Gastroesophageal Reflux Disease Research Articles

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.

Efficacy of rabeprazole for the treatment of gastroesophageal reflux disease in a 7-day non-interventional trial

To evaluate the efficacy of seven-day treatment with rabeprazole (Razo®) 20 mg once daily in patients with NERD and esophagitis based on monitoring the results of pH-impedancemetry of the stomach and esophagus and assessment of clinical symptoms. Thirty patients with typical GERD manifestations were examined. The study included patients who underwent pH-impedancemetry, endoscopic examination, and were prescribed treatment with rabeprazole at a dose of 20 mg once a day. Clinical monitoring was performed during three visits: before treatment, after 3 days, and after 7 days of treatment. Control pH-impedancemetry was performed after 7 days of therapy. The third visit was the endpoint of the study. After 7 days of treatment, the response rate for heartburn was 86.7% in the overall group of patients with GERD, 94.4% in those with NERD, and 75.0% in patients with esophagitis stage A and B. After 7 days of therapy with rabeprazole, we registered a significant decrease in the total number of refluxes (from 88 to 54; p<0.001), the number of acid refluxes (from 53 to 22; p<0.001), the DeMeester index (from 23.81 to 7.62; p<0.001), and AET (from 7.54 to 2.01; p<0.001) in the esophagus and an increase in the median daily pH (from 1.8 to 5.4; p<0.001) and the time with pH>4 in the stomach (from 2.57 hours and 10.7% up to 12.3 hours and 51.3%; p<0.001). 7-day therapy with rabeprazole was accompanied by a significant improvement in GERD patients in all parameters of quality of life. 100% of patients with GERD rated their satisfaction with therapy as "good" and "very good". As a result of 7-day therapy of patients with NERD and esophagitis with Razo® at a dose of 20 mg per day, an excellent clinical response was obtained, confirmed by a marked optimization of pH-impedancemetry parameters.

Systems Biology and Machine Learning Identify Genetic Overlaps Between Lung Cancer and Gastroesophageal Reflux Disease.

One Health and planetary health place emphasis on the common molecular mechanisms that connect several complex human diseases as well as human and planetary ecosystem health. For example, not only lung cancer (LC) and gastroesophageal reflux disease (GERD) pose a significant burden on planetary health, but also the coexistence of GERD in patients with LC is often associated with a poor prognosis. This study reports on the genetic overlaps between these two conditions using systems biology-driven bioinformatics and machine learning-based algorithms. A total of nine hub genes including IGHV1-3, COL3A1, ITGA11, COL1A1, MS4A1, SPP1, MMP9, MMP7, and LOC102723407 were found to be significantly altered in both LC and GERD as compared with controls and with pathway analyses suggesting a significant association with the matrix remodeling pathway. The expression of these genes was validated in two additional datasets. Random forest and K-nearest neighbor, two machine learning-based algorithms, achieved accuracies of 89% and 85% for distinguishing LC and GERD, respectively, from controls using these hub genes. Additionally, potential drug targets were identified, with molecular docking confirming the binding affinity of doxycycline to matrix metalloproteinase 7 (binding affinity: -6.8 kcal/mol). The present study is the first of its kind that combines in silico and machine learning algorithms to identify the gene signatures that relate to both LC and GERD and promising drug candidates that warrant further research in relation to therapeutic innovation in LC and GERD. Finally, this study also suggests upstream regulators, including microRNAs and transcription factors, that can inform future mechanistic research on LC and GERD.

Population pharmacokinetic analysis of zastaprazan (JP-1366), a novel potassium-competitive acid blocker, in patients and healthy volunteers.

Zastaprazan (JP-1366) is a novel potassium-competitive acid blocker for the treatment of acid-related disorders. We aimed to establish a population pharmacokinetic (PK) model of zastaprazan, thereby characterizing the PK of zastaprazan in patients with gastroesophageal reflux disease (GERD) as well as evaluating the impact of various covariates, including CYP2C19 phenotypes, on zastaprazan PK. This population PK analysis included zastaprazan plasma concentration-time data from 92 patients with erosive GERD and 68 healthy volunteers without any gastrointestinal disorders and was performed using nonlinear mixed-effect modeling. Simulations were conducted to predict zastaprazan PK under various dosing regimens in patients with GERD. The plasma PK of zastaprazan was adequately described by a two-compartment model with Erlang-type absorption (six sequential compartments) and first-order elimination. CYP2C19 phenotypes had no significant effect on zastaprazan PK. The disease status was identified as a significant covariate on apparent clearance of zastaprazan, showing lower values in patients with GERD compared to healthy volunteers. However, the model-based simulation indicated that the impact of disease status on zastaprazan exposure was not clinically meaningful. Overall, the current population PK model successfully characterized the observed zastaprazan PK in both patients with GERD and healthy volunteers.

