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Basharat U, Schraff S, Stevens LM, Clarke PY, Kang P, Woodward J, Schroeder SR, Rao A, Page N, Williams DI. Deep interarytenoid notch in young children managed with systematic thickener wean and injection laryngoplasty. Int J Pediatr Otorhinolaryngol 2019; 118:115-119. [PMID: 30611096 DOI: 10.1016/j.ijporl.2018.12.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 12/22/2018] [Accepted: 12/23/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Deep interarytenoid notch (DIN) is a congenital variation of the larynx often associated with dysphagia and aspiration (DA) in young children. Feeding therapy with thickeners and surgical management with injection larygoplasty (IL) are used with various efficacies. Thickeners address the functional domain and IL addresses the anatomical domain of treatment. Our objective was to evaluate DIN patients managed with both interventions. METHODS We conducted a retrospective pilot descriptive study of DIN patients with DA aged 1-3 years receiving thickeners and IL. Patients received a systematic weekly reduction of thickeners, referred to as the Thickener Weaning Protocol (TWP), based on clinical signs and symptoms of DA. The outcomes were assessed by the rate of thickener level reduction and DA-related sign/symptom frequency achieved at 6 months post-treatment. RESULTS Thirteen patients with DIN associated DA were analyzed. The TWP was initiated within 2 months in 77% of patients, and within 4 months in 100% of patients. Thickener scores improved from an average of 5.76 (3/4 honey) to 2.15 (thin) (p = 0.001). DA-related signs/symptoms frequency improved from an average of 3.3 to 0.84 (p = 0.05). CONCLUSIONS These findings suggest that treatment of DIN associated DA with a combination of thickeners and IL results in significant clinical improvements in young children.
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Affiliation(s)
| | - Scott Schraff
- Arizona Otolaryngology Consultants, Phoenix, AZ, USA
| | - Lindsay M Stevens
- Department of Rehabilitation, Aerodigestive Program at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Pamela Y Clarke
- Department of Rehabilitation, Aerodigestive Program at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Paul Kang
- Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Phoenix, AZ, USA
| | - Jim Woodward
- Department of Pulmonology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Shauna R Schroeder
- Department of Gastroenterology, Aerodigestive Program at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Aparna Rao
- Department of Pulmonology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Nathan Page
- Department of Otolaryngology, Aerodigestive Program at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Dana I Williams
- Department of Gastroenterology, Aerodigestive Program at Phoenix Children's Hospital, Phoenix, AZ, USA
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Liu LWC, Andrews CN, Armstrong D, Diamant N, Jaffer N, Lazarescu A, Li M, Martino R, Paterson W, Leontiadis GI, Tse F. Clinical Practice Guidelines for the Assessment of Uninvestigated Esophageal Dysphagia. J Can Assoc Gastroenterol 2018; 1:5-19. [PMID: 31294391 PMCID: PMC6487990 DOI: 10.1093/jcag/gwx008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS Our aim is to review the literature and provide guidelines for the assessment of uninvestigated dysphagia. METHODS A systematic literature search identified studies on dysphagia. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Statements were discussed and revised via small group meetings, teleconferences, and a web-based platform until consensus was reached by the full group. RESULTS The consensus includes 13 statements focused on the role of strategies for the assessment of esophageal dysphagia. In patients presenting with dysphagia, oropharyngeal dysphagia should be identified promptly because of the risk of aspiration. For patients with esophageal dysphagia, history can be used to help differentiate structural from motility disorders and to elicit alarm features. An empiric trial of proton pump inhibitor therapy should be limited to four weeks in patients with esophageal dysphagia who have reflux symptoms and no additional alarm features. For patients with persistent dysphagia, endoscopy, including esophageal biopsy, was recommended over barium esophagram for the assessment of structural and mucosal esophageal disease. Barium esophagram may be useful when the availability of endoscopy is limited. Esophageal manometry was recommended for diagnosis of esophageal motility disorders, and high-resolution was recommended over conventional manometry. CONCLUSIONS Once oropharyngeal dysphagia is ruled out, patients with symptoms of esophageal dysphagia should be assessed by history and physical examination, followed by endoscopy to identify structural and inflammatory lesions. If these are ruled out, then manometry is recommended for the diagnosis of esophageal dysmotility.
