Management Of GERD Research Articles

Comment to: A comparative study of magnetic sphincter augmentation and Nissen fundoplication in the management of GERD

Comment to: A comparative study of magnetic sphincter augmentation and Nissen fundoplication in the management of GERD

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.

Emerging Diagnostic Tools and Medical Management of GERD

Emerging Diagnostic Tools and Medical Management of GERD

Clinician’s Perspectives on the Management of Gastroesophageal Reflux Disease and Prescription Practice of Proton Pump Inhibitors in Indian Settings

Objective: To assess the clinicians’ perspectives on GERD management and the prescription practices of proton pump inhibitors (PPIs) in Indian settings. Methods: This cross-sectional study was conducted among clinicians specialized in GERD management. Participants completed a 24-question questionnaire distributed via email or online platforms. The survey explored prescription practices, clinical observations, and preferences regarding PPIs and GERD management. Data analysis involved descriptive statistics, with responses presented as frequencies and percentages. Results: Out of 123 survey participants, 57% identified diet as the most common predisposing factor for GERD. Nighttime heartburn and disturbed sleep were recognized as key alarm symptoms by 57% of participants. Epigastric tenderness was the most prevalent physical finding, reported by 68% of clinicians. PPIs were favored as the first-line treatment for GERD by 78.86% of respondents. Domperidone was preferred as an adjunctive treatment for functional dyspepsia and gastroparesis. An empirical PPI trial was widely supported for its simplicity and cost-effectiveness. Rabeprazole emerged as the preferred PPI for nighttime heartburn relief due to its rapid onset and sustained efficacy. Conclusion: This study highlighted a consensus among Indian clinicians on the use of PPIs as a primary treatment for GERD, with a preference for rabeprazole. Domperidone is favored as an adjunctive treatment for functional dyspepsia and gastroparesis. Rabeprazole emerged as the preferred option for nighttime heartburn relief, owing to its rapid onset and long-lasting effectiveness.

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

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

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

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

Gastro-esophageal reflux disease among the urban population of Saudi Arabia

IntroductionGastro-esophageal Reflux Disease (GERD) is a significant global health issue affecting millions and placing a substantial burden on healthcare systems. This study investigates the prevalence and influencing factors of GERD among the urban population in Saudi Arabia, amidst rapid urbanization and lifestyle changes. The goal is to provide insights for targeted interventions and improved public health strategies. MethodologyA cross-sectional study was conducted using a comprehensive methodology. A validated, bilingual questionnaire was used to collect data on demographics, awareness, psychosocial aspects, symptoms, and medical history. The study included 493 participants, and data were collected through an online survey. Statistical analysis was performed using SPSS and Excel, maintaining a statistical power of 80 ​%. ResultsThe survey included 493 participants, revealing the following key findings: Gender distribution: 41.37 ​% male, 58.62 ​% female (p ​= ​0.053). Age categories: 18–25 (25.35 ​%), 26–40 (18.05 ​%), 41–55 (26.97 ​%), 56 and above (29.61 ​%) (p ​= ​0.055). Nationality: 51.92 ​% Saudi, 48.07 ​% non-Saudi (p ​= ​0.058). Other notable demographics: marital status, education levels, smoking habits, nutritional habits, BMI categories, and prevalence of bariatric surgery. GERD symptoms and psychological factors showed significant associations. Treatment preferences and lifestyle modifications varied widely. The data provide essential insights for tailored interventions and healthcare strategies. ConclusionThis study highlights the complex demographic patterns and lifestyle factors associated with GERD in Saudi Arabia's urban population. The findings emphasize the importance of tailored interventions and inform healthcare, research, and policy decisions for effective GERD management in urban settings.

Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: impact on reflux and weight loss

BackgroundSleeve gastrectomy (SG) is the most commonly performed weight loss operation, and its 2 most common complications are postoperative reflux and weight recurrence. There is limited evidence to guide decision-making in treating these conditions. ObjectivesTo determine the efficacy of conversion of SG to Roux-en-Y gastric bypass (RYGB) for GERD management and weight loss. SettingForty-one hospitals in Michigan. MethodsWe conducted a retrospective cohort study examining patients who underwent conversion of SG to RYGB from 2014 to 2022. The primary outcomes were changes in GERD-HRQL scores, anti-reflux medication use, and weight from baseline to 1 year after conversion. Secondary outcomes included 30-day postoperative complications and resource utilization. ResultsAmong 2133 patients undergoing conversion, 279 (13%) patients had baseline and 1-year GERD-HRQL survey data and anti-reflux medication data. GERD-HRQL scores decreased significantly from 24.6 to 6.6 (P < .01). Among these, 207 patients (74%) required anti-reflux medication at baseline, with only 76 patients (27%) requiring anti-reflux medication at 1 year postoperatively (P < .01). Of the 380 patients (18%) with weight loss data, mean weight decreased by 68.4lbs, with a 24.3% decline in total body weight and 51.5% decline in excess body weight. In terms of 30-day complications, 308 (14%) patients experienced any complication and 89 (4%) experienced a serious complication, but there were no leaks, perforations, or deaths. Three-hundred and fifty-five (17%) patients presented to the emergency department and 64 (3%) patients underwent reoperation. ConclusionsThis study represents the largest reported experience with conversion from SG to RYGB. We found that conversion to RYGB is associated with significant improvement in GERD symptoms, reduction in anti-reflux medication use, and significant weight loss and is therefore an effective treatment for GERD and weight regain after SG. However, the risks and benefits of conversion surgery should be carefully considered, especially in patients with significant comorbidity burden.

