Therapy For Gastroesophageal Reflux Disease Research Articles

Gastroesophageal reflux disease: new approaches to optimizing pharmacotherapy

Proton pump inhibitors (PPIs) are baseline drugs for induction and maintenance of remission in gastroesophageal reflux disease (GERD). PPIs have proven to be highly effective in healing esophageal mucosal lesions and relieving the symptoms of the disease in most cases. However, according to the literature data, the incidence rate of clinical ineffectiveness of PPIs in the form of partial or complete persistence of current symptoms during administration of standard doses of PPIs ranges from 10 to 40%. Optimization of GERD therapy in PPI refractory patients is a significant challenge. In most cases, experts advise to increase a dose / dosage frequency of PPIs, switch to CYP2C19-independent PPIs (rabeprazole, esomeprazole, dexlansoprazole), add an esophagoprotective or promotility agents to therapy. At the same time, these recommendations have a limited effect in some patients, which opens up opportunities for looking for new solutions related to the optimization of GERD therapy. Today there is growing evidence of the relevance of the role of disruption of the cytoprotective and barrier properties of the esophageal mucosa in the genesis of GERD and the formation of refractoriness. Intercellular contacts ensure the integrity of the barrier function of the esophageal mucosa to protect it from various exogenous intraluminal substances with detergent properties. Acid-peptic attack in patients with GERD leads to alteration of the expression of some tight junction proteins in epithelial cells of the esophageal mucosa. The latter leads to increased mucosal permeability, which facilitates the penetration of hydrogen ions and other substances into the submucosal layer, where they stimulate the terminals of nerve fibers playing a role in the induction and persistence of the symptoms of the disease. The above evidence brought up to date the effectiveness study of the cytoprotective drugs with tropism to the gastrointestinal tract, as part of the combination therapy of GERD.

Integrative Effects and Vagal Mechanisms of Transcutaneous Electrical Acustimulation on Gastroesophageal Motility in Patients With Gastroesophageal Reflux Disease

Impaired esophageal and gastric motilities are known to contribute to symptoms of gastroesophageal reflux disease (GERD). However, there is a lack of GERD therapy, targeting both gastric and esophageal functions. This study was designed to investigate the effects of transcutaneous electrical acustimulation (TEA) on symptoms of GERD and gastroesophageal functions and possible mechanisms in patients with GERD. Thirty patients with GERD with ineffective esophageal motility were equally divided and randomized into a 4-week sham-TEA or 4-week TEA treatment. The GERD questionnaire (GerdQ), GERD health-related quality-of-life questionnaire, high-resolution esophageal manometry, a nutrient drink test, the electrogastrogram, and ECG were performed to assess the severity of reflux symptoms, low esophageal sphincter (LES) pressure, distal contractile integral (DCI), gastric accommodation, gastric slow waves (GSW), and autonomic functions, respectively. Compared with sham-TEA, the 4-week TEA treatment significantly decreased the GerdQ score (P = 0.011) and GERD health-related quality of life (P = 0.028) and improved nutrient drink-induced fullness (P < 0.001) and belching (P < 0.001) in patients with GERD. Although only acute TEA significantly enhanced LES pressure (P < 0.05), both acute and chronic TEA remarkedly increased DCI (P < 0.05) and reduced the incidence of ineffective esophageal contractions during wet swallows (P = 0.02). In addition, chronic TEA significantly increased gastric accommodation and the percentage of postprandial normal GSW compared with sham-TEA and baseline. Concurrently, TEA-enhanced vagal activity (P = 0.02) and the vagal activity positively correlated with LES pressure (r = 0.528; P = 0.003) and DCI (r = 0.522; P = 0.003). The TEA treatment performed in this study improves reflux-related symptoms, increases DCI, reduces the incidence of ineffective esophageal contractions during wet swallows, and improves gastric accommodation and slow waves. The improvement in GERD symptoms might be attributed to the integrative effects of TEA on these gastroesophageal functions mediated via the vagal mechanism.

Proton Pump Inhibitors, Associated Complications, and Alternative Therapies: A Shifting Risk Benefit Ratio.

