Positive Gastroesophageal Reflux Disease Research Articles

250. ASSOCIATION OF SLING-FIBER PRESERVATION POEM AND POST-POEM GERD SYMPTOMS: A NORTH AMERICAN SINGLE-CENTER RETROSPECTIVE STUDY

Abstract Background Peroral endoscopic myotomy (POEM) is standard treatment for achalasia. Gastroesophageal reflux disease (GERD) after POEM has been a limiting factor with this procedure. Preservation of the sling fiber during POEM was reported to reduce post-POEM GERD in Japan, but there are no reports of this technique in a western population. As such, we investigated the association of sling-fiber preservation during POEM and post-POEM GERD symptoms at our institution, which is a large therapeutic endoscopy referral center in Canada. Methods This is a retrospective, single-center study of patients who underwent POEM from October 2017 to January 2023 at our center. The initial cohort of patients were treated by conventional POEM until June 2021, after which a second cohort underwent POEM with sling-fiber preservation, as the techniques advanced. The primary outcome was the rate of positive GERD symptoms after POEM. The secondary outcomes were procedure time, gastric myotomy length, clinical success rate (Eckard score of less than 3), adverse events rate and use of PPI at follow-up. Results 148 POEM cases (52.5 ± 15.6 y/o, female: 61(43%)) were included in this study. There was no significant difference in patient characteristics between the groups. The mean procedure time (108.6 ± 34.5 vs 109.1 ± 45.7 min, P = 0.93) and rate of adverse events (21% vs 14%, P = 0.36) were similar between the traditional and modified groups. In the sling fiber preservation group, gastric myotomy length was significantly longer (2.2 ± 0.7 vs 1.6 ± 0.8 cm, P < 0.05) yet the GERD symptom rate at follow-up was significantly lower (22% vs 41%, P < 0.05), although PPI use was similar (57% vs 50%, P = 0.47). Finally, the clinical success rate was similar between groups (88% vs 84%, P = 0.6). Conclusions Sling fiber preservation during POEM is safe and reduces post-POEM GERD symptoms, despite the longer gastric myotomy length. As such, sling fiber preservation may be a useful solution to reduce post-POEM GERD in western populations.

Laryngopharyngeal Reflux Disease and Gastroesophageal Reflux Disease Can Mutually Influence

To investigate the mutually relationship between gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD). All included patients completed simultaneous 24-hour hypopharyngeal intraluminal multichannel impedance pH monitoring (24h-MII-pH), Reflux Symptom Index (RSI), and Reflux Finding Score (RFS). The LPRD diagnosis was based on the occurrence of ≥1 acid or non-acid hypopharyngeal proximal reflux episode(HRE), GERD was defined as a length of time >4.0% of the 24-hour recording spent below pH 4.0 or a DeMeester score >14.72. Patients with both positive LPRD and GERD were classified as LPRD & GERD group, patients with positive LPRD and negative GERD were classified as ILPRD group, patients with negative LPRD and positive GERD were classified as IGERD group, and patients with both negative LPRD and GERD were classified as N group. The differences in clinical characteristics of reflux between the groups were statistically analyzed. A total of 437 patients were included, including 248 (56.75%) in the ILPRD group, 98 (22.43%) in the LPRD & GERD group, 23 (5.26%) in the IGERD group, and 68 (15.56%) in the N group. There was no significant difference between the types of gastroesophageal reflux in patients with GERD. The number of weak acid/acid/gas/liquid HREs was significantly more in LPRD & GERD patients than in ILPRD patients (P < 0.01), and the number of distal acid reflux events and Longest distal acid clearance time were significantly higher in LPRD & GERD patients than in IGERD patients (P > 0.01). GERD and LPRD are not the same disease but can mutually influence. Combined GERD increased all types of laryngopharyngeal reflux events in patients with LPRD, whereas combined LPRD only increased acidic distal reflux events and acid clearance time in patients with GERD.

Effect of gastroesophageal reflux disease on the clinical characteristics of patients with laryngopharyngeal reflux disease

