Prevalence Of Gastroesophageal Reflux Research Articles

Prevalence and determinants of frequent gastroesophageal reflux symptoms in the Australian community

Frequent gastroesophageal reflux (GER) causes chronic inflammation and damages esophageal mucosa, which can lead to Barrett's esophagus. It has also been consistently found to be a strong risk factor for esophageal adenocarcinoma. The prevalence of GER appears to vary; however, population-based Australian studies investigating the symptoms are limited. This study aimed to estimate the population prevalence and identify the determinants of frequent GER symptoms in the Australian population. Self-reported information on the frequency of reflux symptoms were collected from 1,580 adults from a population register. We estimated age- and sex-standardized prevalence of occasional (<weekly) and frequent (≥weekly) GER symptoms in the Australian population. We also estimated adjusted prevalence ratios (PR) for GER symptoms associated with demographic and lifestyle characteristics. The standardized prevalences of GER symptoms were 10.4% and 38.3% for frequent and occasional symptoms, respectively. Compared with participants with body mass index <25, those with body mass index ≥35 had almost 90% higher prevalence of frequent GER symptoms (PR 1.89; 95% confidence interval [CI] 1.13-3.16). Similarly, the prevalence of frequent GER symptoms was significantly higher among regular users of aspirin or other non-steroidal anti-inflammatory drugs than never users (PR 1.71; 95%CI 1.08-3.16) and regular consumers of medium to well-done barbecued meat (PR 1.75; 95%CI 1.10-2.80) or fried food (PR 2.69; 95%CI 1.66-4.35). The prevalence of frequent GER symptoms was significantly lowered with regular physical activity (PR 0.46; 95%CI 0.32-0.66) and Helicobacter pylori infection (PR 0.53; 95%CI 0.35-0.80). We found no evidence that frequent GER symptoms were associated with smoking, alcohol, spicy food, or coffee consumption. Our results confirm that GER symptoms are common and that frequent GER symptoms are associated with a range of modifiable lifestyle factors.

Concomitant vesicoureteral reflux and gastroesophageal reflux: an analytic cross-sectional study

Vesicoureteral reflux (VUR) and Gastroesophageal reflux (GER) are both common disorders in children and could be associated with significant morbidities. Although they appear to be separate entities, their natural history and underlying pathophysiology are the same and they both tend to resolve over time. We aimed to appraise their concurrent occurrence and prevalence of GER in VUR patients to understand whether they can be considered different manifestations of a syndrome mainly caused by developmental delay resulting in dysfunction of the sphincters. Totally, 174 children ≤ 2 years of age were enrolled and 87 of them with primary VUR constituted patients group. The rest of the cases with the same age and sex distribution entered control group. All the study population underwent ultrasonographic evaluation to detect GER. GER was more frequent in patients with primary VUR. GER was more prevalent in higher grades of VUR. We observed higher prevalence of GER and higher grades of VUR in younger infants demonstrating the tendency of both conditions to resolve overtime. Bilateral VUR was more prevalent among patients with higher grades of VUR. GER was more prevalent in patients with bilateral VUR and Prevalence of bilateral VUR decreased with increase in age. These findings show that the chance of concomitant GER and VUR is higher in children with more severe developmental defect of sphincters. Regarding the higher prevalence of GER among VUR patients and correlation of VUR severity with co-occurrence of GER, besides the natural tendency of both conditions to resolve overtime, they may be considered parts of developmental delay syndrome of sphincters.

Prevalence of gastroesophageal reflux in a Tunisian primary care population determined by patient interview

