Study Of Gastroesophageal Reflux Disease Research Articles

Mendelian randomization study of gastroesophageal reflux disease and major depression.

This study systematically investigated the causal relationship between gastroesophageal reflux disease (GERD) and major depression (MD). Single-nucleotide polymorphisms (SNPs) associated with disorders of interest were screened via the genome-wide association study (GWAS) enrolling individuals of European descent. Summary-level data for GERD and MD were extracted from the UK Biobank. The inverse-variance-weighted (IVW) method was utilized as the primary analysis. Sensitivity analyses were performed using the MR-Egger method, the Maximum likelihood method, the MR-pleiotropy residual sum outlier (MR-PRESSO) method, and MR-robust adjusted profile score (MR-RAPS) method. MR-Egger regression, heterogeneity tests, pleiotropy tests, and leave-one-out tests were also performed to analyze sensitivity. The MR Steiger test was used to verify the directionality of the exposure to the outcome. An available website tool (https://shiny.cnsgenomics.com/mRnd/) was used to calculate the statistical power of MR analysis. Meta-analysis was applied to test MD's average genetically predicted effect on GERD. Our MR study showed a bidirectional causal association between MD and GERD. Regarding MD to GERD, there was a positive association between them; the ORs were 1.500 (95% CI = 1.320-1.704; P = 4.91E-10) and 2.058 (95% CI = 1.868-2.267; P = 2.20E-48) in the IVW method, respectively. In addition, the meta-analysis also showed a strong positive causal association between MD and GERD. When exposure and outcome were reversed, genetic predisposition to GERD was significantly associated with the overall Risk of advanced MD (ieu-a-1187, OR = 1.982, 95% CI = 1.694-2.319, P = 1.41E-17; ieu-b-102, OR = 1.612, 95% CI = 1.530-2.700, P = 1.15E-70). Our study provides 100% power to detect the causal effect of MD on GERD and vice versa. Genetically predicted MD was positively associated with higher GERD risk, and vice versa. Our study reminds clinicians to pay attention to screening for GERD when diagnosing and treating MD and vice versa. Moreover, there may be positive feedback between MD and GERD when treating and preventing one disorder may benefit the treatment and prevention of the other.

A urine and serum metabolomics study of gastroesophageal reflux disease in TCM syndrome differentiation using UPLC-Q-TOF/MS

Gastroesophageal reflux disease (GERD) is a common, chronic and complex upper gastrointestinal disease. In Traditional Chinese medicine (TCM) theory, GERD is classified into two main types: stagnant heat of liver and stomach (SHLS) and deficient cold of spleen and stomach (DCSS). The discovery and evaluation of potential biomarkers for different syndrome types of GERD may contribute to comprehend specific molecular mechanism and identify new targets for diagnosis and appropriate management. In our study, 60 subjects including 40 GERD patients (20 SHLS and 20 DCSS) and 20 healthy controls were recruited, and the serum and urine metabolic profiles from untargeted liquid chromatography coupled to mass spectrometry (LC-MS) metabolomics approach were obtained. Finally 38 biomarkers associated with disease were identified and 9 metabolic pathways were enriched. The most enriched pathways were amino acid metabolism, steroid hormone biosynthesis, glycerophospholipid metabolism, sphingolipid metabolism and TCA cycle. According to the area under curve (AUC) value, we propose a cohort of three metabolites from urine and serum samples as promising biomarkers for TCM syndrome differentiation of GERD, which are prolylhydroxyproline, glycitein-4′-O-glucuronide, capsianoside I in urine and neuAcalpha2–3Galbeta-Cer (d18:1/16:0), sphinganine, arachidonic acid in serum. The cumulative AUC value of merged biomarkers in urine and serum was 0.979 (95%CI 0.927–1) and 0.842 (95%CI 0.704–0.980), respectively. The results indicated that LC-MS based metabolomic profiling method might be an effective and promising tool on further pathogenesis discovering of GERD. The findings provided new strategy for the diagnosis of GERD TCM syndrome differentiation in clinic.

