Gastroesophageal Reflux Disease Symptoms Research Articles

Visualization of deglutition and gastroesophageal reflux using real-time MRI: a standardized approach to image acquisition and assessment

This study aims to develop a standardized algorithm for gastroesophageal image acquisition and diagnostic assessment using real-time MRI. Patients with GERD symptoms undergoing real-time MRI of the esophagus and esophagogastric junction between 2015 and 2018 were included. A 10 ml bolus of pineapple juice served as an oral contrast agent. Patients performed Valsalva maneuver to provoke reflux and hiatal hernia. Systematic MRI assessment included visual presence of achalasia, fundoplication failure in patients with previous surgical fundoplication, gastroesophageal reflux, and hiatal hernia. A total of 184 patients (n = 92 female [50%], mean age 52.7 ± 15.8 years) completed MRI studies without adverse events at a mean examination time of 15 min. Gastroesophageal reflux was evident in n = 117 (63.6%), hiatal hernia in n = 95 (52.5%), and achalasia in 4 patients (2.2%). Hiatal hernia was observed more frequently in patients with reflux at rest (n = 67 vs. n = 6, p < 0.01) and during Valsalva maneuver (n = 87 vs. n = 8, p < 0.01). Real-time MRI visualized a morphologic correlate for recurring GERD symptoms in 20/22 patients (90%) after fundoplication procedure. In a large-scale single-center cohort of patients with GERD symptoms undergoing real-time MRI, visual correlates for clinical symptoms were evident in most cases. The proposed assessment algorithm could aid in wider-spread utilization of real-time MRI and provides a comprehensive approach to this novel imaging modality.

Clinical efficacy of Yukgunja-tang combined with a proton pump inhibitor for refractory gastroesophageal reflux disease: study protocol for randomized, double-blind, double-dummy clinical trial

BackgroundYukgunja-tang (YGJ) is an herbal prescription used to treat the symptoms of gastroesophageal reflux disease (GERD). Although many preclinical and clinical studies on YGJ have been conducted on GERD, there is a lack of evidence from blinded studies to exclude placebo effects. Therefore, this protocol proposes a clinical trial that is single-centered, randomized, double-blinded, double-dummy to objectively evaluate the efficacy and safety of co-administered YGJ and rabeprazole (RPZ) in patients with GERD previously treated with proton pump inhibitors (PPIs) and still experiencing symptoms.MethodsA total of 86 participants with refractory GERD (rGERD) will be randomized in a 1:1 ratio to the treatment [YGJ and RPZ (10 mg/d)] and control groups [double-dose RPZ (20 mg/d)] for 4 weeks of treatment (weeks 0–4) followed by 4 weeks of follow-up (weeks 4–8). The Frequency Scale for the Symptoms of GERD will be analyzed for the primary endpoint. Reflux Disease Questionnaire, Reflux Symptom Score, GERD-Health Related Quality of Life, Overall Treatment Evaluation, Spleen Qi Deficiency Questionnaire, Damum Questionnaire, and dyspepsia Visual Analogue Scale will be used to evaluate treatment effects on GERD related symptoms and quality of life and to compare treatment effects by subgroups. Safety tests will be analyzed by investigating adverse events.DiscussionThis clinical trial will be the first rigorous double-blind, double-dummy, placebo-controlled study to precisely evaluate the efficacy and safety of the combination of YGJ and PPIs in the treatment of rGERD. The results of this study will provide a reliable clinical basis for selecting botanical drug treatments for patients with rGERD.Trial registrationClinical Research Information Service (registration number: KCT0008600, July 13, 2023, https://cris.nih.go.kr).

Сучасні уявлення про вплив гормонів щитоподібної залози на розвиток і перебіг гастроезофагеальної рефлюксної хвороби

The problem of gastroesophageal reflux disease (GERD) remains one of the most relevant in modern gastroenterology. In recent decades, there has been a tendency to increase in the incidence of GERD especially among young people. Symptoms of GERD occur in almost half of the adult population. The main symptom of GERD — intermittent heartburn, which significantly reduces the quality of life, noted in up to 40% of residents of industrialized countries. However, the real prevalence of GERD in the population has not been studied enough due to the low rate of medical treatment seeking, frequent asymptomatic course as well as the course of the disease under masks, the so-called «esophageal» manifestations. At the same time, the number of patients with GERD with combined pathology is growing. One such disease is autoimmune thyroiditis (AIT). AIT — is one of the most common diseases of the thyroid gland. Autoimmune inflammatory process in the thyroid gland leads to the constant production of autoantibodies to thyroperoxidase or thyroglobulin and further leads to permanent destruction of the thyroid gland with the subsequent development of hypothyroidism. Early diagnosis of AIT allows to timely treatment and maintains thyroid function. Both of these diseases have several common pathogenetic mechanisms, the main of which are thyroid hormones that regulate motility and secretion of the gastrointestinal tract. The comorbid course of these pathologies aggravates and modifies the clinical picture each other. For today, the role of thyroid hormones in the mechanism of formation of motor-secretory disorders in patients with GERD with concomitant AIT, their impact on the peculiarities of the formation of psychosomatic status, as well as gender features of GERD and AIT remains unexplored.