Although gastresophageal reflux disease (GERD) is highly prevalent in Western countries, we have very little data about it in African countries. The aim of the study is to determine the prevalence and severity of GERD symptoms among Tunisian subjects and report its characteristics, consultation rate, management modes, as well as patients' satisfaction. Five hundred subjects living in Tunisia were interviewed face to face. The study was conducted at seven centers of primary care at Monastir's department by six interviewer doctors. The questionnaire consisted of 30 questions relating to subject attributes, lifestyle factors, medical history, reflux-related symptom characteristics, consultation behavior, previous treatments for GERD, and description of the last episode. Symptoms were defined as 'frequent' if they occurred at least weekly and 'occasional' if they occurred less frequently during the last year. The mean age was 42.3 ± 17.3 years and 75.6% were females. Over the previous year, 60% of the respondents reported suffering any GERD symptom. The prevalence of frequent GERD is 24%. Female gender (odds ratio [OR]: 1.97[1.15-3.37]) and body mass index ≥ 25 (OR: 1.54[1.042-2.29]) were associated with increased risk of GERD symptom. Only 22.3%, sought medical advice about GERD symptoms in the last year. In the univariate and multivariate analysis, work status, frequency and intensity of symptoms, duration of symptom, and association of atypical symptoms were associated with a higher frequency of medical consultation for GERD symptoms. Among the subjects complaining about heartburn, 34% took medications. GERD symptoms are common among Tunisian subjects. Few heartburn sufferers seek medical attention, and most do not take medications for symptomatic control.

Clinical Features of Asthma in Children Differ with Regard to the Intensity of Distal Gastroesophageal Acid Reflux

Background. The prevalence of gastroesophageal reflux (GER) in children with asthma is higher than in healthy controls, but the nature and direction of this association is unclear. Objective. The aim of our study was to assess the relationship between esophageal acid exposure and the clinical features of asthma in children. Methods. In total, 66 children (mean age 122.8 months [SD 44.89 months]) with chronic pulmonary symptoms, fulfilling diagnostic criteria of persistent asthma, underwent 24-hour esophageal pH monitoring and answered a detailed questionnaire-based survey. The questionnaire topics included environmental factors, familial history, current and previous clinical symptoms, atopy, asthma severity, and medication. Results. Abnormal results of 24-hour esophageal pH monitoring were found in 28 out of 66 children (42.4%). Age, sex, severity of asthma, environmental factors, spirometry results, and the type of medication did not correlate with esophageal acid exposure. However, children with abnormal pH results developed asthma significantly earlier (asthma onset 3.63 years [SD 2.52 years] vs 5.77 years [SD 3.82 years]; p < .01). Nonatopic individuals had more intensive esophageal acid exposure than atopic ones (Boix-Ochoa score 28.19 [SD 18.26] vs 18.26 [SD 12.84]; p < .048). The intensity of GER was also significantly correlated with frequent or difficult-to-control nighttime asthma attacks. Conclusions. There are differences in clinical features of asthma in children with regard to the intensity of esophageal acid exposure. Symptoms of asthma in nonatopic individuals with early onset and difficult-to-control nighttime asthma attacks suggest the possibility of concomitant, clinically relevant GER.

Posttussive emesis as a symptom of asthma in children

Emesis can be triggered by cough in children, and cough is a common symptom of asthma. To explore the association between posttussive emesis and asthma in the pediatric population. A questionnaire was distributed to parents of children between the ages of 2 and 17 years in the pediatric and allergy-immunology clinics at our institution from August 16 through November 3, 2008. Prevalence of posttussive emesis was determined and compared among children with physician-diagnosed asthma, children with no evidence of asthma, and those not formally diagnosed as having asthma but with surrogate markers suggestive of asthma. The predictive value of posttussive emesis was compared with those of known markers of asthma. The prevalence of gastroesophageal reflux and pertussis was evaluated because these conditions might also cause posttussive emesis. The prevalence of posttussive emesis was 33% in our study population of 500 children. Among those with physician-diagnosed asthma (n = 122), 56% reported a history of posttussive emesis. For patients not formally diagnosed as having asthma but with surrogate markers suggestive of asthma (n = 62), 71% had a history of posttussive emesis. Both of these were significantly higher than in those with no evidence of asthma (n = 316), in whom 16% reported a history of posttussive emesis (P < .0005). Children with posttussive emesis were significantly more likely to have asthma than those without posttussive emesis (odds ratio, 7.9; 95% confidence interval, 5.2-12). Neither pertussis nor gastroesophageal reflux accounted for the degree of posttussive emesis reported. Posttussive emesis is more common among children with asthma than among nonasthmatic children. In children with cough and a history of posttussive emesis, asthma should be strongly considered in the differential diagnosis.