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Affiliation(s)
- Louis W C Liu
- Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON
| | - Christopher N Andrews
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, AB
| | | | - Nicholas Diamant
- Division of Gastroenterology, Department of Medicine, Queen’s University, Kingston, ON
| | - Nasir Jaffer
- Department of Medical Imaging, Mount Sinai Hospital, Toronto, ON
| | | | - Marilyn Li
- Division of Gastroenterology, Department of Medicine, Queen’s University, Kingston, ON
| | - Rosemary Martino
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON
| | - William Paterson
- Division of Gastroenterology, Department of Medicine, Queen’s University, Kingston, ON
| | | | - Frances Tse
- Department of Medicine, McMaster University, Hamilton, ON
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Miglani A, Schraff S, Clarke PY, Basharat U, Woodward P, Kang P, Stevens L, Woodward J, Williams H, Williams DI. An Aerodigestive Approach to Laryngeal Clefts and Dysphagia Using Injection Laryngoplasty in Young Children. Curr Gastroenterol Rep 2017; 19:60. [PMID: 29105033 DOI: 10.1007/s11894-017-0599-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE OF REVIEW Our objective is to summarize the presentation, diagnosis, and management of mild laryngeal clefts in children. We focus on deep interarytenoid notches (DIN), a subclassification of type 1 laryngeal clefts (LC1), and review the literature and our multidisciplinary experience utilizing injection laryngoplasty (IL). RECENT FINDINGS DIN is a mild form of LC1 and is considered a normal anatomical variant. Recent cohort studies demonstrate IL to be a safe, low-risk, and efficacious treatment of LC1, but few studies focus on DIN. We present results from two aerodigestive clinic (ADC) pilot studies at our institution, in patients 1-3 years old, with DIN-related dysphagia and aspiration (DA). Feeding, respiratory-related symptom scores, and aspiration/penetration assessed on modified barium swallow (MBS) significantly improved following combined IL and feeding therapy using a thickener weaning protocol (TWP). Subgroup analysis reveals combined IL and TWP to be particularly effective in patients with severe baseline DA. Multidisciplinary aerodigestive evaluation and management with IL and feeding therapy focused on weaning levels of thickener is emerging as a novel and effective approach for treatment of DIN-related DA in young children. Further comparative, prospective trials investigating effects of IL and feeding therapy are required to validate results.
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Affiliation(s)
- Amar Miglani
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Scott Schraff
- Arizona Otolaryngology Consultants, Phoenix, AZ, USA
| | - Pamela Y Clarke
- Department of Gastroenterology, Aerodigestive Program, Phoenix Children's Hospital, Phoenix, AZ, USA
| | | | - Peter Woodward
- Department of Pulmonology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Paul Kang
- Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Phoenix, AZ, USA
| | - Lindsay Stevens
- Department of Gastroenterology, Aerodigestive Program, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Jim Woodward
- Department of Pulmonology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Howard Williams
- Department of Anesthesiology, Valley Anesthesia and Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Dana I Williams
- Department of Gastroenterology, Aerodigestive Program, Phoenix Children's Hospital, Phoenix, AZ, USA.
- Division of Pediatric Gastroenterology, Phoenix Children's Hospital, 1919 E. Thomas Rd., Phoenix, AZ, 85016, USA.
