Prevalence Of Gastroesophageal Reflux Research Articles

Validity of Reflux Symptom Index in the Diagnosis of Laryngopharyngeal Reflux Disease

Introduction: Laryngopharyngeal reflux (LPR) is a disease, in which the diagnosis and treatment are controversial. The main objectives of this study were to assess the validity of the reflux symptom index (RSI) in patients exhibiting symptoms of LPR disease (LPRD) or gastroesophageal reflux disease (GERD). Materials and Methods: This study was a hospital-based, cross-sectional study. The study included all patients above the age of 12 years who presented to the ENT outpatient department with symptoms of LPRD or GERD. Patients who refused to give consent for the study, those who had undergone medical treatment past 6 weeks or surgical treatment for similar complaints, patients with malignancy of the hypopharynx and esophagus, patients with neurological causes of dysphonia and dysphagia, patients with a history of throat trauma or prior intubation, patients with allergies or chronic upper respiratory tract infections, and pregnant patients were excluded from the study. The variables examined in this study included age, sex, RSI, and reflux finding score. Results: The majority of patients (49.3%) with LPRD were in the age group of 31–50 years. Among the patients diagnosed with LPRD were females, only 15 patients (21.7%) diagnosed with LPRD had diabetes mellitus, only 7 patients (10.1%) had bronchial asthma, 4 patients (5.8%) diagnosed with LPRD had a history of thyroid disease, 8.7% had a history of smoking/tobacco usage addiction, and 18.8% of the patients experienced recurrent throat infection. The sensitivity was found to be 97.1%, specificity 66.7%, positive predictive value 84.8%, and negative predictive value 92.3%. The diagnostic accuracy of RSI was calculated to be 86.7%. It was found that only 46 of the 69 LPRD-positive patients (66.7%) showed symptoms suggestive of GERD. Conclusion: LPRD is predominantly a lifestyle-related disease. The fast-food lifestyle and the irregular and unhealthy spicy high acid dietary habits have led to a rapid increase in the prevalence of gastroesophageal reflux, and hence, the LPR in the general population, especially India.

476. PATIENTS WITH TRACHEOSTOMY HAVE HIGHER INCIDENCE OF ESOPHAGEAL REFLUX AND DON’T PRESENT TYPICAL SYMPTOMS

Abstract Background Lung diseases have a strong relationship with gastroesophageal reflux disease (GERD). It has been previously demonstrated that conditions such as tracheal stenosis, asthma and even lung transplantation may worsen with reflux and these patients have few symptoms of GERD. With the COVID-19 pandemic, the number of people who needed mechanical ventilation and tracheostomy increased. Our objective was to demonstrate the prevalence of gastro-oesophageal reflux (GER) in patients with tracheostomy and describe its characteristics. Method Esophageal manometry and 24 h pH-metry was performed in 137 consecutive patients with a tracheostomy already in a chronic phase, independent of symptoms. Inquire on respiratory and digestive symptoms was also carried out at the time of the examination. Prevalence of gastroesophageal reflux was identified in this population and description of the groups with reflux and without it, as well as comparison between them. Results Of the 137 patients, 49 were male, the average age was 40.94 ± 17.3 and the BMI was 26.3 ± 4.85. The prevalence of GER was 45.2%. Characteristics were similar between the groups with and without reflux. In the reflux group, the mean DeMeester score was 36.5 ± 20.8 and the presence of lower sphincter hypotonia was found in 31% of the patients and was not correlated with reflux (p = 0.285). 48% had heartburn symptoms and only 30% had a combination of heartburn and regurgitation. There was no association with higher DeMeester score and presence of symptons (p = 0,14). Conclusion The presence of tracheostomy is related to an increased prevalence of reflux, even without typical symptoms most of the time. The mechanism for this is still unknown, perhaps the altered respiratory dynamics has a role. These patients should be investigated with functional exams if they develop any condition that may be affected by reflux.

Prevalence of gastroesophageal reflux in dogs undergoing MRI for a thoracolumbar vertebral column pathology.