Current status of Barrett's esophagus research in Asia

In Western countries, the epidemiology of esophageal cancer has changed considerably over the past decades with a rise in the ratio of adenocarcinoma to squamous cell carcinoma. Although the prevalence of gastroesophageal reflux is increasing in Asia, the prevalences of Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) have remained low in most Asian countries. The Asian Barrett's Consortium recently conducted a review of published studies on BE from Asia to assess the current status of BE research in Asia, and to recommend potential areas for future BE research in the region. Differences in study design, enrolled population, and endoscopic biopsy protocols used have led to substantial variability in the reported BE prevalence (0.06% to 19.9%) across Asia. In particular, some Japanese studies used diagnostic criteria that differed considerably from what was used in most Asian studies. As in Western countries, increased age, male sex, tobacco smoking, reflux symptoms, and erosive esophagitis have been found to be risk factors for BE in several case-control studies from Asia. The Prague C and M criteria, developed to provide better interobserver reliability in diagnosis and grading of BE, are currently under extensive evaluation in the Asian population. There is a need for standardized protocols for endoscopic and histopathologic diagnosis before initiating collaborative projects to identify etiologic determinants of BE and its ensuing malignant transformation. At present, data regarding the management and long-term outcome of BE are extremely limited in Asia. More studies of BE in this geographic area are warranted.

Symptomatic gastroesophageal reflux amongst hospital personnel in South India

Prevalence of gastro-esophageal reflux (GER) disease is on the rise in South Asian countries. Though there are reports of GER prevalence amongst various ethnic populations there are fewer reports on its prevalence in different occupational groups. To study the prevalence of GER amongst hospital personnel at the tertiary referral hospital in south India. Of the 1468 hospital personnel, the overall prevalence of GER was 28.5%. It was highest amongst the clerical staff (31.3%) and least among nursing students (3%). Eighty five percent of the symptomatic GER personnel were young; those below the age of 35 years had symptoms for less than 6 months while those above 55 years had symptoms for more than 6 months. Combination of reflux symptoms with ulcer or dysmotility type dyspepsia was the dominant type amongst all cadres. The nursing staff (62.5%) preferred antacids whereas the doctors (63%) preferred PPI. GER prevalence is not uncommon amongst the hospital personnel. It is significantly more common amongst doctors, clerical staff and housekeepers.

Prevalence and risk factors for gastroesophageal reflux in pregnancy

Prevalence of gastroesophageal reflux (GER) increases during pregnancy, due to several factors like decreased lower esophageal sphincter pressure, increased intra-abdominal pressure secondary to the enlarged gravid uterus and alteration in gastrointestinal transit. The present study aimed to determine the prevalence of GER in pregnancy in a southern State of the Indian subcontinent and determine the risk factors associated with it. Consecutive pregnant females (n = 400) at various stages of pregnancy attending the antenatal clinic or admitted in the antenatal wards were enrolled. Patients with heartburn or regurgitation or both (n = 182) for at least a week were defined as cases, and controls were those without these symptoms (n = 218). Data on demographic variables and symptoms were analyzed using Pearson chi-square, Yates corrected chi-square and Fischer exact test and student independent t-test as appropriate; p < 0.05 was considered significant. Demographic characteristics between cases and controls were similar. The mean age of cases (23.68±3.37 years) was similar to that of controls (23.25±3.31 years). The overall prevalence of GER was 45.5% (182/400), 77 (19.3%) had heartburn (GER-HB), 54 (13.5%) had regurgitation (GER-R) and 51 (12.8%) had both (GER-HB + R). Age and gravida did not influence the frequency of symptoms. Symptoms were more frequent in the second (43.1%) and third trimester (54.1%) as compared to the first trimester (9.5%) in pregnant women with GER (p < 0.001). Atypical symptoms were uncommon. GER was common among non-vegetarians (p = 0.02) and frequent aerated beverage users (p = 0.001). GER prevalence was high in pregnancy, often in second and third trimester. Non-vegetarianism and aerated beverages increased the risk of reflux in pregnancy.

