Reflux Symptoms In Patients Research Articles

Does hiatal repair affect gastroesophageal reflux symptoms in patients undergoing laparoscopic sleeve gastrectomy?

Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a treatment of choice for morbid obesity and associated comorbidities. There has been a concern about new onset or worsening of gastroesophageal reflux (GERD) following LSG. The objective of the study was to evaluate the effect of surgically treating hiatal weakness on GERD symptoms in patients undergoing LSG. Single tertiary referral institution, Sydney, Australia. A prospective observational cohort study was conducted with consecutive patients undergoing LSG. Hiatal findings, patient demographics, medications and reflux score were recorded prospectively. Patients were followed up post-operatively for a minimum of 12 months and assessed using GERD-HRQL score to quantify reflux symptoms. Data from 100 patients with a minimum of 1-year follow-up were analysed. Mean follow-up was 18.9months. Overall, GERD-HRQL improved from mean 4.5 ± 5.8 pre-operatively to 0.76 ± 1.5 after 18.9months (p = 0.0001). For those with pre-operative reflux, GERD-HRQL improved from mean (SD) 8.43 ± 6.26 pre-operatively to 0.94 ± 1.55 (p = 0.0001). All the nine patients with troublesome daily reflux significantly improved. For those without pre-operative reflux, GERD-HRQL improved from 0.88 ± 1.37 to 0.47 ± 1.25 (p-ns) post-operatively. On multivariate analysis, higher pre-operative reflux and dysphagia/bloat scores, younger age and lower percentage excess weight loss after 18.9months were associated with GERD-HRQL improvement. In the medium term, GERD-HRQL improves following sleeve gastrectomy with meticulous hiatal assessment and repair of hiatal laxity and herniation.

Gastrointestinal Involvement in Systemic Sclerosis: An Update.

Gastrointestinal Involvement in Systemic Sclerosis: An Update.

29 Ivacaftor treatment is associated with a decline in symptoms of extra-oesophageal reflux in patients with cystic fibrosis and the G551D mutation

29 Ivacaftor treatment is associated with a decline in symptoms of extra-oesophageal reflux in patients with cystic fibrosis and the G551D mutation

Sa1289 Persistent Acid Reflux is Most Likely Cause of Recurrent Reflux Symptoms in Patients on PPI Therapy

Sa1289 Persistent Acid Reflux is Most Likely Cause of Recurrent Reflux Symptoms in Patients on PPI Therapy

Randomised clinical trial: alginate (Gaviscon Advance) vs. placebo as add-on therapy in reflux patients with inadequate response to a once daily proton pump inhibitor.

Many reflux patients remain symptomatic on a standard dose of proton pump inhibitor (PPI). Alginates decrease the number of reflux events by forming a raft on top of the stomach content and thus offer a supplemental mechanism of action to acid suppression. To assess the efficacy of an alginate (Gaviscon Advance, Reckitt Benckiser, Slough, UK) on reflux symptoms in patients with persistent symptoms despite once daily PPI. This was a multicentre, randomised, placebo-controlled, 7-day double-blind trial preceded by a 7-day run-in period. Reflux symptoms were assessed using the Heartburn Reflux Dyspepsia Questionnaire (HRDQ). Based on symptom score during run-in, eligible patients were randomised to Gaviscon Advance 10mL four times a day or placebo in addition to a once daily PPI. The primary endpoint was change in HRDQ score post-treatment compared to baseline. One hundred and thirty-six patients were randomised. Change in HRDQ reflux score was significantly greater for Gaviscon Advance (mean: -5.0, s.d.: 4.7) than for placebo (mean: -3.5, s.d.: 5.5) with an LS mean difference of 1.6 [95% CI -3.1 to -0.1], P=0.03. A decrease in the mean (s.d.) number of nights with symptoms was observed from 3.6 (2.8) to 3.0 (3.0) in the placebo group and from 3.9 (2.8) to 2.2 (2.7) for the Gaviscon Advance group. This reduction was significantly greater in the Gaviscon Advance group than in the placebo group [LS mean difference=-0.9, 95% CI (-1.6 to -0.2), P<0.01]. In patients with residual reflux symptoms despite PPI treatment, adding an alginate offers additional decrease in the burden of reflux symptoms (EudraCT/IND Number: 2011-005486-21).

