Prevalence Of Reflux In Patients Research Articles

The Relationship between Primary Acquired Nasolacrimal Duct Obstruction and Gastroesophageal Reflux

ABSTRACTPurpose/Aim of the study: To evaluate if there is any relationship or coincidence between gastroesophageal reflux disease (GERD) and primary acquired nasolacrimal duct obstruction (PANDO).Material and Methods: We enrolled 180 patients with PANDO, confirmed by positive regurgitation on sac squeezing or by irrigation test. In the control group, any patient with lacrimal drainage obstruction was excluded. For diagnosis of gastroesophageal reflux we used a (Gerd Q) questionnaire by R. Jones.Results: According to Gerd Q, prevalence of gastroesophageal reflux in patients with PANDO was 20% (36 out of 180 patients) and in the control group, it was 10.6% (19 out of 180 patients), which was significantly higher in the presence of PANDO (p valve = 0.013). In women, 28 patients (23.5%) in the case group versus 13 patients (10.9%) in the control group has gastroesophageal reflux (p value = 0.01), which was not significant among men (p value = 0.870). When we considered age as an independent variable, results reveled significant value only for patients over 60 years old (p value = 0.008).Conclusion: The prevalence of gastroesophageal reflux disease was significantly higher in patients with PANDO. This statistical relationship was greater among women and patients over 60 years old. In this study, we found an association between GERD and PANDO.

Evaluation of the VANRIS Injection Success Rate in Vesicoureteral Reflux (VUR) Treatment in Children

Background: Vesicoureteral reflux (VUR) is a common condition among children. Although, subureteral injection is a minimally invasive new method for VUR treatment, ideal bulking agent in endoscopic treatment still remains controversial. We aimed to evaluate VANTRIS subureteral injection efficacy in VUR treatment in pediatric patients. Materials and Methods: All patients who referred to Imam Khomeini hospital in Urmia-Iran, Urology ward with VUR diagnosis that had indications for open surgery, enrolled study (during Mar 2013 to Mar 2015). Prior to intervention, VUR severity, urinary tract infection (UTI) and subsequent complications determined using urine analysis and imaging. Subsequently, single injection of the VANTRIS performed for all patients and patients underwent six-month follow up including several clinical and paraclinical evaluations. Results: 31 patients with VUR diagnosis participated; of 31 patients, 18 (58.06%) children with primary UTI who had surgery indication enrolled study; of 18 patients, seven patients (38.88%) were boy and eleven patients (61.12%) were girl with mean age of 6.88 ± 2.61 years, and out of 29 refluxing rental units (RRU), 13 (44.8%) were right and 16 (55.2%) were left kidney. In current study, patients divided to two subgroups regarding their age older than five or younger than five years old and there was no significant difference between the resolution rates following VANTRIS injection in two groups (P>0.05). Eleven (38.88%) RRU detected in boy patients, nonetheless VUR resolved in all of them, postoperatively. On the other hand, of 18 RRU in female patients, complete VUR resolution observed in 16 kidneys (88.8 %), but only 2 (11.11%) kidneys had incomplete, but significant VUR resolution, where no significant difference observed. The prevalence of reflux in patients with UTI was 30% and in patients without UTI was 17%. Conclusion: The current study indicated that in all age groups of patients, the subureteral injection of the VANTRIS was an accurate and effective treatment modality for VUR

Gastro-oesophageal reflux symptoms and coeliac disease: no role for routine duodenal biopsy.

