Presence Of Gastroesophageal Reflux Disease Research Articles

The impact of gastroesophageal reflux disease on the quality of life of children and adolescents in the Republic of Tyva

Aim of the study was to investigate quality of life indicators in children and adolescents with gastroesophageal reflux disease (GERD) in the Mongoloid and Caucasian populations of the Republic of Tyva. Material and Methods. Schoolchildren aged 7–18 years of the indigenous (25 Mongoloids – Tuvans with GERD and 354 practically healthy) and newcomers population Republic of Tyva (5 Caucasians with GERD and 158 practically healthy) were examined using a cross-sectional method. Gastroenterological complaints and demographic information were recorded. To assess the quality of life of children, adapted Russian parent (CHQ-PF28) and child (CHQ-PF45) versions of the Child Health Questionnaire (CHQ) were used. The questionnaire allows you to assess various areas of a child’s life. Results and discussion. A decrease in the quality of life was established in schoolchildren of both ethnic populations in the presence of GERD on a number of scales as assessed by the children themselves and their parents. However, unlike parents, children’s assessments tended to decrease in the “family cohesion” section (p = 0.068), which, to a certain extent, may reflect the presence of intrafamily problems that can have a traumatic effect on the child. According to parents’ assessments, in schoolchildren with GERD in the Caucasian population, the decrease in indicators concerned only the “physical activity” scale (p = 0.039). In the Tuvan population, more extensive deviations were noted ‒ in sections “general health assessment” (p = 0.041), “physical activity” (p = 0.024), “changes in health status” (p = 0.006), “pain/ discomfort” (p = 0.037). According to the assessment of children, Caucasians with GERD did not show a decrease in indicators, and Tuvans with GERD had fewer deviations on the scales than, according to their parents. Conclusions. Tyva schoolchildren with GERD showed a decrease in quality of life indicators, which was more pronounced among Mongoloids - Tuvans, and there were differences in its assessment by the children themselves and their parents.

Relationship between proton pump inhibitor prescription and asthma exacerbation among adult patients: a self-controlled case series study.

Proton-pump inhibitors (PPI) are empirically used to treat asthma symptoms such as cough; however, the effectiveness of PPI on asthma exacerbation has not been well studied. We aimed to evaluate the relationship between PPI use and asthma exacerbation using a large administrative claims database in Japan. We conducted a self-controlled case series using the JMDC Claims Database (JMDC, Inc., Tokyo, Japan). The cases included adult patients with asthma who were prescribed PPI and experienced at least one outcome event between January 2015 and December 2019. The primary outcome was the composite outcome of hospital admissions and unscheduled outpatient clinic visits due to asthma exacerbation. We also conducted stratified analyses based on PPI generation, the presence of gastroesophageal reflux disease (GERD), asthma severity, and the number of allergic comorbidities. A total of 7379 eligible patients were included in the study. PPI prescription was associated with a decrease in the composite outcomes (incidence rate ratio, 0.90; 95% confidence interval, 0.87-0.93). However, PPI prescriptions did not affect the outcomes of hospital admissions (incidence rate ratio, 1.34; 95% confidence interval, 0.86-2.10). Stratified analyses based on PPI generation, the presence of GERD, asthma severity (except for severe asthma), and the number of allergic comorbidities yielded consistent results. PPI use was associated with a moderate decrease in asthma exacerbation, regardless of the patient profile. However, this effect was not as strong as the prevention of hospital admissions, and outcome events were not prevented in patients with severe asthma.

Association of gastroesophageal junction laxity and gastroesophageal reflux disease.

