The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus

Comparing the efficacy of different proton pump inhibitor dosing regimens for the treatment of gastroesophageal reflux disease: a systematic review and meta-analysis

Several proton pump inhibitor (PPI) dosing regimens that vary by strength and frequency (once [Qday] or twice [BID] daily) are available to treat gastroesophageal reflux disease (GERD). We performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the impact of various PPI regimens on esophageal healing and GERD and heartburn symptoms. To identify relevant studies, we searched EMBASE and PubMed in January 2023, which yielded 1381 records. Eligible RCTs included those that enrolled adults diagnosed with GERD and compared different dosing regimens within the same PPI. The outcomes were esophageal healing and resolution of GERD and heartburn symptoms within 12 weeks (i.e. short-term) and > 12 weeks (i.e. long-term). Meta-analysis pooling of the odds ratios with 95% confidence intervals were estimated using the random-effects inverse-variance model. Overall, a total of 38 RCTs across 20 countries (N = 15,540 patients, mean age 50 years, 55% male) were included. Most PPI trials compared half standard dose Qday versus standard dose Qday or standard dose Qday versus double standard dose Qday. In general, when considering daily dosing, higher PPI strength significantly improved esophageal healing and relief of GERD symptoms both in the short- and long-term. Fewer trials compared Qday versus BID dosing; the impact of BID dosing on outcomes was inconsistent across the different PPI strength comparisons. In conclusion, this meta-analysis revealed that increasing PPI Qday dosages led to improved GERD outcomes. However, few studies compared Qday to BID dosing; as twice daily PPI usage is common in clinical practice, further studies are warranted to determine whether such dosing improves clinical outcomes.

Association between laryngopharyngeal reflux clinical scores and esophageal multichannel intraluminal impedance pH monitoring interpretation according to Lyon Consensus 2.0

Laryngopharyngeal reflux remains a diagnostic challenge due to the lack of a definitive diagnostic tool. Esophageal multichannel intraluminal impedance (MII) pH monitoring has been proven reliable for detecting gastric reflux. This study aims to evaluate the association between clinical scores and MII/pH monitoring according to the Lyon Consensus 2.0. Patients with laryngo-pharyngeal symptoms (LPS) who had a reflux symptom index (RSI) ≥13 or reflux finding score (RFS) ≥7 underwent MII/pH monitoring. The findings were analyzed in comparison with clinical scores. A total of 100 patients meeting the inclusion criteria were recruited for this study. MII/pH monitoring revealed a median acid exposure time (AET) of 1.9% (interquartile range [IQR] = 0.2, 4.9), with 22% of patients recording an AET above 6%. The median number of reflux episodes was 29.5 episodes per day (IQR = 19.0, 43.8), with 7% experiencing more than 80 episodes per day. Gas reflux was identified as the most prevalent type. Based on the Lyon Consensus 2.0, 25 patients exhibited conclusive pathological reflux, while 75 patients showed no conclusive evidence of pathological reflux. No significant differences were found in RSI and RFS between these groups. Only gas reflux episodes showed a significant correlation with RSI (r = 0.255, P = 0.011). RSI and RFS among patients with LPS showed no statistically significant differences in identifying pathological reflux or no conclusive evidence of pathological reflux. This finding suggests that the pathophysiology underlying LPS may not be solely attributable to reflux.

Treatment of oesophageal and laryngo-pharyngeal symptoms of reflux in patients diagnosed with SIBO and IMO with antibiotics

Gastro-oesophageal reflux disease (GERD) may present with esophageal and/or extra-oesophageal, laryngo-pharyngeal (LPR) symptoms including cough, throat clearing and dysphonia. A definitive diagnosis can be challenging, and existing treatments are often ineffective in resolving them. Oesophageal symptoms thought to be caused by GERD can overlap with those from functional dyspepsia (FD) and previous studies have proposed intestinal dysbiosis such as small intestinal bacteria overgrowth (SIBO) and intestinal methogenic overgrowth (IMO) as potential causes. This study aims to establish the relationship between SIBO/IMO and LPR symptoms, and if their treatment improves LPR symptoms. We performed a retrospective cohort study of patients with SIBO or IMO in a high-volume, tertiary referral center for anti-reflux procedures between 2018 and 2023. The primary outcome measures were GERD-HQRL and LPR/RSI scores after treatment for SIBO/IMO, and anti-reflux medication use. Twenty-three patients were eligible. The mean decrease in GERD-HQRL score was 11.8 (3.31) (P = 0.0017). The mean decrease in RSI score was 8.57 (1.97) (P = 0.0003). In patients with raised DeMeester scores, the GERD-HQRL scores improved by 17.2 (5.02) (P = 0.009) and RSI scores by 9.33 (3.60) (P = 0.03). The symptom association probability was highest at 72.7% (n = 8) for belching; followed by 80% for heartburn (n = 4) and 66.7% for regurgitation (n = 4). The use of PPIs decreased in 95% (n = 19) of patients; 18 had stopped PPIs completely. All patients avoided potential surgical interventions. The diagnosis and treatment of SIBO in patients with atypical reflux symptoms may prevent unnecessary surgical and pharmacological treatments. Further prospective work is required to confirm this.

Efficacy and safety of Jianpi Qinghua granules for non-erosive reflux disease with spleen deficiency and damp-heat syndrome: a multicenter, randomized, double-blind, placebo-controlled clinical trial

Background

Non-erosive reflux disease (NERD), the most frequent phenotype of gastroesophageal reflux disease, presents without visible esophageal mucosal damage but significantly impacts patients' quality of life. Current treatments like proton pump inhibitors show limited efficacy for many NERD patients, necessitating alternative approaches. Jianpi Qinghua (JQ) granules, a traditional Chinese medicine, have shown promise in treating NERD by targeting symptoms of spleen deficiency and damp-heat syndrome.

Purpose

This study aims to evaluate the efficacy and safety of JQ granules in treating patients with NERD characterized by spleen deficiency and damp-heat syndrome.

Study design

A multicenter, randomized, double-blind, placebo-controlled clinical trial was conducted with a total of 78 NERD patients randomly assigned to receive either JQ granules or placebo for 4 weeks, followed by a 4-week follow-up period.

Methods

Seventy-eight NERD patients with spleen deficiency and damp-heat syndrome were recruited and randomly assigned to receive either JQ granules (n = 39) or placebo (n = 39). The trial included a 1-week lead-in, followed by a 4-week double-blind treatment, and a 4-week follow-up. Primary endpoints were the improvement rates of reflux and heartburn symptoms and VAS score changes. Secondary endpoints included atypical symptom scores, total TCM syndrome scores, GERD Health-Related Quality-of-Life (HRQL), and self-rated depression and anxiety scales. Safety assessments involved routine blood, urine, and liver and kidney function tests.

Results

After 4 weeks, the improvement rate for reflux or heartburn symptoms was 79.49% in the JQ group vs. 58.97% in the placebo group (P < 0.05). VAS scores showed significant reductions in both groups but without notable inter-group differences. Total TCM syndrome scores significantly decreased in both groups, with the JQ group showing greater improvement trends. The JQ group had higher rates of effective TCM syndrome improvement and better GERD-HRQL scores. Both groups saw significant reductions in self-rated depression and anxiety scores, with trends favoring JQ granules. Safety assessments were comparable between groups.

Conclusion

JQ granules significantly outperform placebo in treating NERD symptoms and display long-term effectiveness. They effectively address spleen deficiency and damp-heat syndrome, improving patients' social functioning, and have a favorable safety profile.

Clinical trial registration

https://clinicaltrials.gov/study/NCT04324138?term=NCT04324138&rank=1, identifier: NCT04324138.

Unveiling the intricacies: Insight into gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) poses a substantial global health challenge, with prevalence rates exhibiting geographical variation. Despite its widespread recognition, the exact prevalence and associated risk factors remain elusive. This article comprehensively analyzed the global burden of GERD, shedding light on its risk factors, underlying pathophysiological mechanisms, current diagnostic modalities, evolving management strategies tailored to diverse patient profiles, and complex determinants contributing to treatment failures. A deeper comprehension of GERD is achieved by dissecting these intricate facets, paving the way for enhanced clinical management and improved patient outcomes.

Assessment of the efficacy of on-demand tegoprazan therapy in gastroesophageal reflux disease through a randomized controlled trial

In patients with gastroesophageal reflux disease (GERD) whose symptoms improve with acid-suppression therapy, on-demand treatment could constitute maintenance therapy. This study investigated the comparative efficacy and safety of on-demand tegoprazan and proton-pump inhibitor (PPI) therapy in GERD. From six university hospitals in the Daejeon-Chungcheong region, we enrolled patients with GERD who had experienced symptomatic improvement with acid-suppressive therapy and, using a randomization table, randomly allocated these participants to two groups: to receive either tegoprazan 50 mg + esomeprazole placebo or tegoprazan placebo + esomeprazole 20 mg, respectively. The primary endpoint of this study was the intergroup difference in patient satisfaction with on-demand therapy. Among the 69 participants who completed 8 weeks of on-demand therapy and rated patient satisfaction on a 5-point Likert scale, the tegoprazan and esomeprazole groups scored an average of 4.31 and 4.15 points, respectively, without any significant intergroup difference. In the tegoprazan group, 26.2% (182/694) of those with episodes experienced symptom improvement within 30 min, which is a significantly higher proportion compared to 16.1% (104/646) in the esomeprazole group. Compared to the esomeprazole group, the tegoprazan group had a significantly shorter time to symptom improvement overall and a significantly higher proportion of patients who improved within 30 min. No serious treatment-emergent adverse events were reported. Tegoprazan is effective as on-demand therapy for GERD and offers the expectation of faster symptom improvement than with PPIs. Clinical trial KCT0009296, registered at cris.nih.go.kr.