IBC-Oxford University2023_BJSOral_24Comparison of postoperative GERD after LSG with omentopexy versus LSG without omentopexy, incidence of peri-operative GERD LSG in East Asia.

Abstract Background Gastroesophageal Reflux Disease (GERD) is known as the most common long-term complication after laparoscopic sleeve gastrectomy (LSG). The pathophysiology is assumed that the sleeved stomach after LSG is prone to be herniated through the hiatus with high intra- abdominal pressure in obese patients. The omentopexy is thought to make the remnant stomach fixed in abdominal cavity to decrease GERD symptom. Objectives This study aims to compare postoperative GERD after LSG with omentopexy versus LSG without omentopexy as well as to report incidence of peri-operative GERD LSG in East Asia with obesity. Methods This was a single-center retrospective comparative study. Patients with severe obesity (BMI &amp;gt; 35 or &amp;gt; 30 with second metabolic disease) who underwent LSG between January 2019 and June 2021 in Seoul National University Bundang Hospital were enrolled. Patient data were collected preoperatively and at postoperative 1 year. At each time point, body weight, laboratory tests and esophagogastroduodenoscopy were assessed. The patients were asked if anti-reflux medication including proton-pump inhibitor was taken and responded to GERD questionnaire. The validated Korean version of GERD-Q questionnaire was utilized. Laparoscopic sleeve gastrectomy was performed in the usual manner, with or without omentopexy. Omentopexy was defined as the suturing the stapled stomach to the omentum which must include upper part of the sleeve. Electric medical and surgical records were evaluated by the surgeons who were specialized in gastrointestinal surgery. The primary outcome was GERD incidence evaluated by three criteria: LA classification on esophagogastroduod enoscopy, GERD-Q score and anti-reflux medication history. Results During the study period, 106 and 62 patients were enrolled in the LSG with omentopexy group (LSGO) and LSG without omentopexy group (LSGWO) respectively. The baseline demographics did not significantly differ from each group. The mean age of LSGO group was 37.8 years (standardized deviation [SD] 11.0 years] and that of LSGWO group was 38.4 years [SD 10.9 years] (p=0.959). The LSGO and LSGWO groups were comprised of 34.0% and 35.5% men (p=0.868). There were no significant differences in surgical outcomes and postoperative complications between two groups. On GERD, there was no significant difference in LA classification and anti-reflux medication proportion between two groups after postoperative 1 year. However, LSGO group showed significantly less GERD-Q score (mean, SD; 6.57, 1.56) than LSGWO group (mean, SD; 7.91, 3.0) (p=0.02), which represented less subjective GERD symptoms in LSGO group. Conclusion People with obesity who underwent laparoscopic sleeve gastrectomy combined with omentopexy showed less GERD symptoms 1 year after operation than those who without omentopexy.

IBC-Oxford University2023_BJSOral_15Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Indications, Management and Results

Abstract Introduction Sleeve gastrectomy (SG) represents more than 60% of bariatric procedures worldwide. Conversion of SG to Roux-en-Y gastric bypass (RYGB) for weight loss failure (WLF) or gastro-oesophageal reflux disease (GERD) is increasing. Intrathoracic migration of the sleeve often seems associated. Aim The aim of our study was to analyse the relevance of the indications, the prevalence of an associated de novo hiatal hernia, and the outcomes of the conversion of SG to RYGB. Methods This is a retrospective study of prospectively collected data including all the patients who underwent a conversion of SG to RYGB from August 2013 to December 2022. 2 groups were compared: patients operated on because of weight loss failure (WLF group) and those operated on for GERD (GERD group). Results We analysed in both groups demographic data, the incidence of an associated hiatal hernia, morbidity, weight loss outcomes and resolution of symptoms. 59 patients were included with an average follow-up of 30.5 months: 46 patients in the GERD group (78%) were compared to 13 patients (22%) in the WLF group. Groups were comparable regarding age (47) and gender (women: 74%); BMI at conversion and prevalence of comorbidities were significantly higher in the WLF group (41.8 kg/m² vs 33.3, p=0.0001). In the GERD group: on preoperative gastroscopy, 30% (14/46) had a grade B esophagitis, 48% (22/46) had a significant hiatal hernia which required a posterior crural closure versus 23% (3/13) in the WLF group, not requiring a surgical treatment (p = 0.02). Conversion was very effective on GERD symptoms (93% of improvement), 52% of the patients stopped proton pump inhibitor treatment. In the WLF group, mean percentage total weight loss (% TWL) was 15.3%, significantly greater than in the GERD group (% TWL=4.6%, p = 0.01). The complication rate was 10% at 30 days and 3.4% after 30 days, not significantly different between groups (p = 1 and 1 respectively). Conclusions The main indication of conversion of SG to RYGB was because of GERD: in these indications, the incidence of intrathoracic migration of the sleeve is high requiring a surgical treatment with a very good efficacy on resolution of symptoms. Weight loss results were disappointing.

