Impact Of Gastro-oesophageal Reflux Disease Research Articles

Risk Factors Associated with Oral Manifestations and Oral Health Impact of Gastro-Oesophageal Reflux Disease

Background and aim: The association of gastro esophageal reflux disease with oral health manifestations faced major challenges in terms of invasive investigative approaches to be performed on patients for necessary treatment. The current study aimed to evaluate the risk factors and impact of gastro-esophageal reflux disease on oral health. Materials and Methods: The cross-sectional study was carried out on 194 gastro-oesophageal reflux disease in Gastroenterology department of Isra University Hospital, Hyderabad for duration of six from July 2020 to December 2020. The individuals underwent duodenoscopy for oesophago–gastro–reflux disease and met the inclusive criteria were enrolled. The gastro-oesophageal reflux disease patients were categorized into two group’s namely chronic gastro-oesophageal reflux disease as a group I (97 patients), while mild GORD was group II (97). The exclusion criteria for this study was individuals with limited mouth opening and unconscious patients. Mucosa oral lesion and abnormal conditions were measured as primary and secondary outcomes. Oral Health Impact Profile-14 was utilized for assessment of life quality changes with hard and soft tissue. Results: Of the total 194 patients, 113 (58.2%) were male while 81 (41.8%) were females. The mean age was 48.32±7.56 years with an age range of 20-80 years. The socioeconomic status of the participants was as follows; urban residents 127 (65.5%) and rural 67 (34.5%). The gastro-oesophageal reflux disease prevalence was found 35.6% (n=69) out of which 34.8% (24) were dental erosion (DE). Group I and II had 97 patients each. The group I was comprised of significantly common diseases such as ulceration 52 (53.6%), Oral submucous fibrosis 59 (60.8%), and xerostomia 42 (43.3%). Chronic gastro-oesophageal reflux and dental erosion diseases were statistically significant with an unhealthy pattern of diets such as ulceration, nausea/vomiting, gingivitis, angular cheilitis, and oesophagitis. The prevalence of overall oral tobacco and smoking addiction was 59 (30.4%) and 52 (26.8%). Tea was the most prevalent consumed beverage 141(72.7%). Gastro-oesophageal reflux and dental erosion diseases were positively correlated with oral health assessment scale-14 (p-value <0.05). The psychological discomfort, psychological disability, physical disability, and functional limitation were the notable impacts with their respective ranks correlation coefficient (rs) 0.29, 0.26, 0.28, and 0.19. Conclusion: Gastro-oesophageal reflux and dental erosion disease had higher severity among patients of oral manifestation compared to those with no gastro-oesophageal reflux and dental erosion disease. The systemic and oral disease severity needs to be assessed routinely with dental checkup. Keywords: Oral manifestations, Gastro-oesophageal reflux disease

Risk factors associated with oral manifestations and oral health impact of gastro-oesophageal reflux disease: a multicentre, cross-sectional study in Pakistan

ObjectiveGastro-oesophageal reflux disease (GORD) is a relatively common disorder and manifests with extraoesophageal symptoms, such as dental erosions (DE), cough, laryngitis, asthma, and oral soft- and hard-tissue pathologies. This study...

Burden of Gastro-Oesophageal Reflux Disease in Patients with Persistent and Intense Symptoms Despite Proton Pump Inhibitor Therapy

Research on the negative impact of gastro-oesophageal reflux disease (GORD) on the health-related quality of life (HR-QOL) and resource utilization of patients with persistent and intense GORD symptoms despite proton pump inhibitor (PPI) therapy is lacking. The aim of this study was to describe the population of patients with GORD with persistent moderate-to-severe symptoms despite ongoing PPI therapy, and to compare their HR-QOL and healthcare resource use with patients with low GORD symptom load during ongoing PPI therapy. In this post hoc analysis of the 2007 National Health and Wellness Survey (NHWS), PPI-compliant (≥22 days with PPI use in the past month) European (France, Germany and the UK) and US respondents with physician-diagnosed GORD were stratified into those with persistent and intense GORD symptoms, those with low symptom load, or an intermediate group. 5672 PPI-compliant respondents were identified (persistent and intense symptoms, n = 1741; low symptom load, n = 1805; intermediate group, n = 2126). Respondents with persistent and intense symptoms had poorer HR-QOL than patients with a low symptom load, but none of the differences were statistically significant. Respondents with persistent and intense symptoms also reported lower work productivity (all countries; significant difference [p < 0.01] only in the US), greater activity impairment (all countries; significant difference [p < 0.01] only in the US) and more hours missed from work due to health problems (US, UK and Germany; significant difference [p < 0.01] only in the US). In the UK and US, respondents with persistent and intense symptoms reported significantly more visits to both primary-care physicians and specialists than respondents with a low symptom load (all p < 0.01). Additionally, US respondents with persistent and intense symptoms reported significantly more emergency room visits (p < 0.01). The 2007 NHWS gives support to the hypothesis that persistent and intense GORD symptoms despite PPI therapy have a significant and negative impact on both HR-QOL and healthcare resource utilization. These findings outline the need for new treatment options for symptomatic GORD patients taking PPI therapy.