Scintigraphic Imaging of Extra-Esophageal Manifestation of Gastresophageal Reflux Disease

OBJECTIVES

There is currently no reference standard test for the detection of the extra-esophageal manifestations of gastroesophageal reflux disease (GERD). The current suite of diagnostic tests principally assesses reflux events in the esophagus. A new scintigraphic technique has been developed and validated against reference standards. It allows direct visualization of refluxate in the laryngopharynx and lungs.

METHODS

Fifty patients were assessed by scintigraphy before and after fundoplication at a single nuclear medicine facility. Standardized reflux symptom indices (RSIs) were obtained from each patient before and after surgery. Patients were scanned after oral 99 m technetium Fyton administration with early dynamic images and delayed SPECT/CT images of the head, neck, and lungs. ANOVA, Spearman correlation, and the Student's t-test were utilized for analysis.

RESULTS

The study population (35F, 15 M) had a mean age of 63.9 years. Mean BMI was 26.8 with 67% being overweight or obese. All patients had significant reflux. SPECT/CT showed LPR events in 45/50 and pulmonary micro-aspiration (PMA) in 45/50 preoperatively and in 36/50 and 20/50 postoperatively, respectively. The RSI, cough, and throat clearing indices showed a significant fall postoperatively (p < 0.001). Frequency of scintigraphic reflux events was reduced from a mean of 4.5 in 30 min to 2.9 (t = 9.1, p = 0.004).

CONCLUSION

The novel scintigraphic test detects esophageal and extra-esophageal reflux events and permits direct visualization of refluxate in the head and neck structures and lungs. It correlates well with symptoms of reflux in the esophagus and extra-esophageal structures and the response to therapy.

LEVEL OF EVIDENCE

Although prospective, the study did not randomize patients and in effect each patient became their own control following an intervention (fundoplication). Thus, the study is Level 3 evidence Laryngoscope, 135:73-79, 2025.

Association Between Dinner-to-Bed Time and Gastroesophageal Reflux-Related Diseases in Children

INTRODUCTION

Gastroesophageal reflux disease (GERD) is characterized by esophageal mucosal injury due to the reflux of gastroduodenal contents. Typical symptoms include heartburn and acid regurgitation. In addition, gastroesophageal reflux (GER) can influence conditions such as otitis media, rhinitis, and asthma. This study aimed to examine the association between dinner-to-bed time and GER-related diseases, such as otitis media, allergic rhinitis, and asthma.

METHODS

This was a longitudinal cohort study using secondary data. Data were collected from a large-scale birth cohort study conducted in Japan including babies born in 2001 and 2010. Dinner-to-bed time was categorized as "longer dinner-to-bed time" (>120 minutes), "shorter dinner-to-bed time" (≤120 minutes or less), and "irregular dinner-to-bed time." Modified Poisson regression with robust variance was used to estimate risk ratios (RRs).

RESULTS

A total of 60,392 children were included in this study. Children with shorter dinner-to-bed time had a higher risk of asthma (adjusted RR (aRR) = 1.10; 95% confidence interval (CI), 1.03-1.18) than those with longer dinner-to-bed time. However, no significant association was observed between shorter dinner-to-bed time and otitis media or allergic rhinitis. Furthermore, supplementary analyses revealed that the risk of asthma was significantly higher in children born in 2001 (aRR = 1.13; 95% CI, 1.04-1.22).

CONCLUSION

This study showed that dinner-to-bed time within 120 minutes after dinner increases the risk of developing asthma. This underscores the importance of considering lifestyle modifications, as certain pediatric asthma cases may be influenced by behaviors that promote GER.

Esophageal chest pain resembles heartburn in reflux metrics and response to proton pump inhibitor therapy

BACKGROUND

Gastro-esophageal reflux disease (GERD) is the most common cause for noncardiac chest pain (NCCP), with an estimated prevalence rate ranging between 30% and 60%. Heartburn and NCCP may share common mechanisms.

AIMS/METHODS

To assess whether particular patterns of impedance-pH variables characterize patients with dominant heartburn, regurgitation, or NCCP and their ability to predict proton pump inhibitor (PPI) response for each symptom, GERD patients, evaluated with high-resolution manometry (HRM) and impedance-pH, were included.

RESULTS

In total, 109 NCCP, 68 heartburn, and 64 regurgitation patients were included. Pathological reflux episodes were observed in 28%, 19%, and 56% (p < 0.001). Pathological mean nocturnal baseline impedance (MNBI) values were observed in 55%, 53%, and 34% (p < 0.05). Hypomotility was more frequent in NCCP compared to heartburn patients (p < 0.05). When comparing NCCP with heartburn, hypomotility was associated with NCCP perception (OR: 2.34, 95% CI: 1.23-4.43; p < 0.01). When comparing NCCP with regurgitation, >80 refluxes and type 2/3 esophagogastric junction (EGJ) were associated with regurgitation perception (OR: 0.31, 95% CI: 0.16-0.59; p < 0.001, and OR: 0.5, 95% CI: 0.27-0.93; p < 0.05), while pathological MNBI was associated with NCCP perception (OR: 2.34, 95% CI: 1.23-4.43; p < 0.01). 45.5% NCCP patients, 45.6% with heartburn, and 36% with regurgitation responded to PPIs (p < 0.05). At multivariate analysis, pathological MNBI or PSPW index were associated with PPI responsiveness in patients with NCCP or heartburn, while in patients with regurgitation, pathological MNBI was associated with PPI responsiveness and a reflux number >80 to PPI refractoriness.

CONCLUSIONS

We highlight the usefulness of an accurate clinical and functional evaluation of GERD patients, allowing to discriminate particular characteristics in patients with dominant heartburn, NCCP, or regurgitation, which may benefit of distinct therapeutic strategies.

Antireflux surgery - choosing the right candidate

INTRODUCTION

Surgical gastric fundoplication is an effective treatment option for gastroesophageal reflux disease. In contrast to acid suppression, fundoplication nearly abolishes all types of reflux, acid and nonacid. However, in some cases, lasting side effects of the procedure may overshadow its positive effects. It has remained difficult to determine which patients are the most suitable candidates for fundoplication.

AREAS COVERED

This review aims to evaluate the available data on preoperative factors that are associated with the outcome of fundoplication and to determine which combination of patient characteristics and preoperative test results provides optimal selection. In addition, we assess the need for tailoring the procedure on the basis of the preoperative quality of esophageal peristalsis.

EXPERT OPINION

Surgical treatment of gastroesophageal reflux disease is underutilized as it may provide an excellent option for a subset of GERD patients. It is not sensible to restrict surgical treatment to patients who do not respond to acid suppression. However, meticulous patient selection is key. Most importantly, surgical treatment should not be considered in patients in whom there is no convincing evidence that the symptoms are caused by reflux. Impaired esophageal peristalsis should not be regarded as a contraindication against fundoplication.

Safety of potassium-competitive acid blockers in the treatment of gastroesophageal reflux disease

INTRODUCTION

Proton pump inhibitors (PPIs) are the first-line treatment for gastroesophageal reflux disease (GERD). However, due to their intrinsic limitations, there are still unmet clinical needs that have fostered the development of potassium-competitive acid blockers (P-CABs). Currently, four different drugs (vonoprazan, tegoprazan, fexuprazan, and keverprazan) are marketed in some Asian countries, whereas only vonoprazan and tegoprazan are available in Western countries (USA and Brazil or Mexico, respectively).

AREAS COVERED

This review summarizes the current knowledge on P-CABs acute and long-term safety in GERD treatment compared to that of PPIs. Full-text articles and abstracts were searched in PubMed.

EXPERT OPINION

P-CABs proved to address some of the unmet clinical needs in GERD, with a favorable risk-benefit ratio compared to conventional PPIs. Preclinical and clinical findings have highlighted P-CAB safety to be superimposable, to that of PPIs, in short-term treatments, although further studies are warranted to monitor their effects in long-term therapy. From an epidemiological point of view, the paucity of rigorous data for many variables (e.g. age, ethnicity, drug interactions, comorbidities, genetic polymorphisms, interindividual susceptibility, and gut dysbiosis) deserves a worldwide framework of continuous pre/post-marketing pharmacovigilance programs to reduce potential confounding factors and accurately link acute and chronic P-CAB therapy to adverse outcomes.

Treatable traits in interstitial lung disease: a narrative review

The interstitial lung diseases (ILDs) are a heterogeneous and complex group of diseases. The treatable trait (TT) model represents a shift in ILD management, away from traditional diagnostic labels towards a more individualised, trait-focused approach. This review explores the application of the TT paradigm to ILD, identifying key traits across the aetiological, pulmonary, extrapulmonary and behavioural domains. By addressing these traits, the TT model offers a framework to improve outcomes in ILD through multidisciplinary management with a precision medicine focus. Further research is necessary to evaluate the overall impact of this TT model on ILD care.

Outcomes of transoral incisionless fundoplication (TIF 2.0): a prospective multicenter cohort study in academic and community gastroenterology and surgery practices (with video)

BACKGROUND AND AIMS

Transoral incisionless fundoplication (TIF) is an established safe endoscopic technique for the management of GERD but with variable efficacy. In the past decade, the TIF technology and technique have been optimized and more widely accepted, but data on outcomes outside clinical trials are limited. We tracked patient-reported and clinical outcomes of GERD patients after TIF 2.0.

