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Qureshi F, Asad H, Patel PS, Ramprasad A, Singh SP, Suman S, Cheng AL, Salzman G. Gastroesophageal Reflux Disease-Associated Chronic Cough: A Population-Based Analysis of Patient Presentations in the United States. Cureus 2021; 13:e17512. [PMID: 34595079 PMCID: PMC8473893 DOI: 10.7759/cureus.17512] [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: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
Gastroesophageal reflux disease is an extremely prevalent illness in the United States; however, clinicians report that its association with chronic cough is often overlooked and undiagnosed. We used the CERNER Health Facts® database to analyze the statistical prevalence. Our findings indicate that there is a minority of patients who are untreated for this common complaint. We propose considering this on the differential diagnosis and following current treatment guidelines with proton pump inhibitors to effectively treat this complaint.
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Affiliation(s)
- Fahad Qureshi
- Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Hussein Asad
- Pulmonary and Critical Care, University of Missouri-Kansas City, Kansas City, USA
| | - Parth S Patel
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Aarya Ramprasad
- Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Som P Singh
- Epidemiology and Public Health, University of Missouri-Kansas City School of Medicine, Kansas CIty, USA
| | - Sahil Suman
- Bioinformatics, University of Missouri-Kansas City, Kansas City, USA
| | - An-Lin Cheng
- Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Gary Salzman
- Internal Medicine, University of Missouri-Kansas City/Truman Medical Center, Kansas City, USA
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Kivelä AJ, Kauppi J, Räsänen J, But A, Sintonen H, Vironen J, Kruuna O, Scheinin T. Long-Term Health-Related Quality of Life (HRQoL) After Redo-Fundoplication. World J Surg 2021; 45:1495-1502. [PMID: 33502565 PMCID: PMC8026436 DOI: 10.1007/s00268-021-05954-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND We aim to shed light on long-term subjective outcomes after re-operations for failed fundoplication. METHODS 1809 patients were operated on for hiatal hernia and/or gastroesophageal reflux disease (GERD) at the Helsinki University Hospital between 2000 and 2017. 111 (6%) of these had undergone a re-operation for a failed antireflux operation. Overall, HRQoL was assessed in 89 patients at the latest follow-up using the generic 15D© instrument. The results were compared to a sample of the general population, weighted to reflect the age and gender distribution of patients. Disease-specific HRQoL was assessed using the GERD-HRQoL questionnaire. We studied variation in the overall HRQoL with respect to disease-specific HRQoL and known patients' parameters using univariate and multivariable linear regression models. RESULTS The median postoperative follow-up period was 9.3 years. All patients were operated on laparoscopically (6% conversion rate), and 87% were satisfied with the re-operation. Postoperative complications were minimal (5%). Twelve patients (11%) underwent a second re-operation. The median GERD-HRQoL score was nine. In multivariable analysis, four variables were independently associated with the 15D score, suggesting a decrease in the 15D score with increasing GERD-HRQoL score, increasing Charlson Comorbidity Index (CCI) and the presence of chronic pain syndrome (CPS) and depression. CONCLUSION Re-do LF is a safe procedure in experienced hands and may offer acceptable long-term alleviation in patients with recurring symptoms after antireflux surgery. Decreased HRQoL in the long run is related to recurring GERD and co-morbidities.
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Affiliation(s)
- Antti J Kivelä
- Department of GI Surgery, Abdominal Centre, Helsinki University Hospital and Helsinki University, Jorvi Hospital, Turuntie 150, P.O. Box 800, FI 00029, Espoo, Helsinki, HUS, Finland.
