Gastroesophageal Reflux Disease Symptoms Research Articles

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

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

Features of indicators of macrohemodynamics and systemic inflammation in patients with community-acquired pneumonia combined with gastroesophageal reflux disease

Relevance. The clinical course, treatment approaches, and outcomes of community-acquired pneumonia (CAP) often depend on microcirculatory disorders. The significant prevalence of gastroesophageal reflux disease (GERD) in the population determines the frequency of CAP. Study of the pathogenetic basis of the combined course of CAP in individuals with GERD, incl. microcirculation systems, can target correction paths and increase the effectiveness of therapy.Objective. To identify indicators of systemic inflammation and macrohemodynamics in patients with CAP combined with GERD.Material and methods. A total of 123 patients were under observation, incl. with mild CAP without signs of GERD (group I) — 38, with CAP and GERD — 49 (group 2), and 36 patients with GERD without CAP — group 3. In all patients with CAP, along with traditional studies, the concentrations of C-reactive protein (CRP) and brain natriuretic peptide (BNP) were determined in the blood, and echocardioscopy (EchoCS) was performed to determine the end systolic (ES) and diastolic (ED) volumes of the left ventricle (LV) and right ventricles (RV), blood flow velocity at the level of the pulmonary artery (Vmax PA), pressure gradients ΔPmax at the level of the tricuspid valve (TV), PA, and LV isovolumic relaxation time (IVRT). Control values for indicators were obtained from 34 practically healthy donors.Results. In all patients with CAP, at the beginning of therapy, intoxication and respiratory syndromes were observed, and pneumonia was diagnosed on an X-ray. Patients in groups II and III had characteristic symptoms of GERD. Blood tests revealed leukocytosis in all patients with CAP. The initial CRP concentration in group 1 was 5.2, group 2 — 7.7, group 3 — 1.2 times higher than normal. The initial concentration of BNP in all groups did not differ from the control. By discharge, CRP levels in all patients had decreased: however, in group II, they remained higher than in healthy people (2.6 times (p < 0.05) and higher than in group I, 1.3 times (p < 0.05). Before discharge, the BNP level in group II increased by 1.2 times compared with baseline in group I, in healthy individuals, and in group III. When analyzing the EchoCS indicators in group II patients, a significant increase in the initial indicators of LV EDV and LV ESV and decrease in EF and IVRT were observed. After treatment, no significant dynamics of volume and velocity parameters were observed in patients in group II; in patients in group I, pressure gradients at the TC and PA levels remained slightly reduced.Conclusions. An increase in CRP levels in patients with GERD characterizes low-intensity inflammation, which potentiates systemic inflammation in patients with CAP combined with GERD and is accompanied by an increase in BNP.

Overall satisfaction following laparoscopic fundoplication for patients with atypical extraesophageal symptoms: A comparative cohort study.

Some patients with gastroesophageal reflux (GERD) experience extraesophageal symptoms, which are considered due to laryngopharyngeal reflux (LPR). Most studies evaluating fundoplication for LPR report outcomes from individuals who also have typical esophageal GERD symptoms. Information is limited for patients with LPR but no GERD symptoms. To determine whether LPR patients benefit from fundoplication outcomes were determined for individuals with LPR±GERD and also those without LPR. Patients undergoing fundoplication from 1997 to 2015 were identified and divided into three symptom groups: LPR only, LPR and GERD, and GERD only. Heartburn, dysphagia, and satisfaction were assessed using 0-10 analog scores and compared at short (1-2years) and later (5years) follow-up. 2204 patients underwent fundoplication. 24 patients had LPR only, 130 patients had LPR and GERD, and matched to 1319 patients with GERD only. At 1-2 years follow-up, the LPR only group had lower satisfaction scores than those with GERD symptoms (± concurrent LPR) (7.00±3.49 vs. 8.41±2.42, p=0.019, and mean±s.d.). At 1-2years, 68.1% of the LPR only group had a good outcome (satisfaction score: 7-10) versus 84.6% with LPR and GERD and 84.1% with GERD only. At 1-2years follow-up, patients with LPR only were less satisfied following fundoplication compared with patients with typical GERD (±LPR). However, some patients with LPR only did benefit and might be considered for surgery if appropriately counseled. Outcomes were similar for patients with LPR and typical GERD and those with only typical symptoms.