Impact of Participation of Surgeons in Diagnostic Studies of Gastroesophageal Reflux Disease on Completion of Workup and Utilization of Antireflux Surgery.

Introduction. Patients presenting with symptoms of gastroesophageal reflux disease (GERD) are usually evaluated by gastroenterologists who perform the diagnostic workup and determine when to refer for surgical consideration. The multiple diagnostic studies can be overwhelming, and this leads to dropouts. In a rural setting, without gastroenterology services, the surgeon can diagnose GERD and perform antireflux procedures. This study aimed to assess the completion of the required diagnostic studies and progression to surgical intervention. Methods. This is a retrospective chart review of patients who presented with GERD symptoms between August 2015 and January 2018. Standardized workup included the upper gastrointestinal study and esophagogastroduodenoscopy with concomitant wireless pH placement. High-resolution impedance manometry and the gastric emptying scan were selectively utilized. Results. 429 patients were evaluated. Proton pump inhibitors were used by 82.2% of patients. The required diagnostic workup was completed by 92.7% of all patients. Nearly 75% were suitable candidates for antireflux surgery. Approximately 2/3 of these patients proceeded with antireflux surgery. Discussion. The lack of gastroenterology services in rural hospitals provides a unique opportunity for general surgeons to diagnose and treat GERD patients locally. This avoids fragmentation of care and enables the surgeon to evaluate the entire spectrum of GERD. This structured approach results in increased completion of multiple diagnostic studies. Moreover, surgical candidates are likely to proceed with surgical intervention. Conclusion. A surgical antireflux program with diagnostic and therapeutic capabilities results in increased completion of diagnostic workup and utilization of antireflux surgery.

Epidemiological study of gastroesophageal reflux disease (GERD) in children aged 8-12 years of Darbhanga

Epidemiological study of gastroesophageal reflux disease (GERD) in children aged 8-12 years of Darbhanga

Treatment of Non-erosive Effect of Clinical Study of Gastroesophageal Reflux Disease

<p class="18">Abstract: Objective: To observe the clinical effect of “Chaihu Shugan Powder Zuojin Pill” in the treatment of non-erosive gastroesophageal reflux disease. Methods: Sixty patients with non-erosive gastroesophageal reflux disease were randomly divided into treatment group and control group (30 cases in each group). The patients were treated with “Zaohu Shugan Powder” and “Zangjin Pills” and omeprazole respectively. For 8 weeks, the clinical efficacy and changes in clinical symptoms were observed. Results: The total effective rate was 93.3% in the treatment group and 80.0% in the control group. There was significant difference between the two groups before and after treatment (P <0.05). Conclusion: “Chaihu Shugan Powder Zuojin Pill” can effectively improve the clinical symptoms of non-erosive gastroesophageal reflux disease.</p>

Histologic Features Associated With Columnar-lined Esophagus in Distal Esophageal and Gastroesophageal Junction (GEJ) Biopsies From GERD Patients: A Community-based Population Study.

There are inherent problems with the endoscopic and pathologic criteria for columnar-lined esophagus (CLE). Furthermore, the clinical and biological significance of an irregular squamocolumnar junction (SCJ) is unclear. The aim of this study was to evaluate the association between histologic features in SCJ biopsies and CLE and to gain insight into the significance of an irregular SCJ. The study was a cross-sectional analysis of 2176 mucosal biopsies of the SCJ from 544 patients in a large prospective community clinic-based study of gastroesophageal reflux disease in Washington State. Biopsy samples were evaluated blindly for a wide variety of histologic features, such as the presence and type of mucosal glands, submucosal glands and ducts, goblet cells, multilayered epithelium (ME), inflammation, and buried columnar epithelium. Histologic findings were correlated with the endoscopic findings (normal Z-line, irregular Z-line, or CLE) and evaluated by logistic regression and receiver operating characteristic analysis.Five histologic features were associated with CLE: pure mucous glands, ME, presence of goblet cells, ≥50% of crypts with goblet cells, and buried columnar epithelium. Pure oxyntic glands were inversely associated with CLE. The features most strongly related to CLE included biopsies with ≥50% of crypts with goblet cells, ME, and mucosal gland type (area under the curve=0.71; 95% confidence interval=0.66-0.76). Patients with an irregular Z-line were histologically similar to those with CLE. Certain histologic features in biopsies of the SCJ are associated with the presence of CLE. Irregularity of the Z-line is probably indicative of ultrashort segment CLE, instead of being a potential variation of normal.