| | - Juha Kauppi
- Department of General Thoracic and Esophageal Surgery, Lung and Heart Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Jari Räsänen
- Department of General Thoracic and Esophageal Surgery, Lung and Heart Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Anna But
- University of Helsinki, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jaana Vironen
- Department of GI Surgery, Abdominal Centre, Helsinki University Hospital and Helsinki University, Jorvi Hospital, Turuntie 150, P.O. Box 800, FI 00029, Espoo, Helsinki, HUS, Finland
| | - Olli Kruuna
- Department of GI Surgery, Abdominal Centre, Helsinki University Hospital and Helsinki University, Jorvi Hospital, Turuntie 150, P.O. Box 800, FI 00029, Espoo, Helsinki, HUS, Finland
| | - Tom Scheinin
- Department of GI Surgery, Abdominal Centre, Helsinki University Hospital and Helsinki University, Jorvi Hospital, Turuntie 150, P.O. Box 800, FI 00029, Espoo, Helsinki, HUS, Finland
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Laparoscopic redo fundoplication improves disease-specific and global quality of life following failed laparoscopic or open fundoplication. Surg Endosc 2017; 31:4649-4655. [DOI: 10.1007/s00464-017-5528-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/15/2017] [Indexed: 12/20/2022]
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Özdemir P, Erdinç M, Vardar R, Veral A, Akyıldız S, Özdemir Ö, Bor S. The Role of Microaspiration in the Pathogenesis of Gastroesophageal Reflux-related Chronic Cough. J Neurogastroenterol Motil 2017; 23:41-48. [PMID: 27605525 PMCID: PMC5216633 DOI: 10.5056/jnm16057] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/24/2016] [Accepted: 08/15/2016] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Gastroesophageal reflux disease (GERD) is one of the main causes of chronic cough. We evaluated the role of microaspiration in the pathogenesis of reflux-related cough by determining the amount of lipid-laden macrophages (LLMs) in bronchoalveolar lavage (BAL) specimens. Methods A total of 161 cases of chronic cough were evaluated, and 36 patients (average age 48.2 years) were recruited for this single center prospective study. Patients with a history of smoking, angiotensin converting enzyme inhibitor usage, any abnormality on pulmonary function tests, abnormal chest X-rays, occupational or environmental exposures, or upper airway cough syndrome were excluded. GERD was evaluated by 24-hour esophageal impedance-pH monitoring. BAL specimens for LLM determination were obtained from 34 patients by flexible bronchoscopy. Results Patients with pathological intra-esophageal reflux according to multichannel intraluminal impedance and pH monitoring had higher LLM positivity in BAL specimens than patients without pathological reflux (8/14 in reflux positive group vs 1/22 in reflux negative group; P = 0.004). The BAL cell distribution was not different between the 2 groups (P = 0.574 for macrophages, P = 0.348 for lymphocytes, P = 0.873 for neutrophils and P = 0.450 for eosinophils). Conclusions Our results confirm the role of the microaspiration of refluxate in the pathogenetic mechanism of chronic cough. While bronchoscopy is indicated in patients with chronic cough, in addition to the routine airway evaluation, BAL and LLM detection should be performed. LLM can be used to diagnose aspiration in reflux-related chronic cough. Future studies are needed to evaluate the response to anti-reflux medications or surgery in patients with LLM positivity.