Serum lipid levels are positively associated with non‐erosive reflux disease, but not with functional heartburn

Metabolic syndrome and obesity are known risk factors for gastro-esophageal reflux disease (GERD), especially for erosive esophagitis. Although non-erosive reflux disease (NERD) is probably associated with obesity or other metabolic syndrome, there is little direct evidence to support this assertion. Workers in Keio University who underwent a general health examination between September 2006 and August 2007 were enrolled. Reflux symptom questionnaires were administered and metabolic parameters were obtained. The severity of gastro-esophageal reflux (GER) was scored using a validated scale of videoesophagography. Two hundred and eighty-three subjects (243 men and 40 women; mean age 49.8 +/- 6.9 years) with no radiographic evidence of erosive esophagitis were enrolled. The severity of GER was worse among men than among women, whereas the severity of reflux symptoms was worse among women. The severity of GER was associated with age and serum triglyceride levels in men, and with the serum low-density lipoprotein cholesterol levels in women. The severity of reflux symptoms, however, was not associated with metabolic parameters. There were more women than men with reflux symptoms but without GER ('presumed' functional heartburn group), compared with subjects with neither GER nor reflux symptoms. In men, the presence of both reflux symptoms and GER ('presumed' NERD group) was associated with the serum triglyceride levels. While NERD is associated with serum lipid levels, functional heartburn is not. The prevalence of GER was greater among men; conversely, the prevalence of functional heartburn was greater among women.

W1061 Duodeno-Gastro-Esophageal Reflux and Bile Acids in Saliva in Adult Patients With Cystic Fibrosis

Introduction: It has been established that patients with cystic fibrosis (CF) have a high prevalence of gastroesophageal reflux (GER). Increased acid reflux is most common in CF, however a small subgroup of CF patients has increased weakly acidic reflux. The presence of bile acids (BA) in saliva in almost half of CF patients suggests pathological duodenogastro-esophageal reflux (DGER). The aim of this study was to quantify DGER and BA in saliva in adult CF patients. Methods: 14 adult CF patients [median age 29 (18-58), 5 male] were evaluated using combined 24 hrs impedance-pH and Bilitec monitoring. After an overnight fast, an impedance-pH catheter and Bilitec probe were inserted trans-nasally in the esophageal body with the pH and Bilitec sensors located 5 cm above the lower esophageal sphincter (LES). To avoid Bilitec artifacts patients consumed liquid meals. During the study day, lung function assessesment (FEV1 and FVC) and saliva samples were obtained for BA measurement. Results: 5/14 (35%) of the CF patients had increased DGER. 10 patients had isolated DGER events, mostly during daytime but 3 patients had predominantly nocturnal DGER. There was a significant correlation between DGER and total acid exposure (p<0.0001, r=0.85) and total bolus exposure (p=0.03, r=0.57). There was a significant correlation between DGER and the number of acid reflux episodes (p=0.01, r=0.62). Patients with increased DGER had a higher proximal extent of reflux (number of reflux events reaching up to 15 cm above the LES) compared to those with no DGER [17 (9-35) vs. 5 (3-12), p= 0.03]. There was a negative correlation between DGER and proportion of non-acid reflux events (p=0.03, r=-0.59). DGER was unaffected by age, BMI or history of sputum bacterial colonization. Bile acids were present in saliva of 8 CF patients. The concentration of BA in saliva was slightly higher in patients with increased DGER compared to patients without DGER but the difference did not reach statistical significance. There was no significant correlation between severity of DGER and lung function. Conclusion: Increased DGER is present in 1/3 of adult CF patients. DGER is clearly associated with increased acid reflux and high proximal extent of reflux. Presence of BA in saliva is common in adult patients with CF and its concentration tended to be higher in CF patients with increased DGER, however, a clear correlation between severity of DGER and BA concentration in saliva could not be established.