METHODS

Patients with body mass index <35 kg/m2, hiatal hernia <2 cm, and confirmed GERD with typical or atypical symptoms from 9 academic and community medical centers were enrolled in a prospective registry and underwent TIF 2.0 performed by gastroenterologists and surgeons. The primary outcomes were safety and clinical success (response in 1 subjective and at least 1 of 3 objective secondary end points). Secondary end points were symptom improvement, acid exposure time (AET), esophagitis healing, proton pump inhibitor (PPI) use, and satisfaction. Outcomes were assessed at last follow-up within 12 months.

RESULTS

A total of 85 patients underwent TIF 2.0, and 81 were included in the outcomes analysis. Clinical success was achieved in 94%, GERD Health-Related Quality of Life scores improved in 89%, and elevated Reflux Symptom Index score normalized in 85% of patients with elevated baseline. Patient satisfaction improved from 8% to 79% (P < .0001). At baseline, 81% were taking at least daily PPI, and after TIF 2.0, 80% were on no or occasional PPI (P < .0001). Esophageal AET was normal in 72%, greater with an optimized TIF 2.0 valve (defined as >300-degree circumference and >3-cm length; 94% vs 57%; P = .007). There were no TIF 2.0-related serious adverse events.

CONCLUSIONS

TIF 2.0 is a safe and effective endoscopic outpatient treatment option for selected patients with GERD.

Risk of De Novo Barrett's Esophagus Post Sleeve Gastrectomy: A Systematic Review and Meta-Analysis of Studies With Long-Term Follow-Up

BACKGROUND & AIMS

Sleeve gastrectomy (SG) is one of the most commonly performed bariatric procedures worldwide. Gastroesophageal reflux disease (GERD) is a major concern in patients undergoing SG and is a risk factor for Barrett's esophagus (BE). We conducted a systematic review and meta-analysis to assess the incidence of and analyze predictive factors for post-SG BE.

METHODS

A comprehensive literature search was conducted in April 2024, for studies reporting on incidence of BE, erosive esophagitis (EE), and hiatal hernia (HH) post-SG. Primary outcomes were post-SG pooled rates of de novo BE, EE, GERD symptoms, proton pump inhibitor use, and HH. Meta-regression analysis was performed to assess if patient and post-SG factors influenced the rates of post-SG BE.

RESULTS

Nineteen studies with 2046 patients (79% females) were included. Mean age was 42.2 years (standard deviation, 11.1) and follow-up ranged from 2 to 11.4 years. The pooled rate of de novo BE post-SG was 5.6% (confidence interval, 3.5-8.8). Significantly higher pooled rates of EE (risk ratio [RR], 3.37], HH (RR, 2.09), GER/GERD symptoms (RR, 3.32), and proton pump inhibitor use (RR, 3.65) were found among patients post-SG. GER/GERD symptoms post-SG positively influenced the pooled BE rates, whereas age, sex, body mass index, post-SG EE, and HH did not.

CONCLUSIONS

Our analysis shows that SG results in a significantly increased risk of de novo BE and higher rates of EE, proton pump inhibitor use, and HH. Our findings suggest that clinicians should routinely screen patients with SG for BE and future surveillance intervals should be followed as per societal guidelines.

Anxiety and Depression Features in Laryngopharyngeal Reflux Disease: A Systematic Review

OBJECTIVE

To investigate the anxiety and depression features in laryngopharyngeal reflux disease (LPRD).

METHODS

A laryngologist and librarian conducted a PubMed, Scopus, and Cochrane Library systematic review related to anxiety, depression, and mental health in LPRD through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements.

RESULTS

Of the 96 identified studies, 22 publications met the inclusion criteria, accounting for 2162 patients with suspected LPRD (n = 1607), gastroesophageal reflux disease (GERD; n = 423), both LPRD and GERD (n = 132), and 926 healthy/asymptomatic individuals. The LPRD diagnosis was mainly based on symptoms and findings. Twenty-six different mental health instruments were used across the studies. Anxiety was found in 28.8%-39.3% of patients with suspected LPRD. Depression was documented in 6.3%-45.6% of suspected LPRD. Most studies reported a significantly higher prevalence/incidence of anxiety and depression in suspected LPRD compared to controls. The LPRD symptom severity was associated with the severity of anxiety and depression in all studies exploring association findings. The anxiety and depression symptoms were reported as higher in LPRD compared to GERD populations. The bias analysis highlighted an important heterogeneity between studies, especially for the LPRD diagnosis and the mental health instruments used.

CONCLUSION

The prevalence of depression and anxiety is commonly higher in suspected LPRD compared to asymptomatic individuals. Future studies are needed to understand the association between the development of LPRD and mental health disorders.

Prevalence of common upper gastrointestinal diseases in Chinese adults aged 18-64 years

To investigate the prevalence of gastroesophageal reflux disease (GERD), reflux esophagitis (RE), digestive ulcer gastric ulcer (GU), duodenal ulcer (DU), and Helicobacter pylori infection in Chinese adults aged 18-64 years and their associated factors, a community-based cross-sectional study using a stratified multistage sampling method was conducted. A standardized questionnaire survey, the 13C-urea breath test, and gastroscopy were performed. Weighted methods were used to estimate the prevalence of diseases or infection mentioned above and their risk factors. Finally, 27,637 participants aged 18-64 years were enrolled from 2017 to 2018. The prevalence (95% confidence interval) of GERD, RE, GU, DU, and H. pylori infection was estimated to be 10.5% (7.8%-14.2%), 5.4% (3.9%-7.3%), 2.5% (1.7%-3.7%), 4.5% (3.6%-5.4%), and 41.5% (36.7%-46.4%), respectively. The fraction of H. pylori infection reached 58.6% and 61.1% among the GU and DU patients, respectively. Weighted multivariable logistic regression models showed that GERD, RE, and GU shared the common risk factors of age and obesity. Dose-response relationships were observed between smoking and all four diseases, as well as alcohol consumption and GERD and H. pylori infection. Northwest China had the highest prevalence of GERD (23.9%), RE (8.7%), GU (7.8%), DU (7.3%), and H. pylori infection (63.6%); however, the southwest region had the highest prevalence of GU but the lowest of DU, RE, and H. pylori infection. Non-steroidal anti-inflammatory drugs were positively associated with GERD risk. On the contrary, a reduced risk of GU was observed among H. pylori-infected patients taking this drug. In summary, the prevalence of GERD, RE, and H. pylori infection still appears high in China. H. pylori infection eradication remains the priority to reduce the burden of peptic ulcer disease. The aging population, high prevalence of overweight or obesity, smoking, and drinking in China could explain the high burden of these diseases, thus suggesting the targeted preventive measures for upper gastrointestinal diseases in the future.

European clinical practice guideline: managing and treating laryngopharyngeal reflux disease

OBJECTIVE

To propose a European consensus for managing and treating laryngopharyngeal reflux disease (LPRD) to guide primary care and specialist physicians.

METHODS

Twenty-three European experts (otolaryngologists, gastroenterologists, surgeons) participated in a modified Delphi process to revise 38 statements about the definition, clinical management, and treatment of LPRD. Three voting rounds were conducted on a 5-point scale and a consensus was defined a priori as agreement by 80% of the experts.

RESULTS

After the third round, 36 statements composed the first European Consensus Report on the definition, diagnosis, and treatment of LPRD. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring is the gold standard for diagnosing LPRD (> 1 pharyngeal reflux event) and treating the LPRD with personalized therapy. The empirical treatment needs to be based on diet, stress reduction, and alginates or antiacids to address the acidic and alkaline reflux events. Proton pump inhibitors are kept for patients with acidic LPRD and gastroesophageal reflux disease (GERD) findings. The treatment needs to be as short as possible (minimum two months). The medication can be progressively reduced for patients with relief of symptoms. Changing medication class can be considered for refractory LPRD rather than an increase in drug doses.

CONCLUSION

A consensus endorsed by the Confederation of European Otorhinolaryngology-Head and Neck Surgery Societies is presented to improve the management and treatment of LPRD. The approved statements could improve collaborative research through the adoption of common management approaches to LPRD.

Antireflux mucosal valvuloplasty versus proton pump inhibitors for the treatment of patients with gastro-oesophageal reflux disease in a tertiary healthcare centre in China: study protocol for a randomised controlled trial

INTRODUCTION

Endoscopic antireflux therapy has shown promising potential in the treatment for gastro-oesophageal reflux disease (GERD). However, there is currently no universally accepted standard for endoscopic surgery. Therefore, we introduced antireflux mucosal valvuloplasty (ARMV), an innovative endoscopic treatment for GERD. We have conducted a cohort study to assess the association between ARMV and clinical outcomes, including risks and benefits. The objective of this trail is to compare the efficacy of ARMV with proton pump inhibitors (PPIs) therapy.

METHODS AND ANALYSIS

74 patients with chronic GERD will be randomised (1:1) to undergo either ARMV or continue PPI therapy. The primary endpoint is the GERD health-related quality of life score, measured 6 months postprocedure. Secondary endpoints include the GERD questionnaire score, presence of reflux oesophagitis, appearance of the mucosal flap, DeMeester score, PPI usage and the incidence of adverse events. After 6 months, crossover is allowed for the PPI group. Assessments will occur at baseline and at 3, 6, 12, 24 and 36 months postintervention.

ETHICS AND DISSEMINATION

The study protocol has been approved by the Institutional Review Board of Qilu Hospital, Shandong University. Study results will be disseminated through peer-reviewed journals and presented at scientific conferences.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (NCT06348420).

