Presence Of Pathologic Reflux Research Articles

743. HIATUS HERNIA AND GASTRO-OESOPHAGEAL REFLUX DISEASE. DOES SIZE MATTER?

Abstract Background Hiatus hernia occurs when part of the stomach bulges into the thoracic cavity through the hiatal opening of the diaphragm. In our study, we aimed to assess the impact of the hiatal hernia size on DeMeester score, symptom correlation, and presence of pathological reflux on PH studies. The study also looked at the impact of various characteristics including age, smoking, alcohol consumption, body mass index (BMI), and presence of oesophagitis and/or dysmotility on DeMeester score, symptom correlation, and presence of pathological reflux on PH studies. Methods The study was conducted in an Upper Gastrointestinal surgery unit located in the North West of England. All patients aged over 18 who underwent laparoscopic fundoplication for gastro-oesophageal reflux disease between January 2017 and June 2023 were included. Patients who underwent fundoplication for para-oesophageal hiatus hernia, those who had fundoplication as a complementary step to Heller’s cardio-myotomy, or those who underwent revisional surgery were excluded. Results A total of 115 patients with a median age of 54 were included. Patients’ age was found to have a statistically significant association with hiatus hernia size above 2 cm, DeMeester score, and Symptom Association Probability with a P value of 0.011, 0.021, and 0.030 respectively. Hiatus hernia size above 2 cm was found to have a statistically significant association with pathological reflux (P=0.017). Smoking association with DeMeester score was found to be significant (P=0.027). Hiatus hernia size was not found to have a statistically significant association with DeMeester score, Symptom Index, or Symptom Association Probability (P=0.115, 0.315, 0.904) respectively. Conclusion Hiatus hernia size above 2 cm was found to have a statistically significant association with pathological reflux on PH studies but not statistically associated with elevated DeMeester score above 14.72 or symptom correlation indices. Thorough endoscopic assessment in addition to detailed oesophageal physiological studies are mandatory to evaluate patients with gastro-oesophageal reflux disease prior to considering surgery.

Распространенность полиморфизма генов интерлейкина 1 бета у пациентов с гастроэзофагеальной рефлюксной болезнью, проживающих в Забайкальском крае

Th e aim of the research. To study the frequency of genetic polymorphism of genes IL-1β 31T/C and IL-1β 511T/C in patients with gastroesophageal reflux disease (GERD) living in the Trans-Baikal Territory. Material and methods. A total of 139 people residing in the Trans-Baikal Territory for at least three generations were surveyed. Group 1 included 79 patients with GERD (30 male, 49 female), Group 2 (control) included 60 subjects (28 male and 32 female) without clinical and instrumental signs of the disease. The median age was 43 [33; 57] and 44 [37; 54] years, respectively, p = 0.754. Th e groups were matched by the gender, p = 0.16. Th e diagnosis of GERD was established using the GerdQ questionnaire and/or the presence of reflux esophagitis in endoscopic examination and the presence of pathological reflux in impedance pH measurements. Genotyping of interleukin 1 beta (IL-1β) polymorphic genes at positions 31T/C and 511 T/C was performed via the method of polymerase chain reaction. Results. The IL-1β 31C/C genotype was more common in the control group than in GERD patients (OR = 0.302 CI 95 % 0.088-1.034), p = 0.046. The study of the IL-1β 511T/C genotype did not show statistically significant differences in the studied groups. Heartburn one or more times a week was more oft en observed in patients with the IL-1β 511T/T genotype (OR = 11.143 CI 95 % 1.357-91.523), p = 0.0076. Conclusion. Among the population of the Trans-Baikal Territory, the prevalence of the IL-1β 31C/C genotype is higher in persons without clinical and instrumental signs of gastroesophageal refl ux disease. Th e genotypes IL-1β 31T/T and IL-1β 511T/T are more common in GERD patients with the symptomatic course of the disease.

Transient Lower Esophageal Sphincter Relaxations and Mechanical Incompetence of the Lower Esophageal Sphincter – Is There a Relationship?

