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Javed U, Podury S, Kwon S, Liu M, Kim DH, Fallahzadeh A, Li Y, Khan AR, Francois F, Schwartz T, Zeig-Owens R, Grunig G, Veerappan A, Zhou J, Crowley G, Prezant DJ, Nolan A. Biomarkers of Airway Disease, Barrett's and Underdiagnosed Reflux Noninvasively (BAD-BURN) in World Trade Center exposed firefighters: a case-control observational study protocol. BMC Gastroenterol 2024; 24:255. [PMID: 39123126 PMCID: PMC11312152 DOI: 10.1186/s12876-024-03294-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/12/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Particulate matter exposure (PM) is a cause of aerodigestive disease globally. The destruction of the World Trade Center (WTC) exposed first responders and inhabitants of New York City to WTC-PM and caused obstructive airways disease (OAD), gastroesophageal reflux disease (GERD) and Barrett's Esophagus (BE). GERD not only diminishes health-related quality of life but also gives rise to complications that extend beyond the scope of BE. GERD can incite or exacerbate allergies, sinusitis, bronchitis, and asthma. Disease features of the aerodigestive axis can overlap, often necessitating more invasive diagnostic testing and treatment modalities. This presents a need to develop novel non-invasive biomarkers of GERD, BE, airway hyperreactivity (AHR), treatment efficacy, and severity of symptoms. METHODS Our observational case-cohort study will leverage the longitudinally phenotyped Fire Department of New York (FDNY)-WTC exposed cohort to identify Biomarkers of Airway Disease, Barrett's and Underdiagnosed Reflux Noninvasively (BAD-BURN). Our study population consists of n = 4,192 individuals from which we have randomly selected a sub-cohort control group (n = 837). We will then recruit subgroups of i. AHR only ii. GERD only iii. BE iv. GERD/BE and AHR overlap or v. No GERD or AHR, from the sub-cohort control group. We will then phenotype and examine non-invasive biomarkers of these subgroups to identify under-diagnosis and/or treatment efficacy. The findings may further contribute to the development of future biologically plausible therapies, ultimately enhance patient care and quality of life. DISCUSSION Although many studies have suggested interdependence between airway and digestive diseases, the causative factors and specific mechanisms remain unclear. The detection of the disease is further complicated by the invasiveness of conventional GERD diagnosis procedures and the limited availability of disease-specific biomarkers. The management of reflux is important, as it directly increases risk of cancer and negatively impacts quality of life. Therefore, it is vital to develop novel noninvasive disease markers that can effectively phenotype, facilitate early diagnosis of premalignant disease and identify potential therapeutic targets to improve patient care. TRIAL REGISTRATION Name of Primary Registry: "Biomarkers of Airway Disease, Barrett's and Underdiagnosed Reflux Noninvasively (BADBURN)". Trial Identifying Number: NCT05216133 . Date of Registration: January 31, 2022.
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Affiliation(s)
- Urooj Javed
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine (NYUGSoM), New Bellevue, 16 North Room 20 (Lab), 462 1st Avenue, New York, NY, 10016, USA
| | - Sanjiti Podury
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine (NYUGSoM), New Bellevue, 16 North Room 20 (Lab), 462 1st Avenue, New York, NY, 10016, USA
| | - Sophia Kwon
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine (NYUGSoM), New Bellevue, 16 North Room 20 (Lab), 462 1st Avenue, New York, NY, 10016, USA
| | - Mengling Liu
- Department of Population Health, Division of Biostatistics, NYUGSoM, New York, NY, USA
| | - Daniel H Kim
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine (NYUGSoM), New Bellevue, 16 North Room 20 (Lab), 462 1st Avenue, New York, NY, 10016, USA
| | - Aida Fallahzadeh
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine (NYUGSoM), New Bellevue, 16 North Room 20 (Lab), 462 1st Avenue, New York, NY, 10016, USA
| | - Yiwei Li
- Department of Population Health, Division of Biostatistics, NYUGSoM, New York, NY, USA
| | - Abraham R Khan
- Center for Esophageal Health, NYUGSoM, New York, NY, 10016, USA
