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Veerman GDM, Hurkmans DP, Paats MS, Oomen-de Hoop E, van der Leest CH, van Thiel ERE, Aerts JGJV, van Leeuwen RW, Dingemans AMC, Mathijssen RHJ. Influence of esomeprazole on the bioavailability of afatinib: A pharmacokinetic cross-over study in patients with non-small cell lung cancer. Biomed Pharmacother 2022; 155:113695. [PMID: 36126454 DOI: 10.1016/j.biopha.2022.113695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/25/2022] Open
Abstract
Afatinib is an oral small-molecule kinase inhibitor (SMKI) approved for treatment of metastatic non-small cell lung cancer (NSCLC) with an epidermal growth factor receptor (EGFR) driver mutation. Although oral administration is convenient, most SMKIs experience pH-dependent solubility. A drug-drug interaction between afatinib and proton-pump inhibitors (PPIs) has, however, never been studied in humans. Hence, we performed a randomized, three-period cross-over study. Afatinib (30 mg or 40 mg) was administered without PPI (period A), concomitantly with esomeprazole (period B) and three hours after esomeprazole intake (period C). Primary objective was the area under the curve (AUC0-24 h) comparing period A to period B and period A to period C. Secondary objectives were other pharmacokinetic parameters and toxicity. Linear mixed effect modelling was performed for differences in AUC0-24 h and Cmax between periods A and B and periods A and C. In 18 evaluable NSCLC patients, concomitant use of 40 mg esomeprazole decreased the steady-state afatinib AUC0-24 h with 10.2% (95% CI -29.2 to +14.0%; p = 0.564) compared to afatinib administration without PPI. Esomeprazole intake three hours prior to afatinib did not significantly influence afatinib AUC0-24 h (-0.6%; 95% CI -14.9 to +16.1%; p = 1.0). No differences in toxicity were observed. To conclude, esomeprazole did not change the exposure to afatinib in patients with NSCLC. Since there is no clinically relevant drug-drug interaction, esomeprazole can safely be co-administered with afatinib. This is important for clinical practice, because other EGFR-SMKIs (e.g. erlotinib and gefitinib) do experience clinically relevant drug-drug interactions with acid-suppressive agents.
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Affiliation(s)
- G D Marijn Veerman
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - Daan P Hurkmans
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Marthe S Paats
- Dept. of Pulmonology, Erasmus MC, Rotterdam, the Netherlands
| | - Esther Oomen-de Hoop
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - Eric R E van Thiel
- Dept. of Pulmonology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | - Roelof W van Leeuwen
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands; Dept. of Hospital Pharmacy, Erasmus MC, Rotterdam, the Netherlands
| | | | - Ron H J Mathijssen
- Dept. of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Sugano K, Spechler SJ, El-Omar EM, McColl KEL, Takubo K, Gotoda T, Fujishiro M, Iijima K, Inoue H, Kawai T, Kinoshita Y, Miwa H, Mukaisho KI, Murakami K, Seto Y, Tajiri H, Bhatia S, Choi MG, Fitzgerald RC, Fock KM, Goh KL, Ho KY, Mahachai V, O'Donovan M, Odze R, Peek R, Rugge M, Sharma P, Sollano JD, Vieth M, Wu J, Wu MS, Zou D, Kaminishi M, Malfertheiner P. Kyoto international consensus report on anatomy, pathophysiology and clinical significance of the gastro-oesophageal junction. Gut 2022; 71:1488-1514. [PMID: 35725291 PMCID: PMC9279854 DOI: 10.1136/gutjnl-2022-327281] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/03/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE An international meeting was organised to develop consensus on (1) the landmarks to define the gastro-oesophageal junction (GOJ), (2) the occurrence and pathophysiological significance of the cardiac gland, (3) the definition of the gastro-oesophageal junctional zone (GOJZ) and (4) the causes of inflammation, metaplasia and neoplasia occurring in the GOJZ. DESIGN Clinical questions relevant to the afore-mentioned major issues were drafted for which expert panels formulated relevant statements and textural explanations.A Delphi method using an anonymous system was employed to develop the consensus, the level of which was predefined as ≥80% of agreement. Two rounds of voting and amendments were completed before the meeting at which clinical questions and consensus were finalised. RESULTS Twenty eight clinical questions and statements were finalised after extensive amendments. Critical consensus was achieved: (1) definition for the GOJ, (2) definition of the GOJZ spanning 1 cm proximal and distal to the GOJ as defined by the end of palisade vessels was accepted based on the anatomical distribution of cardiac type gland, (3) chemical and bacterial (Helicobacter pylori) factors as the primary causes of inflammation, metaplasia and neoplasia occurring in the GOJZ, (4) a new definition of Barrett's oesophagus (BO). CONCLUSIONS This international consensus on the new definitions of BO, GOJ and the GOJZ will be instrumental in future studies aiming to resolve many issues on this important anatomic area and hopefully will lead to better classification and management of the diseases surrounding the GOJ.