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Philpott H, Garg M, Tomic D, Balasubramanian S, Sweis R. Dysphagia: Thinking outside the box. World J Gastroenterol 2017; 23:6942-6951. [PMID: 29097867 PMCID: PMC5658312 DOI: 10.3748/wjg.v23.i38.6942] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/29/2017] [Accepted: 09/26/2017] [Indexed: 02/07/2023] Open
Abstract
Dysphagia is a common symptom that is important to recognise and appropriately manage, given that causes include life threatening oesophageal neoplasia, oropharyngeal dysfunction, the risk of aspiration, as well as chronic disabling gastroesophageal reflux (GORD). The predominant causes of dysphagia varies between cohorts depending on the interplay between genetic predisposition and environmental risk factors, and is changing with time. Currently in white Caucasian societies adopting a western lifestyle, obesity is common and thus associated gastroesophageal reflux disease is increasingly diagnosed. Similarly, food allergies are increasing in the west, and eosinophilic oesophagitis is increasingly found as a cause. Other regions where cigarette smoking is still prevalent, or where access to medical care and antisecretory agents such as proton pump inhibitors are less available, benign oesophageal peptic strictures, Barrett's oesophagus, adeno- as well as squamous cell carcinoma are endemic. The evaluation should consider the severity of symptoms, as well as the pre-test probability of a given condition. In young white Caucasian males who are atopic or describe heartburn, eosinophilic esophagitis and gastroesophageal reflux disease will predominate and a proton pump inhibitor could be commenced prior to further investigation. Upper gastrointestinal endoscopy remains a valid first line investigation for patients with suspected oesophageal dysphagia. Barium swallow is particularly useful for oropharyngeal dysphagia, and oesophageal manometry mandatory to diagnose motility disorders.
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Affiliation(s)
- Hamish Philpott
- Department of Gastroenterology, Eastern Health Clinical School Monash University, Melbourne 3128, Australia
| | - Mayur Garg
- Department of Gastroenterology, Eastern Health Clinical School Monash University, Melbourne 3128, Australia
| | - Dunya Tomic
- Department of Gastroenterology, Eastern Health Clinical School Monash University, Melbourne 3128, Australia
| | - Smrithya Balasubramanian
- Department of Gastroenterology, Eastern Health Clinical School Monash University, Melbourne 3128, Australia
| | - Rami Sweis
- University College London, London NW1 2BU, United Kingdom
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Abstract
PURPOSE OF REVIEW This review aims to discuss the putative relationship between hiatus hernia and dysphagia. RECENT FINDINGS Proposed mechanisms of dysphagia in patients with hiatus hernia are usually difficult to identify, but recent advances in technology (high-resolution manometry with or without concomitant impedance, ambulatory pH with impedance, videofluoroscopy, and the endoluminal functional lumen imaging probe (EndoFLIP)) and methodology (inclusion of swallows of various consistencies and volumes or shifting position during the manometry protocol) can help induce symptoms and identify the underlying disorder. Chronic reflux disease is often associated with hiatus hernia and is the most common underlying etiology. Dysmotility because of impaired contractility and vigor can occur as a consequence of repeated acid exposure from the acid pocket within the hernia, and the resultant poor clearance subsequently worsens this insult. As such, dysphagia appears to be more common with increasing hiatus hernia size. Furthermore, mucosal inflammation can lead to fibrotic stricture formation and in turn obstruction. On the other hand, there appears to be a difference in the pathophysiology of smaller sliding hernias, in that those with dysphagia are more likely to have extrinsic compression at the crural diaphragm as compared to those with reflux symptoms only. Sliding hiatus hernia, especially when small, does not commonly lead to dysmotility and dysphagia; however, in those patients with symptoms, the underlying etiology can be sought with new technologies and, in particular, the reproduction of normal eating and drinking during testing.
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Affiliation(s)
- Hamish Philpott
- Department of Gastroenterology, Eastern Health, Melbourne, Australia.