Concomitant hiatal hernia repair with transoral incisionless fundoplication for the treatment of refractory gastroesophageal reflux disease: a systematic review.

Transoral incisionless fundoplication (TIF) is safe and effective in select patients with hiatal hernias ≤ 2 cm with refractory gastroesophageal reflux disease (GERD). For patients with hiatal hernias > 2 cm, concomitant hiatal hernia (HH) repair with TIF (cTIF) is offered as an alternative to conventional anti-reflux surgery (ARS). Yet, data on this approach is limited. Through a comprehensive systematic review, we aim to evaluate the efficacy and safety of cTIF for managing refractory GERD in patients with hernias > 2 cm. We conducted a systematic review of studies evaluating cTIF outcomes from PubMed, EMBASE, SCOPUS, and Cochrane databases up to February 14, 2024. Primary outcomes included complete cessation of proton pump inhibitors (PPIs). Secondary outcomes included objective GERD assessment, adverse events, and treatment-related side effects. Pooled analysis was employed wherever feasible. Seven observational studies (306 patients) met the inclusion criteria. Five were retrospective cohort studies and two were prospective observational studies. The median rate of discontinuation of PPIs was 73.8% (range 56.4-94.4%). Significant improvements were observed in disease-specific, validated GERD questionnaires. The median rate for complications was 4.4% (range 0-7.9%), and the 30-day readmission rate had a median of 3.3% (range 0-5.3%). The incidence of dysphagia was 11 out of 164 patients, with a median of 5.3% (range 0-8.3%), while the incidence of gas bloating was 15 out of 127 patients, with a median of 6.9% (range 0-13.8%). Current data on cTIF suggests a promising alternative to ARS with comparable short-term efficacy and safety profile for managing refractory GERD with a low side effect profile. However, longer-term data and comparative efficacy studies are needed.

Comparative anatomic and symptomatic recurrence outcomes of diaphragmatic suture cruroplasty versus biosynthetic mesh reinforcement in robotic hiatal and paraesophageal hernia repair.

Hiatal and paraesophageal hernia (HH/PEH) recurrence is the most common cause of failure after gastroesophageal anti-reflux surgery. Crural reinforcement with mesh has been suggested to address this issue, but its efficacy remains debated. In this study, we aimed to determine the impact of biosynthetic mesh reinforcement compared to suture cruroplasty on anatomic and symptomatic hernia recurrence. Data of patients who underwent robotic HH/PEH repair with suture cruroplasty with or without biosynthetic mesh reinforcement between January 2012 and April 2024 were retrospectively reviewed. Gastroesophageal reflux disease symptoms and anatomic hernia recurrence were assessed at short-term (3months to 1year) and longer-term (≥ 1year) follow-up. Symptomatic hernia recurrence was defined as having both anatomic recurrence and symptoms. Out of the 503 patients in the study, 308 had undergone biosynthetic mesh repair, while 195 had suture-only repair. After the surgery, both groups demonstrated comparable improvements in symptoms. Short-term anatomic hernia recurrence rates were 11.8% and 15.6% for mesh and suture groups, respectively (p = 0.609), while longer-term rates were 24.7% and 44.9% (p = 0.015). The rates of symptomatic hernia recurrence in the same group were 8.8% and 14.6% in the short-term (p = 0.256), and 17.2% and 42.2% in longer-term follow-ups (p = 0.003). In the repair of medium and large-size hernias, mesh reinforcement resulted in a 50.0% relative risk reduction in anatomic hernia recurrences and a 59.2% reduction in symptomatic hernia recurrences at ≥ 1-year follow-up. After more than a year of follow-up, it has been found that using biosynthetic mesh for medium and large hiatal or paraesophageal hernia repair significantly reduces the likelihood of both anatomic and symptomatic recurrence compared to using only suture cruroplasty. These findings strongly support the use of biosynthetic mesh to manage larger hernias. However, further long-term multicenter randomized studies are needed to provide more conclusive evidence.