The aims of the study were to investigate the prevalence and extent of gastroesophageal reflux, and the prevalence of regurgitation in dogs undergoing thoracolumbar spine magnetic resonance imaging, and to explore possible associations of reflux and regurgitation with signalment (breed, age, sex, neuter status), bodyweight, body condition score and drugs used in the anaesthetic protocol. The thoracic part of the oesophagus was retrospectively assessed for presence and quantification of fluid on two T2 weighted sequences. Patient breed, age, sex, neuter status, weight and body condition score were recorded. Anaesthetic records were reviewed for the presence of regurgitation and detailed anaesthetic protocols. Fifty percent (95% confidence interval: 45 to 57%) of included dogs had evidence of gastroesophageal reflux. Reflux was not associated with the individual breed, age, sex, neuter status or body weight. Brachycephalic dogs did not demonstrate significantly higher rates of reflux compared to non-brachycephalic dogs. A larger volume of reflux was associated with a higher chance of regurgitation. Gastroesophageal reflux is a common finding in dogs undergoing thoracolumbar spine magnetic resonance imaging. Dogs which regurgitated had higher volumes of reflux. Early detection and quantification of the volume of reflux is helpful as it may allow the anaesthetist to take measures which may reduce the risk of associated complications.

Study of Gastro-Oesophageal Reflux Disease among Patients with Type 2 Diabetes Mellitus presenting to Medicine Department at a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: Gastro-oesophageal reflux disease is a chronic condition in which stomach contents regurgitates up into oesophagus causing symptoms like acidic taste in mouth, heart burn, bad breath and chronic cough. There is high prevalence of GERD in patients with Type 2 diabetes mellitus in the western countries, but such related data in our country are just few.
 Objectives: To find out the prevalence of gastroesophageal reflux among patients with Type 2 Diabetes Mellitus attending Nobel Medical College Teaching Hospital.
 Methodology: This was a descriptive cross-sectional study carried out in Department of Medicine of a tertiary care hospital from July 2020 to June 2021. Ethical approval was taken from Institutional Review Committee of Nobel Medical College Teaching Hospital (Reference number: 464/2020). Convenience sampling was done and data was collected from 191 patients presenting to the department. Collected data was entered, analysed in Statistical Package for the Social Sciences version 21 and documented for study. Point estimate at 95% Confidence Interval and descriptive statistics were interpreted as frequency, percentage, or as mean and standard deviations.
 Results: Among 191 patients with type 2 diabetes, gastroesophageal reflux was seen in 78 (40.84%) (33.87-47.81 at 95% Confidence Interval) with more prevalent in male 42 (53.84%) than female 36 (46.15%). Mean duration of type 2 diabetes among reflux cases was 10.20± 5.40 years.
 Conclusions: Gastroesophageal reflux was common associated condition among Diabetic patients.

Detection of gastroesophageal reflux by multichannel intraluminal impedance technology during mechanical ventilation: the first case series

<h2>Summary</h2><h3>Background & Aims</h3> Gastroesophageal reflux (GER) is a common event among mechanically ventilated and tube-fed critically ill patients and it is associated with an increased risk of ventilator-associated pneumonia. Most of the available tools for the detection of GER are experimental and not available bedside. Intraluminal impedance was suggested as a technique for real-time detection and quantification of GER. This study aimed to evaluate the frequency and duration of GER events in mechanically ventilated and tube-fed patients and to determine their correlation with routine procedures performed during patient care. <h3>Methods</h3> This was a prospective observational study of 20 critically ill patients hospitalized in a university hospital general intensive care unit. We included adult, mechanically ventilated patients receiving continuous enteral feeding by feeding tube (FT). A FT with multichannel intraluminal impedance sensors capable of detecting movement of gastro-esophageal content above the lower esophageal sphincter was used for GER detection. The frequency, duration, and association with routine procedures (position change, suction, and fluid bolus administration) were evaluated. <h3>Results</h3> During the median monitoring time of 2.9 days (IQR 2.8–3) per patient, a median number of 2.7 (IQR 2.1–3.8) GER events were detected every hour. 61% of GERs lasted 10–30 seconds. Position changes, endotracheal suctions, and fluid bolus administrations were associated with a high frequency of GERs. <h3>Conclusions</h3> Multichannel impedance sensors embedded on a FT enable real-time bedside detection of GER. This technology provides an opportunity for the development of new strategies aimed to decrease GER prevalence and prevent aspiration. <h3>Registration</h3> The study was registered at http://www.clinicaltrials.gov (NCT02705781).

