Reflux Of Gastric Contents Research Articles

Correlation of gastrointestinal symptom rating scale and frequency scale for the symptoms of gastroesophageal reflux disease with endoscopic findings

Background Gastroesophageal Reflux Disease (GERD) is caused by the reflux of gastric contents into the esophagus and has a 13% global prevalence that is increasing. GERD symptoms negatively impact physical, social, and emotional quality of life. The Frequency Scale for the Symptoms of GERD (FSSG) and the Gastrointestinal Symptom Rating Scale (GSRS) determine the efficacy of treatment but may not correlate with endoscopically estimated esophageal mucosal injury severity. We aimed to probe the correlation between FSSG, GSRS, and esophageal injury severity to evaluate whether these scores can predict GERD severity. Methods A total of 2962 patients who underwent physical examinations, including upper gastrointestinal endoscopy, at the Kyoto Kuramaguchi Medical Center, Japan, were enrolled in this study. Upper gastrointestinal endoscopy was used to diagnose fundic mucosal atrophy, reflux esophagitis based on the Los Angeles (LA) classification, gastroesophageal flap value function (GEFV) based on Hill’s classification, and Barrett’s esophagus. Endoscopic diagnoses were examined for correlations with FSSG and GSRS scores. Results In reflux esophagitis, FSSG and GSRS scores correlated with LA-B and LA-C endoscopic diagnosis but not with LA-M and LA-A endoscopic findings. Multiple regression analysis results were similar. FSSG scores reflected advanced fundic gland mucosal atrophy, while GSRS scores associated with high grade of GEFV. Conclusions This is the first report to examine the correlation between FSSG and GSRS scores and endoscopic findings in a relatively large patient population. Our findings suggest that these scores can diagnose the severity of reflux esophagitis.

580. ESTABLISHMENT OF A RAT MODEL OF GASTROESOPHAGEAL REFLUX DISEASE INDUCED CHRONIC MICROASPIRATION

Abstract Background Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder in Japan, the world’s first super-aging society. Occult microaspiration due to GERD can cause respiratory infections especially in frail elderly individuals. The aim of the study was to establish an experimental in vivo model of GERD induced chronic microaspiration. Methods GERD was induced in 8-week-old male Wistar rats. A 2-cm midline incision was made in the upper abdomen. The border between the forestomach and the glandular portion (limiting ridge) was ligated with a 2–0 silk tie, and the duodenum near the pyloric ring was covered with a 2-mm-wide piece of an 18-Fr Nélaton catheter. CT scan and histopathological evaluation of the bilateral lungs were performed at 3 weeks after surgery. Results The 3-week survival rate was 80% (n=4/5). CT scan showed diffuse dilatation of the esophagus due to the reflux of gastric contents; however, there was no consolidation in the lungs similar to the healthy control. Based on macroscopic evaluation, the lungs had multiple spotted redness. Histopathological evaluation of hematoxylin and eosin staining showed multiple spotted aspiration pneumonia with peribronchiolar inflammatory cells, granuloma formation, goblet cell hyperplasia. Conclusions This model mimics human occult chronic microaspiration due to GERD, and may be useful in the investigation of drug efficacy and the evaluation for pathophysiology of GERD induced pulmonary disorders.

Britannilactone 1-O-acetate induced ubiquitination of NLRP3 inflammasome through TRIM31 as a protective mechanism against reflux esophagitis-induced esophageal injury