Improving Proton-Pump Inhibitor Adherence Intervention Between Primary Care and Community Pharmacies: A Pre-Post Intervention Study

Purpose

Proton-pump inhibitor (PPI) therapy stands as the primary treatment for upper gastrointestinal symptoms, yet poor adherence often results in treatment failure. Given that patients experiencing these symptoms frequently seek assistance at community pharmacies, the development of collaborative tools with primary care is becoming imperative. The objective was to assess the effectiveness of a pharmaceutical intervention, as demonstrated by a collaborative model between primary care and community pharmacies, in enhancing adherence to PPI among patients experiencing upper gastrointestinal symptoms.

Patients and methods

A Pre-post intervention study was carried out in Spanish community pharmacies (June-October 2022). During the baseline visit, patients' sociodemographic and clinical variables were evaluated. Patients were categorized as adherent or non-adherent using the Morisky Medication Adherence Scale (MMAS-4). In the follow-up visit (14 days later), the impact of the intervention was measured by changes in the Gastroesophageal Reflux Disease Impact Scale (GIS).

Results

Of the 351 patients with an active PPI prescription, 178 (50.7%) were non-adherent. Nearly 70% of these patients (122, 68.5%) received an intervention to improve adherence. The overall GIS score improved after the intervention (mean 25.34, SD 5.66 vs mean 27.64, SD 5.63, p < 0.001). All GIS score items showed improvement after the intervention except for the item regarding the taking of additional medication different from that prescribed by the clinician (p = 0.200).

Conclusion

The pharmaceutical intervention had a positive impact on patients' symptom relief and overall quality of life, highlighting the significance and efficacy of a collaborative model between primary care and professional pharmaceutical services.

Clinical Trials Registry

Clinical Trial Registration (NCT05162079).

Exploration oxidative stress underlying gastroesophageal reflux disease and therapeutic targets identification: a multi-omics Mendelian randomization study

INTRODUCTION

Gastroesophageal reflux disease (GERD) is a chronic inflammatory gastrointestinal disease, which has no thoroughly effective or safe treatment. Elevated oxidative stress is a common consequence of chronic inflammatory conditions.

METHODS

We employed Summary-data based MR (SMR) analysis to assess the associations between gene molecular characteristics and GERD. Exposure data were the summary-level data on the levels of DNA methylation, gene expression, and protein expression, which obtained from related methylation, expression, and protein quantitative trait loci investigations (mQTL, eQTL, and pQTL). Outcome data, Genome-wide association study (GWAS) summary statistics of GERD, were extracted from the Ong's study (discovery), the Dönertaş's study (replication), and the FinnGen study (replication). Colocalization analysis was performed to determine if the detected signal pairs shared a causative genetic mutation. Oxidative stress related genes and druggable genes were imported to explore oxidative stress mechanism underlying GERD and therapeutic targets of GERD. The Drugbank database was utilized to conduct druggability evaluation.

RESULTS

After multi-omics SMR analysis and colocalization analysis, we identified seven key genes for GERD, which were SUOX and SERPING1, DUSP13, SULT1A1, LMOD1, UBE2L6, and PSCA. SUOX was screened out to be the mediator, which suggest that GERD is related to oxidative stress. SERPING1, SULT1A1, and PSCA were selected to be the druggable genes.

CONCLUSIONS

These findings offered strong support for the identification of GERD treatment targets in the future as well as for the study of the oxidative stress mechanism underlying GERD.

Gastroesophageal Reflux Disease Among Undergraduate Medical Students in Egypt: Prevalence and Risk Factors

Background

Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal condition that has a detrimental impact on one's quality of life because of acid reflux causing damage to the esophagus. Primary symptoms consist of heartburn and regurgitation, although patients may also encounter chest pain, nausea, and dysphagia. Medical students may be particularly susceptible due to stressful lifestyles and unhealthy habits. This study investigates the prevalence of GERD among medical students in Egypt and explores associated risk factors.

Subjects and Methods

This is a cross-sectional observational study that was conducted among undergraduate medical students at 21 medical schools across Egypt. The study included 602 participants from medical schools. The study utilized a pre-designed, self-administered questionnaire that includes questions about sociodemographic and lifestyle attributes, accompanied by the GERDQ questionnaire used to diagnose gastroesophageal reflux disease.

Results

A total of 602 undergraduate medical students completed the questionnaire. The prevalence of GERD was found to be 28.4%, with heartburn and regurgitation being the most prevalent symptoms among participants. Univariate and multivariate logistic regression revealed family history of GERD and stress after medical school enrollment as significant predictors of GERD symptoms (p=0.043 and p=0.044, respectively).

Conclusion

GERD has become increasingly common among medical students in Egypt. Contributing factors include medical students' stressful lifestyles and familial predispositions. To address this, it is essential to implement counseling programs and raise awareness as initial steps toward reducing GERD prevalence.

Diagnosis and Treatment of Gastroesophageal Reflux Disease (Clinical Guidelines of the Russian Gastroenterological Association, Russian Scientific Medical Society of Internal Medicine, Russian Society for the Prevention of Noncommunicable Diseases, Scientific Community for Human Microbiome Research)

Aim. These recommendations are developed for practitioners in order to familiarize them with modern diagnostic methods, management features and pharmacotherapy of patients with gastroesophageal reflux disease (GERD).

General provisions. GERD is the most common reason for patients to visit clinics. There are esophageal and extraesophageal manifestations of GERD. Patients' complaints of heartburn and regurgitation remain the most sensitive and specific clinical manifestations of GERD. The diagnosis of GERD is established on the basis of anamnestic data, instrumental examination (detection of reflux esophagitis during upper gastrointestinal endoscopy, detection of pathological gastroesophageal reflux with 24-hour pH-metry or/and 24-hour pH-impedance monitoring). Patients with suspected GERD and the absence of erosive and ulcerative changes in the mucous membrane of the esophagus or the presence of erosive esophagitis of Grade A according to Los Angeles Classification of Gastroesophageal Reflux Disease are recommended to conduct 24-hour pH-metry on PPI off to exclude or confirm the diagnosis of GERD. Patients with extraesophageal manifestations of GERD without classic symptoms (heartburn, regurgitation) are recommended to undergo 24-hour pH-impedance monitoring with discontinuation of proton pump inhibitor therapy. When deciding on surgical treatment, all patients need to perform high-resolution esophageal manometry and 24-hour pH-impedance monitoring. Complications of GERD include bleeding, strictures, Barrett’s esophagus and esophageal adenocarcinoma. The main groups of medications used in the treatment of GERD are proton pump inhibitors (PPIs), potassium-competitive acid blockers (P-CABs), alginates, antacids, and prokinetics. PPIs are the drugs of choice in the treatment of both symptoms of gastroesophageal reflux disease and existing erosive esophagitis. Combination therapy Rebamipide with PPIs increases the effectiveness of relief of GERD symptoms, as well as reduces the frequency of relapses.

Conclusion. These clinical recommendations will improve the quality of medical care for patients with GERD.

Peptic Ulcer Disease: A Review

Importance

In the US, peptic ulcer disease affects 1% of the population and approximately 54 000 patients are admitted to the hospital annually for bleeding peptic ulcers.

Observations

Approximately 10% of patients presenting with upper abdominal pain in a primary care setting have a peptic ulcer as the cause of their symptoms. The principal causes of peptic ulcer disease are Helicobacter pylori infection, which affects approximately 42% of patients with peptic ulcer disease, and aspirin or nonsteroidal anti-inflammatory drug (NSAID) use, which are etiologic factors in approximately 36% of people with peptic ulcer disease. Complications of peptic ulcer include bleeding (73% of patients), perforation (9% of patients), and pyloric obstruction (3% of patients). Annually, 10 000 people die of peptic ulcer disease in the US. Endoscopy definitively diagnoses peptic ulcer disease. Acid blockers, such as omeprazole, can heal peptic ulcers in approximately 80% to 100% of patients within 4 weeks, but gastric ulcers larger than 2 cm may require 8 weeks of treatment. Eradication of H pylori decreases peptic ulcer recurrence rates from approximately 50% to 60% to 0% to 2%. Discontinuing NSAIDs heals 95% of ulcers identified on endoscopy and reduces recurrence from 40% to 9%. When discontinuing an NSAID is not desirable, changing the NSAID (eg, from ketorolac to ibuprofen), adding a proton pump inhibitor such as omeprazole or lansoprazole, and eradicating H pylori with treatment such as bismuth, metronidazole, and tetracycline combined with omeprazole can reduce recurrence rates.

Conclusions and Relevance

Peptic ulcer disease is associated with increased hospitalization rates and mortality. Acid blocking with proton pump inhibitors, such as omeprazole or lansoprazole, is the primary treatment. Recurrence of ulcers can be prevented by eradicating H pylori if present and discontinuing aspirin or NSAIDs if applicable.

Established and Novel Methods to Assess GERD: An Update

Background

Gastroesophageal reflux disease (GERD) is common. Management of reflux symptoms includes medical and nonmedical interventions. Proton pump inhibitors (PPIs) continue to be considered first-line agents. Standard investigations to diagnose GERD include upper endoscopy, impedance-pH measurement or capsule-based pH measurements and high-resolution manometry. However, diagnosis can sometimes be difficult in individual cases when measurements yield borderline results. Combination of the three mentioned techniques is considered the diagnostic gold standard now.