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Affiliation(s)
- Pelin Özdemir
- Department of Chest Diseases, Su Hospital, İzmir, Turkey.,Ege Reflux Study Group, Ege University School of Medicine, Izmir, Turkey
| | - Münevver Erdinç
- Ege Reflux Study Group, Ege University School of Medicine, Izmir, Turkey.,Department of Chest Diseases, Ege University School of Medicine, İzmir, Turkey
| | - Rukiye Vardar
- Ege Reflux Study Group, Ege University School of Medicine, Izmir, Turkey.,Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Ali Veral
- Department of Pathology, and 6Otolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Serdar Akyıldız
- Ege Reflux Study Group, Ege University School of Medicine, Izmir, Turkey.,Department of Otolaryngology, Ege University School of Medicine, İzmir, Turkey
| | - Özer Özdemir
- Department of Chest Diseases, Egepol Hospital, İzmir, Turkey
| | - Serhat Bor
- Ege Reflux Study Group, Ege University School of Medicine, Izmir, Turkey.,Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
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Efficacy of Magnetic Sphincter Augmentation versus Nissen Fundoplication for Gastroesophageal Reflux Disease in Short Term: A Meta-Analysis. Can J Gastroenterol Hepatol 2017; 2017:9596342. [PMID: 28466002 PMCID: PMC5390656 DOI: 10.1155/2017/9596342] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/20/2017] [Indexed: 12/12/2022] Open
Abstract
Background. The efficacy of Magnetic Sphincter Augmentation (MSA) and its outcomes for Gastroesophageal Reflux Disease (GERD) are uncertain. Therefore, we aimed to summarize and analyze the efficacy of two treatments for GERD. Methods. The meta-analysis search was performed, using four databases. All studies from 2005 to 2016 were included. Pooled effect was calculated using either the fixed or random effects model. Results. A total of 4 trials included 624 patients and aimed to evaluate the differences in proton-pump inhibitor use, complications, and adverse events. MSA had a shorter operative time (MSA and NF: RR = -18.80, 95% CI: -24.57 to -13.04, and P = 0.001) and length of stay (RR = -14.21, 95% CI: -24.18 to -4.23, and P = 0.005). Similar proton-pump inhibitor use, complication (P = 0.19), and severe dysphagia for dilation were shown in both groups. Although there is no difference between the MSA and NF in the number of adverse events, the incidence of postoperative gas or bloating (RR = 0.71, 95% CI: 0.54-0.94, and P = 0.02) showed significantly different results. However, there is no significant difference in ability to belch and ability to vomit. Conclusions. MSA can be recommended as an alternative treatment for GERD according to their short-term studies, especially in main-features of gas-bloating, due to shorter operative time and less complication of gas or bloating.
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Huang X, Chen S, Zhao H, Zeng X, Lian J, Tseng Y, Chen J. Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis. Surg Endosc 2016; 31:1032-1044. [PMID: 27495332 DOI: 10.1007/s00464-016-5111-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/11/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The efficacy of transoral incisionless fundoplication (TIF) performed with the EsophyX device (Redmond, Washington, USA) and its long-term outcomes in gastresophageal reflux disease (GERD) are debated. We, therefore, performed a systematic review with meta-analysis of studies evaluating the role of TIF in GERD. METHODS A systematic search of EMBASE, SCOPUS, PubMed, and the Cochrane Library Central was performed. All original studies reporting outcomes in GERD patients who underwent TIF were identified. Only randomized controlled trials (RCTs) evaluating the efficacy of TIF, and prospective observational studies reporting outcomes after TIF were included. RESULTS A total of 18 studies (963 patients) published between 2007 and 2015 were identified, including five RCTs and 13 prospective observational studies. The pooled relative risk of response rate to TIF versus PPIs/sham was 2.44 (95 % CI 1.25-4.79, p = 0.0009) in RCTs in the intention-to-treat analysis. The total number of refluxes was reduced after TIF compared with the PPIs/sham group. The esophageal acid exposure time and acid reflux episodes after TIF were not significantly improved. Proton-pump inhibitors (PPIs) usage increased with time and most of the patients resumed PPIs treatment at reduced dosage during the long-term follow-up. The total satisfaction rate after TIF was about 69.15 % in 6 months. The incidence of severe adverse events consisting of gastrointestinal perforation and bleeding was 2.4 %. CONCLUSIONS TIF is an alternative intervention in controlling GERD-related symptoms with comparable short-term patient satisfaction. Long-term results showed decreased efficacy with time. Patients often resume PPIs at reduced doses in the near future.
