Typical Gastroesophageal Reflux Symptoms Research Articles

Inflammatory responses in esophageal mucosa before and after laparoscopic antireflux surgery.

Currently, the primary treatment for gastroesophageal reflux is acid suppression with proton pump inhibitors, but they are not a cure, and some patients don't respond well or refuse long-term use. Therefore, alternative therapies are needed to understand the disease and develop better treatments. Laparoscopic anti-reflux surgery (LARS) can resolve symptoms of these patients and plays a significant role in evaluating esophageal healing after preventing harmful effects. Successful LARS improves typical gastroesophageal reflux symptoms in most patients, mainly by reducing the exposure time to gastric contents in the esophagus. Amelioration of the inflammatory response and a recovery response in the esophageal epithelium is expected following the cessation of the noxious attack. To explore the role of inflammatory biomolecules in LARS and assess the time required for esophageal epithelial recovery. Of 22 patients with LARS (pre- and post/5.8 ± 3.8 months after LARS) and 25 healthy controls (HCs) were included. All subjects underwent 24-h multichannel intraluminal impedance-pH monitoring and upper gastrointestinal endoscopy, during which esophageal biopsy samples were collected using endoscopic techniques. Inflammatory molecules in esophageal biopsies were investigated by reverse transcription-polymerase chain reaction and multiplex-enzyme-linked immunosorbent assay. Post-LARS samples showed significant increases in proinflammatory cytokines [interleukin (IL)-1β, interferon-γ, C-X-C chemokine ligand 2 (CXCL2)], anti-inflammatory cytokines [CC chemokine ligand (CCL) 11, CCL13, CCL17, CCL26, CCL1, CCL7, CCL8, CCL24, IL-4, IL-10], and homeostatic cytokines (CCL27, CCL20, CCL19, CCL23, CCL25, CXCL12, migration inhibitory factor) compared to both HCs and pre-LARS samples. CCL17 and CCL21 levels were higher in pre-LARS than in HCs (P < 0.05). The mRNA expression levels of AKT1, fibroblast growth factor 2, HRAS, and mitogen-activated protein kinase 4 were significantly decreased post-LARS vs pre-LARS. CCL2 and epidermal growth factor gene levels were significantly increased in the pre-LARS compared to the HCs (P < 0.05). The presence of proinflammatory proteins post-LARS suggests ongoing inflammation in the epithelium. Elevated homeostatic cytokine levels indicate cell balance is maintained for about 6 months after LARS. The anti-inflammatory response post-LARS shows suppression of inflammatory damage and ongoing postoperative recovery.

Iceberg Lettuce Reduces the Severity of Gastroesophageal Reflux Symptoms: Two Case Reports

Gastroesophageal reflux is a common disease and generally occurs when a portion of the contents of the stomach pass through the lower esophageal sphincter and into the esophagus and returns. If gastroesophageal reflux occurs regularly then symptoms of gastroesophageal reflux disease or GERD can develop. Typical gastroesophageal reflux symptoms (RS) are often defined as heartburn/discomfort or a feeling that stomach contents could reflux into the oesophagus. Gastroesophageal RS are commonly managed by making dietary and lifestyle changes but may also require the use of antacid tablets or proton pump inhibitors (PPIs). Two cases are presented where the effects of consuming iceberg lettuce (IL) on the severity of RS, classified as mild, medium or severe, are reported. It was found for both patients, IL consumed after a meal could resolve mild RS, resolve or reduce the severity of moderate RS, and reduce the severity of severe RS to mild or moderate symptoms, but not resolve them.

Traditional Chinese medicine based on Tongjiang methodology combined with proton pump inhibitor (PPI) step-down in treating non-erosive reflux disease: a study protocol for a multicentered, randomized controlled clinical trial