Retrospective Study on the Prevalence of Gastro-esophageal Reflux in Brachycephalic and Non-Brachycephalic Dogs Anesthetized for CT Examination

Gastro-esophageal reflux is the return of gastric contents in the esophagus, phenomenon that can be identified in dogs under general anesthesia, but also in dogs without anesthesia, due to disorders of the distal esophageal sphincter. The aim of the present study was the comparative assessment of the incidence of gastro-esophageal reflux in brachycephalic and non-brachycephalic dogs. The medical records were evaluated for 98 dogs, presented with different pathologies of the spine. The animals were subjected to a standardized anesthetic protocol and CT scan. Following the analysis of the acquired CT images, it was found that gastro-esophageal reflux was present in 31 brachycephalic dogs (31/46; 67.39%) and in 9 non-brachycephalic dogs (9/52; 17.31%), respectively. There was an increased predisposition of the brachycephalic breeds regarding the occurrence of gastro-esophageal reflux, using identical anesthesia and positioning protocols.

Association Between Antibodies Against Lung Self-Antigens and Gastroesophageal Reflux in Lung Transplant Candidates

Gastroesophageal reflux (GER) and pretransplant antibodies against lung self-antigens (SAbs) collagen-V and/or k-alpha 1 tubulin are both independently associated with allograft dysfunction after lung transplantation (LTx). The role of GER in inducing lung injury and SAbs is unknown. We aimed to study the association between pre-LTx GER and SAbs. After IRB approval, we retrieved SAb assays conducted between 2015 and 2019 and collected 24 hour GER data for these patients. Patients were divided into 2 groups: no reflux (GER-) and pathologic reflux (GER+) to compare the prevalence of SAbs. Multivariate analysis was used to study the association between GER and SAbs in the whole cohort and in restrictive lung disease (RLD) and obstructive lung disease (OLD) subsets. Proximal esophageal reflux (PER) events ≥5 was considered abnormal. Patients (n=134; 73 men) were divided into groups: GER- (54.5%, n=73) and GER+ (45.5%, n=61). The prevalence of GER was higher in the RLD than in the OLD subset (p < 0.001). The overall prevalence of SAbs was 53.7% (n=72), higher in the GER+ than the GER- group (65.6% vs 43.8%, p=0.012), but comparable between RLD and OLD subsets. Overall, SAbs were associated with GER (p=0.012) and abnormal PER (p=0.017). GER and abnormal PER increased the odds of SAbs in the RLD subset (OR [95% CI]: 2.825 [1.033-7.725], p=0.040 and OR [95% CI]: 3.551 [1.271-9.925], p=0.014, respectively) but not in the OLD subset. LTx candidates have a high prevalence of SAbs, which are significantly associated with GER and abnormal PER in patients with RLD.