Summary

Aside from the current measures considered gold standard, new measurement parameters, mostly focusing on impedance of the esophageal mucosa will help better diagnose GERD. Another promising new modality is the combination of wireless pH measurements and evaluation of esophageal motility and structural abnormalities using the endoscopic functional lumen imaging probe (FLIP). Artificial intelligence may play an increasingly supportive role.

Key Messages

GERD needs to be better diagnosed to avoid unnecessary or potentially harmful long-term acid suppression therapy or reflux surgery. A number of tools is under investigation. However, as of now they only have supportive value.

Prevalence and risk factors of gastroesophageal reflux disease among adults attending primary healthcare in Bahrain

Background

Gastroesophageal reflux disease (GERD) is one of the most diagnosed digestive disorders, with much-conducted research assessing its prevalence and risk factors associated with it worldwide. However, there are no published previous studies to determine such disease and its burden in Bahrain. Hence, this study aims to estimate the prevalence and evaluate the risk factors associated with GERD among adults attending primary care in Bahrain.

Material and Methodology

A total of 385 adults aged 18 years and above participated in this descriptive cross-sectional study in the period from 1st to 27th of April 2023. The sample was collected randomly through an interview-based validated questionnaire from 10 health centers selected randomly. The questionnaire consisted of three sections: Demographic characteristics, risk factors that are associated with GERD and (GERD-Q) questionnaire with a scoring rate for the diagnosis of GERD, in which a score of 8 or more gives us the diagnosis of GERD.

Results

A response rate of 93.6% was accomplished. Most of the participants were female (53.2%), Bahraini (88.6%), university-educated (50.9%) and married (71.2%). The mean age of the participants was 41.5 (SD = ±14.4 years). The prevalence of GERD was 41.5% which was statistically significant associated with family history of GERD, history of hypertension, sleeping within less than 1 hour after dinner, bariatric surgery and use of NSAIDs or Aspirin regularly (P < 0.05).

Conclusions

The prevalence of GERD was 41.5%, which is higher than in the Middle East, East Asia and Western countries. Many modifiable risk factors where associate with it which deserves the conduction of national prevention programs and educational campaigns to prevent this disease and its complications. Further studies are needed to assess other risk factors and the effect of GERD on the overall health status and quality of life.

Effect of on-demand vs continuous prescription of proton pump inhibitors on symptom burden and quality of life: results of a real-world randomized controlled trial in primary care patients with gastroesophageal reflux disease

OBJECTIVES

This study aimed to assess the impact of on-demand versus continuous prescribing of proton pump inhibitors (PPIs) on symptom burden and health-related quality of life in patients with gastroesophageal reflux disease (GERD) presenting to primary care.

METHODS

Thirty-six primary care centres across Europe enrolled adult GERD patients from electronic health records. Participants were randomised to on-demand or continuous PPI prescriptions and were followed for 8 weeks. PPI intake, symptom burden, and quality of life were compared between the two groups using mixed-effect regression analyses. Spearman's correlation was used to assess the association between changes in PPI dose and patient-reported outcomes.

RESULTS

A total of 488 patients (median age 51 years, 58% women) completed the initial visit, with 360 attending the follow-up visit. There was no significant difference in PPI use between the continuous and on-demand prescription groups (b=.57, 95%CI:0.40-1.53), although PPI use increased in both groups (b = 1.33, 95%CI:0.65 - 2.01). Advice on prescribing strategy did not significantly affect patient-reported outcomes. Both symptom burden (Reflux Disease Questionnaire, b=-0.61, 95%CI:-0.73 - -0.49) and quality of life (12-item Short Form Survey physical score b = 3.31, 95%CI:2.17 - 4.45) improved from baseline to follow-up in both groups. Increased PPI intake correlated with reduced reflux symptoms (n = 347, ρ=-0.12, p = 0.02) and improved quality of life (n = 217, ρ = 0.16, p = 0.02).

CONCLUSION

In real-world settings, both continuous and on-demand PPI prescriptions resulted in similar increases in PPI consumption with no difference in treatment effects. Achieving an adequate PPI dose to alleviate reflux symptom burden improves quality of life in GERD patients. EudraCT number 2014-001314-25.

Update Motility Disorders: Gastro-Oesophageal Reflux Disease - Diagnostic and Conservative Approach

Background

Gastro-oesophageal reflux disease (GORD) is extremely common, with at least 1 in 10 people in the general population reporting heartburn and acid regurgitation on a weekly basis. GORD can also be associated with a variety of atypical symptoms, including chest pain, chronic cough, and laryngopharyngeal symptoms. The causes of GORD are multifactorial, and the severity of symptoms is influenced by peripheral and central factors, including psychosocial stress and anxiety. Therefore, for a variety of reasons, no single investigation provides a definitive diagnosis, and standard treatment with acid suppressants is not always effective.

Summary

This review introduces the Lyon Consensus, now in its second iteration, a classification system that provides a "conclusive" positive or negative diagnosis of GORD by integrating the results of endoscopy, ambulatory reflux monitoring, and high-resolution manometry. Different algorithms are applied to patients with high and low pre-test probability of a causal relationship between reflux episodes and patient symptoms. The results of these studies identify patients with "actionable" results that require escalation, revision, or discontinuation of GORD treatment. Guidance is provided on the range of conservative treatments available for GORD, including dietary and lifestyle advice, antacids and alginates, and drugs that suppress acid secretion.

Key Messages

GORD is a common disorder; however, the causes of reflux and symptoms can be complex. As a result, the diagnosis can be missed, and management is sometimes challenging, especially for patients with atypical symptoms. The Lyon classification establishes a conclusive diagnosis of GORD, based on results of endoscopic and physiological investigation. Typical symptoms usually respond to empiric use of alginate-antacid preparations and acid suppression; however, the management of treatment refractory symptoms is tailored to the individual.

Evaluating Vonoprazan for the treatment of erosive GERD and heartburn associated with GERD in adults

INTRODUCTION

Gastroesophageal reflux disease (GERD) is a common debilitating chronic disease presenting in two main forms based on esophageal mucosal appearance, the erosive reflux disease (ERD) and the non-erosive reflux disease (NERD). Acid secretion is a key factor in the disease pathogenesis and management. Potent acid-suppressant drugs have been manufactured since the mid of 1970s, initially with histamine-H2-receptors antagonists, and later, inhibitors of the proton pump (H+-K+-ATPase).More recently, potassium-competitive acid blockers (p-CABs), particularlyVonoprazan, have been introduced. Vonoprazan has shown high efficacy and safety profiles and exhibits several advantages that allow to overcome shortcomings of proton pump inhibitors (PPIs).

AREAS COVERED

In this review, we provide an updated summary of Vonoprazan pharmacodynamics and its role in clinical practice for the management of erosive esophagitis and GERD-related heartburn. Moreover, we discuss characteristics of Vonoprazan that allow to bypass some limitations of the older PPIs.

EXPERT OPINION

Long-term safety and efficacy of Vonoprazan have already been demonstrated for the induction and maintenance of ERD, preventing nocturnal acid breakthrough, reducing reflux symptoms in non-responder to standard therapy. Ongoing and future studies are expected to further elucidate its long-term benefits and potential applications in other acid-related disorders.

How Would You Manage This Patient With Gastroesophageal Reflux Symptoms? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Gastroesophageal reflux disease (GERD) is a common medical condition presenting with heartburn, regurgitation, cough, hoarseness, and/or wheezing. Patients with classic GERD symptoms often do not require diagnostic studies before empirical treatment is initiated. However, if atypical features are present, including alarm symptoms for malignancy, or if symptoms do not respond to conventional treatment, upper endoscopy may be necessary. The optimal management of GERD, which is the subject of debate, depends on the frequency and severity of symptoms. In 2021, the American College of Gastroenterology published updated recommendations for diagnosis and management of GERD. In addition to histamine-2 receptor antagonist or proton-pump inhibitor therapy, which may be prescribed as needed or continuously, lifestyle and dietary modification are often advised. Here, 2 physicians, a primary care practitioner and a gastroenterologist, debate how to manage a patient with GERD symptoms. They discuss the diagnosis of this condition, its initial management, indications for upper endoscopy, and how to care for the patient whose condition does not respond to empirical therapy.

Reflux, eosinophilic esophagitis, and celiac disease - the blurred lines

PURPOSE OF REVIEW

Gastroesophageal reflux disease (GERD) is a commonly recognized cause of dysphagia. Conversely, eosinophilic esophagitis (EoE) and celiac disease are rarer and often overlooked as dysphagia culprits. Overlap between these conditions complicates diagnosis and delays appropriate treatment. This review aims to clarify the distinctive dysphagia characteristics in each condition, explore potential overlaps, and offer guidance on differentiation.

RECENT FINDINGS

Recent studies have advanced our understanding of dysphagia mechanisms in GERD, EoE, and celiac disease, particularly in characterizing disordered motility and dysphagia's natural history. While upper endoscopy, biopsies, and manometry remain crucial in dysphagia assessment, novel diagnostic tools are emerging. New insights highlight the significance of cytokine-induced mucosal injury in all three conditions, revealing potential connections where mucosal damage in one disorder may contribute to the development of others.

SUMMARY

GERD, EoE, and celiac disease can coexist and present with similar symptoms. Distinguishing between them often entails upper endoscopy, esophageal biopsies, pH testing, and celiac serologies. EoE should be considered when GERD patients fail proton pump inhibitor therapy or when celiac patients have persistent esophageal symptoms despite a gluten-free diet. Consider celiac disease if dysphagia accompanies iron deficiency anemia, malabsorptive diarrhea, or osteoporosis. Recognizing the potential overlap between these conditions is crucial for guiding clinical evaluation and therapy.