Objective: To investigate the effect of gastroesophageal reflux disease (GERD) on the clinical characteristics of patients with laryngopharyngeal reflux disease(LPRD). Methods: The data of 141 patients with symptoms of LPRD, who were admitted to the Department of Pharyngology, Laryngology& Phonosurgery at the Sixth Medical Center of the PLA General Hospital from November 2020 to October 2021, were retrospectively analyzed.There were 118 males and 23 females, aged 28-75 (56.72±10.04) years old. The included patients underwent simultaneous 24-hour hypopharyngeal and esophageal multichannel intraluminal impedance pH monitoring (24h-HEMII-pH), salivary pepsin test at multiple times, Reflux Symptom Index (RSI), and Reflux Finding Score (RFS). One laryngopharyngeal reflux event on 24 h-HEMII-pH monitoring results was used as a diagnostic criterion for LPRD. And the duration of lower esophageal pH<4.0>4.0% at 24 h or DeMeester score>14.7 were used as diagnostic criteria for GERD. Among them, patients with both positive LPRD and GERD were classified as L&G group, patients with positive LPRD and negative GERD were classified as IL group, patients with negative LPRD and positive GERD were classified as IG group, and patients with both negative LPRD and GERD were classified as N group. The differences in the clinical characteristics of reflux and salivary pepsin assay in each group were statistically analyzed. SPSS 23.0 software was applied for statistical analysis. Results: According to the 24 h-HEMII-pH results, 116 (82.3%) patients were diagnosed with LPRD and 45 (31.9%) with GERD, including 82 (58.2%) in the IL group, 34 (24.1%) in the L&G group, 11 (7.8%) in the IG group, and 14 (9.9%) in the N group. Based on the salivary pepsin test, a total of 106 patients had positive results, and the L&G group had a significantly higher rate of positive total salivary pepsin test (94.1%) and positive morning test (70.6%) than the IL group (75.6%, 26.8%), IG group (63.6%, 27.3%) and N group (35.7%, 28.6%), with chi-square values of 19.01 and 20.81, both with P<0.001. The patients in the L&G group had a significantly higher RSI score (14.0) than the IL group (7.0), IG group (1.0) and N group (0), H=52.26,P<0.001. The difference in RFS between the L&G and IL groups was not statistically significant (Z=-0.92,P>0.05). Conclusion: Combined with GERD, LPRD patients have more obvious clinical symptoms and higher positive rate of pepsin test in saliva.

Gastroesophageal reflux after per-oral endoscopic myotomy is frequently asymptomatic, but leads to more severe esophagitis: A case-control study.

Background and aimThe incidence of gastroesophageal reflux disease (GERD) is high after per‐oral endoscopic myotomy (POEM). GERD after POEM may be qualitatively different from GERD in patients without motility disorders. In this study, we aimed to analyze and compare different aspects of GERD between patients with post‐POEM GERD and nonachalasia GERD.MethodsThe data of patients with GERD after POEM (January 2018 to June 2019) were compared with that of a control group (nonachalasia GERD group), which included patients presenting with typical reflux symptoms without associated major motility disorders. Patients with lower esophageal sphincter pressure lower than 10 mmHg were excluded from the study. GERD was evaluated at 3 months after POEM. Esophageal acid exposure time higher than 4.2% was used to define GERD. The primary outcome of the study was comparison of GERD‐related quality of life and reflux symptom severity between the two groups. In addition, the severity of erosive esophagitis and reflux‐symptom association were also recorded in the two groups.ResultsA total of 100 patients were included in the study, with 50 patients in each group (post‐POEM GERD vs. controls). The baseline parameters were comparable between the two groups. Median interquartile range of GERD‐related quality of life score was significantly lower in the post‐POEM group (11 [0–23.3] versus 34 [24–44]; p < 0.001). The post‐POEM GERD group had significantly lower median heartburn (6.0 [0–16.3] versus 15.5 [7.5–24.8]; p = 0.001) and regurgitation scores (0 [0–6.0] versus 20.0 [12.3–25.0]; p < 0.001). Erosive esophagitis was more frequent in the post‐POEM group (28 [56%] versus 10 [20.4%], p = 0.001). Only three (6%) patients in the post‐POEM group had a positive reflux‐symptom association as compared with 28 (56%) patients in the control group (p < 0.001).ConclusionIn selected patients with pH positive GERD after POEM, the symptoms are milder and reflux‐symptom association is poor in spite of more severe esophagitis as compared with controls.

Muscle Tension Dysphagia: Contributing Factors and Treatment Efficacy.

To determine factors contributing to disease etiology and treatment efficacy. Original Report. Tertiary academic center. IRB approved prospective study of 20 patients with reported dysphagia who exhibited normal oropharyngeal and esophageal swallowing function as evidenced by videofluoroscopic swallow study, esophagogastroduodenoscopy, high-resolution esophageal manometry with stationary impedance, and Bravo pH probe off proton pump inhibitor. Patients underwent speech-language pathology intervention. Atypical laryngeal muscle tension was present in 100% of patients. Forty percent of patients had diagnosed positive gastroesophageal reflux disease. Sixty-five percent of patients showed signs of non-specific laryngeal inflammation and laryngeal hyperresponsiveness during strobolaryngoscopy. All patients reported a mean of 90% recovery by the completion of voice therapy directed toward unloading muscle tension. The study results suggest an association between laryngeal muscle tension and these patients' dysphagia symptoms regardless of associated conditions. Speech-language pathology intervention showed high treatment efficacy. 2c- Outcomes research.