BackgroundReflux esophagitis (RE) is a disease in which inflammation of the esophageal mucosa owing to the reflux of gastric contents into the esophagus results in cytokine damage. Britannilactone 1-O-acetate (Brt) has anti-inflammatory effects, significantly inhibiting the activation of the NLRP3 inflammasome, leading to a decrease in inflammatory factors including IL-1 β, IL-6, and TNF-α. However, the mechanism underlying its protective effect against RE-induced esophageal injury remains unclear. In the present study, we investigated the protective mechanism of TRIM31 against NLRP3 ubiquitination-induced RE both in vivo and in vitro.MethodsA model of RE was established in vivo in rats by the method of “4.2 mm pyloric clamp + 2/3 fundoplication”. In vitro, the mod was constructed by using HET-1A (esophageal epithelial cells) and exposing the cells to acid, bile salts, and acidic bile salts. The 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay was used to screen the concentration of administered drugs, and the viability of HET-1A cells in each group. HE staining was used to assess the degree of pathological damage in esophageal tissues. Toluidine blue staining was used to detect whether the protective function of the esophageal epithelial barrier was damaged and restored. The enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of IL-1 β, IL-6, and TNF-α factors in serum. Immunohistochemistry (IHC) was used to detect the expression level of NLRP3 in esophageal tissues. The molecular docking and Co-immunoprecipitation assay (Co-IP assay) were used to detect the TRIM31 interacts with NLRP3. Western blotting detected the Claudin-4, Claudin-5, The G-protein-coupled receptor calcium-sensitive receptor (CaSR), NLRP3, TRIM31, ASC, C-Caspase1, and Caspase1 protein expression levels.ResultsBrt could alleviate RE inflammatory responses by modulating serum levels of IL-1 β, IL-6, and TNF-α. It also activated the expression of NLRP3, ASC, Caspase 1, and C-Caspase-1 in HET-1A cells. Brt also attenuated TRIM31/NLRP3-induced pathological injury in rats with RE through a molecular mechanism consistent with the in vitro results.ConclusionsBrt promotes the ubiquitination of NLRP3 through TRIM31 and attenuates esophageal epithelial damage induced by RE caused by acidic bile salt exposure. This study provides valuable insights into the mechanism of action of Brt in the treatment of RE and highlights its promising application in the prevention of NLRP3 inflammatory vesicle-associated inflammatory pathological injury.Graphical

Gastroesophageal Reflux Disease.

Gastroesophageal reflux disease (GERD) is a condition that occurs when reflux of gastric contents into the esophagus causes symptoms and/or complications. The prevalence of GERD in Western societies has been estimated at 30%, making it one of the most commonly encountered disorders in primary care. The spectrum of GERD includes typical symptoms of esophageal reflux (heartburn and/or regurgitation); esophageal injury (erosive esophagitis; stricture; Barrett esophagus; and, rarely, adenocarcinoma); and extraesophageal symptoms, such as hoarseness and chronic cough. Proper diagnosis and treatment of GERD includes symptom control, exclusion of other disorders, avoiding overuse of medications and invasive testing, and minimizing complications.

Endoscopic Advances in the Diagnosis and Management of Gastroesophageal Reflux Disease.

Gastroesophageal reflux disease (GERD) is one of the most common diseases that occurs secondary to failure of the antireflux barrier system, resulting in the frequent and abnormal reflux of gastric contents to the esophagus. GERD is diagnosed in routine clinical practice based on the classic symptoms of heartburn and regurgitation. However, a subset of patients with atypical symptoms can pose challenges in diagnosing GERD. An esophagogastroduodenoscopy (EGD) is the most common initial diagnostic test used in the assessment for GERD, although half of these patients will not have any positive endoscopic findings suggestive of GERD. The advanced endoscopic techniques have improved the diagnostic yield of GERD diagnosis and its complications, such as Barrett's esophagus and early esophageal adenocarcinoma. These newer endoscopic tools can better detect subtle irregularities in the mucosa and vascular structures. The management options for GERD include lifestyle modifications, pharmacological therapy, and endoscopic and surgical interventions. The latest addition to the armamentarium is the minimally invasive endoscopic interventions in carefully selected patients, including the electrical stimulation of the LES, Antireflux mucosectomy, Radiofrequency therapy, Transoral Incisionless Fundoplication, Endoscopic Full-Thickness plication (GERDx™), and suturing devices. With the emergence of these advanced endoscopic techniques, it is crucial to understand their selection criteria, advantages, and disadvantages.

Utilizing Esophageal Motility Tests in Diagnosing and Evaluating Gastroesophageal Reflux Disease.