Study of gastro-esophageal reflux disease among obstructive sleep apnea patients

BackgroundGastro-esophageal reflux disease and obstructive sleep apnea syndrome are often co-morbid disorders. Frequency of GERD among OSAS patients and its response to CPAP treatment need to be clarified. ObjectivesTo determine the prevalence of GERD among OSAS patients and to assess its response to CPAP treatment. Methods30 patients were diagnosed as having OSAS and 15 healthy subjects selected as the controlled group underwent upper GI endoscopy. Then the effect of 6months CPAP treatment on GERD in OSAS patients was assessed. ResultsThe frequency of GERD in patients with OSAS was significantly higher than in controls (43.3% versus 13.3%, p=0.044). The heartburn and regurgitation in patients with OSAS were significantly higher than controls (p=0.015 and 0.048 respectively), while the difference in dysphagia was non significant (p=0.526).The differences in heartburn and regurgitation in OSAS patients with GERD were significantly higher than OSAS patients without GERD (p=0.002 and 0.001 respectively), but the difference in dysphagia was non significant (p=0.806). After CPAP treatment for 6months, GERD was cured in 8 patients out of 13 patients (61.4%). ConclusionGERD occurs more common in OSAS patients as compared to controls. There was positive impact that CPAP treatment reduces GERD in patients with OSAS by 61.5%.

A Population-Based Study of Gastroesophageal Reflux Disease and Sleep Problems in Elderly Twins

Background & AimsPrevious studies indicate an association between sleep problems and gastroesophageal reflux disease (GERD). Although both these conditions separately have moderate heritabilities, confounding by genetic factors has not previously been taken into account. This study aimed to reveal the association between sleep problems and GERD, while adjusting for heredity and other potential confounding factors.MethodsThis cross-sectional population-based study included all 8,014 same-sexed twins of at least 65 years of age and born in Sweden between 1886 and 1958, who participated in telephone interviews in 1998–2002. Three logistic regression models were used 1) external control analysis, 2) within-pair co-twin analysis with dizygotic (DZ) twin pairs discordant for GERD, and 3) within-pair co-twin analysis with monozygotic (MZ) twin pairs discordant for GERD. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and adjusted for established risk factors for GERD, i.e. sex, age, body mass index (BMI), tobacco smoking, and educational level.ResultsA dose-response association was identified between increasing levels of sleep problems and GERD in the external control analysis. Individuals who often experienced sleep problems had a two-fold increased occurrence of GERD compared to those who seldom had sleep problems (OR 2.0, 95% CI 1.8–2.4). The corresponding association was of similar strength in the co-twin analysis including 356 DZ pairs (OR 2.2, 95% CI 1.6–3.4), and in the co-twin analysis including 210 MZ pairs (OR 1.5, 95% CI 0.9–2.7).ConclusionA dose-dependent association between sleep problems and GERD remains after taking heredity and other known risk factors for GERD into account.