Significance of Extra-Esophageal Symptoms in Pediatric Gastroesophageal Reflux Disease.

Introduction Current practice guidelines in gastroesophageal reflux disease (GERD) often require invasive diagnostic testing. Objective The aim of the present study was to evaluate the significance of extra-esophageal symptoms and reliability of a screening risk score that is simple to use. Methods A longitudinal retrospective single-institution cohort study. Setting: A university clinical hospital tertiary referral center. The present study enrolled pediatric patients with symptoms suggestive of GERD: epigastric pain, occasional nausea, regurgitation, tasting acid in the oral cavity, chronic cough, hoarseness of voice, frequent throat clearing. The patients underwent 24-hour esophageal pH monitoring and fiber-optic laryngoscopy. The correlations between the local findings, anamnestic and objective measurement data were analyzed. Results The present study evaluated 89 pediatric patients. Patients with asthma presented significantly more often with adjoining gastrointestinal symptoms ( p = 0.0472). Patients that were obese were linked to a higher rate of reports of gastrointestinal symptoms ( p = 0.0495). After the patients had been assigned to newly developed risk groups, obesity showed to be significantly more frequent in patients placed in higher risk groups ( p < 0.0001) for a positive GERD diagnosis. Conclusion Patients with leading symptoms of asthma presented significantly more often with adjoining gastrointestinal symptoms. Obesity showed to be significantly more frequent in patients placed in higher risk groups for a positive GERD diagnosis.

Effects of prolactin on the results of echocardiography and daily multichanel intraluminal impedans-pH-monitoring of the esophagus of patients with stable angina of effort and gastroesophageal reflux disease in the dynamics of treatment

Objective — to establish the effect of complex therapy with the addition of meldonium on the results of echocardio­graphy, daily multichanel intraluminal impedans-pH-monitoring (DMII-pH-M) of the esophagus and serum prolactin level in patients with stable angina of tension (SAT) and gastroesophageal reflux disease (GERD) in the conditions of comorbidity.Materials and methods. The study included 88 patients with SAT I—II FC with comorbid endoscopically positive GERD, which was divided into 2 groups: in group 1 (43 persons) received treatment: antiaggregant (clopidogrel), β-blocker (bisoprolol), statin (rosuvastatin), prolonged Nitric Oxide Donors donor and nitroglycerin in angina pectoris, proton pump inhibitor (rabeprazole), prokinetic (domperidone) and antacid as needed. Patients in group 2 (45 subjects) received basic therapy with SAT and GERD, with the exception of prokinetics and NO donors, only nitroglycerin, if necessary, and additionally meldonium capsules 500 mg 2 g/d for 30 days. Echocardiography, DMII-pH-M of the esophagus were performed in all patients enrolled in the study and serum levels of prolactin were determined before and at day 30 of treatment.Results and discussion. Blood serum of patients with SAT with comorbid GERD remains high when prokinetic is received and adversely affects the overall contractility of the myocardium of the left ventricle, esophagitis regression, confirmation is correlated0 (r = –0.73) between the serum PL level and emission fraction of left ventricle; MNBI (mean nocturnal baseline impedance) (r = –0.71) in group 1 and (r = –0.7) in group 2. Against the background of correction of baseline therapy for SAT and GERD with cancellation of prokinetic intake and, with additional prescription of meldonium, we observed a statistically significant (р &lt; 0.05) decrease in prolactin level (OR = 3.9609, 95 % CI 1.1761—13.3398, p &lt; 0.0263), decrease in total number of refluxes per day (OR = 14.1, 95 % CI 4.9739—40.2144, p &lt; 0.0001) (р &lt; 0.05), increase of PSPW (postreflux swallow induced peristaltic wave) (OR = 3.9, 95 % CI 1.5845—9.4767, p &lt; 0.003) (р &lt; 0.05), MNBI (р &lt; 0.05) and emission fraction of left ventricle (OR = 4.2, 95 % CI 1.4802—12.2029, p = 0.0072) (p &lt; 0.05), compared with group 1.Conclusions. The correction of the basic therapy of the SAT and GERD with the prokinetics’ cancellation and the additional use of meldonium resulted in the decrease of serum prolactin levels, which closely correlated with the main indicators of echocardiography and DMII-pH-M, manifesting in an increase in the general contractility of the left myocardium ventricle and lower esophageal sphincter, increasing of the kinetic function of the esophagus and improving the regenerative capabilities of its mucous membrane.