794 DOES TRACHEOSTOMY PREDISPOSE GASTROESOPHAGEAL REFLUX?

Lung diseases have a strong relationship with gastroesophageal reflux disease (GERD). It has been previously demonstrated that conditions such as tracheal stenosis, asthma and even lung transplantation may worsen with reflux and these patients have few symptoms of GERD. With the COVID-19 pandemic, the number of people who needed mechanical ventilation and tracheostomy increased. Our objective was to demonstrate the prevalence of gastro-oesophageal reflux in patients with tracheostomy and describe its characteristics.MethodsEsophageal manometry and 24 h pH-metry was performed in 137 consecutive patients with a tracheostomy already in a chronic phase, independent of symptoms. Inquire on respiratory and digestive symptoms was also carried out at the time of the examination. Prevalence of gastroesophageal reflux was identified in this population and description of the groups with reflux and without it, as well as comparison between them.ResultsOf the 137 patients, 49 were male, the average age was 40.94 ± 17.3 and the body mass index was 26.3 ± 4.85. The prevalence of gastroesophageal reflux was 45.2%. Baseline characteristics were similar between the groups with and without reflux. In the reflux group, the mean DeMeester score was 36.5 ± 20.8 and the presence of lower sphincter hypotonia was found in only 31% of the patients and was not correlated with reflux between the groups (p = 0.285). Regarding the symptoms, 48% had heartburn symptoms and only 30% had a combination of typical symptoms (heartburn + regurgitation).ConclusionThe presence of tracheostomy is related to an increased prevalence of reflux, even without typical symptoms most of the time. The mechanism for this is still unknown, perhaps the altered respiratory dynamics has a role. These patients should be investigated with functional exams if they develop any condition that may be affected by reflux.

Does omeprazole improve asthma-control in poorly-controlled asthmatic children with gastro-esophageal reflux

Objectives The role of gastro-esophageal reflux disease (GERD) in poorly controlled asthma is often mentioned, but published studies have presented discordant results. Our main objective was to assess the effectiveness of GERD treatment in controlling asthma in children. Methods We conducted a prospective study including poorly controlled asthmatic children aged 4 to 16 years. We checked the presence of acid reflux using pH monitoring. Patients with GERD were randomized into two groups; one received omeprazole for 6 months and the control group was not treated. The outcome was the score of the children asthma control test at the end of 6 months. The acid suppression was checked at the end of treatment with pH monitoring. After treatment, children with persistent acid reflux received high PPI doses and therefore were reevaluated 6 months later. Results We included 102 children with poorly controlled asthma among which 59 (57.8%) had acid reflux. Gastroesophageal reflux (GER) was significantly more common in boys (p = 0.04). Treatment with omeprazole in sufficient doses improved the control of asthma in 5 children out of 6 (84.8 vs 11.5; p<.0001). Three factors appeared to be statistically associated with asthma control improvement after PPI therapy: male sex (p=.04), normal birth weight (p=.05) and a positive Prick-test (p=.05). These factors were not confirmed or were not sufficiently precise in multivariate analysis. The likelihood of a causal relationship between acid reflux and asthma, difficult to highlight with pH monitoring, was poor. Conclusions This study confirmed the high prevalence of GER in poorly controlled asthmatic children and showed the possible benefit of an efficient GER treatment in improving asthma control.

Eradication of Helicobacter Pylori Infections and GERD: A systematic review and meta-analysis.

This study evaluates the association between the eradication of Helicobacter pylori (H. pylori) and gastroesophageal reflux disease (GERD). Relevant studies were identified by conducting literature search in PubMed, Cochrane, Embase, CNKI, VANFUN, and VIP databases. The prevalence rates of gastroesophageal reflux, heartburn, epigastric pain, and nausea were extracted from the identified research articles and were used in meta-analysis of relative risks (RR) to achieve an overall effect size of the relationship between H. pylori eradication and GERD. A total of 19 randomized controlled trials were included in this meta-analysis. The prevalence of gastroesophageal reflux was significantly higher in patients with H. pylori eradication compared with patients without it (RR: 1.54, 95% CI: 1.06-2.24; p=0.02). A subgroup analysis did not identify any significant difference in GERD prevalence in studies conducted outside China (RR: 1.62, 95% CI: 0.98-2.68) or in China (RR: 1.30, 95% CI: 0.76-2.22). There were no significant differences in heartburn (RR: 1.03, 95% CI: 0.88-1.20), epigastric pain (RR: 0.98, 95% CI: 0.13-7.56), or nausea (RR: 0.44, 95% CI: 0.07-2.72) risk between patients with and without H. pylori eradication. Eradication of H. pylori infection is found to be associated with GERD, although regional differences may exist in the prevalence. Well-designed studies especially those with stratification of patients' basic conditions are needed to seek refined evidence of the association between H. pylori eradication and the GERD.