- Department of Medicine, Division of Gastroenterology, NYUGSoM, New York, NY, 10016, USA
| | - Fritz Francois
- Department of Medicine, Division of Gastroenterology, NYUGSoM, New York, NY, 10016, USA
| | - Theresa Schwartz
- Fire Department of New York, Bureau of Health Services, Brooklyn, NY, 1120, USA
| | - Rachel Zeig-Owens
- Fire Department of New York, Bureau of Health Services, Brooklyn, NY, 1120, USA
| | - Gabriele Grunig
- Department of Medicine, Division of Environmental Medicine, NYUGSoM, New York, NY, 10010, USA
| | - Arul Veerappan
- Department of Medicine, Division of Environmental Medicine, NYUGSoM, New York, NY, 10010, USA
| | - Joanna Zhou
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine (NYUGSoM), New Bellevue, 16 North Room 20 (Lab), 462 1st Avenue, New York, NY, 10016, USA
| | - George Crowley
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine (NYUGSoM), New Bellevue, 16 North Room 20 (Lab), 462 1st Avenue, New York, NY, 10016, USA
| | - David J Prezant
- Fire Department of New York, Bureau of Health Services, Brooklyn, NY, 1120, USA
| | - Anna Nolan
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University Grossman School of Medicine (NYUGSoM), New Bellevue, 16 North Room 20 (Lab), 462 1st Avenue, New York, NY, 10016, USA.
- Fire Department of New York, Bureau of Health Services, Brooklyn, NY, 1120, USA.
- Department of Medicine, Division of Environmental Medicine, NYUGSoM, New York, NY, 10010, USA.
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Javed U, Podury S, Kwon S, Liu M, Kim D, Fallah Zadeh A, Li Y, Khan A, Francois F, Schwartz T, Zeig-Owens R, Grunig G, Veerappan A, Zhou J, Crowley G, Prezant D, Nolan A. Biomarkers of Airway Disease, Barrett's and Underdiagnosed Reflux Noninvasively (BAD-BURN): a Case-Control Observational Study Protocol. RESEARCH SQUARE 2024:rs.3.rs-4355584. [PMID: 38798396 PMCID: PMC11118699 DOI: 10.21203/rs.3.rs-4355584/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND Particulate matter exposure (PM) is a cause of aerodigestive disease globally. The destruction of the World Trade Center (WTC) exposed fifirst responders and inhabitants of New York City to WTC-PM and caused obstructive airways disease (OAD), gastroesophageal Refux disease (GERD) and Barrett's Esophagus (BE). GERD not only diminishes health-related quality of life but also gives rise to complications that extend beyond the scope of BE. GERD can incite or exacerbate allergies, sinusitis, bronchitis, and asthma. Disease features of the aerodigestive axis can overlap, often necessitating more invasive diagnostic testing and treatment modalities. This presents a need to develop novel non-invasive biomarkers of GERD, BE, airway hyperreactivity (AHR), treatment efficacy, and severity of symptoms. METHODS Our observational case-cohort study will leverage the longitudinally phenotyped Fire Department of New York (FDNY)-WTC exposed cohort to identify Biomarkers of Airway Disease, Barrett's and Underdiagnosed Refux Noninvasively (BAD-BURN). Our study population consists of n = 4,192 individuals from which we have randomly selected a sub-cohort control group (n = 837). We will then recruit subgroups of i. AHR only ii. GERD only iii. BE iv. GERD/BE and AHR overlap or v. No GERD or AHR, from the sub-cohort control group. We will then phenotype and examine non-invasive biomarkers of these subgroups to identify under-diagnosis and/or treatment efficacy. The findings may further contribute to the development of future biologically plausible therapies, ultimately enhance patient care and quality of life. DISCUSSION Although many studies have suggested interdependence between airway and digestive diseases, the causative factors and specific mechanisms remain unclear. The detection of the disease is further complicated by the invasiveness of conventional GERD diagnosis procedures and the limited availability of disease-specific biomarkers. The management of Refux is important, as it directly increases risk of cancer and negatively impacts quality of life. Therefore, it is vital to develop novel noninvasive disease markers that can effectively phenotype, facilitate early diagnosis of premalignant disease and identify potential therapeutic targets to improve patient care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05216133; January 18, 2022.