Systematic review of the epidemiology of gastroesophageal reflux disease in Japan

Epidemiological studies of gastroesophageal reflux disease (GERD) in Japan vary in design. This systematic review examines the prevalence of GERD in Japan, distinguishing between study methodologies, and reports on changes over time and factors potentially associated with GERD. PubMed and Embase searches identified studies reporting the prevalence of GERD in the general population, primary care patients, and individuals undergoing routine health checks. Of the twenty eligible studies, half excluded individuals taking acid-suppressive medication, so these studies would have been likely to have underestimated the prevalence by 2-3%. Nine studies reported the prevalence of at least weekly reflux symptoms (the definition closest to the Montreal definition): in seven studies this was 6.5-9.5%, but in two studies that included individuals who underwent upper gastrointestinal endoscopy the prevalence was 19.0 and 21.8%. Eight studies used symptom scores: prevalence estimates ranged from 10.2 to 29.0% in five studies using the Carlsson-Dent self-administered questionnaire (QUEST), and from 27.0 to 37.6% in three studies using the frequency scale for the symptoms of GERD. Prevalence estimates were 15.1-24.3% in three studies that reported the presence of reflux symptoms of undefined frequency. Six studies reported the prevalence of reflux esophagitis as 4.9-8.2%. Changes in prevalence over time and factors associated with reflux symptoms were inconsistent. Few studies have reported the prevalence of GERD in Japan using standardized criteria. Thus, prevalence estimates vary substantially, reflecting differences in study populations and GERD definitions. However, seven studies reported that the prevalence of at least weekly symptoms was 6.5-9.5%, a finding which approaches that reported in Western populations (10-20%).

Review of the persistence of gastroesophageal reflux disease in children, adolescents and adults: does gastroesophageal reflux disease in adults sometimes begin in childhood?

Objective. Understanding the natural history and outcomes of gastroesophageal reflux disease (GERD) in children could help to identify patients at risk of having GERD complications during adulthood. This review aimed to assess evidence of whether GERD in children or adolescents persists into adulthood. Material and methods. PubMed searches (1966–2010) identified longitudinal studies of GERD extending from childhood/infancy into adulthood, as well as longitudinal studies within pediatric age groups. Results. In one study, heartburn during childhood was more often recalled by adults with reflux symptoms than by those without (30% vs. 9%; p < 0.001), as was medication or surgery for GERD (both p < 0.01). Another study found that GERD symptoms were more common in adults diagnosed with reflux esophagitis during childhood/adolescence than in those who were not (46% vs. 30%). Regurgitation during infancy increased the risk of feeding problems after 1 year (odds ratio 4.2 (95% confidence interval: 1.4–12.0)) and of reflux symptoms at 9 years of age (relative risk 2.3 (95% confidence interval: 1.3–4.0)). In one study, abnormal esophageal histology persisted in infants after 12 months without reflux symptoms. A proportion (59–100%: three studies) of patients with reflux symptoms and/or reflux esophagitis during the pediatric years still required treatment after 1–8 years. In another study, however, just 7% of patients with healed reflux esophagitis relapsed after 9 months without treatment. Conclusion. The limited available evidence suggests that some infants, children, and adolescents with GERD are more likely than those without GERD to have symptoms later in life.

Reply

We enjoyed reading Dr. Gerson’s summary and have little to add to her précis of prior work in this field. There are, however, 2 things we should clarify about our study. First, the supplemental gastroesophageal reflux disease (GERD) questionnaire was initially intended for a study of the association between GERD and obstructive airway disease. It was sent to 11,080 women with asthma or chronic obstructed pulmonary disease (COPD) and 11,080 randomly selected controls. For our body mass index (BMI) and GERD study, we included all of the control subjects who did not have asthma or COPD and then added back a proportionate, random sample of surveyed women with obstructive airway disease (n = 1112) such that the percentage of women with asthma or COPD in our study reflected the overall percentage of these conditions among the entire Nurses’ Health Study cohort of 121,700 women.