Coeliac disease (CD) has been linked to gastro-oesophageal reflux disease (GORD). Previous studies have demonstrated an increased prevalence of reflux in patients with CD. However data on the risk for CD in patients presenting with reflux are conflicting. The aim of this study was to establish the prevalence of CD in patients with GORD and to elucidate the mechanisms for reflux symptoms in newly diagnosed CD patients. Group A: patients who had undergone routine duodenal biopsy were prospectively recruited between 2004 and 2014. Diagnostic yield was compared with that of a screening cohort. Group B: 32 patients with newly diagnosed CD who had undergone oesophageal manometry and 24-h pH studies were prospectively recruited. Group A: 3368 patients (58.7% female, mean age 53.4 years) underwent routine duodenal biopsy. Of these patients, 850 (25.2%) presented with GORD. The prevalence of CD among GORD patients was 1.3% (0.7-2.4%), which was not significantly higher than that in the general population (P=0.53). Within the context of routine duodenal biopsy at endoscopy (when corrected for concurrent symptoms, age and sex), reflux was found to be negatively associated with CD [adjusted odds ratio 0.12 (0.07-0.23), P<0.0001]. In group B, 34% of patients complained of reflux. On manometry, 9% had a hypotensive lower oesophageal sphincter and 40.6% had oesophageal motor abnormalities, with 25% significantly hypocontractile. On pH studies, 33% demonstrated reflux episodes. The prevalence of undiagnosed CD among GORD patients is similar to that in the general population, and routine duodenal biopsy cannot be recommended. A significant number of patients with newly diagnosed CD were found to have reflux and/or oesophageal dysmotility on pH/manometry studies; this may explain the high prevalence of reflux symptoms in CD.

PWE-175 Prevalence of pathological gastroesophageal reflux in patients with severe oesophageal hypomotility who do not present with typical reflux symptoms

Introduction Oesophageal hypomotility (OH) disorders are characterised by a decrease in the vigour of distal oesophageal contractions. An estimated 21 to 49% of patients with pathological gastroesophageal reflux (GOR) also have associated OH. However, prevalence of pathological GOR in OH who do not present with reflux symptoms has not been characterised. Overlooked reflux in these patients may hamper the success in treatment and also increase the risk of long-term side effects from chronic reflux. The aim of this study was to investigate the prevalence of pathological GOR and clinical presentation of patients with severe OH who do not present typical gastroesophageal reflux disease (GORD) symptoms. Method All patients diagnosed with frequent failed peristalsis or absent peristalsis on oesophageal high resolution manometry during January 2013 – December 2014 were selected retrospectively. Exclusion criteria were having typical reflux symptoms (heartburn and/or regurgitation) and history of antireflux surgery. All patients underwent ambulatory 24 h reflux monitoring. pH cut off 4 was used and pathological GOR was defined as high acid exposure time (total >6.3%, supine >1.2%, upright >4.2%)1and/or high number of reflux events >73. Symptoms were reported by the patient during interview. P value Results In total, 78 patients (30 male, 48 female; mean age 55 [19–82]) were included. Pathological GOR was detected in 28/78 (36%) of the patients [abnormal acid exposure time: 12/78 (15%) upright, 11/78 (14%) supine, 12/78 (15%) total, abnormal number of reflux events 15/78 (19%)]. The most common symptoms in patients with pathological GOR: dysphagia 21/28 (75%), chest pain 11/28 (39%) and cough 9/28 (32%) and in patients without GOR: epigastric pain: 19/50 (38%), chest pain 18/50 (36%), dysphagia 16/50 (32%). Epigastric pain was more commonly reported in patients without pathological GOR (P Conclusion Pathological GOR is prevalent in one third of the patients with severe OH without typical GORD symptoms. Reflux monitoring maybe indicated in patients with severe OH regardless of their presenting symptoms. Disclosure of interest None Declared. Reference Johnson LF, DeMeester TR. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974:62:325–332.

