Therapy For Gastroesophageal Reflux Disease Research Articles

State of Evidence in Minimally Invasive Management of Gastroesophageal Reflux: Findings of a Scoping Review

Endoscopic management of gastroesophageal reflux disease (GERD) is being employed increasingly. The aim of this scoping review was to assess the volume of available evidence on the benefits of endoscopic and minimally invasive surgical therapies for GERD. criteria were used to perform an extensive literature search of data regarding the reported benefit of endoscopic therapies in GERD. Randomized controlled studies were utilized when available; however, data from observational studies were also reviewed. A formal review of evidence was performed in 22 studies. Inclusion and exclusion criteria and study duration were noted and tabulated. Assessment of outcomes was based on symptoms and objective criteria reported by investigators. Reported outcomes for the interventions were tabulated under the heading of subjective (symptom scores, quality of life metrics, and change in proton pump inhibitor use) and objective metrics (pH parameters, endoscopic signs, and lower esophageal sphincter pressure changes). Adverse events were noted and tabulated. The majority of studies showed symptomatic and objective improvement of GERD with the device therapies. Adverse events were minimal. However, normalization of acid exposure occurred in about 50% of patients and, for some modalities, long-term durability is uncertain. This scoping review revealed that the endoluminal and minimally invasive surgical devices for GERD therapy are a promising alternative to proton pump inhibitor therapy. Their place in the treatment algorithm for GERD will be better defined when important clinical parameters, especially durability of effect, are better understood.

878 CLINICAL OUTCOMES OF ENDOSCOPIC ANTI-REFLUX TREATMENT METHODS; ANTI-REFLUX MUCOSECTOMY (ARMS) AND ANTI-REFLUX MUCOSAL ABLATION (ARMA)

Gastroesophageal reflux disease (GERD) is a common disorder with an increasing prevalence worldwide. Proton pump inhibitors (PPIs) are effective in achieving symptom control, however, approximately 30-40% of patients are reported to have persistent symptoms despite PPI therapy. While the surgical intervention such as Laparoscopic Nissen Fundoplication remains the gold standard treatment for refractory GERD, minimally invasive anti-reflux therapies are gaining its popularity to fill in the “gap” of conventional medical therapy and surgery. In 2014, we reported Anti-reflux mucosectomy (ARMS) which utilizes ESD or EMR-C to rebuild the flap valve at the gastric cardia by scarring of the artificial ulcer. In 2018, we developed Anti-reflux mucosal ablation (ARMA) where we apply ablation instead of mucosectomy as an alternative therapy for PPI-refractory GERD. The aim of this study is to evaluate the clinical outcomes of ARMS and ARMA. This is a retrospective, single center study from a prospectively collected database performed between April 2012 and November 2019. The indication of ARMS/ARMA is PPI refractory GERD patients without prominent sliding hernia. In ARMS, ESD or EMR-C at the gastric cardia mucosa was performed in order to create artificial ulcer. In ARMA, mucosal ablation using Triangle Tip Knife with spray coagulation mode (50W-120W, effect 2) was utilized to create the ulcer. The efficacy was evaluated by the patient’s symptom score (Frequent Scale for the Symptoms of GERD: FSSG) and the objective findings; Acid Exposure Time (AET) and DeMeester composite score by 24h multi-channel intraluminal impedance-pH monitoring, before and 2-3 months after procedure. A total of 109 patients (Age 54.0±15.7, M:F 63:46) underwent ARMS, and 24 patients (57.6±15.9, M:F 16:8) underwent ARMA. Mean procedure time (minutes) were 54.7 vs. 35.6, respectively. FSSG score improved from 25.1 to 11.6 (p<0.01) by ARMS and from 25 to 10.5 (p<0.01) by ARMA. By ARMS, AET and DeMeester composite score improved from 20.8 to 6.9 (p < 0.01, n=27) and 64.4 to 24.9 (p < 0.01, n=27), respectively. By ARMA, median AET showed a decreasing trend from 9 to 0.5 (p=0.068, n=8), and the DeMeester composite score significantly improved from 33.5 to 2.8 (p<0.05, n=8). Both ARMS and ARMA were effective anti-reflux therapy methods for PPI-refractory GERD which improved GERD related symptoms and objective acid reflux parameters. ARMA may be advantageous on its easiness and simplicity regarding operative time. A larger study with long-term follow-up is required to confirm these results.