IBC-Oxford University2023_BJSOral_12Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Indications, Management and Results

Abstract Introduction Sleeve gastrectomy (SG) represents more than 60% of bariatric procedures worldwide. Conversion of SG to Roux-en-Y gastric bypass (RYGB) for weight loss failure (WLF) or gastro-oesophageal reflux disease (GERD) is increasing. Intrathoracic migration of the sleeve often seems associated. Aim The aim of our study was to analyse the relevance of the indications, the prevalence of an associated de novo hiatal hernia, and the outcomes of the conversion of SG to RYGB. Methods This is a retrospective study of prospectively collected data including all the patients who underwent a conversion of SG to RYGB from August 2013 to December 2022. 2 groups were compared: patients operated on because of weight loss failure (WLF group) and those operated on for GERD (GERD group). Results We analysed in both groups demographic data, the incidence of an associated hiatal hernia, morbidity, weight loss outcomes and resolution of symptoms. 59 patients were included with an average follow-up of 30.5 months: 46 patients in the GERD group (78%) were compared to 13 patients (22%) in the WLF group. Groups were comparable regarding age (47) and gender (women: 74%); BMI at conversion and prevalence of comorbidities were significantly higher in the WLF group (41.8 kg/m² vs 33.3, p=0.0001). In the GERD group: on preoperative gastroscopy, 30% (14/46) had a grade B esophagitis, 48% (22/46) had a significant hiatal hernia which required a posterior crural closure versus 23% (3/13) in the WLF group, not requiring a surgical treatment (p = 0.02). Conversion was very effective on GERD symptoms (93% of improvement), 52% of the patients stopped proton pump inhibitor treatment. In the WLF group, mean percentage total weight loss (% TWL) was 15.3%, significantly greater than in the GERD group (% TWL=4.6%, p = 0.01). The complication rate was 10% at 30 days and 3.4% after 30 days, not significantly different between groups (p = 1 and 1 respectively). Conclusions The main indication of conversion of SG to RYGB was because of GERD: in these indications, the incidence of intrathoracic migration of the sleeve is high requiring a surgical treatment with a very good efficacy on resolution of symptoms. Weight loss results were disappointing.

IBC-Oxford University2023_BJSOral_7Ligamentum Teres Augmentation for Hiatus Hernia Repair after Bariatric Surgery: A Systematic Review and Meta-Analysis

Abstract Background Hiatus hernia and symptomatic gastro-oesophageal reflux disease (GORD) are common long-term complications after bariatric surgery. However, no consensus on the best surgical approach to manage those complications has been reached. Despite being regarded as a long-forgotten technique, ligamentum teres cardiopexy (LTC) has been reintroduced as an alternative approach to the suture cruroplasty and mesh hiatoplasty. This meta-analysis aims to investigate the safety and efficacy of ligamentum teres augmentation for hiatus hernia repair after bariatric surgery. Methods CENTRAL, Embase, PubMed, and Scopus were searched for articles from their inception to June 2023 by two independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) system. The review was registered prospectively with PROSPERO (CRD42023435312). In this meta-analysis, unsuccessful LTC is defined as failure to reach any of the milestones: Resolution of GORD, no proton-pump inhibitors (PPIs) usage, and manometric pressure over 12 mmHg. Postoperative symptoms are categorised as reflux (heartburn, volume reflux, regurgitation), entrapment (dysphagia, epigastric pain), or others (dumping, diarrhoea, nausea). Results Five studies met the eligibility criteria, with a total of 110 patients undergoing LTC for hiatus hernia repair after bariatric surgery. The reported mean age ranged from 35.6 to 52.9 years. The proportion of female patients was 81.8% (n=90). The reported mean follow-up period ranged from 3.5 to 7 months. 43 patients (41%) underwent sleeve gastrectomy (SG), 35 (33%) had Roux-en-Y gastric bypass, and 27 (26%) had one anastomosis gastric bypass. A pooled mean BMIs prior to bariatric surgery and LTC were 45.1 kg/m2 (95%CI: 43.8-46.4; I2=0%) and 29.1 kg/m2 (95%CI: 20.1-38.1; I2=99%). A pooled proportion of reflux symptoms prior to LTC was 83.7% (95%CI: 0.644-1.029; I2=86%, n=75). A pooled mean operative time for LTC was 109 minutes (95%CI: 94-125; I2=0%). A pooled proportion of overall postoperative symptoms were 21.0% (95%CI: 0.103-0.316; I2=33%, n=29), consisting of reflux (14.0%, 95%CI: 0.076-0.204; I2=0%, n=15) and entrapment (14.6%, 95%CI: 0.070-0.221; I2=0%, n=12). A pooled proportion of recurrent intrathoracic gastric migration was 14.6% (95%CI: 0.070-0.221; I2=0%, n=12). A pooled proportion of proton pump inhibitors usage after LTC was 15.6% (95%CI: 0.022-0.290; I2=0%, n=4). A pooled proportion of unsuccessful LTC outcomes was 14.0% (95%CI: 0.076-0.204; I2=0%, n=15). Additionally, subgroup analysis was conducted on the SG cohort. A pooled proportion of overall postoperative symptoms were 13.7% (95%CI: 0.022-0.251; I2=0%, n=4), and unsuccessful LTC outcomes were 13.7% (95%CI: 0.022-0.251; I2=0%, n=4). Conclusion Our meta-analysis demonstrated that LTC appears to be a safe and efficacious procedure in the management of hiatus hernia after bariatric surgery for selected patients. Despite the promising results, long-term randomized controlled trials with a larger sample size are necessary to help further strengthen the role of LTC for hiatus hernia repair.