W1062 Gastric Emptying in Adult Patients With Cystic Fibrosis

Introduction: It has been established that patients with cystic fibrosis (CF) have a high prevalence of gastroesophageal reflux (GER). Increased acid reflux is most common in CF, however a small subgroup of CF patients has increased weakly acidic reflux. The presence of bile acids (BA) in saliva in almost half of CF patients suggests pathological duodenogastro-esophageal reflux (DGER). The aim of this study was to quantify DGER and BA in saliva in adult CF patients. Methods: 14 adult CF patients [median age 29 (18-58), 5 male] were evaluated using combined 24 hrs impedance-pH and Bilitec monitoring. After an overnight fast, an impedance-pH catheter and Bilitec probe were inserted trans-nasally in the esophageal body with the pH and Bilitec sensors located 5 cm above the lower esophageal sphincter (LES). To avoid Bilitec artifacts patients consumed liquid meals. During the study day, lung function assessesment (FEV1 and FVC) and saliva samples were obtained for BA measurement. Results: 5/14 (35%) of the CF patients had increased DGER. 10 patients had isolated DGER events, mostly during daytime but 3 patients had predominantly nocturnal DGER. There was a significant correlation between DGER and total acid exposure (p<0.0001, r=0.85) and total bolus exposure (p=0.03, r=0.57). There was a significant correlation between DGER and the number of acid reflux episodes (p=0.01, r=0.62). Patients with increased DGER had a higher proximal extent of reflux (number of reflux events reaching up to 15 cm above the LES) compared to those with no DGER [17 (9-35) vs. 5 (3-12), p= 0.03]. There was a negative correlation between DGER and proportion of non-acid reflux events (p=0.03, r=-0.59). DGER was unaffected by age, BMI or history of sputum bacterial colonization. Bile acids were present in saliva of 8 CF patients. The concentration of BA in saliva was slightly higher in patients with increased DGER compared to patients without DGER but the difference did not reach statistical significance. There was no significant correlation between severity of DGER and lung function. Conclusion: Increased DGER is present in 1/3 of adult CF patients. DGER is clearly associated with increased acid reflux and high proximal extent of reflux. Presence of BA in saliva is common in adult patients with CF and its concentration tended to be higher in CF patients with increased DGER, however, a clear correlation between severity of DGER and BA concentration in saliva could not be established.

Upper Esophageal Sphincter and Gastroesophageal Junction Pressure Changes Act to Prevent Gastroesophageal and Esophagopharyngeal Reflux During Apneic Episodes in Patients With Obstructive Sleep Apnea

Gastroesophageal reflux (GER) is thought to be induced by decreasing intraesophageal pressure during obstructive sleep apnea (OSA). However, pressure changes in the upper esophageal sphincter (UES) and gastroesophageal junction (GEJ) pressure during OSA events have not been measured. The aim of this study was to determine UES and GEJ pressure change during OSA and characterize the GER and esophagopharyngeal reflux (EPR) events during sleep. We studied 15 controls, nine patients with GER disease (GERD) and without OSA, six patients with OSA and without GERD, and 11 patients with both OSA and GERD for 6 to 8 h postprandially during sleep. We concurrently recorded the following: (1) UES, GEJ, esophageal body (ESO), and gastric pressures by high-resolution manometry; (2) pharyngeal and esophageal reflux events by impedance and pH recordings; and (3) sleep stages and respiratory events using polysomnography. End-inspiration UES, GEJ, ESO, and gastric pressures over intervals of OSA were averaged in patients with OSA and compared with average values for randomly selected 10-s intervals during sleep in controls and patients with GERD. ESO pressures decreased during OSA events. However, end-inspiratory UES and GEJ pressures progressively increased during OSA, and at the end of OSA events were significantly higher than at the beginning (P < .01). The prevalence of GER and EPR events during sleep in patients with OSA and GERD did not differ from those in controls, patients with GERD and without OSA, and patients with OSA and without GERD. Despite a decrease in ESO pressure during OSA events, compensatory changes in UES and GEJ pressures prevent reflux.