Noninvasive biomarkers for the detection of GERD-induced pulmonary injury.

The role of gastroesophageal reflux in progressive lung damage is increasingly recognized. We have proposed, based on our work with lung transplant recipients, a novel immune mechanism of pulmonary injury after aspiration of gastric contents, during which higher levels of normally sequestered lung self-antigens (SAgs) collagen V (Col-V) and K-alpha-1 tubulin (Kα1T) in circulating small extracellular vesicles (EVs) induce the production of self-antibodies (SAbs) anti-Col-V and anti-Kα1T. Thus, we aimed to determine whether levels of SAbs or SAgs increased in an animal model of aspiration-induced lung damage in a nontransplant setting. We created a murine model of repetitive lung aspiration using C57BL/6J mice. Mice were aspirated weekly with 1mL/kg of hydrochloric acid (n = 9), human gastric contents (n = 9), or combined (1:1) fluid (n = 9) once, three, or six times (n = 3 in each subgroup; control group, n = 9). Blood samples were periodically obtained, and all animals were sacrificed at day 90 for pathological assessment. SAbs were measured using an enzyme-linked immunosorbent assay; SAgs and NF-κB contained in small EVs were assessed by western blot. Aspirated mice weighed significantly less than controls throughout the study and had histological evidence of pulmonary injury at day 90. Overall, aspirated mice developed higher concentrations of anti-Col-V at day 28 (53.9 ± 28.7 vs. 29.9 ± 4.5ng/mL, p < 0.01), day 35 (42.6 ± 19.8 vs. 28.6 ± 7.2ng/mL, p = 0.038), and day 90 (59.7 ± 27.7 vs. 34.1 ± 3.2ng/mL, p = 0.014) than the control group. Circulating small EVs isolated from aspirated mice on day 90 contained higher levels of Col-V (0.7 ± 0.56 vs. 0.18 ± 0.6m.o.d., p = 0.009) and NF-κB (0.42 ± 0.27 vs. 0.27 ± 0.09m.o.d., p = 0.095) than those from controls. This experimental study supports the theory that gastroesophageal reflux leads to the development of lung damage and an increase of humoral markers that may serve as noninvasive biomarkers to detect asymptomatic lung injury among patients with gastroesophageal reflux disease.

Hiatal Hernias Revisited-A Systematic Review of Definitions, Classifications, and Applications.

A hiatal hernia (HH) can be defined as a condition in which elements from the abdominal cavity herniate through the oesophageal hiatus in the mediastinum and, in the majority of cases, parts of the proximal stomach. Today, the role of HHs within the complex entity of gastroesophageal reflux disease (GERD) is very important with regard to its pathophysiology, severity, and therapeutic and prognostic options. Despite this, the application and stringent use of the worldwide accepted classification (Skinner and Belsey: Types I-IV) are lacking. The aim of this study was to carry out a systematic review of the clinical applications of HH classifications and scientific documentation over time, considering their value in diagnosis and treatment. Following the PRISMA concept, all abstracts published on pubmed.gov until 12/2023 (hiatal hernia) were reviewed, and those with a focus and clear description of the application of the current HH classification in the full-text version were analysed to determine the level of classification and its use within the therapeutic context. In total, 9342 abstracts were screened. In 9199 of the abstracts, the reports had a different focus than HH, or the HH classification was not used or was incompletely applied. After further investigation, 60 papers were used for a detailed analysis, which included more than 12,000 patient datapoints. Among the 8904 patients, 83% had a Type I HH; 4% had Type II; 11% had Type III; and 1% had Type IV. Further subgroup analyses were performed. Overall, the precise application of the HH classification has been insufficient, considering that only 1% of all papers and only 54% of those with a special focus on HH have documented its use. The application and documentation of a precise HH classification in clinical practice and scientific reports are decreasing, which should be rectified for the purpose of scientific comparability.

Conference proceedings: Inaugural meeting of the consortium for autism, genetic neurodevelopmental disorders, and digestive diseases.