Systematic Review and Meta-analysis of Randomized Controlled Trials on Manual Therapy for the Treatment of Gastroesophageal Reflux Disease

Abstract Objective The objective of our study was to systematically evaluate the clinical efficacy and safety of manual therapy in the treatment of gastroesophageal reflux disease (GERD), providing a reference value for clinical decision-making. Method Studies of randomized controlled trials (RCTs) evaluating the efficacy of manual therapy in patients with GERD were searched through Chinese National Knowledge Infrastructure, Wanfang, VIP China Science and Technology Journal Database, China Biology Medicine Database, PubMed, The Cochrane Library, OVID Medline, and Embase. Two researchers independently reviewed the literature, extracted data, and performed a risk of bias analysis using the Cochrane risk of bias assessment tool, and conducted meta-analysis analysis and publication bias evaluation, the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool 26 was used to rate the caliber of the data in this meta-analysis. Results This study included 11 RCTs. Meta-analysis showed that the manual therapy group had a higher total effective rate (odds ratio [OR] = 4.63, 95% confidence interval [CI; 3.01, 7.14], p &lt; 0.00001) and better Reflux Disease Questionnaire scores {weighted mean difference (WMD) = −1.59, 95% CI [−2.85, −0.33], p = 0.01} than the control group. The subgroup analysis showed significant differences in improving the total effective rate in manual therapy versus Western medicine, manual therapy versus Chinese medicine decoction, manual therapy + Western medicine versus Western medicine, and manual therapy + conventional treatment versus conventional treatment groups. Among the 11 trials, 5 reported adverse events, and all RCTs had the possibility of publication bias. Subgroup analysis shows that the differences in age could significantly influence heterogeneity; The GRADE analysis revealed that the overall quality of evidence for all outcome indicators was low and did not support our recommendation for the outcome. Conclusion Manual therapy is more effective than medication therapy alone in relieving GERD symptoms. Furthermore, conventional therapy combined with manual therapy was found to be even more effective. Hence, it is crucial to consider these findings when applying manual therapy to GERD patients to enhance treatment outcomes. Future studies must address issues such as study quality, treatment duration, and generalizability.

IBC-Oxford University2023_BJSPoster_5In The Era of “Sleeve Revision”, What is The Perfect Algorithm?: Suggested Algorithm with Review of the literature

Abstract Background Laparoscopic sleeve gastrectomy (LSG) is the mainstream treatment option for patients with morbid obesity due to restrictive and endocrine mechanisms, however it requires modifications for a subset of patients because of weight regain and tough complications, such as gastroesophageal reflux, strictures, gastric leak, and persistent metabolic syndrome. Revision surgeries have become more and more indispensable in bariatric surgery, accounting for 7.4% in 2016. Methods A systematic literature search was performed in PubMed, Embase and Cochrane library. Data were collected and analysed. Results Revisional bariatric surgeries after LSG include Roux-en-Y gastric bypass, repeated sleeve gastrectomy, biliopancreatic diversion, duodenal switch, duodenal-jejunal bypass, one-anastomosis gastric bypass (MGB), single anastomosis duodeno-ileal bypass (SADI) and transit bipartition. The overall revision rate was 10.4%, but for patients with ≥ 10-year follow-up, the rate was 22.6%. European studies had a higher revision rate (14.4%) than other studies. The most common reason for revision was failure in weight loss, and the most frequent revisional procedure was gastric bypass. Conclusion Reaching a clear algorithm for revisional bariatric surgery is still debated. However, we assume that it depends mainly on pre-revisional BMI and presence of GERD symptoms as follows: patients with BMI&amp;gt; 40 kg/m2 should receive Standard R-Y gastric bypass, those with BMI &amp;lt; 40 kg/m2 with GERD should have R-Y gastric bypass with long biliopancreatic limb or MGB with RY configuration. Patients with BMI &amp;lt; 40 kg/m2 without GERD may benefit from MGB or SADI

Patterns of diet‐related practices and symptoms of gastroesophageal reflux among high school students: A cross‐sectional study

