Presence Of Gastroesophageal Reflux Disease Research Articles

Gastroesophageal reflux after sleeve gastrectomy. Fact or fiction?

BackgroundOne of the most controversial issues surrounding laparoscopic sleeve gastrectomy is the development of gastroesophageal reflux disease following surgery. The aim of the study was to evaluate the occurrence of gastroesophageal reflux disease after laparoscopic sleeve gastrectomy and to analyze patients’ weight loss, comorbidities, and quality of life after surgery. MethodsThe clinical records of 52 patients submitted to laparoscopic sleeve gastrectomy between January and November 2018, with 3 years of follow-up, were retrospectively reviewed. At the end of the follow-up period, the patients underwent screening endoscopy, and those with postoperative esophagitis were submitted to endoscopic biopsies and pH-impedance monitoring (MII-pH). The presence of gastroesophageal reflux disease symptoms was assessed using the modified clinical DeMesteer score questionnaire. The Bariatric Analysis and Reporting Outcome System score and 36-Item Short Form Health Survey were used to assess the postoperative quality of life. ResultsIn the preoperative work-up, only 7.6% of patients had signs of esophagitis at esophagogastroduodenoscopy, whilst at 3-year follow-up, 50% of them had endoscopic signs of gastroesophageal reflux disease. Twenty-one out of 26 patients with signs of esophagitis agreed to undergo MII-pH. The median DeMesteer score questionnaire was 4.5, with only 4 patients (19%) exhibiting a value greater than the pH cut-off value (14.72), indicative of gastroesophageal reflux disease. MII-pH data analysis showed the presence of gastroesophageal reflux disease in 5 patients. An excellent outcome on the Bariatric Analysis and Reporting Outcome System score was reported in 50% of patients, and all 8 domains from the 36-Item Short Form Health Survey improved significantly. ConclusionThis study showed an improvement in these patients’ quality of life and the limited refluxogenic nature of laparoscopic sleeve gastrectomy at 3-year follow-up when diagnosis of gastroesophageal reflux disease is based on the Lyon consensus.

Impact of gastroesophageal reflux disease on idiopathic pulmonary fibrosis and lung transplant recipients.

Idiopathic pulmonary fibrosis (IPF) is a prevalent subset of interstitial lung disease (ILD) that often progresses to require lung transplantation. Gastroesophageal reflux disease (GERD) is common in the IPF population, and GER-related micro-aspiration appears to be an important risk factor for IPF pathogenesis and for the deterioration of transplanted lung function. Many patients with IPF have elevated esophageal acid exposure on reflux testing despite having no or minimal symptoms. Studies on the effects of medical GERD therapy on IPF-related outcomes have had mixed results. Antireflux surgery is safe in appropriately selected IPF patients, and appears to have potential for slowing the decline of lung function. GERD can persist, improve or develop after lung transplantation, and the presence of GERD is associated with allograft injury and pulmonary function decline in lung transplant recipients. Clinicians should have a low threshold to assess for objective evidence of GERD in IPF patients. Antireflux surgery in IPF patients with GERD appears to improve lung function, but further studies are needed before surgical treatment can be recommended routinely in this setting. In lung transplant recipients, reflux testing after transplant is the most accurate way to guide GERD treatment decisions.

Age-related features of gastritis activity in schoolchildren with gastroesophageal reflux disease