Evaluation of laryngopharyngeal reflux in patients with suspected laryngopharyngeal reflux, chronic otitis media and laryngeal disorders

We investigated the prevalence of laryngopharyngeal reflux in patients with signs and symptoms of reflux, chronic otitis media and benign and malignant vocal cord lesions. Three groups of patients in Ankara Ataturk Education and Research Hospital ENT-Head and Neck Surgery Clinics were compared between 2005 and 2006. The first group had patients with signs and symptoms of reflux, the second group consisted of patients with chronic otitis media, and in the third group had patients with laryngeal pathology, i.e. vocal cord lesions. The results of pH monitoring of all the three groups of patients were analyzed for laryngopharyngeal reflux. In the evaluation, two different criteria, based on reflux number and time spent in reflux, were used. It was investigated whether there was a difference in terms of reflux among these three groups. Also, the effects of reflux in etiopathogenesis of chronic otitis media and vocal cord lesions are discussed. A total of 84 patients were studied, with 22 patients with signs and symptoms of reflux in Group 1, 42 patients with chronic otitis media in Group 2, and 20 patients with vocal cord lesions in Group 3. No statistical difference could be detected among the groups in terms of the two criteria mentioned above. The frequency of laryngopharyngeal reflux in patients with chronic otitis media and vocal cord lesions was found to be as high as than in the patients with signs and symptoms of reflux. During the treatment of chronic otitis media and laryngeal disorders, we advise reflux work-up, and in case if there is reflux, we recommend reflux treatment in addition to treatment of primary disease.

Direct Nasopharyngeal Reflux of Gastric Acid is a Contributing Factor in Refractory Chronic Rhinosinusitis

To determine whether there is a difference in the prevalence of reflux in patients with refractory chronic rhinosinusitis (CRS) compared with control patients, including whether direct nasopharyngeal reflux (NPR) occurs in CRS patients. It is hypothesized that refractory CRS patients have a greater incidence of laryngopharyngeal reflux and NPR events and that NPR is a significant etiologic factor for CRS in these patients. Prospective study. The study group consisted of 38 patients with a history of at least one endoscopic sinus surgery (ESS) with continued CRS symptoms and mucosal inflammation on endoscopy. The first control group consisted of 10 patients who had at least one ESS procedure and had no symptoms of CRS or mucosal inflammation a minimum of 1 year postoperatively. The second control group consisted of 20 subjects with no history of CRS or sinus surgery. All patients completed reflux symptom scales, a 20 item sinonasal outcome test, and a sinusitis symptom scale and underwent nasal endoscopy to grade the nasal mucosal findings. Patients underwent a 24 hour pH study with a specially designed probe with sensors located in the nasopharynx, 1 cm above the upper esophageal sphincter (UES), and the distal esophagus. The pH recordings were evaluated for NPR events less than pH 4 and 5. Reflux at the UES probe was considered pathologic if there were more than 6.9 episodes for the entire study or the reflux area index (RAI) exceeded 6.3. Esophageal reflux was defined as abnormal if greater than 4% of the study time was spent at pH less than 4. Statistical analysis was performed with Fisher's exact test to compare the reflux parameters and with analysis of variance and Tukey's post hoc analysis for the symptom and examination scores. No statistical difference was found between the two control groups for any parameters at any sites. When a single outlier was dropped from the nonCRS control group, less NPR was found in the nonCRS group compared with the successful ESS control group (P = .03). Because these groups were statistically homogenous, they were collapsed into a single control group. Compared with the control group, the study group had significantly more patients with NPR events pH less than 4 (39% vs. 7%, P = .004) and an even greater difference in the number of patients with NPR events pH less than 5 (76% vs. 24%, P = .00003). At the UES, 74% of the study group had greater than 6.9 reflux episodes, compared with 38% of control patients (P = .006). The UES RAI was abnormal for 58% of the study group compared with 21% of the control group (P = .007). The study group also had more gastroesophageal reflux (66% vs. 31%, P = .007). For nasopharynx and UES reflux parameters, the differences between study and control groups increased when the patients with isolated frontal recess disease were removed from the dataset. The study group also had higher scores on all symptom and examination scores (P = .001 for each scale). Patients with persistent CRS after ESS have more reflux at the nasopharynx, UES, and distal esophagus than controls. The greatest difference is in NPR, especially pH less than 5. This is the first study to document NPR in CRS patients, and it is likely to represent an important causative factor of refractory CRS in adults.