Predictors Of Gastroesophageal Reflux Disease Research Articles

Dental evaluation is helpful in the differentiation of functional heartburn and gastroesophageal reflux disease.

Heartburn is identically the key symptom of both, gastroesophageal reflux disease (GERD) and functional heartburn (FHB), making the differential diagnosis resource-intensive. Oral manifestations of GERD can be easily examined; therefore, their exploration might be a cheap, widely available, and useful tool in the differentiation of GERD and FHB. To evaluate the prevalence of dental erosions (DE) and periodontal diseases (PD) in patients with heartburn and their association with GERD and FHB. A total of 116 [M/F: 51/65, mean age: 54 (17-80) years] consecutive patients with heartburn were enrolled for detailed esophageal function and orodental examinations. Dental disorders were detected in 89% (103/116). Patients with PD + DE had significantly more often pathologic reflux (90.0% vs 27.8%; P < 0.05), higher esophagitis scores (1.8 vs 0.9; P < 0.05), and a significantly different mean impedance curve (P = 0.04) than those without any dental diseases. The opposite approach established that patients with GERD had significantly higher prevalence of DE and PD, especially if both were present (28.9% vs 2.0%; P < 0.01), more severe PD (1.5 vs 1.0; P < 0.01), and longer history of heartburn (15 years vs 9 years; P < 0.01) than those with FHB. The dental evaluation of patients with heartburn seems to be useful in the differential diagnosis of GERD and FHB. Among the studied parameters, the co-appearance of DE and PD seems to be the best predictor of GERD, whereas the absence of dental disorders was mostly observed in FHB.

GERD and Its Association with BMI in Adult Patients Undergoing Upper GI Endoscopy at the Kenyatta National Hospital

Background: Gastroesophageal reflux disease (GERD) is a common clinical problem affecting millions of people worldwide. GERD is highly prevalent in morbidly obese patients and a high body mass index (BMI) is a risk factor for this condition. However, there is differing data on the use of BMI as a predictor of GERD, its severity and frequency. We therefore aimed to determine the association between GERD and high BMI and to document the esophageal mucosal changes in these patients during endoscopy. Methodology: We conducted a cross-sectional study among the 174 GERD patients to investigate the association between BMI and GERD at Kenyatta National Hospital endoscopy unit. Patients aged 18 years and above presenting with classical symptoms of GERD were evaluated upon voluntary enrolment. Ethical approval was sought from the KNH-UON ethics&amp; research committee. A questionnaire was administered with demographic data (age, gender, weight, height) and specific questions assessing for GERD. At endoscopy, the mucosal changes were recorded. Data was then summarized using means, frequencies and proportions. Association between patient demographics and GERD was evaluated using the Student t-test or Mann–Whitney U test for continuous variables. Chi-square analysis was applied for categorical variables. A p-value of &lt;0.05 was considered statistically significant. Results: This was an analysis of 174 patients (56.9% Female, 43.1% Male) between ages 18- 80 years (x̄=43) who underwent endoscopy. The BMI ranges were 14.5 to 38.6 Kg/m2 (x̄=26.6 Kg/m2). The proportion of patients who were overweight was 40.2% and obese patients made up 21.8% of the population. There was no significant association between BMI measurements and frequency scale of GERD (FSSG) symptoms (p=0.217). During endoscopy, 35.6% of the patients had esophagitis (LA-A -28.7%, LA-B – 6.9%). Hiatal hernia was diagnosed in 20.7% of the patients. There was no significant association between the diagnoses of esophagitis and hiatal hernia and the BMI status of the patients. However, older age was associated with a higher prevalence of hiatal hernia (p=0.002). Conclusion: There was no association between increasing BMI and frequency and severity of GERD symptoms in the study population.