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Affiliation(s)
- Xiaoquan Huang
- Center of Evidence-Based Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Shiyao Chen
- Center of Evidence-Based Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Hetong Zhao
- Department of Traditional Chinese Medicine, Changhai Hospital, Shanghai, 200433, China
| | - Xiaoqing Zeng
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jingjing Lian
- Center of Evidence-Based Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yujen Tseng
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jie Chen
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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Punjabi P, Hira A, Prasad S, Wang X, Chokhavatia S. Review of gastroesophageal reflux disease (GERD) in the diabetic patient. J Diabetes 2015; 7:599-609. [PMID: 25706050 DOI: 10.1111/1753-0407.12279] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/18/2014] [Accepted: 02/07/2015] [Indexed: 12/13/2022] Open
Abstract
This article reviews the known pathophysiological mechanisms of comorbid gastroesophageal reflux disease (GERD) in the diabetic patient, discusses therapeutic options in care, and provides an approach to its evaluation and management. We searched for review articles published in the past 10 years through a PubMed search using the filters diabetes mellitus, GERD, pathophysiology, and management. The search only yielded a handful of articles, so we independently included relevant studies from these review articles along with related citations as suggested by PubMed. We found diabetic patients are more prone to developing GERD and may present with atypical manifestations. A number of mechanisms have been proposed to elucidate the connection between these two diseases. Studies involving treatment options for comorbid disease suggest conflicting drug-drug interactions. Currently, there are no published guidelines specifically for the evaluation and management of GERD in the diabetic patient. Although there are several proposed mechanisms for the higher prevalence of GERD in the diabetic patient, this complex interrelationship requires further research. Understanding the pathophysiology will help direct diagnostic evaluation. In our review, we propose a management algorithm for GERD in the diabetic patient.
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Affiliation(s)
- Paawan Punjabi
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Angela Hira
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Shanti Prasad
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Xiangbing Wang
- Division of Endocrinology, Department of Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Sita Chokhavatia
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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Reavis KM, Perry KA. Transoral incisionless fundoplication for the treatment of gastroesophageal reflux disease. Expert Rev Med Devices 2015; 11:341-50. [PMID: 24918903 DOI: 10.1586/17434440.2014.925394] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Gastroesophageal reflux disease (GERD) is a common and costly chronic medical condition affecting millions of patients. It is associated with substantial morbidity and negatively impacts quality of life. Reflux of gastric contents into the esophagus damages the esophageal mucosa and is associated with conditions including esophagitis and esophageal stricture. While GERD is most commonly seen in Western populations, changes in dietary patterns and the global increase in obesity have led to a pronounced increase in its prevalence worldwide. Medical and surgical GERD therapies are costly and pose considerable side effects, leading many to pursue effective endoscopic treatment options. Transoral incisionless fundoplication is an endoluminal procedure that offers patients a minimally invasive treatment option with the potential to eliminate the need for medical acid suppression with a low risk of side effects.
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Affiliation(s)
- Kevin M Reavis
- Esophageal and Foregut Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, 4805 NE Glisan Street, Ste 6N60, Portland, OR 97213, USA
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Bor S, Lazebnik LB, Kitapcioglu G, Manannikof I, Vasiliev Y. Prevalence of gastroesophageal reflux disease in Moscow. Dis Esophagus 2015; 29:159-65. [PMID: 25604401 DOI: 10.1111/dote.12310] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Limited data exist to determine the prevalence and clinical spectrum of gastroesophageal reflux disease (GERD) in the Russian population, which might be different from those in Western countries. This study was performed in Moscow on randomized 1065 adults aged ≥ 15 years. A validated reflux questionnaire comprising 72 questions and an additional 29 sub-questions were used. The questions assessed (heartburn and regurgitation) and related (dyspepsia, dysphagia, odynophagia and chest pain) symptoms, the triggering factors of these symptoms, family history and data on demographic and socioeconomic features. GERD was defined as heartburn and/or regurgitation once a week or common. Of the 1065 participants, 42.1% were male and 57.9% were female. The prevalences of frequent and occasional symptoms were 17.6 and 22.1% for heartburn and 17.5 and 21.8% for regurgitation, respectively, over the last 12 months. The prevalence of GERD was found to be 23.6%. The rate of GERD was significantly higher in females than in males (15.4 vs. 29.5%, P < 0.001) and significantly increased as the age of the participants increased (P = 0.011). GERD was present in 20.4% of smokers, 24.2% of coffee drinkers, 21.5% of alcohol consumers and 45.9% of stressed participants. Although the rate of alcohol consumers was lower in those with GERD compared with those without GERD, the rate of coffee drinkers and stressed participants was higher among those with GERD. The rate of additional symptoms was higher even in participants complaining of regurgitation/heartburn rarely, compared with those without complaints. Using the same questionnaire, which makes it possible to compare the present results with those from different countries, we found the prevalence of GERD in Moscow to be 23.6%, one of highest in the Western populations. The rates of heartburn and regurgitation were found to be similar, which constitutes a different result than has been found in similar studies. Additional symptoms should be assessed, in all GERD patients even in the presence of rare complaints of regurgitation/heartburn.
