Number Of Gastroesophageal Refluxes Research Articles

12. NEUROKININ A AND SUBSTANCE P SERUM CONCENTRATIONS CORRELATE WITH MOTILITY METRICS PREDISPOSING TO REFLUX, BUT NOT WITH ESOPHAGITIS PRESENCE IN GERD

Abstract Background Neurokinin A (NKA) and substance P (SP) may be responsible for airway hyper-reactivity and hypersensitization. Animal studies showed an increase of their blood concentration in response to acid installation into the esophagus, suggesting the presence of neurogenic inflammation in pathogenesis of asthma and chronic cough. Association between serum concentration of these cytokines and esophageal function testing parameters in patients with gastroesophageal reflux disease (GERD) is poorly studied. Aim of the study was to assess serum concentration of neurokinin A and substance P in patients with erosive esophagitis and non-erosive form of GERD and perform correlation analysis between concentrations of these substances and data of multichannel esophageal pH-impedance (MII-pH) and high-resolution esophageal manometry (HREM). Methods The data of examination of 88 subjects (31 with erosive esophagitis (EE); 57 with non-erosive form of GERD (NERD)) served as a source for the study. Diagnosis of GERD was established per Lyon criteria. Subjects with autoimmune disorders, receiving some medications able to affect esophageal motility were not eligible. Patients underwent HREM with the use of 36-channel solid-state catheters and MII-pH with 2-pH, 6-impedandce sensors. Serum concentrations of NKA and SP were measured with ELISA kits and biochemistry analyzer. Results Acid exposure time (AET), and number of high gastroesophageal refluxes were higher in EE compared to NERD, while number of refluxes and concentrations of NKA and SP were similar. Mean, minimal and residual lower esophageal sphincter resting pressures were lower in EE compared to NERD. There was direct correlation between serum concentration of SP and number of gastroesophageal refluxes (Spearman rank R = 0.26), AET (R = 0.25), and number of refluxes lasting >5 min (R = 0.35). NKA concentration correlated directly with number of refluxes >5 min long (R = 0.28), and inversely with levels of integrated relaxation pressure (R = –0.32), and contractile front velocity (R = –0.38). Conclusions In patients with GERD, serum concentrations of Neurokinin A and Substance P do not depend on the presence of esophagitis and probably are not caused by the influence of reflux content to sensory neurons of esophageal mucosa. Established correlations may support the involvement of Neurokinin A and Substance P in pathogenesis of gastroesophageal reflux disease.

Analysis of local expression of inflammatory cytokines genes in patients with gastroesophageal reflux disease and its association with types and number of gastroesophageal refluxes

The aim of the study was to evaluate gene expression of proinflammatory cytokines in esophageal mucosa in patients with erosive esophagitis (EE) and non-erosive form (NERD) of gastroesophageal reflux disease (GERD) and perform correlation analysis between the genes expression and types and number of gastroesophageal refluxes. Methods. This was a single-center prospective study. Esophageal mucosa samples were taken from lower part of the esophagus during endoscopy. Expression of IL-1b, IL-10, IL-18, TNFA, TLR4, GATA3, CD68 and beta-2 macroglobulin genes was assessed with ImmunoQuantex assays. Multichannel intraluminal esophageal pH-impedance studies were performed with Ohmega recorder and 2pH-6impedance catheters. Results. Data of 60 patients (females - 34; mean age (M±SD) 54.6 years, 20 - with erosive esophagitis) were available for the analysis. In those with EE, there was higher expression of IL-18 (5.89±0.4 vs 5.28±1.1, p=0.04), GATA3 (2.92±0.86 vs 2.23±0.96, p=0.03) genes, and inflammatory index (92.12±32.41% vs 70.1±30.8%, p=0.02) compared to NERD. Direct correlation was found between acid exposure time and expression of IL-1b (Spearman rank R = 0.29), IL-18 (R=0.31), TNFA (R=0.35), GATA3 (R=0.34), TLR4 (R=0.29), CD68 (R=0.37) genes and inflammatory index (R=0.3). Indirect correlation was revealed between mean рН and expressions of IL-18 (R= -0.28), TNFA (R= -0.33), GATA3 (R= -0.28), TLR4 (R= -0.28), CD68 (R= -0.39) genes and inflammatory index (R= -0.17). No correlation was found between the genes’ expression and number of gastroesophageal refluxes. Conclusions: Expression of proinflammatory cytokines’ genes differ in patients with EE and NERD. There is a correlation between expression of studied genes and esophageal acidity.