An advancement of treatment of nasopharyngeal signs of gastroesophageal reflux disease in children against the background of vitamin D deficiency

The work aims at substantiating the prescription of vitamin D3 for treatment and prevention of nasopharyngeal signs of GERD in children through determining the main risk factors of the development of the disease.Materials and methods. Eighty-eight children aged about 4.6 ± 0.14 years were enrolled in the study. The patients were divided into four groups: group 1 consisted of 22 children with nasopharyngeal signs of gastroesophageal reflux disease (GERD); group 2 comprised 22 children with chronic ENT pathology and without GERD; group 3 was formed of 22 children with GERD and without any ENT pathology; group 4 (control group) included 22 children without an ENT or gastrointestinal pathology. No substantial gender differences were observed in each of the groups. GERD was diagnosed on the basis of symptoms and 24-hour pH monitoring; the test for Vitamin D provision was performed; mucosal immunity characteristics were identified and the contamination of the upper airways mucous membranes was studied. The results are statistically processed using Microsoft Office Excel and Statistica 13 software.Results. Children with GERD with nasopharyngeal signs have been proved to have acute respiratory viral infections (ARVI) more frequently than children with GERD and without ENT pathologies (the number of aggravations is 8.5 (8.0;10.0) and 3.0 (2.0;3.0) respectively (р&lt;0.00001)).The contamination of mucus membranes of oropharynx and nose of the children with nasopharyngeal signs of GERD is represented by opportunistic microflora (in 95.5%) with prevailing Haemophilus influenzae. More than two kinds of microorganism have been inoculated in 63.6% of children (р=0.002), which indicates considerable impairment of colonization resistance in palatal tonsils. Moreover, the majority of the prolonged acid refluxes has been registered in children with the presence of Haemophilus influenza (7,5±1,62 against 3,67±1,2, р=0,04). These data confirm that the acid content of the refluxate not only irritates the mucous membrane of the oral cavity but also leads to the impairment of local immunity mechanisms and creates favourable conditions for the colonization and growth of bacteria which results in the development of lesions in the pharyngeal mucous membrane.Children with GERD accompanied with nasopharyngeal signs are characteristic of vitamin D deficiency which is confirmed by lower levels of 25(ОН)D3. This, in its turn, influences the production of antimicrobial peptides (α-defensins 1-3 and cathelicidins LL 37). Group 1 children present with significantly low levels of antimicrobial peptides (α-defensins 1-3 2474.08±180.4 pg/ml and cathelicidins LL 37 18.89±2,84 pg/ml, р˂0.05) against the background of lower 25(OH)D3 (13.05±0.55 ng/ml, р=0.00001). The determined peculiarities substantiated the introduction of vitamin D3 into therapy for GERD.Children of the treatment group were prescribed vitamin D3 in the dosage of 2000 MU per day for a monthly period, and monotherapy with vitamin D3 in the dosage of 1000 MU per day for a year, daily from September to April, including the break between May and September. Before the treatment, the yearly incidence of the acute respiratory viral disease (ARVD) in the treatment group children was 9.0 [8.0;10.0], and in the control group children, it was 8.0 [7.0; 10.0]. After a year since the beginning of the treatment, the incidence of ARVI in the treatment group children was 4,0 [3.0;4.0], which is significantly lower than in the control group children (5.0 [4.0;6.0], р=0.008). During the year, aggravation of chronic tonsillitis was registered only in 45.5% of the control group children (р=0.03), and GERD symptoms were registered only in 18.2 % of the treatment group patients (р=0.03).Obtained results prove the advisability of including vitamin D3 in the therapeutic regimen of gastroesophageal reflux disease, and its nasopharyngeal signs in particular, in preschoolers. Conclusions. It is typical of children with GERD accompanied by nasopharyngeal signs to demonstrate significantly low levels of antimicrobial peptides against the background of even lower 25(OH)D3 (13.05±0.55 ng/ml, р=0.00001). Children with GERD and nasopharyngeal signs tend to have ARVI more frequently than those with GERD but without ENT pathologies (number of aggravations is 8.5 (8.0;10.0) and 3.0 (2.0;3.0) respectively (р&lt;0.00001)). The prescription of vitamin D3 in the complex therapy for GERD with nasopharyngeal signs allows to decrease the incidence of the acute respiratory viral infection (ARVI) over a year (р=0.008) and to gain stable regression of the clinical symptomatology (р=0.03).