Comparative analysis of laparoscopic Nissen fundoplication and Rossetti modification in gastroesophageal reflux disease: A focus on life-quality enhancement

OBJECTIVE

This study aims to investigate the focus of surgical treatment of gastroesophageal reflux disease (GERD) on enhancing life quality beyond symptom relief. The comparison involves laparoscopic Nissen fundoplication and Rossetti modification techniques.

METHODS

Patients intolerant to or experiencing relapse after medical therapy underwent either standard Nissen procedure (Group 1, n = 61) or Rossetti modification (Group 2, n = 42). A disease-specific quality of life questionnaire for GERD was utilized for evaluating life quality preoperatively and 2 years postoperatively. Symptom scores and patient satisfaction were also assessed.

RESULTS

Preoperatively, groups were similar in symptom duration, hiatal hernia presence, and DeMeester scores (p = 0.127, p = 0.427, and 0.584, respectively). Both groups exhibited a statistically significant increase in life quality postoperatively (p < 0.001), with no significant intergroup difference. Symptoms decreased after both surgeries, except for dysphagia and bloating. Bloating significantly increased in both groups after surgery (p = 0.018 and p = 0.017, respectively), and dysphagia increased significantly only in Group 2 (p = 0.007). The surgery refusal rate was significantly higher in Group 2 for similar preoperative symptoms (p = 0.040).

CONCLUSION

Despite increased life quality scores, the combination of increased dysphagia and bloating in patients undergoing Rossetti modification resulted in a decreased satisfaction rate.

Laryngopharyngeal Reflux in Otolaryngology-Head and Neck Surgery Clinic: An Epidemiological Survey

Background and Objectives: Laryngopharyngeal reflux disease (LPRD) has been implicated in the etiology of many laryngeal disorders and is also closely related to the occurrence and progression of a variety of throat diseases, including chronic cough, leukoplakia of the larynx, dysphonia, and even laryngeal tumors. LPRD can significantly reduce the quality of life of patients and cause substantial medical and economic burdens to the society. Reflux Symptom Index (RSI), a self-administered 9-item outcomes instrument for laryngopharyngeal reflux (LPR), has been widely used to screen for LPRD, but there is a lack of feasibility studies on the use of RSI for LPRD screening and alternative diagnostic tools in otolaryngology-head and neck surgery (OHNS) clinics. To study the incidence, clinical characteristics, diagnostic status, and influencing factors of LPRD at OHNS clinics, RSI as an alternative diagnostic tool has also been studied. LPRD was defined as RSI > 13. Methods: Systematic collection of data by the RSI questionnaire was used to identify patients in the outpatient clinic suffering from LPRD; in addition, the personal history of participants was collected. Follow-up observation was carried out for 6 months for patients with suspected LPRD (RSI > 13), including whether they were treated with standardized anti-reflux therapy, and the questionnaire based on RSI was completed again after treatment. Results: The LPRD rate was 7.92% (94/1187) in this survey. The proportions of LPRD patients with smoking history (vs no smoking) and alcohol consumption history (vs. no alcohol consumption) were significantly higher (χ2 values: 7.025 and 4.562, and P values: .008 and .033; respectively). Smoking significantly increased the risk of LPRD (OR: 2.140, 95% CI: 1.058-4.331, P = .034). Among patients with LPRD positive, the incidence of "foreign body sensation in the throat" (symptom 8) score equal to 5 was the highest (19.15%). The severity of "excess mucus in the throat or postnasal drip" (symptom 3) contributed mostly to the total RSI score in patients with LPRD (r = .409, P < .001). ROC curve analysis showed that RSI ≥ 14 had a sensitivity of 72.9% and a specificity of 71.4% for the diagnosis of LPRD, with AUC = 0.797 (95% CI: 0.577-0.884, P < .001). Conclusions: The incidence of LPRD was high in patients we examined in OHNS clinics. We recommend that RSI can be used by otolaryngologists as a reliable tool for screening and diagnosing LPRD in OHNS clinics, which is beneficial for clinical practice.

Association of depression with gastroesophageal reflux disease, and the mediating role of risk factors: a Mendelian randomization study

Background

Growing evidence suggests that depression affects gastroesophageal reflux disease (GERD). But, the relationship between depression and GERD is unclear. To examine the relationship between depression and the risk of GERD, as well as the mediating role of risk factors.

Methods

We found genetic variants associated with GERD (N = 78,707) and depression (N = 500,199 (excluding 23 and Me) from the largest genome-wide association study and we applied two-sample Mendelian randomization (MR) to find out if they are related. We further used two-step MR to find the mediating factors.

Results

The results found a causal link between depression and GERD, inverse-variance weighted (IVW), risk OR 2.149 (95% CI, 1.910 to 2.418; P <0.001). F-statistics for all instrumental variables (IVs) were greater than 10. Multivariate MR maintained the significance of the depression-GERD link even after adjusting for body mass index (BMI), waist-to-hip ratio (WHR), and educational attainment (EA). Mediation analysis revealed that increased depression is associated with lower EA (OR = 0.94; 95% CI, 0.89 to 0.99; P = 0.03), while EA itself significantly impacts GERD risk (OR = 0.25; 95% CI, 0.18 to 0.34; P = 8.24 × 10-9). Ultimately, EA mediates the effect of depression on GERD (OR = 1.09; 95% CI, 1.01 to 1.18; P = 0.04), accounting for 11.4% of the mediated effect.

Conclusions

Depression is associated with an increased risk of developing GERD, with some of the effects mediated by EA. This result may provide important information for the prevention and intervention of depression and GERD.

Association of gastroesophageal junction laxity and gastroesophageal reflux disease

BACKGROUND

Gastroesophageal reflux disease is a prevalent condition with significant clinical variability, complicating its evaluation and treatment. The gastroesophageal flap valve is a fundamental evaluation method, but have shown limitations in specificity and reliance on subjective endoscopists' experience. Recent insights suggest that gastroesophageal junction laxity may offer an objective and quantifiable measurement for the presence of gastroesophageal reflux disease.

METHODS

This retrospective study analyzed data from 401 patients who underwent comprehensive evaluations, including a symptom questionnaire, endoscopy, pH-impedance monitoring, high-resolution manometry, and treatment directions, between January 1, 2022 and October 31, 2023. Gastroesophageal junction laxity was assessed using a modified approach based on endoscopic image analysis, with the diameter of endoscope as reference to estimate the long diameter of the laxity ring. The independent association of gastroesophageal junction laxity with pathologic acid exposure, esophagitis, and hiatal hernia were assessed by adjusting with age and sex.

RESULTS

The mean age was 44.5 ± 5.5 years old, and 49.9% (200/401) were male. The most common symptoms (≥ 1 point) were acid regurgitation (333/401, 83.0%), heartburn (315/401, 78.6%), belching (278/401, 69.3%), bloating (241/401, 60.1%), and globus sensation (241/401, 60.1%). The gastroesophageal junction laxity was significantly associated with pathologic acid exposure, esophagitis, hiatal hernia, and lower esophageal sphincter resting pressure. Notably, with the increase in gastroesophageal junction laxity, the rates of pathologic acid exposure, esophagitis, and hiatal hernia increased gradually, the lower esophageal sphincter resting pressure decreased gradually. The gastroesophageal junction laxity was independent associated with pathologic acid exposure (OR = 2.33, 95%CI 1.77-3.07, p < 0.001), esophagitis (OR = 2.10, 95%CI 1.62-2.73, p < 0.001), and hiatal hernia (high-resolution manometry: OR = 3.39, 95%CI: 2.46-4.67, p < 0.001) (endoscopy: OR = 21.65, 95%CI 11.70-40.06, p < 0.001).

CONCLUSION

The gastroesophageal junction laxity was significantly associated with the indicators of pathophysiology in gastroesophageal reflux disease.

Use of proton pump inhibitors after laparoscopic gastric bypass and sleeve gastrectomy: a nationwide register-based cohort study

BACKGROUND/OBJECTIVES

L-RYGB and L-SG are the dominant bariatric procedures worldwide. While L-RYGB is an effective treatment of coexisting gastroesophageal reflux disease (GERD), L-SG is associated with an increased risk of de-novo or worsening of GERD. The study aimed to evaluate the long-term use of proton pump inhibitors (PPI) following laparoscopic Roux-en-Y gastric bypass (L-RYGB) and sleeve gastrectomy (L-SG).

SUBJECTS/METHODS

This nationwide register-based study included all patients undergoing L-RYGB or L-SG in Denmark between 2008 and 2018. In total, 17,740 patients were included in the study, with 16,096 and 1671 undergoing L-RYGB and L-SG, respectively. The median follow up was 11 years after L-RYGB and 4 years after L-SG. Data were collected through Danish nationwide health registries. The development in PPI use was assessed through postoperative redeemed prescriptions. GERD development was defined by a relevant diagnosis code associated with gastroscopy, 24 h pH measurement, revisional surgery or anti-reflux surgery. The risk of initiation of PPI treatment or GERD diagnosis was evaluated using Kaplan-Meier plots and COX regression models. The risk of continuous PPI treatment was examined using logistic regression modeling.

RESULTS

The risk of initiating PPI treatment was significantly higher after L-SG compared with L-RYGB (HR 7.06, 95% CI 6.42-7.77, p < 0.0001). The risk of continuous PPI treatment was likewise significantly higher after L-SG (OR 1.45, 95% CI 1.36-1.54, p < 0.0001). The utilization of PPI consistently increased after both procedures. The risk of GERD diagnosis was also significantly higher after L-SG compared with L-RYGB (HR 1.93, 95% CI 1.27-2.93, p < 0.0001).