Gastroesophageal reflux disease (GERD), a prevalent clinical condition, is often attributed to aberrant esophageal motility, leading to gastric content reflux and associated symptoms or complications. The rising incidence of GERD presents an escalating healthcare challenge. Endoscopic and esophageal reflux monitoring can provide a basis for the diagnosis of patients with gastroesophageal reflux disease, but when the diagnostic basis is at an inconclusive value, some additional supportive evidence will be needed. Advanced technology is the key to improving patient diagnosis, accurate assessment, and the development of effective treatment strategies. High-resolution esophageal manometry (HREM) and endoscopic functional lumen imaging probe (EndoFLIP) represent the forefront of esophageal motility assessment. HREM, an evolution of traditional esophageal manometry, is considered the benchmark for identifying esophageal motility disorders. Its widespread application in esophageal dynamics research highlights its diagnostic significance. Concurrently, EndoFLIP's emerging clinical relevance is evident in diagnosing and guiding the treatment of coexisting esophageal motility issues. This review integrates contemporary research to delineate the contributions of HREM, EndoFLIP, and novel technologies in GERD. It examines their efficacy in facilitating an accurate diagnosis, differentiating similar gastrointestinal disorders, quantifying the extent of reflux, assessing the severity of the disease, forecasting patient responsiveness to proton pump inhibitor therapy, and guiding decisions for surgical interventions. The overarching aim is to deepen the understanding of GERD's underlying mechanisms and advance the formulation of holistic, efficacious treatment approaches.

Myofilament calcium sensitization in non-human primate lower esophageal sphincter and esophagus

Background/Objectives: Peristalsis in the esophagus (ESO) moves ingested contents into the stomach. The lower esophageal sphincter (LES) is located at the distal end of the ESO and generates tone to prevent reflux of gastric contents. Previous studies suggest that the expression and/or phosphorylation of proteins involved in myofilament Ca2+ sensitization differs between phasic and tonic smooth muscles (Brozovich et al., 2016; PMID: 27037223). We hypothesize that differences in expression and/or phosphorylation of these proteins contributes to differences in contractile activity between LES and ESO. The aims were to 1) characterize contractile activity in Cynomolgus monkey LES and ESO, 2) evaluate myofilament Ca2+ sensitization protein expression and phosphorylation, 3) examine changes in phosphorylation when contractile activity is enhanced or inhibited pharmacologically. Methods: Contraction was assessed in strips of LES and ESO by isometric tension recordings. Carbachol (CCh, 1 μM) was used to enhance contractions. ROCK2 (SR3677; 2 μM) or CavL (nifedipine; 1 μM) antagonists were used to inhibit contractions. Tissues were snap frozen in liquid nitrogen after peak response and prepared for protein expression analysis using Jess immunoelectrophoresis. Results: Under basal conditions, the LES exhibited tone whereas the ESO had phasic activity. CCh significantly increased contractions. Nifedipine and SR3677 significantly decreased basal and CCh-induced contractions with nifedipine having the greater effect. MLCK and MYPT1 expression was significantly greater in LES than ESO while LC20 and CPI-17 expression was greater in ESO. ROCK2 expression was similar in LES and ESO. Under basal conditions MYPT1 and LC20 phosphorylation was greater in LES. MYPT1 and LC20 phosphorylation was decreased by SR3677 but not nifedipine in both tissues. CCh increased MYPT1 and LC20 phosphorylation in both tissues though was greater in LES. SR3677 inhibited phosphorylation of both proteins in LES and ESO. Discussion/Conclusions: The differences in expression and phosphorylation of key proteins involved in myofilament Ca2+ sensitization likely contribute to differences in contractile activity. Notably, there is greater LC20 phosphorylation in LES than ESO under basal conditions and with CCh. Furthermore, there is an important role for ROCK2 in regulating basal contractile activity in LES and ESO as both contraction and phosphorylation of MYPT1 and LC20 are reduced by SR3677. While nifedipine significantly reduced contractile activity in LES and ESO, it did not reduce phosphorylation of MYPT1 indicating that the ROCK2 pathway is independent of Ca2+ influx. These findings may improve understanding of the pathophysiology associated with esophageal dysmotility. NIH DK129528 to CAC. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Natural airway as an alternative to intubation for pediatric endoscopic esophageal foreign body removal: A retrospective cohort study of 326 patients.

