Reflux Of Gastric Contents Research Articles

Matrix metalloproteinase-7 induces E-cadherin cleavage in acid-exposed primary human pharyngeal epithelial cells via the ROS/ERK/c-Jun pathway

Laryngopharyngeal reflux disease (LPRD) is caused by pharyngeal mucosal damage due to the reflux of gastric contents, including acid, pepsin, and bile juice. Our previous study has demonstrated that LPRD is associated with the cleavage of E-cadherin, which is facilitated by the acid-activated matrix metalloproteinase-7 (MMP-7); however, the mechanism by which the acid activates MMP-7 remains unclear. The purpose of this study was to investigate the mechanism by which MMP-7 is activated in the pharyngeal epithelial cells that are exposed to acid. The levels of reactive oxygen species (ROS) were measured in the epithelial cells exposed to acid. To investigate the signaling mechanism of ROS in the expression of MMP-7, the mechanism of action of the mitogen-activated protein kinase was examined. The expression of various signaling factors was determined, according to the presence or absence of each inhibitor in the acid-exposed pharyngeal epithelial cells. To identify changes in the cleavage of E-cadherin, the integrity of the mucosal membrane was assessed using a transepithelial permeability test. We found that acid exposure increased the levels of ROS, phosphorylated-extracellular signal-regulated kinase (p-ERK) 1/2, and phosphorylated-c-Jun (p–c-Jun) in pharyngeal epithelial cells. The ROS inhibitor reduced the expression of p-ERK and MMP-7, while the ERK inhibitor reduced the expression of p–c-Jun and MMP-7. Moreover, the c-Jun inhibitor reduced the expression of MMP-7 and blocked the degradation of E-cadherin. In addition, decrease in the levels of immunostained E-cadherin and increase in transepithelial permeability after acid exposure were collectively alleviated by the inhibitors of ROS, ERK, and c-Jun. The degradation of E-cadherin that occurs after human mucosal cells are exposed to acid appears to be caused by an increase in the expression of MMP-7 via the ROS/ERK/c-Jun pathway, which is thought to be an important mechanism associated with the development of LPRD.Key messages• ROS is triggered when reflux occurs.• ROS regulates the transcription factor c-Jun via the ERK pathway.• The increase in MMP-7 that induces LPRD is induced via the ROS/ERK/c-Jun pathway.• This study revealed for the first time the expression mechanism of MMP-7, which is one of the causes of LPRD.

An update on current treatment strategies for laryngopharyngeal reflux symptoms.

Laryngopharyngeal reflux (LPR) is a syndrome caused by reflux of gastric contents into the pharynx or larynx, which leads to symptoms of throat clearing, hoarseness, pain, globus sensation, cough, excess mucus production in the throat, and dysphonia. LPR is a challenging condition, as there is currently no gold standard for diagnosis or treatment, and thus this presents a burden to the healthcare system. Strategies for treatment of LPR are numerous. Medical therapies include proton pump inhibitors, which are first line, H2 receptor antagonists, alginates, and baclofen. Other noninvasive treatment options include lifestyle therapy and the external upper esophageal sphincter compression device. Endoscopic and surgical options include antireflux surgery, magnetic sphincter augmentation, and transoral incisionless fundoplication. Functional laryngeal disorders and laryngeal hypersensitivity can present as LPR symptoms with or without gastroesophageal reflux disease. Though there are minimal studies in this area, neuromodulators and behavioral interventions are potential treatment options. Given the complexity of these patients and numerous available treatment options, we propose a treatment algorithm to help clinicians diagnose and triage patients into an appropriate therapy.