Aim. To study age-related features of the association of gastroesophageal reflux disease (GERD) with the activity of the inflammatory process in the gastric mucosa (GM) in schoolchildren. Materials and methods. At the first stage in the Republic of Tuva, we collected data on the presence of gastroenterological complaints in 1535 schoolchildren using a transverse method. At the second stage we performed esophagogastroduodenoscopy with biopsy of the mucous membrane of the antrum and the body of the stomach in two hundred forty six children including 76 cases aged from 7-11 years and 170 patients aged from 12 to 17 years. Morphological assessment of gastritis was carried out according to the Sydney classification after staining biopsy sections with hematoxylin-eosin; diagnostics of Helicobacter pylori - after staining by Giemsa method. The study was approved by the ethical committee and the consent of the surveyed patients was obtained. Results. An increase in the prevalence of GERD was found in the older age group of schoolchildren - 15.6% (7-11 years old - 4.7%; p = 0.0001). GERD schoolchildren showed an insignificant tendency with age to an increase in the activity of the inflammatory process in the mucous membrane of the antrum (p = 0.3408) and the body (p = 0.3346) of the stomach. Among infected GERD schoolchildren in both age groups, gastritis with a high degree (II-III degree) of activity was more often detected than in infected schoolchildren without clinical manifestations of GERD (7-11 years old - p = 0.2551; 12-17 years old - p = 0.0536, respectively) and more often than in those uninfected GERD cases (7-11 years old - p = 0.0082; 12-17 years old - p = 0.0002). The association of highly active forms of gastritis in the body of the stomach in infected schoolchildren with manifestations of GERD has not been established. Conclusion. The presence of GERD in schoolchildren, regardless of age, aggravates the course of the inflammatory process in the antrum. When infected with Helicobacter pylori, GERD and infection in schoolchildren act as factors that mutually aggravate the inflammatory process in the antrum.

The prevalence of gastroesophageal reflux disease in named manometric patterns of dysmotility according to the Chicago Classification 4.0.

Esophageal motility disorders (EMD) may be considered primary disorders only in the absence of gastroesophageal reflux disease (GERD). If GERD is present, treatment should be directed toward correction of the abnormal reflux. The actual prevalence of GERD in manometric dysmotility patterns according to the new Chicago Classification 4.0 (CC4) is still elusive. This study aims to evaluate the prevalence of GERD in patients with esophageal motility disorders according to the CC4. We reviewed 400 consecutive patients that underwent esophageal manometry and pH monitoring. Esophageal motility was classified according to the CC4 and GERD + was defined by a DeMeester score > 14.7. Normal motility or unclassified dysmotility was present in 290 (73%) patients, with GERD+ in 184 of them (63%). There were a total of 110 patients (27%) with named esophageal motility disorders, with GERD+ in 67 (61%). The incidence of ineffective esophageal motility was 59% (n = 65) with 69% GERD +, diffuse esophageal spasm was 40% (n = 44) with 48% GERD +, and hypercontractile esophagus was 0.01% (n = 1) with 100% GERD +. There was no correlation between the presence of GERD and the number of non-peristaltic swallows. Our results show that: (i) manometry only is not enough to select patients' treatment as >60% of patients with named esophageal motility disorders have GERD; (ii) there was no correlation between the presence of GERD and the number of non-peristaltic swallows.

Possible Association between the Use of Proton Pump Inhibitors and H2 Receptor Antagonists, and Esophageal Cancer: A Nested Case-Control Study Using a Korean National Health Screening Cohort.

Although safety concerns regarding proton pump inhibitor (PPI)/H2-receptor antagonists (H2RA) in the incident esophageal cancer have been raised, the Asian-based report is unclear. We investigated the estimated likelihood of incident esophageal cancer—its mortality depending on prior history of PPI/H2RA use—and gastroesophageal reflux disease (GERD) in Koreans. Using the Korean National Health Insurance Service-Health Screening Cohort data (2002–2015), a case–control study was retrospectively conducted, including 811 patients with incident esophageal cancer and 3244 controls matched with sex, age, income, and residence. Propensity score overlap weighting was adjusted to balance the baseline covariates. Overlap propensity score-weighted logistic regression analyses were assessed to determine associations of the prior exposure of PPI/H2RA (current vs. past) and the medication duration (<30-, 30–90-, vs. ≥90-days) with incident esophageal cancer and its mortality among the total participants or those with/without the GERD episodes, after adjusting for multiple covariates including PPI/H2RA. The current exposure to either PPI or H2RA showed higher odds for incident esophageal cancer than the nonuser group ([13.23; 95%CI 10.25–17.06] and [4.34; 95%CI 3.67–5.14], respectively), especially in all adults over the age of 40 years without GERD. Both current and past exposures to PPI showed a decreased probability of mortality compared with those of the nonuser group ([0.62; 95%CI 0.45–0.86] and [0.41; 95%CI 0.25–0.67], respectively). However, current or past exposure to H2RA harbored the mutually different likelihoods for mortality depending on the presence of GERD and old age. This study carefully speculates on the possible link between PPI/H2RA and incident esophageal cancer in the Korean population. Mortality appears to be affected by certain risk factors depending on drug types, exposure history, old age, and the presence of GERD.