Anesthesia is required for endoscopic removal of esophageal foreign bodies (EFBs) in children. Historically, endotracheal intubation has been the de facto gold standard for airway management in these cases. However, as more elective endoscopic procedures are now performed under propofol sedation with natural airway, there has been a move toward using similar Monitored Anesthesia Care (MAC) for select patients who require endoscopic removal of an EFB. In this single-center retrospective cohort study, we compared endoscopic EFB removal with either MAC or endotracheal intubation. Descriptive statistics summarized factors stratified by initial choice of airway technique, including intra- and postanesthesia complications and the frequency of mid-procedure conversion to endotracheal intubation in those initially managed with MAC. To demonstrate the magnitude of associations between these factors and the anesthesiologist's choice of airway technique, univariable Firth logistic and quantile regressions were used to estimate odds ratios (95% CI) and beta coefficients (95% CI). From the initial search, 326 patients were identified. Among them, 23% (n = 75) were planned for intubation and 77% (n = 251) were planned for MAC. Three patients (0.9%) who were initially planned for MAC required conversion to endotracheal intubation after induction. Two (0.6%) of these children were admitted to the hospital after the procedure and treated for ongoing airway reactivity. No patient experienced reflux of gastric contents to the mouth or dislodgement of the foreign body to the airway, and no patient required administration of vasoactive medications or cardiopulmonary resuscitation. Patients had higher odds that the anesthesiologist chose to utilize MAC if the foreign body was a coin (OR, 3.3; CI, 1.9-5.7, p < .001) or if their fasting time was >6 h. Median total operating time was 15 min greater in intubated patients (11 vs. 26 min, p < .001). This study demonstrates that MAC may be considered for select pediatric patients undergoing endoscopic removal of EFB, especially those who have ingested coins, who do not have reactive airways, who have fasted for >6 h, and in whom the endoscopic procedure is expected to be short and uncomplicated. Prospective multi-site studies are needed to confirm these findings.

A Case of Gastric Contents Reflux Aspiration during General Anesthesia Induction in A Patient with Femoral Vein Atrial Septal Defect Closure

Background: Aspiration of gastric contents during the induction of general anesthesia remains a significant cause of mortality and morbidity in anesthesia. We report an 18-year-old patient with a closed atrial septal defect who developed gastric content reflux aspiration and severe aspiration pneumonia despite abstaining from drinking and fasting for more than 12 hours. Case Presentation: An 18-year-old female patient with congenital heart disease (atrial septal defect) had no previous history of gastroesophageal reflux. After fully abstaining from drinking and fasting (more than 12h), conventional anesthesia was induced, and after the patient’s spontaneous breathing and consciousness disappeared, the patient was assisted with mandibular support with both hands and mask pressure. The induction process was smooth. When preparing for intubation, a large amount of yellow fluid was found in the patient’s mouth. Intubation was performed immediately after suction. Aspiration pneumonia still occurs after the operation even if the patient is treated promptly. Conclusions: As the incidence of perioperative pulmonary aspiration is relatively low, precautions to prevent aspiration tend to be overlooked. We should be alert to the complications of gastric contents regurgitation aspiration in patients with sufficient abstention and fasting during general anesthesia intubation.

GERD Symptoms Often Improve After Magnetic Sphincter Augmentation (MSA) Device Removal – an Observational Study

Gastroesophageal reflux disease (GERD) affects over 60 million people, more than 20% of the United States population [1]. Treatments include dietary restrictions, behavior modifications, medications, endoscopic therapeutics or surgery. Long term, untreated reflux may lead toward Barrett’s esophagus, esophageal cancer and benign intrinsic strictures resulting in varying degrees of dysphagia. Strictures of the distal esophagus, however, have also been artificially created in order to reduce reflux of gastric contents back into the esophagus. Procedures such as Stretta RFA, Enteryx bulking injections and HALO ablations have had mixed results in successfully managing GERD by way of generating fibrosis at the distal esophagus [2,3].

