Symptom Index Score Research Articles

Consistency analysis of pepsin immunohistochemistry and pepsin test box in the diagnosis of laryngopharyngeal reflux

Objective:To analyze the consistency of pepsin assay kit, pepsin IHC, reflux symptom index（RSI） and reflux finding score（RFS） in the diagnosis of laryngopharyngeal reflux disease（LPRD）. Methods:The clinical data of 61 inpatients with laryngeal diseases who were admitted to the Department of Otolaryngology, the First Affiliated Hospital of Kunming Medical University from May 2020 to December 2021 were retrospectively analyzed. The RSI and RFS scores, the Formwitz score of pepsin immunohistochemistry, and the results of pepsin detection kit were recorded. ICC group correlation coefficient and Kappa consistency analysis was used for three detection methods. Results:Among 61 patients, 30 cases were positive and 31 cases were negative for the pepsin test kit, with a positive rate of 49.18%. The positive rate of pepsin immunohistochemistry was 45.90%（28/61）, and the diagnostic agreement rate between the two was 70.49%. The consistency between them was high（κ=0.409）. The positive rate of RSI and RFS in diagnosing LPRD was 62.30%（38/61）, and the consistency rate was 73.77% with pepsin detection kit. The consistency between them was high（κ=0.486）. Taking pepsin IHC as the reference standard, the sensitivity, specificity, positive predictive value and negative predictive value of pepsin detection kit were 71.43%（20/28）, 69.70%（23/33）, 66.67%（20/30） and 74.19%（23/31）, respectively. Using RSI and RFS scales as reference criteria, the sensitivity, specificity, positive predictive value and negative predictive value of pepsin detection kit were 89.29%（25/28）, 60.61%（20/33）, 65.79%（25/38） and 86.96%（20/23）, respectively. Analysis of correlation coefficient within ICC group: ICC value was 0.628, 95% confidence interval（0.497-0.741）, the three methods have good consistency. Conclusion:The RSI and RFS scale scores were in good agreement with the pepsin test kit, and the pepsin test kit was also in good agreement with pepsin immunohistochemistry. As a non-invasive diagnostic technique, the pepsin test kit can be widely used in the diagnosis of pharyngeal reflux in combination with pepsin immunohistochemistry and RSI and RFS scale.

Role of Reflux Symptom Index and Reflux Finding Score in Diagnosing Laryngopharyngeal Reflux: A Prospective Study.

Laryngopharyngeal Reflux Disease (LPRD) is caused due to reflux of gastric content into the larynx and pharynx. The present study was done to assess the role of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) in the treatment outcomes in symptomatic patients with LPRD. This is a prospective analytical study conducted on 200 patients for a period of 2years, from January 2020 to February 2022. Patients suspected with LPR were evaluated using RSI and RFS, and both pre and post treatment scores were comparedto assess the change in scores of RSI and RFS following 8 weeks of treatment with PPI (Proton pump inhibitor). The patients experienced a greater incidence of moderate symptoms in RSI. Wilcoxon signed-rank test showed significant difference between pre and post treatment scores with respect to reflux symptoms and reflux findings (p < 0.05). Implementation of RSI and RFSscoring system helped for early diagnosis of LPR, and a significant difference was seen between pre and post treatment scores in both RSI and RFS.

The role of patient perceptions and hyperfunctional voice disorders in predicting voice therapy attendance

Objectives/hypothesisAttendance is essential to voice therapy's effectiveness in the treatment of voice and laryngeal disorders. With such high rates of drop-out and non-attendance, it is important to understand the factors that influence this behavior. This study sought to identify potential predictors of attendance to voice therapy at an interdisciplinary voice clinic. Study designSingle-institution retrospective cohort study. MethodsIn this retrospective cohort study, patients evaluated at an interdisciplinary voice clinic who received a referral for voice therapy were identified. Age, gender, voice-related diagnoses, Voice Handicap Index-10 scores, Reflux Symptom Index scores, and measures of patient perceptions (self-rated severity, importance of voice in one's life, and “feelings about voice therapy”) were recorded to evaluate associations with attendance to at least one therapy session. Standard statistical analysis and logistic regressions were performed. ResultsOf 168 subjects included, 111 (66.1 %) attended at least one session of voice therapy. Patients diagnosed with primary hyperfunctional voice disorders had a significantly higher attendance rate than other groups. Attenders had higher self-ratings of severity and more positive “feelings about voice therapy” compared to non-attenders. Regression models found three significant predictors of therapy attendance: primary diagnosis of hyperfunctional voice disorder, self-rated severity, and “feelings about voice therapy.” ConclusionIn this cohort, patients with more positive feelings about voice therapy, higher self-rated severity, and a diagnosis of primary hyperfunctional voice disorder were more likely to attend voice therapy. Level of evidence3.

