Heartburn Symptoms Research Articles

Topic Modeling Analysis of Chinese Medicine Literature on Gastroesophageal Reflux Disease: Insights into Potential Treatment.

To analyze Chinese medicine (CM) prescriptions for gastroesophageal reflux disease (GERD), we model topics on GERD-related classical CM literature, providing insights into the potential treatment. Clinical guidelines were used to identify symptom terms for GERD, and CM literature from the database "Imedbooks" was retrieved for related prescriptions and their corresponding sources, indications, and other information. BERTopic was applied to identify the main topics and visualize the data. A total of 36,207 entries are queried and 1,938 valid entries were acquired after manually filtering. Eight topics were identified by BERTopic, including digestion function abate, stomach flu, respiratory-related symptoms, gastric dysfunction, regurgitation and gastrointestinal dysfunction in pediatric patients, vomiting, stroke and alcohol accumulation are associated with the risk of GERD, vomiting and its causes, regurgitation, epigastric pain, and symptoms of heartburn. Topic modeling provides an unbiased analysis of classical CM literature on GERD in a time-efficient and scale-efficient manner. Based on this analysis, we present a range of treatment options for relieving symptoms, including herbal remedies and non-pharmacological interventions such as acupuncture and dietary therapy.

Pharmacological Evaluation of the Traditional Brazilian Medicinal Plant Monteverdia ilicifolia in Gastroesophageal Reflux Disease: Preliminary Results of a Randomized Double-Blind Controlled Clinical Trial.

The present work aimed to compare the effects of the standardized dry extract from the leaves of Monteverdia ilicifolia, popularly known as "espinheira-santa", with omeprazole in the management of dyspepsia related to gastroesophageal reflux disease (GERD). A double-blind, randomized, non-inferiority and double-dummy clinical trial was conducted. In total, 86 patients with GERD symptoms were randomized into three groups: Omeprazol (20 mg), M. ilicifolia (400 mg), or M. ilicifolia (860 mg). Capsules were provided by SUSTENTEC®, Pato Bragato, Brazil. It was requested that the participants take three capsules before breakfast and dinner for 4 weeks. Clinical outcomes were obtained at the beginning and end of the study, with GERD symptoms (QS-GERD), the impact of heartburn symptoms on quality of life (HBQOL), and medical records. Overall, 75.6% of the participants showed adherence without any differences among the experimental groups. All groups had significant reductions in both QS-GERD and HBQOL scores. Omeprazole and 400 and 860 mg of M. ilicifolia decreased the QS-GERD total scores at the endpoint compared to the baseline (Chi-square = 129.808; p < 0.0001), as well as individual item scores, such as heartburn intensity (Chi-square = 93.568, p < 0.0001) and heartburn after meals (Chi-square = 126.426, p < 0.0001). There were no differences among the experimental groups after the intervention. Our results suggest that capsules with a standardized dry extract from the leaves of M. ilicifolia at a dosage of 400 or 860 mg are non-inferior to omeprazole, a proton pump inhibitor.

Changes Over Time in Masseter Muscle Activity, Symptoms of Discomfort, Stress Level and Salivary Flow Rate Following Intra-Oesophageal Acid Infusion.