Indukanta ghritam – An ayurvedic formulation for acid peptic disorder and longevity: A review

Introduction: Acid peptic disorders are common conditions reported in daily clinical practice in India. Epidemiological study of 30,216 patients inferred 7.8% prevalence of peptic ulcer in India, while prevalence of gastroesophageal reflux is reported to be around 28% in South West India. Repeated gastric ulcers, perforation, or hemorrhage can cause intestinal fibrosis or cancer which can lead to death. As the disease occurs mostly in Madhyama vayas (16-70 yrs of age) and if this age is affected, longevity also be affected. Based on the clinical features, such manifestations can be compared with Amlapitta and Parinama shula. These diseases are preventable and, if not addressed at the right time, may burden the scenario hampering the quality of life of the individuals. Objective: To screen the activities of individual ingredients of Indukanta ghritam and to propose possible mode of action in APDs and longevity. Data Source: Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya, Sahasra yoga, Sharangadhara Samhita and online data bases. Review Methods: The classical text books were reviewed manually and review was also done by referring various scientific journals and other databases. Results: The formulation is a combination of several drugs, i.e., Dashamoola and Panchakola etc. They are referred to be useful in Amlapitta, Parinama shula etc. conditions and latest researches have established activities like gastroprotective, antioxidant, immuno-modulation etc. inferring the use of the formulation the therapeutics of APDs, as well as a rejuvenating drug. Conclusion: Indukanta ghritam can prevent as well as cure the disease and can improve the quality of life. The herbal formulation can minimize the disease burden and possibly can play an important role as a classical rejuvenating drug.

A Cross-Sectional Study to Determine the Prevalence of Gastroesophageal Reflux in Children with Persistent Cough and Wheezing

Background: Gastroesophageal reflux (GER) occurs in more than two-thirds of otherwise healthy infants and is the topic of discussion with pediatricians at one-quarter of all routine 6-month infant visits. GER is considered a normal physiologic process that occurs several times a day in healthy infants, children, and adults. GER is generally associated with transient relaxations of the lower esophageal sphincter independent of swallowing, which permits gastric contents to enter the esophagus. The Objective to find out the prevalence of GER in children with cough and wheezing and its associated factors. Subjects and Methods: A cross-sectional study was done at A tertiary care hospital at the Institute of Naval Medicine, INHS, Mumbai from August 2016 to December 2017. A total of 30 study subjects Aged between the age of one to twelve years with persistent cough and wheezing lasting for more than three months despite treatment were included for the study. Results: The prevalence of gastroesophageal reflux (GER) in our study was 63.3%.The logistic regression analysis showed that Age, Height, Weight, BMI, duration of cough, Duration of asthma were not significantly associated with Gastroesophageal reflux (GER) (p&gt;0.05). Conclusion: GER seems to have a high prevalence in children with chronic cough. However, no definite recommendations can be made regarding the management of such cases from our study.

Prevalence of smooth muscle dysfunction among children with Duchenne muscular dystrophy.

Smooth muscle dysfunction in Duchenne muscular dystrophy (DMD) has been rarely studied. A cross-sectional study was conducted to estimate the prevalence of smooth muscle dysfunction (vascular, upper gastrointestinal, and bladder smooth muscle) in children with DMD using questionnaires (Pediatric Bleeding Questionnaire, Pediatric Gastroesophageal Symptom Questionnaire, and Dysfunctional Voiding Symptom Score). Investigations included bleeding time estimation, nuclear scintigraphy for gastroesophageal reflux, and uroflowmetry for urodynamic abnormalities. Ninety-nine subjects were included in the study. The prevalence of vascular, upper gastrointestinal, and bladder smooth muscle dysfunction was 27.2%. Mean bleeding time was prolonged by 117.5 seconds. The prevalence of gastroesophageal reflux was 21%. Voided volume/estimated bladder capacity over 15% and abnormal flow curves on uroflowmetry were seen in 18.2% and 9.7% of the subjects, respectively. Our study highlights the need for addressing issues related to smooth muscle dysfunction in the routine clinical care of patients with DMD.