- Department of Gastroenterology, Box Hill Hospital, 3 Arnold St Box Hill, Melbourne, 3128, Australia.
| | - Rami Sweis
- Department of Gastroenterology, University College London, London, UK
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Shin GH, Sankineni A, Parkman HP. Bolus retention in hiatal hernia identified by high-resolution esophageal manometry with impedance. Neurogastroenterol Motil 2014; 26:679-84. [PMID: 24460884 DOI: 10.1111/nmo.12312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 01/06/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Esophageal acid retention in a hiatal hernia (HH) may play a role in gastro-esophageal reflux. The aims of this study were to determine the prevalence of bolus retention (BR) in HH and to compare pressure profiles in patients with HH with BR in the hernia to those with bolus clearance (BC) through the hernia using high-resolution esophageal manometry with impedance (HREMI). METHODS Clinical HREMI studies with HH ≥1.5 cm were analyzed for lower esophageal sphincter (LES) and crural diaphragm (CD) pressures and pressure profiles during 12 saline swallows. Impedance was analyzed for swallow retention in the HH. KEY RESULTS Bolus retention in a HH was present in 35 of 53 (66%) patients with a HH. Patients with BR had overall lower pressure profiles including a lower basal LES pressure (14.8 ± 10.6 vs 28.9 ± 16.8 mmHg; p = 0.0001), LES-CD gradient (6.8 ± 17.9 vs 20.6 ± 12.2 mmHg; p = 0.002), residual LES pressure (2.5 ± 4.6 vs 6.1 ± 12.2 mmHg; p = 0.017), amplitude of distal esophageal contractions (83.2 ± 38.8 vs 111.2 ± 42.8 mmHg; p = 0.020), and distal contractile integral (1487 ± 1016 vs 2608 ± 1221 mmHg-cm-sec; p = 0.001) compared to the BC group. Patients with BR were more likely to have a larger sized HH compared to the BC group (3.1 ± 1.6 vs 2.1 ± 0.6 cm; p = 0.016); similar pressure changes were found when the groups were divided up by HH sizes. CONCLUSIONS & INFERENCES Bolus retention was seen in 66% of patients with HH. Bolus retention in the HH was associated with larger HH size, lower LES pressure, and lower esophageal contractile pressures compared to those with BC.
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Affiliation(s)
- G H Shin
- GI Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
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7
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Mahesh VN, Holloway RH, Nguyen NQ. Changing epidemiology of food bolus impaction: is eosinophilic esophagitis to blame? J Gastroenterol Hepatol 2013; 28:963-6. [PMID: 23425056 DOI: 10.1111/jgh.12135] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIM Data on the relationship between epidemiological changes in food bolus impaction (FBI) and its relationship to eosinophilic esophagitis (EoE) are limited. The aim of this study was to evaluate changes in the prevalence and etiology of FBI at the Royal Adelaide Hospital over 15 years. METHODS Details of all patients who presented with FBI to Royal Adelaide Hospital (1996-2010) were reviewed from a prospective database. Detailed endoscopic and histological findings were examined for patients admitted under the Gastroenterology team. RESULTS From 1996-2010, 539 patients were admitted. Prevalence of FBI increased overtime, with a male preponderance. The age at presentation was significantly lower in 2006-2010 (56.2 ± 1.6 years) compared with 2001-2005 (61.6 ± 1.9 years, P=0.03). There was a reduction in the proportion of patients with peptic-related stricture (from 75% [1996-2000] to 41% [2006-2010] [P<0.001]) and an increase in the prevalence of EoE (from 0% [1996-2000] to 35% [2006-2010], P<0.001). The proportion of patients who had esophageal biopsies taken at the index endoscopy also increased (8% [1996-2000] vs 28% [2001-2005] and 61% [2006-2010], P<0.01). There were no significant changes in rate of malignancy or post-surgical strictures. Endoscopic removal of food bolus was required in 86% of cases and, of these, 98% were successful with no complication or death. CONCLUSIONS The prevalence of FBI has increased over the last 15 years. This was associated with an increased prevalence of EoE and a reduction in age of presentation and peptic-related strictures. These findings suggest that EoE is an important cause of FBI and that esophageal mucosal biopsy should be performed in all cases of FBI.