Intra-oesophageal acid stimulation increases masseter muscle activity. However, the infusion speeds used in previous studies are significantly slow, with minimal acid volume (30 mL over 30 min). Additionally, it is unclear how masseter muscle activity, symptoms of discomfort, stress levels and saliva quantity change over time. The time course of masseter muscle activity, heartburn and discomfort symptoms, salivary cortisol concentration to assess stress, autonomic nervous system (ANS) activity and saliva quantity under the influence of intra-oesophageal acid infusion were evaluated at a faster injection rate and larger volume than in previous studies. Ten healthy adults underwent polygraphic monitoring, consisting of electromyography of the masseter muscle and electrocardiography during intra-oesophageal acid infusion (10 mL/min, 10 min). Symptoms of heartburn and discomfort were assessed using the visual analogue scale (VAS), and saliva quantity was measured. Friedman's test was used for multiple comparisons. Masseter muscle activity, VAS scores for heartburn and discomfort, as well as saliva quantity during the 10-min acid infusion, increased significantly compared with that before acid infusion (p < 0.001, 0.001, 0.019 and 0.047, respectively) and decreased 10 and 20 min after acid infusion (p = 0.004, 0.004 and 0.007, respectively). No significant changes were observed in the salivary cortisol concentration or ANS activity. Intra-oesophageal acid infusion stimulated symptoms of heartburn and discomfort and increased masseter muscle activity and saliva production, which may not be related to psychological stress.

Case Study : Observation of Reducing Heartburn Pain in Gastroesophageal Reflux Disease (Gerd) With Hypnotherapy

Hypnotherapy is a form of psychological treatment that utilizes hypnosis to assist in addressing specific mental and physical ailments. It can also be employed for altering habits. Hypnotherapy operates by inducing a hypnotic state in the subject, lowering brain waves to alpha-theta levels for relaxation and enhanced acceptance of suggestions in the subconscious. The aim is to improve psychological issues, emotions, and conduct. The study was carried out on two patients at the Lee Chen Thung Primary Clinic in Jakarta, Indonesia. Sampling was conducted by adhering to specific criteria for selection and administering the GERD-Q questionnaire. The patients included in the study had to have GERD-Q scores higher than 7 and frequently use PPIs for their stomach issues. Management of GERD can be done with drug therapy or pharmacology and non-pharmacology therapy. One of the non-pharmacology therapies that can be given is hypnotherapy. Patients who satisfied the criteria were provided with hypnotherapy in order to alleviate their heartburn symptoms. The process of hypnotherapy can help the body to stimulate the release of endorphins. Endorphins act as the body's innate pain relievers. Following hypnotherapy, patients underwent eval_uation for 1 week using numeric rating scale. Both patients experienced a decrease in pain levels following hypnotherapy.

Effects of capsaicin on esophageal peristalsis in humans using high resolution manometry.

Capsaicin-containing red pepper sauce suspension augments esophageal contraction amplitude on conventional manometry. This study used high-resolution manometry (HRM) to investigate if capsaicin infusion modulates segmental esophageal smooth muscle peristalsis in healthy adults. Sixteen healthy volunteers (mean age 37 years, 14 male) underwent HRM for the evaluation of primary peristalsis and secondary peristalsis using slow and rapid air distensions. Both primary and secondary peristalsis were assessed following infusions of capsaicin-containing red pepper sauce and saline. Capsaicin infusion significantly increased heartburn symptoms compared to saline infusion (p < 0.001), and significantly decreased threshold volumes of secondary peristalsis during rapid air distensions (p = 0.02). The frequency of secondary peristalsis during rapid air distensions was significantly increased by capsaicin infusion (p = 0.03). Neither capsaicin infusion (p = 0.06) nor saline infusion (p = 0.27) altered threshold volume during slow air distensions. Capsaicin infusion significantly increased distal contractile integral (DCI) of primary peristalsis (p = 0.04), particularly in the proximal smooth muscle segment (p = 0.048). It enhanced secondary peristalsis during rapid air distensions (p = 0.003) but not during slow air distension (p = 0.23). Saline infusion significantly increased DCI of secondary peristalsis during rapid air distension (p = 0.01). Augmentation of distension-induced secondary peristalsis can be modulated by activation of capsaicin-sensitive afferents similar to mechanosensitive afferents. Capsaicin-induced augmentation of primary peristalsis isolates to the cholinergic-mediated proximal smooth muscle segment, which warrants study in ineffective esophageal motility to determine therapeutic potential.