Gastroesophageal reflux disease and dental erosion: The role of bile acids

ObjectivesTo identify the bile acids in the saliva of patients with and without gastroesophageal reflux disease (GERD), and evaluate their effect on tooth surface. DesignA cross-sectional study involved 26 GERD patients and 40 controls without GERD. Dental erosions were identified, saliva was collected and analyzed with chromatography for bile acid identification. An in vitro study assessed the effect of enamel exposition to taurocholic acid in concentrations of 1 µM, 10 µM, and a mixture of taurocholic acid and glycocholic acid at 10 µM on enamel microhardness, calcium release, and surface topography. ResultsSalivary bile acids were analyzed from 22 GERD patients and 40 controls. All these participants presented taurocholic acid and glycocholic acid in the saliva. The salivary amount of taurocholic acid was greater than glycocholic acid in both GERD patients (area under the curve: 7946 vs. 1361; p < 0.001) and controls (10,815 vs. 1290; p < 0.001). The salivary amount of taurocholic acid was greater in controls than in GERD patients (10,815 vs. 7946; p < 0.001). Dental erosion was more prevalent in GERD patients than in controls (27% vs. 7%; p = 0.041). In the GERD presence, the amount of glycocholic acid was greater in patients with dental erosion (1777 vs. 1239; p = 0.041). Enamel exposed to taurocholic acid at 10 µM, combined or not with glycocholic acid, had their microhardness increased, accompanied by calcium release, with no changes in surface topography. ConclusionsTaurocholic acid was the predominant salivary bile acid, particularly in controls without GERD. This bile acid had no deleterious effect on the enamel structure.

A Case Report of a Young Patient with Dysphagia: Eosinophillic Esophagitis, Achalasia or Atypical course of Gastroesophageal Reflux Disease ?

A 19 years old female patient presented with symptoms of dysphagia, esophageal retention and radiologic and endoscopic suspicion of esophageal stricture and achalasia in one other institution. After extensive diagnostic procedure including upper gastrointestinal endoscopy with narrow-band imaging and histology of esophageal mucosa, Magnetic resonance imaging (MRI) of the thorax and abdomen, the 24h esophageal impedance pH monitoring and esophageal high-resolution monitoring. We have excluced eosinophilic oesophagitis and achalasia, indicating to the atypical course of gastroesophageal reflux disease. The patient underwent the intense and combined pharmacologic (PPIs, H2 blockers, antacids) and endoscopic (repeated ballon-dilatation of of esophagogastric junction stricture) therapy, over a period of two years. With this combined and long-lasting therapy, the patient significantly improved, clinically. The esophageal peristaltic activity was also recovered, thus incompletely. The patient remained well and gaining weight with minimal symptoms of dysphagia to solids, occasionally. In presented case of a young female patient, we witnessed the overlapping nature of different criteria denoting the distinct entities, linked to esophageal dysphagia and esophageal motility disorder, such as achalasia, eosinophilic oesophagitis and gastroesophageal reflux disease. The complex diagnostic approach, including esophageal functional testing pointed to the presence of gastroesophageal reflux disease, as to underlying condition for this complex clinical situation. The combined therapeutic approach, including antisecretory agents and repeatied balloon dilatations led to significant clinical improvement.