Clinical Manifestations and Treatment Outcome of Laryngopharyngeal Reflux on Larynx and Symptom-Sign Correlation.

To evaluate various clinical signs and symptoms of Laryngopharyngeal reflux on the Larynx along with treatment outcome and to establish symptom-sign correlation. Prospective interventional study. 50 patients with symptoms and signs of LPR were enrolled in the study and were followed up for 9months. Patients were evaluated with a 70° Hopkins rigid laryngoscope and the Reflux Symptom Index and Reflux Finding Score scales were used to grade the sign and symptoms and to diagnose LPR and to compare pre and post-treatment conditions. Patients were given treatments including PPI and diet modification. The most common laryngeal symptom based on the RSI score was sore throat (40%). Other common symptoms were hoarseness of voice (30%) and cough (20%). The most common laryngeal sign based on RFS (Reflux finding score) was Posterior Commissure Hypertrophy (40%). The other common signs were Pseudosulcus (30%), Vocal cord oedema (20%), and Granulomas (10%). Out of the 50 patients, 21 patients (42%) had an RFS score of less than 7. Rest 29 patients (58%) had RFS scores of more than 7. Out of these 29 patients, 19 patients (65.52%) had partial relief from symptoms after 3weeks of treatment and were advised to take treatment for 3 more weeks, and rest 10 (34.48%) patients were completely unresponsive to treatment. The improvement in symptoms does not always manifest in improvement in signs and there is no correlation between the symptoms and signs of LPR.

MODERN METHODS OF NON-INFLAMMATORY CHRONIC PELVIC PAIN SYNDROME TREATMENT

Relevance. Today there is an additional progressive option to apply into the non-inflammatory CPPS, which is presented by regenerative medicine and specifically platelet-rich plasma(PRP) treatment.&#x0D; Aim – to evaluate efficacy of PRP treatment in combination with pharmacotherapy and ESWT for non-inflammatory CPPS.&#x0D; Materials and methods. Prospective study was conducted in a group of 40 outpatients with diagnosis of non-inflammatory chronic pelvic pain syndrome in Men’s Health Clinic (Kyiv, Ukraine). Mean age was equal to 46.4±10.2. The set of specific examinations included: trans-rectal prostate scanning, prostate secret sample analysis, visual analogue pain scale (VAS), International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5).&#x0D; Results. Study results showed that there are significant differences in mean VAS scores in time point at 28-th day of treatment where patients of MG demonstrated lower pain level (p&lt;0.05) than patients of CG, meanwhile both groups had significant (p&lt;0.05) decrease of pain levels in comparison with initial data. In 3 months after treatment, we could see elevation of pain in CG to the level that have no significant differences with initial data, while patients of MG still have significantly lower pain level, but difference between groups come insignificant.&#x0D; IPSS levels at 28-th day of treatment showed significant (p&lt;0.05) efficacy (bringing symptoms from moderate to mild level) in both groups with lack of difference between them. Such situation was observer also in 3 months after treatment with slight increase of symptom intensity in both MG and CG. In 6 months after treatment, we have registered elevation of IPSS mean score in CG up to the level of insignificant difference with initial data.&#x0D; IIEF-5 data showed significant (p&lt;0.05) improvement of symptoms at 28-th day of treatment in both CG and MG without significant difference between groups. In 3 months after treatment, we observed that in CG the level of symptoms raised to the level that have insignificant difference with initial data, but in MG the improvement was still significant. The same situation was observed in 6 months after treatment.&#x0D; Conclusions. The efficacy of PRP treatment in combination with pharmacotherapy and ESWT for non-inflammatory CPPS was evaluated. Significant clinical effects were found both for PRP combination with ESWT and NSAID and just ESWT and NSAID directly after course of treatment, meanwhile in 3 and 6 months after treatment the results start to show difference in favor of PRP inclusion.

To Determine the Prevalence of Laryngopharyngeal Reflux in Patients of Various Throat Disorders and to Evaluate the Efficacy of Anti-reflux Therapy.

