Severe Gastroesophageal Reflux Disease Research Articles

Association between Helicobacter pylori, reflux and chronic rhinosinusitis: a systematic review.

The prevalence, role, and clinical relevance of Helicobacter Pylori (HP) in sinonasal tissues of patients with chronic rhinosinusitis remain unclear. To investigate the prevalence and clinical relevance of Helicobacter Pylori (HP) in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and without nasal polyps (CRSSNP). Three investigators conducted a PubMed, Scopus, and Cochrane Library systematic review of the prevalence and clinical relevance of HP infection in CRS patients through the PRISMA framework. A bias analysis was conducted to identify potential heterogeneity and biases across studies. Of the 42 identified studies, 20 met the inclusion criteria, accounting for 741 CRS patients and 368 controls. HP was detected in 37.1% (n = 127/342) of polyps of CRSwNP patients with the polymerase chain reaction (PCR) and 32.7% (n = 37/113) of polyp tissue with the immunohistochemistry (IHC). Controls reported a nasal PCR and IHC detection rates of 14.8% (n = 36/243) and 3.6% (n = 3/84), respectively. The HP rate did not differ between CRSwNP and CRSsNP. Among patients with CRS, the enzyme-linked immunosorbent assay testing detected blood HP antigens in 48.7% (n = 74/152) of CRS patients and 41.6% (n = 37/89) of controls. The detection of HP in polyps was associated with the severity of gastroesophageal reflux disease (GERD). There was an important heterogeneity between studies for the inclusion criteria, methods of HP detection, and reflux outcomes. Helicobacter Pylori can be detected in one-third of sinonasal tissues from patients with CRS and can be considered a biomarker of GERD. The potential role of HP in the development of CRS remains unclear. The heterogeneity between studies limits the drawing of valid conclusions.

Prevalence and Severity of Gastroesophageal Reflux Disease in Indian Children Presenting with Symptoms of Acid Reflux: A Real-world Evidence Study.

Prevalence and Severity of Gastroesophageal Reflux Disease in Indian Children Presenting with Symptoms of Acid Reflux: A Real-world Evidence Study.

Oxidative Stress and the Severity of Gastroesophageal Reflux Disease: Is There Any Correlation?

Background: Oxidative stress plays a crucial role in the inflammatory response of the oesophageal epithelium; hence, therapies that affect oxidative stress may be a new approach in GERD management. The objective is to analyze and determine the correlation between Total Oxidant Status (TOS), Total Antioxidant Status (TAS), and Oxidative Stress Index (OSI) with severity of GERD.Methods: This is an observational analytic study using a cross-sectional design,that conducted at the Endoscopic Unit of three hospitals in Surabaya, which held from June 2020 to March 2021. The 18 to 60 years old subjects who meet the GERD-Q score 8-18 and not meet the exclusion criteria undergo an endoscopic examination to determine the GERD severity and blood test. Data analysis was using the Spearman rank correlation test.Results: This study indicates that most subjects are women, with mean age 39.31±10.99 years, most are GERD grade A, the mean value of TOS, TAS, ISO respectively is 5.18±1.60, 1.58±0.18, and 3.36±1.35. The laboratory test results show insignificant different based on GERD degree. There is a non-significant positive correlation between TOS and GERD severity, a significant negative correlation between TAS and GERD severity, and a significant positive correlation between OSI and GERD severity (respectively, r = 0.121, p = 0.266 vs r = -0.323, p = 0.044 vs r = 0.345, p = 0.033).Conclusion: The TAS and OSI may be correlated to the GERD severity but still need further investigations.Keywords: Gastroesophageal reflux disease, Oxidative Stress Index, Total Oxidant Status, Total Antioxidant Status

Correlation of the Endoscopic Esophagogastric Junction Integrity with Symptomatic GERD in Patients Undergoing Work-Up for Metabolic and Bariatric Surgery.