Prevalence and predictors of gastroesophageal reflux disease in pregnant women and its effects on quality of life and pregnancy outcomes

Pregnancy is considered a risk factor for Gastroesophageal Reflux (GERD). However, studies on GERD during pregnancy are rare in Korea. We aimed to evaluate the efficacy and clinical outcomes of GERD in late pregnancy in Korea.

203 RISK AND PROTECTIVE FACTORS OF GASTROESOPHAGEAL REFLUX DISEASE AFTER PERORAL ENDOSCOPIC MYOTOMY

Abstract Peroral endoscopic myotomy(POEM)has been reported as safe and effective treatment for achalasia. This procedure is proposed to be a less invasive alternative to conventional laparoscopic Heller-myotomy with Dor-fundoplicatin(LHD), previous studies have shown that POEM may result in a higher incidence of gastroesophageal reflux disease(GERD)compared with LHD. However, certain predictors of GERD after POEM remain unstudied limiting current treatment strategy of achalasia. The aim of this study is to clarify the protective factors of GERD post-POEM. Methods Fifty-one patients who underwent POEM at our institution between January 2016 and December 2019 were included. We performed esophagogram and high-resolution esophageal manometry (HRM) as a part of preoperative evaluation. Upper gastrointestinal endoscopy has been assessed 3 months, 1 year, and then yearly after POEM. Patients were divided into two groups based on post-POEM endoscopic findings: GERD group (patients who had esophagitis [n = 28; median age 53 years with 18 male]) and non-GERD group (patients who did not have GERD [n = 23; median age 50 years with 14 male]). We compared preoperative foregut tests between the two groups. Results Twenty-eight out of 51 patients (54.9%) developed esophagitis. There were no differences in age, sex, BMI, and findings of esophagogram between the groups. Based on HRM test, greater overall lower esophageal sphincter (LES) length was noted in the non-GERD group compared with the GERD group (3.0 vs. 2.6 cm, p = 0.034). Length of gastric myotomy was comparable between the GERD and non-GERD groups (2.0 vs. 3.0 cm, p = 0.477). Similar incidence of esophagitis was evident in patients who had a history of prior LHD and those who underwent POEM as a primary intervention (60% [9/15 patients] vs. 52.8% [19/36 patients], p = 0.437). Conclusion Shorter overall LES length appears to be associated with esophagitis post-POEM. Length of gastric myotomy did not correlate to GERD in the study cohort. Prior Dor fundoplication may not avert development of GERD after POEM. Further study is warranted.

Diagnostic performance of the endoscopic pressure study integrated system (EPSIS): a novel diagnostic tool for gastroesophageal reflux disease.

The endoscopic pressure study integrated system (EPSIS) is a prototypic system for monitoring intragastric pressure (IGP) fluctuations that result from opening of the cardia during gastric distension. The performance of EPSIS for the diagnosis of gastroesophageal reflux disease (GERD) was evaluated. A retrospective analysis was conducted of data prospectively collected over a 2-year period from 59 patients who underwent gastroscopy, EPSIS, and 24-hour pH monitoring. Using a dedicated electronic device and a through-the-scope catheter, maximum IGP (IGPmax) and IGP waveform pattern (uphill/flat) were recorded. The optimal IGPmax cutoff was 18.7 mmHg. IGPmax < 18.7 mmHg (sensitivity 74.2 %, 95 % confidence interval [CI] 56.8 - 86.3; specificity 57.1 %, 95 %CI 39.1 - 73.5) and flat pattern (sensitivity 71.0 %, 95 %CI 53.4 - 83.9; specificity 82.1 %, 95 %CI 64.4 - 92.1) were associated with GERD. "Double" EPSIS positivity (IGPmax < 18.7 mmHg and flat pattern) provided maximum specificity (85.7 %, 95 %CI 68.5 - 94.3), whereas "any" EPSIS positivity (IGPmax < 18.7 mmHg or flat pattern) provided maximum sensitivity (80.6 %, 95 %CI 63.7 - 90.8). Maximum specificity and sensitivity for nonerosive reflux disease (NERD) was > 70 %. In multivariate analysis, "double" EPSIS positivity was the strongest predictor of GERD (odds ratio [OR] 16.05, 95 %CI 3.23 - 79.7) and NERD (OR 14.7, 95 %CI 2.37 - 90.8). EPSIS emerges as a reliable adjunct to routine gastroscopy for GERD diagnosis, and might prove helpful for the stratification and management of patients with reflux disorders.