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Affiliation(s)
- Kentaro Sugano
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Stuart Jon Spechler
- Division of Gastroenterology, Center for Esophageal Diseases, Baylor University Medical Center, Dallas, Texas, USA
| | - Emad M El-Omar
- Microbiome Research Centre, St George & Sutherland Clinical Campuses, School of Clinical Medicine, Faculty of Medicine & Health, Sydney, New South Wales, Australia
| | - Kenneth E L McColl
- Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kaiyo Takubo
- Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
| | - Haruhiro Inoue
- Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | | | - Hiroto Miwa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Kobe, Japan
| | - Ken-Ichi Mukaisho
- Education Center for Medicine and Nursing, Shiga University of Medical Science, Otsu, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Oita University Faculty of Medicine, Yuhu, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hisao Tajiri
- Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | | | - Myung-Gyu Choi
- Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, The Republic of Korea
| | - Rebecca C Fitzgerald
- Medical Research Council Cancer Unit, Hutchison/Medical Research Council Research Centre, University of Cambridge, Cambridge, UK
| | - Kwong Ming Fock
- Department of Gastroenterology and Hepatology, Duke NUS School of Medicine, National University of Singapore, Singapore
| | | | - Khek Yu Ho
- Department of Medicine, National University of Singapore, Singapore
| | - Varocha Mahachai
- Center of Excellence in Digestive Diseases, Thammasat University and Science Resarch and Innovation, Bangkok, Thailand
| | - Maria O'Donovan
- Department of Histopathology, Cambridge University Hospital NHS Trust UK, Cambridge, UK
| | - Robert Odze
- Department of Pathology, Tuft University School of Medicine, Boston, Massachusetts, USA
| | - Richard Peek
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Massimo Rugge
- Department of Medicine DIMED, Surgical Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Jose D Sollano
- Department of Medicine, University of Santo Tomas, Manila, Philippines
| | - Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Friedrich-Alexander University Erlangen, Nurenberg, Germany
| | - Justin Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Duowu Zou
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Peter Malfertheiner
- Medizinixhe Klinik und Poliklinik II, Ludwig Maximillian University Klinikum, Munich, Germany
- Klinik und Poliklinik für Radiologie, Ludwig Maximillian University Klinikum, Munich, Germany
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Singhartinger FX, Wahl L, Weitzendorfer M, Gantschnigg A, Koch OO, Emmanuel K. The role of hormones in symptoms and pathophysiology of reflux and esophageal motility disorders. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022. [PMID: 35697064 DOI: 10.1055/a-1833-9494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE A few studies suggest that hormones play a role in the motility of the lower esophagus, but data is rare. In this prospective study we evaluated the correlation between hormones (TSH, fT3, fT4, calcitonin, gastrin, and VIP) and gastroesophageal reflux disease (GERD), esophageal motility disorders, and gastrointestinal symptoms. METHODS 100 consecutive patients with reflux symptoms and dysphagia were hospitalized for diagnostic evaluation. Self-reporting questionnaires were handed out and patients routinely underwent serum analysis (TSH, fT3, fT4, calcitonin, gastrin, and VIP), 24-hour-pH-impendance monitoring, and high-resolution manometry. RESULTS Motility disorders were found in 38 out of 86 patients. There were no correlations between hormones, the DeMeester Score, and the lower esophageal sphincter pressure. A strong inverse relation between calcitonin and the Integrated Relaxation Pressure of the esophagogastric junction was found (r=-0.492; p<0.001). No correlations were found between hormone levels and the responses given in the questionnaires. Positive correlations, however, were found between VIP and gastrointestinal symptoms, as well as correlations between fT3 and dysphagia. Within the group with minor motility disorders, TSH and fT4 correlated with outcomes of the SCL-questionnaire. fT4 correlated with the typical symptoms, as well as the gastrointestinal symptoms (diarrhea, constipation, flatulence). TSH correlated with the typical symptoms. Moreover, a correlation between VIP and gas-bloat-symptoms was found within group II CONCLUSIONS: No correlation between TSH, fT3, fT4, gastrin, VIP, calcitonin, and GERD in the sense of acid reflux was found, although calcitonin seems to have an effect on the lower esophageal sphincter.