Incidence of Gastroesophageal Reflux Disease in Children With Cleft Lip and Palate and an Evaluation of Its Impact on Weight Gain.

Patients with cleft lip and/or palate have higher rates of failure to thrive (FTT), decreased growth, and more often experience feeding difficulties as compared with the general pediatric population (J Child Health Care. 2014;18:72-83). Although insufficient nursing, excessive air intake, and incorrect feeding methods have been established in the literature, the role of gastroesophageal reflux disease (GERD) as a contributing factor in cleft patients has not been thoroughly examined. Presently, there is a paucity of literature analyzing the incidence and effect of GERD on this unique population. Furthermore, no studies have evaluated the effect of GERD therapy on improvement of weight gain and FTT in cleft patients. The purpose of this retrospective review was to identify the incidence of GERD in the orofacial cleft population and to see if appropriate treatment was effective in improving weight gain. Fifty patients with cleft lip, cleft lip and palate, and isolated cleft palate were identified from a single surgeon's experience at a large academic medical center from 2015 to 2019. The data show that a significantly higher percentage of patients with cleft lip/and or palate have clinical evidence of GERD, which required treatment as compared with published reports of less than 1% in the noncleft population. The data also suggest that the patients diagnosed with GERD who received pharmacologic treatment showed improved weight gain as compared with those who did not. Given our findings, the diagnosis of GERD should be considered in orofacial cleft patients exhibiting signs of feeding difficulty or those with FTT. The early diagnosis and treatment of GERD in patients with orofacial clefts may improve weight gain.

Prevalence and predictors of proton pump inhibitor partial response in gastroesophageal reflux disease in systemic sclerosis: a prospective study

Proton pump inhibitor (PPI) twice daily dosing is a standard therapy for gastroesophageal reflux disease (GERD) in systemic sclerosis (SSc) but there is no data on its response rate or the predictors of PPI-partial response GERD. Aims were to determine the prevalence of PPI-partial response GERD in SSc and to define its predictors. A prospective study was conducted in SSc patients with GERD. The patients were treated with omeprazole 20 mg bid for 4 weeks. The severity of symptom-grading by visual analogue scale (VAS) and frequency of symptoms by frequency scale for symptoms of GERD (FSSG) were assessed at baseline and 4 weeks after treatment. PPI-partial response GERD was defined as less than 50% improvement in the VAS for severity of symptom as well as acid reflux score by FSSG after treatment. According to the sample size calculation, 243 SSc-GERD patients were enrolled; of whom 166 (68.3%) had the diffuse cutaneous SSc. PPI-partial response GERD was found in 131 SSc patients (prevalence 53.9%; 95%CI 47.4–60.3). The multivariate analysis revealed that esophageal dysphagia was an only predictor the PPI-partial response GERD (OR 1.82; 95%CI 1.01–3.29) while neither SSc subset nor severity of skin tightness were significantly associated with PPI-partial response GERD. Half of the SSc patients were PPI-partial response GERD. Esophageal dysphagia was the only predictor of PPI-partial response GERD in SSc patients. Screening for dysphagia before starting GERD treatment is helpful for assessment the risk of PPI refractoriness GERD in SSc patients.

Gastroesophageal reflux disease with cardial manifistations: perspectives of non-pharmacological treatment methods

In this article we present the review of the literature and our own research regarding gastroesophageal reflux disease (GERD) with cardiac manifestations. The methods of treatment of patients with GERD using mineral waters, physio- and balneotherapeutic factors, as well as acupuncture are discussed. The conclusion is drawn about the effectiveness of the use of non-pharmacological methods in mono- and complex therapy of GERD and the need for further research in this direction.

Tegoprazan to treat gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder in the United States. Although proton pump inhibitors (PPIs) are the mainstay of therapy for GERD and its complications, they have several limitations, including incomplete symptom resolution. Potassium-competitive acid blockers (P-CABs) were developed to address the limitations of PPIs as well as the need for improved antisecretory effects. Tegoprazan, the newest P-CAB, was approved in 2018 in South Korea for the treatment of erosive esophagitis (EE) and nonerosive reflux disease (NERD). A highly selective inhibitor of the H+/K+-ATPase, tegoprazan is also safe and effective for nocturnal acid breakthrough (NAB) and motility. Further studies of tegoprazan are warranted to define its potential role in the treatment of acid-related disorders.