Reflux-related Extraesophageal Symptoms Until Proven Otherwise: A Direct Measurement of Abnormal Proximal Exposure Based on Hypopharyngeal Multichannel Intraluminal Impedance as a Reliable Indicator for Successful Treatment Outcomes

Background/AimsThe Lyon Consensus defined parameters based on upper endoscopy and 24-hour combined multichannel intraluminal impedance-pH (MII-pH), that conclusively establish the presence of gastroesophageal reflux disease (GERD). However, the true role of upper endoscopy and MII-pH to evaluate patients with extraesophageal symptoms (EES) has not been well established. Hypopharyngeal MII (HMII), which directly measures laryngopharyngeal reflux (LPR) events, has been utilized to evaluate patients with EES suggestive of LPR.MethodsThis was a retrospective study involving patients with EES for > 12 weeks despite proton pump inhibitor therapy, and had no endoscopic confirmatory evidence for GERD and negative MII-pH. All patients were subsequently referred for further evaluation of EES with “unknown” etiology and underwent laryngoscopy and HMII. Based on HMII, abnormal proximal exposure (APE) was defined as LPR ≥ 1/day and/or full column reflux (reflux 2 cm distal to the upper esophageal sphincter) > 4/day. Patients with APE were offered antireflux surgery (ARS) and the outcome of ARS was objectively assessed using Reflux Symptom Index.ResultsOf 21 patients with EES which was thought to be GERD-unrelated based on endoscopy and MII-pH, 17 patients (81%) had APE. Eight patients with APE who had undergone ARS had significant symptomatic improvement in the Reflux Symptom Index score (19.6 ± 4.9 pre-ARS to 5.8 ± 1.4 post-ARS, P = 0.008).ConclusionsA conventional diagnostic approach using endoscopy and MII-pH may not be sufficient to evaluate patients with EES suggestive of LPR. HMII is essential to evaluate patients with EES, and APE could be a reliable indicator for successful treatment outcomes.

Complex Gastroesophageal Reflux Disease.

Gastroesophageal reflux disease (GERD) is the most prevalent gastrointestinal disorder posing diagnostic and therapeutic challenges. Diagnosis should be objectively defined with endoscopy and pH testing, while novel metrics may augment diagnosis for inconclusive GERD cases, including the postreflux swallow-induced peristaltic wave index and esophageal mucosal impedance. Conditions that overlap with or mimic GERD should be considered such as achalasia, rumination, and eosinophilic esophagitis. Genetic testing for proton pump inhibitor metabolism is an option for precision therapy in complex persistent GERD. Proton pump inhibitor refractory GERD may require medical, surgical, or endoscopic therapies. The presence of GERD should be objectively evaluated in achalasia patients treated with peroral endoscopic myotomy, and further studies are needed to determine timing of this evaluation. Patients with scleroderma are at a high risk for GERD owing to abnormal esophageal motility and should be managed with aggressive medical therapy and lifestyle changes given the high prevalence of esophagitis and Barrett's esophagus in this population. Further studies are needed to understand the complex mechanisms of GERD in idiopathic pulmonary fibrosis and lung transplantation.

May cardia mucosa histopathology aid in the diagnosis of gastroesophageal reflux disease in children?

Introduction: Gastroesophageal reflux disease (GERD) is a common diagnosis in children referred to pediatricians. This disease is diagnosed clinically based on the patient’s signs and symptoms; however, there are endoscopic and pathological evaluations to diagnose this disease too. This study evaluated the relationship between GERD and cardia mucosa histopathology in children under six years old. Objectives: Studies on adults with GERD had shown different cardia histopathology related to GERD, and this relationship in children was less evaluated. According to this and the high prevalence of GERD in children. Patients and Methods: Children who were a candidate for endoscopy were selected. Endoscopy was conducted for each participant and biopsies from the cardia area were obtained. In the recovery room, Infant Gastroesophageal Reflux Disease Questionnaire-Revised (IGERQ-R) was completed by children’s parents for identifying GERD in children. Then the relation between the presence of GERD and histopathology of the cardia area was assessed. Results: In this study, 80 children with a mean age of 33.8±20.7 months were evaluated, while 53.8% of them were male. The histopathology finding in participants with GERD was 48.1% oxyntic mucosa and 51.9% oxyntocardiac mucosa with lymphoid aggregation. This histopathology in patients without GERD was 67.9% oxyntic mucosa and 32.1% oxyntocardiac mucosa with lymphoid accumulation. There was a significant relationship between GERD and cardia mucosa type (P=0.043). Conclusion: Children with GERD had different cardia histopathology compared with those without reflux disease.