Gastroesophageal Reflux Disease: Pathophysiology and New Treatment Trends.

Gastroesophageal reflux disease (GERD) is caused by the reflux of gastric contents into the esophagus due to a decline in esophageal clearance and anti-reflux barrier mechanisms. Mucosal injury is caused by a combination of gastric juice directly damaging the esophageal mucosa and the immune and inflammatory mechanism in which inflammatory cytokines released from the esophageal mucosal epithelium cause neutrophil migration, triggering inflammation. Gastric secretion inhibitors are the first-line treatment for GERD, but they can be combined with prokinetic agents and Chinese herbal remedies. However, pharmacotherapy cannot improve anatomical problems or prevent physical causes of GERD, such as reflux of non-acidic contents. Therefore, surgery can be warranted, depending on the pathology. Intraluminal endoscopic therapy, which is both less invasive and more effective than surgery, was recently developed and applied in Europe and the United States. In Japan, intraluminal endoscopic therapies, such as anti-reflux mucosectomy, anti-reflux mucosal ablation, and endoscopic submucosal dissection, for GERD have been independently developed.

Oestrogen and Gastroesophageal Reflux Disease Dynamics in Premenopausal and Postmenopausal Women: A Cross-sectional Study

Introduction: Gastroesophageal Reflux Disease (GERD) is a common clinical disorder characterised by the reflux of stomach contents into the oesophagus, primarily due to the temporary relaxation of the Lower Oesophageal Sphincter (LES). The aetiology of GERD is multifactorial. The prevalence of GERD in females has been found to sharply increase throughout the postmenopausal period compared to the reproductive phase. Aim: To study the relationship between serum oestrogen levels in premenopausal and postmenopausal women with GERD. Materials and Methods: In this cross-sectional study, 60 patients with GERD were divided into 30 premenopausal and 30 postmenopausal groups. The study subjects underwent high-resolution oesophageal manometry. The Cobas e 411 immunoassay analyser was utilised to measure serum oestrogen levels through electrochemiluminescence. The independent, unpaired Student's t-test was employed to analyse the collected data. Results: The statistical analysis revealed that the mean reduced LES pressure of 9.76±3.80 mmHg and the mean reduced Oesophagogastric Junction Contractile Integral (EGJ-Cl) of 14.503±10.64 mmHg were lower in women with postmenopausal GERD who exhibited lower oestrogen levels compared to those with premenopausal GERD. An increase in LES pressure was also associated with an increase in EGJ-CI, demonstrating a statistically significant positive linear correlation between LES pressure and EGJ-CI. The p-value &lt;0.05 was deemed highly statistically significant. Conclusion: Parameters such as basal LES pressure and EGJCl were observed to be reduced in postmenopausal women with GERD who had low oestrogen levels. This study suggests that oestrogen plays a crucial role in safeguarding the oesophageal epithelium against the reflux of gastric contents.

Investigating the Mechanisms Underlying U46619-Induced Contraction on Porcine Lower Esophageal Sphincter.

Gastroesophageal reflux disease (GERD) is associated with an incompetent lower esophageal sphincter (LES), resulting in the reflux of gastric contents into the esophagus. U46619, a thromboxane A2 (TXA2) receptor agonist, induces contractions in various smooth muscles. Therefore, this study aimed to investigate the effects and mechanisms of action of U46619 on the porcine LES. To achieve this, contractions of the clasp and sling strips of the porcine LES, induced by U46619, were measured using isometric transducers. Furthermore, the contractile mechanism of U46619 in the porcine LES was investigated by pretreating the strips with atropine (a muscarinic receptor antagonist), tetrodotoxin (a neuronal sodium channel blocker), nifedipine (a calcium channel blocker), and Ca2+-free Krebs-Henseleit solution. Additionally, reverse transcription polymerase chain reaction (PCR) and immunohistochemistry (IHC) were performed to determine the presence of the TXA2 receptor in porcine LES. The results of this study demonstrated that U46619 caused marked concentration-dependent contractions in both porcine sling and clasp strips. The mechanism of U46619-induced contraction of the porcine LES was found to be related to calcium channels. Furthermore, the reverse transcription PCR analysis and IHC revealed that the TXA2 receptor was expressed in the clasp and sling fibers of porcine LES. Consequently, this study suggests that U46619 mediates the contraction of porcine LES through calcium channels and has potential as a therapeutic approach for treating GERD. SIGNIFICANCE STATEMENT: This study establishes that U46619 induces concentration-dependent contractions in porcine LES, primarily mediated by calcium channels. The presence of the TXA2 receptor in LES clasp and sling fibers is confirmed. These findings highlight U46619's potential as a GERD therapeutic by targeting calcium channels for LES contraction modulation.