Background: GERD is a gastrointestinal motility disorder characterized by the reflux of gastric contents into the esophagus, causing typical symptoms such as heartburn (a burning sensation in the epigastric region), acid regurgitation (a bitter taste in the mouth), nausea, and dysphagia, which can lead to esophageal mucosal damage. Over the long term, it can result in complications like Barrett's esophagus. The prevalence of GERD in Asia was approximately 2.5%-7.8% in 2014, generally lower compared to Western countries. However, recent data indicates an increasing prevalence. Poor dietary patterns, such as irregular eating habits, consuming low-nutrient foods, excessive or insufficient food intake, can elevate gastric acid production and affect an individual's health.Purpose: To determine the relationship between dietary patterns and symptoms of Gastroesophageal Reflux Disease (GERD) among vocational high school students.Method: A quantitative study was applied using correlation analysis with a cross-sectional study approach. The research was conducted at Vocational High School Bojonegoro in January 2023. The study population comprised 305 students in grade 12. The sampling technique employed was purposive sampling, with a sample size of 74 respondents. The measurement tool for dietary pattern variables was the FFQ questionnaire, and GERD symptoms were assessed using the GERD-Q questionnaire. Data analysis techniques included univariate analysis to describe the frequency distribution of each variable and bivariate analysis using the chi-square test to determine the relationship between dietary patterns and GERD symptoms among students.Results: Poor dietary patterns were found to cause GERD in 47 (97.9%) respondents, whereas good dietary patterns significantly minimized GERD; only 1 (2.1%) respondent experienced GERD symptoms in this study. The research resulted a value of ρ = 0.000 &lt; α (0.05), indicating that the ρ value in this study was less than α (0.05) or below 0.05; thus, H0 was rejected. It can be concluded that there is a relationship between dietary patterns and GERD symptoms, with a correlation coefficient value of 0.542 (moderate) and a positive correlation direction.Conclusion: There is a significant relationship between dietary patterns and GERD symptoms. The correlation coefficient analysis also showed a figure of 0.542 (moderate) with a positive correlation direction, indicating that better dietary patterns lead to fewer respondents suffering from GERD.Suggestion: It is advisable for students to avoid consuming spicy foods, fast food, fried food, and high-sugar food or beverages. They should pay more attention to a balanced diet and timely meals. Additionally, the school authorities are encouraged to establish regulations or advisories to cafeteria owners to refrain from providing fast food, nutritionally poor food, carbonated drinks, spicy food, and other items that may contribute to digestive problems among students.

Association Between Esophagitis Severity and GERDQ Score, Sleep, Life Quality among GERD Patients

Background: Gastroesophageal reflux disease (GERD) is characterized with acid reflux, therefore may lead to esophagitis. Acid reflux may cause night symptom of GERD, therefore resulting in decreased sleep and life quality. Gastroesophageal reflux disease questionnaire (GERDQ) is a simple and validated questionnaire for diagnosing GERD. This article aims to investigate association between esophagitis severity and GERDQ score, sleep, life quality among GERD patients at Prof. Dr. R.D. Kandou Hospital.Method: An analytic-cross-sectional study was conducted in gastroenterology clinic of Prof. Dr. R.D. Kandou Hospital between May–June 2021. We included all patients with reflux esophagitis that proven by esophagoduodenoscopy and the severity was graded using Los-Angeles criteria. The GERDQ score was calculated in all patients. The analysis of sleep and life quality was assessed using validated Indonesian version of Pittsburgh-Sleep-Quality-Index (PSQI) and WHO-quality-of-life-BREF (WHOQOLBREF) questionnaire. Independent T-test was used to compare GERDQ, PSQI, WHOQOLBREF score with esophagitis severity degree.Results: Among 30 patients with esophagitis, 70% was male. We found 22 patients with Los-Angeles-grade-A and 8 patients with Los-Angeles-grade-B. The analysis showed no significant different between GERDQ score with esophagitis grade (p = 0.753). There was no association between esophagitis grade with sleep quality (p = 0.125), physical health (p = 0.161), psychological health (p = 0.728), and environmental health (p = 0.133). But we found significant association between esophagitis grade with social relationship life quality (p = 0.028).Conclusion: Patients with higher esophagitis degree had lower social relationship, but not associated with another domain of WHOQOLBREF, sleep quality, and GERDQ score.

Pilot study on anti-reflux mucoplasty: Advancing endoscopic anti-reflux therapy for gastroesophageal reflux disease.

Anti-reflux mucosectomy (ARMS) and anti-reflux mucosal ablation (ARMA) were developed as interventions for proton pump inhibitor (PPI)-refractory/-dependent gastroesophageal reflux disease (GERD). Although ARMS and ARMA are established treatments for PPI-refractory GERD,reliance on natural healing for ulcer scar formation introduces uncertainty and bleeding risk. To address these issues, we introduced a novel approach called anti-reflux mucoplasty (ARM-P), which involves immediate closure ofmucosal defects following mucosectomy. This pilot studyaims to evaluate the safety, feasibility, and efficacy of ARM-P. A retrospective single-center study was conducted using prospectively collected data from October 2022 to July 2023. Patients with PPI-refractory/-dependent GERD who underwent ARM-P were included. The study evaluated technical success of ARM-P, before and after ARM-P GERD-Health Related Quality of Life Questionnaire, GerdQ, and Frequency Scale for the Symptoms of GERD scores, along with PPI discontinuation and endoscopic esophagogastric junction morphology. A total of 20 patients with a median age of 61.5 years underwent the ARM-P procedure. The procedure achieved 100% technical success without adverse events. After ARM-P, 55.0% discontinued PPI usage and 15.0% reduced PPI dose by half. Median GERD-Health Related Quality of Life Questionnaire score improved from 21 to 6 (P = 0.0026), median GerdQ score improved from 9 to 7 (P = 0.0022), and median Frequency Scale for the Symptoms of GERD score decreased from 16 to 7 (P = 0.0003). Median Hill's Classification significantly improved from grade III to grade I (P = 0.0001). This study presents the first pilot report of ARM-P, demonstrating its procedural safety, technical feasibility, and short-term efficacy.