Individuals with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD), often experience a higher prevalence of gastrointestinal (GI) symptoms but have complex medical and behavioral comorbidities that make diagnosis and treatment difficult. A multi-stakeholder conference was convened to (a) determine patient and family experiences related to GI symptoms in NDDs, (b) review the clinicians' and researchers' perspectives, and (c) determine actionable steps for future research. The Consortium for Autism, Neurodevelopmental Disorders and Digestive Diseases (CANDID; www.candidgi.com) virtually over 2 days in 2022 and consisted of four key activities: (1) an electronic family survey to assess underlying NDDs and GI symptoms, (2) a session focused on family perspectives, (3) review current clinical care and research, and (4) discussion to identify key next steps. Survey results were obtained electronically via the REDCap platform, and descriptive statistics were generated. The sessions were recorded, and themes were identified. The pre-conference survey ran for ~2 months and 739 families provided responses, with 634 completing all items. 83% had a child with an NDD under age 18, and most patients were White (85%) and non-Hispanic (87%). Constipation (80%), gastrointestinal reflux disease (51%), and bloating (49%) were the most frequently reported symptoms. Families gave unstructured feedback that the measures used in the surveys were often difficult to answer for patients with NDDs or who were nonspeaking. Family and clinical/scientific sessions identified several common themes, including (1) the need for less invasive diagnostic modalities, (2) the need to validate or adapt existing diagnostic measures (e.g., the Rome IV criteria) and outcome assessments, and (3) the need for enhanced attention to parent and caregiver input in treatment plans. Those providing care to children with NDDs, especially those with communication and cognitive challenges, should be aware of the differing needs in this community and consider family perspectives in managing, treating, and measuring GI issues. Future research should focus on adapting or creating diagnostic and research measures for those with NDDs, developing new diagnostic methods to account for diversity in neurodevelopment and communication, and improving methods for family and caregiver engagement in the care of GI disorders.

Reevaluating the association between cholecystectomy and gastroesophageal reflux disease: recommendations for enhanced mendelian randomization analysis

Reevaluating the association between cholecystectomy and gastroesophageal reflux disease: recommendations for enhanced mendelian randomization analysis

The role of screening of patients proved to have gastroesophageal reflux disease by upper gastrointestinal endoscope for early detection of interstitial lung diseases

BackgroundGastroesophageal reflux disease (GERD) is a frequent digestive illness in North America, causing symptoms and complications. It affects 18.1–27.28% of people and is associated with decreased quality of life. Treatment improves quality of life, but treatment costs are higher. The study aims to assess the role of screening of patients proven to have GERD by upper gastrointestinal endoscope for early detection of interstitial lung diseases.Subjects and methodsThis research was cross-sectional research. The study will be conducted at the Chest Diseases Department of Ain Shams University hospitals. This prospective cross-sectional research will be performed on 90 randomly selected cases diagnosed with GERD by upper gastrointestinal endoscopy. For 1 year.ResultThe findings of chest HRCT for enrolled patients are 15 patients (16.7%) showed positive CT findings suggestive of interstitial lung disease, whereas 75 patients (83.3%) had normal CT scans. The most common CT finding was atelectasis reported in nine patients (10%). a statistically significant correlation between age and fibrosis and reticular infiltration, female gender, and reticular infiltration. no statistically significant association between CT findings and each of the chest symptoms and GERD symptoms.ConclusionCT chest screen of patients diagnosed with GERD by upper gastrointestinal endoscopy plays a favorable role in the early detection of ILD to help in early management and treatment them. In patients diagnosed with GERD by upper gastrointestinal endoscopy, we revealed that: reticular infiltration is more prevalent in female gender. Reticular infiltration and fibrosis increase with older age. Reticular infiltration and atelectasis increase in patients who have a hiatus hernia. Cough, dyspnea, and wheezes increase in older age.