BackgroundNon-erosive reflux disease (NERD) is characterized by typical gastroesophageal reflux symptoms, such as heartburn and regurgitation but an absence of esophageal mucosal damage during upper gastrointestinal endoscopy. Although proton pump inhibitors (PPIs) are the first line therapy, almost 50% of patients with NERD fail to respond to this treatment. Traditional Chinese medicine (TCM) can better relieve the symptoms of NERD. Therefore, a randomized controlled trial (RCT) was designed to investigate the efficiency of TCM granules based on Tongjiang (TJ) methodology combined with PPI step-down therapy for NERD patients who did not respond to PPIs alone.MethodThis multicentered, double-blinded, RCT with two parallel groups will recruit 174 participants who will be randomized into the TCM granules combined with PPI step-down group (n = 87) and the TCM granules placebo combined with PPI step-down group (n = 87). Both groups of participants will receive 6 weeks of treatment and 4 weeks of follow-up, and all participants will be assessed for related symptoms, mental health status, and quality of life at each visit. The primary outcome measurements include visual analog scale (VAS) for heartburn and regurgitation and the major symptoms scale. The secondary outcome measurements include PPI withdrawal rate, symptom recurrence rate, minor symptoms scale, SF-36, PRO, SAS, SDS, GERD–HRQL, and TCM syndromes scales.DiscussionPrevious research has shown that TCM is capable to alleviate NERD symptoms. This trial will help to provide a better understanding of the synergistic efficiency of the combination of TCM and PPIs, to explore whether the dosage of PPIs can be reduced after the supplement of TCM granules and to provide a feasible plan to reduce dependencies or withdraw NERD patients from PPIs. The outcome of this trial is expected to reduce the symptom recurrence rates, lessen patients’ physical and psychological burdens, and achieve good social benefits.Trial registrationClinicaltrials.gov NCT04340297. Registered on April 9, 2020

Antacids revisited: review on contemporary facts and relevance for self-management.

Heartburn and acid regurgitation are the typical symptoms of gastroesophageal reflux. Despite the availability of several treatment options, antacids remain the mainstay treatment for gastroesophageal reflux-related symptoms based on their efficacy, safety, and over-the-counter availability. Antacids are generally recommended for adults and children at least 12 years old, and the FDA recommends antacids as the first-line treatment for heartburn in pregnancy. This narrative review summarizes the mechanism, features, and limitations related to different antacid ingredients and techniques available to study the acid neutralization and buffering capacity of antacid formulations. Using supporting clinical evidence for different antacid ingredients, it also discusses the importance of antacids as OTC medicines and first-line therapies for heartburn, particularly in the era of the COVID-19 pandemic, in which reliance on self-care has increased. The review will also assist pharmacists and other healthcare professionals in helping individuals with heartburn to make informed self-care decisions and educating them to ensure that antacids are used in an optimal, safe, and effective manner.

The Effect of Rice vs. Wheat Ingestion on Postprandial Gastroesophageal Reflux (GER) Symptoms in Patients with Overlapping GERD-Irritable Bowel Syndrome (IBS).

A randomized crossover study in twenty-one patients (18F, age 50 ± 13 years) with overlapping GERD-IBS was conducted to evaluate the effects of rice noodles (low FODMAPs) vs. wheat noodles (high FODMAPs) on typical GER symptoms, and the correlation between GERD symptoms and intestinal gas production. Results: Heartburn and regurgitation scores were highest in most patients (19/21) during the first 15 min after meals. At 15 min after lunch, wheat was significantly associated with more regurgitation and heartburn than rice. Also, at 15 min after breakfast, wheat aggravated more regurgitation than rice. Wheat ingestion was significantly associated with higher H2 and CH4 levels after lunch compared to rice, whereas gas levels before lunch were similar (p > 0.05). The area under the curve of H2 and CH4 concentration 15 min after a lunch of wheat moderately correlated with the regurgitation severity at 15-min (r = 0.56, p < 0.05). Conclusion: Wheat induced more GERD symptoms than rice in patients with overlapping GERD-IBS. This effect, immediately developed after lunch, was associated with more intestinal gas production. Thus, a low FODMAPs diet may relieve postprandial GERD symptoms in GERD patients with overlapping IBS. Wheat inducing more regurgitation than rice after breakfast suggests other mechanism(s) besides gut fermentation.