Gastroesophageal reflux disease is a prevalent condition with significant clinical variability, complicating its evaluation and treatment. The gastroesophageal flap valve is a fundamental evaluation method, but have shown limitations in specificity and reliance on subjective endoscopists' experience. Recent insights suggest that gastroesophageal junction laxity may offer an objective and quantifiable measurement for the presence of gastroesophageal reflux disease. This retrospective study analyzed data from 401 patients who underwent comprehensive evaluations, including a symptom questionnaire, endoscopy, pH-impedance monitoring, high-resolution manometry, and treatment directions, between January 1, 2022 and October 31, 2023. Gastroesophageal junction laxity was assessed using a modified approach based on endoscopic image analysis, with the diameter of endoscope as reference to estimate the long diameter of the laxity ring. The independent association of gastroesophageal junction laxity with pathologic acid exposure, esophagitis, and hiatal hernia were assessed by adjusting with age and sex. The mean age was 44.5 ± 5.5years old, and 49.9% (200/401) were male. The most common symptoms (≥ 1 point) were acid regurgitation (333/401, 83.0%), heartburn (315/401, 78.6%), belching (278/401, 69.3%), bloating (241/401, 60.1%), and globus sensation (241/401, 60.1%). The gastroesophageal junction laxity was significantly associated with pathologic acid exposure, esophagitis, hiatal hernia, and lower esophageal sphincter resting pressure. Notably, with the increase in gastroesophageal junction laxity, the rates of pathologic acid exposure, esophagitis, and hiatal hernia increased gradually, the lower esophageal sphincter resting pressure decreased gradually. The gastroesophageal junction laxity was independent associated with pathologic acid exposure (OR = 2.33, 95%CI 1.77-3.07, p < 0.001), esophagitis (OR = 2.10, 95%CI 1.62-2.73, p < 0.001), and hiatal hernia (high-resolution manometry: OR = 3.39, 95%CI: 2.46-4.67, p < 0.001) (endoscopy: OR = 21.65, 95%CI 11.70-40.06, p < 0.001). The gastroesophageal junction laxity was significantly associated with the indicators of pathophysiology in gastroesophageal reflux disease.

The impact of gastroesophageal reflux disease and its treatment on interstitial lung disease outcomes

BackgroundTo determine the relationship between gastroesophageal reflux disease (GORD) and its treatment and interstitial lung disease in patients with systemic sclerosis (SSc).MethodsSSc patients from the Australian Scleroderma Cohort Study (ASCS) were included. GORD was defined as self-reported GORD symptoms, therapy with a proton pump inhibitor (PPI) or histamine 2 receptor antagonist (H2RA) and/or the presence of reflux oesophagitis diagnosed endoscopically. The impact of GORD and its treatment on ILD features (including severity and time to ILD development) and survival was evaluated.ResultsGORD was a common manifestation affecting 1539/1632 (94%) of SSc patients. GORD affected 450/469 (96%) of those with SSc-ILD cohort. In SSc-ILD, there was no relationship between the presence of GORD or its treatment and time to ILD development or ILD severity. However, GORD treatment was associated with improved survival in those with ILD (p = 0.002). Combination therapy with both a PPI and a H2RA was associated with a greater survival benefit than single agent therapy with PPI alone (HR 0.3 vs 0.5 p < 0.050 respectively).ConclusionGORD is a common SSc disease manifestation. While the presence or treatment of GORD does not influence the development or severity of ILD, aggressive GORD treatment, in particular with a combination of PPI and H2RA, is associated with improved survival in those with SSc-ILD.

The Impact of Gastroesophageal Reflux Disease and Proton Pump Inhibitor Use on the Risk of Repeat Catheter Ablation for Atrial Fibrillation.

Gastroesophageal reflux disease (GERD) has been associated with increased incidence/recurrence of atrial fibrillation (AF). However, the impact of GERD and proton pump inhibitor (PPI) therapy on outcomes of AF catheter ablation remains unclear. We aimed to assess the association between the presence of GERD and risk of repeat AF ablation, stratified by PPI therapy. A retrospective cohort study was conducted on patients with paroxysmal/persistent AF undergoing initial ablation in January 2011-September 2015. GERD was defined by endoscopic findings, objective reflux testing, or clinical symptoms. The association between GERD/PPI use and time to repeat ablation was evaluated by time-to-event analysis with censoring at the last clinic follow-up within 1 year. Three hundred eighty-one subjects were included. Patients with GERD (n = 80) had a higher 1-year repeat ablation rate compared with those with no GERD (25% vs 11.3%, P = 0.0034). Stratifying by PPI use, patients with untreated GERD (37.5%) more likely needed repeat ablation compared with reflux-free (11.3%, P = 0.0003) and treated GERD (16.7%, P = 0.035) subjects. On multivariable Cox regression analyses, GERD was an independent risk factor of repeat ablation (hazard ratio [HR] 3.30, confidence interval [CI] 1.79-6.08, P = 0.0001). Specifically, untreated GERD was associated with earlier repeat ablation compared with no GERD (HR 4.02, CI 1.62-12.05, P = 0.0013). However, no significant difference in repeat ablation risk was noted between reflux-free and PPI-treated GERD groups. GERD was an independent predictor for risk of repeat AF ablation within 1 year, even after controlling for major cardiovascular comorbidities and confounders. PPI therapy modulated this risk, as repeat ablation-free survival for PPI-treated GERD was noninferior to reflux-free patients.