Gastroesophageal reflux disease (GERD) is a common adverse effect after metabolic and bariatric surgery (MBS). Identifying patients with preexisting GERD is critical for preoperative planning. The American Foregut Society (AFS) recently proposed a new endoscopic classification system for objective assessment of the esophagogastric junction (EGJ) integrity, building upon the Hill classification. Grade 1 represents an intact EGJ, while grades 2, 3, and 4 represent partial, moderate, and complete disruption of the ARB. Unlike Hill classification, the AFS classification includes objective measurement of hiatal axial length and aperture diameter. The study aimed to evaluate the ability of the AFS hiatus classification to predict GERD severity using symptom questionnaires. We performed a prospective study of obese patients who underwent endoscopy as work-up for MBS. The endoscopy was evaluated for esophagitis, Barrett's esophagus, and AFS grade. All patients were also surveyed preoperatively with the GERD-HRQL, GerdQ, and RSI. The correlation between AFS grades and questionnaire scores was analyzed using Spearman's test. A total of 393 patients were included in the study. There were 81% female, with a mean age of 36 ± 10.7years and a mean BMI of 41.7 ± 7.2kg/m2. The AFS grades were distributed as follows: 11 (2.8%) patients had grade 1; 137 (34.9%) had grade 2; 162 (41.2%) had grade 3; and 83 (21.1%) had grade 4. There was a positive but weak correlation between AFS grades and all scoring systems, including GERD-HRQL (r = 0.201), heartburn (r = 0.203), regurgitation (r = 0.212), RSI (r = 0.110), and GerdQ scores (r = 0.202). However, the proportion of patients with esophagitis increased progressively with increasing grades (0% in grade 1, 2.2% in grade 2, 9.9% in grade 3, and 32.5% in grade 4, p = 0.01). The AFS hiatus classification can stratify the population with obesity based on rate of esophagitis and symptom scores. This study supports the practical utility of the AFS classification as an adjunct in the detection of patients who are at risk for GERD after MBS. Further validation studies with pH testing are needed.

Solid versus liquid pulmonary micro-aspiration of reflux disease. Does it make a difference in determining the need for intervention?

Pulmonary micro-aspiration (PMA) is a feared complication of gastroesophageal reflux disease (GORD). A novel scintigraphic test for GORD has been developed and validated. It can demonstrate contamination of the upper and lower airways by refluxate. Current observations have led to the hypothesis that prolongation in solid gastric emptying (SGE) is critical in pulmonary micro-aspiration. Standard LGE and SGE studies and the novel reflux test were evaluated in paired studies in patients with severe GORD to measure rates of PMA after each meal. Either water labeled with 99m Technetium Phyton for the LGE or a labeled egg sandwich for the solid meal was utilized. Major symptoms were noted and the cough and reflux severity index (CSI & RSI) was obtained in all patients. A total of 131 patients were enrolled (59M/72F) with age range of 21-83 years (mean: 52 years). Patients were in the overweight range for BMI (mean: 26.8). Major symptoms were bloating, nausea, belching, and dyspepsia (< 20% had heartburn). SGE was abnormal in 92% (mean 766 min) and LGE abnormal in 53% (mean 82 min). PMA was shown in 35% after the SGE and in 71% after the LGE. PMA+ patients were older. A significant correlation was found between SGE and PMA ( P < 0.00) but not LGE. The only significant symptom in the PMA group was bloating. RSI was abnormal in 64% and CSI in 46%. The majority of patients with PMA do not complain of heartburn. Bloating in patients with severe GORD should raise the possibility of gastroparesis and PMA.

Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-Types of GERD

Abstract Background Gastroesophageal reflux disease (GERD) is a prevalent condition characterized by the troublesome reflux of stomach contents into the esophagus, significantly impacting the quality of life. Pepsin, a protease originating from the stomach, has been implicated in the pathogenesis of GERD and can serve as a potential biomarker for objective assessment. Patients and Methods In this cross-sectional observational study, 45 patients with GERD and 45 healthy volunteers as a control group were examined. Clinical evaluations, laboratory tests, and salivary pepsin measurements were conducted, and esophagogastroduodenoscopy was performed. Results The study revealed a statistically significant increase in body mass index (BMI) among GERD patients (32.2 ± 3.9 kg/m²) compared to the control group (27.8 ± 2.4 kg/m²). Smoking was identified as a significant risk factor for GERD, with 44.5% of GERD patients being smokers compared to 24.4% in the control group. Salivary pepsin levels were significantly higher in GERD patients (108.5 ± 46.6 ng/ml) compared to the control group (24.4 ± 9.9 ng/ml). Additionally, a significant correlation was observed between salivary pepsin levels and the Los Angeles classification of GERD severity. Conclusion This study indicates that obesity negatively impacts esophageal function and smoking is a significant risk factor for GERD. Salivary pepsin levels are significantly elevated in GERD patients and show a strong correlation with GERD severity as classified by the Los Angeles classification system. Salivary pepsin holds promise as a non-invasive biomarker for GERD diagnosis and monitoring.

Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-Types of GERD

Abstract Background Gastroesophageal reflux disease (GERD) is a prevalent condition characterized by the troublesome reflux of stomach contents into the esophagus, significantly impacting the quality of life. Pepsin, a protease originating from the stomach, has been implicated in the pathogenesis of GERD and can serve as a potential biomarker for objective assessment. Patients and Methods In this cross-sectional observational study, 45 patients with GERD and 45 healthy volunteers as a control group were examined. Clinical evaluations, laboratory tests, and salivary pepsin measurements were conducted, and esophagogastroduodenoscopy was performed. Results The study revealed a statistically significant increase in body mass index (BMI) among GERD patients (32.2 ± 3.9 kg/m²) compared to the control group (27.8 ± 2.4 kg/m²). Smoking was identified as a significant risk factor for GERD, with 44.5% of GERD patients being smokers compared to 24.4% in the control group. Salivary pepsin levels were significantly higher in GERD patients (108.5 ± 46.6 ng/ml) compared to the control group (24.4 ± 9.9 ng/ml). Additionally, a significant correlation was observed between salivary pepsin levels and the Los Angeles classification of GERD severity. Conclusion This study indicates that obesity negatively impacts esophageal function and smoking is a significant risk factor for GERD. Salivary pepsin levels are significantly elevated in GERD patients and show a strong correlation with GERD severity as classified by the Los Angeles classification system. Salivary pepsin holds promise as a non-invasive biomarker for GERD diagnosis and monitoring.

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.

Clinical features of gastroesophageal reflux disease and erosive esophagitis: Insights from patients undergoing esophagogastroduodenoscopy in resource-limited Ethiopia.

Gastroesophageal reflux disease (GERD) is a common disease worldwide with varying clinical presentations and risk factors. Prevalence data for Africa is lacking, but an increasing trend is expected due to demographic and epidemiological transitions. Although endoscopic studies for general gastrointestinal disorders have shown some patients with erosive esophagitis (EE), no studies in Ethiopia have investigated the clinical characteristics, risk factors, and severity of GERD using esophagogastroduodenoscopy (EGD). To assess the clinical features of GERD in Ethiopian patients who underwent EGD and determine the severity and risk factors of EE. We conducted a multicenter, retrospective cross-sectional study of 221 patients diagnosed with GERD and endoscopic findings of EE at Trauma Associated Severe Hemorrhage and Amniotic Membrane Stem Cell between January 2019 and August 2022. Data were collected from electronic medical records and phone call interviews. We used descriptive statistics and binary logistic regression analysis with SPSS version 26 to identify the association between variables with a statistical significance set at P value < 0.05. The mean ± SD age of the patients was 44.8 (± 15.9) years, with a male-to-female ratio of 1.6:1. The most commonly reported symptom was epigastric pain (80.5%), followed by heartburn (43%). Los Angeles (LA)-A EE was diagnosed in 71.1% of patients, followed by LA-B (14.9%), LA-C (7.7%), and LA-D (5.9%). Multivariate analysis showed that age 50 or above, presence of bleeding, and endoscopic findings of duodenitis/duodenopathy were significantly associated with severe EE (P < 0.05). Stricture and Barrett's esophagus were observed in 4.5% and 1.36% of patients with EE, respectively. Most of the patients had milder EE with fewer complications. However, severe EE was more prevalent in older patients and those with duodenitis/duodenopathy.

Gastrointestinal dysmotility is associated with proton pump inhibitor refractory esophagitis in patients with systemic sclerosis.