Heartburn in a Sri Lankan community in the UK

Purpose – The aims of this study are to assess the prevalence and timings of heartburn symptoms in a Sri Lankan population living in the UK and to identify diet and lifestyle symptom triggers.Design/methodology/approach – A total of 60 Sri Lankan adults, aged between 18 and 66 years completed a background questionnaire and a nine‐item gastro‐oesophageal reflux disease (GORD) impact scale.Findings – Application of the GORD impact scale verified that all participants experienced heartburn symptoms on a weekly basis. Episodes of heartburn tend to occur post‐prandially. Diet and lifestyle factors were found to trigger heartburn symptoms particularly consuming spicy foods.Research limitations/implications – The incidence of heartburn in Sri Lankans may be due to the process of acculturation to the Western diet and lifestyle.Originality/value – This paper shows that Sri Lankans are susceptible to symptoms of heartburn.

The development and validation of a Nocturnal Gastro‐oesophageal Reflux Disease Symptom Severity and Impact Questionnaire for adults

Current questionnaires for assessing gastro-oesophageal reflux disease (GERD) symptoms are limited in their ability to capture nocturnal symptoms. To develop and validate an instrument, the Nocturnal Gastro-oesophageal Reflux Disease Symptom Severity and Impact Questionnaire (N-GSSIQ), to assess severity and impact of nocturnal GERD symptoms. Two focus groups and 16 cognitive debriefing interviews were conducted among GERD patients to identify key issues about nocturnal symptoms. A draft instrument was tested in 196 patients at 11 clinics in the US to evaluate psychometric properties. Exploratory factor and item response theory analyses were conducted to finalize items and subscales. Internal consistency reliability, reproducibility and construct validity were examined. Mean age was 45 (s.d. = 13.8) years; 76% were female and 68% were Caucasian. Patient-rated severity was mild-moderate for 69% of participants; 48% reported symptoms on two to three nights the past week. The final questionnaire includes 20 items and three subscales: Nocturnal GERD Symptoms, Morning Impact of Nocturnal GERD and Concern about Nocturnal GERD. The subscales demonstrated internal consistency reliability (Cronbach's alpha 0.84-0.94) and were significantly correlated with similar measures and disease severity (0.41-0.81; P < 0.0001). The results support the reliability and validity of the N-GSSIQ as a measure of severity, morning impact and concern about nocturnal GERD.

The influence of environmental risk factors in hospitalization for gastro‐oesophageal reflux disease‐related diagnoses in the United States

The impact of gastro-oesophageal reflux disease on hospitalization is unknown. To describe the characteristics of patients hospitalized for diagnoses related to gastro-oesophageal reflux disease (GERD) and find potential environmental influences that affect their hospitalization. Data from the Healthcare Cost and Utilization Project were used to study the demographic characteristics of hospitalizations associated with GERD during 2003-2006. Data from the Centers for Disease Control were used for information about the US prevalence of obesity. During 2003-2006, 0.5 million patients with a primary and 14.5 million patients with a secondary GERD-related diagnosis became hospitalized in the US. Oesophageal reflux and hiatal hernia were more common in female than in male inpatients, whereas Barrett's oesophagus and oesophageal adenocarcinoma were more common in male than in female inpatients. All GERD-related diagnoses were more common in white people than non-white people. Hospitalizations associated with oesophageal reflux, reflux oesophagitis and Barrett's oesophagus showed resembling geographical distributions among different US states. The prevalence of obesity and the hospitalization for hiatal hernia or reflux oesophagitis were also characterized by similar geographical distributions. The large numbers of inpatients with a discharge diagnosis of GERD-related conditions attest to the frequent occurrence and relevance of GERD in contributing to hospitalization in the US.