Introduction: The detailed process of a gastroesophageal reflux event is still under controversial discussion. Gastroenterologists have developed and favor the concept of Transient Lower esophageal Sphincter Relaxations (TLESR`s) as the major cause of gastroesophageal reflux episodes. TLESR`s are related with reflux episodes both in healthy individuals and patients with GERD. Another concept around the functional mechanism of the antirefluxbarrier is a more mechanical interpretation of the Lower Esophageal Sphincter (LES), developed by surgeons. The aim of this study is to investigate this relationship between TLESR`s and the mechanical failure of the LES by investigating these criteria in the same individuals. Methods: In a referral center for esophageal and gastric functional disease at the University Hospital in Würzburg, Germany, we investigated healthy volunteers and patients with proven GERD. The assessment of the LES consisted of the overall length, the intraabdominal length, and the end-expiratory pressure of the LES. The manometry was performed in a station-to-station-pull-through technique. The changing LES pressure and the TLESRs were measured with a sleeve catheter according to the protocol published by Dent and Schoeman. The presence of pathologic reflux in patients was evaluated by 24h pH monitoring. Results: In total, 8 healthy volunteers were investigated (median age: 26 years (22-34)). In addition, 21 patients with GERD were evaluated (median age: 49 years (25-68)). The frequency of TLESR´s was quite low in volunteers and patients with 0,4 TLESR`s/h and 0,6 TLESR`s/h respectively. While the frequency of TLESR`s was not different between volunteers and GERD-patients, the percentage of reflux-associated TLESR`s was significantly higher in GERD-patients with mechanically incompetent LES (20,8%), compared to the percentage in GERD-patients with intact LES (6,8%) and also compared to the percentage in healthy volunteers (7,8%) (p<0,001). Conclusion: The present analysis shows a relationship between a mechanically incompetent LES and an increased number of reflux-associated TLESR`s, suggesting that the two mechanisms are not mutually exclusive, but may be instead different measurements of the same condition - a functionally and mechanically defective LES.

S1982 Rising Incidence of Eosinophilic Esophagitis in the Calgary Health Region: A Population-Based Study

with abnormal 24-hour pH monitoring (p= .08). In patients who were not taking a PPI, there was no significant difference in number of patients with pathologic reflux or distribution of eosinophils. On multivariate analysis, age, gender and presence of pathologic reflux were not factors associated with distal esophageal eosinophils. There was no significant difference in median eosinophils found in distal biopsies of patients with endoscopic reflux when compared to those with normal EGD and normal esophageal pHmonitoring. CONCLUSIONS We found no causal interaction between reflux and distal esophageal eosinophils, by histologic or pathologic studies. The histologic finding of distal esophageal eosinophils is not necessarily related to GER and may be diagnostic of EoE. Biopsies from multiple sites in the esophagus, as well as formal testing for pathologic reflux should be performed in all patients in whom the diagnosis of EoE is a consideration.

The influence of laparoscopic adjustable gastric banding on gastroesophageal reflux.

Laparoscopic adjustable gastric banding (LAGB) influences gastroesophageal reflux. 26 patients undergoing gastric banding were assessed by a questionnaire for symptom analysis, 24-hour pH monitoring, endoscopy and barium swallows, preoperatively, at 6 weeks and at 6 months after operation. Gastric banding had minimal effect on heartburn scores, but regurgitation and belching scores increased significantly during follow-up. Use of acid-reducing drugs decreased significantly at 6 weeks and increased significantly at 6 months. Pathological reflux was present in 13 of the 26 patients preoperatively. At 6 months pathological reflux was found in only 6 of these 13 patients, but 4 of the 13 patients with preoperative normal reflux patterns had developed pathological reflux. 6 months after the operation esophagitis had disappeared in 6 patients and was increased in 9 patients. In 9 patients, a pouch was found at 6 months. Pouch formation was significantly correlated with the presence of pathological reflux, esophagitis and the use of acid-reducing medication. Preoperative presence of a hiatal hernia did not influence pouch formation or pathological reflux. LAGB decreases gastroesophageal reflux if there is no pouch formation during follow-up.

Phlebographic evaluation of nonthrombotic deep venous incompetence: New anatomic and functional aspects

The anatomy, valvular function, and reflux patterns in the deep veins of the lower extremities were studied by ascending and descending phlebography in 126 limbs with nonthrombotic deep venous incompetence. The most common patterns were isolated reflux in the superficial femoral vein (51%), and combined reflux in the superficial femoral and the deep femoral veins (44%). Isolated deep femoral vein reflux occurred in 5%. As the degree of reflux in this vein varied considerably, a grading system for classification of deep femoral vein reflux was proposed. Depending on variations in the deep femoral vein anatomy, four different patterns could be distinguished. This study demonstrated that contrast filling of the deep femoral vein during ascending phlebography may indicate the presence of reflux in this vein. Complete visualization of the deep femoral vein is a new diagnostic sign that strongly correlates (p < 0.001) with reflux in the deep femoral vein. The mean number of valves in the superficial femoral vein was reduced with increasing degree of reflux compared with a reference group consisting of 41 extremities without reflux. The diameter of the popliteal vein was significantly increased in the presence of pathologic reflux, which may indicate that vein wall dilation is a major cause of primary nonthrombotic deep venous incompetence.