Our goal was to compile the most recent and accurate data on the side effects of proton pump inhibitors (PPI). We also compared the efficacy of PPI to the efficacy of different surgical options for acid reflux control. Proton pump inhibitors are the primary therapy for chronic control of gastroesophageal reflux disease (GERD), but newer studies demonstrate deleterious side effects. Collating this information and contrasting it with surgical therapy for GERD provides evidence for possible practice changes in treatment. A literature search utilizing PubMed was performed evaluating for PPI and anti-reflux surgery (ARS), focusing on articles that reflected information regarding the usage and efficacy of symptom control of both PPI and ARS. Search terms included "ARS, fundoplication, MSA, acute interstitial nephritis, acute kidney injury, chronic kidney disease, meta-analysis, PPI, H2 blocker, cardiovascular risk, and gut dysbiosis." We evaluated 271 articles by title, abstract, and data for relevance and included 70. Long-term control of GERD with PPI may have a greater than expected side effect profile than initially thought. Surgical options may provide greater symptom control than PPI without the side effects of long-term medical therapy. Anti-reflux control can be safely achieved with either PPI or surgical options; however, the long-term side effects noted in the review such as increased risk of cardiovascular events, renal disease, and gut dysbiosis may suggest surgical anti-reflux control as a better long-term option.

Differentiated approach to the choice of PPI in a patient with GERD in the practice of an outpatient (with a clinical case)

Gastroesophageal reflux disease (GERD) is a widespread disease. Despite the fact that different approaches to the treatment and prevention of recurrence of this disease have been developed, the number of patients with GERD, including refractory form of GERD, is only increasing. To date, well studied and described the possible links of the pathogenesis of this disease, which predetermine certain approaches to the treatment of various variants of GERD. Effective drug therapy of GERD includes the appointment of proton pump inhibitors (PPI). However, doctors are often faced with the problem of ineffective use of PPI in patients with GERD or with the so-called refractory form of GERD. The reasons for the ineffectiveness of therapy of PPI can be associated not only with the pathogenetic features of GERD and therapy, but also with the patient himself. Daily pH monitoring allows to determine the cause of the ineffectiveness of the treatment of PPI if the patient complies with all prescriptions. With ineffective acid suppression in the stomach, it is necessary to increase the dose of PPI or replace it. It is important to prescribe both effective and safe means of correcting the symptoms of GERD, and also take into account the possibility of long-term maintenance of remission when using them. These requirements are met by PPI, created in the form of enantiomers, having an improved pharmacokinetic profile. An example of this differentiated approach is dexlansoprazole, a law-converting monoisomer of lansoprazole with double release technology and the ability to maintain the antisecretory effect for a long time, which appeared relatively recently on the Russian pharmaceutical market. The use of this drug is presented in a clinical case.

New endoscopic treatment methods for PPI-resistant GERD

Introduction. Gastroesophageal reflux disease (GERD) is a common disease with the highest prevalence in North America. Up to 40% of patients report persistent gastroesophageal reflux disease (GERD) symptoms despite proton pump inhibitor (PPI) therapy. Aim. The aim of this article is to complete discuss the GERD characterized by heartburn and/or regurgitation symptoms. Material and methods. We discuss here the evidence for medical therapy for PPI nonresponsive GERD. Analysis of the literature. GERD may present with a variety of other symptoms, including water brash, chest pain or discomfort, dysphagia, belching, epigastric pain, nausea, and bloating. In addition, patients may experience extraesophageal symptoms like cough, hoarseness, throat clearing, throat pain or burning, wheezing, and sleep disturbances. Conclusion. There has been an increase in GERD prevalence. GERD is one of the most common gastrointestinal disorders managed by gastroenterologists and primary care physicians.

Risk factors for gastroesophageal reflux disease symptoms related to lifestyle and diet.