Development and validation of a disease‐specific quality of life questionnaire for gastro‐oesophageal reflux disease: the GERD‐QOL questionnaire

A simple and meaningful health-related quality of life (HRQoL) questionnaire for gastro-oesophageal reflux disease (GERD) patients is lacking. To develop and validate a disease-specific HRQoL instrument (GERD-QOL) for GERD patients. An 18-item questionnaire was generated to measure the impact of GERD on sleep, exercise, diet, need for medication, sex life, work, social activity and psychological well-being. GERD patients were invited to complete the GERD-QOL, a visual analogue scale (VAS) and a validated Chinese generic QoL (SF-36) questionnaire before and after esomeprazole treatment. Factor analysis was performed for item selection and psychometric properties were measured. An English version was developed by a forward-backward translation process. A final 16-item GERD-QOL questionnaire was developed. The items were grouped into four subscales (Daily activity, Treatment effect, Diet, and Psychological well-being) after factor analysis. GERD-QOL had good item-internal consistency (Cronbach's alpha: 0.64-0.88), high test-retest reliability (intraclass correlation coefficient: 0.73-0.94, P < 0.001). Its subscale scores were correlated with SF-36 and VAS, which demonstrated high construct validity (P < 0.001). Discriminant validity was verified by correlating GERD-QOL scores with symptom severity (P < 0.001). Responsiveness after esomeprazole treatment was significant (paired-t-test P < 0.001). An English version of GERD-QOL was developed. The instrument, GERD-QOL, is valid and reliable.

Impact of gastro-oesophageal reflux disease on work productivity despite therapy with proton pump inhibitors in Germany

BackgroundGastro-oesophageal reflux disease (GERD) is a common disorder with consequences for the patient's health-related quality of life (HRQoL). In Germany, few data are available on the impact of GERD on work-related productivity.AimTo study the impact of GERD on work productivity despite proton pump inhibitor (PPI) therapy and the association between productivity and symptom duration, severity, and HRQoL.MethodsRetrospective data from randomly selected patients with chronic GERD symptoms, treated by office-based general practitioners or general internists with routine clinical care, were analyzed together with information from self-administered instruments assessing work productivity (WPAI-GERD), symptoms (RDQ), and HRQoL (QOLRAD).ResultsReduced productivity was reported by 152 of 249 patients (61.0%), although 89.5% of them were treated with PPI. The reduction in work productivity was 18.5% in all patients and 30.3% in those with reduced productivity. Patients with impaired productivity showed a significantly lower HRQoL and more-severe symptoms of reflux disease. In all patients, the mean sick leave attributable to reflux symptoms was 0.6 hours in the previous seven days and 1.4 work days in the previous three months.ConclusionGERD has a substantial impact on work productivity in Germany, even in patients receiving routine clinical care and PPI therapy.

Oral impact of gastro-oesophageal reflux disease: a case report

This case report describes the dental management of a 30-year-old male with cerebral palsy and dyspraxia. Recall examination identified multiple erosive carious lesions despite previous oral hygiene and dietary related instruction. A comprehensive approach to patient management was required to identify the aetiological factors associated with the continued loss of tooth structure. The identification of the aetiological factors required a detailed medical history and clinical examination, as well as liaison with the patient's general medical practitioner. Preventive measures were adopted prior to restorative intervention in order to stabilize and remineralize the dentition. Medical intervention for gastro-oesophageal reflux disease (GORD) and a targeted prevention programme resulted in remineralization of all carious exposed dentine with stabilization of the dentition. Patients with cerebral palsy are known to have a higher incidence of GORD as well as problems with swallowing, vomiting and recurrent chest infections. Long-term gastric acid attacks can contribute to dental erosion, and dental professionals may be the first to diagnose silent GORD. The successful treatment of erosion caused by GORD requires a multidisciplinary and minimal intervention approach.