Local inflammatory response to gastroesophageal reflux: Association of gene expression of inflammatory cytokines with esophageal multichannel intraluminal impedance-pH data.

BACKGROUNDGene expression of inflammatory cytokines may take part in the pathophysiology of different forms of gastroesophageal reflux disease (GERD).AIMTo explore gene expression of inflammatory cytokines in esophageal mucosa in patients with erosive esophagitis (EE) and non-erosive forms of GERD (NERD) and its association with data of esophageal multichannel intraluminal impedance-pH (MII-pH) measurements.METHODSThis was a single-center prospective study. Esophageal mucosa samples were taken from the lower part of the esophagus during endoscopy. Expression of interleukin (IL)-1β, IL-10, IL-18, tumor necrosis factor α (TNFA), toll-like receptor 4 (TLR4), GATA binding protein 3 (GATA3), differentiation cluster 68 (CD68) and β-2 microglobulin genes in esophageal mucosa was assessed with ImmunoQuantex assays. MII-pH measurements were performed on all the participants. Diagnosis of GERD was confirmed by the results of the MII-pH data. Based on the endoscopy, patients were allocated to the groups of EE and NERD. The control group consisted of non-symptomatic subjects with normal endoscopy and MII-pH results. We used nonparametric statistics to compare the differences between the groups. Association of expression of the mentioned genes with the results of the MII-pH data was assessed with Spearman’s rank method.RESULTSData from 60 patients with GERD and 10 subjects of the control group were available for the analysis. Higher expression of IL-18 (5.89 ± 0.4 vs 5.28 ± 1.1, P = 0.04) and GATA3 (2.92 ± 0.86 vs 2.23 ± 0.96, P = 0.03) was found in the EE group compared to NERD. Expression of IL-1β, IL-18, TNFA, and TLR4 was lower (P < 0.05) in the control group compared to EE and NERD. Esophageal acid exposure correlated with the expression of IL-1β (Spearman’s rank r = 0.29), IL-18 (r = 0.31), TNFA (r = 0.35), GATA3 (r = 0.34), TLR4 (r = 0.29), and CD68 (r = 0.37). Mean esophageal рН correlated inversely with the expression of IL-18, TNFA, GATA3, TLR4, and CD68. No association of gene expression with the number of gastroesophageal refluxes was found.CONCLUSIONIn patients with EE, local expression of IL-18 and GATA3 was higher compared to subjects with NERD. Esophageal acid exposure correlated directly with expression of IL-1β, IL-18, TNFA, TLR4, CD68, and β-2 microglobulin genes. Inverse correlation was revealed between expression of IL-18, TNFA, GATA3, TLR4, and CD68 and mean esophageal pH.

622 CORRELATION ANALYSIS BETWEEN MAJOR FOOD GROUPS' CONSUMPTION AND THE RESULTS OF 24-HOURS OESOPHAGEAL PH-IMPEDANCE STUDIES

Abstract Aim To evaluate association of number of gastroesophageal refluxes detected with oesophageal pH-impedance study with dietary patterns. Methods Food frequency questionnaire (Nutrilogic, Russia) was used to assess diet of subjects enrolled in the study in terms of nutrients consumption and food groups' structure. Dietary patterns were calculated according to the Healthy Eating Index (HEI), for the following major groups of foods: grains, fruits, vegetables, dairy products, meats, fats and confectioneries. The results are shown as a quotient of a division of actual values by the recommended. Oesophageal 24-hours pH-impedance (Ohmega, Laborie, the Netherlands) parameters were analysed. Spearman rank R was used to reveal correlation between number and type of gastroesophageal refluxes (GER) and the dietary patterns assessment. Results Forty consecutive patients (12 with gastroesophageal reflux disease, 28 females, age: 52.2 ± 12.9 y.o.) were enrolled. Mean energy value of the ration was 2302 ± 1391 kcal/day. Pattern of major food groups consumption was as follows: grains 1.4 ± 0.7, vegetables 1.1 ± 0.7, fruits 0.8 ± 0.9, dairy products 0.6 ± 0.6, meats 1.7 ± 1.0, fats 0.6 ± 0.8, confectioneries 0.3 ± 0.5. Mean number of GERs was 43.8 ± 24.4, acid GERs—26.2 ± 20.5 a day. Pattern of dairies consumption correlated with total number of GERs (Spearman R = 0.47, p &amp;lt; 0.05), weak-acid GERs (R = 0.49, p &amp;lt; 0.05), and non-acid GERs (R = 0.62, p &amp;lt; 0.05). Consumption of confectioneries correlated with high (at 17 cm above LES) GERs: R = 0.47, p &amp;lt; 0.05. Conclusion Type and number of gastroesophageal refluxes correlate with major food groups consumption. This preliminary results may serve as a basis for further research in larger comparative trials and may be considered when diet modification is planned for patients with GERD.