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Affiliation(s)
- Urooj Javed
- New York University Grossman School of Medicine (NYUGSoM)
| | - Sanjiti Podury
- New York University Grossman School of Medicine (NYUGSoM)
| | - Sophia Kwon
- New York University Grossman School of Medicine (NYUGSoM)
| | - Mengling Liu
- New York University Grossman School of Medicine (NYUGSoM)
| | - Daniel Kim
- New York University Grossman School of Medicine (NYUGSoM)
| | | | - Yiwei Li
- New York University Grossman School of Medicine (NYUGSoM)
| | - Abraham Khan
- New York University Grossman School of Medicine (NYUGSoM)
| | - Fritz Francois
- New York University Grossman School of Medicine (NYUGSoM)
| | | | | | | | - Arul Veerappan
- New York University Grossman School of Medicine (NYUGSoM)
| | - Joanna Zhou
- New York University Grossman School of Medicine (NYUGSoM)
| | - George Crowley
- New York University Grossman School of Medicine (NYUGSoM)
| | - David Prezant
- New York University Grossman School of Medicine (NYUGSoM)
| | - Anna Nolan
- New York University Grossman School of Medicine (NYUGSoM)
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Mashali G, Kaul A, Khoury J, Corsiglia J, Dolan LM, Shah AS. Screening for Gastric Sensory Motor Abnormalities in Pediatric Patients With Type 1 Diabetes. Endocr Pract 2023; 29:168-173. [PMID: 36572278 DOI: 10.1016/j.eprac.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the frequency of gastric sensory motor symptoms in youth with type 1 diabetes. METHODS A prospective cross-sectional study was performed to evaluate symptoms of delayed gastric emptying in participants with type 1 diabetes, aged 12 to 25 years, using the Gastroparesis Cardinal Symptom Index (GCSI) questionnaire. In addition, a 5-year (January 2015 to December 2019), a retrospective study was completed on all gastric emptying scans performed in youth at our institution. RESULTS A total of 359 participants (mean age, 17.7 ± 3.33 years) with type 1 diabetes completed the GCSI questionnaire. Compared with nonresponders, responders were more likely to be non-Hispanic White (90% vs 86%; P =.003) and female patients (58% vs 44%; P <.0001), with a lower HbA1c (8.1 ± 1.8 vs 9.0 ± 2.1; P <.0001). At least 1 gastrointestinal symptom was reported in 270 (75%) of responders, of which nausea was the most common (71%). A GCSI score of ≥1.9 suggestive of more severe gastrointestinal symptoms was reported in 17% of responders. Participants with scores ≥1.9 were older (19.1 ± 3.0 vs 17.8 ± 3.3 years; P =.01). In the retrospective study, 778 underwent gastric emptying scan, 29 participants had type 1 diabetes and 11 (38%) showed delayed gastric emptying. CONCLUSION Gastrointestinal symptoms related to gastric sensory motor abnormalities are seen in youth and young adults with type 1 diabetes. In particular, for those with higher GCSI scores, earlier recognition and referral may be warranted.
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Affiliation(s)
- Gamal Mashali
- Division of Pediatric Endocrine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, Ohio.
| | - Ajay Kaul
- Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, Ohio
| | - Jane Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, Ohio
| | - Joshua Corsiglia
- Xavier University, College of Arts and Sciences, Cincinnati, Ohio
| | - Lawrence M Dolan
- Division of Pediatric Endocrine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, Ohio
| | - Amy S Shah
- Division of Pediatric Endocrine, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, Ohio
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Assessment of pyloric sphincter physiology after Ivor-Lewis esophagectomy using an endoluminal functional lumen imaging probe. Surg Endosc 2022:10.1007/s00464-022-09714-9. [DOI: 10.1007/s00464-022-09714-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 10/11/2022] [Indexed: 12/04/2022]
Abstract
Abstract
Objective of the study
The most common functional complication after Ivor-Lewis esophagectomy is the delayed emptying of the gastric conduit (DGCE) for which several diagnostic tools are available, e.g. chest X-ray, upper esophagogastroduodenoscopy (EGD) and water-soluble contrast radiogram. However, none of these diagnostic tools evaluate the pylorus itself. Our study demonstrates the successful measurement of pyloric distensibility in patients with DGCE after esophagectomy and in those without it.