Особливості перебігу патології верхнього відділу шлунково-кишкового тракту у хворих з орофарингеальним кандидозом

У статті подано результати вивчення шостої шкали коморбідності The Cumulative Illness Rating Scale, у якій наведені захворювання верхнього відділу травного тракту у хворих з орофарингеальним кандидозом порівняно з пацієнтами, у яких гриби не виявлено, та з особами iз незначним/помірним ростом грибів роду Candida на слизовій оболонці ротової порожнини. Визначено, що при однаковій частоті хронічного гастродуоденіту та хронічного гастриту для пацієнтiв з орофарингеальним кандидозом характерним є зменшення частоти як гастроезофагеальної рефлюксної хвороби — в 1,6 і 1,5 раза порівняно з тими, у яких гриби не знайдено, та з тими, у кого рiст незначний/помірний (р &lt; 0,05 і р &lt; 0,05 відповідно), так і виразкової хвороби із рубцевою деформацією в луковиці дванадцятипалої кишки — у 2,1 раза порівняно із особами, у яких гриби не виявлено (р &lt; 0,05). За наявності гастроезофагеальної рефлюксної хвороби ризик орофарингеального кандидозу у хворих вірогiдно менший (відношення шансів (ВШ) = 0,49, 95% довiрчий iнтервал (ДI) = 0,29–0,83) порівняно із пацiєнтами, у яких гриби не виявлено. Кандидоз стравоходу зареєстрований майже у третини хворих з орофарингеальним кандидозом, що вірогiдно вище порівняно з тими, у кого гриби не знайдено (n = 1) (р &lt; 0,001), та у чотири рази вище, нiж у хворих iз незначним/помірним ростом (р &lt; 0,001). Висока оцінка шансів виявлення кандидозу стравоходу при орофарингеальному кандидозі (ВШ = 55,00, 95% ДI = 7,43–407,07) свідчить про здатність грибів Candida при надмірному рості на слизовій оболонці ротової порожнини адгезуватися та проростати в слизову оболонку в дистальних відділах верхнього відділу травного тракту. Висока прогностична оцінка виявлення орофарингеального кандидозу за наявності інфекції Нelicobacter pylori у хворих на гастроентерологічну патологію свідчить про єдність патогенетичних процесів (ВШ = 5,76, 95 % ДI = 2,95–11,26).Подальше вивчення стану імунного захисту в умовах надмірного росту грибів роду Candida у хворих гастроентерологічного профілю дозволить пояснити особливості коморбідного стану при цій патології.

Reflux After Sleeve Gastrectomy: An Update.

Background: Modifications of gastric anatomy, function, and of the esophagogastric junction secondary to sleeve gastrectomy (SG) can worsen the symptoms of gastroesophageal reflux disease (GERD). Its late diagnosis and poor treatment can lead to serious complications. In recent years, attempts have been made to optimize preoperative studies and improve surgical techniques to prevent this problem. The aim of this study was to update on the presence of GERD and their symptoms post-SG. Methods: A literature review of articles based on randomized clinical trials on the presence of GERD after SG was carried out, in a period of 10 years. Results: A result of 336 articles was obtained, of which 327 were discarded and 9 were included. The variables of GERD post-SG were analyzed according to their symptoms ("improved," "worsened," and "unchanged"), "remission," or appearance "de novo." Conclusion: GERD is a frequently associated pathology in obese patients. Several authors reported that symptoms worsen after SG, and has been diagnosed de novo. The application of exhaustive preoperative studies and a correct surgical technique could reduce its incidence.