Diets including Animal Food Are Associated with Gastroesophageal Reflux Disease.

Gastroesophageal reflux disease (GERD) is a clinical condition with a prevalence of up to 25% in Western countries. Typical GERD symptoms include heartburn and retrosternal regurgitation. Lifestyle modifications, including diet, are considered a first-line therapeutic approach. To evaluate the impact of life habits on GERD in this cross-sectional study, we used data collected through an online survey from 1146 participants. GERD was defined according to the Montreal Consensus. For all participants, clinical and lifestyle characteristics were recorded. Overall, 723 participants (63.1%) consumed a diet including animal food (non-vegans), and 423 participants (36.9%) were vegans. The prevalence of GERD was 11% (CI 95%, 9-14%) in non-vegans and 6% (CI 95%, 4-8%) in vegans. In the multivariate analysis, after adjusting for confounding factors, subjects on a non-vegan diet were associated with a two-fold increase in the prevalence of GERD compared to vegans (OR = 1.96, CI 95%, 1.22-3.17, p = 0.006). BMI and smoking habits were also significantly associated with GERD. This study shows that an animal food-based diet (meat, fish, poultry, dairy, and eggs) is associated with an increased risk of GERD compared to a vegan diet. These findings might inform the lifestyle management of patients with GERD-related symptoms.

YouTube as a Patient Information Source for Gastrointestinal Reflux Disease.

Introduction Gastroesophageal reflux disease (GERD) affects a substantial portion of the global population, resulting in significant morbidity and impacting the quality of life. YouTube (YouTube,San Bruno, California) serves as a platform where medical professionals, individuals with personal experiences, and educational channels share their insights on GERD. However, with the vast amount of information available on YouTube, the question of credibility and reliability is a concern and, thus, is crucial to evaluate. This research paper aims to explore the impact of YouTube as a source of information on GERD. The aim of this study is to assess the quality and reliability of the information on YouTube about GERD. Methodology This cross-sectional observational study was conducted in June 2023.A questionnaire was designed using Google Forms (Google, Mountain View, California) with predetermined criteria such as characteristics of YouTube videos (time since uploaded, uploader, number of likes and comments); information about GERD (symptoms, investigations, treatment); and quality and reliability of information on YouTube about GERD using Global Quality Scale (GQS) and Reliability score. The Kruskal-Wallis Test was used to evaluate the difference in quality and reliability of information about GERD on YouTube based on the type of uploader. Results Out of 90 videos analyzed, 68 YouTube videos on GERD that met inclusion criteria were included in the study. The number of videos uploaded by hospitals was 28 (41.2%), those by doctors was 12 (17.6%), and the remaining by others (like pharmacists, patients, and non-medical personnel) was 28 (41.2%).A significant proportion of videos (88.24%) shared information pertaining to disease symptoms and cause/etiology. The videos uploaded by "others" hadsignificantly higher (p<0.05) reach as assessed by the Video Power Index (VPI) compared to those uploaded by doctors and hospitals. However, there was no significant difference (>0.05) in the quality and reliability of videos uploaded by doctors, hospitals, and othersources. Conclusion Although the YouTube videos uploaded by doctors and hospitals had less reach among viewers compared to other uploaders (patients, news agencies, pharmaceutical companies, and others unrelated to healthcare), the quality and reliability of videos uploaded by doctors, hospitals, and other uploaders were of goodquality and reliability and with no significant difference based on type of uploader. Healthcare organizations and government agencies should ensure that viewers have access to accurate and reliable information from social media like YouTube, which is crucial in their health decision-making.

Threshold level of Peptest in diagnosing gastroesophageal reflux disease with extraesophageal symptoms: Evidence from Vietnam.