Nutrients Consumption Affect the Number of Gastroesophageal Refluxes and Oesophageal Acidity in Children

ObjectivesTo evaluate the correlation between types and number of gastroesophageal refluxes and nutrients consumption in children and adolescents. MethodsThe study was approved by IEC. The data of examination of 219 children (7–17 y.o.), 147 with GERD and 72 controls served as a source for the study. The amount and types of GER were determined using 24-hours esophageal pH-impedansometry (Ohmega, MMS, The Netherlands). Food frequency questionnaire was used to evaluate level of nutrients consumption. To make possible comparison of data obtained in different age and sex groups of children, direct levels of nutrients consumption were converted to a percentage deviation from the recommended daily allowance rates. Spearman rank correlation analysis was performed with the use of Statistica 10 (StatSoft Inc., USA) to reveal association between usual nutrition and number of gastroesophageal reflux episodes, their acidity and duration in children. ResultsStatistically significant (p < .05) correlation of Acid exposure time was found with amounts of PUFA (Spearman R = –0.334), ω-3 (R = –0.33), ω-6 (R = –0.3); retinols (R = –0.34), niacin (R = –0.28) and ascorbic acid (R = –0.37) consumption. The number of acid refluxes correlated with energy values of the ration (R = 0.269), amount of total protein (R = 0.279), total fat (R = 0.272), total carbohydrates (R = 0.152), and added sugar (R = 0.157) consumption. The number of weak-acid refluxes was not correlated with any of the parameters of actual nutrition. We found significant correlation between the number of non-acid refluxes and amount of PUFAs (R = 0.19), ω-6 (R = 0.151), ω-3 (R = 0.19); sodium (R = 0.158), phosphorus (R = 0.166), vitamin B1 (R = 0.17), niacin (R = 0.19), and ascorbic acid (0.23). ConclusionsWe found that types and number of gastroesophageal refluxes, as well as acidification of the lower part of oesophagus may be associated with diet in children. Our results may mean that different nutrients have different impact on esophageal motility in children. The results may have practical outcome for planning non-pharmacological intervention in children with GERD Funding SourcesMinistry of Science and Hiigher Education of Russia, research project #0529–2019-0055.

Number of Gastroesophageal Refluxes Detected With Oesophageal pH-Impedance Study Correlates With Dietary Patterns

Abstract Objectives To evaluate association of number of gastroesophageal refluxes detected with oesophageal pH-impedance study with dietary patterns Methods Subjects referred to oesophageal pH-impedance examination were invited to participate in the study, approved by LEC. In case of agreement, they were asked to provide data of their usual nutrition based on food frequency questionnaire (Nutrilogic, Russia). Diet was assessed in accordance with healthy eating index, for the following main groups of products: grains, fruits, vegetables, dairy products, meats, fats and confectioneries. The results are shown as a quotient of dividing the actual values by the recommended. Spearman rank R was used to analyse correlation between number of gastroesophageal refluxes (GER) detected with oesophageal pH-impedance examination and dietary patterns assessment. Results Data of 40 consecutive patients (12 of them with confirmed gastroesophageal reflux disease, 28 females, age (Mean ± SD): 52.2 ± 12.9 y.o.) served as the source for the study. Mean energy value of the ration was 2302 ± 1391 kcal/day. Dietary patterns for main food groups was as follows: grains 1.4 ± 0.7, vegetables 1.1 ± 0.7, fruits 0.8 ± 0.9, dairy products 0.6 ± 0.6, meats 1.7 ± 1.0, fats 0.6 ± 0.8, confectionaries 0.3 ± 0.5. Mean number of GERs was 43.8 ± 24.4, acid GERs - 26.2 ± 20.5 per day. Direct medium-strength correlation was found between pattern of dairy products consumption and total number of GERs (Spearman R = 0.47, P &amp;lt; 0.05), weak-acid GERs (R = 0.49, P &amp;lt; 0.05), non-acid GERs (R = 0.62, P &amp;lt; 0.05). Pattern of confectionaries consumption was associated with high (that reached proximal oesophagus, ∼17 cm above LES) GERs: R = 0.47, P &amp;lt; 0.05. Conclusions This preliminary results may serve as a basis for further research in larger comparative trials and may be considered when diet modification is planned for patients with GERD. Funding Sources Russian Science Foundation research grant #19–76-30014.