Dental mask of gastroesophageal reflux disease

In clinical practice, there are patients for whom traditional methods of treatment do not allow getting rid of a dental disease. Dental mask of underlying pathology may be a potential cause of this. The aim of the study was to study the features of the clinical course of dental manifestations of gastroesophageal reflux disease. Methods. The study group included 45 patients aged 20 to 50 years with complaints of pathological changes in the oral cavity that did not stop during the last month. The survey included a survey and clinical examination. The GerdQ questionnaire was used to verify gastrointestinal disorders. Results. It was found that 85% of the surveyed complained of a burning sensation behind the breastbone, the ingress of acidic contents into the oral cavity. 100% of the surveyed presented dental complaints. At the same time, the frequency of dental complaints was significantly higher compared to the frequency of complaints of esophageal symptoms. According to the results of the GerdQ questionnaire, the average score among the subjects was 11.0, which corresponds to the presence of gastroesophageal reflux disease. According to the results of the dental examination, 87% of the examined patients had pathological elements on the oral mucosa, and the pathological elements of aphthous and herpetic stomatitis were found significantly more often in patients with an exacerbation of gastroesophageal reflux disease (p&lt;0.05). Desquamative glossitis was detected in 33% of the examined patients, benign migratory glossitis (“geographical” tongue) in 59% of patients, exfoliative cheilitis (dry form) in 70% of patients, angular cheilitis in 23% of patients. The pathology of hard dental tissues was represented by multiple carious lesions in 75% of patients and non-carious lesions in 53% of patients. Conclusions. Diseases of the oral mucosa and non-carious lesions accompany patients with gastrointestinal tract pathology in the form of gastroesophageal reflux disease.

Correlation of Probe-Based Confocal Laser Endomicroscopy (pCLE) and Mucosal Integrity Testing (MIT) with Epithelial Barrier Function and Presence of Gastroesophageal Reflux Disease (GERD).

Epithelial barrier function (EBF) disruption is a key mechanism underlying gastroesophageal reflux disease (GERD). Our aim was to assess whether two novel technologies, probe-based confocal laser endomicroscopy (pCLE) and mucosal integrity testing (MIT), could assess EBF. We prospectively enrolled patients undergoing upper endoscopy for refractory GERD or non-GERD conditions. Patients underwent esophagogastroduodenoscopy, pCLE, MIT, esophageal biopsy at 2 cm and 6 cm above the esophagogastric junction, and wireless pH testing. To assess EBF in vitro, biopsies were mounted in a mini-Ussing chamber, 1 ml of fluorescein was instilled on the mucosal side, and concentration of fluorescein on the serosal side was measured at 3h. We enrolled 54 subjects (28 GERD, 26 non-GERD based on Lyon consensus criteria). In vivo permeability assessed by pCLE did not differ significantly between GERD vs. non-GERD patients and did not correlate with in vitro permeability. Mean MIT at 2cm was lower in GERD compared to non-GERD (1914 vs. 3727 ohms). MIT correlated inversely with in vitro permeability at 2cm and at 6cm. Using a predictive model that used slope and intercept of MIT at 2 cm and 6 cm, sensitivity and specificity of MIT at identifying GERD was 76% and 72%, respectively. pCLE did not differentiate GERD vs non-GERD and did not correlate with EBF measured in vitro. MIT, on the other hand, may be more promising as it differentiated GERD vs non-GERD and correlated with EBF measured in vitro.

Predictors of poor outcomes in children with tracheoesophageal fistula/oesophageal atresia: an Australian experience

ObjectiveThe aim of this study is to characterize long-term morbidities of oesophageal atresia (OA) with or without tracheoesophageal fistula (TOF).MethodsInfants born with OA/TOF from 2000 to 2016 in Western Australia...

Gastroparesis after Lung Transplantation is Common but Not Associated with Inferior Outcomes