To study the prevalence of Laryngopharyngeal reflux in individuals having throat complaints by applying the Reflux Symptom Index and Reflux finding score as a prognostic tool after anti reflux therapy. Materials and Methods: A Cross-sectional study of 75 patients of age 18years and above with clinical diagnosis of Laryngopharyngeal reflux was conducted in ENT. Cases were examined with detailed history and thorough examination with indirect laryngoscopy and Hopkins 70 degree endoscope. Symptoms and findings of patients were assessed by Belafsky Reflux Symptom Index and Reflux Finding Score. Patients presenting Belafsky Reflux Symptom Index > 13 and also Reflux Finding Score > 7 were classified as having Laryngopharyngeal reflux. After 6weeks of treatment, patients were reassessed and Reflux Symptom Index and Reflux finding score were calculated. Results: The mean age of the study subjects was 37.12 ± 12.39years. Most common symptom reported based on RSI questionnaire was excessive throat mucus (81.33%) followed by clearing of throat (75%) and coughing on lying down and heartburn. Based on the Laryngoscopy, about 57.33% had thick endolarygeal mucus, 56% had diffuse erythema, 45.33% had granulations and 29.33% had subglottic edema. Based on the reflux symptom scores, we found 53.33% and 80% of patients based on reflux findings score to have Laryngopharyngeal Reflux. The mean Reflux Symptom Index scores were 16.25 ± 5.53 and 10.73 ± 4.40 and also the mean Reflux Finding scores were 13.81 ± 2.42 and 6.61 ± 2.16 respectively before and after the treatment which was statistically significant.

Study Protocol for a Prospective Observational Analytical Multicentric Study Evaluating the Efficacy of Pistacia lentiscus Plant (Rumi Mastagi) in Patients With Diabetic Gastroparesis Using the Gastroparesis Cardinal Symptom Index

Abstract Introduction: Diabetes is a group of metabolic diseases characterized by hyperglycemia due to insulin secretion or action defects. Gastrointestinal neuropathies in patients with diabetes represent vital aspects of the chronic course of the disease. This can be perceived as chronic delayed gastric emptying associated with nausea, vomiting, postprandial fullness, weight loss, anorexia, and abdominal pain without evidence of mechanical obstruction. Traditional treatments for diabetic gastroparesis include dietary changes and medication, but severe cases may require surgery or gastric electrical stimulation. Pistacia species extracts suggest alleviating gastrointestinal symptoms, yet no Indian studies support the evidence despite Pistachia plant species being present in the Great Himalayan regions. This study explores the therapeutic potential of Pistacia plants in treating diabetic gastroparesis, leveraging their natural antioxidants to enhance gut motility. Materials and Methods: This randomized controlled trial will be conducted in two regions of Uttarakhand, India: Garhwal (7 centers) and Kumaon (8 centers) over a total of 15 centers. Each center will enroll 10 patients with diabetic gastroparesis who consent to participate based on a predefined Gastroparesis Cardinal Symptom Index (GCSI) score, totaling 150 patients using convenience sampling. Patients with GCSI scores ≥15 will receive twice-daily drug therapy for 10 days, overseen by a designated study observer at each center. Data will be collated at AIIMS Rishikesh for analysis. Discussion: This study aims to validate the effectiveness of Pistacia lentiscus plant extract in treating diabetic gastroparesis, addressing a critical gap in Indian literature. If successful, P. lentiscus could offer a cost-effective and minimally invasive intervention for severe gastroparesis in India. Conclusion: The study’s robust design and methodology inspire confidence in its potential contribution to diabetes management.

Sistemik İzotretinoin Tedavisinin Depresyon ve Diğer Psikolojik Belirtiler Üzerine Etkisi: Bir Vaka Kontrol Çalışması