Methods and procedures
Between May 2021 and October 2021, we performed a retrospective single-centre study of all patients who had an oncological Ivor-Lewis esophagectomy and underwent our post-surgery follow-up programme with surveillance endoscopies and computed tomography scans. EndoFlip™ was used to perform measurements of the pylorus under endoscopic control, and distensibility was measured at 40 ml, 45 ml and 50 ml balloon filling.
Results
We included 70 patients, and EndoFlip™ measurement was feasible in all patients. Successful application of EndoFlip™ was achieved in all interventions (n = 70, 100%). 51 patients showed a normal postoperative course, whereas 19 patients suffered from DGCE. Distensibility proved to be smaller in patients with symptoms of DGCE compared to asymptomatic patients. For 40 ml, 45 ml and 50 ml, the mean distensibility was 6.4 vs 10.1, 5.7 vs 7.9 and 4.5 vs 6.3 mm2/mmHg. The differences were significant for all three balloon fillings. No severe EndoFlip™ treatment-related adverse events occurred.
Conclusion
Measurement with EndoFlip™ is a safe and technically feasible endoscopic option for measuring the distensibility of the pylorus. Our study shows that the distensibility in asymptomatic patients after esophagectomy is significantly higher than that in patients suffering from DGCE. However, more studies need to be conducted to demonstrate the general use of EndoFlip™ measurement of the pylorus after esophagectomy.
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Greaney C, Bohan K, Tecklenborg S, Casserly B, Green J, Van de Ven P, Robinson K, Tierney A. Diet quality in cystic fibrosis - associations with patient reported outcome measures and enablers and barriers to eating a healthy diet: A protocol paper for a mixed methods study. HRB Open Res 2022; 5:33. [PMID: 36091185 PMCID: PMC9428499 DOI: 10.12688/hrbopenres.13533.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background: People with cystic fibrosis (PWCF) have increased energy requirements. However, in recent years concerns have emerged regarding the 'cystic fibrosis (CF) diet' in terms of reliance on energy-dense, nutrient poor foods, which tend to be higher in saturated fat, sugar, and salt. These foods lack essential nutrients and are aetiologically linked with diet-related chronic diseases. The aim is to explore habitual dietary intakes in PWCF and (i) assess adherence to CF dietary guidelines and population specific healthy eating guidelines; (ii) derive a diet quality score and the inflammatory potential for the average diet consumed by PWCF and assess associations with patient reported outcome measures; (iii) assess drivers for current consumption patterns and enablers and barriers to eating a healthy diet. Methods: The aim is to recruit between 100-180 PWCF. A mixed methods study will be performed. Using three-day food diaries and food frequency questionnaires, aims (i) and (ii) will be addressed. The Dietary Approaches to Stop Hypertension (DASH) score and Healthy Eating Index-International (HEI-I) will derive diet quality scores. The Dietary Inflammatory Index (DII®) will ascertain inflammatory potential of the diet. Validated questionnaires will be used to report health related quality of life measures. Online focus groups and semi-structured interview with PWCF will address aim (iii). Conclusions: It is timely to revise dietary priorities and targets for CF. However, a greater understanding of what adults with CF currently consume and what they require in terms of nutrition and dietary guidance into the future is needed. In doing so, this research will help to clarify nutrition priorities and simplify the dietary aspects of CF treatment, thereby supporting adherence.