Patterns of diet‐related practices and symptoms of gastroesophageal reflux among high school students: A cross‐sectional study

Background: GERD is a gastrointestinal motility disorder characterized by the reflux of gastric contents into the esophagus, causing typical symptoms such as heartburn (a burning sensation in the epigastric region), acid regurgitation (a bitter taste in the mouth), nausea, and dysphagia, which can lead to esophageal mucosal damage. Over the long term, it can result in complications like Barrett's esophagus. The prevalence of GERD in Asia was approximately 2.5%-7.8% in 2014, generally lower compared to Western countries. However, recent data indicates an increasing prevalence. Poor dietary patterns, such as irregular eating habits, consuming low-nutrient foods, excessive or insufficient food intake, can elevate gastric acid production and affect an individual's health.Purpose: To determine the relationship between dietary patterns and symptoms of Gastroesophageal Reflux Disease (GERD) among vocational high school students.Method: A quantitative study was applied using correlation analysis with a cross-sectional study approach. The research was conducted at Vocational High School Bojonegoro in January 2023. The study population comprised 305 students in grade 12. The sampling technique employed was purposive sampling, with a sample size of 74 respondents. The measurement tool for dietary pattern variables was the FFQ questionnaire, and GERD symptoms were assessed using the GERD-Q questionnaire. Data analysis techniques included univariate analysis to describe the frequency distribution of each variable and bivariate analysis using the chi-square test to determine the relationship between dietary patterns and GERD symptoms among students.Results: Poor dietary patterns were found to cause GERD in 47 (97.9%) respondents, whereas good dietary patterns significantly minimized GERD; only 1 (2.1%) respondent experienced GERD symptoms in this study. The research resulted a value of ρ = 0.000 &lt; α (0.05), indicating that the ρ value in this study was less than α (0.05) or below 0.05; thus, H0 was rejected. It can be concluded that there is a relationship between dietary patterns and GERD symptoms, with a correlation coefficient value of 0.542 (moderate) and a positive correlation direction.Conclusion: There is a significant relationship between dietary patterns and GERD symptoms. The correlation coefficient analysis also showed a figure of 0.542 (moderate) with a positive correlation direction, indicating that better dietary patterns lead to fewer respondents suffering from GERD.Suggestion: It is advisable for students to avoid consuming spicy foods, fast food, fried food, and high-sugar food or beverages. They should pay more attention to a balanced diet and timely meals. Additionally, the school authorities are encouraged to establish regulations or advisories to cafeteria owners to refrain from providing fast food, nutritionally poor food, carbonated drinks, spicy food, and other items that may contribute to digestive problems among students.

Atractylenolide III ameliorated reflux esophagitis via PI3K/AKT/NF-κB/iNOS pathway in rats