Gastroesophageal Reflux Poses a Potential Risk for Late Complications of Bronchopulmonary Dysplasia: A Prospective Cohort Study

Bronchopulmonary dysplasia (BPD) is the most common respiratory disorder in extremely low birth weight infants. Although most symptoms of BPD improve, some late complications exist, even with regular treatment. Gastroesophageal reflux (GER), also common in extremely premature infants, may be related to many cardiorespiratory symptoms. However, the potential of GER as a risk factor for late complications associated with BPD is still unclear. The goal of this study was to determine if GER increases the risk of late complications of BPD in infants. A multicenter prospective cohort of 131 infants (79 male subjects, 52 female subjects) with BPD was enrolled. The development of late complications was assessed over an 18-month follow-up period. Twenty-four-hour pH-multichannel intraluminal impedance and gastric sodium concentrations were analyzed in all infants at 36weeks' postmenstrual age and at the last interview. Prevalence and risk factors of late complications of BPD were analyzed by using forward logistic regression. The prevalence of late complications in BPD infants was 63.79%and included respiratory symptoms (49.14%), vomiting (38.79%), retinopathy of prematurity (25.86%), hypoxic-ischemic injury (3.45%), rehospitalization (26.72%), and sudden death (0.86%). Respiratory diseases constituted the most frequent complication. The prevalence of GER in BPD was 42.24%and included acid GER (18.10%) and duodenogastroesophageal reflux (DGER; 24.14%). Risk factors for respiratory symptoms were gestational age≤ 30weeks (OR, 3.213; 95%CI, 1.221-8.460), birth weight< 1,500g (OR, 2.803; 95%CI, 1.014-7.749), invasive ventilation > 7days (OR, 4.952; 95%CI, 1.508-16.267), acid GER (OR, 4.630; 95%CI, 1.305-16.420), and DGER (OR, 5.588; 95%CI, 1.770-17.648). Infants with BPD and DGER were more prone to late complications than those with acid GER or no reflux. The prevalence of late complications is high in infants with BPD. GER (and in particular, DGER) poses a tentative risk for these late complications. ClinicalTrials.gov; No.: NCT03014453; URL: www.clinicaltrials.gov.

Impact of gastroesophageal reflux in the pathogenesis of tracheal stenosis.

Benign airway stenosis is a multifactorial and heterogeneous disease often occurring after tracheal intubation. Despite the frequent finding of pathological gastroesophageal reflux (GER) in benign tracheal stenosis, the cause-and-effect relationship between these two entities and its impact on the outcome of the stenosis itself have not been established. The altered ventilatory dynamics caused by an increased thoracoabdominal pressure gradient in such patients has been proposed as a central cause. The presence of GER in a setting of microaspiration can also induce changes in the local collagen proliferation response, as well as in the local microbiome of the tracheal stenosis site, which may potentially cause and enhance the harm imposed to the already diseased tracheal wall. Diagnosis of GER remains underestimated in the general population, thus making its accurate detection and treatment in central airway stenosis a matter of investigation. The high prevalence of GER in tracheal stenosis patients often occurs in the absence of typical upper digestive signs and symptoms, therefore requiring an objective assessment using a 24-hour ambulatory esophageal pH/impedance study that has shown abnormal results in more than half the patients. The impact of the treatment of GER in patients with benign tracheal has been scarcely reported. Our group showed recently that the surgical control of GER through laparoscopic fundoplication in selected patients with tracheal stenosis can improve substantially the chance of resolution of the tracheal stenosis as opposed to the medical management with high dose proton pump inhibitors. This chapter describes the impact of GER in the pathogenesis of tracheal stenosis with a focus on its mechanisms, diagnosis and treatment strategy.