Pharmacological Evaluation of the Traditional Brazilian Medicinal Plant Monteverdia ilicifolia in Gastroesophageal Reflux Disease: Preliminary Results of a Randomized Double-Blind Controlled Clinical Trial.

The present work aimed to compare the effects of the standardized dry extract from the leaves of Monteverdia ilicifolia, popularly known as "espinheira-santa", with omeprazole in the management of dyspepsia related to gastroesophageal reflux disease (GERD). A double-blind, randomized, non-inferiority and double-dummy clinical trial was conducted. In total, 86 patients with GERD symptoms were randomized into three groups: Omeprazol (20 mg), M. ilicifolia (400 mg), or M. ilicifolia (860 mg). Capsules were provided by SUSTENTEC®, Pato Bragato, Brazil. It was requested that the participants take three capsules before breakfast and dinner for 4 weeks. Clinical outcomes were obtained at the beginning and end of the study, with GERD symptoms (QS-GERD), the impact of heartburn symptoms on quality of life (HBQOL), and medical records. Overall, 75.6% of the participants showed adherence without any differences among the experimental groups. All groups had significant reductions in both QS-GERD and HBQOL scores. Omeprazole and 400 and 860 mg of M. ilicifolia decreased the QS-GERD total scores at the endpoint compared to the baseline (Chi-square = 129.808; p < 0.0001), as well as individual item scores, such as heartburn intensity (Chi-square = 93.568, p < 0.0001) and heartburn after meals (Chi-square = 126.426, p < 0.0001). There were no differences among the experimental groups after the intervention. Our results suggest that capsules with a standardized dry extract from the leaves of M. ilicifolia at a dosage of 400 or 860 mg are non-inferior to omeprazole, a proton pump inhibitor.

Expert consensus on the multifaceted utility of alginates in addressing diverse manifestations of acid reflux

Gastroesophageal reflux disease (GERD) is one of the most frequent reasons for seeking outpatient gastroenterology consultations. Current professional guidelines advocate the use of proton pump inhibitors (PPIs) as the primary medical approach to manage GERD. However, PPIs may not be as effective, especially for certain patients like those with non-erosive reflux disease (NERD). An alternative strategy for addressing symptomatic GERD involves obstructing the flow of acidic refluxate. Alginate-based pharmaceutical formulations have proven effective in alleviating symptoms of acid reflux for many years and provide rapid relief of symptoms with a long duration of action. Alginic acid derivatives, or alginates, combat acid reflux through a unique mechanism: they create a physical barrier that displaces the post-prandial acid pocket. Alginates have recently garnered renewed interest for promoting symptomatic relief especially when employed alongside antacids or PPIs. Here, the role of alginates is reviewed in the treatment of various profiles of acid reflux, including post-prandial acid reflux, nocturnal GERD, refractory GERD, and GERD during pregnancy, along with the opinion of expert gastroenterologists on the same. The experts believed that not all alginate formulations are equivalent and raft strength is the most important physicochemical property to be considered while selecting the alginate-based product. The physicochemical properties of the rafts eventually impact their effectiveness in relieving symptoms in clinical settings.

Endoscopic cardiac mucosal ligation: a novel minimally invasive procedure for gastroesophageal reflux disease

Background Our objective in this study was to evaluate the short-term clinical efficacy and safety of endoscopic cardiac mucosal ligation, a novel endoscopic procedure, in the treatment of gastroesophageal reflux disease (GERD). Methods Patients diagnosed with refractory GERD or recurrent patients due to drug withdrawal admitted to our hospital were recruited in this clinical trial. All GERD patients were treated with endoscopic cardiac mucosal ligation. Postoperatively, all patients received subsequent follow-ups for approximately four months to evaluate the efficacy and safety of this endoscopic procedure. Results A total of 13 GERD patients were enrolled. Endoscopic cardiac mucosal ligation was successfully performed in all cases. Postoperatively, relevant symptoms were significantly alleviated in 10 patients (76.9%). The average Gastroesophageal Reflux Disease Questionnaire (GERD-Q) score in all participants significantly decreased from preoperative 10.0 ± 3.5 to postoperative 7.8 ± 2.9 (p = .022). The average GERD symptom questionnaire score was 27.0 ± 12.0 prior to surgery, which significantly decreased to 18.3 ± 7.5 postoperatively (p = .032). No severe postoperative complications were observed during subsequent follow-ups. Conclusions Endoscopic cardiac mucosal ligation might be a novel effective and safe endoscopic procedure for GERD.