Reflux esophagitis (RE), an esophageal inflammation caused by reflux of gastric contents, often damages the lower esophagus, seriously affecting the quality of life of patients. This study aims to investigate the therapeutic effects and underlying molecular mechanisms of atractylenolide III (ATL III) on RE model rats. In this research, the RE rat model is established sequentially following hemipyloric ligation, cardia transection, and hydrochloric acid perfusion. Further, the RE-induced rats are intragastrically administrated with ATL III (0.6, 1.2, and 2.4 mg/kg/D) for 28 days to evaluate ATL III therapeutic effects. To study the molecular mechanism, RE rats are treated with a phosphoinositide-3 kinase (PI3K) agonist (740 Y–P) combined with ATL III. The histopathological changes in the esophagus are eventually observed by hematoxylin & eosin (H&E) staining. In addition to changes in gastric pH and levels of reactive oxygen species (ROS), enzyme-linked immunosorbent assay (ELISA) and Western blot analyses are used to detect the expression levels of tumor necrosis factor-α (TNF-α, mmol/L), interleukin (IL)-8, IL-6, IL-1β in the esophageal tissues. As a result, the lesions in the esophageal tissues of RE rats are alleviated, decreasing the macroscopic observation scores of the esophageal mucosa after ATL III treatment,. The experimental results indicated significantly increased pH value of the gastric contents and reduced ROS, thiobarbituric acid reactants (TBARS), TNF-α, IL-8, IL-6, and IL-1β levels, as well as expression levels of p-PI3K, p-AKT, iNOS, and nuclear NF-κB proteins in esophageal tissues. In conclusion, the study indicated that ATL III could efficiently treat RE in rats by inhibiting oxidative stress and inflammatory damage through the PI3K/AKT/NF-κB/iNOS pathway.

Health significance of body position during sleep - literature review

Introduction: Sleep is a fundamental biological need of the body, crucial for maintaining health and body’s regeneration. The body position during sleep not only affects sleep quality and well-being but also influences various health aspects, such as obstructive sleep apnea, back pain or gastroesophageal reflux. Aim of the study: The aim of our study is to summarize the impact of body position during sleep on human health. We paid attention to the relationship between sleep position and aspects like: sleep quality, obstructive sleep apnea, back pain and gastroesophageal reflux. State of knowledge: The body position during sleep is crucial for maintaining mental and physical health. It affects sleep quality as well as health aspects such as: obstructive sleep apnea, back pain or gastroesophageal reflux disease. In the case of sleep quality, the most beneficial position is on the right side. The supine position is associated with worsened obstructive sleep apnea, while on the side - with reducing the frequency of symptoms. Neck pain is connected with an asymmetrical side and an upright head position, while lower back pain is associated with a supine position. The described position that reduces the reflux of gastric contents into the esophagus, and thus reduces the symptoms of reflux disease, is on the left side and with an elevated head of the bed. Summary: Sleep position is significant for many aspects of human health. Besides affecting sleep quality and well-being, it also has an impact on conditions such as obstructive sleep apnea, back pain and gastroesophageal reflux.

Assessment of Ventricular Arrhythmias Risk in Gastroesophageal Reflux Disease Patients

Abstract Gastroesophageal reflux disease (GERD) is characterized by acid regurgitation and epigastric burning that occur as the result of reflux of gastric content into the esophagus. Disturbances in the autonomic nervous system (ANS) were observed in patients with GERD. The evidence suggests that chronic GERD can cause an autonomic response, which results in ventricular arrhythmias (VAs). Our aim in the study is to examine T wave peak-to-end interval (TpeI) and the TpeI/QT ratio as highly sensitive gauges of ventricular repolarization anomalies and VAs potential in patients with GERD. In our study, The ECG measurements of both GERD and control groups are as follow; The QT wave dispersion (QTd) and corrected QT dispersion (cQTd) were higher in patients with GERD in comparison to controls (p = 0.002 and P = 0.09, respectively). Moreover, TpeI, corrected TpeI (cTpeI), and the TpeI/QT ratio were increased in patients with GERD in comparison to controls (p &amp;lt; 0.001, p = 0.018, and p &amp;lt; 0.001, respectively). We can conclude that patients with GERD may have an increased risk for VAs, and the VAs risk in patients with GERD can be predicted by measuring TpeI and the TpeI/QT ratio, which are the indicators of ventricular repolarization anomalies.

Gastroesophageal reflux disease in bronchial asthma: What we need to know?

