Severe Gastroesophageal Reflux Disease Research Articles

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 crical 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 Phytate 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.

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).

Analyzing the correlation between gastroesophageal reflux disease and anxiety and depression based on ordered logistic regression

Numerous studies have indicated a connection between psychiatric symptoms, specifically anxiety and depression, and gastroesophageal reflux. However, the precise nature of the link between the severity of gastroesophageal reflux disease and the severity of anxiety and depression remains uncertain. Here, we gathered 24-h pH monitoring data and baseline patient information from a cohort of 518 individuals. Additionally, we evaluated their psychological well-being using the Hospital Anxiety and Depression Scale. The relationship between baseline characteristics and varying degrees of anxiety, depression, and gastroesophageal reflux disease (GERD) was assessed using R software version 4.1.3 and logistic regression models. The findings indicate a statistically significant variation in anxiety levels based on gender, as well as a significant disparity in depression groups when considering age and literacy levels. Kruskal–Wallis test analysis revealed a significant positive correlation between the severity of anxiety and depression and the 24-h pH monitoring results in our patient cohort. As the anxiety and depression levels increased, the rank mean for each examination result also increased. Logistic regression modeling analysis showed that a higher anxiety level was associated with a higher level of GERD. In the presence of mild anxiety, there is a statistically significant association with a higher incidence of GERD with an odds ratio (OR) of 2.64 (95% CI 1.50, 4.64). Similarly, the moderately severe anxiety group also exhibits a causal relationship with an increased GERD incidence, with an OR of 6.84 (95% CI 3.92, 12.17). Additionally, moderate to severe depression is associated with a higher incidence of GERD, with an OR of 2.32 (95% CI 1.23, 4.37). The prevalence of GERD was greater among males compared to females (OR 2.29, 95% CI 1.51–3.49). Additionally, an elevated body mass index (BMI) demonstrated a positive correlation with the susceptibility to GERD (OR 1.07, 95% CI 1.01–1.14). Increasing age may promote the occurrence of GERD in patients. These findings may help to provide a better basis for psychological or pharmacological interventions for GERD patients with psychosomatic symptoms in the future, and provide a reference basis for clinical treatment of the disease.

Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass at 5 years (YOMEGA): a prospective, open-label, non-inferiority, randomised extension study

The multicentre randomised trial YOMEGA (NCT02139813) comparing the one anastomosis gastric bypass (OAGB) with the Roux-en-Y gastric bypass (RYGB) confirmed the non-inferiority of OAGB on weight loss outcomes at 24 months. We aimed to report weight loss, metabolic, and safety outcomes at 5 years. YOMEGA is a prospective, open-label, non-inferiority, randomised trial conducted at nine centres in France. Inclusion criteria were BMI of 40 kg/m2 or more, or 35 kg/m2 or more with comorbidities. Key exclusion criteria were severe gastro-oesophageal reflux disease or Barrett's oesophagus and previous bariatric surgery. Patients were randomly assigned (1 :1) to OAGB (one gastrojejunal anastomosis with a 200 cm biliopancreatic limb) or RYGB (with a 150 cm alimentary limb and a 50 cm biliary limb), stratified by centre, with blocks of variable size. The primary endpoint of this extension study was percentage excess BMI loss and was analysed in the per-protocol population, including patients with data who were operated on with the technique randomly assigned to them and excluding patients with major deviations from the protocol during the follow-up (change of surgical technique, death, or withdrawal of consent). Non-inferiority was concluded for the primary endpoint if the upper bound of the CI was less than the non-inferiority limit (7 percentage points). YOMEGA is registered with ClinicalTrials.gov, NCT02139813, and the 5-year follow-up of YOMEGA is registered with ClinicalTrials.gov, NCT05549271. Between May 13, 2014, and March 2, 2016, 253 patients were randomly assigned to OAGB (n=129) or RYGB (n=124), and from these patients 114 in the OAGB group and 118 in the RYGB group were included in the per-protocol analysis. In the per-protocol population, at baseline, mean age was 43·0 years (SD 10·8), mean BMI was 44·0 kg/m2 (5·6), 54 (23%) patients were male and 178 (77%) were female; 55 (27%) of 207 patients had type 2 diabetes. After 5 years, mean percentage excess BMI loss was -75·6% (SD 28·1) in the OAGB group versus -71·4% (SD 29·8) in the RYGB group, confirming non-inferiority (mean difference -4·1% [90% CI -12·0 to 3·7], p=0·0099). Remission of type 2 diabetes was similar in both groups. Nutritional status did not differ; the most common adverse event was clinical gastro-oesophageal reflux disease, occurring in 27 (41%) of 66 patients in the OAGB group versus 14 (18%) of 76 patients in the RYGB group (p=0·0030). Among serious adverse events, ten (8%) of 127 patients converted from OAGB to RYGB. 171 (68%) of 253 patients were followed up. OAGB was not inferior to RYGB regarding percentage excess BMI loss at 5 years with similar metabolic outcomes. The high rate of clinical gastro-oesophageal reflux disease after OAGB raises questions about its long-term consequences, which need to be further investigated. Medtronic.