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Affiliation(s)
- Cian Greaney
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Katie Bohan
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Sarah Tecklenborg
- Cystic Fibrosis Ireland, 24 Lower Rathmines Rd, Rathmines, Dublin, Ireland
| | - Brian Casserly
- Department of Respiratory Medicine, University Hospital Limerick, Dooradoyle, Limerick, V94 F858, Ireland
| | - James Green
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Pepijn Van de Ven
- Department of Electronic and Computer Engineering, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Katie Robinson
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Audrey Tierney
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
- Department of Dietetics, Human Nutrition and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
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Wan C, Chen Y, Gao L, Zhang Q, Li W, Quan P. Development and Validation of the Chronic Gastritis Scale Under the System of Quality of Life Instruments for Chronic Diseases QLICD-CG Based on Classical Test Theory and Generalizability Theory. J Clin Gastroenterol 2022; 56:e137-e144. [PMID: 33852446 PMCID: PMC8754093 DOI: 10.1097/mcg.0000000000001511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/25/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM Quality of life (QOL) for patients with chronic gastritis (CG) is of interest worldwide and disease-specific instruments are needed for clinical research and practice. This paper focused on the development and validation of the CG scale under the system of Quality of Life Instruments for Chronic Diseases (QLICD-CG) by the modular approach and both classical test theory and generalizability theory. METHODS The QLICD-CG was developed based on programmed decision procedures including multiple nominal and focus group discussions, in-depth interviews and quantitative statistical procedures. Based on the data measuring QOL 3 times before and after treatments from 142 inpatients with CG, the psychometric properties of the scale were evaluated with respect to validity, reliability and responsiveness employing correlation analysis, multi-trait scaling analysis, factor analyses, t tests and also G studies and D studies of generalizability theory analysis. RESULTS Correlation, multi-trait scaling and factor analyses confirmed good construct validity and criterion-related validity when using SF-36 as a criterion. The internal consistency α for all domains were higher than 0.70 except for the social domain (0.62). Test-retest reliability coefficients (Pearson r and intraclass correlations) for the overall score and all domains were higher than 0.80 except for the social domain (0.77), while they were ranging between 0.72 to 0.94 at facets level; The overall score and scores for all domains/facets had statistically significant changes (P<0.01) after treatments except for facets of social effects and sexual function with standardized response mean ranging from 0.04 to 1.03, but from 0.34 to 1.03 for the domain level scores. G-coefficients and index of dependability (Ф coefficients) confirmed the reliability of the scale further with more exact variance components, and decision information on number of items changing. CONCLUSIONS The QLICD-CG could be used as a useful instrument in assessing QoL for patients with CG, with good psychometric properties including validity, reliability and responsiveness and also several advantages.
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Affiliation(s)
- Chonghua Wan
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Key Laboratory for Quality of Life and Psychological Assessment and Intervention, Guangdong Medical University, Dongguan
| | - Ying Chen
- School of Public Health, Kunming Medical University
| | - Li Gao
- Taian city central hospital, Taian
| | - Qingqing Zhang
- Department of Statistics and Medical Record Management, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Wu Li
- The First Affiliated Hospital of Kunming Medical University, Kunming
| | - Peng Quan
- School of Humanities and Management, Research Center for Quality of Life and Applied Psychology, Key Laboratory for Quality of Life and Psychological Assessment and Intervention, Guangdong Medical University, Dongguan
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Parkman HP, Wilson LA, Yates KP, Koch KL, Abell TL, McCallum RW, Sarosiek I, Kuo B, Malik Z, Schey R, Shulman RJ, Grover M, Farrugia G, Miriel L, Tonascia J, Hamilton F, Pasricha PJ. Factors that contribute to the impairment of quality of life in gastroparesis. Neurogastroenterol Motil 2021; 33:e14087. [PMID: 33493377 PMCID: PMC8310540 DOI: 10.1111/nmo.14087] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/12/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Understanding factors that impair quality of life (QOL) in gastroparesis is important for clinical management. AIMS (a) Determine QOL in patients with gastroparesis; (b) Determine factors that impair QOL. METHODS Gastroparetic patientsAQ6 underwent history and questionnaires assessing symptoms (PAGI-SYM and Rome III), QOL (SF-36v2 and PAGI-QOL), depression (Beck Depression Inventory [BDI]), and anxiety (State Trait Anxiety InventoryAQ7). KEY RESULTS 715 gastroparesis patients (256 diabetic (DG), 459 idiopathic (IG)) were evaluated. SF-36 physical component (PC) score averaged 33.3 ± 10.5; 41% had impaired score <30. SF-36 PC scores were similar between diabetic and idiopathic gastroparesis. Impaired SF-36 PC associated with increased nausea/vomiting and upper abdominal pain subscores, acute onset of symptoms, higher number of comorbidities, use of narcotic pain medications, and irritable bowel syndrome (IBS). SF-36 mental component (MC) score averaged 38.9 ± 13.0; 26% had impaired score <30. Poor SF-36 MC associated with diabetic etiology, higher Beck depression inventory, and state anxiety scores. PAGI-QOL score averaged 2.6 ± 1.1; 50% had a score of <2.6. Low PAGI-QOL associated with higher fullness, bloating, and upper abdominal pain subscores, more depression and Trait anxiety, smoking cigarettes, need for nutritional support, progressively worsening symptoms and periodic exacerbations. CONCLUSIONS & INFERENCES Multiple measures show poor QOL present in gastroparesis. Several areas impacted on reduced QOL: (a) Symptoms of nausea, vomiting, and abdominal pain, as well as IBS; (b) Etiology and acute onset and progressively worsening symptoms; (c) Comorbidities and psychological factors such as anxiety and depression; (d) Patient-related factors such as smoking. Targeting the modifiable factors may improve patient outcomes in gastroparesis.