Patients with systemic sclerosis present with severe gastroesophageal reflux disease, often refractory to proton-pump inhibitors (PPI) treatment. The aim of the present study was to identify factors associated with PPI-refractory esophagitis. We performed a cross-sectional study in a single-center cohort of patients diagnosed with systemic sclerosis. We included patients who underwent an esophagogastroduodenoscopy while on PPI treatment. Patients with PPI-refractory erosive esophagitis were compared with those with endoscopically normal esophageal mucosa. A total of 69 patients were included, from these, 23 patients (33%) had PPI-refractory esophagitis (Grade A, n = 11; Grade B, n = 7; Grade C, n = 2; Grade D, n = 3) and 46 (67%) had an endoscopically normal esophageal mucosa. On univariate analysis, patients with PPI-refractory esophagitis were more frequently diffuse SSc subset (43% vs 17%; p= 0.041). Evaluating gastrointestinal motility tests, neither absent esophageal contractility (39% vs 25%, p= 0.292) nor hypotensive lower esophageal sphincter (47% vs 44%, p= 0.980) were significantly associated with PPI-refractory esophagitis. Gastrointestinal dysmotility, defined as abnormal gastric emptying and/or small bowel dilated loops, was significantly associated with PPI-refractory esophagitis (66 vs 8%, p = <0.001). On a multivariate regression model to evaluate the association between motility test results adjusted for the diffuse subset, gastrointestinal dysmotility (β = 0.751, p= 0.010) was independently associated with PPI-refractory esophagitis, while absent esophageal contractility (β = 0.044, p= 0.886) or a hypotensive LES were not (β=-0.131, p= 0.663). Our findings suggest that gastric and small intestinal motor dysfunction may be an important contributor to the development of PPI-refractory esophagitis in patients with systemic sclerosis.

Long-term efficacy of total versus posterior partial fundoplication in patients with gastro-oesophageal reflux disease: a systematic review and meta-analysis.

Laparoscopic fundoplication remains the standard treatment for patients with severe gastro-oesophageal reflux disease (GORD). Multiple randomised controlled trials (RCTs) have compared the two most commonly performed surgical techniques, total and posterior partial fundoplication (Nissen [NF] and Toupet [TF]), in terms of symptom control and treatment failure in patients without subsequent dysmotility disorders. We aimed to conduct a systematic review and meta-analysis of these two techniques with regard to the long-term effect on reflux control and associated dysphagia. The MEDLINE®, Embase®, PubMed® and Cochrane Library databases were searched, and all the relevant published RCTs were shortlisted according to the inclusion criteria. The summated outcomes of long-term results relating to the recurrence of GORD and dysphagia were evaluated in a meta-analysis using RevMan software. Eight studies (all RCTs) on 1,545 patients undergoing NF or TF were eligible for inclusion in this meta-analysis. There were 799 patients in the NF group and 746 in the TF group. In the random effects model analysis, the incidence of long-term recurrence of GORD was not statistically different between the NF and TF cohorts (odds ratio [OR]: 0.69, 95% confidence interval [CI]: 0.34-1.41, z=1.01, p=0.31). However, the incidence of long-term dysphagia was statistically lower in the TF group (OR: 2.92, 95% CI: 1.49-5.72, z=3.13, p=0.002) with low between-study heterogeneity (I2=0%). The findings of this systematic review and meta-analysis on symptomatic GORD appear to be in favour of partial posterior fundoplication (TF) as the optimal treatment. It provides equivalent outcomes in reflux symptom control with a lower risk of postoperative dysphagia compared with total fundoplication (NF).

Abstract ID: 51High-Resolution Manometry Features Can Segregate Non-Severe from Severe Gastro-Esophageal Reflux Disease

Abstract ID: 51High-Resolution Manometry Features Can Segregate Non-Severe from Severe Gastro-Esophageal Reflux Disease

362. DELAY IN SOLID GASTRIC EMPTYING IS ASSOCIATED WITH SILENT REGURGITATION EVENTS, PULMONARY MICROASPIRATION AND LARYNGOPHARYNGEAL REFLUX DISEASE