Systematic review: gastro‐oesophageal reflux disease and dental lesions

Dental erosion (DE), which is the irreversible loss of tooth substance that does not involve bacteria ranging from a minimal loss of surface enamel to the partial or complete exposure of dentine by a chemical process, is acknowledged as an established extra-oesophageal manifestation of gastro-oesophageal reflux disease (GERD). However, the real impact of GERD in the genesis of this lesion remains unclear. To review the existing literature to assess the relationship between DE and GERD. Studies that assessed the prevalence of DE in individuals with GERD or vice versa were identified in Medline and the Cochrane Controlled Trials Register via a systematic research strategy. Seventeen studies met the selection criteria. Studies, however, differed greatly as far as design, population methods of diagnosing GERD, duration of follow-up and, consequently, findings. The median prevalence of DE in GERD patients was 24%, with a large range (5-47.5%), and the median prevalence of GERD in DE adults patients was 32.5% (range: 21-83%) and in paediatric population 17% (range: 14-87%). Children with GERD are found by a majority of studies at increased risk of developing DEs in comparison with healthy subjects, as are intellectually disabled people. This systematic review shows that there is a strong association between GERD and DE. The severity of DEs seems to be correlated with the presence of GERD symptoms, and also, at least in adults, with the severity of proximal oesophageal or oral exposure to an acidic pH. The inspection of the oral cavity in search for DEs should become a routine manoeuvre in patients with GERD.

Accounting for the effect of GERD symptoms on patients’ health-related quality of life: supporting optimal disease management by primary care physicians

AimTo review, from a primary care physician (PCP) perspective, the use of patient-reported outcome (PRO) instruments for assessment of gastro-oesophageal reflux disease (GERD) symptoms, their impact on health-related quality of life (HRQL) and the effectiveness of therapy.ResultsWhile generic and disease-specific PRO instruments have been used in the assessment of GERD, the latter can be considered to be more appropriate as they focus only on problems relevant to the disease in question (and therefore tend to be more responsive to change). Such instruments include the Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire and the Gastrointestinal Symptom Rating Scale and the Reflux Disease Questionnaire (RDQ). Their use indicates that GERD symptoms are troublesome and significantly reduce patients’ HRQL, and that effective treatment of GERD improves HRQL. The GERD Impact Scale (GIS) questionnaire, primarily developed for use within primary care, can also help to determine the impact of symptoms on patients’ everyday lives and, in turn, the benefit of appropriately targeted therapy. Notably, these PRO instruments were developed from focus groups of GERD patients, and only aspects rated of highest importance are used in the final instruments. Consequently, PCPs can feel confident that these questionnaires encompass the most relevant points that they are likely to ask in terms of how symptoms affect patients’ everyday lives.ConclusionsPrimary care physicians are encouraged to make wider use of PRO instruments within routine practice to improve communication with their GERD patients that, in turn, could lead to improved clinical outcomes and greater patient satisfaction.Review CriteriaWe conducted a review of validated patient-reported outcome (PRO) instruments used in gastro-oesophageal reflux disease (GERD), based on the authors’ expertise in the field and a supplementary MEDLINE search with the terms ‘health-related quality of life’, ‘quality of life questionnaire’, ‘patient-reported outcomes’, ‘patient satisfaction’ and ‘gastro-oesophageal reflux disease’.We reviewed papers reporting health-related quality of life (HRQL) data in patients with GERD, including the effect of GERD on HRQL, treatment efficacy and HRQL, patient satisfaction and physician-patient agreement, to help primary care physicians to incorporate PRO instruments into their day-to-day management of patients with GERD.Message for the ClinicAn evidence-based review shows that PRO instruments can accurately assess the nature of GERD symptoms, their impact on HRQL and the efficacy of treatment.Primary care physicians are encouraged to make wider use of PRO instruments as part of their management of patients with GERD, given that such questionnaires can facilitate patient communication and help physicians understand and satisfy the therapeutic needs of their patients.Among validated PRO instruments, the GERD Impact Scale represents a practical tool that is easy for primary care physicians to incorporate into their everyday practice.