Gastro-Esophageal Junction Precancerosis: Histological Diagnostic Approach and Pathogenetic Insights.

Barrett's esophagus (BE) was initially defined in the 1950s as the visualization of gastric-like mucosa in the esophagus. Over time, the definition has evolved to include the identification of goblet cells, which confirm the presence of intestinal metaplasia within the esophagus. Chronic gastro-esophageal reflux disease (GERD) is a significant risk factor for adenocarcinoma of the esophagus, as intestinal metaplasia can develop due to GERD. The development of adenocarcinomas related to BE progresses in sequence from inflammation to metaplasia, dysplasia, and ultimately carcinoma. In the presence of GERD, the squamous epithelium changes to columnar epithelium, which initially lacks goblet cells, but later develops goblet cell metaplasia and eventually dysplasia. The accumulation of multiple genetic and epigenetic alterations leads to the development and progression of dysplasia. The diagnosis of BE requires the identification of intestinal metaplasia on histologic examination, which has thus become an essential tool both in the diagnosis and in the assessment of dysplasia's presence and degree. The histologic diagnosis of BE dysplasia can be challenging due to sampling error, pathologists' experience, interobserver variation, and difficulty in histologic interpretation: all these problems complicate patient management. The development and progression of Barrett's esophagus (BE) depend on various molecular events that involve changes in cell-cycle regulatory genes, apoptosis, cell signaling, and adhesion pathways. In advanced stages, there are widespread genomic abnormalities with losses and gains in chromosome function, and DNA instability. This review aims to provide an updated and comprehensible diagnostic approach to BE based on the most recent guidelines available in the literature, and an overview of the pathogenetic and molecular mechanisms of its development.

Clinicopathological features of superficial esophageal squamous cell carcinomas in patients without history of smoking and drinking

Abstract Introduction/Objective Cigarette smoking and drinking are the major causative risk factors for esophageal squamous cell carcinoma (ESCC). ESCCs in patients without history of smoking and drinking account for approximately 5% of all ESCCs. Clinicopathological features of superficial ESCCs in patients without history of smoking and drinking have not been well investigated. The aim of this study is to clarify the clinicopathological features of superficial ESCCs in patients without history of smoking and drinking. Methods/Case Report A multicenter study including 12 leading institutions of the Japan Research Society of Early Esophageal Cancer and Chromoendoscopy was conducted. Clinical data and pathological features of 108 superficial ESCCs in endoscopic submucosal dissection (ESD) specimens of 102 patients without history of smoking and drinking (NSND group) were reviewed. For comparison, clinicopathological features of 767 superficial ESCCs in ESD specimens of 544 patients with history of smoking and drinking (SD group) were also reviewed. Clinicopathological features including age, sex, synchronous/metachronous cancer, gastroesophageal reflux disease (GERD), tumor size, tumor site, macroscopic type, Lugol-voiding lesion (LVL), invasion depth, and lymphovascular invasion were analyzed in both NSND group and SD group. LVLs were graded according to the number of LVLs in preoperative endoscopic examination (grade A, no lesions; B, 1 – 9 lesions; C, more than 9 lesions). Results (if a Case Study enter NA) The univariate analysis revealed that female predominance (95.1% vs. 11.6%, p&amp;lt;0.001), absence of synchronous/metachronous cancer (81.4% vs. 60.8%, p&amp;lt;0.001), grade A LVLs (74.5% vs. 6.6%, p&amp;lt;0.001), presence of GERD (42.2% vs. 18.0%, p&amp;lt;0.001), tumor location at the posterior wall (58.3% vs. 47.5%, p&amp;lt;0.005), and 0-IIa macroscopic type (14.8% vs. 3.0%, p&amp;lt;0.001) were significantly more frequently observed in NSND group than SD group. Conclusion ESCCs in patients without history of smoking and drinking are characterized by female predominance, absence of synchronous/metachronous cancer, grade A LVLs, presence of GERD, tumor location at the posterior wall, and 0-IIa macroscopic type.