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Affiliation(s)
- Venkat N Mahesh
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Australia
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8
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Tsutsui H, Manabe N, Uno M, Imamura H, Kamada T, Kusunoki H, Shiotani A, Hata J, Harada T, Haruma K. Esophageal motor dysfunction plays a key role in GERD with globus sensation--analysis of factors promoting resistance to PPI therapy. Scand J Gastroenterol 2012; 47:893-9. [PMID: 22594305 DOI: 10.3109/00365521.2012.685756] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Patients with gastroesophageal reflux disease (GERD) also have various extra-esophageal symptoms. Laryngopharyngeal reflux disease (LPRD) is a subtype of GERD associated with globus sensation, but proton pump inhibitor (PPI) therapy achieves disappointing results. This study investigated esophageal motility in GERD patients with globus sensation who were resistant to PPI therapy. DESIGN The subjects were 350 patients with globus sensation. All patients underwent both laryngoscopy and upper gastrointestinal endoscopy to exclude organic disease. After 4 weeks of treatment with rabeprazole sodium (20 mg daily), the patients were divided into PPI-responsive and PPI-resistant groups. Then we investigated esophageal motility in the PPI-resistant group by a multichannel intraluminal impedance and manometry study. RESULTS A total of 119 patients (55.6%) were resistant to PPI therapy, among whom 57 patients (47.9%) had abnormal esophageal motility. They included 36 patients (66.4%) with ineffective esophageal motility, 9 patients (14.4%) with achalasia, 6 patients (9.6%) with diffuse esophageal spasm, 5 patients (8%) with nutcracker esophagus, and 1 patient (1.6%) with hypertensive lower esophageal sphincter. There were significant differences of upper esophageal sphincter pressure and esophageal body peristalsis between the patients with PPI-resistant LPRD and healthy controls matched for age and sex. CONCLUSION Among patients with PPI-resistant LPRD, 47.9% had abnormal esophageal motility.
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Affiliation(s)
- Hideaki Tsutsui
- Department of Internal Medicine, Division of Gastroenterology, Kawasaki Medical School, Kurashiki, Japan
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Danjo A, Yamaguchi K, Fujimoto K, Saitoh T, Inamori M, Ando T, Shimatani T, Adachi K, Kinjo F, Kuribayashi S, Mitsufuji S, Fujiwara Y, Koyama S, Akiyama J, Takagi A, Manabe N, Miwa H, Shimoyama Y, Kusano M. Comparison of endoscopic findings with symptom assessment systems (FSSG and QUEST) for gastroesophageal reflux disease in Japanese centres. J Gastroenterol Hepatol 2009; 24:633-8. [PMID: 19220681 DOI: 10.1111/j.1440-1746.2008.05747.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIM We compared endoscopic findings of the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG), a written questionnaire developed in Japan, to that for the questionnaire for the diagnosis of reflux esophagitis (QUEST) for the diagnosis of reflux esophagitis. METHODS We registered 475 patients with untreated symptoms of upper abdominal pain (male/female: 252/223, average age 52.4 +/- 17.8 years). Subjects were assessed first with the FSSG and QUEST questionnaires, then by endoscopy, before allocation to a gastric ulcer (GU), duodenal ulcer (DU), gastroesophageal reflux disease (GERD) or functional dyspepsia (FD) group. RESULTS On the basis of the endoscopic findings the diagnoses for the 475 subjects were as follows: FD 52.2%, DU 7.6%, GU 7.8%, and GERD 32.4% (Grade M 10.1%, Grade A + B 20.2%, Grade C + D 2.3%). There was no difference between the FSSG and QUEST in sensitivity, specificity or accuracy for any condition. The FSSG score rose with increasing endoscopic severity of GERD, but there was no correlation between the QUEST score and endoscopic severity. The FSSG total score was inferior to QUEST in terms of distinguishing GERD from other conditions, but when only the questions relating to reflux symptoms were used, the FSSG was able to distinguish GERD from other conditions as well as QUEST. CONCLUSIONS The FSSG score reflects the severity of the endoscopic findings of GERD.