Endoscopic appearance of GERD: Putative role of cell proliferation

Background Erosive esophagitis is a frequent endoscopic feature in patients with gastro-oesophageal reflux disease. However, most of patients with heartburn/regurgitation have a non-erosive reflux disease. The reason for this heterogeneous impact of gastro-oesophageal reflux disease on oesophageal mucosa is unknown to date. Aim To evaluate the cell proliferation status of oesophageal epithelium in both healthy normal subjects and patients with gastro-oesophageal reflux disease with or without erosions. Materials and methods All the subjects underwent endoscopy and biopsies were taken at 5 cm from the squamo-columnar junction. Specimens were analysed both at histology and at transmission electron microscopy. Cell proliferation was evaluated by MIB1 immunostaining. Of the 85 subjects were studied, 10 were healthy controls with normal pH-testing and macroscopical, histological and ultrastructural patterns; 37were patients with erosive esophagitis, and 38 patients with non-erosive reflux disease. Results At histology, of the 37 patients affected by erosive esophagitis, 30 had normal mucosa and 7 showed mild oesophagitis. One patient with non-erosive reflux disease showed signs of oesophagitis at histology. At TEM, all patients with gastro-oesophageal reflux disease had ultrastructural patterns of damage i.e. dilations of intercellular spaces (DIS), and all controls had a normal ultrastructural pattern. The mean (±SD) MIB1-LI values of normal subjects and non-erosive reflux disease and erosive oesophagitis patients were 62.2% (±9.1), 29.7% (±7.2) and 16.2% (±5.2), respectively; there were significant differences among the three groups ( p < 0.001). Conclusions Oesophageal mucosa of patients with reflux symptoms presents a decrease in MIB1 immunostaining of 50% and 25% in non-erosive reflux disease and erosive esophagitis patients with respect to normal subjects.

Review article: quality‐of‐life issues in gastro‐oesophageal reflux disease

The purpose of this review is to explore issues relating to quality of life in gastro-oesophageal reflux disease, examining the range of generic and disease-specific instruments available, their applicability and limitations and to overview the effect of gastro-oesophageal reflux disease on quality of life. Whereas instruments have been developed to assist researchers, there is a paucity of reliable instruments for pragmatic use in the clinical setting. The situation is complicated because there is not necessarily a direct correlation between endoscopic findings and symptom severity and non-erosive reflux disease is now recognized as an important manifestation of gastro-oesophageal reflux disease. However, quality-of-life instruments are useful in evaluating the impact of therapies and interventions, although these are limited, particularly in surgical interventions. Impaired quality of life now forms part of a definition of gastro-oesophageal reflux disease, the impact of which goes beyond the symptoms alone. While the symptoms themselves have a negative effect on sufferers' lives, there are secondary effects caused by impaired physical, emotional and social functioning on productivity. Non-gastrointestinal problems caused by gastro-oesophageal reflux disease also impair quality of life. There is an ongoing need to develop instruments which truly measure the impact of gastro-oesophageal reflux disease and which are readily interpretable to the individual patient and clinician.

Impact of referral for gastro-oesophageal reflux disease on the workload of an academic Gastroenterology Unit

Background. Gastro-oesophageal reflux disease is known to be a frequent cause of patients’ referral to hospital gastroenterologists. Aim. To increase knowledge on referral for reflux disease, in an Italian academic setting. Patients and methods. The impact of gastro-oesophageal reflux disease on 1 year's workload, comprising upper endoscopy, outpatients’ consultations in the general clinic, oesophageal pH monitoring and oesophageal manometry was retrospectively assessed. Appropriateness of oesophageal pH monitoring and oesophageal manometry was also evaluated. Results. Endoscopy: Out of 2269 upper endoscopies reflux symptoms comprised 16.9% ( n = 386) of referrals; 19.1% only of these 386 patients had erosive oesophagitis at endoscopy and none had oesophagogastric malignancies (68% of the patients were >45 years). Consultations: Thirty-three percent out of 553 patients were referred for reflux symptoms. Upper endoscopy had already been performed before consultation in 64% of them. pH monitoring and oesophageal manometry: Two hundred and sixteen oesophageal pH monitorings and 160 oesophageal manometries were performed and 29% and 28%, respectively, were inappropriate, being performed in the diagnostic work-up of patients with typical reflux symptoms. Conclusions. At an academic Gastroenterology Unit, (a) gastro-oesophageal reflux disease is a frequent referral for upper endoscopy and consultations, (b) prevalence of oesophagitis is low, (c) consultation is preceded by endoscopy in the majority of patients and (d) oesophageal pH monitoring and oesophageal manometry are often inappropriately used.