Association Between Chronic Rhinosinusitis and Reflux Diseases in Adults: A Systematic Review and Meta-Analysis.

Over the last few decades, reflux diseases, such as laryngopharyngeal reflux (LPR) and gastroesophageal reflux disease (GERD), have been identified as significant contributors to inflammatory upper aerodigestive tract diseases. Establishing a direct relationship between reflux disease and chronic rhinosinusitis (CRS) is challenging due to the high prevalence of both diseases and their potential for independent coexistence. The purpose of this study is to review the existing literature and evaluate the evidence of an association between reflux diseases and CRS. A comprehensive electronic search was conducted across multiple databases to identify all studies that investigated the relationship between LPR, GERD, and CRS from January 1, 1950, to June 16, 2022. Only studies with English manuscripts involving adult populations were included, while case series, case reports, and in vitro studies were excluded. The risk of bias was evaluated using The Newcastle-Ottawa Scale for case-control studies and the NIH quality assessment tool for observational cohort and cross-sectional studies. The search strategy yielded a total of 427 articles, out of which 25 studies examined the correlation between reflux diseases and CRS. The meta-analysis indicated a significant association between the presence of GERD and CRS compared to control groups (P < .001; CI 3.56 [2.25, 5.65]), as well as significantly higher pH values and pepsin detection in CRS patients when compared to healthy individuals (P = .003). Furthermore, all studies that evaluated proton pump inhibitor (PPI) therapy in CRS patients reported positive outcomes, with 93% of CRS patients showing improvement on PPIs. The existing literature provides suggestive evidence of an association between reflux diseases and CRS, with regards to both prevalence and treatment. Nonetheless, further studies are required to confirm this relationship.

Risk of dysphagia in a population of infants born pre-term: characteristic risk factors in a tertiary NICU

ObjectiveTo examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties. MethodA cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic. ResultsThe prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %). ConclusionDysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability.

The Association Between Acidification Time on Wireless Motility Capsule and Gastroesophageal Reflux Disease.

Gastric physiological characteristics such as fundus accommodation, gastric distention, emptying/transit time, and basal acid output may contribute to the pathogenesis of gastroesophageal reflux disease (GERD). Wireless motility capsule (WMC) uses pH data to determine gastric transit time but has not been used in the evaluation of GERD. Certain metrics such as acidification time, nadir pH, and gastric transit time may provide insight into the mechanisms of GERD related to gastric physiology, allowing WMC to be a complementary tool in the diagnosis of GERD. We aimed to determine whether pH data and transit time on WMC tests correlated with the presence of GERD on ambulatory reflux testing. This was a retrospective study of 28 patients who had undergone both WMC and reflux testing via wireless pH or pH/impedance. Acidification time (time from capsule ingestion to pH<2), nadir postprandial pH, and gastric transit time were manually determined from the WMC capsule proprietary software. Spearman correlation was used to compare these metrics with gastric transit time, percent esophageal acid exposure, and DeMeester score. Acidification time moderately correlated with gastric transit time, R: 0.44, P=0.02, but not nadir pH, percent esophageal acid exposure, or DeMeester score. Patients with an abnormal reflux test had a significantly longer median acidification time (135.5 vs. 78.5min, P=0.021). After stratifying by patients with normal versus prolonged gastric transit time, there was a trend toward longer acidification time in patients with positive reflux testing in both groups, but this was not statistically significant. Patients with prolonged gastric transit time >300 minutes were not more likely to have a positive reflux test (38% vs. 35%, P=1). The acidification time on WMC was significantly longer in patients with proven GERD and acidification time positively correlated with gastric transit time. Larger studies are needed to determine whether WMC could be used as a complementary tool in investigating patients with GERD symptoms.

Role of Preoperative High-Resolution Manometry in the Identification of Patients at High Risk of Postoperative GERD Symptoms 1 Year After Sleeve Gastrectomy.