S463 Range and Severity of Atypical and Typical Gastroesophageal Reflux Symptoms in Patients Undergoing Lung Transplant Evaluation

S463 Range and Severity of Atypical and Typical Gastroesophageal Reflux Symptoms in Patients Undergoing Lung Transplant Evaluation

Masa epigástrica como causa de dolor abdominal crónico en pediatría

Introduction. Gastroesophageal reflux symptoms are highly prevalent in the world and in Latin America. In Argentina, the prevalence is 23%. Typical symptoms include heartburn and regurgitation, and its treatment is based on the administration of proton pump inhibitors. However, up to 44% of patients fail to respond totally or partially to them. Of these, 50% have gastroesophageal reflux disease and the other 50% have a functional disorder (functional heartburn or reflux hypersensitivity) that often respond poorly or not at all to proton pump inhibitors. The prevalence of functional heartburn and reflux hypersensitivity in Argentina is unknown. Objective. To estimate the prevalence of functional heartburn and reflux hypersensitivity in patients with typical gastroesophageal reflux symptoms refractory to proton pump inhibitors and to evaluate the association with mean nocturnal basal impedance. Materials and Methods. Observational cross-sectional descriptive study; we included data from patients with typical reflux symptoms, refractory to the administration of proton pump inhibitors, who underwent a 24-hour impedance pH study in a tertiary care center. Gastroesophageal reflux disease was considered as the presence of a percentage of acid exposure time greater than 6%, gray area between 4% and 6% and a normal study at acid exposure of less than 4%. Moreover, functional heartburn was defined as the percentage of acid exposure time less than 4% with negative symptomatic association and reflux hypersensitivity with positive symptomatic association. The mean nocturnal basal impedance of each 24hs pH-impedance study was measured and the association with each category was evaluated. In addition, the association between mean nocturnal basal impedance less than 2292 Ohms and the categories GERD, reflux hypersensitivity and functional heartburn was evaluated. Results. Data from 139 patients were included, 77% women with a mean age of 55 +/- 13 years. It was observed that 47.24% had gastroesophageal reflux disease, 6.3% were in the gray area and 46.46% had a normal acid exposure time percentage. In the latter group, 57.66% corresponded to the category of functional heartburn and 42.37% were reflux hypersensitivity. Significantly lower values of mean nocturnal basal impedance measured in channel 6 were observed among patients with gastroesophageal reflux and patients with functional disorders Establishing a cut-off value of 2292 Ohms, it was observed that 87.5% of patients in the gray area had an IBNM ≤ 2292 Ohms. Furthermore, it was observed that 76.67% of patients with reflux disease were below the cut-off value, in reflux hypersensitivity 52% and in functional heartburn, 47.06% (p= 0.007). Conclusion. We observed a high prevalence of functional esophageal disorders in patients with gastroesophageal reflux symptoms refractory to the use of proton pump inhibitors. Mean nocturnal basal impedance was found to be lowest in patients with gastroesophageal reflux, followed by patients with reflux hypersensitivity, and those with functional heartburn.

The symptomatology of the gastroesophageal reflux disease and the first line therapy

Over time, gastroesophageal reflux has undergone an unexpected and at the same time undesirable evolution towards the most commonly diagnosed upper gastrointestinal disease, called gastroesophageal reflux disease. The symptoms of gastroesophageal reflux disease are complex, difficult to treat and often recurrent. In order to prevent the disease recurrences, it is also necessary to establish the treatment in accordance with the gastroesophageal reflux symptoms. Unfortunately, nowadays, more and more patients of all ages go to the pharmacy with typical symptoms of gastroesophageal reflux, this ailment having a negative impact on the quality of life. This article aims to highlight the role of the pharmacist in recognizing the symptoms of gastroesophageal reflux and initiating firstline treatment.

Perception of Proton Pump Inhibitor Side Effects Among Members of the American Broncho-Esophagological Association

ObjectivesTo investigate awareness of proton pump inhibitor (PPI) side effects and the resulting changes in reflux mana management among members of the American Broncho-Esophagological Association (ABEA) caring for adult patients in light of increasing concern for PPIs long-term adverse effects. Study designCross-sectional survey study MethodsOnline surveys were electronically distributed to ABEA members assessing awareness of PPI side effects and current practice in reflux management. Results374 ABEA members were contacted, of whom, 43 (11.5%) completed the survey. The majority of respondents (94.1%) selected laryngology as their principal focus. The entire cohort warned their patients about PPI side effects, with highest concern for osteoporotic risk. Most respondents (88.2%) had changed their PPI prescription frequency in light of recent studies on PPI side effects, with 55.9% avoiding PPI prescription and 94.1% limiting the duration of PPI courses. Instead of PPIs, 73.5% of responders prescribe H2-receptor blockers. The primary reasons for starting patients on PPIs were typical gastroesophageal reflux symptoms (47.1%), followed by laryngopharyngeal reflux symptoms (41.2%), and endoscopic findings suspicious for reflux (11.8%). Finally, the majority of respondents (82.4%) had referred at least one patient for surgical management of gastroesophageal reflux in the past year. ConclusionsThe majority of surveyed ABEA members were concerned about reports of PPI adverse effects and had modified their prescription patterns as a result. Avoidance of PPI recommendation was common, along with the preference for H2 blockers in the management of GERD and LPR. PPI side effects of greatest concern to broncho-esophagologists treating adult patients were osteoporosis, renal dysfunction and dementia. Level of evidence5

