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Nocturnal Gastroesophageal Reflux Disease (GERD) and Sleep: An Important Relationship That Is Commonly Overlooked. J Clin Gastroenterol 2020; 54:663-674. [PMID: 32657961 DOI: 10.1097/mcg.0000000000001382] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastroesophageal reflux disease (GERD) is a prevalent, chronic medical condition that affects 13% of the adult population globally at least once a week. Sleep disturbances are frequently encountered in up to 25% of the GERD patients, likely due to nocturnal gastroesophageal reflux (GER). With advance in diagnostic techniques allowing for an improved understanding of involved physiological mechanisms of nocturnal reflux, there is growing evidence of a bidirectional relationship between GERD and sleep disturbances. Furthermore, nocturnal GER is associated with more complicated GERD. Obstructive sleep apnea (OSA) and GERD also have been linked, but to what degree remains controversial. Treatment of nocturnal GER has been shown to improve both subjective and objective sleep measures. The therapeutic approach includes lifestyle modifications and medication individualization and optimization with proton-pump inhibitors serving as the mainstay of treatment. Antireflux surgery and newer endoscopic procedures have been demonstrated to control nocturnal GER.
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Wang YJ, Lang XQ, Wu D, He YQ, Lan CH, Xiao X, Wang B, Zou DW, Wu JM, Zhao YB, Dettmar PW, Chen DF, Yang M. Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related Disorders. J Neurogastroenterol Motil 2020; 26:74-84. [PMID: 31650768 PMCID: PMC6955190 DOI: 10.5056/jnm19032] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/14/2019] [Accepted: 07/23/2019] [Indexed: 12/13/2022] Open
Abstract
Background/Aims To determine the value of salivary pepsin in discriminating sub-types of gastroesophageal reflux disease (GERD) and GERD-related disorders. Methods Overall, 322 patients with different sub-types of GERD and 45 healthy controls (HC) were studied. All patients took Gastroesophageal Reflux Disease Questionnaire (GerdQ) and underwent endoscopy and 24-hour esophageal pH monitoring and manometry. Salivary pepsin concentration (SPC) was detected by using colloidal gold double-antibody immunological sandwich assay. Oral esomeprazole treatment was administrated in the patients with non-erosive reflux disease (NERD) and extra-esophageal symptoms (EES). Results Compared to HC, patients with erosive esophagitis, NERD, EES, EES plus typical GERD symptoms, or Barrett’s esophagus had a higher prevalence of saliva and SPC (all P < 0.001). There was no significant difference in the positive rate for pepsin in patients with functional heartburn or GERD with anxiety and depression, compared to HC. After esomeprazole treatment, the positive rate and SPC were significantly reduced in NERD (both P < 0.001) and in EES (P = 0.001 and P = 0.002, respectively). Of the 64 NERD patients, 71.9% (n = 46) were positive for salivary pepsin, which was significantly higher than the rate (43.8%, n = 28) of pathological acid reflux as detected by 24-hour esophageal pH monitoring (P = 0.002). Conclusions Salivary pepsin has an important significance for the diagnosis of GERD and GERD-related disorders. Salivary pepsin and 24-hour esophageal pH monitoring may complement with each other to improve the diagnostic efficiency.
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Affiliation(s)
- Yan-Jun Wang
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Xiu-Qiong Lang
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Dan Wu
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Yu-Qin He
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Chun-Hui Lan
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Xiao Xiao
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Bin Wang
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Duo-Wu Zou
- Department of Gastroenterology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ji-Min Wu
- Department of Gastroenterology, Department of Gastroesophageal Reflux Disease, PLA Rocket Force General Hospital, Beijing, China
| | - Yong-Bin Zhao
- Department of Gastroenterology, Xinqiao Hospital, Chongqing, China
| | | | - Dong-Feng Chen
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
| | - Min Yang
- Department of Gastroenterology, Daping Hospital, Army Medical Center of PLA, Army Medical University, Chongqing, China
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