Improvement of Magnesium and Calcium Deficiency in Patients with Gastroesophageal Reflux Disease Associated with Undifferentiated Connective Tissue Disease

The objective of the research was to study the effectiveness of course application of magnesium and calcium-containing drugs on the background of conventional therapy on the changes in the content of macronutrients in red blood cells and the activity of matrix metalloproteinase - 9 in the patients with a co-existence of undifferentiated connective tissue disease and gastroesophageal reflux disease.&#x0D; Materials and Methods. All 75 patients with gastroesophageal reflux disease associated with undifferentiated connective tissue disease were divided into three groups: Group I included 25 patients who received Magne-B6 at a dose of 2 tablets 3 times a day in addition to the standard background therapy with “Panocid” at a dose of 40mg once a day; Group II comprised 25 patients who received “Ca-D3 Nycomed” at a dose of 1 tablet 3 times a day in addition to the standard background therapy; Group III included 25 patients who received a combination of “Magne-B6” and “Ca-D3 Nycomed” in addition to the standard background therapy. &#x0D; Results. In Group I, the proposed complex therapy resulted in a significant increase in Mg2+ by 40.9%. Mg2+ dynamics was less significant in Group II; this index reached the level of 17.9 ± 2.04 µg/g (р"˃0.05); in its turn, Ca2+ level increased to 80.6 ± 2.12 μg/g (p"&lt;0.05) in these patients. Mg2+ and Ca2+ indices showed the most significant positive dynamics in Group III: 21.52 ± 2.47 μg/g (р"&lt;0.05) and 102.7±1.37 µg/g, respectively. After combination treatment, we traced the dynamics of changes in the level of matrix metalloproteinase - 9: it decreased by 39.45% in Group I, by 35.3% in Group II, by 53.18% in Group III and reached the level of 1689.266 ± 14.89 pg/ml, approaching the indicators of the control group.&#x0D; Сonclusions. Based on the data obtained, it can be argued that simultaneous addition of “Magne-B6” and “Ca-D3 Nikomed” to the standard therapy for gastroesophageal reflux disease in the patients with undifferentiated connective tissue disease contributed to a significant decrease in the level of matrix metalloproteinase-9 resulting in reduced degradation and increasing synthesis of new connective tissue components.

Use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease in hospitalized older people.

The aims of this study were to assess the prevalence of use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease (GERD) at hospital admission and discharge. Patients aged 65years or more hospitalized from 2010 to 2016 in 101 Italian internal medicine and geriatric wards in the context of the REPOSI register were scrutinized to assess if they were prescribed with drugs for peptic ulcer and GERD at hospital admission and discharge. Appropriateness of prescription was assessed considering the presence of specific conditions (i.e., history of peptic ulcer or gastrointestinal hemorrhages, advanced age, Helicobacter Pylori) or gastro-toxic drug combinations, according to the criteria provided by the reimbursement rules of the Agenzia Italiana del Farmaco (NOTA 1 and 48). Among 4715 enrolled patients, 3899 were discharged alive. At hospital discharge, 2412 (61.9%, 95%CI: 60.3-63.4%) patients were prescribed with drugs for peptic ulcer and GERD, a 12% of increase from hospital admission. Almost half of the patients (N = 1776, 45.6%, 95%CI: 44.0-47.1%) were inappropriately prescribed or not prescribed: among the drugs for peptic ulcer and GERD users, about 60% (1444/2412) were overprescribed, and among nonusers, 22% (332/1487) were underprescribed. Among patients newly prescribed at hospital discharge, 60% (392/668) were inappropriately prescribed. The appropriateness of drugs for peptic ulcer and GERD therapy decreased by 3% from hospital admission to discharge. Hospitalization missed the opportunity to improve the quality of prescription of this class of drug.

No Barrett's-No Cancer: A Proposed New Paradigm for Prevention of Esophageal Adenocarcinoma.