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Affiliation(s)
- S Bor
- Section of Gastroenterology & Ege Reflux Study Group, Ege University, Izmir, Turkey
| | - L B Lazebnik
- Central Research Institute of Gastroenterology, Moscow, Russia
| | - G Kitapcioglu
- Department of Biostatistics & Ege Reflux Study Group, Ege University, Izmir, Turkey
| | - I Manannikof
- Central Research Institute of Gastroenterology, Moscow, Russia
| | - Y Vasiliev
- Department of Pathology of Upper Digestive Tract, Moscow Clinical and Research Center, Moscow, Russia
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Promberger R, Lenglinger J, Riedl O, Seebacher G, Eilenberg W, Ott J, Riegler F, Gadenstätter M, Neumayer C. Gastro-oesophageal reflux disease in type 2 diabetics: symptom load and pathophysiologic aspects - a retro-pro study. BMC Gastroenterol 2013; 13:132. [PMID: 23972125 PMCID: PMC3765380 DOI: 10.1186/1471-230x-13-132] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 08/14/2013] [Indexed: 12/15/2022] Open
Abstract
Background Information about gastro-oesophageal reflux disease (GERD) in patients with Diabetes mellitus type 2 (T2D) is scarce, although the incidence of both disorders is increasing. We aimed to determine GERD symptoms and their underlying pathophysiologic characteristics in T2D patients. Methods This “retro-pro” study compared 65 T2D patients to a control group of 130 age- and sex-matched non-diabetics. GERD was confirmed by gastroscopy, manometry, pH-metry and barium swallow. Results In patients with T2D compared to controls, dysphagia (32.3% vs. 13.1%; p = 0.001) and globus sensation (27.7% vs. 13.8%; p = 0.021) were found more frequently, whereas heartburn (76.9% vs. 88.5%; p = 0.046) and regurgitation (47.7% vs. 72.3%; p = 0.001) were predominant in non-diabetics. Despite higher body mass indices (31.1 ± 5.2 vs. 27.7 ± 3.7 kg/m2; p < 0.001), hiatal hernia was less frequent in T2D patients compared to controls (60.0% vs. 90.8%, p < 0.001). Lower oesophageal sphincter (LES) pressure was higher in patients with T2D (median 10.0 vs. 7.2 mmHg, p = 0.016). DeMeester scores did not differ between the groups. Helicobacter pylori infections were more common in T2D patients (26.2% vs. 7.7%, p = 0.001). Barrett metaplasia (21.5% vs. 17.7%), as well as low- (10.8% vs. 3.8%) and high-grade dysplasia (1.5% vs. 0%) were predominant in T2D patients. Conclusions T2D patients exhibit different GERD symptoms, higher LES pressures and a decreased prevalence of hiatal hernia than non-diabetics, which may be related to worse oesophageal motility and, thus, a more functional rather than anatomical cause of GERD. Low-grade dysplasia was more than twice as high in T2D than in non-diabetics patients. Trial registration Ethics committee of the Medical University of Vienna, IRB number 720/2011.