Objective: Isotretinoin is highly preferred in the treatment of severe and resistant acne, but there are still disagreements about whether it has psychogenic side effects. In this study; we aim to investigate the changes in psychological symptoms before and after the treatment in a group of patients treated with isotretinoin. Material and Methods: A total of 110 patients who had moderate or severe acne, and decided to start isotretinoin treatment, were included. Acne Quality of Life Scale, Beck Depression Inventory (BDI), Beck Suicidal Ideation Scale, and Symptom Check List (SCL-90-R) Psychological Symptom Screening tests were performed and compared before starting treatment and at the 6th month of treatment. Results: In our study, in both the pre-treatment and post-treatment groups, the rate of patients at risk for depression was significantly higher in the group that had severe acne (p<0.05). The scores of psychiatric tests with moderate acne were found to be significantly lower than those with severe acne in all parameters (p<0.05). We have found that somatization, depression, phobic thoughts, and general symptom index scores were significantly higher in women before and after the treatment (p<0.05). Acne treatment was associated with improved quality of life and BDI scores in both male and female patients (p=0.001). SCL-90-R somatization, obsession, depression, sensitivity, anger, and general symptom index scores decreased significantly after the treatment. Conclusion: Our study objectively demonstrated that isotretinoin treatment does not cause depression and psychological symptoms, and even improves depression and psychological symptoms caused by acne and improves the quality of life.

Effect of Rabeprazole on Pachydermia Laryngis in Patients with Laryngopharyngeal Reflux

Introduction Laryngopharyngeal reflux (LPR) is defined as the retrograde flow of gastric content into larynx and pharynx. It is a multifactorial syndrome. Empiric trial of PPI therapy represents the first step to confirm LPR and to treat it accordingly as all currently available diagnostic tests have poor sensitivity and specificity. However, there is no accepted protocol for the most effective treatment of patients with LPR. Objective of the study was to assess the effect of Rabeprazole on pachydermia laryngis (posterior commissure hypertrophy) in patients with LPR. Materials and Methods In this prospective study, 75 subjects diagnosed with LPR using Reflux symptom index (RSI) and Reflux finding score (RFS) tools were recruited. Using RFS, posterior commissure hypertrophy was scored at presentation and after 8 weeks of rabeprazole therapy. The mean pre- and post-treatment posterior commissure hypertrophy scores for each patient were compared using paired T-test. Results Posterior commissure hypertrophy did not show statistically significant improvement following 8 weeks of 20 mg once daily oral rabeprazole therapy. Conclusion Eight weeks of oral therapy with Rabeprazole 20 mg once daily did not show statistically significant improvement in posterior commissure hypertrophy.

Laryngopharyngeal Reflux in Obstructive Sleep Apnea-Hypopnea Syndrome: An Updated Meta-Analysis.

Laryngopharyngeal reflux (LPR) is a common disorder in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). This meta-analysis was carried out to evaluate the LPR prevalence in individuals with OSAHS and to analyze the correlation of LPR positivity with the clinical features of patients with OSAHS. A detailed review of the English and Chinese literature on the occurrence of LPR in patients with OSAHS was performed by employing online search tools such as PubMed, EMBASE, Web of Science, VIP, CNKI, WanFang, etc. Two researchers analyzed the studies for quality according to the STROBE standard checklist. The acquired data were analyzed using Stata 11.0 and R 3.6.1 software. The effect size was estimated and calculated using weighted mean difference (WMD) and correlation coefficients. Moreover, a combined analysis was performed by employing either a random- or fixed-effects model. Ultimately, 27 studies met our inclusion criteria. Our study revealed that the LPR prevalence in OSAHS patients was 49%. We carried out subgroup analyses as per OSAHS severity, ethnicity, and body mass index (BMI). The results suggested that the probability of LPR in European and American patients with OSAHS was higher, and the prevalence of LPR was higher in obese individuals and patients with severe OSAHS. Moreover, apnea-hypopnea index (AHI) and BMI were higher in LPR-positive OSAHS patients than in LPR-negative OSAHS patients, but no significant variation in age was observed in the two groups. Moreover, the reflux symptom index (RSI) scores and the reflux finding score (RFS) exhibited a positive correlation with AHI. The current literature shows a higher incidence of LPR in individuals with OSAHS (49%). The severity of AHI in individuals with OSAHS is associated with the presence of LPR. Patients with OSAHS accompanied by LPR showed higher BMI and AHI as compared to those patients with LPR-negative OSAHS.