Usefulness of Endoscopic Hill Grade in Evaluating Children Suspected of Having Gastroesophageal Reflux Disease.

Background/AimsThis study aim to evaluate the relationship between the Hill grade confirmed by esophagogastroduodenoscopy (EGD) and the degree of gastroesophageal reflux (GER) by 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH) in children suspected of having gastroesophageal reflux disease (GERD).MethodsA retrospective review of 105 children and adolescents who underwent EGD and MII-pH for the evaluation of GERD from March 2013 to July 2019 was performed. Clinical features and results of EGD and 24-hour MII-pH were collected and statistically analyzed.ResultsHill grades 1, 2, 3, and 4 were identified using EGD in 56 (53.3%), 22 (22.0%), 16 (15.2%), and 11 (10.5%) patients, respectively. As the Hill grade increased, the proportion of neurological diseases (P < 0.001) and endoscopic erosive esophagitis (P < 0.001) increased significantly. The acid exposure index, bolus exposure index, number of reflux episodes, and number of GER reaching proximal extent on MII-pH increased significantly as the endoscopic Hill grade increased (all P < 0.001). Linear regression analysis revealed an increase in the Hill grade by 1 increased the acid exposure index by 2.0%, bolus exposure index by 0.7%, number of reflux episodes by 18.9 episodes, and the number of GER reaching the proximal esophagus increased by 10.5 episodes on average (all P < 0.001).ConclusionsHill grade on EGD was associated with GER in children. Estimating the degree of GER by applying Hill grade in the retroflexion view may be useful in practice when evaluating children suspected with GERD.

560 CORRELATION ANALYSIS OF TYPES AND NUMBER OF GASTROESOPHAGEAL REFLUXES WITH NUTRIENTS CONSUMPTION IN CHILDREN

Abstract Little is known about association of types and number of gastroesophageal refluxes with nutrients consumption in children. However this may be important for planning further research and from the practical point of view. The aim of the study was to perform a correlation analysis between the number and type of gastroesophageal refluxes (GER) with nutrients consumption in children and adolescents. Methods The data of the examination of 219 children served as the source for the study. The complex examination included the analysis of nutrients consumption (Validated language-specific food frequency questionnaire), esophageal pH-impedance recordings (Ohmega, MMS, the Netherlands) esophagogastroscopy (Olympus Excera II, Olympus, Japan). Spearman rank correlation analysis between types and number of gastroesophageal refluxes and level of nutrients consumption was performed with the use of Statistica 10 software (StatSoft Inc, USA). To analyze the data on actual nutrition of children of different age groups, the obtained direct values of were converted into a percentage deviation from the recommended daily allowance rates. Results Significant (P &amp;lt; 0.05) inverse correlation was found between AET and consumption of PUFAs (Spearman rank R = -0.33), ω-3 PUFA (R = -0.33), ω-6 PUFA (R = -0.3), vitamin A (R = -0.34), niacin (R = -0.28) and ascorbic acid (R = -0.37). The number of acid refluxes, was associated with energy values of the rations (R = 0.269), amount of protein (R = 0.279), total fat (R = 0.272), total carbohydrates (R = 0.152), and added sugar (R = 0.157) consumption. There was no correlation between number of weak-acid refluxes and diet. Nr of non-acid refluxes was associated with the amount of PUFAs (R = 0.19), ω-6 (R = 0.151), ω-3 (R = 0.19), sodium (R = 0.158), phosphorus (R = 0.166), vitamin B1 (R = 0.17), niacin (R = 0.19), and ascorbic acid (0.23) consumed. Conclusion We found that esophageal acid exposure time and number of different types of refluxes (but not weak-acid) may be associated with the consumption of some of the nutrients in children. This information may be of use for the diet correction as a component of treatment of children with GERD.