Quality of life in relation to symptoms in patients with gastro‐oesophageal reflux disease — an analysis based on the ProGERD initiative

To determine the impact of gastro-oesophageal reflux disease (GERD) on the quality of life, to assess changes in the quality of life during treatment with esomeprazole and to define factors that can predict these changes. Patients with GERD (n=6215) were included in a prospective cohort study (ProGERD). All patients underwent endoscopy and received esomeprazole. At baseline and after 2 weeks of treatment, symptoms and quality of life were assessed. Factors that influenced changes in the quality of life were determined by multiple regression analyses. At baseline, the quality of life in GERD patients was lower than that in the general population, and was similar to that in patients after acute coronary events. No differences in symptoms or quality of life were observed between the subgroups of patients with non-erosive GERD, erosive GERD and Barrett's oesophagus. After treatment with esomeprazole, the symptoms and quality of life were improved in all subscales within 2 weeks (P<0.001). The mean score of the disease-specific quality of life instrument (Quality of Life in Reflux and Dyspepsia Patients) increased from 4.6 to 6.2 points, representing a highly relevant clinical improvement. The generic quality of life (SF-36) reached levels similar to those in the general population, but, again, no difference was found between the three different subgroups of GERD patients. The main factors associated with an improvement in the quality of life after treatment were symptom relief, severe erosive reflux disease, absence of extra-oesophageal disorders, avoidance of non-steroidal anti-inflammatory drug intake and positive Helicobacter pylori status. GERD causes a significant impairment in the quality of life that can be attenuated or normalized within a time period as short as 2 weeks by treatment with esomeprazole. These findings were similar across the whole GERD patient spectrum.

The burden of illness of gastro-oesophageal reflux disease: impact on work productivity.

The impact of gastro-oesophageal reflux disease on work productivity has become increasingly important, as the symptoms of gastro-oesophageal reflux disease affect individuals in their productive years of life. To assess the impact of gastro-oesophageal reflux disease on reduced work productivity and to identify the predictors of reduced productivity. A sample of employed individuals reporting chronic heartburn was selected from US household mail survey respondents. Heartburn severity and frequency were recorded using a diary, and work productivity was assessed using the Work Productivity and Activity Impairment Questionnaire for Patients with Symptoms of Gastro-oesophageal Reflux Disease. Predictors of reduced productivity were evaluated. Over 30% of heartburn sufferers reported reduced productivity. Individuals with symptoms of gastro-oesophageal reflux disease (n = 1003) reported 6.0% reduced productivity attributable to symptoms. Over 48% of respondents with severe symptoms reported reduced productivity, compared with 40% and 12% of respondents with moderate and mild symptoms, respectively. Using logistic regression, severity, a younger age and nocturnal symptoms were associated with increased odds of reduced productivity. In those reporting nocturnal heartburn, medication use and sleep interference increased the odds of reduced productivity. Reduced work productivity is seen in a large proportion of subjects on prescription medication for gastro-oesophageal reflux disease. Symptom severity and nocturnal heartburn are significantly associated with reduced work productivity, particularly when nocturnal heartburn interferes with sleep.

Improving Health-Related Quality of Life in Gastro-Oesophageal Reflux Disease

Gastro-oesophageal reflux disease (GORD) is a common, chronic disorder that can progress to erosive or ulcerative oesophagitis and other complications. Uncomplicated GORD can be defined using criteria that combine symptom assessment and the impact of symptoms on well being or quality of life. The extent of impairment of health-related quality of life (HRQL) in GORD patients has been evaluated using generic HRQL questionnaires, GORD-specific quality of life questionnaires or a combination of the two types of instruments. The impact of GORD on HRQL in affected individuals is proportional to the frequency and severity of heartburn, and is greater than that associated with many other chronic diseases. In the treatment of GORD, the goal should be complete symptom resolution as this has been shown to be associated with a clinically significant improvement in HRQL. Both drug treatment and surgical intervention have been successful in improving HRQL of patients with GORD when complete symptom resolution can be attained.