoms was not linked to the presence or severity of endoscopic lesions. Follow-up data > 2 month were available for 38 patients. Out of these 86.8% continued to have heartburn and 76.3% an acid taste after more than 2 months of treatment. The symptomatic response to PPI was significantly better (p 0.05). 36% of patients reported a history of anxiety and depression but these disorders were not correlated with symptom frequency or response to PPI therapy. CONCLUSIONS: a) Frequency of GERD symptoms is not associated with severity of mucosal lesions; b) presence of a hiatal hernia is linked to more frequent symptoms; c) presence of a hiatal hernia predicts a favourable response to PPI therapy.

W1806 The Frequency of Functional Heartburn (Fh) and Other Gastroesophageal Reflux (GER)-Related Symptoms in Subjects with IBS in the Community Is Higher Than That of the Controls, and More Likely Among Those with An Abnormal Body Mass Index (BMI)

W1806 The Frequency of Functional Heartburn (Fh) and Other Gastroesophageal Reflux (GER)-Related Symptoms in Subjects with IBS in the Community Is Higher Than That of the Controls, and More Likely Among Those with An Abnormal Body Mass Index (BMI)

Validation of the reflux disease questionnaire for an Italian population of patients with gastroesophageal reflux disease

The reflux disease questionnaire (RDQ) is a very simple questionnaire based on only 12 questions that can be answered and evaluated quickly in a primary care setting, which was already found to be valid and reliable in the diagnosis of gastroesophageal reflux disease (GERD). As an English and a German version of the RDQ exist, but not an Italian one, we aimed at translating the RDQ into Italian and evaluating its reliability for the use of Italian-speaking GERD patients. For the purpose of linguistic validation, we translated backward and forward the original RDQ into Italian and again into English. For the purpose of assessing internal consistency, test-retest, and interrater reliability, 130 GERD patients were used, of whom 57 patients had an endoscopic oesophagitis of grade A to C according to the Los Angeles classification and 63 patients had uninvestigated GERD symptoms but with a frequency of heartburn and/or regurgitation at least twice a week. After professional translation, the Italian RDQ was judged to retain fully the meaning of the original RDQ. Internal consistency, as judged by the (Cronbach's alpha) was satisfactory, with an overall RDQ scale alpha=0.86 (minimum acceptable value=0.70). Test--retest reliability (Spearman coefficient) was again found to be optimal, with individual item values ranging between 0.74 (for 'pain in the upper stomach: frequency') and 0.90 (for 'burning feeling behind breastbone: severity'). Finally, the correlation coefficient was 0.96 for the total scale and a range of 0.85-0.98 for individual items, indicating extremely satisfactory concordance. The Italian RDQ appears to be a simple, reproducible, and reliable tool for the diagnosis of GERD. We believe that this questionnaire is well suited for use, both in primary care settings and in epidemiological studies, in particular for the assessment of so-called typical symptoms.

Correlation of gastroesophageal reflux disease symptoms with body mass index

Background/Aim:To find a correlation between symptoms of gastroesophageal reflux disease (GERD) and body mass index (BMI).Materials and Methods:A total of 603 patients who presented at Ghurki Trust Teaching Hospital and Surgimed Hospital Lahore with symptoms of GERD, were included and interviewed according to a validated GERD questionnaire. It included questions regarding GERD symptoms and their severity/frequency. Symptoms were defined: “frequent” if occurred daily; “occasional,” if weekly; and “severe,” if they were sufficiently intense to change lifestyle. Height and weight were also recorded and their BMI calculated. We used logistic regression analysis was performed to assess the association between the presence of each specific GI symptom and BMI. The odds ratios (OR) for a given specific symptom and 95% confidence intervals (CI) were computed from the coefficients in logistic regression models.Results:The prevalence of obesity was 25.3%, while 38.1% were overweight. There was an increase in reporting of GI symptoms in obese individuals compared to those with normal BMI who were taken as reference group. Frequent nausea, vomiting, early satiety, epigastric pain, heart burn, regurgitation, postprandial fullness, and dysphagia were present in 10.4, 5.6, 8.9, 17.2, 10.2, 22.1, 23.5, and 21.7%, respectively, of obese subjects compared to 7.9, 1.2, 6.5, 3.5, 4.4, 11.4, 17.1, and 16.6% of normal BMI subjects. BMI showed a positive relationship with frequent vomiting (P = 0.02), epigastric pain (P = 0.03), regurgitation of food (P = 0.02), heart burn (P = 0.002), and postprandial fullness (0.01).Conclusion:The majority of GERD symptoms have a greater likelihood of occurring with increasing BMI.

“Redo” Fundoplications: Satisfactory Symptomatic Outcomes With Higher Cost of Care

With ever greater numbers of fundoplications being undertaken, inevitably there will be an increase in the number of failed fundoplications, which will be considered for operative revision. This study was undertaken to compare the hospital costs of and outcomes after "redo" fundoplications to those of "first time" fundoplications. Patients undergoing anti-reflux surgery were prospectively followed. From 2000 to 2006, costs of and outcomes after 76 "redo" fundoplications were compared with 76 concurrent "first time" fundoplications. Prior to and after fundoplication, patients scored the frequency and severity of many symptoms, including dysphagia, chest pain, regurgitation, choking, and heartburn, using a Likert scale (0 = none/never, 10 = severe/always). The cost of care, including medical equipment, operating room expenses, and anesthesia was determined with standardization to 2006 cost and dollars. Data are presented as median (mean +/- standard deviation) where appropriate. Prior to "redo" fundoplications, patients reported significantly greater dysphagia frequency and severity scores and significantly greater chest pain severity. DeMeester scores for patients undergoing "redo" fundoplications versus "first time" fundoplications were similar (45 (62 +/- 55.6) versus 39 (44 +/- 27.7)). After fundoplication, dysphagia frequency and severity significantly improved for all patients. Length of stay was significantly longer for patients requiring "redo" fundoplications [3 d (6 +/- 8.5) versus 1 d (3 +/- 7.6)]. Hospital costs for patients undergoing "redo" fundoplications were significantly greater. Patients requiring re-operative fundoplications report more frequent and severe symptoms, especially of dysphagia, when compared with patients undergoing "first-time" fundoplications. Laparoscopic "redo" fundoplications are technically challenging, more expensive, and more morbid (e.g., longer hospital stays). However, symptoms of reflux and dysphagia are ameliorated with "redo" fundoplications and application of "redo" fundoplication is warranted.