Complications of gastroesophageal reflux disease: 10-year experience

Purpose: Gastroesophageal reflux disease (GERD) is a common condition of modern times resulting from chronic reflux of gastric contents into the esophagus. The cause underlying GERD involves an imbalance between noxious and protective factors of the esophageal mucosa and a functional disorder of the lower esophageal sphincter (LES). The transitional release of the LES appearing more frequently and longer than physiologically normal is the main cause for the development of GERD. The negative effects of reflux can increase by disturbed esophageal motility, which is unable to regularly clear the esophagus in esophageal motility disorders and disturbed gastric emptying in large hiatal hernias and peptic ulcers. Typical GERD symptoms include a burning sensation or pain behind the sternum, return of bitter or acidic gastric content into the esophagus, rare odynophagia and extraesophageal signs, such as non-cardiac chest pain, chronic cough, and hoarseness
 Methods: A literature revue and a review of clinical cases over a 10-year span in the Department for Thoracic Surgery University Medical Centre Maribor.
 Results: The study was also drawn from 10 years of experience with surgical treatment of GERD and its complications. The treatment of reflux esophagitis and asthma as a GERD complication is not the domain of a surgeon. Surgical treatment is indicated in passage-blocking conditions and in cases in which GERD cannot be managed with medical therapy. In the period from 2006–2015 we performed 928 surgeries to remove and prevent GERD complications.
 Conclusion: Several possible complications of GERD are known, among which the development of Barret’s esophagus as a pre-malignant condition of the esophageal mucosa and the development of glandular carcinoma of distal esophagus are especially dangerous. Therefore, a precise diagnostic treatment is necessary when treating the underlying disease of patients as the clinical picture of GERD often resembles problems related to other thoracic pathologies.

70-Year-Old Man With Chronic Nausea and Vomiting

70-Year-Old Man With Chronic Nausea and Vomiting

Post-reflux swallow-induced peristaltic wave is impaired in laryngopharyngeal and gastro-oesophageal reflux disease.

Laryngopharyngeal reflux (LPR) and gastro-oesophageal reflux disease (GORD) result from the reflux of gastric contents. The post-reflux swallow-induced peristaltic wave (PSPW) is an oesophageal reflex that facilitates chemical clearance of gastric contents following reflux events. PSPW index is a novel parameter that has been validated in assessing the effectiveness of chemical clearance in GORD, but not in LPR. This study aimed to assess chemical clearance in LPR and GORD by measuring PSPW indices in a consecutive series of patients. Reviewers blindly analysed off-therapy impedance-pH tracings from 187 patients clinically categorized as LPR (n=105) or GORD (n=82) by predominant symptom profile. Conventional impedance-pH measures and PSPW indices were analysed. Mean PSPW index in the LPR group was higher than in the GORD group (39.7% (±17.7%) vs. 20.6% (±13.4%); p<0.001). Abnormally low PSPW index (<61%) was seen in 85 (81%) of the LPR group, and 80 (97.6%) of the GORD group (p<0.001). Area under the ROC curve for PSPW index to diagnose LPR was 0.83 (95% CI: 0.767-0.889; p<0.001). Post-reflux swallow-induced peristaltic wave was impaired in patients with LPR as well as oesophageal GORD, indicating an abnormality of chemical clearance following a reflux episode in both groups. PSPW index was more severely impaired in gastro-oesophageal reflux disease (GORD). The present study shows PSPW index is useful in the diagnosis of both LPR and GORD and exposes an abnormality of clearance of the oesophagus.

Gastrointestinal Bleeds.

Gastrointestinal Bleeds.