Repetitive transcranial magnetic stimulation: Course and early prediction of response in depression

BackgroundRepetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression, yet few studies have mapped the trajectories of symptom change over treatment. Tracking clinical response during early treatment may be helpful to predict outcome, particularly non-response. MethodsWe used naturalistic data (N = 117) to examine changes in the Daily Symptom Index (DI-5) scores of adult patients with unipolar or bipolar depression who underwent ≥16 treatment sessions of left dorsolateral prefrontal cortex rTMS at a private psychiatric facility in Western Australia, between 2016 and 2019. ResultsTwo response trajectories were charted: non-response (N = 71, 61%) and response (N = 46, 39%). Both trajectories diverged at 99% confidence interval at session 10, which was used as the point to predict treatment response at session 20. The response group showed a reduction of 4.21 in the mean DI-5 score from baseline at session 10. On this basis, a 4-point reduction in the DI-5 score at session 10 was defined as predictor of responder status at session 20. If the improvement is < 4 points at session 10, the probability of non-response at session 20 is 75%. If the improvement is ≥ 4 points, the probability of response at session 20 is 66%. LimitationsThe DI-5 scores were not examined beyond 20 treatment sessions, which may have shown delayed responders in the non-response group. ConclusionsIn this study of depression response trajectories with rTMS treatment, prediction of response at session 20 can be made at session 10 of treatment. Further research is required to generalise the current findings.

Clinical Evaluation of Laryngopharyngeal Reflux and its Response to Proton Pump Inhibitors.

To clinically evaluate the patients of laryngopharyngeal reflux(LPR) and their response to Proton Pump Inhibitors(PPIs) using laryngeal Reflux Symptom Index (RSI) and Reflux Finding Score (RFS). This prospective observational study was conducted on 128 patients attending the ENT-OPD of VSSIMSAR,Burla,India,who had persistent laryngeal symptoms for more than 2 months.Data was collected using standardized RSI and RFS after taking detailed history and laryngoscopic examination.Patients who were diagnosed of LPR on the basis of their RSI & RFS were subjected to treatment with PPI-Pantoprazole & were called back for follow up at 2nd, 4th and 6th months.Pre and post treatment RSI& RFS were compared using appropriate statistical tests and results with p-value< 0.01 were considered statistically significant. The overall effect of PPIs on all symptoms & signs of LPR,included in RSI and RFS respectively,is statistically significant except on swallowing (not statistically significant at p<0.01) showing a careful usage of RSI & RFS while diagnosing LPR clinically.Study also elucidated that PPI are effective in relieving symptoms of LPR patients.Evaluating Pearson correlation coefficient,the value of R=0.3717;R2=0.1382 shows low positive correlation between the RSI & RFS.RSI & RFS are related to each other and any change in the RSI will affect the value of RFI and vice versa. From this study we conclude that LPR is prevalent in age of 28-37 years & has female preponderance.PPIs are effective in treating LPR.Though RSI and RFS are effective and valid parameters for managing LPR cases but have to be used cautiously while interpreting the results.

The Effect of a Climate Event on Voice-Related Processes in Seniors

Purpose: This project considered the relationship of harmful algal blooms, specifically red tide, to patient reports of respiratory diseases, use of respiratory medications, reflux symptoms, excessive coughing/throat clearing, water consumption, voice handicap scores, clinician judgments of voice quality, and voice therapy outcomes in senior voice patients in coastal Southwest Florida. Method: A retrospective chart review of 131 seniors receiving voice therapy during 2013–2019 was conducted. Patients formed two groups—those evaluated during periods of high versus low red tide. Patient reports, clinician ratings, and therapy outcomes were analyzed with nonparametric statistics to determine differences between patient groups. Results: No relationship was found between the presence of high red tide and reports of airway disorders, use of airway medications, coughing/throat clearing, Reflux Symptom Index scores, or voice therapy success. A significant relationship was found between high red tide months and ratings of voice severity and Voice Handicap Index scores. Conclusions: Harmful algal blooms may have negatively impacted the voices of seniors in this study, as shown by higher clinician voice severity ratings and higher patient perceptions of voice handicap during periods of high red tide. While voice success was still achieved by many of these seniors, speech-language pathologists should be aware of environmental issues and their possible negative impacts on voice.

The preliminary application of vonoprazan fumarate on laryngopharyngeal reflux disease