Recognizing the impact of Samyoga Viruddha in clinical practice: A case report on Ayurvedic management of chronic urticaria

BACKGROUND: The Ayurvedic concept of Samyoga Viruddha addresses the significant health risks associated with incompatible mixtures of substances, including food components, medications, and environmental factors. This concept is pivotal in understanding how these combinations can disrupt Doshic balance, leading to various health issues. METHODS: A case study was conducted involving a 38-year-old male patient who presented with symptoms of intense itching, rashes, heartburn, dyspepsia, and abdominal heaviness. During history taking, it was revealed that the patient had recently consumed milk with meals followed by an over- the-counter pain reliever for a severe headache. As per Ayurvedic principles, this combination is considered incompatible and was believed to have destabilized the Pitta and Kapha Doshas, leading to the observed symptoms. RESULTS: The patient’s symptoms were successfully managed through a combination of Virechana (medication-induced purgation) and Shamana therapy (pacification of vitiated Doshas). The treatment effectively alleviated hyperacidity, poor digestion, fatigue, and urticaria, demonstrating the practical application of Ayurvedic principles in addressing Doshic imbalances. CONCLUSION: This case study illustrates the importance of recognizing and avoiding Samyoga Viruddha in clinical practice. By adhering to harmonious combinations, healthcare professionals and individuals can mitigate the adverse effects of incompatible substances, thereby promoting better health and vitality. The case also highlights the efficacy and affordability of Ayurvedic treatments like Shodhana and Shamana Chikitsa in managing conditions such as chronic urticaria.

S559 Heartburn Frequency and Symptom Improvement Rates of Treated Episodes when Switching From Daily to On-Demand Vonoprazan Treatment for Non-erosive Reflux Disease

S559 Heartburn Frequency and Symptom Improvement Rates of Treated Episodes when Switching From Daily to On-Demand Vonoprazan Treatment for Non-erosive Reflux Disease

IL-8, TNF-α, and IL-17 in the Development of Erosive Esophagitis and Symptom Perception in Gastroesophageal Reflux Disease (GERD)

Background: The diverse clinical characteristics of erosive esophagitis (EE) and symptom perception in patients with gastroesophageal reflux disease (GERD) remain a major challenge in understanding their underlying pathogenesis. This study aimed to investigate the association between the levels of IL-8, TNF-α, and IL-17 in serum and the presence of erosive esophagitis and symptoms related to GERD. Method: We enrolled 65 subjects presenting with GERD symptoms. Based on the findings of upper endoscopy, the subjects were categorized into two groups: (1) erosive esophagitis (EE LA grades B-D) and (2) non-erosive esophagitis (normal-EE LA grade A). Symptom perception was assessed via GERD questionnaire (GERD-Q) and the frequency scale for the symptoms of GERD (FSSG). The enzyme-linked immunosorbent assay (ELISA) method was used to analyze serum levels of IL-8, TNF-α, and IL-17. Analysis of cytokine levels between different symptoms severity was performed using the Kruskal-Wallis H test. Results: Median serum IL-8 levels were significantly higher in the erosive esophagitis group compared to those with non-erosive esophagitis (20.2 (IQR 16.9–32.2) vs. 17.7 (IQR 15.2–19.6), p &lt; 0.05). The study found a significant association between IL-8 levels and the presence of globus symptoms (median IL8 level 46.961 (38.622–92.644) in subjects with globus vs. 18.06 (16.68–20.49) in those without globus; p &lt; 0.05). Similarly, TNF-α levels were associated with the frequency of regurgitation symptoms (H index = 10.748; dr = 3; p &lt; 0.05). We observed a significant correlation between IL-17 levels and the frequency of heartburn and early satiety symptoms. Conclusions: IL-8 may play a role in the development of mucosal erosion in GERD. IL-8, TNF- α, and IL-17 might be involved in the development of globus symptoms, the frequency of regurgitation, and the frequency of heartburn and early satiety, respectively. The diverse symptom phenotypes observed in patients with GERD symptoms may be mediated by distinct profiles of proinflammatory cytokines.