711 POST-REFLUX SWALLOW-INDUCED PERISTALTIC WAVE IS IMPAIRED IN LARYNGOPHARYNGEAL AND GASTRO-OESOPHAGEAL REFLUX DISEASE

Abstract Laryngopharyngeal reflux (LPR) and gastro-oesophageal reflux disease (GORD) result from the reflux of gastric contents. The post-reflux swallow-induced peristaltic wave (PSPW) induces chemical clearance following reflux events. PSPW index is a novel parameter that has been validated in GORD, but not in LPR. This study aimed to assess the efficacy of chemical clearance by assessing PSPW indices in patients with LPR and GORD. Methods Reviewers blindly analysed off-therapy impedance-pH tracings from 187 patients divided into LPR (n = 105) or GORD (n = 82) by predominant symptom profile. Conventional impedance-pH measures and PSPW indices were analysed for the two groups. Results Mean PSPW index in the LPR group was higher than in the GORD group (39.7% (±17.7%) vs. 20.6% (±13.4%); p &amp;lt; 0.001). Abnormally low PSPW index (&amp;lt;61%) was seen in 85 (81%) of the LPR group, and 80 (97.6%) of the GORD group (p &amp;lt; 0.001). Area under the ROC curve for PSPW index to diagnose LPR was 0.828 (95% CI: 0.767–0.889; p &amp;lt; 0.001). The LPR group had a lower AET (1.5% vs. 8.1%; p &amp;lt; 0.001) and fewer distal reflux episodes (46.5 (±24.5) vs. 64.4 (±39); p &amp;lt; 0.001). Conclusion PSPW was impaired in patients with LPR as well as oesophageal GORD, indicating an abnormality of chemical clearance following a reflux episode in both groups. PSPW index was more severely impaired in gastro-oesophageal reflux disease (GORD). The present study shows PSPW index is useful in aiding in the diagnosis of both LPR and GORD.

Clinical Efficacy of Unani Drug in the Management of Tabkheer-I-Meda (Gastroesophageal Reflux Disease)

Tabkheer-i-meda has been described as reflux of acid from stomach in the Unani classical literatures. This disease is characterized by various symptoms like indigestion, pain in abdomen, suppression of thrust, burning sensation in the epigastrium, anorexia, nausea and acid reflux etc. In modern medicine, Gastro-esophageal Reflux Disease (GERD) is defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus or beyond, into the oral cavity (including larynx) or lungs. The objective of the present study was to evaluate the efficacy of Safoof-i-Tabkheer on the patients suffering with associated symptoms of Tabkheer-i-Meda (Gastro-esophageal Reflux Disease). Patients were advised orally 5grams of Safoof-i-Tabkheer with water twice daily after the meal. It was observed that after the treatment, all associated symptoms of Tabkheer-i-Meda/ GRED including retrosternal burning, epigastric pain acidic brash and anorexia were significantly (p&lt;0.05) reduced. The percentage reduction in retrosternal burning, acidicbrash, epigastric pain and anorexia were 53.89%, 51.56%, 48.53% and 40.65% respectively as compared to base line. No adverse effect of drug was found. Highly significant improvements (p&lt;0.001, paired t test) in all associated symptom of the disease suggest that the results are really due to the therapy. On the ground of above observation, it can be concluded that the Unani pharamacopieal formulation ‘Safoof-i-Tabkheer’ is very effective and safe in the treatment of Tabkheer-i-Meda.

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Pepsin as a biomarker for self-diagnosing reflux associated symptoms in UK and USA individuals

Background: Reflux is a common clinical complaint within the UK and USA population, often causing troublesome symptoms for example, heartburn, regurgitation and hoarseness. These symptoms are commonly associated with gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR). Procedures for diagnosing reflux are at present invasive, time consuming and in some cases not reliable, leading to many individuals seeking a quick and easy non-invasive diagnostic method for self-diagnosis. It has been shown that pepsin detection within a sputum and/or saliva sample is a sensitive, non-invasive diagnostic method for proximal reflux of gastric contents. Using pepsin as a biomarker for reflux led to the development of Peptest, which is a non-invasive, rapid diagnostic procedure used to identify pepsin within a saliva sample. The aim of this study was to show how pepsin can be used as a biomarker for reflux, using Peptest for the self-diagnosis of reflux related symptoms.

Role of Semisulcospira gottschei extract as medicinal food on reflux esophagitis in rats.