BS SO16 - How to improved quality of life and prevented long term vomiting after laparoscopic sleeve gastrectomy(Vertical and Buttress technique)

Abstract Background The clinical nausea/vomiting and clinical GERD are most common symptom after laparoscopic sleeve gastrectomy for treatment the morbid obesity patients and impaired to quality of life. We observed the other technique, laparoscopic vertical sleeve gastrectomy, is less in clinical nausea/vomiting and quality of life is better tan classical laparoscopic sleeve gastrectomy. Method This retrospective cohort study includes patients morbid obesity who underwent laparoscopic vertical sleeve gastrectomy(50 patients) at King Taksin Memorial Hospital(between January 1st 2023- January 1st 2024, mean and average follow up 7 months). Results The morbid obesity patients who underwent laparoscopic vertical sleeve gastrectomy was female 76%, average age 38.60 +/-9.67 years old, body weight 119.35+/-24.65 kg and BMI 44.48+/-7.0 kg/m2. There was no clinical vomiting and only 13.33 % had clinical GERD symptom(GERDQ score). The average % total weight loss was 23.66+/-10.24 kg, total weight loss was 29.95+/-16.66 kg within 1 year(comparable to other standard technique). There were no perioperative complications, no reoperation and no readmission with improved comorbidity. The total score gastrointestinal quality of life was 81.94%. Conclusion The laparoscopic vertical sleeve gastrectomy had % total weight loss comparable to other standard technique. There was 0% of the patient had clinical vomiting and only 13.33% of the patient had clinical GERD symptom. There were no intraoperative or postoperative complication, reoperation, readmission and improved comorbidity. In this study, laparoscopic vertical sleeve gastrectomy is less in clinical vomiting and GERD symptom and improve the gastrointestinal quality of life. However, the data comparison between laparoscopic vertical sleeve gastrectomy with laparoscopic classical sleeve gastrectomy in nausea/vomiting, gastrointestinal quality of life with long term outcomes and randomized controlled studies are still needed.

BS SO03 - Revisional bariatric surgery following sleeve gastrectomy, a meta-analysis comparing RYGB and OAGB

Abstract Background The number of bariatric operations is on the rise each year. Sleeve gastrectomy is the most popular procedure however often requires a revision surgery because of insufficient weight loss, weight regain or GERD. The most popular procedures are RYGB and OAGB. Our primary outcome was to look at the effect on weight loss in patients undergoing revision surgery and the secondary outcomes were gastro-oesophageal reflux, BMI difference, operative time, bleeding and anastomotic leak Method A systematic electronic search was undertaken using PubMed, MEDLINE®, Ovid®, Cochrane Library and Google Scholar™ according to PRISMA. Initial search identified 2,546 articles, after screening seven papers met the inclusions criteria, six retrospective studies and one RCT. Results There were a total of 802 patients that fit the inclusion criteria. 390 patients had a OAGB and another 412 had a RYBG. All patients previously had sleeve gastrectomy for weight loss. The length of follow-up was 12 months for our primary outcome. We found no statistically significant difference in %EWL between OAGB and RYGB (p=0.11). The incidence of post-operative reflux was statistically significantly higher in the OAGB group (16% vs 10.1%, p&amp;lt;0.003). Operative time was statistically significantly lower in the OAGB group (p=0.04). Conclusion Our meta-analysis showed no statistically significant difference between the two revision bariatric surgery procedure for %EWL. RYGB was superior to OAGB in reducing the incidence of symptomatic GERD while OAGB had a significant shorter operative time.

Is Screening for GERD Necessary in All Asymptomatic Lung Transplant Candidates?