Abstract Background Pulmonary micro-aspiration (PMA) is a feared complication of severe and sometimes silent gastroesophageal reflux disease (GORD). A novel scintigraphic test that shows refluxate contamination of the pharynx, upper and lower airways has recently been developed. This test and multiple observations allowed the development of a hypothesis that prolongation in solid gastric emptying (SGE) may be a more critical than delays in liquid gastric emptying (LGE) in micro-aspiration into the airways. Methods Standard LGE and SGE studies together with the novel microaspiration test were evaluated in paired studies in patients with medially resistant symptoms GORD to measure rates of micro-aspiration after each meal. Either water labelled with 99m Technetium Phytate for the LGE or a labelled egg sandwich for the solid meal was utilised. Major symptoms were noted and the cough and reflux severity index (CSI &amp; RSI) obtained in all patients. Results A total of 131 patients were included in this study (59M/72F). The age range was 21 to 83 years with a mean of 52 years. Patients were in the overweight range for body mass index (BMI), with a mean of 26.8. Major symptoms were of bloating, nausea, belching and dyspepsia as well as cough, throat clearing and globus. Less than 20% complained of heartburn. Results. SGE was abnormal in 92% (Mean 766 min) and LGE was abnormal in 53% (Mean 82 min). PMA was shown in 35% after the SGE and in 71% after the LGE. PMA positive patients were older. SGE and PMA were significantly correlated (p&amp;lt;0.00) but not LGE. The only significant symptom in the PMA group was bloating. RSI was abnormal in 64% and CSI in 46%. Conclusion The majority of patients with PMA do not complain of heartburn. Bloating in patients with severe GORD should raise the possibility of gastroparesis and PMA. Prolonged SGE may be critical in the physiology of atypical reflux and present another treatment goal with addition of pyloroplasty to anti-reflux procedure of choice.

Abstract ID: 65 Outcomes of Modified Laparoscopic Sleeve Gastrectomy with Toupet Fundoplication in Patients with Severe Obesity and Gastroesophageal Reflux Disease

Abstract ID: 65 Outcomes of Modified Laparoscopic Sleeve Gastrectomy with Toupet Fundoplication in Patients with Severe Obesity and Gastroesophageal Reflux Disease

Gastroesophageal reflux disease after laparoscopic sleeve gastrectomy

Background. GastroEsophageal Reflux Disease (GERD) is a common problem among obese and overweight people, including as a complication of bariatric surgery, Laparoscopic Sleeve Gastrectomy (LSG). Aim. To conduct a retrospective analysis of the frequency of GERD in patients with morbid obesity after laparoscopic sleeve gastrectomy. Materials and Methods. In this retrospective study, data from 152 patients who underwent LSG were analyzed. All patients were diagnosed with morbid obesity and were deemed suitable for surgery. The minimum follow-up period was twelve months. All patients were assessed preoperatively for the severity of GERD using 24-hour pH monitoring, and upper gastrointestinal tract examination via FibroGastroDuodenoScopy (FGDS) to identify signs of reflux disease, esophagitis and Barrett's esophagus and GERD-HRQL (Health-Related Quality of Life) questionnaire. Results. During the study, out of 152 patients without GERD (DeMeester Index (DMI) was 6.87±3.38), 23 (15.1%) of them within 12 months after LSG developed de novo GERD (DMI 9.12±8.87, p=0.04). In four patients with de novo GERD, esophagitis grade A was detected. The pathomechanism of GERD following LSG was multifactorial, caused by a combination of anatomical, physiological, and physical factors. Contributing factors included the shape of the sleeve, damage to the lower esophageal sphincter, and esophageal motility disorders. Conclusions. LSG is effective in promoting weight loss, but poses a significant risk of developing GERD. Our study found a 15.1% incidence of GERD after LRH, which is lower than other studies, probably due to the routine use of 24-hour pH monitoring to identify patients with asymptomatic GERD. Anatomical changes due to LSG, in particular resection of the gastric fundus and dissection in the area of the angle of His, increase the temporary relaxation of the lower esophageal sphincter, contributing to the development of GERD. Keywords: bariatric surgery, morbid obesity, GERD.