Mechanism of gastroesophageal reflux in patients with obstructive sleep apnea syndrome

It has been reported that the prevalence of gastroesophageal reflux (GER) disease is high in patients with obstructive sleep apnea (OSA). End-inspiratory intra-esophageal pressure decreases progressively during OSA, which has been thought to facilitate GER in OSA patients. The aim of our study was to clarify the mechanisms of GER during sleep (sleep-GER) in OSA patients. Eight OSA patients with reflux esophagitis (RE), nine OSA patients without RE, and eight healthy controls were studied. Polysomnography with concurrent esophageal manometry and pH recording were performed. Significantly more sleep-GER occurred in OSA patients with RE than without RE or in controls (P < 0.05). The severity of OSA did not differ between OSA patients with RE and without RE. Sleep-GER was mainly caused by transient lower esophageal sphincter relaxation (TLESR), but not by negative intra-esophageal pressure during OSA. During OSA gastroesophageal junction pressure progressively increased synchronous to intra-esophageal pressure decrease. OSA patients had significantly more TLESR events during sleep related to preceding arousals and shallow sleep, but the number of TLESR events was not related to RE. In OSA patients, sleep-GER was mainly caused by TLESR, but not by negative intra-esophageal pressure due to OSA.

Nocturnal Reflux in Children and Adolescents with Persistent Asthma and Gastroesophageal Reflux

Background. A higher frequency of nocturnal gastroesophageal reflux (GER) in adult patients with respiratory symptoms has been demonstrated. The aim of this study was to determine the prevalence of nocturnal GER by using prolonged intraesophageal pH monitoring and compare it with spirometry results in children with persistent asthma. Methods. Thirty-eight patients with persistent asthma for at least 2 years were studied. Gastrointestinal symptoms suggestive of GER were considered as regurgitation, heartburn, and abdominal pain. All patients underwent prolonged intraesophageal pH study and spirometry. GER was considered positive when a reflux index (RI) was higher than 5%. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced mid-expiratory flow rate (FEF25 − 75%), and FEV1/FVC ratio were measured. Results. Median age was 10 years of age (range 5 to 15) and 58% were male; GER prevalence was 47.3%. Median (range) of reflux index during supine and upright periods from GER patients were, respectively, 8.7% (3.2 to 23.6) and 10.5% (5.2 to 15.0) (p = 0.913), and only FEF25 − 75% was below the predicted value: 54.5% (39.4 to 96.9). Reflux index was not significantly correlated with FVC, FEV1 and FEF25 − 75%. Conclusions. A high prevalence of GER was found in children and adolescents with persistent asthma, equally distributed in the supine (nocturnal) and upright positions. There was no correlation with pulmonary function test.

Research on the relationship between obstructive sleep apnea hypopnea syndrome and gastroesophageal reflux

To study the relationship between obstructive sleep apnea and nocturnal gastroesophageal reflux (GER). Seventy-six patients with obstructive sleep apnea hypopnea syndrome (OSAHS) underwent polysomnography (PSG) and nocturnal distal esophageal pH monitoring, to assess the prevalence of GER in OSAHS patients. Among these patients, thirty-two OSAHS patients with GER disease had been operated on. Surgical treatment included uvulopalatopharyngoplasty (UPPP), inferior turbinate reduction, nasal septoplasty et al. After 6 months of surgical treatment, the PSG and pH probe testing were rechecked. The pre and post operative apnea-hypopnea index (AHI), micro-arousal index (MAI), lowest artery oxygen saturation (LSaO2), acidified index of distal esophagus (pHI) and percentage of acid contact time of esophagus were compared. The correlation analysis was also employed. The AHI of 76 OSAHS patients was (38.6 +/- 29.5)/h (average +/- s), GER was present in 48 patients (63.2 %). The pre and post operative AHI, MAI, LSaO2, pHI and percentage of ACT in 32 OSAHS patients associated with GER were (51.2 +/- 23.1)/h and (17.3 +/- 10.3)/h, (38.3 +/- 21.4 )/h and (14.5 +/- 10.0)/h, 0.698 +/- 0.107 and 0.858 +/- 0.076, (12.5 +/- 6.6)/h and (6.3 +/- 4.2)/h, (10.3 +/- 5.2)% and (4.5 +/- 2.9)%. The differences were statistically significant by matching t test (t were 10.95, 7.82, 15.97, 6.12, 7.62 respectively, P < 0.001). There were positive relationships between the reductions of AHI, MAI and the reductions of pHI (r were 0.775, 0.764, P < 0.001). The improved levels of AHI and MAI were correlated with the reduction of the percentage of ACT (r were 0.607, 0.730, P < 0.001). GER is prevalent in OSAHS patients. Surgical treatment of OSAHS has significant reduction in AHI, MAI as well as marked improvement in the GER, which suggests that nocturnal gastroesophageal reflux is correlated with the disorder of sleep respiration and the sleep disturbances.