Prevalence of gastro-esophageal reflux in diabetic patients at a tertiary hospital in Central Saudi Arabia

Objectives:To estimate the prevalence of gastro-esophageal reflux disease (GERD) among diabetic patients and to investigate GERD’s potential association with diabetic complications, and patients’ sociodemographic and clinical characteristics.Methods:This cross-sectional study used the GERD questionnaire (GerdQ) in 403 diabetic patients attending the outpatient clinics at King Khalid University Hospital, King Saud University Medical City, King Saud University; a tertiary hospital in Riyadh, Saudi Arabia, between January and February 2019. On the basis of a cutoff GerdQ score of 8, we distinguished GERD and non-GERD groups.Results:Gastro-esophageal reflux disease prevalence was 44.9%. Of the diabetic patients with GERD, 76.8% were female (p<0.001). Gastro-esophageal reflux disease patients were older (mean age: 55.27, p=0.038) and had a slightly higher body mass index (BMI) than non-GERD (32.04 versus, 30.20 p=0.006), respectively. Smokers in the GERD group were 1.7% versus 7.2% in the non-GERD group (p=0.007). Peripheral numbness (p=0.023) and nephropathy (p=0.041) were more prevalent in patients with GERD, while myocardial infarction was more prevalent in non-GERD subjects (p=0.038). On multi variable analysis, the only independent GERD risk factors were female gender (p=0.013) and age >65 years (p=0.007).Conclusion:Gastro-esophageal reflux disease prevalence in diabetic patients was 45%. Diabetic patients with GERD were more often female and older >65 years. None of the other tested factors (BMI, smoking status, diabetes mellitus duration, therapeutic plan, or diabetic complications) showed significant difference between GERD and non-GERD groups.

Natural history of gastroesophageal reflux: A prospective cohort study in a stratified, randomized population in Beijing

To explore the natural history of and risk factors for gastroesophageal reflux (GER) in a prospective cohort in Beijing, China. We selected adult participants using a stratified randomized method and performed initial surveys in 1996 and the current survey in 2008. Well-trained investigators administered the survey questionnaire using face-to-face interviews. Reflux symptoms were evaluated by their intensity and frequency. GER was defined as heartburn, acid reflux, and food regurgitation at least once a week, and monthly reflux was defined as at least one of the above symptoms occurring 1-3 days per month. The resurvey response rate was 47.8% (1189/2486). Over 12 years, 66.9% of the respondents remained unchanged, and one-third changed, with a GER new onset rate of 7.0 per 1000 person-years and a GER disappearance rate of 64.6 per 1000 person-years. This kept the GER prevalence stable at 8.2% to 9.5% (P = 0.28). GER and monthly reflux exhibited significant differences in their tendency to persist or become aggravated to GER (22.4% vs 11.9%, P = 0.02). Participants who initially had single, mild to moderate, daily GER were more likely to recover from reflux over time. Participants with persistent and aggravated GER had more severe heartburn and acid reflux than those with new-onset GER in the current survey. Multiple logistic regression analysis showed that emotional depression is a risk factor for GER aggravation (odds ratio 3.52, 95% confidence interval 1.43-8.67, P = 0.006). The initial symptom profile of reflux determines the outcome of GER over time.

Prevalence of gastroesophageal reflux and risk factors for erosive esophagitis in obese patients considered for bariatric surgery