We aimed to evaluate the application of Peptest, a novel technique to detect pepsin in the saliva, and identify its threshold level for the diagnosis of gastroesophageal reflux disease (GERD) with extraesophageal symptoms. A cross-sectional study was conducted in two groups: patients with extraesophageal GERD symptoms (symptomatic group divided into GERD and non-GERD groups according to 24-h esophageal pH-impedance monitoring [pH-I] results) and healthy controls. For the symptomatic group, endoscopy, pH 24 h, high-resolution manometry (HRM), and salivary Peptest were performed. For the healthy control group, only Peptest was done. The accuracy of Peptest was compared with that of pH-I by the Lyon consensus criteria. Chronic laryngitis was the most frequent extraesophageal symptom. On saliva testing, the GERD group had a higher prevalence of positive samples and pepsin concentration than the control group. Between GERD and non-GERD groups, the optimal threshold level was 31.2 ng/mL, with a sensitivity of 86.7% and specificity of 27.5%. The optimal threshold level was 31.4 ng/mL to differentiate GERD from healthy controls, with a sensitivity of 86.7% and specificity of 66.0%. Age, number of total refluxes, DeMeester score, post-reflux swallow-induced peristaltic wave (PSPW) index, and mean nocturnal baseline impedence (MNBI) were associated with pepsin concentration. Regarding HRM metrics, there was no significant difference of pepsin concentration between low/normal upper esophageal sphincter (UES) resting pressure, low/normal lower esophageal sphincter (LES) resting pressure, low/normal 4-s integrated relaxation pressure (IRP4s), and hypomotility/normal motility. Patients with extraesophageal symptoms had a higher prevalence of positive Peptest. The optimum threshold level of 31.4 ng/mL had high sensitivity and moderate specificity to differentiate between patients with GERD and healthy controls.

OGBN P06 Co-location of pulmonary abnormalities on high resolution CT imaging and pulmonary microaspiration reflux scan: Suggests a causative relationship

Abstract Background The relationship between micro-aspiration of refluxate as a form of gastro-oesophageal reflux disease (GORD) and pulmonary diseases including bronchiectasis and lung fibrosis has been circumstantially suggested but not proven. Clarification of the role of GORD and microaspiration in pulmonary disease may enable targeted therapies. This study aims to determine whether there is a relationship between anatomical location of aspiration of radiological tracer on scintigraphic imaging and changes associated with pulmonary disease on high resolution computed tomographic imaging of the lung (HRCT-L). Methods Data were obtained from a prospectively populated database of patients with treatment resistant typical and atypical GORD and suspected reflux pulmonary microaspiration. Patients who underwent microaspiration studies and had concurrent HRCT-L for chest symptoms were included. Modified novel digital technique of reflux pulmonary microaspiration scintigraphy using a previously validated technique was performed to evaluate the possibility of significant GORD or extra-oesophageal symptoms, including typical symptoms such as heartburn and reflux and atypical symptoms such as throat symptoms, cough, globus, mucous, throat clearing, dysphonia and recurrent respiratory infections. HRCT-L was obtained in clinically indicated patients and compared with scintigraphic findings. Results Pulmonary reflux microaspiration scanning was performed in 121 patients (75% female, 25% male). The mean age was 67 years (range: 31 – 91 years). All patients demonstrated reflux microaspiration on scintigraphy in the supine delayed phase and all had intermittent or continuous full column gastro-oesophageal reflux. Lung parenchymal changes were apparent in 66 of 73 patients who underwent HRCT-L. Fibrotic changes were demonstrated in 51% of patients and bronchiectactic changes in 46%. Correlation at anatomical lobar levels with areas of aspiration of isotope on scintigraphic imaging was seen in 97% of fibrosis patients and 85% of bronchiectasis patients. Conclusions Modified reflux pulmonary microaspiration scintigraphy demonstrated the presence of pulmonary aspiration on delayed imaging. This is the first imaging technique with the ability to confirm the presence of lung aspiration of gastric content. Given the large proportion of cases showing lobar co-location of pulmonary abnormality on HRCT-L, this study indicates a strong relationship between aspiration of refluxate and parenchymal lung changes associated with pulmonary diseases such as IPF and bronchiectasis. There may be a significant role for modified technique scintigraphy to accurately diagnose the presence of reflux aspiration, allowing further research into pathogenesis and management of pulmonary disease.

OGBN P29 Short term outcomes after anti-reflux surgery for Gastro-Oesophageal Reflux disease

Abstract Background Laparoscopic fundoplication is the standard surgical practice for management of Gastro-oesophageal reflux Disease (GORD). However, post operative complications and recurrence can be problematic. We conducted this study to assess short-term post operative outcomes following anti-reflux surgery (ARS) for GORD at our UGI surgery unit at a busy District General Hospital (DGH). Methods All patients above 18 years of age undergoing ARS between January 2016 and December 2021 were included. We excluded patients who underwent fundoplication as part of treatment of achalasia or large hiatus hernia repairs. Data was collected retrospectively from a prospectively maintained database. Pre –operative investigations and surgical procedure was recorded. Primary outcome assessed were post-operative complications recorded as per Clavien-Dindo grade and re-operation rates. Secondary outcomes assessed were symptomatic relief and proton pump inhibitor (PPI) discontinuation. Results 86 patients were included. The median age at surgery was 52 years. 98% patients had typical symptoms of GORD at presentation. On pre-operative OGD, 29% patients had oesophagitis and 77.91% had hiatus hernia. 79 (91.86%) patients underwent pH manometry. 97.67% patients underwent Nissen fundoplication. All cases were successfully completed laparoscopically with no conversions to open. The median post-operative length of stay was 1 day. 93.02% had no post operative complications, and none had 30 day re-operation. At 1-year follow up, 97.67% patients reported improvement in symptoms and 94.19% patients were able to stop PPI use. Conclusions Laparoscopic fundoplication provides excellent relief of GORD symptoms with low incidence of post operative complications and re-operation rates.