Background: Gastroesophageal reflux disease (GERD) is a known contributor to allograft dysfunction after lung transplantation. Evaluation for GERD has been advocated for all lung transplant candidates. The aim of this study is to evaluate the outcomes of GERD testing in lung transplant patients without GERD symptoms and determine if a subset can skip/defer these tests. Methods: A retrospective chart review was conducted on lung transplant candidates who had pre- transplant GI evaluation at our institution between 2019 and 2022. Adult patients were included if they reported no GERD symptoms and completed GERD screening with Multichannel intraluminal impedance-pH testing. Demographics and results of prior testing were collected for included patients. Results were analyzed using STATA. Results: 176 patients met inclusion criteria. 88 (50%) tested positive for GERD and 88 (50%) tested negative. 68/88 (77.3%) were positive by pH alone. Only 20/176 (11%) had elevated reflux episodes and were recommended to undergo anti-reflux procedures. There were no statistically significant differences in evaluated variables differentiating GERD+ versus GERD- patients. Conclusion: Lung transplant candidates without symptoms concerning for GERD tested positive for GERD 50% of the time with no reliable pre-test characteristics to stratify patients. The large majority of positive results were from high acid exposure time alone without elevated reflux episodes—a low risk phenotype for allograft dysfunction. Only 11% had increased reflux episodes and thus were recommended for anti-reflux procedures. Thus, deferring GERD screening in asymptomatic low-risk candidates until post-transplant is unlikely to impact clinical management while benefiting patients and health systems.

Robotic versus laparoscopic revision to Toupet fundoplication for failed Nissen fundoplication: a single-center experience.

Nissen fundoplication (NF) is a common surgical procedure to treat gastroesophageal reflux disease; however, a subset of patients may continue to experience symptoms or develop symptom recurrence despite a successful procedure. This study aims to compare laparoscopic and robotic approaches for treating failed NF and evaluate the outcomes after converting to Toupet fundoplication (TF). We conducted a retrospective analysis of patients who underwent robotic or laparoscopic revision to TF for failed NF between 2016 and 2023. The data collected included demographics, pre-operative workup, and peri- and post-operative outcomes. Symptom analysis and anti-reflux medication usage were collected using a patient questionnaire. Failed fundoplication was defined as the need for an additional operation due to unresolved GERD symptoms or the emergence of a new issue. Eighty-eight patients (56 laparoscopic, 32 robotic) were included. Mean operative time was 148.71 ± 53.64min for the total cohort and was significantly longer in the robotic group (RG) 167.43min vs 138.01min in the Laparoscopic group (LG) (p value = 0.012). The LG had a length of hospital stay of 2.16 ± 1.69days vs RG 2.21 ± 1.28days (p value = 0.867). The LG had a higher number of early readmissions (5.4%, p value = 0.629) and both the LG and the RG had 1 patient that required an early reintervention. Symptoms of dysphagia and reflux decreased in both groups at last follow-up, but the reduction in PPI use was not significant. Surgical revision to TF for failed NF provides significant symptom improvement with low rates of complications and recurrences. Our study shows that both approaches are safe and feasible and have comparable surgical and symptom outcomes.

Prevalence and Risk Factors of Gastroesophageal Reflux Disease Among Medical and Dental Students of Rawalpindi/Islamabad

Objectives: To determine the prevalence of gastroesophageal reflux disease among medical and dental students of Rawalpindi Islamabad Pakistan and to find the associated risk factors. Study Design: Analytical cross-sectional study. Place and Duration of Study: Students of Medical colleges in Rawalpindi Islamabad Pakistan, from March to May 2021. Methodology: Non-probability convenience sampling technique was used. Sample size was found to be 352 using Rao soft.Only undergraduate students from Rawalpindi Islamabad Pakistan were included whereas postgraduate students were excluded. The data was collected via online distributed google forms and analyzed by SPSS version 25.0. Results: There were 157(44.6%) males and 195(55.41%) females among whom 296(84.1%) were enrolled in medical program and 56(15.9%) in dental program. 94 students (26.7%) reported having symptoms of gastroesophageal reflux disease .Based on a GERD score of &gt;=4, 35(9.94%) students were diagnosed with gastroesophageal reflux disease .Use of analgesics (OR=3.11[95% CI 1.32-7.36]; P≤0.010), family history of gastroesophageal reflux disease (OR=6.48[95% CI 3.09-13.57]; P≤0.000),family history of peptic ulcer (OR=2.85[95%CI 1.18-6.83] P≤0.038), frequent use of non-steroidal anti-inflammatory drugs(P≤0.013) had a significant association with the presence of gastroesophageal reflux disease . Conclusion: Gastroesophageal reflux disease was diagnosed in approximately 10% of students. There was a significant association of Gastroesophageal reflux disease with use and frequent consumption of non-steroidal anti-inflammatory drugs and family history of peptic ulcer/Gastroesophageal reflux disease

Diagnosis and treatment of patients with gastroesophageal reflux disease - a systematic review of cost-effectiveness and economic burden.