A commentary on 'Intraoperative endomanometric laparoscopic Nissen fundoplication improves postoperative outcomes in large sliding hiatus hernias with severe gastroesophageal reflux disease: a retrospective cohort study'.

A commentary on 'Intraoperative endomanometric laparoscopic Nissen fundoplication improves postoperative outcomes in large sliding hiatus hernias with severe gastroesophageal reflux disease: a retrospective cohort study'.

Association of body mass index and blood pressure with GERD severity

Background: Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disorder characterized by the chronic reflux of stomach contents into the esophagus, leading to various symptoms and complications. Aims and Objectives: This study aims to investigate the association between body mass index (BMI), blood pressure, and GERD severity. Materials and Methods: A cross-sectional study was conducted involving 50 participants diagnosed with GERD, recruited from the Department of Medical Gastroenterology at King George’s Medical University in Lucknow, India. Data on BMI, blood pressure, and GERD severity were collected through standardized assessments. Results: It was observed that patients in the first tertile (T1) of the GERD score, as compared to their counterparts in the second and third tertiles (T2 and T3), were lower in age, smaller in height, and had lower body weight, BMI, systolic blood pressure, and diastolic blood pressure levels, but none of the associations were found to be significant statistically. Conclusion: There are significant clinical implications for knowing how blood pressure, GERD severity, and BMI relate to one another. To maximize treatment success and lower the risk of complications, health-care practitioners should think about evaluating and treating modifiable risk factors, such as obesity and hypertension, in patients with GERD. Pharmacological therapies may be used in conjunction with lifestyle adjustments such as blood pressure control, diet adjustments, and weight loss to help treat GERD symptoms and enhance overall patient health.

Does weather and time have any effect on gastroesophageal reflux disease symptoms in a sample of the Saudi community?

Objective: This study aimed to determine if there was any correlation between weather and time and their effects on gastroesophageal reflux disease (GERD) symptoms. Methods: The analytical cross-sectional study was conducted using an online questionnaire to gather information from the population of Saudi Arabia aged above 16 years. The questionnaire included questions regarding the demographic factors of the patients, the severity of GERD in patients, and whether the symptoms change depending on the weather and time of day. Results: In this study, the data were collected from 400 participants. Among the sample, 31% were aged between 16 and 25 years old and 57% were females. Furthermore, 40.0% of the patients described the severity of pain associated with GERD as moderate, while 6.7% reported having very severe pain. Considering the relation between symptoms of GERD and climate differences, it was found that morning was the last time that was reported by patients to have severe and painful reflux (15%). Moreover, almost three quarters of the participants reported having severe and painful reflux in both the summer and winter seasons (35.5% and 39.3%). Furthermore, most of the participants reported that symptoms become worse at high temperatures (36.5%) and low temperatures (36.8%). Conclusion: There was a significant relation between the symptoms of GERD and weather and time of the day. Severe symptoms of GERD were found to be reported significantly at bedtime and in extreme weather conditions (high and low temperatures). The results were not affected by the demographic factors of the patients.

Gastroesophageal reflux disease and one anastomosis gastric bypass

This review examines the incidence, diagnosis, and management of gastroesophageal reflux disease (GERD) following one anastomosis gastric bypass (OAGB), a notable concern in bariatric surgery outcomes. Through a literature review from 2010 to 2024, utilizing databases such as PubMed, Embase, and the Cochrane Library, this study collects evidence from both large scale and smaller studies that report on acid reflux post-OAGB. The aim is to provide a comprehensive overview of GERD occurrence, diagnostic methodologies, and treatment options postsurgery. The findings reveal a varied incidence rate of GERD post-OAGB, from as minimal as 0.17% to a peak of 4.1%. Diagnostic practices differ, with bile reflux predominantly identified, alongside instances of acid reflux. Management strategies primarily involve proton-pump inhibitors (PPIs), with recommended treatment durations ranging from 3 to 12 months, favoring a 6-month regimen. The study validates the importance of customizing treatment durations based on individual patient profiles and the potential implications of extended PPI use. Surgical intervention remains a last resort, reserved for severe GERD cases unresponsive to medical treatment or when significant pathological changes are evident.