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Affiliation(s)
| | | | | | | | | | | | - Irene Sarosiek
- Texas Tech University Health Sciences Center, El Paso, TX
| | | | | | | | | | | | | | | | | | - Frank Hamilton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
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Liebenberg A, dos Santos M. Health-related subjective well-being with emetophobia. JOURNAL OF PSYCHOLOGY IN AFRICA 2018. [DOI: 10.1080/14330237.2018.1501880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Anuscha Liebenberg
- Department of Psychology, University of South Africa, Pretoria, South Africa
| | - Monika dos Santos
- Department of Psychology, University of South Africa, Pretoria, South Africa
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Acid Secretion and Its Relationship to Esophageal Reflux Symptom in Patients with Subtotal Gastrectomy. Dig Dis Sci 2018; 63:703-712. [PMID: 29372475 DOI: 10.1007/s10620-018-4923-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 01/09/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Esophageal reflux symptom has been reported as common in patients with subtotal gastrectomy. Management of postoperative esophageal reflux symptom is not satisfactory. The aim of this study is to investigate prevalence of esophageal reflux symptom after subtotal gastrectomy and assess factors affecting esophageal reflux symptom in subtotal gastrectomy patients. METHODS We prospectively enrolled 100 consecutive patients with subtotal gastrectomy who were regularly followed up by endoscopic examination. Acid secretory capacity was assessed by measuring messenger RNA (mRNA) expression of H+/K+-adenosine triphosphatase (ATPase) via real-time polymerase chain reaction (PCR) in biopsy specimens. RESULTS In total, 47 % of patients had typical esophageal reflux symptom, where heartburn or regurgitation was experienced at least weekly. Age, sex, body mass index, and type of reconstruction did not differ between esophageal reflux and non-esophageal-reflux groups. The esophageal reflux group had longer duration from time of operation until study (median 5.0 versus 3.6 years; P = 0.017). Hill grade for gastroesophageal (GE) flap valve was higher in the esophageal reflux group than in the non-esophageal-reflux group (P = 0.027). H+/K+-ATPase mRNA expression was higher in the esophageal reflux group than in the non-esophageal-reflux group [3967.6 (± 7583.7) versus 896.2 (± 1456.0); P = 0.006]. Multivariate analysis revealed that postoperative duration, H+/K+-ATPase mRNA expression level, and GE flap valve disruption were significantly associated with esophageal reflux symptom development. CONCLUSIONS Esophageal reflux symptom is common in patients after subtotal gastrectomy, possibly because of anti-reflux-barrier impairment and preservation of acid secretory capacity following surgery. Optimal acid suppression may be helpful in managing postoperative esophageal reflux symptom.