Gastroesophageal reflux disease (GERD) is one of the most common diseases of the upper gastrointestinal tract. The most characteristic symptom of the disease is heartburn, which occurs at least once a week. The prevalence of the disease varies and, depending on the region of the world, it may affect from a few to over 30% of an adult population. It is estimated that in Poland this disease may affect up to 35.5% of adults reporting abdominal ailments. If untreated, the disease can lead to serious complications including precancerous conditions and esophageal adenocarcinoma. Pharmacotherapy is considered as the first-line treatment in GERD patients but lifestyle modifications, including diet changes, are an important element supporting the treatment of the disease. Many factors may contribute to the development of the disease. Among them, there are non-modifiable factors such as age, sex or genetic factors and modifiable factors, e.g. lifestyle, diet, excessive body weight. This review focuses on GERD risk factors related to lifestyle and nutrition that include both dietary components and nutritional behaviour. Lifestyle risk factors that may contribute to GERD symptoms include excessive body weight, particularly obesity, moderate/high alcohol consumption, smoking, postprandial and vigorous physical activity, as well as lack of regular physical activity. Many studies indicate fatty, fried, sour, spicy food/products, orange and grapefruit juice, tomatoes and tomato preserves, chocolate, coffee/tea, carbonated beverages, alcohol as triggers for GERD symptoms. Eating habits such as irregular meal pattern, large volume of meals, eating meals just before bedtime may correlate with the symptoms of GERD. The role of lifestyle, diet and eating habits as risk factors for GERD is not clearly understood, and the results of the available studies are often contradictory. Determination of modifiable risk factors for this disease and its symptoms is important for effective dietary prevention and diet therapy of GERD.

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is the most common gastrointestinal diagnosis made in outpatient clinics, responsible for over 5 million annual outpatient visits and likely hundreds of thousands of inpatient stays for noncardiac chest pain. GERD’s current definition, based on international consensus, is a “condition which develops when the reflux of stomach contents causes troublesome symptoms (i.e., at least two heartburn episodes per week) and/or complications.” Also defining GERD is the presence of erosive esophagitis on upper endoscopy (esophagogastroduodenoscopy [EGD]) with or without the presence of troublesome symptoms or the presence of troublesome symptoms without endoscopic evidence of erosive esophagitis (also known as nonerosive reflux disease). This review looks at GERD in detail, including its epidemiology and risk factors, genetics, pathogenesis and etiologic factors, clinical presentation and symptoms, differentials, diagnosis, and complications. Figures presented are an EGD image showing signs of erosive esophagitis, Barrett esophagus, and hiatal hernia and sample recordings from a 24-hour combined multichannel intraluminal impedance and pH testing. Tables list differential diagnoses for GERD, indications for performing EGD in patients with GERD symptoms, and a summary of GERD therapies. This review contains ­2 figures, 4 tables, and 74 references.

Response to therapy among neonates with gastro-esophageal reflux is associated with esophageal clearance

BackgroundFew studies evaluated the efficacy of pharmacological therapy for gastro-esophageal reflux disease (GERD) in newborns, whose safety has been questioned. Esophageal basal impedance (BI) is a marker of mucosal integrity, and treatment with proton pump inhibitors significantly increases BI in infants; however, no correlation with clinical improvement was reported. AimsTo evaluate the relationship between BI and other esophageal pH-impedance parameters and clinical response to therapy in newborns with GERD. Study designMulticenter retrospective study. SubjectsInfants who received omeprazole or ranitidine for GERD. Outcome measuresComplete response to therapy was defined as symptom decrease by ≥50% compared to baseline, partial response as symptom decrease <50%, no response as no symptom decrease based on chart analysis. Response to therapy was assessed 2 and 4 weeks after the onset of therapy. Univariate and multivariate statistics were performed to assess associations between response to therapy and clinical/pH-impedance parameters. ResultsWe studied 60 infants (51 born preterm): 47 received omeprazole, 13 ranitidine. Response to therapy was associated with decreasing esophageal clearance time: odds ratio 0.308, 95%CI 0.126–0.753, p = 0.010 at 2 weeks, odds ratio 0.461, 95%CI 0.223–0.955, p = 0.037 at 4 weeks. ConclusionsClinical response to therapy among infants with GERD was associated with esophageal clearance but not with esophageal BI level.

Differentiated approach to the choice of PPI in a patient with GERD in the practice of an outpatient (with a clinical case)