Gastroesophageal reflux disease (GERD) is a globally prevalent disease and results from a reflux of gastric contents into the esophagus. Existing synthetic drug‐based treatments for GERD have various drawbacks including refractory symptoms, relapse, or resistance due to long‐term use or may result in mucosal degeneration, polyps, and osteoporosis. Semisulcospira gottschei (SE), a freshwater snail, has been generally consumed as a food source due to its excellent flavor and nutritional value in Korea and considered to have therapeutic properties for various diseases including dyspepsia, stomachache, and hepatic diseases. The present study aims to investigate whether Semisulcospira gottschei extract (SGE) has a protective effect on reflux esophagitis‐induced rat models. The anti‐inflammatory effects of SGE were evaluated via NO production in LPS‐induced Raw 264.7 macrophage. And the protection effects of SGE were analyzed by assessing the amelioration of mucosal damage and expression of inflammation‐associated proteins in reflux esophagitis (RE) rats. Our results indicate that SGE significantly suppressed NO production in LPS‐induced raw 264.7 cells without any cytotoxicity. We observed mucosal lesions and histological changes in the esophagus of RE control rats. However, SGE treatment markedly ameliorated mucosal lesion ratio indicated through histological changes. SGE administration suppressed the expression of proteins related to inflammation, such as p‐NF‐κB, p‐IκBα, COX‐2, and TNF‐α, in esophageal tissue. Moreover, SGE elevated the expression of claudin‐5, which is a tight junction protein, involved in barrier function of epithelium and endothelium. The results suggest that SGE is useful as a medicinal food in esophagitis and may be helpful in developing effective treatment protocols for GERD.

Diagnostic work up and indications for gastro-esophageal reflux surgery

: Gastro-esophageal reflux disease (GERD) has a worldwide prevalence and presents with a broad spectrum of symptoms and various grade of severity: from mild disease to complicated disease in relation with long standing disease. Etiopathology is related to abruption of anti-reflux mechanisms, including anatomical barrier which protects by reflux of gastric content and esophageal peristalsis that cleans the reflux to avoid the exposition of esophageal mucosa to acid. Diagnosis is based primarily on typical symptoms, the presence of atypical symptoms that can be related to GERD needs additional testing, as pH-impedance monitoring and esophageal manometry. These additional tests are necessary to assess the association between pathologic reflux and the symptoms. Lifestyle interventions are recommended; to date, the proton pump inhibitors are milestone of the medical treatment and the 8-week trial is first line therapy and it is considered also as diagnostic mean. Other possible medications include histamine-receptor antagonists and neuromodulators. When medical therapy lacks in relieving symptoms, anti-reflux surgery (ARS) can be suggested after an adequate characterization of disease. The 24-hour esophageal pH-impedance monitoring allows to demonstrate the pathological reflux and the association between acid and not-acid reflux with the symptoms. The high-resolution manometry (HRM) is useful to identify esophageal major motility disorders. These tests are suggested to select patients with better outcome from surgery and to tailor the most suitable procedure for patients.

Pepsin as a biomarker for self-diagnosing reflux associated symptoms in UK and USA individuals

Background: Reflux is a common clinical complaint within the UK and USA population, often causing troublesome symptoms for example, heartburn, regurgitation and hoarseness. These symptoms are commonly associated with gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR). Procedures for diagnosing reflux are at present invasive, time consuming and in some cases not reliable, leading to many individuals seeking a quick and easy non-invasive diagnostic method for self-diagnosis. It has been shown that pepsin detection within a sputum and/or saliva sample is a sensitive, non-invasive diagnostic method for proximal reflux of gastric contents. Using pepsin as a biomarker for reflux led to the development of Peptest, which is a non-invasive, rapid diagnostic procedure used to identify pepsin within a saliva sample. The aim of this study was to show how pepsin can be used as a biomarker for reflux, using Peptest for the self-diagnosis of reflux related symptoms.

Proton pump inhibitors for the treatment of laryngopharyngeal reflux disease: A protocol for systematic review and meta-analysis.