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Barshop K, Staller K, Semler J, Kuo B. Duodenal rather than antral motility contractile parameters correlate with symptom severity in gastroparesis patients. Neurogastroenterol Motil 2015; 27:339-46. [PMID: 25521513 PMCID: PMC4432031 DOI: 10.1111/nmo.12496] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 11/23/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies of symptomatic gastroparetics consistently find poor correlation with gastric emptying. We hypothesized that concomitant small bowel dysmotility may play a role in symptom causation in gastroparesis and sought to test this hypothesis by using wireless motility capsule (WMC) testing to simultaneously measure antral and duodenal area under pressure curve (AUC) in patients with delayed gastric emptying. METHODS Using a cohort from a multicenter clinical trial and a separate tertiary clinical database, we identified gastroparetics that underwent concurrent WMC testing and completed the Gastroparesis Cardinal Symptom Index, a validated questionnaire. Our study included 35 gastroparetics defined by a gastric emptying time (GET) ≥ 5 h. Antral and duodenal AUC were assessed at 1-h windows pre-GET and post-GET, respectively. KEY RESULTS We found moderate correlations between duodenal AUC and symptom severity in the combined cohort (n = 35; R = -0.42; p = 0.01; 95% CI -0.7, -0.1). Removing patients with colonic delay resulted in a stronger correlation of duodenal AUC to symptom severity (n = 21; R = -0.63; p < 0.01; 95% CI -0.81, -0.31). The multicenter trial (n = 20) and clinical practice cohorts (n = 15) had significantly different symptom severity and exclusion criteria. When analyzed separately, significant correlations between duodenal AUC and symptom severity were observed (R = -0.71; p < 0.01; 95% CI -0.9, -0.4 and R = -0.72; p < 0.01; 95% CI -0.9, -0.3, respectively). Symptom severity and antral motility showed no correlation. CONCLUSIONS & INFERENCES We found significant correlations between duodenal AUC and symptom severity in two cohorts of gastroparetics. Small bowel motility may contribute to symptom generation in gastroparetic patients and this may inform therapeutic considerations.
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Affiliation(s)
| | - Kyle Staller
- Division of Gastroenterology, Massachusetts General Hospital, MA
| | | | - Braden Kuo
- Division of Gastroenterology, Massachusetts General Hospital, MA
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Tack J, Zerbib F, Blondeau K, des Varannes SB, Piessevaux H, Borovicka J, Mion F, Fox M, Bredenoord AJ, Louis H, Dedrie S, Hoppenbrouwers M, Meulemans A, Rykx A, Thielemans L, Ruth M. Randomized clinical trial: effect of the 5-HT4 receptor agonist revexepride on reflux parameters in patients with persistent reflux symptoms despite PPI treatment. Neurogastroenterol Motil 2015; 27:258-68. [PMID: 25530111 PMCID: PMC4681320 DOI: 10.1111/nmo.12484] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/12/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Approximately, 20-30% of patients with gastro-esophageal reflux disease (GERD) experience persistent symptoms despite treatment with proton pump inhibitors (PPIs). These patients may have underlying dysmotility; therefore, targeting gastric motor dysfunction in addition to acid inhibition may represent a new therapeutic avenue. The aim of this study was to assess the pharmacodynamic effect of the prokinetic agent revexepride (a 5-HT4 receptor agonist) in patients with GERD who have persistent symptoms despite treatment with a PPI. METHODS This was a phase II, exploratory, multicenter, randomized, placebo-controlled, double-blind, parallel-group study in patients with GERD who experienced persistent symptoms while taking a stable dose of PPIs (ClinicalTrials.gov identifier: NCT01370863). Patients were randomized to either revexepride (0.5 mg, three times daily) or matching placebo for 4 weeks. Reflux events and associated characteristics were assessed by pH/impedance monitoring and disease symptoms were assessed using electronic diaries and questionnaires. KEY RESULTS In total, 67 patients were enrolled in the study. There were no significant differences between study arms in the number, the mean proximal extent or the bolus clearance times of liquid-containing reflux events. Changes from baseline in the number of heartburn, regurgitation, and other symptom events were minimal for each treatment group and no clear trends were observed. CONCLUSIONS & INFERENCES No clear differences were seen in reflux parameters between the placebo and revexepride groups.