Esophageal adenocarcinoma is inflammation-associated cancer with a recognizable preneoplastic stage, Barrett's. Barrett's describes the metaplastic transformation of esophageal squamous mucosa into columnar epithelium that typically results secondary to mucosal damage caused by acidic gastroduodenal reflux. Continued acid reflux may then result in mucosal inflammation which results in progressive inflammation-induced genetic instability that may eventuate in esophageal adenocarcinoma. Barrett's is the only recognized precursor lesion to esophageal carcinoma. Barrett's mucosa is unique among preneoplastic lesions; ablation therapy results in restitution of a squamous epithelium reducing or eliminating accumulated genetic instabilities and resetting the biological clock progressing toward invasive cancer. However, recurrence of Barrett's after ablation is common. We propose that both Barrett's and recurrence of Barrett's after ablation can be prevented and discuss how current approaches to therapy for gastroesophageal reflux disease, for Barrett's screening, chemoprevention, and ablation therapy all might be reconsidered. We propose (1) improved approaches to Barrett's prevention, (2) universal Barrett's screening by linking Barrett's screening to colon cancer screening, (3) ablation of all Barrett's mucosa along with (4) acid-suppressive-antireflux therapy tailored to prevent development of Barrett's or the recurrence of Barrett's after ablation therapy. We propose that ultimately, treatment decisions for gastroesophageal reflux disease and prevention of Barrett's and esophageal carcinoma should be based on assessing and maintaining esophageal mucosal integrity. This will require development and verification of specific measurements that reliably correlate with prevention of Barrett's. We outline the new research and technical advances needed to cost-effectively achieve these goals.

Tailored modern GERD therapy \u2013 steps towards the development of an aid to guide personalized anti-reflux surgery

As the incidence of gastroesophageal reflux disease (GERD) is rising, surgical treatment is continuously advancing in an effort to minimize side effects, whilst maintaining efficacy. From a database of patients that underwent anti-reflux surgery at our institution between 2015 and 2018, the last 25 consecutive patients that underwent electrical stimulation (ES), magnetic sphincter augmentation (MSA) and Nissen fundoplication (NF), following a personalized treatment decision aid, were included in a comparative analysis. After preoperative evaluation each patient was referred for an ES, MSA or NF based on esophageal motility, hiatal hernia (HH) size and the patients’ preferences. Postoperative gastrointestinal symptoms and GERD-Health-related-Quality-of-Life were assessed. Preoperatively the median DCI (299 ES vs. 1523.5 MSA vs. 1132 NF, p = 0.001), HH size (0.5 cm ES vs. 1 cm MSA vs. 2 cm NF, p = 0.001) and presence of GERD-related symptoms differed significantly between the groups. The highest rate of postoperative dysphagia was seen after MSA (24%, p = 0.04), while the median GERD HRQL total score was equally distributed between the groups. The positive short-term postoperative outcome and patient satisfaction indicate that such an aid in treatment indication, based on esophageal motility, HH size and patient preference, represents a feasible tool for an ideal choice of operation and an individualized therapy approach.

Novel therapies for gastroesophageal reflux disease

Novel therapies for gastroesophageal reflux disease

Effects of Osteopathic Visceral Treatment in Patients with Gastroesophageal Reflux: A Randomized Controlled Trial.

Osteopathic manual treatment has been recommended as a non-pharmacological therapy for Gastroesophageal Reflux Disease (GERD). However, to date, no study has supported the effectiveness of this intervention with respect to the symptoms of the disease. Our goal was to assess the effect of an osteopathic manual technique for the lower esophageal sphincter on GERD symptoms, cervical mobility and on the C4 spinous process pressure pain threshold (PPTs). Methods: A randomized, double-blind placebo-controlled trial was performed. Sixty subjects suffering from GERD participated in this study and were randomly assigned to either an experimental group (EG) (n = 29), who received the osteopathic technique for the lower esophageal sphincter, or to a control group (CG) (n = 31), who received a manual contact, which mimicked the osteopathic technique without exerting any therapeutic force. Randomization was computer-generated, with allocation concealed by sequentially numbered, opaque, sealed envelopes. The GerdQ questionnaire was used to assess symptom changes the week after intervention. Cervical Range of Motion (CROM) and algometer were used to evaluate cervical mobility and PPTs before and after both treatments. Before–after between groups comparison (t-test) was used for statistical analysis of the outcome, with two measurement points (GerdQ), while repeated-measures ANOVA was used for those outcomes with four measurement points (CROM and PPT). Results: The application of the osteopathic manual treatment in subjects with GERD produced a significant improvement in symptoms one week after the intervention (p = 0.005) with a between-groups difference of 1.49 points in GerdQ score (95% CI: 0.47–2.49). PPT C4 improved in the EG after the treatment (p = 0.034; η2 = 0.048) (between-groups difference 8.78 Newton/cm2; 95% CI: 0.48–17.09). CROM also increased in the EG compared to the CG (p < 0.001; η2 = 0.108) (between-groups difference 33.89 degrees; 95% CI: 15.17–52.61). Conclusions: The manual osteopathic technique produces an improvement in GERD symptoms one week after treatment, cervical mobility, and PPTs. This may mean that osteopathic treatment is useful for improving symptoms of GERD.