In recent years, functional disorders of the gastrointestinal tract (GIT) are quite common. The most significant functional disorders are functional dyspepsia (FD), which is widespread in the population. In addition, in the clinical practice of outpatient doctors, the proportion of combined variants or overlap of several types of functional disorders or a combination of functional disorders with organic pathology has increased. So, according to systematic reviews, the combined course of gastroesophageal reflux disease (GERD) and FD occurs in at least one third of patients. At the same time, the combined functional pathology of the gastrointestinal tract changes the clinical picture of GERD, which complicates differential diagnosis, leads to inadequate and multiple prescription of drugs and often low effectiveness of the prescribed therapy. All this negatively affects the quality of life of patients. The tactics of managing patients with the combined course of GERD and FD sometimes presents certain difficulties, since there are no available recommendations for pathogenetic therapy and preventive measures. To date, possible links in the pathogenesis of both GERD and FD have been studied and described, which predetermine certain approaches to the treatment of various variants of these two diseases. Drug therapy for GERD includes the appointment of proton pump inhibitors (PPIs), antireflux drugs. In FD therapy, prokinetics and/or PPIs are effective. A rational approach in the treatment of the intersection of GERD and FD is the appointment of a drug with a dual mechanism of action, which contains both a prokinetic and a PPI. An example of this approach is the appointment of omeprazole and domperidone. The use of this drug is presented in a clinical case.

Magnet-assist endoscopic augmentation of the lower esophageal sphincter for treatment of gastroesophageal reflux disease: cadaveric and survival studies in a porcine model (with video).

Augmentation of the lower esophageal sphincter (LES) is the primary goal of both surgical and endoscopic therapies for gastroesophageal reflux disease (GERD). The feasibility, efficacy, safety, and reversibility of a newly developed endotherapy for GERD using intraluminal magnets referred to as a magnet closure device (MCD) were evaluated. This study involved nine cadaveric and six survival pigs. The MCD consisted of a ring neodymium magnet attached to a 2-0 polypropylene suture and suture anchor. The MCD was deployed onto the esophageal wall at the region of the LES using an endoscopic suturing device. Two to three MCDs were placed on opposing walls to induce closure of the esophageal lumen. LES pressures were measured using high-resolution manometry at the index procedure (baseline and immediately post-MCD placement) and at survival endoscopy. Endoscopic removal of the devices was performed followed by necropsy at week 2. MCDs were successfully deployed in all cadaveric (n = 22) and survival animals (n = 12). In cadavers, 20/22 (91%) sutures were full-thickness with no adjacent organ injury. In survival animals, mean LES pressure increased from 8.4mmHg (baseline) to 32.4mmHg immediately post-procedure (p < 0.01). No clinically significant adverse events occurred. Repeat endoscopy at two weeks showed intact MCDs in 4/6 (67%) animals with significant increase in median LES pressure (n = 4, 24.0mmHg versus 7.4mmHg [baseline], p < 0.05). Endoscopic removal of MCDs was successfully achieved. Endoscopic augmentation of the LES using a new MCD was feasible, safe and reversible with significantly increased LES pressures recorded. Future studies are needed to enhance durability. These preliminary results on a reversible technique are promising and may represent an attractive alternative to endoluminal GERD therapy.

S1351 A Study for Every Second Day Administration of Vonoprazan in Maintenance Treatment of Erosive GERD (ESD Von GERD): A Multicenter Randomized Crossover Study

INTRODUCTION: Vonoprazan, a potassium competitive acid blocker, with stronger and more stable acid-suppressing effects than proton pump inhibitors (PPIs), is used to treat erosive gastroesophageal reflux disease (GERD). We clarified the usefulness and superiority of vonoprazan administered every second day over PPIs in maintenance therapy of erosive GERD. METHODS: This was a prospective, multicenter, open-label, two-period randomized crossover study. Patients were randomized to the PCPP group, which was administered vonoprazan 10 mg daily (q.d.) for the first 4 weeks and then lansoprazole 15 mg q.d. the next 4 weeks both administered every second day, and the PPPC group, which was treated in reverse. GERD symptoms including heartburn and acid reflux were compared between vonoprazan and lansoprazole using symptom diaries, frequency scale for symptoms of GERD (FSSG) and gastrointestinal symptom rating scale (GSRS). RESULTS: We enrolled 122 patients between December 2017 and May 2019. Asymptomatic proportion in vonoprazan administration and lansoprazole administration were 93.6% (105/112) and 82.1% (92/112), respectively, and it had a significant difference with analysis using McNemar’s test (P = 0.003). During the first 4 weeks, 93.3% and 85.7% patients were asymptomatic following treatment for ≥6 consecutive days a week in the PCPP and PPPC groups, respectively (P = 0.228), whereas during the second 4 weeks, 94.4% and76.7% patients, respectively were asymptomatic (P = 0.009). Furthermore, 96.7% and 80.0% of patients were asymptomatic with less than once weekly in the PCPP and PPPC groups, respectively, during the first 4 weeks (P = 0.007). GERD symptoms were significantly decreased with vonoprazan administered every second day using FSSG and GERD. CONCLUSION: vonoprazan every second day administration may reduce patient symptoms more effectively than PPIs in erosive GERD maintenance. Furthermore, vonoprazan could be effective maintenance therapies because of their inhibitory effects on gastric acid secretion even when administered every second day and could be selected on-demand. However, further research on long-term administration effects would be necessary.