Impact of fundoplication for gastroesophageal reflux in the outcome of benign tracheal stenosis

ObjectiveThis study focuses on the impact of antireflux surgery in the outcome of tracheal stenosis. MethodsWe performed a retrospective study including patients with benign tracheal stenosis who underwent esophageal manometry and dual-probe 24-hour ambulatory esophageal pH study. Patients with an abnormal pH study were managed with laparoscopic modified Nissen fundoplication or medically (omeprazole 80 mg/d, orally). Patients with normal pH study results were observed. After a 24-month follow-up, the outcome was considered satisfactory if tracheal stenosis could be managed by resection and there was no need for further dilatation or definitive decannulation. The management groups were compared using propensity score matching. ResultsA total of 175 patients were included. Abnormal pH study results were found in 74 patients (42.3%), and 12.6% of patients had typical gastroesophageal reflux symptoms. Follow-up was completed in 124 patients (20 had fundoplication, 32 received omeprazole, and 72 were observed). After propensity score matching, the outcome of tracheal stenosis in the fundoplication group was similar to that of the observation group (odds ratio, 1; P = .99) and better than that of the omeprazole group (odds ratio, 5.31; P = .03). The observation (no gastroesophageal reflux) group had a better outcome of stenosis than those treated with omeprazole (odds ratio, 3.54; P = .02). ConclusionsThe outcome of the airway stenosis was superior after laparoscopic fundoplication compared with medical treatment with omeprazole and was similar to the outcome of patients without gastroesophageal reflux. A prospective randomized trial is warranted.

PS01.059: REFLUX RELATED SYMPTOMS ARE LESS COMMON IN SOUTH-EAST HUNGARIAN SUBJECTS, THAN EXPECTED ON THE BASIS OF EPIDEMIOLOGIC STUDIES OF THE WESTERN COUNTRIES

Abstract Background Most population based epidemiologic studies indicate approximately 20% prevalence of Gastroesophageal Reflux (GER) related typical symptoms appearing at least monthly. Since most of these works were carried out in the western countries, a little is known about Central-Europe, where substantial part of the population still lives outside of the larger cities. The aim of the study was to obtain population-based data on the prevalence of GER related symptoms in South-East Hungary. Methods Two thousand and two consecutive blood donor volunteers (M/F: 1156/846, mean age: 39 (17–66) years) were enrolled. Data collection was carried out by means of a questionnaire. Typical (heartburn, regurgitation) and atypical (esophageal, extraesophageal) symptoms were assessed. Results Typical symptoms of GER such as heartburn and acidic regurgitation were reported by 22% (450/2002) and 17% (333/2002) of the studied healthy subjects. The 63% and 51% of them had such symptoms less than once per month. Monthly heartburn episodes were reported by 14, and weekly by 6 percent of the cases, while acidic regurgitation occurred in 8 and 3 percent respectively. Of the atypical (esophageal and extraesophageal) symptoms upper airway symptoms were the most prevalent (19%), although only 13% had such symptom at least monthly. Globus occurred in 6%, while other atypical symptoms were reported by less than 5% of the subjects. Typical GER symptoms occurred more frequently in females, coffee drinkers and subjects with moderate obesity. Current and former smoking and alcohol-use were associated with increased GER symptom prevalence. Conclusion In contrast to the studies carried out in the western countries South-East Hungarian subjects seem to have less GER related symptoms. Disclosure All authors have declared no conflicts of interest.