Gastroesophageal reflux disease: actual aspects of diagnostics and treatment in real clinical practice of therapist

Gastroesophageal reflux disease (GERD) in terms of prevalence ranks first among gastroenterological diseases. A large number of works on the diagnosis and treatment of GERD, forms the point of view that about GERD «everything is long and well known.» However, in real clinical practice, for various reasons, possible «pitfalls, reefs and shallows» are not taken into account, the underestimation of which can introduce certain difficulties in the diagnosis and treatment. This review discusses the most significant aspects of the diagnosis and treatment of GERD in real clinical practice by a general practitioner and general practitioner. Currently, proton pump inhibitors are the main drugs for the treatment of GERD and other acid-dependent diseases. The results of numerous foreign and Russian studies indicate the effectiveness and safety of pantoprazole in the treatment of GERD, especially in multimorbid patients due to the lower potential of drug interactions. The presence on the Russian pharmaceutical market of two forms of release of the generic drug pantoprazole Panum® increases the availability of effective and safe therapy for GERD and other acid-dependent diseases.

Comorbid patient with GERD and cardiovascular disease receiving antiplatelet therapy. The possibilities of choosing a proton pump inhibitor on a case study

The high prevalence of cardiovascular disease and its frequent pathogenetic relationship with various comorbid diseases and conditions lead to polypragmasia and the development of undesirable adverse reactions. Treatment premorbidly disorders requires high clinical expertise and breadth of knowledge in the field of related disciplines that allows you to efficiently prescribe the appropriate drug therapy. It is important to emphasize that a patient with cardiovascular disease often receives antiplatelet therapy, including double, which can lead to adverse reactions from the upper gastrointestinal tract (due to the peculiarities of the mechanism of action of antiplatelet drugs), including from the esophagus, provoking the development or deterioration of gastroesophageal reflux disease (GERD). Proton pump inhibitors (PPI) are used for the prevention and treatment of these adverse events on the part of the gastrointestinal tract. Effective drug therapy for GERD also includes the administration of these drugs. However. Given the polymorbidity of patients and polypragmasia, the practitioner should strive to prescribe drugs with the lowest risk of drug interactions. These requirements are met by PPI rabeprazole, the metabolism of which is predictable. The use of this drug is presented in a clinical case.

Acupoint-catgut embedment combined with medication does not decrease interleukin-6 levels serum in patients with gastroesophageal reflux disease: a randomized controlled clinical trial

BACKGROUND Gastroesophageal reflux disease (GERD) is a pathological condition caused by the reflux of stomach contents into the esophagus. GERD is a multifactorial disorder with an increase in prevalence worldwide. Interleukin-6 (IL-6) is a proinflammatory cytokine that is commonly found in the esophageal mucosa of GERD patients and associated with esophageal motor disorders. Acupoint-catgut embedment has long been known as adjunctive therapy for GERD. This study was aimed to establish the effect of acupoint-catgut embedment combined with medication on the IL-6 serum levels of patients with GERD. &#x0D; METHODS This single-blind randomized controlled trial involved 40 GERD patients from the Gastroenterology Outpatient Clinic of Cipto Mangunkusumo Hospital that were randomly allocated to either catgut-embedding therapy plus medication or sham acupuncture with medication. Catgut-embedding therapy was given two times at CV12 (Zhongwan), ST36 (Zusanli), and BL21 (Weishu) every 15 days. Serum levels of IL-6 were measured by enzyme-linked immunosorbent assay as research output. &#x0D; RESULTS There were no significant differences in the baseline levels of proinflammatory (IL-6) mediators between the groups. After 1-month treatment, the median levels of IL-6 were statistically insignificant decreased in catgut-embedding therapy plus medication versus sham acupuncture with medication (0.15 versus -0.16 pg/ml, respectively; p = 0.14). &#x0D; CONCLUSIONS The results suggest that catgut-embedding therapy has not been proven to statistically influence the levels of IL-6 in patients with GERD.