Sleeve gastrectomy (SG) has become the most common bariatric procedure, but it is often characterized by the onset of postoperative gastroesophageal reflux disease (GERD). High-resolution manometry (HRM) is a useful tool to detect risk factors for GERD. The aim of this study was to evaluate preoperative manometric parameters as possible predictors of postoperative GERD. This was a monocentric retrospective study. We analyzed 164 patients, with preoperative esophagitis/GERD symptoms who underwent preoperative HRM and were submitted to SG (July 2020-February 2022). Postoperative GERD was observed in 60 patients (36.6%): 41 of them (68%) already had preoperative GERD symptoms, whereas the remaining 19 patients (32%) developed postoperative symptoms. Female patients developed postoperative GERD in a significantly higher fraction of cases as compared to male patients (82% versus 18%; p < 0.001). DCI (distal contractile integral) was identified as the only HRM parameter correlating with the presence of GERD. Patients with DCI ≤ 1623 mmHg*cm*s developed postoperative GERD in 46% of cases (n = 43/94), as compared to 24% of cases (n = 17/70) among patients with DCI > 1623 mmHg*cm*s (p = 0.005). At multivariable analysis, female sex (OR 3.402, p = 0.002), preoperative GERD symptoms (OR 2.489, p = 0.013), and DCI ≤ 1623 mmHg*s*cm (OR 0.335, p = 0.003) were identified as independent determinants of postoperative GERD. All the patients with preoperative risk factors for reflux, such as GERD symptoms or esophagitis on EGDS (esophagogastroduodenoscopy), should be considered for an HRM. Moreover, when a DCI ≤ 1623 mmHg*s*cm is found, a bariatric procedure different from SG might be considered.

Associations of the timing of sleep and meals with the presence of gastroesophageal reflux disease in community-dwelling women in Japan.

It has been suspected that circadian rhythms may play a part in the pathogenesis of gastrointestinal diseases including gastroesophageal reflux disease (GERD). The present study aimed to examine the cross-sectional association of the timing of sleep and meals with the presence of GERD in community-dwelling women in Japan. In total, 605 women responded to a self-administered questionnaire asking for information on GERD symptoms, sleep habits, sleep disturbances and the timing of meals. GERD symptoms were evaluated using the Frequency Scale for the Symptoms of GERD, and participants with a score of more than seven points were classified as having GERD. In total, 104 (17.2%) women were found to have GERD. Later bedtime on both weekdays and weekends and later midpoint of sleep were significantly associated with the odds ratios (OR) of GERD after controlling for covariates: ORs for each 1 h delay were 1.31 (95% confidence interval [CI] = 1.03-1.68), 1.38 (95% CI = 1.08-1.75) and 1.43 (95% CI = 1.06-1.95). Having lunch at irregular times was significantly associated with the increased OR of GERD (1.99; 95% CI = 1.02-3.91). Longer overnight fasting duration and longer time intervals from the midpoint of sleep to breakfast and lunch were significantly associated with decreased OR of GERD (ORs for each 1 h increase were 0.73 [95% CI = 0.56-0.95], 0.64 [95% CI = 0.46-0.88] and 0.70 [95% CI = 0.51-0.96]). These data suggest that the timing of sleep and timing of meals relative to the sleep/wake cycle are associated with the presence of GERD.

Association between obstructive sleep apnea and gastroesophageal reflux disease: A systematic review and meta-analysis.

We aim to conduct a systematic review and determine the association between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD). Literature search for eligible studies was performed across major databases. The main endpoint was to assess the association between GERD and OSA. Subgroup analyses were performed to determine this strength of the association stratified by the diagnostic tools used for OSA (nocturnal polysomnogram or Berlin questionnaire) and GERD (validated reflux questionnaire or esophagogastroduodenoscopy). We also compared sleep efficiency, apnea hypopnea index, oxygen desaturation index, and Epworth Sleepiness Scale in OSA patients with or without GERD. Results were pooled together using Reviewer Manager 5.4. Six studies involving 2950 patients with either GERD or OSA were included in the pooled analysis. Our findings suggest that there was a statistically significant unidirectional association between GERD and OSA (odds ratio [OR]=1.53, P=0.0001). Subgroup analyses redemonstrated an OSA-GERD association irrespective of the tools used for diagnosing either GERD or OSA (P=0.24 and P=0.82, respectively). Sensitivity analyses demonstrated the same association after controlling for gender (OR=1.63), BMI (OR=1.81), smoking (OR=1.45), and alcohol consumption (OR=1.79). In patients with OSA, there were no statistically significant differences between patients with or without GERD in terms of apnea hypopnea index (P=0.30), sleep efficiency (P=0.67), oxygen desaturation index (P=0.39), and Epworth Sleepiness Scale (P=0.07). There exists an association between OSA and GERD that is independent of the modalities used for screening or diagnosing both disorders. However, the presence of GERD did not affect the severity of OSA.