GERD after Bariatric Surgery: A Review of the Underlying Causes and Recommendations for Management.

GERD after bariatric surgery is an ongoing concern for bariatric surgeons and their patients. This paper reviews the association of persistent or de novo GERD after multiple types of bariatric surgery, and focuses on the work up and management of GERD after SG. Two recent large, multicenter randomized clinical trials have shown stronger associations between SG and GERD compared to RYGB. A large group of internationally recognized bariatric surgeons collaborated on 72 consensus statements to help guide the bariatric community on the subject of redo surgeries after SG, including as it pertains to GERD. We present an algorithm that consolidates the best-practices recommendations of the work-up and management of GERD after sleeve gastrectomy, and mention areas of persistent controversy where future research is warranted.

Management of GERD after POEM

Management of GERD after POEM

Evaluating physicians' awareness and prescribing trends regarding proton pump inhibitors: a cross-sectional study.

Introduction: Proton pump inhibitors (PPIs) are commonly used to treat acid-related disorders. Their appropriate use depends on the correct indications from the clinician. Owing to the high incidence of use and misuse, PPIs have been identified as an essential pharmacological class for developing deprescribing recommendations. Therefore, assessing physicians' knowledge and practice regarding PPI usage is critical for paving the way toward targeted recommendations and efforts. Objective: This study aimed to assess Syrian physicians' perceptions of proton pump inhibitors adverse effects, their benefit in upper gastrointestinal bleeding (UGIB) prophylaxis, and how these perceptions are related to PPI prescription practice. Methods: A cross-sectional study was performed using a web-based questionnaire distributed among Syrian physicians in internal medicine between 28 November and 23 December 2022. The questionnaire assessed perceptions and experiences of PPIs, concerns about specific adverse effects, and their effectiveness for UGIB prophylaxis, in addition to the different scenarios used to determine the best practice for appropriate treatment to manage minimal, mild, moderate, and high-risk UGIB patients. Results: A total of 473 participants completed the questionnaire, with median age ±SD was (28.46 ± 4.58), and most participants (83.3%) were residents. Approximately half of the participants (45.5%) agreed that discussion assistance was provided to continue or terminate PPIs properly. Only 8.9% were very familiar with published evidence of PPI adverse effects. Bone weakening and vitamin B12 deficiency were the most frequently reported side effects (81.8% and 79.7%, respectively). However, dementia (0.4%) and mortality (1.9%) were the least reported adverse effects. More than half of the participants (64%) perceived using PPIs to prevent upper GI bleeding. Non-trainee physicians were less knowledgeable about appropriate GERD management than resident physicians (p < 0.001). Conclusion: The study showed a gap between Syrian physicians' perceptions and practices regarding PPI use, which necessitates spreading awareness of updated guidelines for PPI usage and their side effects.

Methods of quality assurance in multicenter trials in laparoscopic fundoplication for gastroesophageal reflux disease.

Operative performance may affect the internal and external validity of randomized trials. The aim of this study was to review the use of surgical quality assurance mechanisms of published trials on laparoscopic anti-reflux surgery, with the objective to appraise their internal (research quality) and external validity (applicability to the clinical setting). Building upon a previous systematic review and network meta-analysis published by the authors, Medline, Embase, AMED, CINAHL, CENTRAL, and OpenGrey databases were searched for randomized control trials comparing different methods of laparoscopic anti-reflux surgery for the management of gastroesophageal disease. Quality assurance in individual studies was appraised using a specified framework addressing surgeon accreditation, procedure standardization, and performance monitoring. In total, 2276 articles were screened to obtain 43 publications reporting 29 randomized controlled trials. Twenty-five out of 43 (58.1%) articles reported the number of participating centers and surgeons involved. Additionally, only 21/43 (48.8%) of articles reported consistent use of a bougie, while 23/43 (53.5%) of articles reported consistent division of the short gastric arteries during fundoplication. Surgical experience and credentials were stated in half of the studies. Standardization of the technique was reported in almost 70% of cases, whereas operative notes or video was submitted in one fourth of the studies. Monitoring of the operative performance during the trial was not documented in most of the trials (62%). Surgical quality assurance in randomized trials on laparoscopic anti-reflux surgery is insufficient, which does not allow appraisal of the internal and external validity of this research. With improved reporting, trials assessing the use of laparoscopic anti-reflux surgery will enable surgeons to make informed treatment decisions to enhance patient care in the surgical management of GERD.