Background:Laryngopharyngeal Reflux disease refers to abnormal reflux of gastric contents through the esophagus into the throat, which irritates and damages the pharyngeal mucosa, and causes corresponding symptoms. Proton Pump Inhibitors are an important class of gastric acid secretion inhibitors after H2 receptor blockers, which can be used clinically to treat peptic ulcer, abnormal gastric acid secretion and other related diseases. The common clinical drugs include omeprazole, lansoprazole, rabeprazole and so on. Clinical practice has shown that Proton Pump Inhibitors have a good therapeutic effect on Laryngopharyngeal Reflux disease, but evidence of evidence-based medicine is lacking. The purpose of this protocol is to systematically evaluate the efficacy and safety of Proton Pump Inhibitors in the treatment of Laryngopharyngeal Reflux disease and to improve the evidence-based basis for the clinical application of Proton Pump Inhibitors in the treatment of Laryngopharyngeal Reflux disease.Methods:English computer retrieval database (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese computer retrieval database (Wanfang Database, VIP Information Chinese Journal Service Platform, Chinese Biomedical Database) . In addition, Baidu Scholar and Google Scholar were manually searched for randomized controlled clinical studies on the treatment of laryngeal reflux disease with Proton Pump Inhibitors from the establishment of the database to July 2020. Two researchers independently extracted and evaluated the data of the included studies, and meta-analysis was conducted on the included literatures with RevMan5.3 software without language restrictions.Results:In this study, the efficacy and safety of Proton Pump Inhibitors in the treatment of Laryngopharyngeal Reflux disease are evaluated by the overall response rate, clinical symptom remission rate and other indicators.Conclusions:This study will provide reliable evidence-based evidence for the clinical application of Proton Pump Inhibitors in the treatment of Laryngopharyngeal Reflux disease.OSF Registration number: DOI 10.17605 / OSF.IO / NY6SC

Prevalence and Correlation of Laryngopharyngeal Reflux in Females with Vitamin D Deficiency in a Multi-Specialty Polyclinic in New Delhi, India

Background: Laryngopharyngeal Reflux (LPR) is a condition in which gastric content reflux into the larynx and pharynx. It is one of the extraesophageal manifestations of gastroesophageal reflux disease (GERD), involving the laryngeal regio. The laryngopharyngeal epithelium is more susceptible to reflux-related tissue injury than the esophageal epithelium. Objectives: This study aimed to test the hypothesis of whether severe vitamin D deficiency results in increased Laryngopharyngeal reflux (LPR) symptoms in Indian females. The objective was to find out the prevalence of LPR in the severe vitamin D deficient Indian female population. Methods: A descriptive observational study was done at a multispecialty polyclinic in New Delhi, India, over a period of one year. Based on a pilot study, a sample size of 185 individuals was taken. All females referring to the general outpatient department (OPD) with vitamin D levels below 20 ng/ml were included. The frequency of LPR symptoms in the study participants was assessed using the reflux symptom index (RSI) and reflux finding score (RFS) given for all symptomatic patients using a validated scoring system. The data were analyzed descriptively with Microsoft Excel and SPSS version 21 using appropriate tests. Results: In this study, 92% of the subjects aged more than 25 years, and the mean vitamin D level was 9.87 (± 3.425) ng/ml. Moreover, 74% of study participants had severe vitamin D deficiency (≤ 10 ng/ml). The mean RSI for our study participants was 14.54 (± 10.353). Also, the mean RFS was 1.77 (± 3.069). No significant correlation was established between the severity of vitamin D deficiency and RSI as well as RFS. The prevalence of LPR was 43%. Conclusions: Hypovitaminosis D does not have any effect on LPR in the Indian female population.

Gastroösophageale Refluxkrankheit – Update 2021

Gastro-oesophageal reflux disease (GORD), ahighly prevalent disease, is defined by troublesome symptoms and/or oesophageal lesions caused by reflux of gastric content. Adiagnostic gold standard does not exist. Areliable diagnosis may be difficult in individual cases. Patients' history, endoscopic findings and pH-impedance monitoring contribute to the evaluation of gastro-oesophageal reflux and its consequences. High-resolution manometry may add important information on the pathophysiology of the disease and may help to rule out motility disorders as the leading cause of the symptoms. Proton pump inhibitors (PPI) are the drugs of first choice. In patients with insufficient PPI response, optimization of PPI therapy and/or combination with drugs having another mechanism of action are the available options. If PPIs are not sufficiently effective, not tolerated, or not wished antireflux procedures may be offered in specialized centers taking pathophysiological data into account.