Effect of Fermented Soybean (FSB) Supplementation on Gastroesophageal Reflux Disease (GERD).

Gastroesophageal reflux disease (GERD) is a prevalent chronic condition affecting the well-being of both adults and children in general medical practice. Research on the effects of fermented soybean (SB) supplementation in managing GERD is relatively new, with limited studies available. The existing research often lacks sufficient dosing regimens and study durations to differentiate between transient placebo effects and sustained benefits. In this study, the beneficial effects of FSB supplementation were investigated in 110 voluntary participants (NCT06524271). The participants were required to take 1 g of FSB supplement once daily for 12 weeks. GERD symptoms were evaluated using the Reflux Disease Questionnaire (RDQ), while inflammatory markers, including interleukin-4 (IL-4), interleukin-6 (IL-6), and interleukin-8 (IL-8), were measured to assess inflammation. The Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire was used to evaluate participants' quality of life. The results indicated that FSB supplementation significantly (p < 0.05) alleviated heartburn and regurgitation symptoms and reduced levels of IL-4, IL-6, and IL-8, indicating a notable anti-inflammatory effect. Additionally, significant (p < 0.05) improvements were observed in QOLRAD scores, particularly in vitality, emotional distress, and physical/social functioning. Collectively, our findings support the use of FSB as an adjuvant approach in managing GERD, with notable improvements in patients' quality of life.

The effectiveness and safety of the anti gastroesophageal reflux system in the treatment of gastroesophageal reflux disease: a single center study of 23 cases

Objective: To evaluate the safety and efficacy of domestically produced magnetic sphincter augmentation (MSA) for gastroesophageal reflux disease. Method: This study is a prospective cohort study. Patients with typical heartburn and reflux symptoms (at least partial response to proton pump inhibitors), abnormal esophageal acid exposure and normal esophageal peristalsis were included, prospectively in the Department of Gastroesophageal Surgery, Rocket Force Characteristic Medical Center from June 2019 to September 2022. Patients with hiatal hernia >2 cm and severe esophagitis were excluded. The MSA was wrapped around the distal esophagus after esophageal hiatus repair by laparoscopy. A postoperative questionnaire survey was conducted to assess the relief of symptom, complications, the discontinuation rate of proton pump inhibitor, and surgical satisfaction. Gastroscopy, high-resolution esophageal pressure measurement, and pH value impedance monitoring were also reviewed. The pre- and postoperative rates were compared using the McNeinar χ2 test. Result: Currently, 23 patients with gastroesophageal reflux disease were enrolled and underwent MSA surgery. There were 20 males and 3 females, aged (M (IQR)) 48 (14) years (range: 25 to 64 years). All cases were successfully implanted with MSA. Subjective indicators were followed for 17 (18) months (range: 14 to 53 months), while objective indicators were followed for 17 (1) months (range: 12 to 23 months). The postoperative gastrointestinal and extraesophageal symptom scores showed a significant decrease compared to preoperative levels as follows: the degree of subjective relief of overall digestive symptoms was 90 (20)% (range:0~100%), the degree of subjective relief of overall respiratory symptoms was 100(10)% (range: 10%~100%), the overall satisfaction rate was 83% (19/23), the proton pump inhibitor discontinuation rate was 70% (16/23). The proportion of esophagitis has decreased from 44% (10/23) to 9% (2/23) (κ=0.169, P=0.039), The Hill grade of gastroesophageal valve morphology improved from 1 case of grade Ⅰ, 5 cases of grade Ⅱ, 10 cases of grade Ⅲ, and 7 cases of grade Ⅲ preoperative to 22, 1, 0, and 0 cases postoperative. The proportion of lower esophageal sphincter pressure below normal has decreased from 70% (16/23) to 35% (8/23) (κ=0.170, P=0.012). There were 21 patients who restored normal esophageal acid exposure. Eleven patients had mild long-term dysphagia, but it didn't affect their daily life. No postoperative device migration, erosion, or secondary surgical removal occurred. Conclusions: Laparoscopic implantation of the MSA device was safe and well tolerated. It can effectively control the symptoms of gastroesophageal reflux disease, reduce medication, restore normal cardia morphology and function, and esophageal acid exposure. The main postoperative complication was dysphagia, but it was relatively mild.