Real-World Evidence to Evaluate the Efficacy and Safety of Vonoprazan in Gastrointestinal Disorders in the Pakistani Population.

While proton pump inhibitor (PPI) therapy has proven to be effective in managing gastroesophageal reflux disease (GERD), a notable portion of patients who experience GERD symptoms may not respond to this treatment. Research suggests that roughly 30% of individuals with a presumed GERD diagnosis may continue to experience symptoms, whether partially or completely, even when receiving PPI therapy. The aim of this study was to assess the treatment of gastrointestinal diseases with a novel potassium-competitive acid blocker (P-CAB), vonoprazan, in terms of its effectiveness and safety in the Pakistani population. This prospective, multicenter, observational study was conducted in Pakistan. This study included 1,642 patients from January 2023 to August 2023, aged 18 years, with gastrointestinal disorders. All demographic data, medical history, GERD severity assessment questionnaire (GerdQ), and laboratory parameters, including stool assessment for Helicobacter pylori (H. pylori), were observed. Patients were orally treated with vonoprazan at doses of 10 mg or 20 mg, once or twice daily. Statistical analysis was done by one-way ANOVA. Out of 1,642 patients, 840 (51.2%) were males and 802 (48.8%) were females, with a mean age of 39.81±14.61 years. The mean GerdQ score at baseline was 20.37±15.87, 7.24±8.15 at the secondweek of treatment, and 3.70±6.31 at the fourth week of treatment (p<0.001). 90.74% of patients achieved H. pylori eradication. Most patients were acid regurgitation and heartburn-free for >70% of days. Most of the patients, 1,283 (78.13%), exhibited good treatment compliance. Mild adverse events were reported in 37 (2.3%) patients. The use of vonoprazan significantly reduced the likelihood of GERD by improving symptoms and was also highly effective in the elimination of H. pylori infections. Vonoprazan was generally well tolerated.

Patients With Esophageal Adenocarcinoma With Prior Gastroesophageal Reflux Disease Symptoms Are Similar to Those Without Gastroesophageal Reflux Disease: A Cross-Sectional Study.

A substantial proportion of patients with esophageal adenocarcinoma (EAC) do not report gastroesophageal reflux disease (GERD) symptoms. This study aimed to compare the risk factor profiles and cancer stage at presentation of patients with EAC with and without prior GERD. In this retrospective cross-sectional study, patients with EAC were divided into 2 cohorts: (i) EAC with prior GERD: patients who reported typical GERD symptoms (heartburn or regurgitation) ≥1 year before cancer diagnosis and (ii) EAC without prior GERD: patients who did not report prior GERD symptoms or reported symptoms within 1 year of their cancer diagnosis. Baseline demographics, risk factors, and cancer stage at presentation were compared between the 2 cohorts. In addition, the distribution of patients based on numbers of BE/EAC-associated risk factors (1, 2, 3, 4, and 5 or more) was examined in the symptomatic and asymptomatic cohorts. Over 13 years, 388 patients with EAC with prior GERD and 245 patients with EAC without prior GERD were recruited. Both groups had similar baseline demographics and risk factors, but patients with EAC with prior GERD were more likely to have a history of BE. Asymptomatic patients had more advanced disease. Patients with 3 or more BE/EAC-related risk factors formed the largest proportion of patients in both the symptomatic and asymptomatic cohorts. Patients with EAC with and without prior GERD symptoms are phenotypically similar, suggesting that BE screening efforts to prevent or detect early EAC should not be restricted to just those with GERD.

Health related quality of life is associated with gastroesophageal reflux symptoms in overweight children.

The association between obesity and gastroesophageal reflux disease (GERD) is well-established in adults; however, data in pediatric population is scarce. Our study aimed to assess the association between GERD and health-related quality of life (HRQoL) in overweight children. From April to August of 2020, we included children aged 7-18 years who attended the Endocrinological Outpatient Clinic at the Paediatric Institute, University of Debrecen, Hungary. The participants completed two questionnaires: the Pediatric Gastroesophageal Reflux Disease Symptom Questionnaire (PGSQ) and the HRQoL questionnaire (PedsQL). Based on the criteria of the World Health Organization (WHO), the patients were categorized into two groups: an overweight or obese group and a group with normal weight. A total of 107 children (51 % female, mean age 13.2 years, 46 % overweight or obese) completed the questionnaires. The median PGSQ score was similar in both groups (4.0 (IQR: 1.0-7.8) vs. 3.0 (IQR: 1.0-7.0), p=0.6). However, the total PedsQL score was significantly lower in the children with overweight or obesity compared to those with normal weight (80.1 (71.1-91.0) vs. 88.0 (76.1-94.6), p=0.031). The PedsQL score was lower among overweight patients with GERD symptoms than that of normal-weight patients without GERD symptoms. Our findings highlight the importance of raising awareness about GERD to enhance the HRQoL and prevent long-term complications in obese children.