Objective: To evaluate the clinical effect of vonoprazan fumarate on laryngopharyngeal reflux disease (LPRD). Methods: The clinical data of 89 patients from June 2020 to January 2022, including 45 males and 44 females, aged 18-77 (45.54±13.53) years old, were retrospectively analyzed. All the patients were diagnosed as suspected LPRD according to reflux symptom index (RSI) and reflux finding score (RFS). Patients of the Vonoprazan Fumarate group were prescribed Vonoprazan Fumarate orally (20 mg, qd) for 8 weeks.Patients of the Esomeprazole group were prescribed Esomeprazole orally (20 mg, bid) for 8 weeks. RSI and RFS of all the patients before and after treatment were compared. SPSS 18.0 was used for statistics analysis. Results: Before treatment, gender, age, RSI and RFS of the two groups had no obvious differences. After treatment, RSI and RFS in both groups were alleviated significantly. In the vonorazan fumarate group, the RSI before treatment was 12.62±7.18, and after treatment was 4.74±3.87(t=6.91, P<0.001), the RFS was 10.78±2.29 before treatment and 8.24±2.45 after treatment (t=7.06, P<0.001). While in the esomeprazole group, the RSI was 13.27±6.95 before treatment and 6.02±4.28 after treatment (t=7.50, P<0.001), the RFS was 10.59±3.14 before treatment and 8.14±3.30 after treatment (t=5.41, P<0.001). There was no significant difference in the effective rate between the two groups (86.7% in the vonoprazan fumarate group and 77.3% in the esomeprazole group, χ2=1.443, P=0.486). Conclusion: Vonoprazan fumarate could effectively alleviate the symptoms and signs of LPRD patients. The effect of vonoprazan fumarate on LPRD is not inferior to Esomeprazole. It can be used as a supplement to PPI.

Patient Reported Quality of Life after Moderately Hypofractionated Proton Beam Therapy or Intensity Modulated Radiation Therapy for Prostate Cancer

<h3>Purpose/Objective(s)</h3> We aim to quantify and compare changes in patient reported quality of life (PRQOL) after moderately hypofractionated (MHF) Proton Beam Therapy (PBT) or Intensity Modulated Radiation Therapy (IMRT) for prostate cancer (PC). <h3>Materials/Methods</h3> This multi-institutional analysis included patients with NCCN low or intermediate risk PC treated at 4 tertiary cancer centers with MHF PBT or IMRT with prospective PRQOL collection. Patients completed International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC) pre-treatment and at 3-to-6-month intervals starting at the end of treatment. EPIC is a questionnaire measuring health related quality of life (HRQOL) domains of genitourinary (GU), gastrointestinal (GI), sexual, and hormonal function. Questions are scored from 0 (no problem) to 4 (big problem). EPIC score of 3 or more was considered a meaningful QOL decrement. IPSS measures GU HRQOL; each question is measured from a score of 0 to 5 with a maximum score of 35. Baseline characteristics were compared with Chi squared and t test for IPSS. Models were limited to long term data, at 12 and 36 months. Generalized linear regression models testing effects of time, treatment, and their interaction were fit via Generalized Estimating Equations, controlling for age, race, and NCCN risk group. <h3>Results</h3> 287 IMRT and 485 PBT patients were included. Intermediate NCCN risk group (81.2 vs. 68.2%; p < 0.001), median age at diagnosis (70 vs 66.9 years; p < 0.001) were higher in the IMRT group. Mean IPSS was slightly worse at baseline in the PBT arm (+0.22; CI, -1.54 – 1.10; p=0.74) and slightly better at 3 years (-0.09; CI, -1.48 – 1.65; p=0.91). On Poisson regression controlling for age, race, and NCCN risk group, PBT IPSS trended worse at 12 months (OR, 1.19; CI, 0.98 - 1.44; p=0.077) without any difference at 36 months (OR, 1.08; CI, 0.80 - 1.26; p=0.94). Similarly, EPIC questionnaire for overall GI function trended worse with PBT at 12 months (CI, 0.83 - 16.27; p=0.085) without difference at 36 months (CI, 0.49 - 12.27, p=0.27). 4.9% and 4.8% patients in the PBT and IMRT arms, respectively, rated their overall GI function at 12 months as a severe problem. Among PBT and IMRT patients combined, severe GU concerns were unlikely at 12 months (GU frequency: 17.5; GU pain: 3.6; stream problem: 11.2%). <h3>Conclusion</h3> PRQOL showed a non-significant trend toward worse 1-year overall GI function and IPSS for PBT; this effect was not present at 3 years. In this multi-institutional, prospective study of PC, long-term GU and GI function was not significantly different between PBT or IMRT arms.