Features of the blood cytokine profile in gastroesophageal reflux disease in schoolchildren with gastritis and family history of peptic ulcer

Gastroesophageal reflux disease (GERD) is a common acid-dependent disease among the population, including children, with multifactorial genesis. It, like many other acid-dependent diseases (peptic ulcer, etc.) is associated with a family predisposition to the disease. Of interest is the study of the role of cytokines in the regulation of pathology in childhood, depending on the severity of a family history of peptic ulcer disease. Aim: to evaluate the levels of cytokines in the blood serum in case of family history of ulcerative diseases in schoolchildren with gastritis associated with GERD. In the course of a scientific study, 142 children with gastroenterological complaints aged 7-17 years were examined. The diagnosis of GERD was made in the presence of weekly heartburn in accordance with the global consensus on pathology in children. All subjects underwent gastroscopy with taking biopsy material from the gastric mucosa and morphological confirmation of their diagnosis of gastritis in accordance with the Sydney classification. The concentration of cytokines in blood serum (IL-2, IL-4, IL-6, IL-8, IL-10, IL-18, IL-1β, IFNα, TNFα) was obtained by enzyme immunoassay. During statistical processing, the χ2 and Mann–Whitney tests were used. The studies were approved by the ethics committee and informed consents of patients and their parents were obtained prior to the start of the study. The results of the study did not show significant differences in the concentration of cytokines in schoolchildren depending on the presence of GERD. In children with a family burden of peptic ulcer, GERD was detected more often (p = 0.054), which is probably a consequence of their increased acid formation. Changes in the cytokine profile of the blood were noted. During GERD, with aggravation of peptic ulcer, there was an increase in the replication of IL-4 (p = 0.027) and IFNα (p = 0.001). The increase in blood IFNα in children with GERD with family burden is obviously aimed at enhancing immune responses involving the whole body to damage. This is due to its functional role – participation in the immune response. Increased replication of IL-4, obviously, provides an increase in metabolic, immune processes in the body aimed at optimizing the course of proliferative processes in the esophageal mucosa under conditions of increased secretion of hydrochloric acid in the stomach. Thus, when a family history of peptic ulcer is aggravated in schoolchildren with gastritis associated with GERD, a number of links in the cytokine network (IL-4, IFNα) move to the systemic level of regulation.

0879 The Association Between Obstructive Sleep Apnea and Gastroesophageal Reflux Disease: A Meta-Analysis and Systematic Review

Abstract Introduction The relationship between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD) remains an area of controversy with varying hypotheses. Both disorders negatively impact health-related quality of life and lead to detrimental clinical outcomes. The aim of our study was to determine the association between OSA and GERD. Methods We performed a review of the literature across major databases including PubMed/MEDLINE, Embase, and Google Scholar in November 2021. Studies including patients with GERD and OSA were eligible for inclusion. The endpoints were to assess the association between OSA and GERD, the prevalence of OSA in patients with GERD or without GERD, and the prevalence of GERD in patients with or without OSA. Subgroup analyses were performed to determine whether body mass index (BMI), sex, smoking, or alcohol intake affect the degree of association. The total sleep time, sleep efficiency, and apnea hypopnea index (AHI) were compared between OSA patients with or without GERD. Results were pooled together using Reviewer Manager 5.4 software, and heterogeneity was quantified using I2 statistics Results 6 studies involving 2950 patients with either GERD or OSA were included in the pooled analysis. Our findings suggest that there was a statistically significant association between GERD and OSA (OR=1.67, 95% CI [1.18, 2.37], P=0.004). The prevalence of GERD was higher in patients with OSA compared to those without OSA (OR=1.63, P=0.001). Conversely, there was no difference in the prevalence of OSA in patients with or without GERD (OR=1.94, P=0.11). Subgroup analysis shows that BMI, sex, smoking, and alcohol intake did not alter the association between GERD and OSA. In patients with OSA, there were no statistically significant differences in the total sleep time, sleep efficiency, and AHI between those with or without GERD. The mean differences were -5.89 minutes (P=0.19), -0.81% (P=0.67), and 0.80 (P=0.83), respectively. Conclusion Our results showed an increased prevalence of GERD is observed in patients with OSA but not vice-versa. However, the presence of GERD does not alter the total sleep time, sleep efficiency, and AHI in patients with OSA. BMI, sex, smoking, and alcohol intake do not seem to affect the strength of this association. Support (if any)

Anti-acid therapy in SSc-associated interstitial lung disease: long-term outcomes from the German Network for Systemic Sclerosis.