CT Findings of the Esophagus in Patients With Excessive Central Airway Collapse and Gastroesophageal Reflux

SESSION TITLE: Medical Imaging: New Approaches to Old Technologies SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Gastroesophageal reflux (GER) is increasingly recognized as an exacerbating or causal factor in patients with excessive central airway collapse (ECAC). Esophageal air of ≥10 mm and thickened esophageal wall (≥5 mm) on computed tomography of the chest might suggest esophageal pathology such as GER.1,2 The aim of this study was to evaluate the frequency of these and other CT findings of the esophagus in patients with GER and ECAC. METHODS: This was a retrospective review of patients with confirmed positive GER testing (acid and nonacid reflux) and ECAC on dynamic CT chest. We measured the largest internal lumen diameter and thickness of the esophagus at the level of the cricoid, sternal notch, and carina and in between the ventricles and distal esophageal sphincter at end inspiration on dynamic chest CT. We also recorded presence of GER-specific symptoms, presence of diaphragmatic hernia, signs of aspiration, and bronchial changes. RESULTS: Twenty-nine patients (median age 58[IQR 45-65]), 21(72%) women were included. Median BMI was 34 (IQR 29-39). Twenty-one patients (79%) have tracheobronchomalacia and 7 patients (21%) have excessive dynamic airway collapse. Frequent comorbidities included obesity in 72% (n=21), asthma in 48% (n=14), obstructive sleep apnea in 31 % (n=9) and cystic fibrosis in 3% (n=1). Seventeen of the 29 patients (58%) did not have clinical symptoms of GER. The median DeMeester score was 29.5 (IQR 23.9-45.9); impedance (non-acid reflux) was abnormal in 9 patients. The median of the maximal air-containing esophageal lumen and wall thickness were 9 mm (IQR 5.5-13) and 4mm (IQR 3-5) respectively. 12 patients (41%) had esophageal lumen of ≥ 10mm, 11 patients (38%) had wall thickness of ≥ 5mm, eight patients (27%) had sign of possible aspiration and 12 patients (41%) had hiatal hernia. Twenty of the 29 patients (69%) had at least one of the previous abnormalities. Nine patients (31%) had a complete normal esophagus on CT scan. CONCLUSIONS: Abnormal esophageal findings on CT have low sensitivity for GER. In patients with ECAC, normal esophagus on chest CT scan or absence of symptoms should not rule out GER. CLINICAL IMPLICATIONS: In ECAC patients, the decision to pursue a formal GER evaluation should not be based on the presence of typical GER symptoms (heartburn or reflux sensation) or esophageal abnormalities on chest CT scan.

Pattern of food intolerance in patients with gastro-esophageal reflux symptoms.

Many food items have been involved in gastro-esophageal reflux disease pathogenesis and dietary modification has been proposed as first-line treatment. Test-based exclusion diets have shown to significantly reduce reflux symptoms. We aimed to assess the patterns of food intolerance in a series of patients with typical gastro-esophageal reflux symptoms (GERS). We retrospectively evaluated all patients with typical reflux symptoms, attending the Centre Study Association on Food Intolerance and Nutrition of Ferrara from January 2010 to October 2015, who resulted positive to at least one food item at the Leucocytotoxic Test. The presence and severity of typical GERS (heartburn and/or acid regurgitation) were assessed using the Gastro-esophageal Reflux Disease Impact Scale (GIS) questionnaire. Only individuals with a GIS Score of at least 5 points were included. Almost all patients (91.1%) were intolerant to at least 5 food items. The most frequent food intolerance (more than 33% of patients) were found for milk (55.4%), lettuce (46.4%), coffee (43.7%), brewer's yeast (42.9%), pork (42.9%), tuna (37.5%), rice (35.7%), sole (34.8%), asparagus (34.8%) and eggs (33.9%). Nine different clusters of food intolerance were detected. Patients with typical gastro-esophageal reflux symptoms seem to have intolerance to multiple food items, some of which (lettuce, brewer's yeast, tuna, rice, sole and asparagus) have not yet been associated to gastro-esophageal reflux disease.