572 NUTRITIONAL PATTERNS MAY AFFECT ESOPHAGEAL ACID EXPOSURE, AND THE NUMBER AND TYPE OF GASTROESOPHAGEAL REFLUXES

Abstract The role of nutritional patterns on esophageal function testing parameters is not widely studied. Earlier published data focused on symptoms of GERD and their association with the food structure. Aim of the study was to assess the influence of nutritional patterns on esophageal acid exposure and types and number of gastroesophageal refluxes Methods The data of complete examination of 165 participants served as a source data for the study. Diagnosis of GERD was based on clinical data (heartburn and acid regurgitation at least once a week for not less than 6 month, actual during last 3 month, history of effective PPI treatment), GERD-Q questionnaire (≥8 points), endoscopic evaluation (Excera II, Olympus, Japan) and 24-hours esophageal pH-impedance studies (Ohmega, MMS, the Netherlands; 2 pH, 6 impedance catheters, UnisensorAG, USA). Food frequency questionnaire was used to analyse food structure. StatSoft (USA) software was used for correlation analysis. The work has been performed within RSF 19–76-30014. Results We enrolled 124 GERD patients and 41 controls. Significant (P &amp;lt; 0.05) correlation of AET was with energy value of the ration (Spearman rank R = 0.19), amount of fat (R = 0.2). Significant correlation of number of GERs was with energy values (R = 0.35), protein (R = 0.3), fat (R = 0.33), alcohol (R = 0.28) and dietary fibre (R = -0.22) consumption. Number of acid GERs correlated with calorie (R = 0.35), fat (R = 0.32), protein (R = 0.25), carbohydrates (R = 0.24) and alcohol (R = 0.24) consumption. Number of weak-acid GERs correlated with calories (R = 0.22), fat (R = 0.21), protein (R = 0.22), alcohol (R = 0.23) and dietary fibre (R = -0.24) consumption. High GERs correlated with fat (R = 0.3), protein (R = 0.22), alcohol (R = 0.25) and fibre (R = -0.25). Conclusion High energy value, consumption of fat and alcohol showed direct medium-strength correlation with esophageal acid exposure and the total number gastroesophageal refluxes. The total number of gastroesophageal refluxes, number of weak acid and high gastroesophageal refluxes had inverse correlation with the amount of dietary fibre consumed. Found trends are used to establish nutritional patterns for reflux events in GERD patients.

Food patterns in Russian patients with gastroesophageal reflux disease: the results of pilot comparative study

To evaluate nutritional patterns in patients with gastroesophageal reflux disease (GERD) compared to the control group without GERD. The data of complex examination of patients referred to perform esophageal pH-impedance recording and who gave written informed consent to participate in the study served as a source data. All the participants underwent complex examination, including clinical data (presence of heartburn and acid regurgitation), symptom evaluation (GERD-Q questionnaire), esophagogastroscopy, esophageal pH-impedance recordings and food frequency questionnaire. Diagnosis of GERD was based on GERD-Q score 8, acid exposure time 6%, number of gastroesophageal refluxes 80/day by 24-hrs esophageal pH-impedance recordings. Nutritional patterns were assessed with the use of healthy eating pyramid principles. Overall 165 patients were enrolled and the data of 150 of them (34 with confirmed GERD and 116 of the control group) were available for the final analysis. The patients of the both groups consumed lower compared to the recommended amounts of dairy and higher amounts of meat. Those with GERD consumed larger amounts of fruits (0.910.68 compared to the values of healthy eating pyramid vs 0.520.57 in the control group, p=0.001), and fats (0.690.55 vs 0.490.55, p=0.001). Compared to the controls, patients with GERD consumed lower amounts of vegetables (0.860.46 of the healthy eating pyramid vs 0.940.63 in the control group, р=0.004) and sugars confectionaries (0.380.39 vs 1.930.98, p=0.0001). Nutritional patterns of patients with gastroesophageal reflux disease significantly differ compared to the control group. The obtained data may be used for diet modification in patients with arterial hypertension.

Effects of upper airway obstruction or hypoxia on gastroesophageal reflux in newborn lambs

Although it is commonly accepted that upper airway obstruction (UAO) increases gastroesophageal reflux (GER), the link is poorly understood and insufficiently documented. In addition, while hypoxia is often encountered in infants with UAO, its consequences on GER are virtually unknown. The two aims of the present study were to characterize the effects of (1) UAO and (2) hypoxia on GER. Seventeen lambs underwent polysomnographic and esophageal impedance/pH-metry monitoring during UAO vs. a control condition (6 h, ten lambs) or 10% hypoxia vs. normoxic condition (3 h, seven other lambs). Moderate-to-severe UAO was maintained throughout monitoring (inspiratory tracheal pressure of -13 (-15, -12) cm H2O vs. -1 (-1, -1) cm H2O in control condition, p = 0.005). While the number of GERs increased with UAO (2 (1, 4) vs. 0 (0, 3) in the control condition, p = 0.03), the increase was less than anticipated and inconsistent among the lambs. Also, sustained 10% hypoxia did not alter the number of GERs (2 (1, 3) vs. 0 (0, 5) in the control condition, p = 0.9). The presence of an UAO for 6 h mildly increased the number of GERs, whereas hypoxia for 3 h had no significant effect. The effect of upper airway obstruction and hypoxia on gastroesophageal reflux is poorly documented in the neonatal period. A moderate-to-severe upper airway obstruction for 6 h results in a mild, inconsistent increase in the number of gastroesophageal refluxes. Overall, a hypoxia of 10% for 3 h had no significant impact on gastroesophageal reflux. The prescription of an antireflux medication in infants with upper airway obstruction must not be systematic but rely on objective signs of a pathologic gastroesophageal reflux.