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Affiliation(s)
- Akiko Danjo
- Department of Internal Medicine, Saga Medical School, Saga 849-8501, Japan
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10
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Pallotta S, Pace F, Marelli S. Rabeprazole: a second-generation proton pump inhibitor in the treatment of acid-related disease. Expert Rev Gastroenterol Hepatol 2008; 2:509-22. [PMID: 19072398 DOI: 10.1586/17474124.2.4.509] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Rabeprazole is a proton pump inhibitor (PPI) presenting a very advantageous pharmacodynamic and pharmacokinetic profile over older PPIs. In particular, this drug has a very fast onset of action, due to a short activation time and a very high pKa, and may therefore be defined as a 'second generation' PPI. The aim of this article is to provide an update on the pharmacology and clinical profile of rabeprazole and its use in acid-related disorders, with a particular focus on its role in gastroesophageal reflux disease; in the treatment and prevention of duodenal and gastric ulcers and Zollinger-Ellison syndrome; in the therapy of the extraesophageal manifestations of gastroesophageal reflux disease (in particular the respiratory and ear, nose and throat ones); and in the eradication of Helicobacter pylori.
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Affiliation(s)
- Stefano Pallotta
- University of Milan, Via GB Grassi, 74, 20157 Milano, MI, Italy.
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11
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Yamagishi H, Koike T, Ohara S, Kobayashi S, Ariizumi K, Abe Y, Iijima K, Imatani A, Inomata Y, Kato K, Shibuya D, Aida S, Shimosegawa T. Prevalence of gastroesophageal reflux symptoms in a large unselected general population in Japan. World J Gastroenterol 2008; 14:1358-64. [PMID: 18322948 PMCID: PMC2693682 DOI: 10.3748/wjg.14.1358] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine the prevalence of gastroesophageal reflux disease (GERD) symptoms in a large unselected general population in Japan.
METHODS: In Japan, mature adults are offered regular check-ups for the prevention of gastric cancer. A notice was sent by mail to all inhabitants aged > 40 years. A total of 160 983 Japanese (60 774 male, 100 209 female; mean age 61.9 years) who underwent a stomach check up were enrolled in this study. In addition, from these 160 983 subjects, we randomly selected a total of 82 894 (34 275 male, 48 619 female; mean age 62.4 years) to evaluate the prevalence of abdominal pain. The respective subjects were prospectively asked to complete questionnaires concerning the symptoms of heartburn, dysphagia, and abdominal pain for a 1 mo period.
RESULTS: The respective prevalences of the symptoms in males and females were: heartburn, 15.8% vs 20.7%; dysphagia, 5.4% vs 7.8%; and abdominal pain, 6.6% vs 9.6%. Among these symptoms, heartburn was significantly high compared with the other symptoms, and the prevalence of heartburn was significantly more frequent in females than in males in the 60-89-year age group. Dysphagia was also significantly more frequent in female patients.
CONCLUSION: The prevalence of typical GERD symptoms (heartburn) was high, at about 20% of the Japan population, and the frequency was especially high in females in the 60-89 year age group.
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Kusano M, Shimoyama Y, Kawamura O, Maeda M, Kuribayashi S, Nagoshi A, Zai H, Moki F, Horikoshi T, Toki M, Sugimoto S, Mori M. Proton pump inhibitors improve acid-related dyspepsia in gastroesophageal reflux disease patients. Dig Dis Sci 2007; 52:1673-7. [PMID: 17385034 DOI: 10.1007/s10620-006-9674-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 11/07/2006] [Indexed: 01/02/2023]
Abstract
It has been reported that proton pump inhibitors are more effective than H2 receptor antagonists in patients with functional dyspepsia. Dyspeptic symptoms that respond to proton pump inhibitors are classified as acid-related dyspepsia. A new questionnaire for assessing gastroesophageal reflux disease (GERD), the Frequency Scale for Symptoms of GERD, covers the 12 most common symptoms of GERD patients. A quantitative assessment of the changes of reflux symptoms and acid-related dyspepsia was made in GERD patients receiving proton pump inhibitor therapy. Sixty-eight GERD patients receiving proton pump inhibitor therapy completed the questionnaire before and after treatment for 8 weeks. There is a significant positive correlation between reflux symptoms and acid-related dyspepsia before and after therapy (r = 0.569 and r = 0.569; both P's < 0.001) and acid-related dyspepsia in patients with both nonerosive and erosive GERD. We conclude that GERD patients suffer not only from reflux symptoms, but also from acid-related dyspepsia, and proton pump inhibitors improve both types of symptoms.