Purpose Gastroparesis (GP) affects 23-91% lung transplant (LT) recipients and may be associated with increased gastro-oesophageal reflux disease (GORD), an established risk factor for Chronic Lung Allograft Dysfunction (CLAD). The temporal association between GP, CLAD and GORD remains unclear. This study assessed whether patients with GP post LT experienced more GORD, CLAD and inferior nutrition-related outcomes. Methods Single centre retrospective review of adult LT recipients between January 2015 and December 2018 was conducted. GP was identified by either abnormal Gastric emptying studies (GES) or significant food residue retained within the stomach on upper endoscopy. GES were performed on patients symptomatic for gastroparesis - bloating, early satiety, nausea. Reflux was diagnosed via routine performance of 24-hour pH studies on all patients irrespective of symptoms, from 3 months post LT. Outcome variables included demographics, diagnosis of CLAD, survival at 3, 12 months, surgery duration, fundoplication pre and post LT, presence of GORD and weight trajectory post LT. Presence of GP was compared to the above variables. Results 149 patients were analysed; 27.5% (n=41) had GP, diagnosed through GE study (n=33), or Endoscopy (n=8). There was no association between GP and GORD (p=0.265), CLAD (p=0.529), 3-month (p=0.621), or 12-month (p=0.645) survival. GP was associated with an increased BMI, both as a continuous and categorical variable (BMI: 25.0 SD 4.6 vs 23.3 SD 3.9 kg/m2, p=0.030), and patients with GP were more likely to have unintentional weight loss at 6 weeks (GP: -6.2 ± 5.7%, 95% CI -4.4 to -8.1 vs. no GP: -1.7 ± 5.8%, 95% CI -3 to -0.56; p Conclusion Patients with gastroparesis post LT did not have worse short-term survival, GORD or CLAD outcomes. They were, however, more likely to experience unintentional weight loss. Intensive Dietetic input post LT is required in patients identified with GP to prevent malnutrition.

The prevalence and clinical features of chronic obstructive pulmonary disease patients with traits of asthma in Taiwan

The application of the checkbox for identifying patients with traits of both chronic obstructive pulmonary disease (COPD) and asthma proposed by the 2015 Global Initiative for Asthma (GINA)/Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations has not been well studied although such identification is important in clinical practice. Thus, we aimed to investigate the prevalence and features of COPD coexistent with asthma traits diagnosed based on the 2015 GINA/GOLD strategies, and explore the gap between guidelines and routine practice in the diagnosis and pharmacological management of such condition in a COPD cohort. COPD subjects were enrolled retrospectively throughout Taiwan. A patient record form was completed for each participant and the data were analyzed. Of 340 participants, the prevalence of COPD coexistent with traits of asthma was 39.4% and 30.3% based on guidelines and physician's judgment, respectively. Coexistent patients were characterized by blood eosinophilia, higher total immunoglobulin E (IgE) levels, preserved lung function, and the presence of gastro-esophageal reflux disease and atopic disease while total IgE level>100 kU/L and the presence of atopic disease were predictors for coexistent patients. Gaps existed in the diagnosis (a weak agreement with kappa=0.53) and treatment (non-adherence to the preferred therapy in 18.4% of physician-judged coexistent patients) in COPD patients with asthma traits. The exacerbation history was similar between coexistent and non-coexistent patients. We found that measuring circulatory eosinophil and total IgE levels may raise clinicians' awareness of the presence of traits of asthma in the management of COPD.

Gastroesophageal reflux disease is a risk factor for sputum production in the general population: the Nagahama study

BackgroundChronic sputum production in the general population is historically associated with clinical indices including male sex and smoking history. However, its relationship with gastroesophageal reflux disease (GERD), which may prove an underlying factor in sputum production, is unclear. We aimed to clarify factors associated with sputum production in the general population in cross-sectional and longitudinal manners.MethodsIn the Nagahama study, a community-based cohort study, 9804 subjects were recruited between 2008 and 2010 (baseline assessment), 8293 of whom were followed from 2013 to 2015 (follow-up assessment). This study contained a self-completed questionnaire which included medical history, assessment of sputum production, and a frequency scale for symptoms of GERD. A Frequency Scale for Symptoms of Gastroesophageal Reflux Disease score of ≥ 8 was defined as GERD. In addition to the frequency of sputum production at each assessment, frequency of persistent sputum production defined as sputum production at both assessments was examined.ResultsFrequency of sputum production was 32.0% at baseline and 34.5% at follow-up. Multivariable analysis demonstrated that sputum production at baseline was significantly associated with GERD [odds ratio (OR), 1.92; 95% confidence interval (CI) 1.73–2.13] and post-nasal drip (PND) (OR, 2.40; 95% CI 2.15–2.68), independent of other known factors such as older age, male sex and smoking history. These associations between sputum production and GERD or PND were also observed at follow-up. In longitudinal analysis, 19.4% had persistent sputum production and 12.3% had transient sputum production, i.e., at baseline only. Multivariable analysis for risk of persistence of sputum production revealed that persistent sputum production was associated with GERD and PND, in addition to the known risk factors listed above. The proportion of subjects with GERD at both assessments was highest among subjects with persistent sputum production.ConclusionsCross-sectional and longitudinal analysis demonstrated an association in the general population between sputum production and GERD, as well as PND, independent of known risk factors. The presence of GERD should be assessed in patients complaining of sputum production.