Technical details and outcomes of peroral endoscopic myotomy with fundoplication: the first U.S. experience (with video)

Peroral endoscopic myotomy (POEM) is an established endoscopic treatment for achalasia; however, post-POEM rates of GERD remain a significant cause of concern. Single-session POEM with fundoplication (POEM-F) to treat achalasia was recently described to reduce post-POEM GERD. This study aims to report the technical feasibility, safety, and early outcomes of the first U.S. cohort of POEM-F. We retrospectively reviewed all patients with achalasia treated with POEM-F at our center. The primary endpoint was technical success, defined as the successful completion of all steps of the POEM-F procedure. Six patients (mean age, 50 ± 4.8 years; 1 woman) underwent POEM-F for achalasia. Technical success was achieved in all patients (6/6), and no major immediate or delayed (up to 30 days postprocedure) adverse events were seen. At the 1-month follow-up visit, the mean Eckardt score decreased from 8.8 ± 1.1 to .3 ± .5. The GERD health-related quality of life and reflux symptom index scores obtained at the 1-month follow-up, with patients on proton pump inhibitors, were 2.3 ± 3.7 and 2.2 ± 2.5, respectively. This first case series on POEM-F in the United States suggests that POEM-F is feasible and safe with excellent short-term outcomes.

Effectiveness of intravesical ozone in interstitial cystitis by the O'Leary-Sant symptom index.

Introduction and hypothesisA prospective clinical, preliminary study was performed in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) who were nonresponders to conventional treatment and received intravesical ozone as a therapeutic alternative.MethodsSixteen patients received six applications of intravesical ozone at a concentration of 41 μg/mL. We evaluated therapeutic efficacy by the percentage reduction of Interstitial Cystitis Symptom and Problem Index scores (ICSI/ICPI—the O'Leary–Sant symptom index), recurrence rate, nonresponse, and side effects in scores collected on admission (pre-treatment), at the end of the therapeutic protocol (post-treatment), and 180 days (follow-up) after the last ozone application.ResultsThe mean age of women was 52.9 years (SD: 15.5), and the duration of symptoms was 5.7 years (SD: 7.1). The median ICSI on admission was 17 (IQR: 14.25–19.5) and at follow-up was 0.5 (IQR: 0–2), with a reduction of 97.5% (CI: 85.7–100). The median ICSI/ICPI on admission was 31.5 (IQR: 29–35.2) and at follow-up was 2.0 (IQR: 0–3.75), with a reduction of 92.3% (CI: 88.8–100). The recurrence rate was only 6.25%, and no patients were nonresponders to the treatment.ConclusionsThe application of intravesical ozone was effective in the treatment of patients with IC/BPS who were nonresponders to conventional therapy, showing a progressive and safe effect, at least in the short term.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00192-022-05383-3.

Mechanism of pepsin promoting lingual tonsil hypertrophy by stimulating macrophage

Objective: To investigate the possible pathophysiological mechanism of laryngopharyngeal reflux (LPR) in the development of lingual tonsil hypertrophy (LTH). Methods: The lingual tonsil tissues were collected from 73 patients [48 males and 25 females, aged from 24 to 76 (52.86±12.04) years] who underwent surgery for laryngopharyngeal diseases at the Department of Otolaryngology and Head and Neck Surgery, Southern Hospital of Southern Medical University from October 2019 to December 2020, and the lingual tonsil grade (LTG), reflux symptom index (RSI) and reflux finding score (RFS) were assessed. The expression of pepsin in LTH was detected by immunohistochemistry. The coexpression of pepsin and macrophages were detected by immunohistofluorescence. In vitro, cytological experiments and pathway assays were performed on macrophages stimulated by pepsin. Pathway alterations of macrophages in pepsin-positive high-grade LTH were detected by double-fluorescence immunohistochemistry. Data were analyzed by SPSS 20.0 software. Results: There were 44 clinically significant LPRD patients with LTG 3 and 4, and the pepsin positive rate was 88.6% (39/44). While, the pepsin positive rate of LTG 1 and 2 was 48.3% (14/29). LTG was significantly positively correlated with RFS/RSI positive rate(χ2=23.01/19.62, P<0.001/0.001; r=0.54/0.51, P<0.001/0.001) and pepsin tissue staining intensity (H=21.58, P<0.001; r=0.53, P<0.001), respectively. Pepsin and macrophages were clearly colocalized in high grade LTH. In vitro, pepsin promoted macrophage proliferation (P<0.05) and production of IL-6/IL-8 (P<0.05). Pepsin significantly up-regulated the p38/JNK MAPK pathway in macrophages (P<0.05). Pepsin up-regulated the expression of IL-6 and IL-8 of macrophages by activating the p38 MAPK pathway (P<0.05), and up-regulated the expression of IL-8 by activating the JNK pathway (P<0.05). The p38/JNK MAPK pathways were highly expressed in macrophages of pepsin-positive LTH (P<0.05). Conclusions: LPR is an important pathogenic factor in LTH. Macrophages may mediate pepsin-induced inflammation and the pathogenesis of LTH.