A child is worried about heartburn: modern views on the problem and possibilities of non-pharmacological support

Background. The relevance is associated with a significant spread of dyspeptic symptoms in children. On average, every third-fourth child with such symptoms complains of heartburn, which is a frequent reason for consulting a doctor. For the pediatric category of patients, not only the timely diagnosis and effective treatment of pathological conditions associated with heartburn are important, but also the awareness of the parents of our patients and the children themselves about the possibilities of providing ade­quate first aid, safe and effective use of effective non-medicinal means. The purpose: to study the clinical effectiveness of using the special drink ISOTA for the first aid and preliminary treatment of children with heartburn in non-erosive reflux disease, functional dyspepsia and a combination of these conditions (overlap of non-erosive gastroesophageal reflux disease and functional dyspepsia). Materials and methods. Design: a single-center, open-label, pilot clinical trial. Fifty-four children aged 7–18 years with heartburn and other dyspeptic complaints were under observation. The study included 2 stages. The diagnosis was verified by means of surveys (GERDQ and QOLRAD questionnaires) and the use of fibrogastroscopy, endoscopic pH-metry. The results were recorded in the developed individual patient card and statistically processed. Results. Results of the study presented in the corresponding section testify to the high effectiveness of using ISOTA to eliminate heartburn and reduce other dyspeptic symptoms, as well as to a reliable improvement in the psychoemotional state, general well-being and quality of life of patients. Conclusions. The obtained results make it possible to recommend a slightly carbonated hydrocarbonate-containing special drink developed in Ukraine for a long-term use in a treatment course or as needed, and prophylactically to prevent heartburn and other dyspeptic symptoms in children, taking into account the high profile of effectiveness, safety and good tolerabi­lity.

Comparison of Potassium-Competitive Acid Blockers and Proton Pump Inhibitors in Patients With Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

This meta-analysis evaluated the efficacy and safety of potassium-competitive acid blockers (PCABs) compared to proton pump inhibitors (PPIs) in treating gastroesophageal reflux disease (GERD). A comprehensive literature search was conducted across multiple databases, and 11 randomized controlled trials comparing PCABs with PPIs were included. The primary outcome was the healing of erosive esophagitis (EE), with secondary outcomes, including relief of heartburn symptoms and adverse events. The analysis included 11 studies and a pooled sample of 4,108 GERD patients. Results showed that PCABs were significantly more effective in healing EE compared to PPIs (OR: 1.67, 95% CI: 1.24-2.24, p<0.01). PCABs also demonstrated a higher rate of complete resolution of heartburn symptoms, although this difference did not reach statistical significance (OR: 1.43, 95% CI: 0.98-2.09, p=0.06). In terms of safety, there was no significant difference in adverse events between PCABs and PPIs (OR: 0.91, 95% CI: 0.79-1.04, p=0.18), including serious adverse events. The superior efficacy of PCABs can be attributed to their unique pharmacological properties, which allow for more rapid and potent acid suppression compared to PPIs. However, the long-term safety profile of PCABs, particularly newer agents, requires further investigation. The study was limited by the predominance of vonoprazan among the PCABs studied and the focus on patients with EE rather than non-erosive reflux disease. In conclusion, this meta-analysis suggests that PCABs are more effective than PPIs in treating GERD, particularly in healing EE, while maintaining a comparable safety profile. Future research should focus on evaluating a wider range of PCABs, assessing their efficacy in non-erosive reflux disease, and investigating their long-term safety in GERD management.