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Abstract
BACKGROUND AND OBJECTIVES Diagnosing eosinophilic esophagitis (EoE) depends on intraepithelial eosinophil count of ≥15 eosinophils per high-power field (HPF); however, differentiating EoE from gastroesophageal reflux disease (GERD) continues to be a challenge because no true "criterion standard" criteria exist. Identifying clinical and endoscopic characteristics that distinguish EoE could provide a more comprehensive diagnostic strategy than the present criteria. The aim of the study was to determine symptoms and signs that can be used to distinguish EoE from reflux esophagitis. METHODS Adult and pediatric patients with EoE were identified by present diagnostic guidelines including an esophageal biopsy finding of ≥15 eosinophils/HPF. Patients with GERD were age-matched one to one with patients with EoE. Clinical, endoscopic, and histologic information at the time of diagnosis was obtained from the medical record and compared between pairs by McNemar test. A conditional logistic regression model was created using 6 distinguishing disease characteristics. This model was used to create a nomogram to differentiate EoE from reflux-induced esophagitis. RESULTS Patients with EoE were 75% men and 68% had a history of atopy. Many aspects of EoE were statistically distinct from GERD when controlling for age. Male sex, dysphagia, history of food impaction, absence of pain/heartburn, linear furrowing, and white papules were the distinguishing variables used to create the logistic regression model and scoring system based on odds ratios. The area under the curve of the receiver-operator characteristic curve for this model was 0.858. CONCLUSIONS EoE can be distinguished from GERD using a scoring system of clinical and endoscopic features. Prospective studies will be needed to validate this model.
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Abstract
BACKGROUND We investigated Quality of Life (QoL) and Johnsson & DeMeester score of patients after Nissen-Rossetti fundoplication. MATERIALS AND METHODS From January 2007 to June 2008, 43 patients with chronic gastroesophageal reflux underwent laparoscopic Nissen-Rossetti fundoplication; 7 were lost during the follow-up. Patients underwent endoscopy, 24-hour pH-metry, Gastroesophageal Reflux Disease-Health-Related Quality-of-Life (GERD-HRQL), and Short Form 36 (SF-36) questionnaires preoperatively, 6 months, and 12 months after surgery. RESULTS Endoscopic findings revealed complete healing of esophagitis in all patients. Barrett esophagus was still present. Six patients reported persistence of symptoms but postoperative pH-metry and endoscopy showed the absence of reflux; 2 patients (5.5%) were still on proton pump inhibitor therapy at 12 months. Seven patients (19.4%) reported dysphagia for solids for at least 3 months. Readmission for dysphagia was required for 2 (5.5%) and 1 patient underwent endoscopic dilatation. At 6 and 12 months, no dysphagia was reported. During the follow-up, no gas-bloat syndrome was reported. The Johnsson & DeMeester score and QoL measurement obtained from GERD-HRQL and SF-36 revealed a significant improvement in the related domain. At 6 months, 23 patients (63.8%) were completely satisfied and after 12 months, 30 patients (83.3%) were satisfied. CONCLUSIONS Nissen-Rossetti fundoplication is safe and effective for the treatment of GERD, improving QoL.
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Partial or total fundoplication (with or without division of the short gastric vessels): which is the best laparoscopic choice in GERD surgical treatment? Surg Laparosc Endosc Percutan Tech 2011; 20:371-7. [PMID: 21150412 DOI: 10.1097/sle.0b013e3181fd6990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) has emerged as one of the most common diseases in the modern civilization.The immense success of laparoscopic surgery as an effective treatment of GERD has established the minimally invasive surgery as the gold standard for this condition with lower morbidity and mortality, shorter hospital stay, faster recovery, and reduced postoperative pain. METHODS Articles were sourced from PubMed and Medline, using the MeSH terms "gastroesophageal reflux disease" and "laparoscopic surgery" and "fundoplication technique." The selection of articles was based on peer review, journal, relevance, and English language. RESULTS AND CONCLUSIONS There are some controversies with regard to the technique. First, whether total or partial fundoplication is the more appropriate treatment for GERD; second, if a total fundoplication (360 degrees) is performed, what is the effect of fundic mobilization and the division of short gastric vessels. In this review article the authors evaluate the most recent articles to establish the parameters for a "gold standard technique" in antireflux surgery.