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Affiliation(s)
- Motoyasu Kusano
- Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, 3-39-19 Showamachi, Maebashi, Gunma, Japan.
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Yoshihara K, Yamaguchi K, Kuroki T, Takashima T, Inoue N, Sakata H, Tsunada S, Shiraishi R, Mannen K, Fujise T, Nakayama M, Shimoda R, Iwakiri R, Fujimoto K. Dysphagia in adult Japanese is not equivalent to the grade of endoscopic reflux esophagitis. Intern Med 2007; 46:1951-5. [PMID: 18084115 DOI: 10.2169/internalmedicine.46.0301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study was aimed to evaluate the correlation between dysphagia, detected by nursing staff in a brief interview and endoscopic findings in reflux esophagitis. PATIENTS AND METHODS A total of 8,031 Japanese subjects without medication for gastrointestinal disease were briefly asked about the presence of heartburn, dysphagia, odynophagia, and acid regurgitation by nursing staff before endoscopy for assessment of esophagitis utilizing the Los Angeles Classification. RESULTS The grade of endoscopic esophagitis was not equivalent to symptoms of dysphagia in 8,031 subjects. We evaluated the characteristics of subjects who complained of only dysphagia. Univariate analysis indicated that non-smoking, and non-drinking females were associated with a higher risk for dysphagia, and multivariate analysis indicated the gender was associated with dysphagia. There was no association of dysphagia with herniation and distribution of age. CONCLUSION This study indicated that dysphagia was not equivalent to the endoscopic findings according to a brief interview by nursing staff and that dysphagia might be more common in females and those who do not smoke or drink.
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Affiliation(s)
- Kumiko Yoshihara
- Department of Internal Medicine and Gastrointetinal Endoscopy, Saga Medical School
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des Varannes SB, Sacher-Huvelin S, Vavasseur F, Masliah C, Le Rhun M, Aygalenq P, Bonnot-Marlier S, Lequeux Y, Galmiche JP. Rabeprazole test for the diagnosis of gastro-oesophageal reflux disease: Results of a study in a primary care setting. World J Gastroenterol 2006; 12:2569-73. [PMID: 16688803 PMCID: PMC4087990 DOI: 10.3748/wjg.v12.i16.2569] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the diagnostic value of the rabeprazole test in patients seen by general practitioners.
METHODS: Eighty-three patients with symptoms suggestive of GERD were enrolled by general practitioners in this multi-centre, randomized and double-blind study. All patients received either rabeprazole (20 mg bid) or a placebo for one week. The diagnosis of GERD was established on the presence of mucosal breaks at endoscopy and/or an abnormal esophageal 24-h pH test. The test was considered to be positive if patients reported at least a “clear improvement” of symptoms on a 7-point Likert scale.
RESULTS: The sensitivities of the test for rabeprazole and the placebo were 83% and 40%, respectively. The corresponding specificity, positive and negative predictive values were 45% and 67%, 71% and 71%, and 62% and 35%, respectively. A receiver operating characteristics (ROC) analysis confirmed that the best discriminatory cut-off corresponded to description of “clear improvement”.
CONCLUSION: The poor specificity of the proton-pump inhibitor (PPI) test does not support such an approach to establish a diagnosis of GERD in a primary care setting.
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