SP9.14 - Gastro-oesophageal reflux disease outcomes in patients with obesity following gastric bypass surgery: a systematic review and meta-analysis

Abstract Introduction Obesity is associated with increased incidence of gastro-oesophageal reflux disease (GORD). Gastric bypass is one of the most common bariatric procedures and has favourable weight loss outcomes leading to a decrease in morbidity and mortality. However, the exact impact of gastric bypass on GORD symptoms remains less well understood. This systematic review and meta-analysis aimed to investigate the relationship between gastric bypass surgery and GORD. Methods A literature search of MEDLINE, Embase, Emcare and CINAHL was performed for studies that reported on GORD outcomes following gastric bypass from January 2000 to June 2023. Meta-analysis was performed using random-effect models and between-study heterogeneity was assessed. The study was registered in the PROSPERO database (CRD42023495567). Results 16 studies with 28,438 patients (follow-up ranging from 6-100 months), with laparoscopic Roux-en-Y gastric bypass being the most common procedure performed (25,567; 90%). The mean operative time for gastric bypass was 101 ± 14.0 minutes, with a re-operation rate of 0.025% ± 0.005. Sixty percent of patients permanently stopped proton-pump inhibitors following surgery. Overall, gastric bypass surgery led to a significant improvement in GORD symptoms (OR 5.31%; 95% CI: 1.77-15.91; p&amp;lt;0.003), with a postoperative mortality rate of 0.037% ± 0.009. Conclusions The findings of this systematic review and meta-analysis showed that gastric bypass surgery is an effective and safe treatment for GORD. This has significant implications for counselling patients with obesity and GORD for bariatric surgery. Further research is required to understand the precise mechanism of the improvement in GORD symptoms following bariatric surgery.

Current Advances in Diagnosis, Therapeutics, and Surgical Interventions for the Management of Refractory Gastroesophageal Reflux Disease (GERD): An Update.

Gastroesophageal reflux disease (GERD) is a chronic illness characterized by complications arising from the reflux of stomach contents, which significantly lower the quality of life, increase morbidity, and increase medical expenses associated with treating the condition. The main goal of treatment in GERD is symptomatic relief, relapse prevention, and healing of erosive esophagitis. The treatment mainly involves lifestyle changes to control acid production and proton pump inhibitors (PPIs) as the first line of treatment. Endoscopic interventions or anti-reflux surgery may be beneficial in relieving symptoms in people whose symptoms are triggered by reflux. In this review, we discuss the pathophysiology and newer diagnostic and treatment modalities including available surgical management options to manage refractory GERD.

Psychopathology in asthma patients: analysis of demographic and clinical associations.

Asthma, a chronic inflammatory condition affecting the airways, significantly impacts both respiratory function and quality of life. Recent studies have highlighted the psychological dimensions of chronic diseases like asthma. Despite growing evidence linking asthma with various psychopathological conditions, comprehensive data remains scarce. This study aims to explore the psychopathological status of asthma patients and identify demographic and clinical factors associated with higher levels of psychopathological symptoms. Data were collected from 42 asthma patients attending the Asthma Outpatient Clinic at the University of Thessaly, Greece. Participants completed a detailed questionnaire on demographics and clinical parameters, along with the Symptoms Checklist-90 (SCL-90) to assess psychological symptoms. The sample included patients with varying asthma severity: 38% with severe asthma and 62% with mild-moderate asthma, with a mean age of 60.8 ± 15.6 years. Results indicated that 23.8% exhibited somatization symptoms, 23.8% showed compulsive behaviors, 33.8% reported interpersonal sensitivity, and 38.1% experienced depression and 38.1% aggressiveness. Additionally, 45.2% struggled with fearful anxiety, 4.8% showed paranoid ideation, and 11.9% had traits of psychoticism. Women had significantly higher psychopathology scores than men. Factors such as longer disease duration, uncontrolled asthma, severe asthma, and comorbid conditions like atopy and gastroesophageal reflux disease (GERD) were linked to higher psychopathological scores. The study found a high prevalence of psychopathological symptoms among asthma patients. Female gender, prolonged asthma duration, persistent symptoms, comorbid diseases (GERD, atopy) and greater disease severity were significantly associated with higher psychopathology, underscoring the need for integrated mental health care in asthma management.