Ineffective esophageal motility phenotypes following fundoplication in gastroesophageal reflux disease

Ineffective esophageal motility (IEM) is associated with reflux disease, but its natural history is unclear. We evaluated patients undergoing repeat esophageal high resolution manometry (HRM) for symptomatic presentations after antireflux surgery (ARS) to understand the progression of IEM. Patients with repeat HRM after ARS were included. Ineffective esophageal motility was diagnosed if ≥5 sequences had distal contractile integral (DCI) <450 mmHg cm s. Augmentation of DCI following multiple rapid swallows (MRS) was assessed. The esophagogastric junction (EGJ) was interrogated using the EGJ contractile integral (EGJ-CI). Esophageal motor function was compared between patients with and without IEM. Sixty-eight patients (53.9 ± 1.8 years, 66.2% female) had pre- and post-ARS HRM studies 2.1 ± 0.19 years apart. Esophagogastric junction-CI augmented by a mean of 26.3% following ARS. Four IEM phenotypes were identified: 14.7% had persistent IEM, 8.8% resolved IEM after ARS, 19.1% developed new IEM, and 57.4% had no IEM at any point. Patients with IEM had a lower DCI pre- and post-ARS, lower pre-ARS EGJ CI, and lower pre-ARS-integrated relaxation pressure (p ≤ 0.02 for all comparisons); presenting symptoms and other EGJ metrics were similar (p ≥ 0.08 for all comparisons). The IEM phenotypes could be predicted by MRS DCI response patterns (p = 0.008 across groups); patients with persistent IEM had the least DCI augmentation (p = 0.007 compared to no IEM), while those who resolved IEM had DCI augmentation comparable to no IEM (p = 0.08). Distinct phenotypes of IEM exist among symptomatic reflux patients following ARS. Provocative testing with MRS may help identify these phenotypes pre-ARS.

PWE-172 Does salivary pepsin measurement change diagnostic outcome in patients investigated by 24h ph monitoring?

Introduction Pepsin, a gastric enzyme, has been proposed as a marker of gastro-oesophageal reflux disease (GORD) when present in saliva.1 In contrast to routine diagnostic methods, quantification of salivary pepsin is rapid and non-invasive. Furthermore, 24h pH-monitoring has limited sensitivity.2We aimed to evaluate the impact of salivary pepsin measurement on diagnosis of GORD in patients undergoing 24h pH-monitoring. Method Patients referred for 24h pH-monitoring (off medication) were invited to take part in the study. Eligible participants complained of heartburn, regurgitation, chest pain or acid in the mouth and were referred for testing by a gastroenterologist, upper gastrointestinal surgeon or respiratory consultant. Presence of additional atypical symptoms was assessed by questionnaire (Reflux Symptom Index). Patients underwent high resolution oesophageal manometry and catheter-based 24h pH-monitoring. During the monitoring period, participants collected up to three saliva samples at the time of experiencing their predominant symptom (s). Pepsin concentration of samples was quantified using a lateral flow device (Peptest) where at least one sample containing >25ng/ml pepsin was indicative of reflux disease. Diagnostic outcome by pepsin measurement and 24h pH-monitoring (>4.2% of time pH Results 100 participants recruited; 80 participants included in final analysis (exclusions: corrupt pH study (n = 1), no pepsin samples collected (n = 19)). 81% of participants returned at least one positive pepsin sample. 39/80 (49%) patients were classified as having reflux disease based on 24h-pH monitoring (mean%time pH Conclusion A higher proportion of the total population was found to have GORD based on pepsin measurement (81% vs 49% using pH), which may reflect the poor sensitivity of 24h pH-monitoring. Measurement of salivary pepsin changed the diagnostic outcome when compared to 24h pH-monitoring in 44% of symptomatic reflux patients. Further studies should explore the relationships between pepsin concentration and symptoms of reflux. This study may support the use of salivary pepsin measurement to prevent false-negative diagnosis based on 24h pH-monitoring alone. Disclosure of interest A. Rasijeff: None Declared, W. Jackson: None Declared, J. Burke: None Declared, P. Dettmar Shareholder of: RD Biomed Limited. References Hayat JO, et al. Gut 2015;64:373–380 Dent J, et al. Gut 2010;59:714–721