This study aims to review the existing knowledge on the cost-effectiveness and item costs related to the diagnosis and treatment of gastroesophageal reflux disease (GERD) patients at different stages. The study adhered to the PRISMA guidelines. The systematic search involved several steps: finding and identifying relevant articles, filtering them according to the set criteria, and examining the final number of selected articles to obtain the primary information. The number of articles published between 2013 and September 2024 in the Web of Science and PubMed databases was considered. The CHEERS checklist was used for the risk of bias assessment. Ultimately, 36 studies were included. Regarding the cost-effectiveness of GERD treatment, Proton pump inhibitors (PPIs) appeared to be the dominant solution for non-refractory patients. However, this might change with the adoption of the novel drug vonoprazan, which is more effective and cheaper. With advancements in emerging technologies, new diagnostic and screening approaches such as Endosheath, Cytosponge, and combined multichannel intraluminal impedance and pH monitoring catheters should be considered, with potential implications for optimal GERD management strategies. The new diagnostic methods are reliable, safe, and more comfortable than standard procedures. PPIs are commonly used as the first line of treatment for GERD. Surgery, such as magnetic sphincter augmentation or laparoscopic fundoplication, is only recommended for patients with treatment-resistant GERD or severe symptoms. Advances in emerging technologies for diagnostics and screening may lead to a shift in the entire GERD treatment model, offering less invasive options and potentially improving patients' quality of life.

To Dor or Not to Dor? Heller Myotomy, a Retrospective Study.

Achalasia is a neurodegenerative disorder affecting esophageal sphincter function. Treatment options include non-surgical and surgical approaches, such as Heller myotomy (HM). Combining Dor fundoplication with HM is controversial but may prevent gastroesophageal reflux disease (GERD). This retrospective cohort study aimed to assess whether HM with Dor fundoplication reduces GERD rates and increases dysphagia rates. Eighty patients who underwent HM between January 2018 and August 2023 were included. Sixty-four patients had Dor fundoplication and were matched 4:1 to 16 patients without fundoplication. Records were reviewed for GERD and achalasia symptoms at various postoperative time points. No significant differences in GERD or dysphagia symptoms were found between the two groups at any time point. Similarly, there were no significant differences in chest pain or dysphagia treatment. In conclusion, this study suggests that the addition of Dor fundoplication to HM does not significantly impact postoperative GERD or achalasia-related symptoms.

A clinical study on the efficacy and safety of poly-herbal formulation in managing functional dyspepsia

IntroductionFunctional dyspepsia is a common condition that affects millions of people worldwide. It is characterized by symptoms such as abdominal discomfort, bloating, and nausea, which can significantly impact a person's quality of life. While there are several pharmaceutical treatments available, many individuals are turning to herbal remedies as a safer and more natural alternative. This clinical study aimed to evaluate the efficacy and safety of poly-herbal formulation (PHF), marketed under brand names like Dizester® Herbal, Great Day®, etc. in patients suffering from functional dyspepsia compared to Pantoprazole, a commonly used pharmaceutical treatment. Materials & MethodsThe study included 80 patients, with 40 patients in each treatment arm. The primary objective was to assess the improvement in symptoms using various questionnaires at All India Institute of Medical Science Bhubaneswar, including the Reflux Disease Questionnaire, Short-Form Leeds Dyspepsia Questionnaire, GERD-Health Related Quality of Life Questionnaire, visual analogue scale (VAS) for pain, and Investigator's Symptomatic Assessment. The secondary objective was to evaluate the safety of PHF by assessing liver and renal function parameters and hemogram. Results & discussionThe results showed significant improvement in symptoms of GERD in the PHF group, which was comparable to the Pantoprazole group. The burning feeling behind the breastbone, pain behind the breastbone, burning feeling in the center of the upper stomach, acid taste in the mouth, and unpleasant movement of material upwards towards the mouth improved significantly from the beginning of the study to the follow-up visits. The mean VAS score reduced by 71.5 % in the PHF arm and 67.85 % in the Pantoprazole arm. Additionally, the study found no abnormal elevations in liver and renal function parameters in blood or any abnormal changes in hemogram, indicating the safety for use in patients with functional dyspepsia. Since the synthetic anti-dyspeptic drugs like proton pump inhibitors are known to have adverse effects, this natural alternative PHF shows promising results in a safer way. ConclusionIn conclusion, this study provides evidence for the efficacy and safety of PHF in improving symptoms of functional dyspepsia. The use of synthetic anti-dyspeptic medications has been associated with the occurrence of undesirable effects. In light of this, PHF has demonstrated encouraging outcomes in a manner that is considered safer.