Gastroesophageal Reflux Type and Number Correlate with Nutritional Patterns (P06-066-19)

ObjectivesThe correlation of nutritional patterns with number and types of gastroesophageal refluxes is poorly studied yet.Aim: To assess the effect of actual nutrition of GERD patients on the number and type of gastroesophageal reflux detected with 24-hours esophageal pH-impedance. MethodsOne hundred twenty-four GERD patients (54 men, age (M ± m): 46 ± 17.7 y.o., BMI 28.5 ± 0.6 kg/m2) and 41 healthy controls (8 men, age 42 ± 12.4 y.o., BMI 28.3 ± 1.3 kg/m2) were examined with the use of language-specific food frequency questionnaire and 24-hours esophageal pH-impedance (Ohmega, MMS; 2 pH, 6 impedance catheters, Unisensor). The correlation analysis between macro- and micronutrient consumption and the number of gastroesophageal refluxes (GER), their acidity and duration was performed (Statistica 10, StatSoft) ResultsDirect medium-strength correlation was found between esophageal acid exposure time and the energy value of the ration (Spearman rank R = 0.19, p < 0.05), and the amount of consumed fat (R = 0.2, p < 0.05).There was a direct correlation of the total number of GERs with the energy value of the ration (R = 0.35, p < 0.05), protein (R = 0.3, p < 0.05), fat (R = 0.33, p < 0.05), and alcohol consumption (R = 0.28, p < 0.05) and the inverse one with the dietary fiber consumption (R = –0.22).Significant direct correlation was found between the number of acid GERs and total energy value of the ration (R = 0.35, p < 0.05), consumption of fat (R = 0.32, p < 0.05), protein (R = 0.25, p < 0.05), carbohydrates (R = 0.24, p < 0.05) and alcohol (R = 0.24, p < 0.05).Number of weak-acid GERs showed direct correlation with the calories intake (R = 0.22, p < 0.05), fat (R = 0.21, p < 0.05), protein (R = 0.22, p < 0.05), alcohol (R = 0.23, p < 0.05) consumption, and the inverse one with the amount of dietary fiber intake (R = –0.24, p < 0.05). Number of high GERs correlated directly with the amount of fat (R = 0.3, p < 0.05), protein (R = 0.22, p < 0.05), alcohol (R = 0.25, p < 0.05) consumed, and inversely with the amount of dietary fiber (R = –0.25, p < 0.05) in the ration.Paired comparison of the correlation coefficients was performed, but didn’t reveal any difference. ConclusionsHigh energy value, consumption of fat and alcohol showed direct medium-strength correlation with esophageal acid exposure and number of GERs. Dietary fiber consumption correlated inversely with total number, weak acid and high GERs. Funding SourcesFederal research Center of Nutrition and Biotechnology, Russian science foundation.

RA06.07: PSYLLIUM SUPPLEMENTATION EFFECT ON ESOPHAGEAL FUNCTION TESTING AND SYMPTOMS IN PATIENTS WITH NON-EROSIVE GERD

Abstract Background Epidemiological data showed negative correlation between heartburn frequency and amount of dietary fiber consumed. However no interventional study was performed to prove clinically beneficial effect of dietary fibers in gastroesophageal reflux disease (GERD) patients. The aim of the study was to investigate the effect of dietary fiber on symptoms and esophageal function testing parameters in non-erosive GERD patients (NCT01882088) Methods Thirty six NERD patients were examined using food frequency questionnaire and in case of less than 20 g/day dietary fibre intake underwent high-resolution esophageal manometry and 24-hours esophageal pH-impedance. Language-specific GERD-Q questionnaire was used to assess symptoms. Repeated examinations were performed after 10 days of usual diet supplemented by psyllium 15.0 gram a day. Complete data of 30 NERD patients were available for the final analysis. Study design is shown in a figure 1. Wilcoxon matched pairs test was used to assess changes in the studied parameters Results The decrease in proportion of patients experiencing heartburn as well as GERD-Q score decrease were found. Minimal resting lower esophageal sphincter pressure increased from 5.41 ± 10.1 to 11.3 ± 9.4, P = 0.023. No change in residual LES pressure and mean resting pressure was found. Total number of gastroesophageal refluxes decreased from 67.9 ± 17.7 to 42.4 ± 13.5, P &lt; 0.001 (Table 1). Conclusion Supplementation of diet with psyllium 5.0 gram TID in NERD patients led to significant increase of minimal esophageal resting pressure, decrease of number of gastroesophageal refluxes and frequency of heartburn per week. The work was supported by Federal Agency of Scientific Organizations of Russia (0529–2017-0057) Disclosure All authors have declared no conflicts of interest.