Sa1295 Reflux Symptoms in Patients With Celiac Disease Are Associated With Alkaline or Weakly Acid Reflux

Sa1295 Reflux Symptoms in Patients With Celiac Disease Are Associated With Alkaline or Weakly Acid Reflux

Mo1119 Detection of Reflux Mechanisms in PPI Non-Responder Patients: Post Prandial High Resolution Impedance Manometry (HRIM) Study

Background: In the last decade combined impedance-pH monitoring has become the gold standard for the detection of reflux episodes with several studies demonstrating its increased diagnostic yield in gastro-esophageal reflux disease (GERD). This is mainly due to the capability of impedance-pH to correlate symptoms to both acid and non-acid reflux episodes. However, despite its large use in clinical practice, limited data about its clinical usefulness for the management of GERD patients are present. AimM mean age 49; 14 ERD, 22 NERD and 12 NARD) reporting at least 3 symptoms during the impedance-pH monitoring were included. Fundoplication had a similar effect in all groups, as shown in the Figure. At 1 year, esophageal AET and number of total, acid and non-acid refluxes significantly decreased after surgery (in all cases, p<0.01), whereas mean lower esophageal pressure increased (p<0.05). The percentage of patients with resolved or markedly improved typical symptoms at 12 months after surgery was similar among the groups (ERD 93% vs. NERD 82% vs NARD 83%, p=ns). Quality of life similarly improved in all groups (p=ns). Finally, the percentage of failure or adverse events did not differ among the groups (ERD 21% vs. NERD 23% vs NARD 17%, p=ns). Conclusion: Our data show that laparoscopic fundoplication was a safe and effective procedure in relieving typical reflux symptoms in patients with NARD as well as in patients with ERD and NERD, thus markedly improving their quality of life. Therefore, impedance-pH monitoring facilitated a more focused therapeutical approach to patients with PPI-resistant GERD.

Mo1117 Patients With Non-Acid Reflux Disease and Those With Erosive and Non-Erosive Reflux Disease Have Similar Response to Anti-Reflux Surgical Therapy

Background: In the last decade combined impedance-pH monitoring has become the gold standard for the detection of reflux episodes with several studies demonstrating its increased diagnostic yield in gastro-esophageal reflux disease (GERD). This is mainly due to the capability of impedance-pH to correlate symptoms to both acid and non-acid reflux episodes. However, despite its large use in clinical practice, limited data about its clinical usefulness for the management of GERD patients are present. AimM mean age 49; 14 ERD, 22 NERD and 12 NARD) reporting at least 3 symptoms during the impedance-pH monitoring were included. Fundoplication had a similar effect in all groups, as shown in the Figure. At 1 year, esophageal AET and number of total, acid and non-acid refluxes significantly decreased after surgery (in all cases, p<0.01), whereas mean lower esophageal pressure increased (p<0.05). The percentage of patients with resolved or markedly improved typical symptoms at 12 months after surgery was similar among the groups (ERD 93% vs. NERD 82% vs NARD 83%, p=ns). Quality of life similarly improved in all groups (p=ns). Finally, the percentage of failure or adverse events did not differ among the groups (ERD 21% vs. NERD 23% vs NARD 17%, p=ns). Conclusion: Our data show that laparoscopic fundoplication was a safe and effective procedure in relieving typical reflux symptoms in patients with NARD as well as in patients with ERD and NERD, thus markedly improving their quality of life. Therefore, impedance-pH monitoring facilitated a more focused therapeutical approach to patients with PPI-resistant GERD.

Gastroesophageal Reflux Symptoms in Patients with Chronic Obstructive Pulmonary Disease

BACKGROUND: It is known that there is some relation between airways obstruction and gastroesophageal reflux symptoms (GER) symptoms in patients with chronic obstructive pulmonary disease (COPD).AIM: The aim was to determine frequency of GER symptoms and correlation with pulmonary function tests in patients with COPD.MATERIAL AND METHODS: The study included 58 patients. First group had 20 patients with mild COPD, second group had 18 patients with moderate COPD and third group had 20 patients with severe COPD. We had also a control group with 12 healthy subjects. All subjects completed their self-reported questionnaire about symptoms like: acid-regurgitation, heartburn, dysphagia, dyspnea and chronic cough.RESULTS: COPD patients with airways obstruction and significant GER symptoms had their respiratory symptoms associated with reflux events. More of COPD patients had significant GER symptoms defined as regurgitation and dysphagia once or more per week. Patients with FEV1 less than 50% showed more prevalent GER symptoms compared to those with values of FEV1 grater then 50%.CONCLUSION: GER symptoms are more prevalent in patients with severe airways obstruction when compared to less airways obstructed group and controls. We could suggest an association between the degree of airways obstruction in patients with COPD and the increased rate of GER symptoms.