Revision paraesophageal hernia repair outcomes in patients with typical and atypical reflux.

Revision laparoscopic anti-reflux surgery (RLARS) is effective in alleviating the typical symptoms of gastroesophageal reflux disease (GERD). RLARS outcomes in patients with atypical GERD symptoms has not been well established. A composite Reflux Symptom Index (RSI) score greater than 13 indicates extraesophageal manifestation of pathological reflux. In this study, we analyzed the differences in quality-of-life (QOL) and perioperative outcomes between patients with atypical versus typical GERD who underwent RLARS. A retrospective review was conducted of a prospectively maintained database of patients with pathologic reflux who underwent RLARS from February 2003 to October 2019. The cohort was divided into two groups, those with typical versus atypical manifestations of GERD, as defined by their RSI score. Patients with a RSI score of > 13 were assigned to the Atypical group and those ≤ 13 were assigned to the Typical group. Patient QOL outcomes were prospectively followed using the RSI survey. Significance was defined by p-value less than 0.05. A total of 133 patients (Typical 61, Atypical 72) were included in the final analysis. The two groups were similar (p > 0.05) in mean age (58.1 ± 13.3 vs. 55.3 ± 15.5years), body mass index (29.6 ± 5.0 vs. 30.3 ± 5.4), female sex distribution (60.7% vs. 59.7%) and age adjusted Charlson score (1.76 ± 1.58 vs. 1.98 ± 1.94). The Typical group had a higher frequency of type III hiatal hernia (62.3% vs. 29.2%) and Collis gastroplasty (29.5% vs. 5.6%). The groups had similar rates of partial and complete fundoplication with similar median length of stay (Typical: 3.0 ± 3.4days vs. Atypical: 2.4 ± 1.7days). After a mean follow-up of 30.2 ± 33.6months, both groups reported similar rates of improvement in RSI outcome from baseline (58.1% vs 43.3%, p = .149). However, the RSI outcome at the latest follow-up for the Typical group was significantly better than the Atypical group after RLARS (2.8 ± 5.3 vs. 15.9 ± 11.1, respectively). Patients who undergo revision paraesophageal hernia repair with objective findings of GERD and subjective complaints of atypical reflux symptoms may show long-term improvement in QOL outcomes. However, these results are contingent on proper patient selection and a thorough work-up for pathological reflux in this population. Further research is needed to determine universal diagnostic criteria to assist in the early detection and surgical treatment of patients with atypical GERD.

Positive and negative impact of anti-reflux mucosal intervention on gastroesophageal reflux disease.

Anti-reflux mucosal intervention (ARMI), including anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA), is a promising endoscopic treatment for gastroesophageal reflux disease (GERD). Few studies reported a detailed analysis of the objective reflux parameters. Patients with chronic PPI-dependent GERD and receiving ARMI were prospectively enrolled. Comprehensive clinical symptom profiles, endoscopy results, and 24-h multichannel intraluminal impedance-pH (MII-pH) monitoring were collected and analyzed before and 3months after ARMI. Twenty-three patients undergoing ARMI (11 ARMS and 12 ARMA) were enrolled. The median (IQR) operative time and post-procedure stays were 50 (46-56) min and 2 (2-2) days without major complications. 73.9% of patients reported subjective global improvement. A significant decrease in the total reflux symptom index score was noted from 12 (5-19) to 8 (4-12) (P = 0.010). The esophageal acid exposure time (AET) significantly decreased from 4.6 (2.8-6.9) to 2.1 (1.1-5.6) (P = 0.013), and the number of acid refluxes and DeMeester score were significantly reduced. Three patients (13%) had increased AET (3.4% to 6.1%, 6.3% to 15.4%, and 3.2% to 5.6%); however, all reported global improvement and two patients could discontinue PPI subjectively. One patient (4.3%) had worsened erosive esophagitis and reflux symptoms. 56.5% of patients stopped PPI. ARMI is generally effective and safe in PPI-dependent patients. However, possible negative effects of ARMI exist in some patients; further application of MII-pH is necessitated to evaluate the treatment response after ARMI and avoid the detrimental effect of PPI discontinuation. Graph.