Influence of serum prolactin on the results of echocardiography in patients with stable exertional angina and gastroesophageal reflux disease

Objective: to investigate the possible influence of serum prolactin level on the left ventricular myocardial functional capacity in patients with stable exertional angina (SEA) and gastroesophageal reflux disease (GERD). Material and methods. 118 patients were examined. Among them, 30 patients with isolated SEA (I–II FC) who made up 2 groups of study and 88 patients with SEA with comorbid endoscopically positive GERD (A, B, C), who were included in 1 group of the study. The control group consisted of 20 healthy persons (HP). Echocardiography was performed for all patients enrolled in the study and HP to determine the morphofunctional status of the left ventricular myocardium (LV) and its contractile function), to determine the serum prolactin (PL) level. Results. According to the echocardiography of patients with SEA with comorbid GERD, the indices that characterize the contractile capacity of the LV: the final diastolic volume of the LV and the ejection fraction (EF) of the LV are significantly lower than in both healthy subjects and patients with isolated SEA. The PL level of serum of patients with SEA with GERD is significantly higher than that of patients with isolated SEA and in healthy subjects. The incidence of hyperprolactinemia in patients with SEA in the presence of comorbid GERD is 3.1 times higher and is statistically significant (OR = 3.1183; CI 95% 1,326 –7.3331; р&lt; 0,009) compared with the isolated course of CCN. The content of PL in the serum of patients with SEA and GERD is in a strong inverse correlation (r=-0,74, p&lt;0,05) with the left ventricular EF. Conclusion. Therefore, we found that elevated prolactin levels of serum in patients with stable exertional angina and gastroesophageal reflux disease adversely affect the contractile capacity of the left ventricular myocardium, which is confirmed by the established negative high correlation between the serum levels of prolactin and ejection fraction of the left ventricule.

Correction of psychosomatic status of patients with stable angina of tension and gastroesophageal reflux disease

The relationship between stress, anxiety and depression in patients with cardiovascular diseases, especially in conditions of comorbidity, is a relevant subject for research, and requires to be studed from the standpoint of evidence-based medicine.The aim of the study. To determine the changes in the psycho-emotional state and prolactin level in patients with stable angina of tension (SAT) and gastroesophageal reflux disease (GERD) in the dynamics of treatment.Materials and methods. The study included 88 patients with SAT of I-II functional class with a comorbid, endoscopically positive GERD. In all of the patients including in the study a serum prolactin level was determined prior the beginning of treatment and 30 days later. To identify the presence of anxiety and depression interviews were conducted using the questionnaire “Hospital Anxiety and Depression Scale” (HADS), and an assessment of the quality of life of the ShortFormMedicalOutcomesStudy (SF-36) questionnaire was also performed. The patients were divided into 2 groups, depending on treatment. 1group (43 persons) received baseline treatment of SAT and GERD. Patients from the second group (45 people) received baseline therapy for SAT and GERD, with the exception of prokinetics and NO donors, only nitroglycerin, if needed, and, additionally, meldonium (Vasonat) capsules 500 mg 2 times daily for 30 days. All drugs were prescribed in average therapeutic doses, according to the individual needs.Results. Patients with SAT with comorbid GERD have an elevated level of prolactin, which directly and strongly correlates with the obtained scores of anxiety (anxiety average degree) and depression (subclinical degree depression) of the HADS questionnaire. Before treatment, the quality of life of patients was, in general, at a low level. At day 30 of treatment in group 2, prolactin levels decreased to almost the norm, what was not detected in group 1 as well as scores from the HADS questionnaire, reflecting the positive effect of baseline therapy correction on the tendency for anxiety and depression to decrease among patients with SAT and GERD. The results of the SF-36 group, additionally receiving Vasonat, were significantly higher in all subscales compared to the identical indeced of group 1, what indicates improvement of quality of patients’ life.Conclusion. Correction of the basic therapy of SAT and GERD (no prokinetics and prolonged-acting nitrates; additional administration of meldonium (Vasonate), at a dose of 500 mg 2 times daily) leads to a significant decrease in serum prolactin, reduction of anxiety and depression, according to the HADS questionnaire, as well as improvement of the quality of patients’ life with SAP and GERD compared to the patients receiving basic therapy of these diseases.

ПРОТЕКТИВНАЯ РОЛЬ МЕЛАТОНИНА ПРИ ГАСТРОЭЗОФАГЕАЛЬНОЙ РЕФЛЮКСНОЙ БОЛЕЗНИ

Background. It is known that the degree of damage to the mucous membrane (MM) of the esophagus in gastroesophageal reflux disease (GERD) depends on the severity of the impairment of its protective properties. The role of melatonin in the protection of the MM of the gastrointestinal tract (GIT) from the damaging effects of endogenous and exogenous factors is currently being studied. Objective. To study the characteristics of melatonin daily rhythm secretion in patients with endoscopically positive GERD and to assess the relationship of its level to the degree of MM damage to the esophagus. Materials and methods. 59 patients with reflux esophagitis (RE) were examined. The level of melatonin metabolite was determined: 24-hour urinary 6-sulfatoxymelatonin (6-SOMT) and separately in day and night urine output. The night/day index has been calculated. Results. In patients with erosive RE, the level of 6-SOMT in 24-hour urine and in day urine output is significantly lower than in patients with non-erosive RE. In patients with non-erosive RE, the shift of melatonin synthesis peak to daytime has been noted. The correlation between the degree of damage to the esophageal MM and 6-SOMT urine level has been established. Conclusion. The results of the study prove the esophagoprotective action of melatonin on the MM of the esophagus in patients with endoscopically positive GERD. It is its enteral synthesis that allows for the high level of melatonin in daytime in patients with RE.