The predictors of Gastroesophageal Reflux Disease among University students: A cross sectional study in the western region of Saudi Arabia

Background: Gastroesophageal reflux disease (GERD) is one of the most common health problems that cause a financial burden on healthcare systems worldwide. The prevalence of GERD in Saudi Arabia is steadily increasing. There is a paucity of data regarding GERD among University students. Material and Methods: This cross-sectional observational study was conducted to assess the prevalence of GERD among male students of Taif University in the western region of Saudi Arabia in addition to determining the risk factors associated with the occurrence of GERD. Data were collected through a self-administration questionnaire. In addition, weight and height were measured to calculate the body mass index (BMI) of participating students. Results: Of 464 students who participated from different colleges of the University; More than half of the male students in Taif University (53.2%, 95% CI= 48.7% to 57.8%) suffer from GERD. There was higher prevalence among smokers, overweight and obese students, those who drink plenty of soft drinks. Students with hypertension, psychiatric diseases, diabetes mellitus, asthma or irritable bowel syndrome had higher prevalence of reflux. GERD was significantly present among students with history of psychological stress. Conclusion: Special consideration should be given to raising the awareness of about gastro esophageal reflux disease among the public and its controllable risk factors. The psychological stress among University students needs to be tackled to decrease reflux among them.

The predictors of Gastroesophageal Reflux Disease among University students: A cross sectional study in the western region of Saudi Arabia

Background: Gastroesophageal reflux disease (GERD) is one of the most common health problems that cause a financial burden on healthcare systems worldwide. The prevalence of GERD in Saudi Arabia is steadily increasing. There is a paucity of data regarding GERD among University students. Material and Methods: This cross-sectional observational study was conducted to assess the prevalence of GERD among male students of Taif University in the western region of Saudi Arabia in addition to determining the risk factors associated with the occurrence of GERD. Data were collected through a self-administration questionnaire. In addition, weight and height were measured to calculate the body mass index (BMI) of participating students. Results: Of 464 students who participated from different colleges of the University; More than half of the male students in Taif University (53.2%, 95% CI= 48.7% to 57.8%) suffer from GERD. There was higher prevalence among smokers, overweight and obese students, those who drink plenty of soft drinks. Students with hypertension, psychiatric diseases, diabetes mellitus, asthma or irritable bowel syndrome had higher prevalence of reflux. GERD was significantly present among students with history of psychological stress. Conclusion: Special consideration should be given to raising the awareness of about gastro esophageal reflux disease among the public and its controllable risk factors. The psychological stress among University students needs to be tackled to decrease reflux among them.

Multivariate Analysis of Clinical Predictors of Sleep Disturbance Related to Frequent Nighttime Heartburn and Acid Regurgitation Symptoms in Individuals Taking Esomeprazole 20 mg or Placebo