Psychometric validation of the Japanese translation of the Quality of Life in Reflux and Dyspepsia questionnaire in patients with heartburn

The purpose of this study was to document the psychometric characteristics of the Japanese translation of the Quality of Life in Reflux and Dyspepsia (QOLRAD-J) questionnaire in patients with heartburn. Patients with heartburn or acid regurgitation and healthy subjects completed the QOLRAD-J and the Japanese version of the Short-Form 36-Item (SF-36) Health Survey. Overall, 224 patients with heartburn and 24 healthy subjects entered the study; 72% of patients had heartburn 1-3 days per week; 84% reported their symptoms as mild. Psychometric validation of the QOLRAD-J showed that factor loadings were >0.55 for 19 of the 25 items in the five-factor structure. Pearson correlation coefficients for inter-item correlations in the same domain were all >0.30, demonstrating reliability. The internal consistency reliability was good (Cronbach's alpha, 0.83-0.94). Inter-item correlations between domains ranged from 0.70 to 0.80, indicating strong correlations. Each QOLRAD-J domain correlated positively with at least five of the eight SF-36 domains (Pearson r >or= 0.3). Negative correlations between the QOLRAD-J and patient-reported frequency and severity of heartburn symptoms indicated decreasing quality of life with increasing symptoms. All domains of the QOLRAD-J were able to differentiate between groups of patients whose health status differed according to severity and frequency of heartburn, thus confirming the known-groups validity. Patients with heartburn had clinically significant decreases in SF-36 scores compared with the Japanese general population. The psychometric characteristics of the QOLRAD-J demonstrated good validity and reliability. The QOLRAD-J can be used to assess quality of life in Japanese patients with heartburn.

Characteristics of Patients with Reflux Esophagitis, Non-Erosive Reflux Disease and Functional Heartburn

Purpose: Patients with non-erosive reflux disease (NERD) account for up to 70% of the gastroesophageal reflux disease (GERD) population and represent a heterogenous group. Our aim was to compare the demographics and clinical characteristics of patients with reflux esophagitis (RE), NERD, and functional heartburn (FH). Methods: We reviewed the medical records of 81 consecutive patients with frequent heartburn and regurgitation on whom Bravo™ capsule 48-h esophageal pH monitoring was performed after capsule placement under endoscopic guidance. Patients were instructed to stop taking acid-suppressive therapy at least 7 days before the pH study. An abnormal study was defined as either a DeMeester score ≥ 14.72 or a mean acid exposure time (the percentage of time pH less than 4) ≥ 4.5%. Patients with esophageal mucosal injury observed during capsule placement or during a prior endoscopy comprised the RE group. The remaining patients were divided into two groups according to pH monitoring study results: NERD (those with an abnormal pH study) and functional heartburn (FH) (those with a normal pH study). Chi-square and t-test were used to compare categorical and continuous data between groups. Results: Of 81 patients, 28 (35%) were in the RE group, 27 (51%) comprised the NERD group and 26 (49%) met our criteria for the FH group. No statistically significant difference was found between the three groups in distribution with respect to age, prevalence of hiatal hernia, and presenting symptoms, except that patients with RE had more respiratory symptoms (cough, hoarseness, shortness of breath) compared to patients with NERD or FH (See Table), and patients with FH were more likely to be female. Interestingly, only 16 of 28 RE patients had an abnormal pH study. Conclusion: Patients with RE experience more respiratory symptoms compared to patients with NERD or FH. As only 57% of RE patients had an abnormal pH study, factors other than acid exposure may contribute to the development of esophagitis. FH is more common in women than men.Table

Epidemiology of gastroesophageal reflux disease in Tehran, Iran

Epidemiological studies have indicated an increase in the prevalence of gastroesophageal reflux disease in Western countries; however, there is a lack of information about its prevalence in Iran. The aim of this study was to measure gastroesophageal reflux disease prevalence in a representative sample of the Tehran population in 1999. In a cross-sectional study, 700 people, with a male : female ratio of 1:1, were selected by stratified randomization based on the probability of 20% prevalence of gastroesophageal reflux disease and 3% error. They were divided equally into seven age groups. Heartburn and acid regurgitation were considered as the most common symptoms of gastroesophageal reflux disease. The severity and frequency of heartburn and the role of personal habits in the appearance of this symptom were determined. The prevalence of gastroesophageal reflux disease in samples was measured, and its actual prevalence in society was estimated. Of 700 people, 350 were male and 350 were female. The major symptoms of gastroesophageal reflux disease were observed in 278 (39.7%) people. The prevalence of gastroesophageal reflux disease of smokers was twice that of non-smokers. Gastroesophageal reflux disease is a serious and unresolved problem in Western countries, and its increasing prevalence correlates with an increasing prevalence of adenocarcinoma of distal esophagus. The prevalence of gastroesophageal reflux disease appears to be increasing in Iran also; therefore, it is recommended that major attention be paid to this disease.