BackgroundGastroesophageal reflux disease (GERD) is common in obese individuals. Prospective studies investigating validated GERD questionnaires and clinical parameters at identifying erosive esophagitis (EE) in this population are limited. ObjectiveTo prospectively evaluate the prevalence of GERD in obese patients considered for bariatric surgery and identify risk and predictive factors for EE. MethodsEligible patients completed two validated questionnaires: GERDQ and Nocturnal Symptom Severity Impact (N-GSSIQ) before routine esophagogastroduodenoscopy. Results242 consecutive patients were enrolled (130 females; mean age 37.8 ± 11.8 years; mean BMI 40.4 ± 5.3 kg/m2). The overall prevalence of gastroesophageal reflux (GERDQ ≥ 8, EE and/or PPI use) was 62.4%. EE was identified in 82 patients (33.9%) including 13/62 (21.0%) receiving PPIs at baseline. Multivariate logistic regression identified GERDQ ≥ 8 (OR = 6.3, 95%CI 3.0–13.1), hiatal hernia (OR = 4.2, 95%CI 1.6–10.7), abnormal Hill grade (OR = 2.7, 95%CI 1.4–5.4), and tobacco use (OR = 2.5, 95%CI 1.2–4.9) as independent risk factors for EE. A pre-endoscopic composite assessment including GERDQ ≥ 8 and presence of severe nocturnal reflux symptoms had 90% specificity and 20.7% sensitivity in identifying EE (NPV 68.9% and PPV 51.5%). ConclusionGERD is highly prevalent in obese patients. Anthropometric data and GERD questionnaires have limited accuracy at predicting erosive disease. Pre-operative endoscopic assessment in this population appears warranted.

The Prevalence of Gastroesophageal Reflux in Patients With Excessive Central Airway Collapse

Gastroesophageal reflux (GER) is increasingly recognized as an exacerbating or causal factor in several respiratory diseases. There is a high prevalence of GER in infants with airway malacia. However, such data are lacking in adults. This retrospective study was conducted to determine the relationship between GER and excessive central airway collapse (ECAC). The study included consecutive patients with ECAC referred to the Complex Airway Center at Beth Israel Deaconess Medical Center who underwent esophageal pH testing for GER between July 2014 and June2018. Sixty-three of 139 patients with ECAC (45.3%) had documented GER as shown by an abnormal esophageal pH test result. The mean DeMeester score was 32.2, with a symptom association probability of 39.7%of GER-positive patients. Twenty-nine of 63 patients (46%) with GER reported improvement in respiratory symptoms following maximal medical therapy or antireflux surgery without requiring further treatment forECAC. GER is prevalent among patients with ECAC, and aggressive reflux treatment should be considered in these patients prior to considering invasive airway procedures or surgery.

PS01.059: REFLUX RELATED SYMPTOMS ARE LESS COMMON IN SOUTH-EAST HUNGARIAN SUBJECTS, THAN EXPECTED ON THE BASIS OF EPIDEMIOLOGIC STUDIES OF THE WESTERN COUNTRIES

Abstract Background Most population based epidemiologic studies indicate approximately 20% prevalence of Gastroesophageal Reflux (GER) related typical symptoms appearing at least monthly. Since most of these works were carried out in the western countries, a little is known about Central-Europe, where substantial part of the population still lives outside of the larger cities. The aim of the study was to obtain population-based data on the prevalence of GER related symptoms in South-East Hungary. Methods Two thousand and two consecutive blood donor volunteers (M/F: 1156/846, mean age: 39 (17–66) years) were enrolled. Data collection was carried out by means of a questionnaire. Typical (heartburn, regurgitation) and atypical (esophageal, extraesophageal) symptoms were assessed. Results Typical symptoms of GER such as heartburn and acidic regurgitation were reported by 22% (450/2002) and 17% (333/2002) of the studied healthy subjects. The 63% and 51% of them had such symptoms less than once per month. Monthly heartburn episodes were reported by 14, and weekly by 6 percent of the cases, while acidic regurgitation occurred in 8 and 3 percent respectively. Of the atypical (esophageal and extraesophageal) symptoms upper airway symptoms were the most prevalent (19%), although only 13% had such symptom at least monthly. Globus occurred in 6%, while other atypical symptoms were reported by less than 5% of the subjects. Typical GER symptoms occurred more frequently in females, coffee drinkers and subjects with moderate obesity. Current and former smoking and alcohol-use were associated with increased GER symptom prevalence. Conclusion In contrast to the studies carried out in the western countries South-East Hungarian subjects seem to have less GER related symptoms. Disclosure All authors have declared no conflicts of interest.