Gastroesophageal reflux disease (GERD) occurs frequently in patients with SSc. We investigated whether the presence of GERD and/or the use of anti-acid therapy, specifically proton-pump inhibitors (PPIs), are associated with long-term outcomes, especially in SSc-associated interstitial lung disease (SSc-ILD). We retrospectively analysed patients with SSc and SSc-ILD from the German Network for Systemic Sclerosis (DNSS) database (2003 onwards). Kaplan-Meier analysis compared overall survival (OS) and progression-free survival (PFS) in patients with GERD vs without GERD (SSc and SSc-ILD), and PPI vs no PPI use (SSc-ILD only). Progression was defined as a decrease in either percentage predicted forced vital capacity of ≥10% or single-breath diffusing capacity for carbon monoxide of ≥15%, or death. It was found that 2693/4306 (63%) registered patients with SSc and 1204/1931 (62%) with SSc-ILD had GERD. GERD was not associated with decreased OS or decreased PFS in patients in either cohort. In SSc-ILD, PPI use was associated with improved OS vs no PPI use after 1 year [98.4% (95% CI: 97.6, 99.3); n = 760 vs 90.8% (87.9-93.8); n = 290] and after 5 years [91.4% (89.2-93.8); n = 357 vs 70.9% (65.2-77.1); n = 106; P < 0.0001]. PPI use was also associated with improved PFS vs no PPI use after 1 year [95.9% (94.6-97.3); n = 745 vs 86.4% (82.9-90.1); n = 278] and after 5 years [66.8% (63.0-70.8); n = 286 vs 45.9% (39.6-53.2); n = 69; P < 0.0001]. GERD had no effect on survival in SSc or SSc-ILD. PPIs improved survival in patients with SSc-ILD. Controlled, prospective trials are needed to confirm this finding.

The Evaluation of Gastric Emptying Using the 13 C-Acetate Breath Test in Neurologically Impaired Patients - A Focus on the Stomach Function and Morphology.

We explored factors affecting gastric emptying in neurologically impaired (NI) patients using the 13C-acetate breath test. Twenty-four NI patients were classified by the presence of gastroesophageal reflux disease (GERD), which was treated by fundoplication plus gastrostomy, or the absence of GERD, which was treated by gastrostomy alone, along with gastric malposition involving cascade stomach and organoaxial gastric volvulus (OGV). Gastric emptying parameters (GEPs), which were the emptying half time (T 1/2 , minute), the lag phase time (T lag , minute), and the gastric emptying coefficient (GEC), were measured before and after surgery. We evaluated the relationship between GEPs and GERD, gastric malposition, and surgical intervention. All data were expressed as the median (interquartile range). The T1/2 and GEC of patients with OGV were significantly worse than in those without OGV before surgery (T1/2 with OGV: 241.3 [154.9, 314.3] vs. T1/2 without OGV: 113.7 [105.2, 151.4], p = 0.01, GEC with OGV: 3.19 [2.46, 3.28] vs. GEC without OGV: 3.65 [3.24, 3.90], p = 0.02). GERD and cascade stomach were not associ ated with GEPs. The GEPs of all NI patients showed no significant difference between before and after surgery. The surgical change in T1/2 (ΔT 1/2 ) in the patients with OGV was significantly lower than in those without OGV (ΔT1/2 with OGV: -47.1 [-142.7, -22.1] vs. ΔT1/2 without OGV: -3.78 [-26.6, 12.0], p = 0.03). Stomach malposition, such as OGV, seems to affect gastric emptying and may be improved by surgi cal intervention.