Comparison of EsophyX2.0 and MUSE systems for transoral incisionless fundoplication: Technical aspects and outcomes up to 3 years.

We compared the efficacy and safety of transoral incisionless fundoplication (TIF) with the EsophyX2.0 and MUSE systems for treatment of gastroesophageal reflux disease (GERD). TIF outcomes from prospective protocols (Esophy2.0X: 2007-2012; MUSE: 2015-2019) were retrospectively compared regarding technical success, moderate/severe adverse events, morpho-functional findings up to 1 year, and clinical outcomes up to 3 years. Inclusion criteria were: (i) at least 6-month symptomatic GERD, full/partial response to proton pump inhibitors (PPI), esophagitis, and nonerosive reflux disease/hypersensitive esophagus (both protocols); (ii) hiatal hernia <3 cm (Esophy2.0X) and ≤2.5 cm (MUSE); and (iii) Barrett's esophagus <3 cm (MUSE). In the 50 EsophyX2.0 and 46 MUSE procedures, technical success and adverse event rates were similar, but MUSE-related adverse events (4.4%) were life-threatening. At 12 months, hiatal hernia recurred more frequently after EsophyX2.0 (P = 0.008). At 6 months, significantly fewer total and acid refluxes were reported after both TIF, but not more significantly at 1 year. Symptoms improved after both TIF up to 1 year (P < 0.0001), but to a greater extent in MUSE patients up to 3 years (P < 0.0001 vs. P < 0.01 for EsophyX2.0). The rates of 3-year off-PPI therapy patients were 73.5% in the MUSE and 53.3% in the EsophyX2.0 series (P = 0.069). Although no conclusion could be drawn from this limited study, the MUSE technique seemed more effective in the long term in patients with hiatal hernia; however, there were more severe adverse events than with EsophyX2.0.

Scalp and auricular acupuncture attenuate recurrent gastroesophageal reflux disease and related inflammatory cytokines

BackgroundGastroesophageal reflux disease (GERD) is increasingly common in developed countries. The pathogenesis involved in the symptoms includes gastric acid, esophageal or gastric motility disorders, visceral hypersensitivity, and lower esophageal sphincter (LES) dysfunction. Proton pump inhibitors (PPIs) are the most effective treatment, but long-term use can lead to gastric hypoacidity and nutrient deficiencies. AimsThis study exams the potential of meridian acupoint stimulation to modulate visceral hypersensitivity and LES tone in patients who are dependent or have failed PPIs. calp acupuncture activates the trigemino-parasympathetic reflex, while auricular acupuncture stimulates the vagus nerve, affecting the autonomic nervous system (ANS) of the viscera. This approach may restore LES function and reduce visceral hypersensitivity. However, its effectiveness for recurrent and PPI-dependent GERD remains unclear. MethodsPatients with recurrent GERD dependent on PPIs for at least 6 months were enrolled. The intervention involved four sessions of 2-week treatments with Wen's modern scalp and auricular acupuncture (WMA) versus seed acupressure (SAP). Reflux disease questionnaire (RDQ) scores, serum Gamma-aminobutyric acid (GABA), and serum inflammatory cytokines were evaluated before and after treatment. ResultsWMA significantly reduced total RDQ scores, on-demand PPI use, esophageal epithelial cell-derived cytokines, tight junction-modulating cytokines, and recurrent GERD markers. Patients with increased GABA levels post-WMA showed significant decreases in RDQ scores and PPI use. ConclusionWMA may alleviate recurrent, PPI-dependent GERD symptoms by modulating the ANS, potentially reducing systemic and local inflammatory cytokines within the lower esophageal epithelial barrier.