Experience in the use of Noophen® 500 in patients with stable angina and gastroesophageal reflux disease in preparation for esophagogastroduodenofibroscopy

The objective: was to determine the frequency of cardiac symptoms in patients with stable angina pectoris with co-morbidity with gastroesophageal reflux disease (GERD) in the course of esophagogastroduodenofibroscopy (EHDS), determining the efficacy of Noophen®500 in order to prevent the development of cardiac symptoms of CHF, anxiety symptoms that may occur during ECGDS.Materials and methods. 89 patients with HF, I-II FC with comorbid endoscopically positive GERD (A, B, C) were examined. Two representative groups of the study were formed: group 1 (main group) – 45 patients who received a 500 mg dose of Noophen® 500 for a premedication, once a day, on the eve of EGGFS 2 hours before bedtime; 2nd (control) group – 44 patients who did not receive premedication. Endoscopic examination was carried out in the morning, on an empty stomach, 1 hour after awakening, under ECG monitoring. All patients before the use of the drug for 1 hour before the endoscopic examination and 1 hour after it, it was suggested to pass the tests of C.D. Spielberger and Yu.L. Hanina, and SUN. When conducting the efGDS, the possible effect of the drug on the technique of carrying out the endoscopic study was evaluated, and after diagnosis, the degree of satisfaction with the studies was determined in the patients surveyed.Results. A single application of Noophen® 500 can be recommended to prevent the occurrence of negative cardiac events during the endoscopic diagnosis, reduce the level of anxiety of patients, and provide a more comfortable diagnosis. Does not affect the state of sphincters, secretory and peristaltic activity of the digestive tract, facilitates the conduct of this diagnostic study for both the patient and the doctor.Сonclusion. The use of Noophen® 500 for the purpose of premedication provides an easy tranquilizing effect, anxiolytic, normotimic and moderate activating effects, improves mood, well-being and does not cause retardation, drowsiness, a feeling of exhaustion, and does not adversely affect the course of comorbid pathologies.

ПОШИРЕНІСТЬ ГАСТРОЕЗОФАГЕАЛЬНОЇ РЕФЛЮКСНОЇ ХВОРОБИ ЗА ДАНИМИ ЕНДОСКОПІЧНИХ ДОСЛІДЖЕНЬ

РЕЗЮМЕ. Гастроезофагеальна рефлюксна хвороба (ГЕРХ) залишається на сьогодні однією з найактуальніших проблем гастроентерології. Значна поширеність даної патології серед осіб працездатного віку погіршує соціально-економічні умови їх життя та потребує подальших досліджень для ранньої діагностики та лікування. Різноманітність клінічних проявів, не до кінця з’ясовані етіопатогенетичні ланки зумовлюють постійний інтерес до вивчення ГЕРХ. На жаль, достовірні дані щодо поширеності ГЕРХ в Україні практично відсутні.Мета – дослідити поширеність ендоскопічно позитивної форми ГЕРХ серед пацієнтів Новояворівської районної лікарні протягом 2011–2015 років.Матеріали та методи. Ретроспективно проаналізовано журнали реєстрації ендоскопічних досліджень з 2011 по 2015 рік. Ендоскопічні дослідження проводили фіброгастроскопами фірм Olympus та Pentax. Зміни слизової оболонки стравоходу визначали за Лос-Анджелеською системою класифікації (1997). Комп’ютерну обробку даних проводили за допомогою програми Microsoft Excel.Результати. За період 2011–2015 рр. виконано 7571 ендоскопію, у 959 обстежених (12,7 %) діагностовано ерозивний езофагіт. У 2011 р. виявлений 241 пацієнт з ерозивними змінами стравоходу: ст. А – 230 хворих, ст. В – 10 осіб та ст. D – 1 хворий. За 2012 рік діагностовано 117 випадків езофагіту: 110 – ст. А, 6 – ст. В, 1 – ст. С. Впродовж 2013 року було встановлено 239 випадків езофагіту:197 – ст. А, 34 – ст. В, 5 – ст. С та 3 – ст. D. Структура ендоскопічно позитивної ГЕРХ у 2014 році була наступною: 94 випадків езофагіту ст. А, 20 випадків езофагіту ст. В і 3 випадки езофагіту ст. С. У 2015 році виявлено 245 пацієнтів з ерозивним езофагітом, з них 201 – з езофагітом ст. А, 41 – з езофагітом ст. В та 3 – з езофагітом ст. С.Висновки. Поширеність ендоскопічно позитивної форми ГЕРХ у 2011–2015 роках на території обслуговування Новояворівської РЛ № 1 становила в середньому 13,4 %. Найхарактернішим для ерозивних уражень стравоходу був езофагіт ст. А. Найчастіше ерозивні езофагіти виявляли у пацієнтів працездатного віку.