Effects of Diaphragmatic Breathing on the Pathophysiology and Treatment of Upright Gastroesophageal Reflux: A Randomized Controlled Trial.

Uncontrolled results suggest that diaphragmatic breathing (DB) is effective in gastroesophageal reflux disease (GERD) but the mechanism of action and rigor of proof is lacking. This study aimed to determine the effects of DB on reflux, lower esophageal sphincter (LES), and gastric pressures in patients with upright GERD and controls. Adult patients with pH proven upright GERD were studied. During a high-resolution impedance manometry, study patients received a standardized pH neutral refluxogenic meal followed by LES challenge maneuvers (Valsalva and abdominal hollowing) while randomized to DB or sham. After that, patients underwent 48 hours of pH-impedance monitoring, with 50% randomization to postprandial DB during the second day. On examining 23 patients and 10 controls, postprandial gastric pressure was found to be significantly higher in patients compared with that in controls (12 vs 7 mm Hg, P = 0.018). Valsalva maneuver produced reflux in 65.2% of patients compared with 44.4% of controls (P = 0.035). LES increased during the inspiratory portion of DB (42.2 vs 23.1 mm Hg, P < 0.001) in patients and healthy persons. Postprandial DB reduced the number of postprandial reflux events in patients (0.36 vs 2.60, P < 0.001) and healthy subjects (0.00 vs 1.75, P < 0.001) compared with observation. During 48-hour ambulatory study, DB reduced the reflux episodes on day 2 compared with observation on day 1 in both the patient and control groups (P = 0.049). In patients, comparing DB with sham, total acid exposure on day 2 was not different (10.2 ± 7.9 vs 9.4 ± 6.2, P = 0.804). In patients randomized to DB, esophageal acid exposure in a 2-hour window after the standardized meal on day 1 vs day 2 reduced from 11.8% ±6.4 to 5.2% ± 5.1, P = 0.015. In patients with upright GERD, DB reduces the number of postprandial reflux events pressure by increasing the difference between LES and gastric pressure. These data further encourage studying DB as therapy for GERD.

The role of alginate-based therapy in gastroesophageal reflux disease

The role of alginate-based therapy in gastroesophageal reflux disease

Recommendations of the Russian Gastroenterological Association in Diagnosis and Treatment of Gastroesophageal Reflux Disease

Aim . Current recommendations of the Russian Gastroenterological Association are developed to acquaint medical practitioners with modern diagnostics, treatment and trends in rational drug therapy for gastroesophageal reflux disease (GERD). General provisions . Incidence rate of GERD in the Russian Federation varies from 11.3 to 23.6%. GERD is diagnosed with medical history and laboratory examination evidence. Esophagogastroduodenoscopy (EGDS) allows detection of reflux esophagitis of various severity and cylindrical epithelial metaplasia of esophagus. The refractory form of disease (lack of conclusive clinical and endoscopic remission during 4-8 weeks of standard-dose PPI therapy), presence of strictures and Barrett's esophagus require EGDS with esophageal biopsy and bioptic histological examination. Patients should be conclusively performed esophageal 24-hour pH-metry or pH-impedance monitoring, high-resolution manometry to thoroughly examine functionality of esophagus, esophagogastric junction and assess disease prognosis and therapy outcomes. Treatment of GERD should be personalised accounting for clinical manifestations and severity, as well as aimed at symptom improvement, lesion healing in erosive esophagitis, averting complications, Barrett's esophagus progression, dysplasia and esophageal adenocarcinoma. Proton pump inhibitors (PPIs) are most effective agents in primary (4-8 weeks) and maintenance anti-GERD therapy. Antacids are recommended in monotherapy for occasional nonerosive heartburn and complex anti-GERD settings for fast symptom improvement. Prokinetics can be used in combination with PPIs for their properties to recover normal functionality of esophagus through affecting pathogenetic mechanisms of GERD. Complicated patients (repeated bleedings, peptic esophageal strictures) are recommended anti-reflux surgery with prior examination of esophageal functionality using pH-impedance and high-resolution manometry. Conclusion . Current recommendations provide an up-to-date evidential medicial review of GERD and guidelines to advance special medical care and timely preventive measures.