Gastroesophageal reflux disease after laparoscopic sleeve gastrectomy

Background. GastroEsophageal Reflux Disease (GERD) is a common problem among obese and overweight people, including as a complication of bariatric surgery, Laparoscopic Sleeve Gastrectomy (LSG). Aim. To conduct a retrospective analysis of the frequency of GERD in patients with morbid obesity after laparoscopic sleeve gastrectomy. Materials and Methods. In this retrospective study, data from 152 patients who underwent LSG were analyzed. All patients were diagnosed with morbid obesity and were deemed suitable for surgery. The minimum follow-up period was twelve months. All patients were assessed preoperatively for the severity of GERD using 24-hour pH monitoring, and upper gastrointestinal tract examination via FibroGastroDuodenoScopy (FGDS) to identify signs of reflux disease, esophagitis and Barrett's esophagus and GERD-HRQL (Health-Related Quality of Life) questionnaire. Results. During the study, out of 152 patients without GERD (DeMeester Index (DMI) was 6.87±3.38), 23 (15.1%) of them within 12 months after LSG developed de novo GERD (DMI 9.12±8.87, p=0.04). In four patients with de novo GERD, esophagitis grade A was detected. The pathomechanism of GERD following LSG was multifactorial, caused by a combination of anatomical, physiological, and physical factors. Contributing factors included the shape of the sleeve, damage to the lower esophageal sphincter, and esophageal motility disorders. Conclusions. LSG is effective in promoting weight loss, but poses a significant risk of developing GERD. Our study found a 15.1% incidence of GERD after LRH, which is lower than other studies, probably due to the routine use of 24-hour pH monitoring to identify patients with asymptomatic GERD. Anatomical changes due to LSG, in particular resection of the gastric fundus and dissection in the area of the angle of His, increase the temporary relaxation of the lower esophageal sphincter, contributing to the development of GERD. Keywords: bariatric surgery, morbid obesity, GERD.

Analysis of the Correlation Between Dynamic Characteristics and Symptoms of Gastroesophageal Reflux Disease.

To investigate the esophageal motility characteristics of gastroesophageal reflux disease (GERD) and their relationship with symptoms. We examined 101 patients diagnosed with GERD by endoscopy and divided them into 3 groups as follows: nonerosive reflux disease (NERD), reflux esophagitis, and Barrett esophagus. Esophageal high-resolution manometry and the GERD Questionnaire were used to investigate the characteristics of esophageal dynamics and symptoms. In addition, the reflux symptom index was completed and the patients were divided into 7 groups according to symptoms. We then determined the correlation between dynamic esophageal characteristics and clinical symptoms. Upper (UES) and lower (LES) esophageal sphincter pressures and the 4-second integrated relaxation pressure in the RE group were lower than those in the NERD group. The 4-second integrated relaxation pressure in the Barrett esophagus group was also lower than that in the NERD group. In the analysis of extraesophageal symptoms, high-resolution manometry showed significant differences in UES pressures among all groups. Further subgroup analysis showed that compared with the group without extraesophageal symptoms, the UES pressure of the groups with pharyngeal foreign body sensation, throat clearing, and multiple extraesophageal symptoms was lower. As GERD severity increases, motor dysfunction of the LES and esophageal body gradually worsens, and the LES plays an important role in GERD development. Decreased UES pressure plays an important role in the occurrence of extraesophageal symptoms, which is more noticeable in patients with pharyngeal foreign body sensation and throat clearing.

Relationship between endoscopic gastroesophageal valve grading and mean nocturnal baseline impedance and postreflux swallow-induced peristaltic wave index in patients with gastroesophageal reflux disease.

This study aimed to investigate the relationship between endoscopic gastroesophageal valve grading and mean nocturnal baseline impedance (MNBI) and postreflux swallow-induced peristaltic wave index (PSPWI) in patients with gastroesophageal reflux disease (GERD). A total of 120 patients diagnosed with GERD disease were included in the study. According to the classification of endoscopic gastroesophageal valves, the patients were divided into 5 groups, group 1 as baseline group, and Group 2-4 as Hill grade I-IV. Basic information about the patients was collected, including age and gender. The mean nocturnal baseline impedance and creep wave index induced by swallowing after rumination were measured by high resolution creep measurement technique. Through statistical analysis, the relationship between valve classification and observation index was discussed. In terms of MNBI, impedance values gradually decreased with increasing valve classification. The average impedance of the Grade 1 group was 23.5 mm Hg/cm2, while the average impedance of the Grade 5 group was 15.2 mm Hg/cm2. This reduction showed a significant decreasing trend (P < .001). In addition, in terms of the peristaltic wave index caused by swallowing after regurgitation, the peristaltic wave index gradually increased with the increase of valve classification. The mean index in the Grade 1 group was 1.8 beats/min, while the mean index in the Grade 5 group was 3.6 beats/min. This increase showed a significant positive relationship (P < .001). Endoscopic gastroesophageal valve grading was significantly correlated with MNBI and PSPWI in patients with GERD. These observations can serve as useful tools for assessing the severity of GERD and monitoring disease progression.