The Prevalence of Rome IV Nonerosive Esophageal Phenotypes in Children

To assess the prevalence of Rome IV nonerosive esophageal phenotypes in children using multichannel intraluminal impedance testing and to describe the rates of proton pump inhibitor (PPI) responsiveness and the frequency of microscopic esophagitis in these patients. We conducted a retrospective review of all children ≥5 years of age who underwent esophagogastroduodenoscopy and multichannel intraluminal impedance testing off PPI therapy for evaluation of typical gastroesophageal reflux symptoms. Only children with symptoms during the multichannel intraluminal impedance testing were included. Children were categorized into the following nonerosive esophageal phenotypes using Rome IV criteria: nonerosive reflux disease, reflux hypersensitivity, and functional heartburn. Rates of esophagitis and responsiveness to acid suppression therapy were assessed. Forty-five children were included: 27% were categorized as having nonerosive reflux disease, 29% with reflux hypersensitivity (27% acid and 2% nonacid), and 44% with functional heartburn. Older children reported significantly more heartburn (P < .001) than younger children, whereas younger children were more likely to report nonspecific pain (P = .047). There were no differences between groups in other reflux symptoms, rates of responsiveness to PPIs, or the presence of microscopic esophagitis on biopsy. Functional heartburn is the most common Rome IV nonerosive esophageal phenotype in children. Neither microscopic esophagitis nor PPI responsiveness can predict phenotype in pediatric patients.

Does gastroesophageal reflux increase chronic obstructive pulmonary disease exacerbations?

BackgroundThe relationship between chronic obstructive pulmonary disease (COPD) exacerbations and gastroesophageal reflux (GER) has been investigated less than asthma-GER. We aimed to evaluate the presence of GER in patients with COPD and its impact on exacerbations. MethodsWe included 24 patients with stable mild-moderate stage COPD and 19 volunteers as the control group. We conducted a gastroesophageal reflux disease (GERD) symptom questionnaire, gastroscopy, manometry, and an ambulatory 24-h pH-impedance study. ResultsAccording to the GERD questionnaire, only 5 (20.8%) patients with COPD had typical GER symptoms. According to the 24-h pH-impedance study, the mean DeMeester score (DMS) was 38.1 ± 34.6 in the COPD group and 13.3 ± 16.8 in the control group (p = 0.01). The acid reflux (DMS > 14.7) rate was higher in patients with COPD than in controls (73.9% vs 26.3%, p = 0.01). The symptom association probability positivity rate was 17.4% (n = 4) in the COPD group, which was similar to the controls (p = 0.11). The mean proximal extension rate of reflux (Z 17 cm) was 26.4 ± 12.9% in the COPD group. The proximal extent of reflux was positively correlated with the number of COPD exacerbations per year (p = 0.03, r = 0.448). In the motility results, only 2 (20%) patients in the control group had a minor motility disorder. Seventeen (70.8%) patients in the COPD group had a minor motility disorder, and 4 (16.7%) had major motility disorders (p < 0.001). ConclusionIn our study, gastroesophageal reflux was frequent in patients with COPD, but only a quarter had typical reflux symptoms. The proximal extent of reflux may trigger frequent exacerbations of COPD.

Use of a Positional Therapy Device Significantly Improves Nocturnal Larygngopharyngeal Reflux Symptoms

Introduction: Laryngopharyngeal reflux (LPR) is defined as the reflux of gastroduodenal contents to the laryngopharynx, casuing symptoms such as cough, globus, throat clearing, and hoarseness. Proton pump inhibitors (PPIs) are often used for treatment; however, these are often not effective. Among patients with LPR, nocturnal symptoms are common. Recent studies have demonstrated that use of a positional therapy device (PTD) significantly decreased typical gastroesophageal reflux symptoms; however, use of a PTD for LPR symptoms has not been previously studied. Methods: This is a single center prospective trial of a PTD consisting of a two-component wedge-shaped base and a lateral positioning body pillow (MedCline, Amenity Health, Inc., San Diego, CA) in patients with a clinical diagnosis of LPR and nocturnal symptomology. Patients were supplied the PTD and asked to sleep using the device for at least 6 hours per night for 28 consecutive nights. Patients completed the Nocturnal Gastroesophageal Reflux Symptom Severity and Impact Questionnaire (N-GSSIQ) and Reflux Symptoms Index (RSI) at baseline and after 2 and 4 weeks of PTD use. The primary endpoint of this study was reduction from baseline RSI at 4 weeks. Results: A total of 23 patients (70% female; mean (SD): age 60±12.9; BMI 28.1±8.0) were recruited. 70% patients were on PPI prior to enrollment. At baseline, mean N-GSSIQ was 50.0±7.9 and mean RSI of 22.5±9.6. All patients completed the study protocol. Matched-pair analysis showed that subjects' total N-GSSIQ scores decreased by an average of 24.0 (p=0.0024) points by two weeks and 30.5 points by 4 weeks (p=0.0002). RSI decreased an average of 9.5 points by 2 weeks (p=0.015) and an average of 16.8 points by 4 weeks (p=0.0023). Mean RSI improvement at 2 weeks and 4 weeks was 42% and 75%, respectively. N-GSSIQ subsets all reached statistical significance at 4 weeks of use: nocturnal reflux (p=0.0019), morning impact of nocturnal reflux (p=0.0002) and concern about nocturnal reflux (p=0.0006). No adverse events were reported, no patients withdrew from the study. Conclusion: In patients with LPR, use of a PTD significantly improves self-reported symptoms of typical nocturnal reflux symptoms as well as symptoms specific to LPR. Use of a PTD may be considered as a potential treatment option for patients with nocturnal LPR symptoms.