Introduction: Determine predictors of gastroesophageal reflux disease (GERD)-related sleep disturbance resolution with 14-day esomeprazole (ESO) 20 mg (administered as 22.3 mg ESO magnesium trihydrate) or placebo treatment. Methods: Data were pooled from the first 14 days in subjects with frequent nighttime heartburn (HB) and GERD-related sleep disturbances assigned to ESO 20 mg or placebo in 2 similarly designed randomized, double-blind studies.(1,2) Multivariate analyses were performed to identify predictors of complete resolution of GERD-related sleep disturbance (no sleep disturbance for 7 consecutive days as documented on subject diary cards). Clinical variables (treatment; study; site; age; gender; BMI [available in 1 study]; run−in sleep disturbance frequency; 24−hour, daytime, and nighttime HB) were assessed by stepwise logistic regression. Results: In the pooled data set, treatment (P<.0001), absence of daytime (P=.0018) or nighttime HB (P<.0001), and lower run−in sleep disturbance frequency (P<.0001) were significant predictors of complete resolution of GERD-related sleep disturbance at 14 days (Table 1, 2).Table 1: Complete Resolution of Sleep Disturbance by 14 DaysTable 2: Predictors of Complete Resolution of Sleep Disturbance at 14 DaysConclusion: Individuals with less frequent baseline sleep disturbance and those without daytime or nighttime HB during the first 14 days’ treatment were more likely to have complete resolution of GERDrelated sleep disturbance. Studies were funded by AstraZeneca, which entered into an agreement with Pfizer for the over-thecounter rights for NEXIUM® (esomeprazole magnesium). Medical writing support provided by Diane Sloan, PharmD, of Peloton Advantage, LLC; funded by Pfizer.

Prevalence and Associated Clinical Factors of GERD (Gastro-Esophageal Reflux Disease) in Ischemic Stroke Patients

Purpose: Aspirin is protective against ischemic stroke, but its use is a significant risk factor for gastro-esophageal reflux disease (GERD). We investigated the prevalence and associated clinical factors of GERD in ischemic stroke patients treated with aspirin. Methods: We recruited 116 ischemic stroke outpatients who were receiving aspirin. Sixteen patients who had received proton pump inhibitors or H2 receptor antagonists within the previous month were excluded. The presence of GERD was defined using the GerdQ questionnaire, with a score of 8 or higher considered positive for GERD. Logistic regression analysis was conducted using variables which exhibited a significant correlation coefficient on two-group comparison as factors, with the presence or absence of GERD as the dependent variable. Results: Mean age of the 100 patients analyzed was 69.3 ± 8.9 years. The prevalence of GERD was 28%. Mean BW of patients with GERD was significantly higher than of those without GERD (P =0.02). The proportion of patients receiving angiotensin II receptor blockers (ARBs) was significantly lower in the GERD group (P=0.04). In contrast, no significant difference was seen in the proportion of patients receiving calcium channel blockers (CCBs). Multivariable logistic regression analysis showed that ARB disuse and increased BW were independent predictors of GERD. Conclusions: The prevalence of GERD was 28% in ischemic stroke patients treated with aspirin. Increased BW as well as ARBs disuse was independent risk factors of GERD. With all these factors, ARBs appear to be better suited than CCBs for use in patients with ischemic stroke with regard to the prevention of GERD. A comprehensive understanding of the relationship between ARBs and GERD prevalence awaits additional studies in a larger number of patients.

Evaluation of Histologic Criteria for the Diagnosis of Gastroesophageal Reflux Disease