Endoscopic Advances in the Diagnosis and Management of Gastroesophageal Reflux Disease.

Gastroesophageal reflux disease (GERD) is one of the most common diseases that occurs secondary to failure of the antireflux barrier system, resulting in the frequent and abnormal reflux of gastric contents to the esophagus. GERD is diagnosed in routine clinical practice based on the classic symptoms of heartburn and regurgitation. However, a subset of patients with atypical symptoms can pose challenges in diagnosing GERD. An esophagogastroduodenoscopy (EGD) is the most common initial diagnostic test used in the assessment for GERD, although half of these patients will not have any positive endoscopic findings suggestive of GERD. The advanced endoscopic techniques have improved the diagnostic yield of GERD diagnosis and its complications, such as Barrett's esophagus and early esophageal adenocarcinoma. These newer endoscopic tools can better detect subtle irregularities in the mucosa and vascular structures. The management options for GERD include lifestyle modifications, pharmacological therapy, and endoscopic and surgical interventions. The latest addition to the armamentarium is the minimally invasive endoscopic interventions in carefully selected patients, including the electrical stimulation of the LES, Antireflux mucosectomy, Radiofrequency therapy, Transoral Incisionless Fundoplication, Endoscopic Full-Thickness plication (GERDx™), and suturing devices. With the emergence of these advanced endoscopic techniques, it is crucial to understand their selection criteria, advantages, and disadvantages.

Studi Penggunaan Obat pada Pasien Gastroesophageal Reflux Disease (GERD) Rawat Jalan di RS. Aura Syifa Kediri Periode Januari - November 2022

Background: Gastroesophageal Reflux Disease (GERD) is a pathological condition caused by reflux of contents from the stomach entering the esophagus, with various signs and symptoms involving the esophagus, pharynx, larynx and airway. Gastroesophageal Reflux Disease (GERD) has typical symptoms of heartburn and regurgitation. So that the symptoms that appear will interfere with all activities carried out by someone. Objective: This study is to determine the profile picture of drug use in outpatient Gastroesophageal Reflux Disease (GERD) patients at Aura Syifa Hospital Kediri and to determine the study of drug use in outpatient Gastroesophageal Reflux Disease (GERD) patients at Aura Syifa Hospital Kediri by analyzing the right indications and right doses. Method: This study is a descriptive observational study with retrospective data collection from patient medical record data. Results: The results of a study on the useof drugs in outpatient gastroesophageal reflux disease (GERD) patients at Aura Syifa Hospital Kediri for the period January-November 2022 by analyzing the right indications and correct doses, which were obtained as many as 175 patients. The most GERD patients were women as many as 114 patients and men as many as 61 patients. The most common age for GERD is 56-65 years old and &gt;65 years old. The most widely used drug class is the Proton Pump Inhibitor (PPI) class with a percentage of 38% and the drug in this class that is often used is lansoprazole with 167 prescriptions. The results of a study on drug use in outpatient gastroesophageal reflux disease (GERD) patients at Aura Syifa Hospital Kediri for the period January- November 2022 that meet the rationality of treatment based on the literature of the Indonesian GERD Consensus in 2013 or BNF 2017 or Pharmacotherapy A Pathophysiologic Approach 11th edition in 2020 or Medscape, where the indication is 100% (175 patients) and the right dose is 100% (175 patients).

Prevalence and risk factors of gastro-oesophageal reflux symptoms among adolescents, the HUNT study

