Characteristics of symptomatic GERD in Japanese patients based on 24-h pH monitoring

Factors affecting the treatment outcomes of laparoscopic fundoplication for erosive reflux esophagitis: findings of esophageal pathological function tests

PURPOSE

To identify the factors that affect laparoscopic fundoplication (LF) treatment efficacy in patients with erosive gastroesophageal reflux disease (e-GERD) esophagitis, based on the findings of multichannel intraluminal impedance pH (MII-pH) and high-resolution manometry (HRM).

METHODS

The subjects were 102 patients with e-GERD diagnosed by endoscopy, who underwent LF as the initial surgery. To analyze the findings of MII-pH and HRM, the patients were divided into two groups: a cured group (CR), comprised of patients whose esophagitis was cured postoperatively; and a recurrence group (RE), comprised of patients who suffered recurrent esophagitis.

RESULTS

There were 96 patients in the CR group and 6 in the RE group. MII-pH indicated that the acid reflux time, the longest reflux time, and the number of refluxes longer than 5 min, were significantly higher in the RE group than in the CR group (p = 0.0028, p = 0.0008, p = 0.012, respectively). The HRM indicated that only the distal contractile integral (DCI) was significantly lower in the RE group (p = 0.0109).

CONCLUSION

The results of this study indicate that esophageal clearance may affect the treatment outcome of LF. Based on the findings of MII-pH, the longest reflux time and the number of refluxes longer than 5 min were important factors influencing the therapeutic effect, whereas based on the HRM, the DCI value was most important.

Impact of truncal vagotomy on complicated peptic ulcer after distal gastrectomy with reconstruction by jejunal pouch interposition

BACKGROUND

We encountered a case of marginal ulcer in the jejunum after distal gastrectomy with jejunal pouch interposition. However, it has not been reported and not confirmed the treatment. We chose truncal vagotomy, considering reduced morbidity and postoperative complications.

CASE PRESENTATION

A case was a 69-year-old woman who was admitted to our hospital with melena. She had received curative distal gastrectomy with a 15-cm jejunal pouch reconstruction for early gastric cancer. Marginal ulcer in the jejunal pouch was detected by upper gastrointestinal endoscopy. She was given medication; however, she repeated hospitalization for melena and abdominal pain. Therefore, we decided to perform surgery, and truncal vagotomy was performed. The patient's postoperative course was uneventful and was discharged on the 22nd postoperative day. Symptoms such as abdominal pain and melena were improved after truncal vagotomy.

CONCLUSION

We presented a case with a complicated peptic ulcer after distal gastrectomy with reconstruction by jejunal pouch interposition, which was successfully treated by truncal vagotomy, a surgical acid-reducing procedure which does not require resection of remnant stomach.

Relationship of the frequency scale for symptoms of gastroesophageal reflux disease with endoscopic findings of cardiac sphincter morphology

BACKGROUND

Kusano et al. developed a questionnaire for the evaluation of gastroesophageal reflux disease (GERD), the frequency scale for the symptoms of GERD (FSSG). The FSSG is now widely used in Japan. We investigated the relationship between FSSG results and cardiac sphincter endoscopic findings.

METHODS

The subjects were 470 patients who responded to the FSSG before undergoing endoscopy. From the FSSG results, we calculated the total, acid reflux, and dysmotility scores. Endoscopic findings were assessed in terms of the anatomic-functional-pathological (AFP) classification as the A factor, or degree and type of hiatal hernia, and the valve factor, or laxity of the cardiac sphincter. The degree of esophagitis was assessed using the modified Los Angeles classification. We investigated correlations between each score and the anatomy of the cardia.

RESULTS

With either definition of esophagitis (grade M or greater, or grade A or greater), the total and acid reflux scores were both significantly higher in the group with reflux esophagitis than in the group without reflux esophagitis. Examination of the relationship between FSSG scores and the A factor revealed no significant differences in the total, acid reflux, or dysmotility scores whether a hiatal hernia was present or absent. Similarly, examination of the valve factor showed no significant difference in any scores between V0 and V1 versus V1 and V2, indicating no correlation between cardiac sphincter laxity and FSSG scores.

CONCLUSIONS

The FSSG was useful in determining whether reflux esophagitis is present, but it did not predict the anatomy of the cardia.

Gastroesophageal flap valve is associated with gastroesophageal and gastropharyngeal reflux

BACKGROUND

The endoscopic grade of the gastroesophageal flap valve (GEFV) is suggested to be a good predictor of reflux status. The aim of this study was to investigate the association of the GEFV and gastroesophageal and gastropharyngeal reflux.

METHODS

A total of 364 patients (151 men and 233 women; mean age, 52.2 years) who underwent endoscopy, esophageal manometry, and ambulatory 24-h dual-probe pH monitoring were included. GEFV was graded I through IV using Hill's classification; then, GEFV was classified into two groups: a normal GEFV group (grades I and II) and an abnormal GEFV group (grades III and IV). Findings of endoscopy, esophageal manometry, and ambulatory pH monitoring were compared between the groups.

RESULTS

Increased GEFV grade was significantly associated with an increased prevalence of both reflux esophagitis and Barrett's epithelium (P < 0.001). Lower esophageal sphincter pressure was significantly lower in the abnormal GEFV group than in the normal GEFV group (P < 0.001). All variables showing gastroesophageal reflux in the distal probe were significantly higher in the abnormal GEFV group than in the normal GEFV group (P < 0.001). In addition, all variables, except the supine time of pH < 4, showing gastropharyngeal reflux in the proximal probe were significantly higher in the abnormal GEFV group than in the normal GEFV group (P < 0.001). The frequency of gastroesophageal reflux disease and of gastropharyngeal reflux disease was significantly higher in the abnormal GEFV group than in the normal GEFV group (P < 0.001).

CONCLUSION

Endoscopic grading of the GEFV is easy and provides useful information about the status of gastroesophageal and gastropharyngeal reflux.