Gastro-esophageal reflux (GER) related symptoms are less common in south-east Hungarian subjects than expected on the basis of epidemiologic studies of the western countries

Introduction: Most population based epidemiologic studies indicate approximately 20% prevalence of GER related typical symptoms appearing at least monthly. Since most of these works were carried out in the western countries, a little is known about Central-Europe, where substantial part of the population still lives outside of the larger cities. The aim of the study was to obtain population based data on the prevalence of GER related symptoms in South-East Hungary. Methods: Seven-hundred and fifty-one consecutive blood donor volunteers (M/F: 450/301, mean age: 38 (17 – 65) years) were enrolled. Data collection was carried out by means of a questionnaire. Typical (heartburn, regurgitation) and atypical (esophageal, extraesophageal) symptoms were assessed. Results: Typical symptoms of GER such as heartburn and acidic regurgitation were reported by 23% (174/751) and 20% (152/751) of the studied healthy subjects. The half of them 80/174 and 92/152 had such symptoms less than once per month. Monthly heartburn episodes were reported by 12, and weekly by 7 percent of the cases, while acidic regurgitation occurred in 8 and 3 percent respectively. Of the atypical (esophageal and extraesophageal) symptoms upper airway symptoms were the most prevalent (21%), although only 8% had such symptom at least monthly. Globus occurred in 8%, while other atypical symptoms were reported by less than 5% of the subjects. Typical GER symptoms occurred more frequently in females, coffee drinkers, former smokers and subjects with moderate obesity. Current smoking, alcohol use were not associated with increased GER symptom prevalence. Conclusions: In contrast to the studies carried out in the western countries South-East Hungarian subjects seem to have less GER related symptoms.

Gastroesophageal Reflux Disease in Children with Cystic Fibrosis.

Previously published studies have indicated that gastroesophageal reflux (GER) disease is common in pediatric patients with cystic fibrosis. The aim of the present study was to get insight into the incidence of GER and to characterize the nature of reflux episodes in children with cystic fibrosis. This was a multicenter, prospective study of children with cystic fibrosis older than 18 months. Forty four consecutive patients (22 boys, mean age 10.4 ± 3.6, range 3.0-17.8 years) were enrolled into the study. All patients underwent 24 h pH-impedance monitoring. GER were classified according to the widely recognized criteria as an acid, weakly acid, weakly alkaline, or proximal. The pH-impedance trace was considered abnormal when acid exposure was >6 %. GER was diagnosed in 24/44 (54.5 %) children. A total of 1585 (median 35, range 7-128) reflux episodes were detected; 1199 (75.6 %) were acidic, 382 (24.1 %) weakly acidic, and 4 (0.3 %) weakly alkaline. Six hundred and ninety-one (43.6 %) reflux episodes reached the proximal esophagus. In 14/44 patients typical GER symptoms were present. We conclude that the incidence of GER in children with cystic fibrosis is very high. In the majority of patients typical GER symptoms are absent. Therefore, diagnostic procedures should be considered, regardless of lacking symptoms. Although acid reflux episodes predominate in children with cystic fibrosis, classical pH-metry may not constitute a sufficient diagnostic method in this population because of a relatively high number of proximal reflux episodes. Such episodes also indicate an increased risk for aspiration. The pH-impedance diagnostic measurement is advocated when suspecting GER in children with cystic fibrosis.