356 Mucosal Ablation and Suturing at the Esophagogastric Junction (MASE): A Novel Procedure for the Management of Gastroesophageal Reflux Disease in Altered Anatomy Patients

INTRODUCTION: Gastroesophageal reflux disease (GERD) is caused by reflux of gastric contents into the esophagus. For patients with esophageal or gastric surgery there are limited options for endoscopic or surgical therapy for GERD. There has recently been introduced an endoscopic suturing platform that allows for full thickness suturing. We created a technique called Mucosal Ablation and Suturing at the Esophagogastric Junction (MASE) to anatomically correct the GEJ in patients where other surgical or endoscopic options may not be possible. METHODS: This is a single-center prospective observational study. The standardized procedure involved APC ablation below the GE junction to improve tissue apposition prior to suturing. Three sutures were placed along the lesser curvature of the cardia immediately below the EGJ. This creates a tightening and tissue bulge that acts as a barrier to reflux. The primary outcome evaluated was 30% improvement in reflux disease questionnaire (RDQ) and GERD Health Related Quality of Life Questionnaire. The secondary outcomes evaluated were reduction in PPI use, procedure tolerance and safety. RESULTS: 10 patients with a mean age of 63 years with altered anatomy: Fundoplication (N = 5), Billroth II (N = 1), Roux-en-Y (N = 3), and Sleeve gastrectomy (N = 1) underwent MASE procedure. The RDQ and HRQL questionnaires were recorded for each patient before and after MASE. Mean follow-up time was 113 days. Primary outcome of 30% improvement in RDQ and GERD HRQL were achieved for all patients (Figure 1). There was a 90 % reduction in PPI use in the study group; 6 patients (66%) were able to discontinue PPI use, and 2 patients (22%) reduced their dose. The most common side effect was self-limited post-procedure epigastric pain (9%). CONCLUSION: The MASE procedure represents a novel endoscopic treatment option for management of GERD in patients with altered anatomy. Altered anatomy patients have limited treatment options once they fail standard PPI therapy. The MASE procedure can reduce GERD symptoms in this difficult to treat patient population and reduce reliance of daily anti-secretory medication use. Further studies need to be performed to determine longevity of this procedure.

Current advances in the treatment of gastroesophageal reflux disease: a focus on esophageal protection

Gastroesophageal reflux disease (GERD) is characterized by high morbidity and a significant decrease in the quality of life of patients, and is a major risk factor for esophageal adenocarcinoma. Nowadays, antisecretory therapy with proton pump inhibitors (PPI) is the "gold standard" of conservative treatment of GERD, but in some cases this therapy is unsuccessful. According to various studies, the prevalence of refractory GERD can reach 30-40%. The latest scientific data in the field of genetics and pathophysiology of GERD demonstrate that a disruption of the barrier function of the esophageal mucosa and an increase of its permeability can be the leading causes of refractoriness. Thus, the optimal therapy for patients with GERD should not only suppress the secretion of hydrochloric acid, but also restore the barrier function of the mucous membrane, providing an esophagoprotective effect. To achieve these goals, Alfasoxx was developed, which consists of a mixture of low molecular weight hyaluronic acid and low molecular weight chondroitin sulfate dissolved in a bioadhesive carrier (poloxamer 407). The clinical efficacy of this product has been confirmed by three prospective, randomized, placebo - controlled trials. Alfasoxx has a healing and restorative effect towards the esophageal epithelium and due to high ability for bioadhesion provides long - term protection of the mucous membrane of the esophagus. Combination therapy for GERD with the use of PPI and an esophagoprotector offers new perspectives for the treatment of patients with GERD.

The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn.

Gastroesophageal reflux disease (GERD) is a common esophageal disorder that is characterized by troublesome symptoms associated with increased esophageal acid exposure. Cornerstones of therapy include acid suppressive agents like proton pump inhibitors (PPI) and lifestyle modifications including dietary therapy, although the latter is not well defined. As concerns regarding long term PPI use continue to be explored, patients and providers are becoming increasingly interested in the role of diet in disease management. The following is a review of dietary therapy for GERD with an emphasis on the effect food components have on pathophysiology and management. Although sequential dietary elimination of food groups is common, literature supports broader manipulation including reduction of overall sugar intake, increase in dietary fiber, and changes in overall eating practices.

Effectiveness of Vonoprazan vs Omeprazole as Empiric Therapy for Gastroesophageal Reflux Disease (GERD) Patients Without Alarm Features

Effectiveness of Vonoprazan vs Omeprazole as Empiric Therapy for Gastroesophageal Reflux Disease (GERD) Patients Without Alarm Features