Background Gastro-oesophageal reflux disease (GORD) is recognized by symptoms of heartburn and acid regurgitation. These gastro-oesophageal reflux symptoms (GORS) are common in adults, but data from adolescents are sparse. This study aimed to assess the prevalence and risk factors of GORS among adolescents in a large and unselected population. Methods This study was based on the Trøndelag Health Study (HUNT), a longitudinal series of population-based health surveys conducted in Nord-Trøndelag County, Norway. This study included data from Young-HUNT4 performed in 2017–2019, where all inhabitants aged 13–19 years were invited and 8066 (76.0%) participated. The presence of GORS (any or frequent) during the past 12 months and tobacco smoking status were reported through self-administrated questionnaires, whereas body mass index (BMI) was objectively measured. Results Among 7620 participating adolescents reporting on the presence of GORS, the prevalence of any GORS and frequent GORS was 33.2% (95% confidence interval [CI] 32.2 − 34.3%) and 3.6% (95% CI 3.2 − 4.0%), respectively. The risk of frequent GORS was lower among boys compared to girls (OR 0.61; 95% CI 0.46 − 0.79), higher in current smokers compared to never smokers (OR 1.80; 95% CI 1.10 − 2.93) and higher among obese compared to underweight/normal weight adolescents (OR 2.50; 95% CI 1.70 − 3.66). Conclusion A considerable proportion of adolescents had GORS in this population-based study, particularly girls, tobacco smokers, and individuals with obesity, but frequent GORS was relatively uncommon. Measures to avoid tobacco smoking and obesity in adolescents may prevent GORS.

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.

Vonoprazan is Efficacious for Treatment of Heartburn in Non-erosive Reflux Disease: A Randomized Trial

Potassium-competitive acid blockers have documented efficacy for erosive esophagitis. We performed a randomized trial in United States subjects diagnosed with non-erosive reflux disease of vonoprazan vs placebo for 4 weeks, followed by a 20-week active-treatment extension. Adult subjects with heartburn ≥4 days/week during screening without erosive esophagitis on endoscopy were randomized to placebo, vonoprazan 10 mg, or vonoprazan 20 mg. After 4 weeks, subjects on placebo were re-randomized to vonoprazan 10 mg or 20 mg, and those already on vonoprazan continued at the same dose for 20 weeks. Electronic diaries were completed twice daily. The primary endpoint was percentage of days without daytime or nighttime heartburn (24-hour heartburn-free days). Among 772 randomized subjects, the percentage of 24-hour heartburn-free days was 27.7% for placebo vs 44.8% for vonoprazan 10 mg (least squares mean difference, 17.1%; P < .0001) and 44.4% for vonoprazan 20 mg (least squares mean difference, 16.7%; P < .0001). Differences in percentage of subjects with a 24-hour heartburn-free day for vonoprazan 10 mg vs placebo and vonoprazan 20 mg vs placebo were 8.3% and 11.6% on day 1 and 18.1% and 23.2% on day 2. The mean/median percentages of 24-hour heartburn-free days over the extension period were similar across the 4 study arms: 61%-63%/76%-79%. Vonoprazan reduced heartburn symptoms in subjects diagnosed with non-erosive reflux disease, with the benefit appearing to begin as early as the first day of therapy. Treatment effect persisted after the initial 4-week placebo-controlled period throughout the 20-week extension period. The 2 vonoprazan doses (10 mg and 20 mg) were similar in efficacy. (ClinicalTrials.gov: NCT05195528).

Beneficial Effect of Heat-Killed Lactic Acid Bacterium Lactobacillus johnsonii No. 1088 on Temporal Gastroesophageal Reflux-Related Symptoms in Healthy Volunteers: A Randomized, Placebo-Controlled, Double-Blind, Parallel-Group Study.

A randomized, placebo-controlled, double-blind, parallel-group clinical study was conducted to examine the effects of ingesting a heat-killed lactic acid bacterium, Lactobacillus johnsonii No. 1088 (LJ88) on temporal gastroesophageal reflux-related symptoms in healthy volunteers. A total of 120 healthy Japanese volunteers of both sexes, aged between 21 and 63 years, whose Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) total score was 8 or greater, but who were not diagnosed with functional dyspepsia according to the Rome IV classification, were enrolled. They were randomly assigned to either the LJ88 or placebo group and instructed to ingest the test food (1 billion heat-killed LJ88 or placebo) once a day for six weeks. Gastroesophageal reflux-related symptoms were evaluated using FSSG scores as a primary endpoint. The Gastrointestinal Symptoms Rating Scale (GSRS), stomach state questionnaire, and serum gastrin concentration were used as secondary endpoints. In the FSSG evaluation, the heartburn score was significantly improved at 6 weeks in the LJ88 group compared to the placebo group. No severe adverse events related to the test food were observed. In conclusion, daily ingestion of heat-killed LJ88 improved temporal heartburn symptoms in non-diseased individuals.