Studying of Gastroesophageal Reflux Disease with High-Resolution Esophageal Manometry in Different Positions

Purpose: High-resolution esophageal manometry (HREM) is usually performed in supine position. While it is known that posture has effect on gastroesophageal reflux (GER), studies describing the effect of posture on HRM measurements in gastroesophageal reflux disease GERD are lacking. The aim of this study is to compare the impact of different body positions on HREM recording in patients with GERD. Methods: Prospective study included 42 patients presented with typical and atypical GER symptoms had undergone HREM. A solid-state HREM assembly with 32 circumferential sensors spaced 1 cm apart (Unisensor) was used in the study, plotting graphs with high resolution color topography and pressure waves (GI Solar MMS). HREM recording was done while the patients is fasting and in different positions: recumbent at LT side, RT side, supine and sitting position; 10 minutes each. Patients were given ten 5-ml water swallows in each position. Pressure profiles across the esophagogastric junction (EGJ), upper esophageal sphincter (UES), peristaltic integrity, transient lower esophageal sphincter relaxations (TLESRs) were analyzed and interpreted according to Pandolfino et al, Am J Gastroenterol 2008;103:27. Results: A total of 1680 water swallows in different positions were analyzed. RT recumbent position had the lowest EGJ pressure, and the highest number of TLESRs. On the other hand, change of body position did not significantly change EGJ length, UES pressure, % of peristaltic contractions, and upper and lower body contraction amplitude (table 1). Normal body peristalsis was found in 47.7% of patients, while weak peristalsis with small peristaltic defects, large peristaltic defects, aperistlasis and distal esophageal spasm were found in 26.3%, 14.3%, 2.3%, and 9.4%, respectively. Hiatal hernia was observed manometrically in 14.3% of patients.Table 1: HREM measurements in different body positionsConclusion: RT recumbent position showed the lowest EGJ pressure and the highest number of TLESRs. Sitting, LT recumbent and supine positions did not significantly affect HREM measurements. Ineffective esophageal motility disorder is a common finding with GERD.

Barrett's esophagus and the risk of obstructive sleep apnea: a case-control study.

BackgroundPrior studies suggest that obstructive sleep apnea may be associated with gastroesophageal reflux disease, a strong risk factor for Barrett’s esophagus. The goals of this pilot case–control study were to determine whether Barrett’s esophagus patients have an increased likelihood of obstructive sleep apnea and to determine whether nocturnal gastroesophageal reflux symptoms affect the relationship between Barrett’s esophagus and obstructive sleep apnea risk.MethodsPatients with Barrett’s esophagus completed the Berlin Questionnaire, a validated survey instrument identifying subjects at high risk for obstructive sleep apnea. Two outpatient control groups were recruited: 1) EGD Group, subjects matched to Barrett’s esophagus cases by age, race, and gender with esophagogastroduodenoscopy negative for Barrett’s esophagus; and 2) Colonoscopy Group, patients getting colonoscopy. Rates of scoring at high risk for obstructive sleep apnea were compared. Respondents were also questioned regarding severity of their typical gastroesophageal reflux symptoms and presence of nocturnal gastroesophageal reflux symptoms.ResultsThe study included 287 patients (54 Barrett’s esophagus, 62 EGD, and 171 colonoscopy subjects). Barrett’s esophagus patients were slightly older than colonoscopy patients and more obese. 56% (n = 30) of Barrett’s esophagus subjects scored at high risk for obstructive sleep apnea, compared with 42% (n = 26) of EGD subjects (OR 1.73, 95% CI [0.83, 3.62]) and 37% (n = 64) of colonoscopy patients (OR 2.08, 95% CI [1.12, 3.88]). The association between Barrett’s esophagus and scoring at high risk for obstructive sleep apnea compared with colonoscopy patients disappeared after adjusting for age. Barrett’s esophagus patients reported more severe typical heartburn and regurgitation symptoms than either control group. Among all subjects, patients with nocturnal reflux symptoms were more likely to score at high risk for obstructive sleep apnea than patients without nocturnal reflux.ConclusionsIn this pilot study, a high proportion of Barrett’s esophagus subjects scored at high risk for obstructive sleep apnea. Having Barrett’s esophagus was associated with more severe gastroesophageal reflux symptoms, and nocturnal reflux symptoms were associated with scoring at high risk for obstructive sleep apnea. The need for obstructive sleep apnea screening in Barrett’s esophagus patients with nocturnal gastroesophageal reflux symptoms should be further evaluated.