S0391 Black Esophagus Trends Across American College of Gastroenterology (ACG) Scientific Meetings Over a Decade: 2010–2020

INTRODUCTION: Acute Esophageal Necrosis (AEN) is a rare syndrome characterized by a diffuse necrotic black appearing mucosa preferentially affecting the distal esophagus with various proximal extensions and an abrupt demarcation at the GE junction. Its etiology is multifactorial, a combination of ischemic injury, massive reflux of gastric contents, and impaired esophageal mucosal defense systems. AEN incidence is 0.01–0.28% in selected studies, and population-based information regarding AEN is sparse. Presentation in literature is typically based on published reports, but scientific abstracts are often overlooked. We aim to present a systematic review of a large number of previously presented abstracts from 2010 to 2020 ACG annual meetings. METHODS: We identified all ACG published abstracts over the past ten years using “acute esophageal necrosis” OR “black esophagus” OR “acute necrotizing esophagitis” across databases (Figure 1). RESULTS: Amongst 89 abstracts, 97 patients were identified. Mean age was 63.68 ± 14 years, while 65% were males. Most common presenting features were hematemesis (34%), melena (22%), coffee-grounded emesis (16%), abdominal pain (11%), dysphagia (9%) and odynophagia (6%). Risk factors included diabetes mellitus (39%), CKD (33%), HTN (32%), cirrhosis (25%), alcohol use (23%), CAD (18%) and cancer (18%). Patients received an EGD within 3.41 ± 10.34 days from symptom onset. Over 95% of cases were confirmed visually on endoscopy and remaining on autopsy. Affected segments were middle-distal (34%), pan-esophageal (28%), distal (20%), middle (5%), while proximal was seen in less than 1%. Histology findings uniformly confirmed necrosis, although biopsies were not performed in 54%. Majority received medical management with PPIs (80%), antibiotics (43%), and sucralfate (12%). Patients treated medically remained NPO for 5 ± 2.52 days, with 9% receiving TPN. Follow-up endoscopies were seen in 32%, with a mean of 31.84 ± 64.95 days. Majority demonstrated significant improvement, with complete resolution in 10%, as early as 3 days. Complications included perforation (18%), strictures (5%) and infections (4%), and a mortality rate of 23%. CONCLUSION: AEN syndrome is increasingly being reported as awareness increases, with the majority of all ACG abstracts being published over the past decade. Patients with chronic diseases are more commonly afflicted. Endoscopy is diagnostic. Increased awareness of the disease may lead to a rise in prevalence.Figure 1.: PRISMA flowsheet for black esophagus trends across ACG scientific meetings from 2010 to 2020.

S1893 Black Esophagus (Acute Esophageal Necrosis) and Diabetes Mellitus: Is It Time to Reconsider Their Association?