Prevalence and Associated Factors of Gastroesophageal Reflux Disease After Laparoscopic Sleeve Gastrectomy.

Objectives To determine the prevalence of gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) and associated factors. Methods A cross-sectional study was conducted in different regions around the Kingdom of Saudi Arabia between 2022 and 2023. The questionnaire was distributed among patients who underwent LSG at different periods, ranging from six months to more than two years. The questionnaire comprised a risk factor assessment and the GERD-Health-Related Quality of Life (GERD-HRQL) questionnaire. Results A total of 387 participants with a mean age of 35.7±10.95 were included. The study included 225 females (58.1%) and 162 males (41.9%). The mean preoperative body mass index (BMI) was 44.36±8.07 kg/m2, which decreased to 28.78±6.31 kg/m2 postoperatively. Notably, dissatisfaction with general health surged from 17 (24.6%) preoperatively to 165 (42.6%) postoperatively. Despite no significant difference in GERD-HRQL scores in the group who had preoperative symptoms,282 (72.9%) reported experiencing heartburn, and 289 (74.7%) reported bloatingpostoperatively. Postoperatively, 203 (52.5%) reported improved quality of life. Moreover, changes in BMI were strongly correlated with heartburn, dysphagia, odynophagia, and bloating. The postoperative prevalence of GERD was 355 (91.7%), with 318 (82.2%) of participants reporting new-onset symptoms. Sex (P=0.013), age (P=0.024), and hypercholesterolemia (P=0.046) were significantly associated with postoperative GERD severity. Conclusions The majority of participants developed GERD symptoms following surgery, with a significant proportion reporting new-onset symptoms. Sex, age, and hypercholesterolemia have emerged as significant factors for postoperative GERD severity.

The Milan score: A novel manometric tool for a more efficient diagnosis of gastro-esophageal reflux disease.

A definitive diagnosis of gastroesophageal reflux disease (GERD) depends on endoscopic and/or pH-study criteria. However, high resolution manometry (HRM) can identify factors predicting GERD, such as ineffective esophageal motility (IEM), esophago-gastric junction contractile integral (EGJ-CI), evaluating esophagogastric junction (EGJ) type and straight leg raise (SLR) maneuver response. We aimed to build and externally validate a manometric score (Milan Score) to stratify the risk and severity of the disease in patients undergoing HRM for suspected GERD. A population of 295 consecutive patients undergoing HRM and pH-study for persistent typical or atypical GERD symptoms was prospectively enrolled to build a model and a nomogram that provides a risk score for AET>6%. Collected HRM data included IEM, EGJ-CI, EGJ type and SLR. A supplemental cohort of patients undergoing HRM and pH-study was also prospectively enrolled in 13 high-volume esophageal function laboratories across the world in order to validate the model. Discrimination and calibration were used to assess model's accuracy. Gastroesophageal reflux disease was defined as acid exposure time >6%. Out of the analyzed variables, SLR response and EGJ subtype 3 had the highest impact on the score (odd ratio 18.20 and 3.87, respectively). The external validation cohort consisted of 233 patients. In the validation model, the corrected Harrel c-index was 0.90. The model-fitting optimism adjusted calibration slope was 0.93 and the integrated calibration index was 0.07, indicating good calibration. A novel HRM score for GERD diagnosis has been created and validated. The MS might be a useful screening tool to stratify the risk and the severity of GERD, allowing a more comprehensive pathophysiologic assessment of the anti-reflux barrier. ClinicalTrials.gov (Identifier: NCT05851482).