Homeopathy as an Emerging Alternative for GERD Management: A Comprehensive Review

Homeopathy as an Emerging Alternative for GERD Management: A Comprehensive Review

Medical and Dental Management of GERD

Medical and Dental Management of GERD

A149 CHARACTERIZING INAPPROPRIATE PROTON-PUMP INHIBITOR DISCONTINUATION IN PATIENTS WITH ESOPHAGEAL STRICTURES

Abstract Background Recent recommendations to reduce proton pump inhibitor (PPI) usage may cause uncertainty for clinicians and patients. We have shown increased PPI discontinuation rates in patients with esophageal strictures in recent years. Purpose: We aim to determine the appropriateness of PPI discontinuation in patients undergoing esophageal dilation for symptomatic strictures. Purpose We aim to determine the appropriateness of PPI discontinuation in patients undergoing esophageal dilation for symptomatic strictures. Method All patients from two gastroenterology practices who received dilations to treat symptomatic esophageal strictures in 2015-2021, (group 1: 2015-17 and group 2: 2019-21) were identified using physician billing codes for this retrospective study. Patient demographics, medications, and previous GI diagnoses were collected using endoscopy reports, nursing reports and medication records from the local hospital database. We defined PPI discontinuation as either a 50% dose reduction, 50% frequency reduction or complete medication discontinuation at the time of endoscopic dilation compared to the established PPI therapy. Next, we defined inappropriate PPI discontinuation as a patient who discontinued their PPI medication with a past history of 1. esophageal stricture, 2. Barrett’s esophagus 3. grade C/D esophagitis, or 4. experienced symptom reoccurrence after PPI discontinuation. We selected these criteria as they are consistent with both Canadian and American Gastroenterology Society GERD management guidelines. This information was coded on a standard data sheet and entered into SPSS for analysis. Result(s) In total, 223 patients were identified with an average age of 58.7 and a sex ratio of (125:98, M:F). 26 patients discontinued their PPI medication prior to esophageal stricture dilation. The most frequent type of event was complete PPI discontinuation at 58% (15/26 cases). Followed by frequency reduction at 27% (7/26), dose reduction at 8% (2/26), and both dose and frequency reduction at 8% (2/26). The 26 patients with PPI discontinuations had an average length of 13 months between PPI discontinuation and esophageal stricture dilation. 57% (15/26 cases) of patients meet our criteria for inappropriate PPI discontinuation (table 2). The proportion of inappropriate PPI discontinuation are as follows: Group 1: 33% (3/9 cases) inappropriate PPI discontinuations and Group 2: 70% (12/17 cases) inappropriate PPI discontinuations, (P=0.06) upon Chi-squared analysis. Table 2- Inappropriate PPI discontinuations Previous Stricture: 10/26 Barrett’s Esophagus: 0/26 Grade C/D Esophagitis: 1/26 Symptom Reoccurrence: 4/26 Total inappropriate discontinuations: 15/26 = 57% Total appropriate discontinuations (no PMH): 11/26 = 43% Conclusion(s) Compete PPI discontinuation was the most common type of PPI discontinuation event. There was a trend toward more inappropriate PPI discontinuations in the second time period. Physicians should carefully consider indications for PPI use prior to discontinuation. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest K. Kecskemeti: None Declared, M. Borgaonkar Consultant of: $10K, Speakers bureau of: $20K, J. McGrath: None Declared

Review on management of GERD

Review on management of GERD

GERD and its homoeopathic approach

This article reviews about GERD, which is a common clinical problem in this modern world due to change in lifestyle, dietary habits and sedentary occupations. GERD is more common in people above 40 years age. About 10-30 percent of people in western countries suffer from GERD symptoms. Homoeopathy has wide scope in preventive and curative aspect of GERD. This article deals about Homoeopathic management of GERD, different Homoeopathic remedies and also various rubrics of GERD.