Differentiation therapy for non-acidic gastroesophageal reflux disease

To investigate the clinical and pathogenetic features of the non-acidic types of gastroesophageal reflux disease (GERD) and to evaluate the impact of combined therapy versus monotherapy on the course of this disease. The investigation enrolled 62 patients with non-acidic GERD. The follow-up period was 6 weeks. The patients were divided into 2 groups: 1) weakly acidic gastroesophageal refluxes (GER); 2) weakly alkaline GER. Then each group was distributed, thus making up 4 groups: 1) 19 patients with weakly acidic GER who received monotherapy with rabeprazole 20 mg/day; 2) 21 patients with weakly acidic GER had combined therapy with rabeprazole 20 mg and itopride; 3) 8 patients with weakly alkaline GER who received ursodeoxycholic acid (UDCA) monotherapy; and 4) 14 patients with weakly alkaline GER who had combined therapy with UDCA and itopride, The clinical symptoms of the disease, the endoscopic pattern of the upper gastrointestinal tract (GIT) mucosa, histological changes in the esophageal and gastric mucosa, and the results of 24-hour impedance pH monitoring were assessed over time. During differentiation therapy, the majority of patients reported positive clinical changes and an improved or unchanged endoscopic pattern. Assessment of impedance pH monitoring results revealed decreases in the overall number of GERs, the presence of a bolus in the esophagus, and the number of proximal refluxes. These changes were noted not only in patients taking proton pump inhibitors (PPIs), but also in those treated with UDCA monotherapy or combined PPI and prokinetic therapy. A differentiated approach to non-acidic GER treatment contributes to its efficiency. Adding the prokinetic itomed (itopride hydrochloride) to PPI therapy in a patient with weakly acidic GER enhances the efficiency of treatment, by positively affecting upper GIT motility. The mainstay of therapy for GERD with a predominance of weakly alkaline refluxes is UDCA, the combination of the latter and the prokinetic can exert a more pronounced effect on the clinical and endoscopic pattern and upper GIT motility.

PP‐15 THE EFFECT OF EXTENSIVELY HYDROLYZED PROTEIN FORMULA IN PRETERM INFANTS WITH SYMPTOMATIC GASTRO‐OESOPHAGEAL REFLUX

Background:Gaestroesophageal reflux (GER) occurs commonly in infants especially preterm infants. Current anti‐reflux medication has shown limited therapeutic benefits for this age group. Our study aims to evaluate the efficacy of extensively hydrolyzed formula feed (EHFF) compared to standard infant formula (SF) on GER episodes in preterm infants using Multichannel intraluminal impedance and pH monitoring (MII‐pH).Methods:This is a prospective crossover trial involving preterm infants &gt;29 weeks corrected gestation age with symptoms of GER. All patiets were recruited from a single tertiary neonatal unit in Singapore. MII‐pH was performed over 48 hours. For the first 24 hours the infants were either fed on standardized infant formula (SF) or Expressed Breast Milk (EBM) depending on maternal choice. For the second 24 hours their feeds were changed to EHFF. All infants were on orogastric/nasagastric tube feeding and were given 2 to 3 hourly bolus feeding throughout the study period.Results:23 infants completed the study:14males: 9 females. Mean weight 2971 g (SD +1569 g). None of the patients were on any anti‐reflux medications (apart from one). Type of feeds during first 24 hours were EBM 8/23(35%), SF 5/23(22%) or mixed feeding 10/23(43%). GER symptoms were: desaturations16/23(70%), cough 8/23(35%), arching7/23 (30%), vomit 3/23(13%), crying2/23(8%) and apnoea1/23 (4%). The median total GER episodes (detected by pH and MII) was significantly lower during the EHFF period compared to SF/EBM period 42(21–71) vs 68(32–104) p &lt; 0.001. The median acidic reflux episodes detected by pH was also significantly lower in EHFF vs SF/EBM period 8(4–24) vs 23(3–58) p &lt; 0.005. Total number of refluxes detected by MII showed a significant reduction for EHFF compared to SF/EBM: 17(11–56) vs 46(20–65) p &lt; 0.015. There was no difference in reflux index, MII bolus exposure indexes, and number of long lasting episodes (&gt;5 min) between the 2 groups. There were no significant difference in the number of symptoms recorded between the two study period.Conclusions:Our data suggest that the number of gastroesophageal reflux was significantly lower in preterm infants fed with EHFF compared to standard formula as measured by pH‐MII monitoring. EHFF may potentially be an effective treatment modality for gastroesophageal reflux disease in infants with minimal side‐effects. The lack of symptom reduction during EHFF despite fewer GER episodes suggests that other pathology other than GER should be considered. A larger study is required to further evaluate the efficacy and mechanism of EHFF on reduction of GER in infants.