Feeding and Swallowing Disorders and Related Factors in Iranian Children with Cerebral Palsy

Background: Children with cerebral palsy (CP) are at a heightened risk of developing feeding and swallowing disorders, which are influenced by a variety of medical, cultural, psychosocial, and nutritional factors. The prevalence rates of these disorders vary widely across different studies, highlighting the complexity and multifaceted nature of these challenges. Objectives: This study aimed to determine the prevalence of feeding and swallowing disorders and to explore the factors associated with the severity of swallowing issues in Iranian children with CP. Methods: A cross-sectional study was conducted with a convenience sample of 111 Iranian children with CP. The study assessed feeding and swallowing problems through clinical evaluations and parental reports. Data analysis was performed using IBM SPSS version 20, utilizing chi-square and Spearman's correlation coefficient tests. Results: The study found that feeding and swallowing problems are common among Iranian children with CP, with 79.2% of children having feeding disorders and 78.3% experiencing swallowing difficulties. Of particular concern, 40.5% of the children showed issues during the pharyngeal phase of swallowing, and 12.6% exhibited unsafe swallowing patterns. There were significant correlations between the severity of swallowing issues and several factors: Malnutrition (P ≤ 0.001), gastroesophageal reflux disease (GERD) (P = 0.007), motor impairment (P ≤ 0.001), and caregiver concern (P ≤ 0.001). Malnutrition was found in 60% of the children, yet only 23% were receiving dietary supplements, and a mere 2.7% were using tube feeding. Conclusions: Feeding and swallowing disorders, along with malnutrition, are highly prevalent in Iranian children with CP. The positive correlation between the severity of swallowing issues and malnutrition underscores the critical need for early, multidisciplinary interventions to address these challenges.

Evaluation of Aluminum and Magnesium Absorption Following the Oral Administration of an Antacid Suspension Containing Magaldrate in Healthy Women Under Fed Conditions.

Antacids are commonly used during pregnancy, and they are approved for the relief of symptoms of gastroesophageal reflux disease (GERD) during pregnancy. However, there are no reports of the quantification of the absorption of aluminum and magnesium in the antacid magaldrate in women. The aim of this study was to quantify the rate and magnitude of absorption of aluminum and magnesium in magaldrate. An open-label, controlled, randomized, one-treatment study with a two-group design was conducted in healthy women in a fed state. The volunteers had a standard breakfast, and 30min later, they were given a single-medication sachet containing 500mg of sodium alginate, 267mg of sodium bicarbonate, 800mg of magaldrate, and 120mg of simethicone (groupA, n = 8) or no medication (groupB, n = 2). Blood samples were obtained 36h before and up to 12h after antacid administration. The method used for quantification was inductively coupled plasma-mass spectrometry. There was no absorption of aluminum in any of the blood samples from the healthy volunteers who received the drug or in those from the control group. Magnesium was detected at normal concentrations. These findings suggest that the use of this antacid is safe and without risk in healthy women, including pregnant women. Clinicaltrials.gov registration: NCT06367452.

How I Do It—Transoral Incisionless Fundoplication with Concomitant Hiatal Hernia Repair

AbstractTransoral incisionless fundoplication with concomitant hiatal hernia repair (cTIF) is an antireflux procedure that combines hiatal hernia repair with TIF. As such, it restores the antireflux barrier using a two-step, hybrid procedure utilizing both minimally invasive surgery and endoscopy in one operative procedure. In this article, we discuss the procedure as well as its role in the armamentarium of interventions for gastroesophageal reflux disease and outline technical details.

Gastrointestinal dysmotility is associated with proton pump inhibitor refractory esophagitis in patients with systemic sclerosis.

Patients with systemic sclerosis present with severe gastroesophageal reflux disease, often refractory to proton-pump inhibitors (PPI) treatment. The aim of the present study was to identify factors associated with PPI-refractory esophagitis. We performed a cross-sectional study in a single-center cohort of patients diagnosed with systemic sclerosis. We included patients who underwent an esophagogastroduodenoscopy while on PPI treatment. Patients with PPI-refractory erosive esophagitis were compared with those with endoscopically normal esophageal mucosa. A total of 69 patients were included, from these, 23 patients (33%) had PPI-refractory esophagitis (Grade A, n = 11; Grade B, n = 7; Grade C, n = 2; Grade D, n = 3) and 46 (67%) had an endoscopically normal esophageal mucosa. On univariate analysis, patients with PPI-refractory esophagitis were more frequently diffuse SSc subset (43% vs 17%; p= 0.041). Evaluating gastrointestinal motility tests, neither absent esophageal contractility (39% vs 25%, p= 0.292) nor hypotensive lower esophageal sphincter (47% vs 44%, p= 0.980) were significantly associated with PPI-refractory esophagitis. Gastrointestinal dysmotility, defined as abnormal gastric emptying and/or small bowel dilated loops, was significantly associated with PPI-refractory esophagitis (66 vs 8%, p = <0.001). On a multivariate regression model to evaluate the association between motility test results adjusted for the diffuse subset, gastrointestinal dysmotility (β = 0.751, p= 0.010) was independently associated with PPI-refractory esophagitis, while absent esophageal contractility (β = 0.044, p= 0.886) or a hypotensive LES were not (β=-0.131, p= 0.663). Our findings suggest that gastric and small intestinal motor dysfunction may be an important contributor to the development of PPI-refractory esophagitis in patients with systemic sclerosis.