Prevalência de refluxo gastroesofágico em pacientes com doença pulmonar avançada candidatos a transplante pulmonar

To assess the esophageal function profile and the prevalence of gastro-esophageal reflux (GER) in lung transplant candidates. From July of 2005 to November of 2006, a prospective study was conducted involving 55 candidates for lung transplantation at the Santa Casa de Misericórdia Hospital in Porto Alegre, Brazil. Prior to transplantation, patients underwent outpatient stationary esophageal manometry and 24-h esophageal pH-metry using one and two electrodes. Abnormal esophageal manometry was documented in 80% of the patients, and 24% of the patients presented pathological acid reflux. Digestive symptoms presented sensitivity and specificity for GER of 50% and 61%, respectively. Of the patients with chronic obstructive pulmonary disease, 94% presented abnormal esophageal manometry, and 80% presented lower esophageal sphincter hypotonia, making it the most common finding. Patients with bronchiectasis presented the highest prevalence of GER (50%). In patients with advanced lung disease, GER is highly prevalent. In the population studied, digestive symptoms of GER were not predictive of pathological acid reflux. The role that GER plays in chronic rejection should be examined and clarified in future studies.

The Prevalence of Gastroesophageal Reflux in Patients with Paradoxical Vocal Fold Motion

Purpose: Paradoxical vocal fold motion (PVFM) is an inappropriate adduction of the true vocal folds, which causes airway obstruction and inspiratory stridor. PVFM may lead to wheezing and is often mistaken for asthma, and patients are treated with glucocorticoids and beta-agonists inappropriately. There is a body of evidence stating that irritation of the vocal folds may cause or exacerbate PVFM. One-third of PVFM patients have been shown to report GERD symptoms, but studies to evaluate PVFM patients with pH monitoring have all been small (<10 subjects). We studied patients with PVFM to determine the prevalence of GERD in this population as diagnosed by esophagogastroduodenoscopy (EGD) or 48-hour esophageal acid monitoring. Methods: Patients diagnosed with PVFM by flattened inspiratory loop on pulmonary function testing underwent EGD with BRAVO capsule placement at 6 cm proximal to SCJ. All patients abstained from acid suppression agents (PPI's, H2RA's) for 7 days prior to the EGD. 48 hours of pH monitoring was performed with the BRAVO capsule. Patients were considered to have a diagnosis of GERD if they had any evidence of erosive esophagitis on EGD or if they had a positive Johnston-Demeester (JD) score (>22) during the second 24-hour period of pH monitoring by BRAVO capsule. Results: 32 patients (20 females, mean age 42 + 16 yrs) with PVFM completed the study. 31% (10/32) of subjects had a positive JD score, 50% of which had significant combined upright and supine reflux. On EGD, 18.8% (6/32) had evidence of esophagitis. Two subjects with esophagitis had a normal JD score. In this study the prevalence of GERD in PVFM was 37.5% (12/32, 95% CI 21.1–56.3%). Of GERD positive subjects, 50% (6/12) had evidence of esophagitis and 50% had atypical or no symptoms of GERD. GERD pos and GERD neg groups were similar in mean age (43 + 16 yrs vs. 41 + 16 yrs, P= 0.708) and sex (female, 50% of GERD pos vs. 70% of GERD neg, P= 0.452). Conclusion: GERD prevalence in this study was 37.5%. This suggests a high prevalence of GERD in the PVFM population. Because of this, PVFM patients should be studied for GERD, especially since many are asymptomatic. This may also suggest that GERD plays a role in the pathogenesis of PVFM.