Gastroesophageal Reflux Symptoms in Patients with Chronic Obstructive Pulmonary Disease

BACKGROUND: It is known that there is some relation between airways obstruction and gastroesophageal reflux symptoms (GER) symptoms in patients with chronic obstructive pulmonary disease (COPD).AIM: The aim was to determine frequency of GER symptoms and correlation with pulmonary function tests in patients with COPD.MATERIAL AND METHODS: The study included 58 patients. First group had 20 patients with mild COPD, second group had 18 patients with moderate COPD and third group had 20 patients with severe COPD. We had also a control group with 12 healthy subjects. All subjects completed their self-reported questionnaire about symptoms like: acid-regurgitation, heartburn, dysphagia, dyspnea and chronic cough.RESULTS: COPD patients with airways obstruction and significant GER symptoms had their respiratory symptoms associated with reflux events. More of COPD patients had significant GER symptoms defined as regurgitation and dysphagia once or more per week. Patients with FEV1 less than 50% showed more prevalent GER symptoms compared to those with values of FEV1 grater then 50%.CONCLUSION: GER symptoms are more prevalent in patients with severe airways obstruction when compared to less airways obstructed group and controls. We could suggest an association between the degree of airways obstruction in patients with COPD and the increased rate of GER symptoms.

Comparative study of pantoprazole and esomeprazole for erosive gastroesophageal reflux disease: a prospective study

Background: The objective of this study was to compare the efficacy of pantoprazole and esomeprazole to heal and relief from erosive esophagitis (EE) disease related symptoms. Methods: One hundred and ten patients (IIT-patients) with EE were randomized to receive 8 weeks of 40 mg pantoprazole (n=55) twice before food for first 7 days followed by once daily and esomeprazole 40 mg (n=55) once daily. Daily changes in heartburn and reflux were assessed. Results: The mean heartburn score with esomeprazole is more rapidly decreased than with pantoprazole. There no mild significant differences between two groups in the rate healing of reflux esophagitis at week and 4 and 8. The LA grade severity compare with esomeprazole group is rapidly decreased compared with pantoprazole. Esomeprazole 40 mg provided significantly greater healing than pantoprazole 40 mg after 4 weeks of treatment in patients with EE (56.36% vs. 49.09 %). Esomeprazole-treated patients were healed after up to 8 weeks of treatment similar those treated with pantoprazole (94.54% vs. 70.90 %). Conclusion: Esomeprazole is more effective than pantoprazole for rapid relief of heartburn symptoms and acid reflux symptoms in patients with reflux esophagitis.

Relationship between intramucosal inflammation and reflux symptoms in patients with gastroesophageal reflux disease -role of nociceptors and neuropeptides-

Relationship between intramucosal inflammation and reflux symptoms in patients with gastroesophageal reflux disease -role of nociceptors and neuropeptides-

Efficacy, Safety, and Tolerability of Pantoprazole Magnesium in the Treatment of Reflux Symptoms in Patients with Gastroesophageal Reflux Disease (GERD): A Prospective, Multicenter, Post-Marketing Observational Study