Management of GERD After Myotomy for Achalasia

Acid reflux is a well-known outcome after surgical or endoscopic myotomy, resulting from disruption of the natural anti-reflux barrier. The incidence of post-myotomy GERD remains difficult to estimate as studies cite variable definitions including endoscopic evidence of reflux, abnormal pH testing, and GERD symptoms. Future studies should focus on “clinically significant reflux” defined as abnormal pH testing associated with either GERD symptoms or endoscopic evidence of reflux esophagitis. Large meta-analyses have demonstrated significantly higher rates of abnormal acid exposure after peroral endoscopic myotomy (POEM) compared to laparoscopic heller myotomy (LHM). Focusing on POEM, studies show that while nearly half of patients will have esophagitis on follow-up endoscopy, the majority of these cases are mild or moderate and do not lead to significant clinical sequelae. While PPI therapy can be used effectively as treatment, new anti-reflux procedures are being developed, including transoral incisional fundoplication (TIF) and POEM + fundoplication (POEM + F) that may help to manage postmyotomy reflux in the same way the Dor fundoplication is performed with Heller myotomy. Currently, there is no reliable method for determining which patients are at risk for post-myotomy GERD. New methods are being developed to help risk- stratify these patients such as the use of EndoFLIP (endoscopic intraluminal functional imaging probe) to tailor the degree of myotomy. In addition, variable techniques of POEM are being studied to understand if the procedure can be performed in such a way as to minimize or even prevent post-myotomy GERD from occurring.

Preliminary Results of a Study Comparing Pre-sleeve Endoscopic Fundoplication to Gastric Bypass on Gastroesophageal Reflux Disease Outcomes.

Gastroesophageal reflux disease (GERD) is a significant complication of sleeve gastrectomy (SG). Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is considered the primary treatmentfor bariatric surgery candidates with GERD. Post-operative options for GERD management are limited. This study compares the effect of transoral fundoplication (TF) prior to SG vs LRYGB in patients with GERD . Of 30 consecutive bariatric surgery patients with GERD between 3/22/2018 and 6/23/2020, 15 patients underwent TF prior to SG (TF/SG) and 15 patients underwent LRYGB. Subjective and objective criteria, including the GERD Health-Related Quality of Life (HRQL) and Reflux Symptom Index (RSI) survey, were used to assess symptoms. Surveys were collected pre-operatively, post-TF/pre-SG, 4-6 and 12-15months post bariatric procedure. Preoperative mean scores were as follows: HRQL 32.53, RSI 21.7, 93% proton pump inhibitor (PPI) usage, 6.5% satisfaction rate. Mean BMI: 45.99 (TF/SG), 42.27 (LRYGB). At 12-15months postoperatively: mean HRQL scores were 5.53 (TF/SG) and 6.67 (LRYGB). Both groups had a statistically significant improvement in HRQL-RSI postoperatively. PPI usage was 13% (TF/SG) and 34% (LRYGB). BMI decrease was 24% (TF/SG) and 31% (LRYGB). TF/SG is at least equivalent to LRYGB in resolution or reduction of reflux symptoms at 12-15months.

Correlation of the Endoscopic Gastroesophageal Flap Valve with Gastroesophageal Reflux Disease

INTRODUCTION: Hill Grade (HG) characterizes the gastroesophageal flap valve and abnormal HGs (III/IV) correlate with GERD. Although considered normal, many patients with HG II have GERD in clinical practice. The aim of this study was to correlate the incidence of GERD across HGs and determine the incidence of GERD in patients with HG II. METHODS: A retrospective review was performed on 365 patients who underwent EGD and BRAVO pH monitoring between August 2018 and August 2021. Of 365 patients, 187 (51.2%) had a HG reported and were further reviewed for the association with pathologic acid exposure defined as overall acid exposure time (AET): 4.9% and DeMeester score (DMS): 14.7. RESULTS: Of the 187 patients, 37 (19.8%) had HG I; 80 (42.8%) HG II; 49 (26.2%) HG III, and 21 (11.2%) HG IV. The proportion of abnormal AET increases with increasing HG (p = 0.023): I (37.8%), II (55.0%), III (63.7%), IV (76.2%); and the median AET also increases with HG (p = 0.008): I (1.6%), II (5.9%), III (8.3%), IV (9.5%). The proportion of abnormal DMS increases with HG (p = 0.022): I (43.2%), II (66.3%), III (71.4%), IV (76.2%); and the median DMS also increases with HG (p = 0.003): I (7.2), II (20.6), III (27.6), IV (34.3) (Table 1). Table 1. - Comparison of the Findings of 24-Hour pH Monitoring According to Hill Grade Variable Hill grade Median Mean Kruskal-Wallis test p Value DeMeester score 1 7.2 18.01 0.003 2 20.60 27.29 3 27.60 37.02 4 34.30 32.44 Acid exposure time overall (%) 1 1.6 5.11 0.008 2 5.95 7.50 3 8.30 10.34 4 9.50 8.96 CONCLUSION: Increasing HG is associated with higher median AET and DMS. HG II, which has been considered normal, correlates with pathologic reflux. Efforts are needed to educate endoscopists on the importance of accurately documenting the HG within the context of GERD management.