Gastroesophageal reflux disease (GERD) is most common disease with variable presentation from asymptomatic to frank symptomatic disease having impact on various respiratory disease such as cough, bronchitis, bronchial asthma, chronic obstructive pulmonary disease, and interstitial lung diseases. GERD is defined by retrograde reflux of gastric contents to the esophagus leading to various signs and symptoms that range from heartburn/ regurgitation to the development of extraesophageal respiratory syndromes like asthma. Bronchial asthma and GERD are more common diseases and usually reported more frequently as “two side sides of same coin.” GERD has been associated with a causal link for asthma, worsening of asthma control, one of the causes for refractory asthma, and a main factor in asthma cases with recurrent asthma exacerbation. Asthma itself and medicines used for the treatment of asthma are associated with GERD, worsening of GERD and one of the causes for refractory GERD. However, asthmatics have been found to have a much greater prevalence of GERD symptoms than the general population. There remains debate regarding the underlying physiologic mechanism of this relationship and whether treatment of GERD actually translates into improved asthma outcomes. The clinical prevalence of the two conditions in many patients cannot be ignored, and multiple theories highlighting plausible pathogenic explanations for these associations have been described. The treatment of symptomatic GERD in patients with asthma is important to control the underlying GERD and should be undertaken based on current guidelines for the treatment of the GERD.

Relationship between Degrees of Severity Gastroesophageal Reflux Disease (Gerd) with Quality of Life

Background. Gastroesophageal reflux disease (GERD) is a pathological condition caused by the reflux of gastric contents into the esophagus, with symptoms that appear inside and outside the esophagus which can reduce the patient's quality of life. The aim study is to analyze the relationship between the severity of GERD and the quality of life of students Faculty of Medicine at Universitas Sumatera Utara (USU) in 2019 and 2020. Method. Cross-sectional research with a sampling technique in the form of total sampling. Data collection was carried out using an online questionnaire in the form of a Google form with an assessment using the GERD Questionnaire (GerdQ), Frequency scale for the symptoms of GERD (FSSG), Gastroesophageal reflux disease-health related quality of life questionnaire (GERD-HRQL), and the 20-item self-reporting questionnaire (SRQ-20). After that, the data that has been collected will be tabulated. This study used bivariate analysis, with the Chi-square test and the Fisher Exact Test. Results. The total number of samples that met the inclusion and exclusion criteria of the study was 225 people with 41 people with GERD (18.2%) suffering from GERD. Of the 41 Students of the Faculty of Medicine from USU in 2019 and 2020 with GERD, 29 people (70.7%) had a good quality of life, and the remaining 12 people (29.3%) had a bad quality of life. There is a relationship between GERD and gender and psychological stress. In addition, there is a relationship between quality of life and the severity of GERD, psychological stress, and drinking alcohol, but there is no relationship between quality of life and gender, smoking habits, and BMI. Conclusion. Most Medical School Students have a good quality of life, and there is a significant relationship between the severity of GERD and the quality of life.

Gastro‑oesophageal reflux disease in liver cirrhosis: Possible pathogenesis and clinical intervention (Review).

Oesophageal variceal bleeding is a common complication of decompensated liver cirrhosis (LC). Some studies have reported that reflux oesophagitis (RE) is a risk factor for upper gastrointestinal bleeding, and greatly impacts the quality of life. However, the frequency and mechanism of gastro-oesophageal reflux disease (GERD) in LC remain unclear. The present review explored the possible pathogenesis, and analysed the advantages and disadvantages of the interventional measures and the need for implementation of these measures. By combining the comprehensive terms associated with LC, GERD and RE, EMBASE, Medline/PubMed and the Cochrane Library were systematically searched. The underlying pathological mechanism of GERD in LC was summarized: Transient relaxation of the lower oesophageal sphincter, delayed gastric emptying, increased intra-abdominal pressure, increased intragastric pressure and excessive nitric oxide production destroyed the 'anti-reflux barrier', causing gastric content reflux. Proton pump inhibitors (PPIs) have been widely used empirically to lower the risk of oesophageal venous rupture and bleeding. However, long-term use of acid inhibitors in patients with LC may induce complications, such as spontaneous bacterial peritonitis. The metabolic half-life of PPIs is prolonged in patients with severe liver function impairment. Therefore, the indications for using acid inhibitors lack clarity. However, after endoscopic oesophageal variceal eradication, additional benefits may be gained from the long-term use of PPIs in small doses.