Analysis of the Effectiveness of Biling Weitong Granules Combined with Trimethoprim and Vonoprazan in The Treatment of Reflux Esophagitis

Objective: To analyze the effectiveness of Biling Weitong Granules (BLWTG) combined with trimethoprim and vonoprazan in treating reflux esophagitis. Methods: Sixty patients with reflux esophagitis admitted to our hospital from March 2020 to March 2023 were selected as study subjects and randomly divided into a control group and an experimental group, with 30 cases in each group. The control group received only the combination treatment of trimethoprim and vonoprazan, while the experimental group was treated with BLWTG based on the control group. The acid reflux and heartburn symptom scores, quality-of-life scores, clinical efficacy, Chinese medicine symptom incidences, and the occurrence of adverse reactions before and after treatment in the two groups were compared. Results: After treatment, the acid reflux and heartburn symptom scores of patients in the experimental group were lower than those of the treatment control group, and the quality-of-life scores were higher than those of the treatment control group (P &lt; 0.05). The total clinical efficacy of the experimental group was 96.66%, which was significantly higher than that of the control group (73.33%, P &lt; 0.05). After treatment, the incidence of Chinese medicine symptoms, such as nausea and vomiting, abdominal distension and abdominal pain, and loss of appetite of the patients in the experimental group were significantly lower than those of the control group (P &lt; 0.05). During the treatment period, there was no significant difference in the incidence of adverse reactions between the two groups, which indicated that the safety of the two treatments was comparable (P &gt; 0.05). Conclusion: BLWTG combined with trimethoprim and vonoprazan was safe and reliable in treating reflux esophagitis, effectively relieving the symptoms and improving its clinical efficacy. This treatment is worthy of popularization.

Treatment Outcomes of Patients With Overlapping Eosinophilic Esophagitis and Gastroesophageal Reflux Disease After Antireflux Surgery

Background: The relationship between eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) is complex, and there are scant data about the role of fundoplication when GERD/EoE overlap. We aimed to describe treatment outcomes of patients with GERD/EoE overlap undergoing antireflux surgery. Methods: We conducted a retrospective cohort study of patients with overlapping EoE and GERD who had undergone laparoscopic fundoplications. Patient demographics, clinical characteristics, EoE history, and procedural/surgical data were extracted from the medical record. Endoscopic and histologic responses were assessed for pre- and post-operative endoscopies. Results: We identified 10 patients with GERD/EoE overlap who underwent antireflux surgery, and 9 patients underwent post-operative repeat EGD. All patients had heartburn and regurgitation symptoms that were refractory to PPI and/or persistent erosive disease, and also demonstrated signs/symptoms of EoE such as dysphagia (80%), food impaction (60%), fibrostenotic disease requiring dilation (70%), and lack of symptom or histologic response to topical steroids (70%). Patients demonstrated expected improvements in erosive esophagitis and hiatal hernia. The peak eosinophil count improved from 47.1 ± 35.9 eos/hpf to 7.8 ± 12.3 eos/hpf ( P = .02). Total EREFS score decreased from 3.0 ± 2.2 to 1.2 ± 2.3 ( P = .009). Conclusions: Patients who have GERD/EoE overlap can have endoscopic and histologic improvement in both conditions after fundoplication. This implies that in a subset of patients, GERD may drive an EoE response, and this must be recognized for successful treatment.