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Roman S, Pandolfino JE. Environmental - lifestyle related factors. Best Pract Res Clin Gastroenterol 2010; 24:847-59. [PMID: 21126698 PMCID: PMC3582190 DOI: 10.1016/j.bpg.2010.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 09/24/2010] [Accepted: 09/30/2010] [Indexed: 02/08/2023]
Abstract
The prevalence of gastro-oesophageal reflux disease (GORD) has been increasing worldwide. This increase is likely associated with the increased prevalence of obesity, the ageing of the population and the decreased prevalence of Helicobacter pylori (Hp) infection. These different environmental factors interact with GORD pathogenesis in a potentially negative way. Oesophago-gastric junction (OGJ) competence, oesophageal clearance mechanisms and reflux causticity are involved in GORD pathophysiology. Obesity alters GORD pathogenesis by disrupting the OGJ and increasing intragastric pressure. Additionally, the number of transient lower oesophageal sphincter relaxations is potentially increased in obese patients. The potential effect of obesity on oesophageal peristalsis and the implication of impaired oesophageal clearance in GORD pathogenesis are still to establish. Ageing also plays an important role in GORD pathogenesis by decreasing lower oesophageal sphincter pressure and impairing oesophageal clearance. However a link between these abnormalities and an increased acid oesophageal exposure has not yet been demonstrated in the elderly. The role of H. pylori and its eradication remain controversial. The type of Hp gastritis may explain the controversial effect. Hp with antral predominant gastritis is responsible for an increased gastric acid secretion and thus promotes GORD. On the opposite spectrum, Hp with diffuse gastritis induces a gastric atrophy and in this particular case, the Hp eradication may restore acid secretion and lead to a more caustic refluxate in patients with predisposing conditions for GORD. The association of GORD and the type of Hp gastritis remains to be confirmed.
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Affiliation(s)
- Sabine Roman
- Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,Digestive Physiology, Lyon 1 University and Hospices Civils de Lyon, Lyon, France
| | - John E Pandolfino
- Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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15
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Yuen E, Romney M, Toner RW, Cobb NM, Katz PO, Spodik M, Goldfarb NI. Prevalence, knowledge and care patterns for gastro-oesophageal reflux disease in United States minority populations. Aliment Pharmacol Ther 2010; 32:645-54. [PMID: 20629972 DOI: 10.1111/j.1365-2036.2010.04396.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND While there is evidence of ethnic variation in the prevalence of gastro-oesophageal reflux disease (GERD) symptoms, few population-based studies examine GERD symptom prevalence amongst the growing Hispanic minority in the US as well as Asians in the West. AIM To examine the prevalence, awareness and care patterns for GERD across different ethnic groups. METHODS A population-based, cross-sectional survey was fielded in English, Chinese and Spanish that assessed self-reported GERD prevalence, awareness and care patterns in four ethnic groups (Caucasian, African American, Asian, Hispanic). RESULTS A total of 1172 subjects were included for analysis: 34.6% experienced GERD symptoms at least monthly, 26.2% at least weekly and 8.2% at least daily. Statistically significant differences in raw prevalence rates between racial groups were found: 50% of Hispanics experienced heartburn at least monthly, compared with 37% of Caucasians, 31% of African Americans and 20% of Asians (P > 0.0001). Significant differences in knowledge and care-seeking patterns by ethnicity were also observed. CONCLUSIONS This study confirms the high prevalence of GERD symptoms in the US and introduces Hispanics as the ethnicity with the highest prevalence rate. Asians in the US have higher rates of symptoms than in the Far East. These data demonstrate a need for culturally appropriate education about GERD symptoms and treatment.
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Affiliation(s)
- E Yuen
- Thomas Jefferson University, Philadelphia, PA 19107, USA.