Associations between the symptoms of gastroesophageal reflux disease and dietary and lifestyle behavior among young Korean adults: a preliminary cross-sectional study

Objectives: Gastroesophageal reflux disease (GERD) is a clinical condition caused by esophageal tissue damage resulting from the reflux of stomach or duodenal contents. An increasing number of GERD cases have been reported recently; however, research on this population, especially young adults, is lacking. This study aimed to investigate the dietary and lifestyle factors associated with GERD symptoms in young Korean adults. Methods: A total of 202 individuals (19–34 years old) living in Gwangju were surveyed using a questionnaire to examine their general characteristics, lifestyle, and dietary behaviors. GERD symptoms were investigated using the gastroesophageal reflux disease questionnaire (GerdQ). The participants were grouped into normal (GerdQ score ≤ 4) and caution (GerdQ score ≥ 5), and their characteristics were analyzed according to the group. Results: The findings suggested 15 participants (7.4%) belonged to the GERD caution group. More non-office workers were in the caution group than in the normal group (P &lt; 0.05). The participants’ smoking, physical activity, sleep duration, and pillow height were not significantly different between the GERD phenotypes; however, the caution group consumed alcohol more frequently than the normal group (P &lt; 0.001). The analyses of the participants’ eating behaviors revealed that the frequency of overeating, late-night snacking and chocolate consumption was significantly higher in the caution group (P &lt; 0.001). Conclusion: Lifestyle and dietary behaviors were associated with GERD symptoms in young Korean adults. Further studies with larger cohorts are required to confirm these findings.

Multidisciplinary management of gastroesophageal reflux disease: an italian retrospective study

Abstract Background Millions of individuals are affected by gastroesophageal reflux disease (GERD) that causes significant discomfort negatively affecting patients’ overall quality of life. For a collaborative approach of continuous improvement in public health we wanted to know the real-world perspectives in the multidisciplinary and multimodal management pathway. Methods We aimed to interview a sample of gastroenterologists (GE), primary care physicians (GP), and otolaryngologists (ENT) to investigate the management of the intake and treatment of patients reporting symptoms of GERD. Symptoms were divided into typical and extraesophageal, and their severity and impact on quality of life was explored with the GERD Impact Scale (GSI) and Reflux Symptom Index (RSI). Results A total of 6211 patients were analyzed of whom with typical symptoms were 53.5%, while those with extraesophageal symptoms were 46.5%. The latter were more frequently reported by ENT patients (53.6%, p &amp;lt; 0.0001). GSI was highest in patients followed by GE (9 points) and GP (9 points) than ENT specialists (8 points), while the RSI was higher in the ENT group (14.3 ± 6.93) than in the groups of GP and GE, respectively (10.36 ± 6.36 and 10.81 ± 7.30, p &amp;lt; 0.0001). Chest pain had the greatest negative impact on quality of life (p &amp;lt; 0.0001). Of the 3,025 patients who used (proton pump inhibitors) PPIs, non-responders had a lower GSI when treated with a combination of adjunctive drug treatments and bioadhesive compounds, compared with single-component drugs. Conclusions The multidisciplinary and multimodal approach to the management pathway of GERD patients reveals variations in patient profiles by physician specialty, directing toward more appropriate and targeted treatments. In addition, the combination of adjunctive drug treatments and bioadhesive compounds appears to be effective in the management of patients refractory to PPIs. Key messages • The presentation of GERD symptoms is different in accordance with the physician’s speciality: the patients with GERD referred to a gastroenterologist had more severe disease and poorer quality of life. • The combination of adjunctive pharmacological treatments and bioadhesive compounds seems to be effective in the management of PPI refractory patients.

Short-term effects of laparoscopic sleeve gastrectomy combined with reconstruction of the acute His angle on postoperative gastroesophageal reflux disease