Spatiotemporal Characteristics of Acid Refluxate and Relationship to Symptoms in Premature and Term Infants with Chronic Lung Disease

The prevalence of gastroesophageal reflux (GER) is high among infants with chronic lung disease (CLD), and the associated pathogenic mechanisms are not clear. The relationship of symptoms to the extent or duration of acid reflux events (AREs) is not well known in preterm or term infants. Our aim was to evaluate the relationship between spatial (height) and temporal (duration) characteristics of AREs (pH <4.0) with symptoms in CLD. We tested the hypothesis that in infants with CLD, AREs into the pharynx are associated with increased symptom occurrence and delayed clearance. Nine infants born at 29.8 +/- 5.5 wk gestation (mean +/- SD, range 24.7-39.0 wk) with CLD were evaluated for GER at 49.7 +/- 8.0 wk postmenstrual age (mean +/- SD, range 39.9-67.4 wk). Esophageal manometry was first performed to determine the nares-lower esophageal sphincter (LES) distance. A pH-impedance probe was placed at 87% of the nares-LES distance, and a recording was performed for about 24 h at cribside. Symptoms (respiratory, sensory, and movement) were documented by nurses that were blinded to the pH-impedance recordings. A symptom was considered associated with an ARE if it occurred 2 min before, during, or 2 min after the ARE. The proximal extent and associated clearance mechanisms were correlated with symptom sensitivity index (SSI = number of AREs with symptoms/total AREs *100). Multiple logistic regression methods, analysis of variance (ANOVA) models, and chi(2) tests were performed. Data are described as median, mean +/- SD, or %. A total of 511 AREs, based on pH-Impedance methods, were analyzed from 203 h of recordings in the nine infants. The distal esophagus was the maximal height reached in 80% of AREs (P < 0.001, compared to other esophageal segments). Overall 33% of the AREs were associated with symptoms, and an SSI of 77% was noted with high AREs into the pharynx. The average acid clearance time was prolonged with symptomatic AREs versus nonsymptomatic AREs by 3.5-fold (P < 0.001). The occurrence and frequency of symptoms with AREs depend on the most proximal extent of the ARE and the acid clearance time.

Pulmonary surgery in cystic fibrosis

Cystic fibrosis (CF) has a variety of pulmonary manifestations that include pneumonia, pulmonary abscess, bronchiectasis, hemoptysis, and pneumothorax. Although newer therapies have greatly improved survival of patients with CF, surgical interventions for definitive treatment of these sequelae are often required. Several reports have illustrated that, with the current advances in the perioperative treatment and care of CF patients, surgical interventions for these pulmonary manifestations may be performed safely, resulting in a greatly improved quality of life. Also, although improvements in lung transplantation offer new hope for definitive treatment of those patients with cystic fibrosis, special considerations regarding other surgical issues, such as the prevalence of gastroesophageal reflux, need to be addressed.

Results of laparoscopic Heller myotomy without anti-reflux procedure in achalasia. Monocentric prospective study of 106 cases

Heller myotomy (HM) combined with an anti-reflux procedure has been shown to be effective for the treatment of achalasia, as postoperative gastro-esophageal reflux (GER) is observed in about 10% of the cases. Laparoscopy has brought an undeniable benefit in providing excellent visualisation of the gastro-esophageal junction (GEJ) without lateral and posterior dissection. Respecting the anatomical fixation of the GEJ seems to permit the performing of HM without an anti-reflux procedure, the need for which is therefore debatable. The purpose of this study was to analyse the results of this controversial procedure. A monocentric prospective study was carried out on 106 patients who underwent HM without an anti-reflux procedure. The postoperative assessment consisted of a manometry and a 24-hour pH study two months after surgery, and a yearly clinical examination for a minimum of five years. The data capture was done using a statistical analysis. There was no mortality, one conversion to an open procedure, and four mucosal perforations. Postoperative morbidity was 2%. The average follow-up period was 55 months (range, 2 to 166), with 10 patients lost to follow-up. Good functional results were observed in 91.4% of patients at one year, and 78.6% at five years. Two months after surgery, a 9.4% prevalence of GER was detected in the pH study, and the lower esophageal sphincter pressure had significantly decreased. After a long term follow-up we observed an 11.3% global rate of GER. No repeat surgery was necessary to control postoperative GER. Laparoscopic HM without anti-reflux procedure gives good functional results provided the anatomical fixation of the GOJ is respected.