Ассоциация неалкогольного стеатоза печени с гастроэзофагеальным рефлюксом у больных воспалительными заболеваниями кишечника

Background: to date, the question of possible association between non-alcoholic fatty liver disease (NAFLD) and gastroesophageal reflux disease (GERD) is being considered. This association may be due to common risk factors for these two conditions, for example, obesity. However, several study results suggest the role of pro-inflammatory cytokines in the pathogenesis of NAFLD and GERD. Of great interest is the study of these syndromes association in a group of patients with diseases accompanied by a systemic inflammatory process. Aim: study of the association of NAFLD and GERD in a group of patients with inflammatory bowel diseases (IBD) without obesity and other metabolic risk factors. Patients and Methods: the study involved 58 patients with a diagnosis of IBD. The study did not include patients with overweight, obesity and other metabolic risk factors. The presence of GERD was assessed based on survey data, the GERD-Q questionnaire and the results of an endoscopy. Results and Discussion: the presence of GERD was associated with the presence of NAFLD in the studied group of patients (odds ratio (OR)=5.17; 95% confidence interval (CI) 1.46–18.28). There were no statistically significant differences in body mass index (BMI) between the groups of patients with NAFLD and without NAFLD (21.05 kg/m2 vs. 20.04 kg/m2, respectively, p=0.419). There was no statistically significant association of NAFLD with the use of systemic glucocorticosteroids in the anamnesis (OR=1.11; 95% CI 0.3–4.05), the presence of episodes of weight loss in the anamnesis (OR=0.48; 95% CI 0.11–2.11). Conclusion: in patients with IBD, NAFLD is associated with the presence of GERD, regardless of BMI, the presence of carbohydrate metabolism disorders, as well as a history of weight loss episodes. KEYWORDS: gastroesophageal reflux disease, fatty liver disease, inflammatory bowel diseases. FOR CITATION: Krasner Ya.A., Osipenko M.F., Bikbulatova E.A., Kholin S.I. Association of non-alcoholic fatty liver disease with gastroesophageal reflux disease in patients with inflammatory bowel diseases. Russian Medical Inquiry. 2021;5(6):373–376 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-373-376.

Measurement of hiatal surface area and other hiatus oesophageal diameters at computed tomography imaging in patients with gastroesophageal reflux disease and its relationship with hiatal hernia.

Background:The oesophageal hiatus is a long and oblique opening in the diaphragm where the thoracic section of the oesophagus passes into the abdomen. Enlarged hiatal surface and insufficiency are considered to be associated with gastroesophageal reflux disease (GERD) and hiatal hernia (HH). In this study, we aimed to retrospectively evaluate the relationship and the presence of GERD with HH by performing hiatal surface area (HSA) and other hiatal measurements at the thorax and abdominal computed tomography (CT) images in cases without any intra-abdominal or oesophageal surgery history.Patients and Methods:A total of 192 patients of GERD+ and 173 cases with GERD− as a control group were included in the study. In CT examinations of 365 patients included in the study, measurements and comments were made by an experienced radiologist in abdominal radiology. In CT scans, the following were evaluated for each case; HSA, hiatus anterior–posterior (A-P) diameter, hiatus transverse diameter, and HH types. The HSA measurement was made with the freehand region of interest in the picture archiving and communication system.Results:A total of 365 cases were included in this study; there was a significant difference between the median HSA, A-P diameter, and transverse diameter measurements between GERD− and GERD+ groups (P < 0.001). A statistically significant difference was found between the presence of GERD and HH types (P < 0.001).Conclusions:CT imaging helps investigate the presence of HH at GERD+ patients. In addition, pre-operative valuable data can be obtained from the detection of HH types and HSA measurements in cases with HH.