Prevalence and Risk Factors of Gastroesophageal Reflux Disease Among Medical and Dental Students of Rawalpindi/Islamabad

Objectives: To determine the prevalence of gastroesophageal reflux disease among medical and dental students of Rawalpindi Islamabad Pakistan and to find the associated risk factors.&#x0D; Study Design: Analytical cross-sectional study.&#x0D; Place and Duration of Study: Students of Medical colleges in Rawalpindi Islamabad Pakistan, from March to May 2021. &#x0D; Methodology: Non-probability convenience sampling technique was used. Sample size was found to be 352 using Rao soft.Only undergraduate students from Rawalpindi Islamabad Pakistan were included whereas postgraduate students were excluded. The data was collected via online distributed google forms and analyzed by SPSS version 25.0. &#x0D; Results: There were 157(44.6%) males and 195(55.41%) females among whom 296(84.1%) were enrolled in medical program and 56(15.9%) in dental program. 94 students (26.7%) reported having symptoms of gastroesophageal reflux disease .Based on a GERD score of &gt;=4, 35(9.94%) students were diagnosed with gastroesophageal reflux disease .Use of analgesics (OR=3.11[95% CI 1.32-7.36]; P≤0.010), family history of gastroesophageal reflux disease (OR=6.48[95% CI 3.09-13.57]; P≤0.000),family history of peptic ulcer (OR=2.85[95%CI 1.18-6.83] P≤0.038), frequent use of non-steroidal anti-inflammatory drugs(P≤0.013) had a significant association with the presence of gastroesophageal reflux disease .&#x0D; Conclusion: Gastroesophageal reflux disease was diagnosed in approximately 10% of students. There was a significant association of Gastroesophageal reflux disease with use and frequent consumption of non-steroidal anti-inflammatory drugs and family history of peptic ulcer/Gastroesophageal reflux disease

Gastroesophageal refl ux disease and cardiovascular disease: comorbidity features.

Study of comorbidity features of gastroesophageal refl ux disease (GERD) and cardiovascular diseases (CVD) due to their frequent occurrence and mutual infl uence is still urgent, which was the aim of our study. Overall 357 people (men — 26,9%; women — 73,1%) were interviewed. GERD was registered in 8.7% of cases (men — 13.5%; women — 6.5%). Its detection rate naturally increased with increasing age, as well as obesity, hypertension, coronary heart disease, heart rhythm disorders and chronic heart failure. GERD was signifi cantly more common in GERD than in the absence of GERD. Common risk factors (obesity, tobacco smoking and alcohol abuse) were signifi cantly more frequent in GERD and CVD compared to the absence of GERD. The highest comorbidity of GERD and CVD was found in patients with GERD under 5 years compared to those with a history of GERD of 5 years or more. This is associated with the fact that in the absence of GERD the incidence of CVD increased with increasing age and did not with GERD. The latter is explained by the fact that the registration of such common FRS of GERD and CVD, as obesity, tobacco smoking and alcohol abuse in the absence of GERD naturally increased with increasing age, while this did not occur in the presence of GERD. Close associative link between GERD and CVD was established. It was determined both by risk factors common for them (obesity, tobacco smoking and alcohol abuse) and by age of patients and duration of GERD.

Relationship between gastroesophageal reflux disease and objective sleep quality.

To objectively characterize (1) the relationship between gastroesophageal reflux disease (GERD) and sleep quality, and (2) the influence of sleep position on this relationship, using in-laboratory polysomnography. We retrospectively analyzed first-night diagnostic in-laboratory polysomnography data for 3411 patients (median age 55 years; 48% male). Medication use and medical condition data were obtained through self-reported questionnaires. Associations between sleep quality and the presence of GERD, and the influence of sleep position on these associations, were analyzed using multivariable linear regression models. After adjusting for age, sex, body mass index, and relevant comorbidities, GERD was associated with a 3.0% decrease in sleep efficiency, 8.8-minute increase in wake after sleep onset, 24.4-minute increase in rapid eye movement (REM) latency, 13.4-minute decrease in total sleep time, 1.4% decrease in %REM sleep, and 1.5% increase in %N3 sleep. Having both GERD and the majority of sleep on the right side was associated with an 8.6% decrease in sleep efficiency, 27.5-minute increase in wake after sleep onset, 35.6-minute decrease in total sleep time, 2.1% decrease in %REM sleep, and 3.5% increase in %N3 sleep. Having both GERD and the majority of sleep on the left side was associated with an 8.7-minute increase in sleep onset latency. GERD is associated with an impairment in objective sleep quality. These associations were more pronounced in right-sided sleep and mostly ameliorated in left-sided sleep. Physicians should recognize the potential for poor sleep quality in patients with GERD and the effect of body position on this relationship. Gurges P, Murray BJ, Boulos MI. Relationship between gastroesophageal reflux disease and objective sleep quality. J Clin Sleep Med. 2022;18(12):2731-2738.