To improve proton pump inhibitor effects, pharmacological modifications have been developed such as the use of enantiomer molecules (e.g., S-omeprazole, S-pantoprazole, or dexlansoprazole), or addition of NaHCO3 (for an immediate release) or magnesium (with a lower absorption for a more sustained effect). The objective of this study was to assess the efficacy, safety, and tolerability of pantoprazole magnesium 40 mg once daily for 4 weeks, on the relief of reflux symptoms in gastroesophageal reflux disease (GERD) patients. A phase IV, open-label, prospective, multicenter study was designed. Patients included were prescribed pantoprazole magnesium 40 mg orally once daily for 28±2 days. All patients had a history of persistent or recurrent heartburn and/or acid regurgitation for at least 3 months. Effectiveness and tolerability data obtained from patients who completed a minimum of 4 weeks of pantoprazole magnesium treatment were considered for analysis. The account of baseline characteristics and demographics of GERD symptom intensity was made by analyzing the group of 4,343 patients that fulfilled all inclusion criteria; 54% were females (n=2,345) and 46% (n=1,998) males, with a mean age of 36.2±7.5 years. Severity of symptoms, assessed by the physician using the 4-point Likert scale, reduced by at least 80% from baseline intensity after treatment in the per protocol population. In the case of the intention-to-treat population, the improvement in symptom intensity was 73%. The number of patients that experienced any adverse events was 175/5,027 (3.48%). Pantoprazole magnesium is a safe, effective, and well-tolerated drug that significantly improves GERD symptoms.

Clinical characteristics and effectiveness of lansoprazole in Japanese patients with gastroesophageal reflux disease and dyspepsia

Patients with gastroesophageal reflux disease (GERD) frequently have symptoms of dyspepsia in addition to reflux symptoms. Treatment options for dyspepsia are not standardized. The aim of this study was to clarify the therapeutic effect of lansoprazole on dyspepsia in Japanese patients with GERD. GERD patients with dyspepsia were enrolled and treated with lansoprazole 15 or 30mg once daily for 4weeks. Reflux and dyspeptic symptoms were assessed by questionnaires before treatment, and 2 and 4weeks after the start of lansoprazole treatment. In the effectiveness analysis set (n=12,653), heartburn was reported by 91.6% of patients at study enrollment. Postprandial fullness was the most frequently reported dyspepsia symptom at the start of the study, reported by 79.0% of enrolled patients. After 4weeks of lansoprazole treatment, heartburn symptoms were improved in 75.7% of patients and symptoms of postprandial fullness were improved in 68.7% of patients. The therapeutic effect of low and high doses of lansoprazole on dyspepsia, as well as on reflux symptoms, was approximately 10% higher in patients with endoscopy-confirmed erosive esophagitis (60.1-82.2%), than in patients with non-erosive reflux diseases (53.0-73.3%). Lansoprazole was well tolerated. In this large-scale clinical study, lansoprazole effectively relieved dyspepsia in addition to reflux symptoms in patients with GERD.

The Antisecretory Therapy Improves Anxiety and Depression Symptoms in Patients with Symptomatic Gastroesophageal Reflux Disease

Background/Aims: Anxiety and depression are associated with reflux symptoms in patients with gastroesophageal reflux disease (GERD). The purpose of this study is to investigate whether the anxiety and depression in patients with GERD will improve with anti-secretory treatment. Materials and Methods: Participants who had taken upper endoscopic evaluation and who had symptoms of heartburn or acid regurgitation more than once a week were included through questionnaires. The hospital anxiety and depression scale was used to compare the scores before and after anti-secretory drug (proton pump inhibitor [PPI] or histamine-2 receptor blocker [H2 blocker]) treatment for four weeks. Results: Eighty-four out of a total 94 patients were randomly assigned to a four week treatment, in which, 46 and 38 patients were each assigned to PPI and H2 blocker, respectively. Regardless of the type of treatment, anxiety scores decreased significantly from 5.8±3.8 to 5.2±3.9 after treatment (P=0.033). Depression scores of 6.3±3.4 before treatment reduced to 5.5±3.4 after treatment (P=0.011). Anxiety scores and depression scores decreased significantly after treatment in the H2 blocker group. In the response group, anxiety and depression showed significant improvement (P=0.008, P=0.011). Conclusions: Regardless of the type of drugs, anti-secretory therapy is helpful in treating symptomatic GERD patients, not only in relieving symptoms, but also in relieving anxiety and depression accompanied with GERD. (Korean J Helicobacter Up Gastrointest Res 2013;13:30-35)

High Prevalence of Gastroesophageal Reflux Symptoms in Patients with Non-Alcoholic Fatty Liver Disease Associated with Serum Levels of Triglyceride and Cholesterol but Not Simple Visceral Obesity