The role of the traditional surgical procedures for gastroesophageal reflux disease cannot be ignored

Gastroesophageal reflux disease (GERD) is a common digestive disease with characteristics of a multitude of pathogenesis, a variety of clinical manifestations and a strong negative impact on physical and mental health of the patients. GERD is classified into non-erosive reflux disease and reflux esophagitis in terms of absence or presence of mucosal damage at endoscopic findings. Proton pump inhibitors (PPI) are widely used in the treatment of GERD, especially for patients with non-erosive reflux disease or mild reflux esophagitis. However, PPI do not affect pathophysiologic mechanisms of GERD or reduce the number of reflux events. When PPI fails to adequately control the symptoms of GERD as a result of gastroesophagel junction structural defects, the antireflux surgical procedures are indicated to create a mechanical barrier to reflux. The laparoscopic fundoplication remains the most commonly performed and is the current "gold-standard" anti-reflux procedure. The outcomes of the antireflux surgical procedures are superior to medical therapy for GERD in light of subjective symptoms, objective examinations, quality of life and patient satisfaction. As of now, enough attention has not been paid to the traditional surgical procedures of GERD in China. It is controversial about which is optimal among the three major types of procedures, selection should be tailored to classification, mechanism, age, mental status and esophageal motility. GERD is a chronic disease and either medical or surgical therapy may put the patient at different risk, therefore the patient's preferences should be considered adequately before choosing the treatment protocols.

Gastrointestinal pharmacology: practical tips for the esophagologist.

Gastroesophageal reflux disease (GERD) is primarily a motor disorder, and its pathogenesis is multifactorial. As a consequence, treatment should be able to address the underlying pathophysiology. Proton pump inhibitors (PPIs) are the mainstay of medical therapy for GERD, but these drugs only provide the control of symptoms and lesions without curing the disease. However, continuous acid suppression with PPIs is recommended for patients with Barrett's esophagus because of their potential chemopreventive effects. In addition to the antisecretory activity, these compounds display several pharmacological properties, often overlooked in clinical practice. PPIs can indeed affect gastric motility, exert a mucosal protective effect, and an antioxidant, anti-inflammatory, and antineoplastic activity, also protecting cancer cells from developing chemo- or radiotherapeutic resistance. Even in the third millennium, current pharmacologic approaches to address GERD are limited. Reflux inhibitors represent a promise unfulfilled, effective and safe prokinetics are lacking, and antidepressants, despite being effective in selected patients, give rise to adverse events in a large proportion of them. While waiting for new drug classes (like potassium-competitive acid blockers), reassessing old drugs (namely alginate-containing formulations), and paving the new avenue of esophageal mucosal protection are, at the present time, the only reliable alternatives to acid suppression.

Diagnostic predictors of effective therapy for gastroesophageal reflux disease

In Chelyabinsk from January 2020 the method of 24-hour pH-impedance-monitoring of the esophagus was introduced. The analysis of diagnostic possibilities of this research even on a small initial sample of patients confirms high informativeness of the method in the section of diseases of the upper parts of the gastrointestinal tract. The combination of parameters of daily recording of pH-impedanceograms allows reliable identification of gastroesophageal refl ux disease (GERD) and functional dyspepsia. The tasks of differentiating the nosological affiliation of symptoms (heartburn, burning, chest pain, lump in the throat, voice axis, cough) arise for doctors of different specialties: gastroenterologists, otolaryngologists, pulmonologists, cardiologists. Comparing the complaints noted by the patient with episodes of the bolus hitting the esophagus, we get the opportunity to calculate the probability of association of symptoms with refl uxes, and thus correctly route the “complex” patient.Thus, the daily pH-impedanceometry demonstrates high diagnostic capabilities and allows us to reliably distinguish the pathological gastroesophageal refl ux from functional heartburn. Conducting research at the stage of diagnosis and during treatment makes the technique an effective tool for quality control of the therapeutic solution in each clinical situation.