The clinical-epidemiological characteristics and comorbidity of endoscopically positive gastroesophageal reflux disease

The clinical-epidemiological characteristics and comorbidity of endoscopically positive gastroesophageal reflux disease

Helicobacter pylori detection and clinical symptomatology of gastroesophageal reflux disease in pediatric patients with otitis media with effusion

ObjectivesThe study aimed to demonstrate Helicobacter pylori presence in otitis media with effusion (OME) and its association with symptomatology of gastroesophageal reflux disease (GERD). MethodsIn a cohort study, 69 effusions were collected during tympanostomy tube insertion for H. pylori detection using PCR and ELISA. Validated questionnaires were performed according to age for clinical diagnosis of GERD; chi-square ×2 statistical analysis was made. ResultsEight of the 69 ear effusions (5.7%) were positive for H. pylori detection using ELISA. Two patients (2.9%) had positive results for H. pylori detection using ELISA and PCR. These eight patients had positive results too in GERD questionnaires. None of the patients with negative/suspect questionnaires had positive results for H. pylori. We found statistical association between the results of ELISA, PCR and questionnaires (×2, p = 0.001). ConclusionsThe H. pylori presence in effusions varies widely, in our population the frequency was lower than other reports. We found strong association between H. pylori in effusions and positive GERD questionnaires. The bacterium role in OME chronicity is not clear, but this study supports the GERD participation in OME pathogenesis.

Gastroesophageal Reflux Disease and Its Association With Bronchiolitis Obliterans Syndrome in Allogeneic Hematopoietic Stem Cell Transplant Recipients

Bronchiolitis obliterans syndrome is a significant postallogeneic hematopoietic stem cell transplant problem. Recent data in lung transplant patients suggest an association with gastroesophageal reflux disease and bronchiolitis obliterans syndrome. We studied posthematopoietic stem cell transplant patients with bronchiolitis obliterans syndrome for gastroesophageal reflux disease and its response to a proton pump inhibitor. Seven postallogeneic hematopoietic stem cell transplant patients with bronchiolitis obliterans syndrome were studied. Gastroesophageal reflux disease was assessed by 24-hour pH monitoring with a Bravo catheter-free radio pH capsule. Patients with positive gastroesophageal reflux disease were started on omeprazole. Pretreatment and posttreatment pulmonary function tests were done at 3-month intervals. Of 7 patients, 5 had positive results for gastroesophageal reflux disease (71%). Omeprazole had a disease-stabilizing effect on the patients' pulmonary function tests. Our study shows a significant association between bronchiolitis obliterans syndrome and gastroesophageal reflux disease in postallogeneic hematopoietic stem cell transplant patients. Use of omeprazole may have a disease-stabilizing effect in short-term follow-up.

Gastroesophageal Reflux Disease in Children With Chronic Otitis Media With Effusion

We aimed to evaluate a possible relation between gastroesophageal reflux disease and middle ear effusion in children. Children who came to ear, nose, and throat (ENT) department with the symptoms of hearing loss or aural fullness and diagnosed as OME by examination and tympanometry were included into the study. Children were reviewed gastroesophageal reflux disease symptoms including the following: (a) airway symptoms: stridor, frequent cough, recurrent croup, wheezing, nasal congestion, obstructive apnea, hoarseness, and throat clearing; (b) feeding symptoms: frequent emesis, dysphagia, choking: gagging, sore throat, halitosis, food refusal, regurgitation, pyrosis, irritability, failure to thrive, and anemia. Diagnosis is made with at least one positive test of radionuclide gastroesophageal scintigraphy or 24 h pH probe in the patients with reflux. ENT findings were also examined between gastroesophageal reflux disease positive and gastroesophageal reflux disease negative groups. Approximately 39 (54.9%) of 71 children had at least 1 positive test for gastroesophageal reflux disease. Between the gastroesophageal reflux disease-positive and gastroesophageal reflux disease-negative groups, symptoms of reflux were not significantly different. Two pooled variables were created: airway complex (stridor, frequent cough, throat clearing), and feeding complex (irritability, pyrosis, failure to thrive). Percentage of positive symptom complexes were no statistically different between gastroesophageal reflux disease-positive and gastroesophageal reflux disease-negative groups (>0.05). Ear, nose, and throat disorders (including rhinitis/sinusitis, adenoid hypertrophy, tonsillitis/pharyngitis, and laryngitis) were more frequent in gastroesophageal reflux disease-positive group. Tonsillitis/pharyngitis was significantly different between the gastroesophageal reflux disease positive and gastroesophageal reflux disease-negative groups. Upper respiratory tract infections were seen more frequently in gastroesophageal reflux disease positive group. Children who present with gastroesophageal reflux disease symptoms are more likely to have a positive gastroesophageal reflux disease test. However, no concordance may be found between the complaints and gastroesophageal reflux disease findings. For this reason, a decision about gastroesophageal reflux disease should not only be made by looking to complaints; diagnostic tests must also be performed.