Background/Aims: Visceral obesity is commonly involved in the pathogenesis of gastroesophageal reflux disease (GERD) and non-alcoholic fatty liver disease (NAFLD). However, other characteristic factors different from visceral obesity are associated with the pathogenesis of NAFLD. We investigated the prevalence of GERD symptoms in patients with NAFLD and its associated risk factors. Methods: NAFLD (n = 96) and controls (n = 139) were enrolled in this study. GERD symptoms were evaluated by using a frequency scale for the symptoms of GERD. Results: GERD symptom score and its prevalence rate were higher in the NAFLD group (7.4 ± 0.7, 37%) than those seen in the control groups (4.5 ± 0.4, 20%), which was independent of sex, age, and body mass index (BMI). GERD symptoms were correlated with insulin resistance (r = 0.167, p = 0.011), total cholesterol (T-CHO) (r = 0.138, p = 0.034), triglyceride (TG) (r = 0.178, p = 0.006), or immunoreactive insulin (r = 0.173, p = 0.008) but not BMI (r = 0.089, p = 0.175). GERD symptoms of the NAFLD group were significantly severer in the higher group of T-CHO and TG levels than those in the lower group. Multivariate analysis proved that risk factors related to GERD symptoms were TG (OR 3.96, 95% CI 1.31–11.9) and T-CHO (OR 3.39, 95% CI 1.11–10.3). Conclusion: The severity and prevalence of GERD symptoms in patients with NAFLD were high, which was associated with serum levels of TG and T-CHO but not BMI.

Beyond acid suppression: mechanisms underlying the beneficial effects of STW 5 in experimental reflux esophagitis (RE)

Proton pump inhibitor (PPI) therapy is the most effective medical treatment for symptom relief in gastro-esophageal reflux disease (GERD). However, up to 40% of patients do not achieve adequate symptom control. STW5 was shown to relieve heartburn and concomitant reflux symptoms in patients with functional dyspepsia and to prevent inflammation in an acute model of RE, without affecting the pH of the refluxate. In the present study, the efficacy of STW5 was assessed in a sub-chronic model of RE, and the underlying mechanisms were investigated. After pre-treatement for 7d with STW5 or omeprazole, esophagitis was induced surgically. Rats were treated for further 10d with the drugs before sacrifice. The esophagi were excised and evaluated macroscopically. Tissue homogenates were used for a proteome-profiler cytokine array. Tissue samples and peripheral blood were analyzed using Agilent whole genome microarray. Both treatments improved macroscopic parameters to similar extents. However, STW5 had a much more pronounced anti-inflammatory effect as evidenced by the cytokine array, which showed a marked increase in the number and amount of cytokines released in the esophagitis group. STW5 inhibited the vast majority of these changes dose dependently. The effect was much more prominent than that of omeprazole, suggesting a direct anti-inflammatory/mucosa protecting action. This was confirmed by microarray analysis. Since gastric acid does not seem to be the only causative agent involved in the pathogenesis of GERD, the present findings suggest that multi-target anti-inflammatory drugs like STW5 might present an alternative/additional treatment option for GERD patients not responding adequately to PPIs.

Mechanisms underlying the potential usefulness of STW 5 in reflux esophagitis

STW 5, a multi-component herbal preparation, was shown to relieve heartburn and concomitant reflux symptoms in patients with functional dyspepsia and to prevent inflammation in an acute model of reflux esophagitis (RE), without affecting the pH of the refluxate. The present study assesses the efficacy of STW 5 in a sub-chronic model of RE, and the underlying mechanisms both in vivo and in vitro. Rats were pretreated for 7d with STW 5 or omeprazole (as reference drug) before surgical induction of esophagitis. RE was achieved by ligation of the fore-stomach and covering the pylorus with a piece of Nelaton catheter. Rats were treated for a further 10d with the drugs and then sacrificed, their esophagi excised, weighed and evaluated macroscopically. Tissue homogenates were used for determination of cytokines using a cytokine array. Both STW 5 and omeprazole, improved body weight, tissue damage score and esophageal weight index to similar extents. However, STW 5 had a much more pronounced anti-inflammatory effect. As shown in the cytokine array, STW 5 inhibited the majority of the measured pro-inflammatory cytokines induced by surgical reflux, suggesting a direct anti-inflammatory and/or mucosa protecting action.