CONCLUSIONS

The risk of initiating and continuing PPI treatment was significantly higher after L-SG compared with L-RYGB, and a continuous increase in the utilization of PPI was observed after both procedures.

Dysfunction of the autonomic nervous system in gastro-esophageal reflux disease: Consequences for the cardiovascular system

OBJECTIVE

The pathophysiology of gastro esophageal reflux disease (GERD) implicates autonomic dysregulation of the lower esophageal sphincter tone. Our goal is to investigate whether this dysregulation of the autonomic nervous system (ANS) function observed in isolated GERD cases can affect other systems, such as cardiovascular regulation.

METHODS

Twenty-five participants were included in the study, 11 patients with isolated GERD and 14 controls. All patients and 7 controls responded to a COMposite Autonomic Symptoms Score 31 (COMPASS 31) questionnaire and underwent functional explorations including EMLA test, sympathetic skin response (SSR), 24-hour heart rate recording and ambulatory blood pressure measurement (ABPM). Seven additional controls underwent a 24-hour heart rate recording only.

RESULTS

GERD patients (Age: mean 36.81±7.82; SR= 0.22) showed high clinically dysautonomic scores (COMPASS 31) (p = 0.015), increased Heart rate variability (HRV) parameters (daytime, nighttime, 24-hour SDNN (standard deviation of the RR interval (NN)), respectively p = 0.003, p < 0.001, p = 0.001; daytime and nighttime very low frequencies (VLF) respectively p = 0.03 and p = 0.007), impaired nocturnal dipping of blood pressure (3/11 patients) and high positivity of EMLA test (7/11, p = 0.037). These outcomes were strongly correlated with clinical dysautonomic assessment. No difference was observed between patients and controls regarding SSR.

CONCLUSION

Our data suggests a high parasympathetic tone amongst patients with GERD and a dysregulation of parasympathetic and sympathetic balance in the cardiovascular system with an impairment of the peripheral sympathetic fibers of cutaneous microcirculation, assessed by the EMLA test. GERD may be an inaugural symptom of autonomic neuropathy. Further functional exploration of peripheral small fibers seems to be necessary.

A systematic review and meta-analysis exploring the bidirectional association between asthma and gastroesophageal reflux disease in children

Background: Asthma is the most prevalent chronic respiratory disease in children, and gastroesophageal reflux disease (GERD) is one of its extraesophageal complications of asthma. Both conditions are commonly observed in pediatric outpatient clinics, but the causality between them in children is still debated. Therefore, we conducted a systematic review and meta-analysis to evaluate the bidirectional association between asthma and GERD in children. Methods: We systematically reviewed original studies published from January 2000 to February 2024 by searching the data bases. We also performed manual retrieval and screening to identify studies that met the inclusion criteria. The quality of the final included studies was evaluated by using the Newcastle-Ottawa Scale, and outcome measures were extracted. Results: We identified nine eligible studies, which included 304,399 children of different ages from seven countries. Overall, the risk of developing GERD in children with asthma (odds ratio [OR] 2.16 [95% confidence interval [CI], 1.6-2.91) was higher than the risk of developing asthma in children with GERD (OR 1.55 [95% CI, 1.32-1.82]). Conclusion: Based on the available studies, it can be concluded that asthma and GERD are mutually aggravating factors in children, presenting a bidirectional association. However, the risk of developing GERD in children with asthma is higher to some extent. More large-scale and high-quality prospective cohort studies are needed in the future to provide richer evidence and more research opportunities.

BariClip: Outcomes and Complications from a Single-Center Experience

BACKGROUND

Laparoscopic BariClip gastroplasty (LBCG) is a new reversible bariatric procedure designed to replicate the restrictive effects of laparoscopic sleeve gastrectomy (LSG) by placing a clip vertically on the stomach. This technique achieves gastric lumen restriction without the need for resection, ensuring organ preservation and reversibility. However, concerns have arisen regarding potential complications such as gastroesophageal reflux disease (GERD), slippage, or erosion of the stomach. The aim of the study is to evaluate the outcomes and complications of LBCG.

METHODS

This is a monocentric retrospective study. We analyzed 149 patients who underwent LBCG procedure between July 2021 and November 2023. A minimum follow-up period of 6 months was observed for all patients, recording clinically relevant GERD through GERD-Q score questionnaires. Weight loss was monitored through body mass index (BMI) and % total weight loss (%TWL), registered during follow-up visits.

RESULTS

Overall, 149 patients were eligible for this study. Overall complication rate was 8% (12/149). The average BMI went from 40 ± 4.37 kg/m2 to 28 ± 4.29 kg/m2 (p < 0.05) in 6 months, while the mean %TWL was 22.6% after at least 6 months of follow-up. Clinically relevant GERD went from 18.1% (27/149) to 10.7% (16/149), p = 0.1262. As expected, also the PPI usage was not altered significantly (17.8% vs 16.4%), p = 0.8714.

CONCLUSIONS

LBCG remains an experimental procedure that must be approached with caution. Nonetheless, the potential of LBCG to reproduce the effects of LSG while reducing GERD makes it a promising new reversible option for the treatment of morbid obesity.

Gastroesophageal reflux disease: indications for antireflux surgery, outcomes, and side effects

INTRODUCTION

Gastroesophageal reflux disease (GERD) is a frequent digestive disorder that presents with a broad spectrum of symptoms. Global consensus on which patients should be selected for anti-reflux surgery is lacking.

AREAS COVERED

This evidence-based review will analyze current indications for anti-reflux surgery, outcomes of the operation, and potential side effects.

EXPERT COMMENTARY

Treatment of GERD has three main purposes: control symptoms, improve quality of life, and prevent potential serious complications such as bleeding, esophageal stenosis, Barrett's esophagus, and esophageal adenocarcinoma. Although medical therapy is effective in the majority of patients, some might require anti-reflux surgery in order to achieve these goals. Adequate patient selection for anti-reflux surgery is critical to obtain optimal outcomes. Most patients undergoing a fundoplication have adequate long-term symptomatic relief. However, potential side effects of anti-reflux surgery should also be discussed with patients to help manage expectations from the operation.

Regurgitation, eructation, and supragastric belch: retrograde esophageal motility, disorders, and treatment

PURPOSE OF REVIEW

This review describes pathologic conditions of retrograde flow into the esophagus along with recent therapeutic advances and treatment options.

RECENT FINDINGS

The esophagus facilitates anterograde and retrograde movement of contents, the latter of which is mediated by transient lower esophageal sphincter relaxations (TLESRs). Gastroesophageal reflux disease (GERD) often includes esophageal-specific symptoms such as heartburn or regurgitation. Volume regurgitation responds less frequently to acid suppression with proton pump inhibitors (PPIs) than heartburn, given its relationship with incompetence of the esophagogastric junction (EGJ) and increased frequency of TLESRs. Therefore, although the refluxate pH can be altered with PPIs, the frequency of reflux episodes is generally not reduced and surgical and endoscopic treatments may be favored. Other instances of abnormal retrograde esophageal flow respond better to medical therapy, or lifestyle interventions. Compared to gastric belching because of increased stomach distension, supragastric belching is caused by intake of air from pharynx into the esophagus followed by rapid expulsion of air. These conditions can be distinguished on esophageal tests such as high-resolution manometry and are likely to respond to behavioral modifications.

SUMMARY

Retrograde flow into the esophagus can be a normal occurrence, but diagnostic testing to distinguish causes can guide appropriate intervention.

The Saudi Gastroenterology Association consensus on the clinical care pathway for the diagnosis and treatment of GERD

ABSTRACT

Gastroesophageal reflux disease (GERD) is one of the most common problems encountered in outpatient general medicine and gastroenterology clinics. GERD may present with classic esophageal symptoms, extraesophageal symptoms, or mixed symptoms. The diagnosis and treatment of GERD are challenging due to the variety of symptoms and multifactorial pathophysiology. Since there is no consensus on the diagnosis and treatment of GERD in Saudi Arabia, the Saudi Gastroenterology Association established an expert group to formulate a consensus on the clinical care pathway for the diagnosis and treatment of GERD to update health-care providers in Saudi Arabia. The expert group reviewed the literature including recently published international guidelines, clinical trials, and expert opinion and conducted virtual and in-person meetings. A total of 22 statements on the definition, diagnosis, and treatment of GERD were formulated, and three algorithms for the clinical care of GERD were developed with a detailed description for each step. The expert group endorsed the new definition of GERD, the practical principles of interpretation of the diagnostic GERD evaluation, and the practical guidance for GERD treatment including medical, surgical, and endoscopic therapy. The expert group recommends further studies to investigate local data on the diagnosis and treatment of GERD.

Vegetarian Diet Reduced Gastroesophageal Reflux Disease in a Nationwide Longitudinal Survey in Taiwan

BACKGROUND/OBJECTIVES

This large, longitudinal follow-up cohort study aimed to explore how being a vegetarian and related factors impacted the incident gastroesophageal reflux disease (GERD) in a comprehensive Taiwanese cohort.

METHODS

The study cohort was enrolled from the Taiwan Biobank. Vegetarian status, duration of being a vegetarian, type of vegetarian diet, and whether or not the participants had GERD were recorded from self-reported surveys. Associations between vegetarian status, duration, and type of diet with incident GERD were analyzed with multivariate logistic regression with adjustments for confounding variables.