Prevalence of endoscopically negative and positive gastroesophageal reflux disease in the Japanese

Objective. The frequency of gastroesophageal reflux disease (GERD) has not been fully investigated in the Asian population. The aim of this study was to investigate the prevalence of GERD, endoscopy-negative GERD (NERD), and erosive GERD in Japan, and the factors influencing disease prevalence. Material and methods. A total of 2760 subjects (mean age 50.4 years, range 24–84 years) were prospectively enrolled in this multicenter study. GERD symptoms were assessed with the Japanese version of the Carlsson-Dent self-administered questionnaire (QUEST) and upper gastrointestinal endoscopy was performed on all study participants. Results. A total of 495 (17.9%) individuals were diagnosed with GERD by the presence of erosive esophagitis at endoscopy and/or by the presence of GERD symptoms. Erosive esophagitis was diagnosed endoscopically in 195 (7.1%), and symptomatic GERD was diagnosed in 351 (12.7%) based on a QUEST score of over 6. Of these 351 subjects, 300 (10.9%) were considered to have NERD. Male gender, hiatal hernia, and mild gastric mucosal atrophy were significant positive predictive factors of erosive esophagitis by multiple regression analysis. Hiatal hernia was the only significant predictor of GERD symptoms. Traditional Japanese foods, such as sweet cakes and rice cake, frequently exacerbated GERD symptoms. Conclusions. The prevalence of GERD in the Japanese was 17.9% and the prevalence rates of NERD and erosive esophagitis were 10.9% and 8.6%, respectively. The majority of symptomatic patients did not have endoscopically proven esophagitis. Hiatal hernia is the only important predictor of the presence of GERD symptoms.

Gastroesophageal reflux pattern in patients with endoscopy negative and endoscopy positive gastroesophageal reflux disease

Gastroesophageal reflux pattern in patients with endoscopy negative and endoscopy positive gastroesophageal reflux disease

The impact of upper GI endoscopy referral volume on the diagnosis of gastroesophageal reflux disease and its complications: a 1-year cross-sectional study in a referral area with 260,000 inhabitants

OBJECTIVES: Less than half of patients with gastroesophageal reflux disease (GERD) have endoscopic erosive esophagitis (endoscopy positive GERD). Symptomatic GERD and Barrett’s esophagus (BE), however, are risk factors for esophageal and gastric cardia adenocarcinomas. The aim of the present study was to examine the prevalence of GERD-related findings on endoscopy according to the volume of referrals to upper GI endoscopy. METHODS: The following data were gathered on all GERD patients who were sent for upper GI endoscopy by general practitioners (GPs) during 1 yr in our hospital referral area of 260,000 inhabitants: the number of referrals to endoscopy in health care units, and the numbers of endoscopy positive GERD, BE, and esophageal neoplasms. Patients with symptoms or signs suggesting acute upper GI bleeding and those attending follow-up endoscopy ( e.g., for BE, peptic ulcer, or dysplasia) were excluded, as were patients with previous esophagogastric surgery or Helicobacter pylori eradication therapy. RESULTS: The study population consisted of 3378 patients, with a mean age of 58.1 yr (95% CI = 57.5–58.6) and a male:female ratio of 1:1.3. Of the 760 patients who underwent endoscopy because of heartburn or regurgitation, 254 (33.4%) had endoscopy positive (erosive) GERD, 11 (1.4%) BE (one with esophageal adenocarcinoma), six (0.8%) esophageal ulcer, and one peptic esophageal stricture (0.1%). Between health care units, the referrals to endoscopy (number of endoscopies/population/yr) varied from 0.6 to 9.2/1000 inhabitants/yr (median 3.3/1000/yr). In health care units with “high” referral volumes (≥3.3 referrals/1000/yr, N = 15, 1297 patients) and “low” referral volumes (<3.3/1000/yr, N = 15, 2081 patients), the numbers of endoscopy positive GERD were 281 (21.7%) versus 308 (14.9%, p <0.001), esophageal ulcer 13 (1.0%) versus 14 (0.7%, p = 0.3), esophageal stricture five (0.4%) versus seven (0.3%, p = 0.4), Barrett’s esophagus eight (0.6%) versus 16 (0.8%, p = 0.6), and esophageal neoplasm two (0.2%) versus six (0.3%, p = 0.2). Five of the neoplasms were squamous cell carcinomas, two were adenocarcinomas, and one was lymphoma. Multivariate analyses showed that independent risk factors for endoscopy positive GERD were male sex (OR = 1.4, 95% CI = 1.2–1.7), GERD symptoms (OR = 3.3, 95% CI = 2.7–4.0), dysphagia (OR = 1.4, 95% CI = 1.0–2.1), and living in a high referral area (OR = 1.4, 95% CI = 1.2–1.7). Independent risk factors for BE were male sex (OR = 2.6, 95% CI = 1.1–6.1) and GERD symptoms (OR = 2.9, 95% CI = 1.3–6.6), whereas the only independent risk factor for esophageal neoplasm was dysphagia (OR = 40.0 (95% CI = 7.7–207.5). CONCLUSIONS: There is a wide variation in GPs’ referrals for endoscopy. Increasing the referral volume significantly increases the proportion of endoscopy positive GERD cases, but not that of GERD complications such as BE, esophageal ulcer, peptic stricture, or esophageal neoplasms.