Esophageal capsule endoscopy in patients refusing conventional endoscopy for the study of suspected esophageal pathology

Esophageal capsule endoscopy is a well tolerated procedure that does not require sedation and has proved its value for the study of the esophagus. The aim of our study was to assess the feasibility, accuracy, safety and acceptability of esophageal capsule endoscopy for the study of gastroesophageal reflux disease and esophageal varices in patients who refused conventional upper gastrointestinal endoscopy. Thirty consecutive examinations performed in 28 patients (15 men/13 women; mean age: 58.5+/-12.4 years; range: 23-87 years) were reviewed. Twenty-five examinations were performed in 23 patients presenting with chronic gastroesophageal reflux disease symptoms and the remaining five were carried out in patients with cirrhosis for screening of esophageal varices. The procedures were done with the new PillCam ESO that harbors two viewing cupules and takes a total of 14 frames/s. Technical data (total recording time, esophageal transit time and Z-line visualization), clinical findings (Savary-Miller grade; presence and characteristics of esophageal varices or portal hypertension gastropathy), and patient's opinion (quality and comfort questionnaire) were analyzed. All the patients ingested and excreted the capsule without complications. Two examinations in the gastroesophageal reflux disease group were repeated; one was issued as a follow-up and the other because no images were recorded in the first capsule endoscopy. From the former, only the satisfaction questionnaire was analyzed. Mean total recording time and esophageal transit time were 1224 and 243.79 s, respectively (range: 2-1192 s). Complete study of the Z-line was possible in 23 examinations (23/29; 79.3%). Esophageal erosions were seen in 58.33% (14/24) of the examinations carried out in patients with gastroesophageal reflux disease. Nine out of 14 patients (64.29%) presented with grade I esophagitis and the other five (35.71%) with grade II esophagitis. Among the five patients with cirrhosis, small varices were visualized in one (1/5; 20%), while large varices with red spots were evidenced in the remaining three (3/5; 60%). All four patients showing esophageal varices were found to have portal hypertension gastropathy. In most examinations, patients found the capsule easy to swallow (28/30; 93.33%), asymptomatic (29/30; 96.66%), evaluated the procedure as comfortable (29/30; 96.66%), and would repeat it if necessary (30/30; 100%). Esophageal capsule endoscopy is an adequate alternative diagnostic method for the study of gastroesophageal reflux disease and for the screening of esophageal varices in patients refusing to undergo conventional upper gastrointestinal endoscopy.

Acid and Duodenogastroesophageal Reflux after Esophagectomy with Gastric Tube Reconstruction

Patients who undergo esophagectomy with gastric tube reconstruction incur increased risk for acid reflux and duodenogastroesophageal reflux. Few postesophagectomy studies of gastroesophageal reflux disease have included simultaneous 24-h pH and bilirubin monitoring. The aim of this study is to evaluate acid reflux and duodenogastroesophageal reflux after esophagectomy with gastric tube reconstruction. Reflux symptom evaluation, endoscopy, and simultaneous 24-h pH and bilirubin monitoring in the cervical esophagus were performed in 25 patients who underwent Ivor Lewis esophagectomy, intrathoracic esophagogastrostomy, and digital dilation of the pyloric ring as treatment for esophageal cancer. Reflux symptoms were severe, mild, and absent in 2, 7, and 16 patients, respectively. Reflux esophagitis and Barrett's esophagus was observed in 11 and 1 patients, respectively. Elevated acid reflux occurred in 7 patients (28%). Elevated duodenogastroesophageal reflux was recorded in 11 patients (44%). Reflux profile analysis identified three patterns: 4 subjects (16%) with both elevated acid reflux and duodenogastroesophageal reflux; 3 (12%) with only elevated acid reflux; and 7 (28%) with only elevated duodenogastroesophageal reflux. Of 7 patients with only elevated duodenogastroesophageal reflux, 4 developed reflux esophagitis. Although reflux symptoms did not correlate with endoscopic esophagitis, a significant correlation was observed between endoscopic esophagitis and acid reflux and/or duodenogastroesophageal reflux. Reflux symptoms represented a poor indication of esophagitis in patients with esophagectomy and gastric tube reconstruction. Simultaneous 24-h pH and bilirubin monitoring can help in identifying patients at high risk for reflux esophagitis, as well as indicating the cause of esophagitis.