Objective: To compare the short-term efficacy of laparoscopic sleeve gastrectomy (LSG) combined with sharp His angle reconstruction (LSG-His) versus traditional LSG. Methods: In this retrospective cohort study we collected clinical data of patients with obesity who had undergone LSG or LSG-His in the Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, from January to June 2022. After excluding patients with incomplete follow-up data and those with hiatal hernia, 83 obese patients, of which 39 who had undergone LSG (LSG group) and 44 who had undergone LSG-His (LSG-His group), were included in the study. The basic steps in LSG-His are the same as in conventional LSG. After continuous suturing of the gastric staple line, one stitch is placed between the proximal side of the gastric greater curvature staple line and the proximal side of the gastric fundus posterior wall with the left diaphragm, and another stitch between the right side of the gastric fundus and the esophagus, reconstructing the sharp His angle. Clinical data, postoperative complications, and follow-up data on weight loss and gastroesophageal reflux disease (GERD) symptoms 1-, 3-, 6-, and 12-months post-discharge were compared between the two groups. GERD symptoms were assessed using the Gastroesophageal Reflux Disease Questionnaire and Reflux Diagnostic Questionnaire. Results: There were no significant differences between the two groups in baseline characteristics, length of hospital stay, hospitalization costs, intraoperative bleeding, postoperative nausea and vomiting, dysphagia, or postoperative complications (all P>0.05). Compared with the LSG group, the LSG-His group had significantly longer operative times (92 [80, 100] minutes vs. 80 [70, 100] minutes, U=2.227, P=0.026), higher postoperative 24-hour pain scores (5.2±1.8 vs. 4.3±1.9, t=-2.065, P=0.041), and higher rates of morphine use (70.5% [31/44] vs. 46.2% [18/39], χ²=4.519, P=0.025). The incidence of new-onset GERD 12 months postoperatively was significantly lower in the LSG-His than the LSG group (10.7% [3/28] vs. 61.3% [19/31], χ²=14.00, P<0.001). According to changes in Gastroesophageal Reflux Disease Questionnaire and Reflux Diagnostic Questionnaire scores, the LSG-His group also had significantly lower rates of exacerbation of GERD (2/16 vs. 5/8, χ²=4.27, P=0.021) and higher rates of GERD remission (12/16 vs. 2/8, χ²=3.62, P=0.032) than did the LSG group. Additionally, excess weight loss rates were significantly higher in the LSG-His group at 3 months [(54.7± 18.7)% vs. (46.5±15.0)% , t=-2.166, P=0.033], 6 months [(73.8±24.7)% vs. (64.0±19.1)% , t=-2.018, P=0.047], and 12 months [(82.9±26.7)% vs. (72.2±19.3)%, t=-2.063, P=0.042] than in the LSG group. Conclusion: Compared with LSG, LSG-His is safe and feasible and achieves better short-term control of postoperative GERD and more effective weight loss. Further large-scale, long-term, prospective studies are needed to confirm the long-term efficacy of LSG-His.

Bolus exposure as a novel predictor of postoperative symptom resolution after laparoscopic nissen fundoplication: A two-institutional retrospective cohort study.

Even in the absence of definite evidence of pathological acid reflux, antireflux surgery (ARS) can still effectively improve gastroesophageal reflux symptoms. Nonetheless, predicting postoperative reflux symptom improvement has been primarily dependent on acid-based parameters. No objective index reflecting both acid and non-acid reflux was identified to select ARS candidates. Prospectively collected data of 121 patients with gastroesophageal reflux disease (GERD), who underwent laparoscopic Nissen fundoplication from two institutions, were retrospectively reviewed. The patients reported preoperative and postoperative GERD symptoms using the Korean version of the GERD questionnaire, along with the gastroesophageal reflux disease-health-related quality of life (GERD-HRQL). The patients assessed for reflux symptoms using bolus exposure, acid exposure time (AET), and DeMeester score (DMS) as measurements were selected. For each reflux parameter, its association, correlation, and predictive capacity of the degree of postoperative symptom resolution were analyzed using chi-squared tests, point-biserial correlations, logistic regression analyses, and receiver operating characteristic curve analyses. 72 patients were eligible for this study. Bolus exposure was superior to the other parameters in terms of the degree of association and correlation with resolution of typical symptoms. Bolus exposure also showed a higher diagnostic accuracy in predicting the resolution of epigastric pain (area under the curve [AUC]=0.723, P=0.013) and regurgitation (AUC=0.981, P<0.001). Secondary analyses were performed in patients without pathological reflux, defined as the DMS-negative (DMS<14.7) or AET-negative (AET<6%) groups. In the secondary analyses, bolus exposure showed considerable diagnostic accuracy with statistical significance for all typical symptoms in both in the DMS-negative (heartburn: AUC=0.717, P=0.025; epigastric pain: AUC=0.717, P=0.025; regurgitation: AUC=0.975, P<0.001) and AET-negative (heartburn: AUC=0.681, P=0.045; epigastric pain: AUC=0.749, P=0.009; regurgitation: AUC=0.975, P<0.001) groups. Bolus exposure, a parameter of total reflux, was superior to AET or DMS in defining candidates for ARS. Further studies investigating the surgical indications for ARS in patients with non-acid reflux using bolus exposure are required.