The Role of Sleep in the Modulation of Gastroesophageal Reflux and Symptoms in NICU Neonates

BackgroundNewborns sleep about 80% of the time. Gastroesophageal reflux disease is prevalent in about 10% of neonatal intensive care unit infants. Concurrent polysomnography and pH-impedance studies clarify the relationship of gastroesophageal reflux with sleep. AimsTo characterize spatiotemporal and chemical characteristics of impedance-positive gastroesophageal reflux and define symptom associations in sleep and wake states in symptomatic neonates. We hypothesized that frequency of impedance-positive gastroesophageal reflux events and their association with cardiorespiratory symptoms is greater during sleep. MethodsEighteen neonates underwent concurrent polysomnography with a pH-impedance study. Impedance-positive gastroesophageal reflux events (weakly acidic or acidic) were categorized between sleep versus wake states: Symptom Index = number of symptoms with gastroesophageal reflux/total symptoms*100; Symptom Sensitivity Index = number of gastroesophageal reflux with symptoms/total gastroesophageal reflux*100; Symptom Association Probability = [(1 − probability of observed association between reflux and symptoms)*100]). ResultsWe analyzed 317 gastroesophageal reflux events during 116 hours of polysomnography. During wake versus sleep, respectively, the median (interquartile range) frequency of impedance-positive gastroesophageal reflux was 4.9 (3.1-5.8) versus 1.4 (0.7-1.7) events/hour (P < 0.001) and the proximal migration was 2.6 (0.8-3.3) versus 0.2 (0.0-0.9) events/hour (P < 0.001). The Symptom Index for cardiorespiratory symptoms for impedance-positive events was 22.5 (0-55.3) versus 6.1 (0-13), P = 0.04, whereas the Symptom Sensitivity Index was 9.1 (0-23.1) versus 18.4 (0-50), P = 0.04, although Symptom Association Probability was similar (P = 0.68). ConclusionsContrary to our hypothesis, frequency of gastroesophageal reflux in sleep is lower; however, spatiotemporal and chemical characteristics of gastroesophageal reflux and symptom-generation mechanisms are distinct. For cardiorespiratory symptoms during sleep, a lower Symptom Index entails evaluation for etiologies other than gastroesophageal reflux disease, a higher Symptom Sensitivity Index implies heightened esophageal sensitivity, and similar Symptom Association Probability indicates other mechanistic possibilities.

Esophageal impedance baselines in infants before and after placebo and proton pump inhibitor therapy

Esophageal impedance monitoring records changes in conductivity. During esophageal rest, impedance baseline values may represent mucosal integrity. The aim of this study was to assess the influence of acid suppression on impedance baselines in a placebo-controlled setting. Impedance recordings from 40 infants (0-6 months) enrolled in randomized placebo-controlled trials of proton pump inhibitor (PPI) were retrospectively analyzed. Infants underwent 24 h pH-impedance monitoring prior to and after 2 weeks of double blind therapy with placebo or a PPI. Typical clinical signs of gastro-esophageal reflux (GER) were recorded and I-GERQ-R questionnaire was completed. Median (IQR) impedance baseline increased on PPI treatment (from 1217 (826-1514) to 1903 (1560-2194) Ω, P < 0.001) but not with placebo (from 1445 (1033-1791) to 1650 (1292-1983) Ω, P = 0.13). Baselines before treatment inversely correlate with the number of GER, acid GER, weakly acid GER, acid exposure, and symptoms. The change in baseline on treatment inversely correlates with acid exposure and acid GER. Patients with initial low baselines have no improved symptomatic response to treatment. Impedance baselines are influenced by GER and increase significantly more with PPI therapy than with placebo. Clinical impact of this observation remains undefined as targeting therapy at infants with low baselines does not improve symptomatic response to treatment.