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16
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Riedl O, Gadenstätter M, Lechner W, Schwab G, Marker M, Ciovica R. Preoperative lower esophageal sphincter manometry data neither impact manifestations of GERD nor outcome after laparoscopic Nissen fundoplication. J Gastrointest Surg 2009; 13:1189-97. [PMID: 19370381 DOI: 10.1007/s11605-009-0890-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 03/29/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Experience with laparoscopic antireflux surgery (LARS) in patients with gastroesophageal reflux disease (GERD) and manometrically intact lower esophageal sphincter (LES) is limited. The disease pattern may be different and LARS may fail to control reflux or result in higher rates of dysphagia. This is the first study investigating the impact of preoperative LES manometry data not only on manifestations of GERD and subjective outcome alone but also on objective outcomes 1 year after LARS. METHODS Three hundred fifty-one GERD patients underwent LARS and had subjective symptom and quality of life assessment, upper gastrointestinal endoscopy, barium swallow esophagogram, 24-h esophageal pH monitoring, and manometry pre- and 1 year postoperatively. Patients were divided into those with a preoperatively intact versus defective LES based on intraabdominal length and resting pressure. Baseline and 1-year postoperative follow-up data were compared. RESULTS Preoperative manifestations of GERD were similar in each group. Postoperatively, all symptoms except flatulence, quality of life scores, and objective manifestations improved significantly in each group. CONCLUSIONS The preoperative manometric character of the LES neither impacts the manifestations of GERD nor subjective and objective outcomes after LARS. Patients with GERD and manometrically intact LES have no higher risk for postoperative dysphagia.
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Affiliation(s)
- Otto Riedl
- Department of Surgery, General Hospital of Krems, Krems, Austria.
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17
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McMahon BP, Jobe BA, Pandolfino JE, Gregersen H. Do we really understand the role of the oesophagogastric junction in disease? World J Gastroenterol 2009; 15:144-50. [PMID: 19132763 PMCID: PMC2653305 DOI: 10.3748/wjg.15.144] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 11/18/2008] [Accepted: 11/25/2008] [Indexed: 02/06/2023] Open
Abstract
The role of the oesophago-gastric junction (OGJ) in gastro-oesophageal reflux disease is still not completely understood, and there is no clinically used method to assess the OGJ function in patients. Only indirect methods such as pH studies are carried out. The OGJ acts a valve controlling the flow of solids, liquids and gases between the oesophagus and the stomach. Manometry can determine if a sphincter is toned or relaxed; but, it cannot confirm that the sphincter region is actually open. Distension is a new technique for measuring function in the OGJ. By measuring the cross-sectional area through the narrow region in the junction during distension of a catheter mounted bag, much more information on the opening and closing patterns of the junction can be determined. This technique has already been demonstrated to show changes in the OGJ after surgical treatments for reflux disease. New measurement ideas around the concept of distending the OGJ offer new hope that a clinically useable test for compliance at the junction can be developed and could potentially help in determining appropriate therapy.
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18
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Biomechanics of the esophagogastric junction in gastroesophageal reflux disease. Curr Gastroenterol Rep 2008; 10:246-51. [PMID: 18625134 DOI: 10.1007/s11894-008-0051-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Gastroesophageal reflux is inherently mechanical in nature, driven by the pressure difference between the stomach and the esophagus in the setting of a relaxed or hypotensive sphincter. Recent advances in our understanding of esophagogastric junction (EGJ) biomechanics in the etiology of gastroesophageal reflux disease are highlighted here. We focus this review on three critical areas: the anatomy and physiology of the EGJ that predispose the junction to reflux, the mechanical compliance of the EGJ musculature that has significant pathophysiologic underpinnings, and the trans-sphincteric pressure gradients during gastroesophageal reflux. We also examine the mechanistic basis of a higher incidence of reflux in obese patients and conclude with some observations on the future of understanding EGJ biomechanics.
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