Psychometric and methodological characteristics of a culturally adjusted gastroesophageal reflux disease questionnaire

Population-based data regarding the prevalence of gastroesophageal reflux disease (GERD) in Turkey is lacking. Therefore, a valid and reliable instrument for population-based study of GERD is important. The purpose of the study is to establish the feasibility, reproducibility, reliability and validity of the Turkish version of the GERD questionnaire. The study sample of 630 people was randomly recruited from the 20- to 65-year-old-population of Menderes, Izmir. Face to face interviews were conducted using the Turkish GERD questionnaire. The questionnaire was translated into Turkish, and then test-retest reliability of the study was carried out with 25 individuals. Internal reliability was measured using Cronbach's alpha. Additionally, a validity study was performed at the gastroenterology outpatient clinic at Ege University, Faculty of Medicine (45 people). This Turkish GERD questionnaire was easily understood and completed in a reasonable time by members of the population for whom the survey was intended. For all questions (omitting the demographic questions) kappa statistics were calculated; the median kappa for the outpatient assessment was 0.82. The sensitivity of the questionnaire concerning heartburn was strong and the specificity of the test was weak. By calculating Cronbach's alpha coefficient, we estimated the internal consistency or the reliability of each component. The Cronbach's alpha coefficients were above 0.70. This instrument can be used for large-scale population based studies in Turkey.

Clinical and endoscopic peculiarities of gastroesophageal reflux disease during bronchial asthma combined with chronic opisthorchosis

The results of the study of gastroesophageal reflux disease (GERD) clinico-endoscopic peculiarities in 318 patients with bronchial asthma (BA) of different severity degree, combined with chronic opisthorchosis or without it, have been cited in the present article. It has been revealed an often incidence of GERD in BA patients and GERD frequency increased as the disease severer. At that the GERD clinical manifestation have been observed more frequently than the reflux-esophagitis had been discovered by endoscopic ways. GERD structure during BA has been presented. More frequent GERD with BA combined with chronic opisthorchosis has been discovered than in patients without associated parasitic invasion.

Gastroesophageal Reflux in Healthy Subjects: Significance of Endoscopic Findings, Histology, Age, and Sex

Background: Our aim was to evaluate which specific factors are of importance for the gastroesophageal reflux seen in presumably healthy subjects. Methods: We investigated 57 healthy, asymptomatic volunteers with computer-aided medical history interrogation, endoscopy, biopsy specimens from the distal esophagus, manometry, and 24-h ambulatory pH-monitoring. Results: Eight subjects (14%) claimed intermittent reflux symptoms at the computer interview, but they did not have more acid reflux at pH-monitoring than asymptomatic volunteers. Thirteen subjects (23%) had abnormalities at endoscopy, 3 of whom had an erosion in the distal esophagus, and 12 had hiatus hernia. Subjects with hiatus hernia had increased acid reflux at 24-h pH-monitoring compared with those without hernia. If subjects with hernia were excluded, the degree of acid reflux was similar in all age groups. Men had more acid reflux than women, and these differences persisted if subjects with hernia were excluded. There was no correlation of histologic signs of esophagitis in the distal esophagus, lower esophageal sphincter pressure, smoking habit, or body mass index with reflux of acid to the esophagus. Conclusion: Hiatus hernia is a common finding in healthy subjects, and it predisposes to gastroesophageal acid reflux. Histologic abnormalities are poorly related to acid reflux in healthy volunteers. We found increased acid reflux in healthy men compared with women, but larger studies are needed to confirm these findings. Symptom evaluation is not sufficient to exclude significant gastroesophageal reflux in healthy volunteers, and we suggest that the possibility of esophageal abnormalities should be excluded by endoscopy in comparative studies of gastroesophageal reflux disease.