Gastroesophageal Reflux Disease and Aerodigestive Disorders

Extraesophageal reflux and reflux aspiration in dogs with respiratory diseases and in healthy dogs

BACKGROUND

Salivary bile acids are used to diagnose extraesophageal reflux (EER) and to evaluate the risk of reflux aspiration that is associated with respiratory diseases in dogs.

OBJECTIVES

To study total bile acid (TBA) concentrations in saliva and in bronchoalveolar lavage fluid (BALF) to investigate EER and reflux aspiration in dogs with respiratory diseases and in healthy dogs.

ANIMALS

 Thirty-one West Highland White Terriers (WHWTs) with idiopathic pulmonary fibrosis (IPF), 12 dogs with inflammatory airway disease (IAD), 6 dogs with recurrent pneumonia (RP), 26 brachycephalic dogs (BD), 27 healthy WHWTs (HW), 52 healthy dogs (HD). All privately-owned dogs.

METHODS

Saliva and BALF were collected from dogs in each group.

RESULTS

Salivary TBA concentrations were higher in IPF (median 0.1692 μM, interquartile range [IQR] 0.1115-0.2925 μM, Cohen's d 3.4, 95% confidence interval [CI] 2.2-4.0, P < .001) and BD (0.0256 μM, IQR 0.0086-0.0417 μM, d 0.5, CI -0.1 to 1.1, P = .003) compared to HD (0 μM, IQR not quantifiable [n.q.]-0.0131 μM). Bronchoalveolar lavage fluid TBA concentrations were higher in IPF (0.0117 μM, IQR 0.0048-0.0361 μM, d 0.5, CI 0-1.1, P < .001) compared to HD (0 μM, IQR n.q.-0.0074 μM).

CONCLUSION AND CLINICAL IMPORTANCE

Extraesophageal reflux and reflux aspiration occur in healthy dogs and those with respiratory diseases.

The Role of Pediatric Gastroenterologists in the Evaluation of Complex Aerodigestive Disorders

PURPOSE OF REVIEW

Children with aerodigestive disorders frequently have concerns regarding difficulty breathing, swallowing, and growing. In this review, we explored the role of pediatric gastroenterologists in the evaluation of complex aerodigestive disorders and the overall approach to these often-challenging patients.

RECENT FINDINGS

Pediatric gastroenterologists evaluate children with aerodigestive concerns ranging from dysphagia and gastroesophageal reflux to complex congenital abnormalities such as esophageal atresia. Diagnostic tools, such as multichannel intraluminal impedance-pH monitoring, are used for diagnosing gastroesophageal reflux and assessing the correlation with symptoms. Endoscopic evaluation, and in some complex cases, with therapeutic dilations may also be performed. Gastrointestinal dysmotility evaluation with manometry studies are also being increasingly utilized. Multidisciplinary aerodigestive programs can provide a coordinated approach to children with complex airway, pulmonary and gastrointestinal tract disorders. A pediatric gastroenterologist's expertise and specialized skills not only offer many diagnostic tools for these complicated medical cases but are also important in long term medical management.

Efficacy of Two Toothpaste in Preventing Tooth Erosive Lesions Associated with Gastroesophageal Reflux Disease

Patients suffering from acid reflux due to endogenous causes are often affected by gastroesophageal reflux disease which, in the oral environment, causes lingual and palatal enamel erosion. As enamel does not have the intrinsic ability to repair itself, the application of alloplastic materials, such as toothpastes is suggestable. The aim of this “in vitro” study was to compare the effectiveness of two different toothpastes in preventing erosion due to gastroesophageal reflux disease. Six tooth elements from bovine jaws were prepared using a high-speed diamond bur and water irrigation. Acid attack simulation was carried out using a 15% HCl hydrochloric acid solution. After that, two different toothpastes with or without fluoride, were brushed at the sample surface using an electric toothbrush at standard position and force. SEM and profilometer analysis were performed. Statistically significant difference was found in average tooth surface roughness after using toothpaste with or without fluoride after the acid attack, as the former offered a greater remineralization. No difference was found in long-term prevention. Fluoridated toothpastes offer a greater degree of remineralization at a first acid attack, however, there is no difference in long-term prevention independently from the toothpaste type.

Efficacy and Safety of Esomeprazole for the Treatment of Reflux Symptoms in Patients with Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis

Background:

We investigated the efficacy of esomeprazole for the treatment of gastroesophageal reflux disease (GERD) in a meta-analysis of clinical trials results.

Methods:

Medline, Embase, PubMed and Web of Science databases were systematically searched for suitable studies, and double-blind, randomized controlled trials (RCTs) were involved. A meta-analysis of RCTs was performed to analyze the efficacy of esomeprazole on clinical outcomes that associated with the severity of GERD.

Results:

A total of 8 clinical trials were selected in our meta-analysis (N=4495, patients with GERD). Esomeprazole treatment yielded a significant improvement in clinical signs and symptoms of GERD compared to placebo group. Funnel plot and Egger test showed there was no significant bias in the publication. Cochrane collaboration tool and Jadad scale were used to indicate that all 8 RCTs were of high quality. The results of Galbraith radial plot showed that no study was the major source of heterogeneity. Esomeprazole treatment significantly decreased the relapse rates more than that of placebo group (RR = 0.729; 95% CI: 0.670 to 0.794; P<0.001). It seems to be lower rates of heartburn (RR = 0.747; 95%CI: 0.665–0.839; P <0.001) and epigastric pain (RR = 0.795; 95%CI: 0.679–0.932; P =0.005) in esomeprazole-treated group compared with the placebo group. Moreover, serious adverse events was less likely to happen after esomeprazole therapy (RR = 1.406, 95% CI: 1.030–1.918; P =0.032).

Conclusion:

Compared with the control group, esomeprazole is a promising therapeutic agent that improves the management of patients with GERD.