Association of residual gastric acid secretion with persistent symptoms in gastroesophageal reflux disease patients receiving standard-dose proton pump inhibitor therapy.

Although a third of gastroesophageal reflux disease (GERD) patients are refractory to proton pump inhibitor (PPI) therapy, the underlying mechanism of the refractoriness remains unclear. We compared the level of gastric acid suppression during PPI treatment between responders and non-responders by directly measuring gastric acid secretion in GERD patients taking PPIs. Seventy-five consecutive patients receiving standard-dose PPI therapy for GERD were prospectively recruited, irrespective of persistent GERD symptoms. They were asked about their GERD symptoms using a validated questionnaire, and simultaneously underwent both a routine endoscopic examination and a gastric acid secretory testing using an endoscopic gastrin test. Associations between residual gastric acid secretion during PPI treatment and persistent GERD symptoms were analyzed by a logistic regression analysis. Overall, 26 of 75 (34.7%) patients were judged to be positive for persistent GERD symptoms. The patients with and without persistent symptoms showed similar gastric acid secretion levels (1.3 [1.3]mEq/10min vs. 1.4 [2.0]mEq/10min). Sufficient gastric acid suppression, defined as < 0.6, was not significantly associated with persistent GERD symptoms (odds ratio 1.1, 95% confidence interval 0.40-3.5). This study provided solid evidence to support that the gastric acid suppression level during PPI treatment does not differ between patients with and without persistent GERD symptoms. The insignificant role of residual gastric acid in the persistent GERD symptoms suggests that the use of medications other than those that enhance gastric acid inhibitory effects would be an essential approach for the management of PPI-refractory GERD.

A comparison of the efficacy and safety of complementary and alternative therapies for gastroesophageal reflux disease: A protocol for network meta-analysis.

Background:Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases in the world and is showing increasing prevalence in some countries. The disease has a chronic course that leads to a significant decline in the quality of life of patients and is associated with a high economic burden worldwide. And complementary and alternative medicine is used to treat the disease. Over the past few decades, a number of randomized controlled trials and systematic evaluations have been conducted to evaluate the effectiveness and safety of different types of complementary and alternative medicine methods, so there is an urgent need to summarize and further evaluate these studies.Methods:We will search the following sources without restrictions for date, language, or publication status: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) Cochrane Library, and EMBASE, China National Knowledge Infrastructure, Chinese Bio-medicine Database, VIP Chinese Periodical Database, Wan Fang Database. We will apply a combination of Medical Subject Heading and free-text terms incorporating database-specific controlled vocabularies and text words to implement search strategies. We will also search the ongoing trials registered in the World Health Organization's International Clinical Trials Registry Platform. Besides, the previous relevant reviews conducted on complementary and alternative therapies for GERD and reference lists of included studies will also be searched.Results:This study will provide a reliable basis for the treatment of GERD with complementary and alternative therapies.Conclusions:The findings will be an available reference to evaluate the efficacy and safety of complementary and alternative therapies on GERD and may provide decision-making reference on which method to choose for clinicians.PROSPERO registration number:PROSPERO CRD42020169332.

7RECENT Advances in Endoscopic Treatments for Gastroesophageal Reflux Disease

There is a growing interest in minimally invasive approaches to the management of gastroesophageal reflux disease (GERD), including endoscopic GERD therapy. This review evaluates available endoscopic therapeutic options utilized in GERD management. Application of radiofrequency energy at the esophagogastric junction (EGJ) reduces reflux symptoms, but esophageal acid exposure does not necessarily normalize, and esophageal sensation is compromised. Two approaches to the creation of a valve at the EGJ, the Medigus ultrasonic surgical stapler (ultrasound guided stapling of the gastric fundus to the EGJ) and EsophyX (fasteners to create a 270 ° partial fundoplication), improve symptoms and reduce esophageal acid burden, but long-term durability remains unknown. Endoscopic management is widely utilized for GERD complications. Selecting the appropriate patient is key for therapeutic success with endoscopic GERD therapy. Patients with minimally disrupted EGJ barrier (< 2 cm hiatus hernia) and intact esophageal peristalsis are optimal candidates.