INTRODUCTION: As awareness for Acute Esophageal Necrosis syndrome increases, so does our ability to understand its associations and causations. It classically presents as a striking necrotic appearance of black mucosa preferentially affecting the distal esophagus and extending proximally to various degrees while stopping at the GEJ. Its etiology is multifactorial and related to tissue hypoperfusion, massive reflux of gastric contents, and compromised local mucosal barriers. Historically, diabetes mellitus was seen in nearly 36% of AEN cases, although its association with hyperglycemia has never been parsed out. We aim to present a case of diabetic ketoacidosis (DKA) and review the literature with a focus on hyperglycemia and acute esophageal necrosis (AEN). CASE DESCRIPTION/METHODS: A 34-year-old female had called emergency services after experiencing coffee-ground emesis, abdominal pain, and pre-syncopal like symptoms for 5 days. She was found hypotensive, tachycardic with a blood sugar over 400 mg/dL. She was an active smoker with a history of diabetes mellitus type 1 with her last hemoglobin A1c at 16.9%. On arrival to the ED, her labs revealed blood glucose greater than 1000 mg/dL, pH of 7.1, bicarbonate <10 mEq/L, anion gap over 30 mEq/L with acute kidney injury and cystitis. She was initiated on an insulin drip and antibiotics, made NPO, and IV esomeprazole was started. Esophagogastroduodenoscopy (EGD) revealed circumferential black appearing mucosa and a necrotic complexion in the middle and distal segments (Figures 1–3). She was managed conservatively with antiacid therapy. Enteral feeds were restarted shortly, and she was discharged home. DISCUSSION: Despite growing literature revealing DKA as a common precipitant for black esophagus, a bonafide association to hyperglycemia has not been shown. A literature review across all reported cases revealed diabetes mellitus as its most common risk factor (39%). Blood glucose over 150 mg/dL was seen in 15% of all black esophagus cases, while 67% of all hyperglycemic patients had blood glucose levels over 350 mg/dL. Average hemoglobin A1c was 11.46%, and approximately 13% that met DKA criteria developed black esophagus. Cases of DKA reported unusually high glucose levels, with the highest recorded at 1294 mg/dL. The mortality amongst patients with black esophagus and hyperglycemia nears 19%, while patients that develop concomitant black esophagus and DKA, mortality is 15%.Figure 1.: Presence of severe inflammation and necrotic appearance of the esophagus.Figure 2.: Presence of severe inflammation and necrosis mainly affecting the middle and distal segments.Figure 3.: Necrotic appearance of the esophagus.

Frequency of gastroesophageal reflux disease in children with adenoid hypertrophy

ObjectivesRecent studies have suggested that the reflux of gastric contents can cause adenoid hypertrophy (AH). The frequency of gastro-oesophageal reflux disease (GERD) in this AH population is unknown, but according to studies using pH-metry it may be as high as 65%. The aim of this study was to estimate the frequency of GERD among children with AH. MethodsThis was a cross-sectional, multicentre, prospective study of children with AH selected for adenoidectomy. The diagnosis of AH was made by a single laryngologist using a flexible fiberscope. All children had 24-hr multichannel intraluminal pH-impedance (MII/pH) assessment. A GERD diagnosis was made using BioVIEW software analysis after manual review by a single investigator. Results38 consecutive patients (21 males, mean age 6.58 years) were enrolled in the study. GERD was diagnosed in 5 (13.2%) patients. A total of 1462 gastro-oesophageal reflux events (GERs) were detected by MII/pH and the majority (60.9%) were acidic. The only significant differences between the GERD-positive and GERD-negative groups were the total number of GERs, and the number of acid GERs. ConclusionIt is first study using MII/pH to assess the frequency of GERD in children with AH. The data suggest that GERD in children with AH seems to be not as common as it was previously raised. Further studies are needed to confirm these results.

The Role of Symptom Association Analysis in Gastroesophageal Reflux Testing.

Gastroesophageal reflux disease is characterized by the reflux of gastric contents into the esophagus with an estimated worldwide prevalence of 8%-33%. The current paradigm in gastroesophageal reflux disease diagnosis relies on recognition of symptoms and/or the presence of mucosal disease at the time of esophagogastroduodenoscopy. Recognition of symptoms, however, can arise with challenges, particularly when patients complain of less typical symptoms. Since first reported in 1969 by Spencer et al., the application of prolonged intraesophageal pH monitoring to identify pathologic reflux has evolved considerably. Utility of pH monitoring aims to investigate the degree of acid burden and frequency of reflux episode, and the relationship between symptoms and acid reflux events. This relationship is represented by either the Symptom Index, Symptom Sensitivity Index, Symptom Association Probability, or Ghillebert Probability Estimate. This article reviews symptom-association analysis during esophageal reflux testing, covering the literature on current methods of reflux testing, interpretation of symptom association, and practical issues that can arise during symptom analysis.