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Affiliation(s)
- J Tack
- Universitair Ziekenhuis LeuvenLeuven, Belgium
| | - F Zerbib
- CHU de Bordeaux, Hôpital Saint AndréBordeaux, France
| | - K Blondeau
- Universitair Ziekenhuis LeuvenLeuven, Belgium
| | | | - H Piessevaux
- Cliniques Universitaires Saint-LucBrussels, Belgium
| | - J Borovicka
- Kantonsspital St GallenSt Gallen, Switzerland
| | - F Mion
- Hospices Civils de Lyon, Digestive Physiology, University LyonLyon, France
| | - M Fox
- Division of Gastroenterology and Hepatology, University Hospital ZürichZurich, Switzerland
| | | | - H Louis
- CUB Hôpital Erasme, Université Libre de BruxellesBrussels, Belgium
| | - S Dedrie
- Shire-Movetis NVTurnhout, Belgium
| | | | | | - A Rykx
- Shire-Movetis NVTurnhout, Belgium
| | | | - M Ruth
- Shire-Movetis NVTurnhout, Belgium
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Bolier EA, Kessing BF, Smout AJ, Bredenoord AJ. Systematic review: questionnaires for assessment of gastroesophageal reflux disease. Dis Esophagus 2013; 28:105-20. [PMID: 24344627 DOI: 10.1111/dote.12163] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Numerous questionnaires with a wide variety of characteristics have been developed for the assessment of gastroesophageal reflux disease (GERD). Four well-defined dimensions are noticeable in these GERD questionnaires, which are symptoms, response to treatment, diagnosis, and burden on the quality of life of GERD patients. The aim of this review is to develop a complete overview of all available questionnaires, categorized per dimension of the assessment of GERD. A systematic search of the literature up to January 2013 using the Pubmed database and the Embase database, and search of references and conference abstract books were conducted. A total number of 65 questionnaires were extracted and evaluated. Thirty-nine questionnaires were found applicable for the assessment of GERD symptoms, three of which are generic gastrointestinal questionnaires. For the assessment of response to treatment, 14 questionnaires were considered applicable. Seven questionnaires with diagnostic purposes were found. In the assessment of quality of life in GERD patients, 18 questionnaires were found and evaluated. Twenty questionnaires were found to be used for more than one assessment dimension, and eight questionnaires were found for GERD assessment in infants and/or children. A wide variety of GERD questionnaires is available, of which the majority is used for assessment of GERD symptoms. Questionnaires differ in aspects such as design, validation and translations. Also, numerous multidimensional questionnaires are available, of which the Reflux Disease Questionnaire is widely applicable. We provided an overview of GERD questionnaires to aid investigators and clinicians in their search for the most appropriate questionnaire for their specific purposes.
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Affiliation(s)
- E A Bolier
- Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
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Peura DA, Pilmer B, Hunt B, Mody R, Perez MC. Distinguishing the impact of dexlansoprazole on heartburn vs. regurgitation in patients with gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2013; 38:1303-11. [PMID: 24118079 DOI: 10.1111/apt.12504] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 04/21/2013] [Accepted: 09/02/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Gastro-oesophageal reflux disease (GERD) is characterised by symptomatic heartburn and regurgitation. Treatment with proton pump inhibitors (PPI) effectively decreases heartburn symptoms, but their effects on symptomatic regurgitation are less clear. AIM To determine the impact of PPI therapy on heartburn and regurgitation severity in patients with either non-erosive GERD (NERD) or erosive oesophagitis (EE). METHODS Endoscopically-confirmed NERD patients received dexlansoprazole 30 or 60 mg or placebo in a randomised, blinded, 4-week study. Endoscopically-confirmed EE patients received dexlansoprazole 60 mg or lansoprazole 30 mg in two 8-week, randomised, blinded healing studies. The Patient Assessment of Upper Gastrointestinal Symptom Severity questionnaire, which includes a heartburn/regurgitation subscale, was administered to assess symptom severity at baseline, and at weeks 2 and 4 of the NERD study and at weeks 4 and 8 during the EE trials. We defined separate subscales for heartburn and regurgitation for this post-hoc analysis. Among patients with both symptoms at baseline, improvements in individual heartburn and regurgitation subscales along with the original combined heartburn/regurgitation subscale were determined. RESULTS In the NERD and EE studies, 661 and 1909 patients, respectively, had both heartburn and regurgitation at baseline. NERD patients receiving dexlansoprazole 30 and 60 mg experienced significantly greater improvements in symptom severity for both heartburn and regurgitation compared with placebo. EE patients receiving dexlansoprazole 60 mg had significantly greater improvements in heartburn/regurgitation and heartburn-only subscales at week 4 compared with those receiving lansoprazole. CONCLUSIONS Dexlansoprazole appears to be effective in improving both heartburn and regurgitation, and this improvement is maintained for the duration of treatment.
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Affiliation(s)
- D A Peura
- Department of Gastroenterology & Hepatology, University of Virginia Health Sciences Center, Charlottesville, VA, USA
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