RESULTS

After excluding participants with pre-existing GERD, we included 23,714 participants into the study. Multivariable analysis showed that vegetarian status (current vs. never; hazard ratio [HR], 0.697; 95% confidence interval [CI], 0.546 to 0.889; p = 0.004) was significantly inversely associated with incident GERD; conversely, ever being a vegetarian was not associated (p = 0.489). In addition, those who had been a vegetarian for 6 years or more had 0.72 times lower risk of GERD compared to those who had never been a vegetarian (HR, 0.717; 95% CI 0.558 to 0.922, p = 0.009). No significant differences were observed regarding the type of vegetarian diet with incident GERD.

CONCLUSIONS

The results showed that following a vegetarian diet was an independent protective factor for incident GERD, with a significant protective effect observed in those who adhered to a vegetarian diet for at least 6 years. Future research is warranted to explore the underlying mechanisms and whether adopting a vegetarian diet can decrease the incidence of GERD.

Potential Risks Associated With Long-term Use of Proton Pump Inhibitors and the Maintenance Treatment Modality for Patients With Mild Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) significantly affects the health-related quality of life and healthcare costs. The prevalence of this disease is increasing in Asia, leading to a rapid increase in the demand of proton pump inhibitors (PPIs). Despite effective symptom management during initial treatment, relapse rates after PPI cessation remain high in patients with GERD, warranting longterm maintenance therapy. Concerns regarding potential side effects related to the long-term use of PPIs are escalating with increased usage. Studies have reported diverse side effects of PPIs, such as increased fracture risk, cardiovascular concerns, enteric infections, neurological diseases, and potential associations with gastric cancer. However, definitive causal relationships remain unclear. This review comprehensively summarizes the latest knowledge on the potential risks associated with long-term use of PPIs. Continuous or noncontinuous therapy can be used as a maintenance treatment modality for GERD. For patients with mild GERD, including those with nonerosive and mildly erosive reflux disease, on-demand therapy following a sufficient period of continuous maintenance therapy is recommended as a long-term maintenance treatment option.

Association Between Gastroesophageal Reflux Disease and Periodontitis: A Longitudinal Follow-Up Study from the Korean National Health Screening Cohort

BACKGROUND

Gastroesophageal reflux disease (GERD) and periodontitis are common conditions in older adults that can lead to serious complications, gaining public health attention. Although GERD and periodontitis share common risk factors, such as age, lifestyle habits, and socioeconomic status, large-scale studies examining their specific relationship are limited.

METHODS

This study aimed to assess the association between GERD and the likelihood of developing periodontitis using a national validated cohort data from Korea. Data were drawn from the Korean National Health Insurance Service Health Screening Cohort (2004-2019) using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnostic codes. The study included 16,744 GERD patients and 66,976 matched controls (matched 1:4 by age, sex, income, and residence). Cox proportional hazard models estimated hazard ratios (HRs) for periodontitis, adjusting for various factors, with subgroup analyses based on age, income, and other covariates.

RESULTS

The overall incidence of periodontitis was similar between the GERD and control groups, with no significant difference in the adjusted hazard ratios (aHR = 1.00, 95% CI 0.99-1.02, p = 0.625). However, subgroup analyses in the GERD group showed a slightly increased likelihood of periodontitis in individuals over 60 years old (aHR = 1.03, 95% CI 1.00-1.06, p = 0.050) and those in lower-income brackets (aHR = 1.03, 95% CI 1.01-1.06, p = 0.023).

CONCLUSIONS

In summary, while GERD was not associated with an increased overall probability of periodontitis, age and socioeconomic factors may influence the likelihood of periodontitis development in certain GERD patients. These findings may highlight the need for targeted preventive strategies and closer oral health monitoring in older and lower-income populations with GERD.

Improving treatment of people with gastro-esophageal reflux disease refractory to proton pump inhibitors

Proton pump inhibitors (PPIs) are the main treatment recommended and used for gastro-esophageal reflux disease (GERD). However, they fail to control symptoms in a substantial proportion of patients who have PPI-refractory GERD, which is defined as persistent symptoms attributable to objective findings of gastro-esophageal reflux. There remains a lack of dedicated guidelines to direct the management of these patients, some of whom could benefit greatly from surgical treatment. Too often patients remain long-term on ineffective treatment or stop treatment with lack of active review often resulting in their dissatisfaction going unnoticed. Also, concerns over efficacy and side effects of surgical procedures can be off-putting for both patients and physicians. It has been suggested that response to PPIs is predictive of surgical outcome. In this Perspective article we instead recommend that the key determinant should be whether symptoms are caused by GERD. We also discuss the traditional and newer surgical treatment options for people with PPI-refractory GERD.

Secondhand smoke is associated with peptic ulcer disease and gastroesophageal reflux disease in non-smokers in a large Taiwanese population study

Background

Active smokers are known to be at an increased risk of both gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD), however the role of passive smoking remains unclear. In this study, we aimed to examine whether secondhand smoke (SHS) is associated with PUD and GERD.

Methods

In this population-based study, we conducted a large-scale analysis with 88,297 never-smokers (male: 18,595; female: 69,702; mean age 50.1 ± 11.0 years) from the Taiwan Biobank. The exposure group was comprised of those who had been exposed to SHS, and the no exposure group as those without SHS exposure. According to the frequency of exposure, we further divided the participants into "no exposure," "<1 h per week," and "≥1 h per week" groups. A cutoff point of 1 h per week was chosen according to the median exposure time in our participants. Associations between SHS and SHS frequency with PUD and GERD were assessed.

Results

Of the 88,297 enrolled participants, 11,909 (13.5%) had PUD and 76,388 (86.5%) did not. In addition, 11,758 (13.3%) had GERD and 76,539 (86.7%) did not. Multivariable analysis showed a significant association between SHS with PUD (odds ratio [OR] = 1.166; 95% confidence interval [CI] = 1.084-1.254; p < 0.001), and GERD (OR = 1.131; 95% CI = 1.053-1.216; p = 0.001). Furthermore, those exposed to SHS ≥ 1 h per week (vs. no exposure) were associated with higher risks of PUD (OR = 1.232; 95% CI = 1.121-1.355; p < 0.001) and GERD (OR = 1.200; 95% CI = 1.093-1.319; p < 0.001).

Conclusion

SHS was significantly associated with PUD and GERD. Furthermore, exposure to SHS ≥ 1 h per week (vs. no exposure) was associated with a 1.23-fold higher risk of PUD and 1.20-fold higher risk of GERD. This study represents the largest population-based investigation to explore the association between SHS with PUD and GERD in Taiwanese never-smokers.

Causal Relationship Between Gastroesophageal Reflux Disease and the Risk of Chronic Rhinosinusitis: Insights from Multivariable and Mediation Mendelian Randomization Analysis

Background: Previous studies have shown an association between chronic rhinosinusitis (CRS) and gastroesophageal reflux disease (GERD). However, the findings of these studies are controversial, and evaluating this association could help in the treatment of CRS. Thus, we aimed to clarify the relationship between GERD and CRS. Methods: We conducted a Mendelian randomization (MR) study. Pooled data on CRS, GERD, and their associated risk factors were extracted from large genome-wide association studies. Independent single-nucleotide polymorphisms were rigorously screened as instrumental variables. Causal associations between GERD and CRS were assessed, and mediation analyses were performed using multivariate and 2-step MR. Asthma served as a mediator because of its association with both CRS and GERD. Sensitivity tests were also performed. Results: MR analysis showed that genetically predicted GERD was associated with an increased risk of CRS (P < .001). Multivariate MR analysis showed that the effect of GERD on CRS was relatively independent. Mediation analysis showed that asthma mediated the association with a mediation effect of 21.07% (95% CI, 2.70%-40.18%). Sensitivity analyses did not reveal any significant effects of pleiotropy and heterogeneity. Conclusions: We found a causal relationship between genetically predicted GERD and an increase in the risk of CRS. As a mediator, asthma contributed to the effect of GERD on CRS. This study provides high-quality causal evidence for the prevention of CRS.

Effectiveness of treatment with budesonide orodispersible tablets in 76 patients with eosinophilic oesophagitis - real-life experience from the population-based DanEoE cohort

BACKGROUND

Eosinophilic oesophagitis (EoE) is a chronic immune-mediated disease. In Denmark, the budesonide orodispersible tablet (BOT) is recommended as a second-line treatment for proton pump inhibitor-refractory EoE patients.

AIMS

To evaluate the effectiveness of treatment with BOT in adult EoE patients in a population-based setting in Denmark.

METHODS

This was a retrospective, registry-based, DanEoE cohort study of all 76 adult EoE patients treated with BOT and diagnosed between 2007 and 2021 in the North Denmark Region. After medical record revision, the EoE diagnosis was defined according to the AGREE consensus. Symptomatic response was based on the information found in the patients' medical reports and histologic remission was defined as <15 eosinophils per high-power field (eos/hpf).

RESULTS

Histologic remission was achieved in 89% of the patients treated with BOT who underwent histologic evaluation. Clinicohistologic remission was achieved in 71% of the patients who underwent both symptomatic and histologic evaluation. Despite histologic remission, 18% of patients still experienced symptoms. Non-responders were found in 7% of the patients. Complications were rare, with dilation of strictures performed in 7% and food bolus obstruction (FBO) occurring in 3%. Discontinuation of the treatment due to unacceptable side effects was observed in 11% of the treated patients.

CONCLUSIONS

Treatment with BOT effectively induced histologic remission in most of the EoE patients. Despite achieving histologic remission, approximately 1/5 of the patients were still symptomatic. Complications were rare. In non-responders and those with unacceptable side effects, alternative treatment options such as biologic agents might be needed.