Dysfunction of the autonomic nervous system in gastro-esophageal reflux disease: Consequences for the cardiovascular system

ObjectiveThe pathophysiology of gastro esophageal reflux disease (GERD) implicates autonomic dysregulation of the lower esophageal sphincter tone. Our goal is to investigate whether this dysregulation of the autonomic nervous system (ANS) function observed in isolated GERD cases can affect other systems, such as cardiovascular regulation.Methods: Twenty-five participants were included in the study, 11 patients with isolated GERD and 14 controls. All patients and 7 controls responded to a COMposite Autonomic Symptoms Score 31 (COMPASS 31) questionnaire and underwent functional explorations including EMLA test, sympathetic skin response (SSR), 24-hour heart rate recording and ambulatory blood pressure measurement (ABPM). Seven additional controls underwent a 24-hour heart rate recording only. ResultsGERD patients (Age: mean 36.81±7.82; SR= 0.22) showed high clinically dysautonomic scores (COMPASS 31) (p = 0.015), increased Heart rate variability (HRV) parameters (daytime, nighttime, 24-hour SDNN (standard deviation of the RR interval (NN)), respectively p = 0.003, p < 0.001, p = 0.001; daytime and nighttime very low frequencies (VLF) respectively p = 0.03 and p = 0.007), impaired nocturnal dipping of blood pressure (3/11 patients) and high positivity of EMLA test (7/11, p = 0.037). These outcomes were strongly correlated with clinical dysautonomic assessment. No difference was observed between patients and controls regarding SSR. ConclusionOur data suggests a high parasympathetic tone amongst patients with GERD and a dysregulation of parasympathetic and sympathetic balance in the cardiovascular system with an impairment of the peripheral sympathetic fibers of cutaneous microcirculation, assessed by the EMLA test. GERD may be an inaugural symptom of autonomic neuropathy. Further functional exploration of peripheral small fibers seems to be necessary.

Genetic evidence causally linking gastroesophageal reflux disease to cholecystitis: a two-sample mendelian randomization study

BackgroundGastroesophageal reflux disease (GERD) and cholecystitis share overlapping symptoms, including belching, acid reflux, and heartburn. Despite this, the causal relationship between these two conditions remains unclear. This study aimed to investigate the causal link between GERD and cholecystitis using a Mendelian randomization (MR) approach.MethodsA two-sample MR analysis was conducted using the inverse variance weighted (IVW), weighted median, weighted mode, and MR-Egger method to assess the causal effects of GERD on the cholecystitis risk. Genome-wide association studies (GWASs) on GERD (N cases = 129080; N controls = 473524) and cholecystitis (N cases = 1930; N controls =359264) were obtained from the IEU Open GWAS project. Various techniques were employed to assess pleiotropy and heterogeneity.ResultsSeventy-seven single nucleotide polymorphisms from GERD GWASs were selected as instrumental variables (IVs). The primary IVW method revealed a significant association between GERD and an increased risk of cholecystitis (odds ratio = 1.004; 95% confidence interval = 1.003–1.005, p = 2.68 × 10− 9). The absence of heterogeneity and pleiotropy in the data supports the reliability of the results.ConclusionsGERD was positively associated with the risk of cholecystitis. This study provides insights into potential avenues for the development of prevention strategies and treatment options for cholecystitis in patients with GERD. These findings contribute to our understanding of the complex interplay between GERD and cholecystitis.