The impact of upper GI endoscopy referral volume on the diagnosis of gastroesophageal reflux disease and its complications: a 1-year cross-sectional study in a referral area with 260,000 inhabitants.

Less than half of patients with gastroesophageal reflux disease (GERD) have endoscopic erosive esophagitis (endoscopy positive GERD). Symptomatic GERD and Barrett's esophagus (BE), however, are risk factors for esophageal and gastric cardia adenocarcinomas. The aim of the present study was to examine the prevalence of GERD-related findings on endoscopy according to the volume of referrals to upper GI endoscopy. The following data were gathered on all GERD patients who were sent for upper GI endoscopy by general practitioners (GPs) during 1 yr in our hospital referral area of 260,000 inhabitants: the number of referrals to endoscopy in health care units, and the numbers of endoscopy positive GERD, BE, and esophageal neoplasms. Patients with symptoms or signs suggesting acute upper GI bleeding and those attending follow-up endoscopy (e.g., for BE, peptic ulcer, or dysplasia) were excluded, as were patients with previous esophagogastric surgery or Helicobacter pylori eradication therapy. The study population consisted of 3378 patients, with a mean age of 58.1 yr (95% CI = 57.5-58.6) and a male:female ratio of 1:1.3. Of the 760 patients who underwent endoscopy because of heartburn or regurgitation, 254 (33.4%) had endoscopy positive (erosive) GERD, 11 (1.4%) BE (one with esophageal adenocarcinoma), six (0.8%) esophageal ulcer, and one peptic esophageal stricture (0.1%). Between health care units, the referrals to endoscopy (number of endoscopies/population/yr) varied from 0.6 to 9.2/1000 inhabitants/yr (median 3.3/1000/yr). In health care units with "high" referral volumes (> or = 3.3 referrals/1000/yr, N = 15, 1297 patients) and "low" referral volumes (< 3.3/1000/yr, N = 15, 2081 patients), the numbers of endoscopy positive GERD were 281 (21.7%) versus 308 (14.9%, p < 0.001), esophageal ulcer 13 (1.0%) versus 14 (0.7%, p = 0.3), esophageal stricture five (0.4%) versus seven (0.3%, p = 0.4), Barrett's esophagus eight (0.6%) versus 16 (0.8%, p = 0.6), and esophageal neoplasm two (0.2%) versus six (0.3%, p = 0.2). Five of the neoplasms were squamous cell carcinomas, two were adenocarcinomas, and one was lymphoma. Multivariate analyses showed that independent risk factors for endoscopy positive GERD were male sex (OR = 1.4, 95% CI = 1.2-1.7), GERD symptoms (OR = 3.3, 95% CI = 2.7-4.0), dysphagia (OR = 1.4,95% CI = 1.0-2.1), and living in a high referral area (OR = 1.4, 95% CI = 1.2-1.7). Independent risk factors for BE were male sex (OR = 2.6, 95% CI = 1.1-6.1) and GERD symptoms (OR = 2.9, 95% CI = 1.3-6.6), whereas the only independent risk factor for esophageal neoplasm was dysphagia (OR = 40.0 (95% CI = 7.7-207.5). There is a wide variation in GPs' referrals for endoscopy. Increasing the referral volume significantly increases the proportion of endoscopy positive GERD cases, but not that of GERD complications such as BE, esophageal ulcer, peptic stricture, or esophageal neoplasms.