Background. Standardized criteria for the histologic assessment of gastroesophageal reflux disease (GERD) were recently developed and evaluated by an international working group, and showed promising levels of intraand inter-assessor agreement1. To gain clinical acceptance these criteria require appropriate validation2.Aim. To evaluate new criteria for histologic markers of GERD in a well characterized primary care population. Methods. The study included primary care patients from the Diamond study3 (ClinicalTrials.gov: NCT00291746) who had not previously taken proton pump inhibitors and who had upper gastrointestinal symptoms ≥ 2 times a week for ≥ 4 weeks, and at least mild symptoms on ≥ 3 days in the week before biopsy. GERD was diagnosed as any of the following: Los Angeles grade reflux esophagitis; distal esophageal pH 5.5% of 24 hours; ≥ 95% symptom association probability. Biopsies were collected at 0.5 cm and 2.0 cm above the Z-line and data were analyzed in a single-blind manner by one pathologist (MV). Variables assessed included total epithelial thickness (TET), papillary length (PL), basal cell thickness (all in μm), presence of dilated intercellular spaces (severity score: 0-2)1, number of inflammatory cells (in one high powered field), presence of necrosis, and presence of active or healed erosions. Logistic regression analysis of the histologic variables was performed for GERD versus non-GERD. Cut-off values for sensitivity, specificity, and predictive power (positive and negative) were calculated, and the receiver operating characteristic (ROC) curve was analyzed. Results. The analysis included 258 subjects: 138 (53%) GERD and 120 (47%) non-GERD. TET and PL (μm) at 0.5 cm and 2.0 cm were both significant predictors of GERD (p < 0.005), as was the presence of eosinophils at 2.0 cm (p < 0.05). The optimal efficiency based on the ROC analysis was observed for TET at 0.5 cm, with sensitivity and specificity values of 77% and 52%, and positive and negative predictive values of 65% and 66%, based on a cut-off of 390 μm. TET and PL were significant (p < 0.05) predictors of both reflux esophagitis and of pathologic esophageal pH. TET and PL were also significant predictors (p < 0.05) of non-erosive reflux disease versus non-GERD. Conclusions. Potential new criteria for the histologic evaluation of GERD showed good diagnostic properties when assessed in a well-characterized primary care population with upper gastrointestinal symptoms.

Increased Risk of Graft Failure in Kidney Transplant Recipients After a Diagnosis of Dyspepsia or Gastroesophageal Reflux Disease

Gastrointestinal complications are common in patients who undergo kidney transplantation and may affect posttransplant outcomes. We examined the incidence and predictors of gastroesophageal reflux disease (GERD) and dyspepsia and their associations with graft survival and mortality after transplant. We examined United States Renal Data System data and Medicare billing claims to identify diagnoses of dyspepsia and GERD among Medicare beneficiaries transplanted in 1995-2002 (n=42,257). Among GERD cases, we identified patients with reflux esophagitis (RE). We determined independent predictors of upper gastrointestinal complications and modeled these conditions as time-dependent outcomes predictors with Cox regression. The 3-year cumulative incidences of GERD, RE, and dyspepsia were 20%, 5%, and 6%, respectively. Overall, 23% of transplant recipients received a diagnosis of at least one of these complications by 3 years after transplant. Female gender and a pretransplant upper gastrointestinal disease diagnosis predicted posttransplant gastrointestinal complications. Older age, obesity, Caucasian, and African-American race were associated to increased risk of developing GERD. Patients diagnosed with any of the examined upper gastrointestinal complications experienced an increased risk of graft-failure (hazard ratio 1.58; 95% confidence interval 1.48-1.69) and death (hazard ratio 1.61; 95% confidence interval 1.46-1.77). Upper gastrointestinal complications are relatively common after kidney transplantation and are associated with a significantly increased risk of graft loss and death. Further research is needed to elucidate mechanisms underlying the observed adverse prognoses conferred by diagnosis of upper gastrointestinal complications after kidney transplant.

Laryngopharyngeal Symptoms and Gastroesophageal Reflux Disease

The incidence of gastroesophageal reflux disease (GERD) in patients with laryngopharyngeal symptoms is greater than expect. A prospective study was performed to investigate the incidence of gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) in patients with laryngopharyngeal symptoms. Laryngologic evaluation with nasopharyngeal and laryngeal endoscopy and gastroenterologic evaluation with esophagogastroduodenoscopy including measurement of pH value were performed in 46 patients. Therapeutic intervention included general antireflux precautions and antireflux medication, and eradication of Helicobacter pylori in selected cases. Posterior laryngitis was present in 33 patients. GERD was present in 25 patients, hiatus hernia in 4 patients, H pylori-positive gastritis in 11 patients, and Barrett's metaplasia in 2 patients. Increasing evidence shows that GERD may cause laryngopharyngeal symptoms. Otherwise laryngopharyngeal symptoms can be predictors of GERD. Medical antireflux treatment is also effective for laryngopharyngeal symptoms.