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Affiliation(s)
| | - Lisa Wahl
- Internal Medicine, Salzkammergut-Klinikum Gmunden, Gmunden, Austria
| | | | | | - Oliver Owen Koch
- Department for Surgery, University Hospital Salzburg, Salzburg, Austria
| | - Klaus Emmanuel
- Department for Surgery, University Hospital Salzburg, Salzburg, Austria
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Lupu VV, Miron I, Tarca E, Trandafir LM, Anton-Paduraru DT, Moisa SM, Starcea M, Cernomaz A, Miron L, Lupu A. Gastroesophageal Reflux in Children with Asthma. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030336. [PMID: 35327708 PMCID: PMC8947462 DOI: 10.3390/children9030336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022]
Abstract
Background: Nowadays it is considered that a specific causal relationship exists between asthma and gastroesophageal reflux (GER), because of the aspiration of gastric refluate which leads to and maintain spasticity even real crisis of paroxystic expiratory dyspnea. This study explores this relationship and evaluates the results after treatment. Methods: 56 children diagnosed with asthma, hospitalized in a regional center of pediatric gastroenterology in Northeast Romania, underwent 24-hour continuous esophageal pH monitoring in order to establish the presence of GER. The Boix-Ochoa score was used to interpret the results. Proton pump inhibitors were administered to those with GER and the patients were reevaluated after 2 months. Results: 39 patients (69.64%) had GER, with a Boix-Ochoa score above normal (N < 11.99), and 17 patients (30.36%) had normal score. After administering proton pump inhibitors for 2 months, 7 patients still had high Boix-Ochoa score (17.95%). The result of this analysis shows that the presence of asthma increases the chance of GER by 2.86 times. Conclusions: In children with asthma we have to look for GER in order to treat, because it can help the treatment of asthma or even solve some cases resistant to standard treatment.
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Affiliation(s)
- Vasile Valeriu Lupu
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.V.L.); (I.M.); (L.M.T.); (D.-T.A.-P.); (M.S.); (A.L.)
| | - Ingrith Miron
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.V.L.); (I.M.); (L.M.T.); (D.-T.A.-P.); (M.S.); (A.L.)
| | - Elena Tarca
- Department of Surgery II—Pediatric Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (E.T.); (S.M.M.); (A.C.)
| | - Laura Mihaela Trandafir
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.V.L.); (I.M.); (L.M.T.); (D.-T.A.-P.); (M.S.); (A.L.)
| | - Dana-Teodora Anton-Paduraru
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.V.L.); (I.M.); (L.M.T.); (D.-T.A.-P.); (M.S.); (A.L.)
| | - Stefana Maria Moisa
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.V.L.); (I.M.); (L.M.T.); (D.-T.A.-P.); (M.S.); (A.L.)
- Correspondence: (E.T.); (S.M.M.); (A.C.)
| | - Magdalena Starcea
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.V.L.); (I.M.); (L.M.T.); (D.-T.A.-P.); (M.S.); (A.L.)
| | - Andrei Cernomaz
- 3rd Medical Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Correspondence: (E.T.); (S.M.M.); (A.C.)
| | - Lucian Miron
- 3rd Medical Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Ancuta Lupu
- Pediatrics Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (V.V.L.); (I.M.); (L.M.T.); (D.-T.A.-P.); (M.S.); (A.L.)
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Lupu VV, Miron IC, Lupu A, Moscalu M, Mitrofan EC, Munteanu D, Luca AC. The relationship between gastroesophageal reflux disease and recurrent wheezing in children. Medicine (Baltimore) 2021; 100:e27660. [PMID: 34964728 PMCID: PMC8615307 DOI: 10.1097/md.0000000000027660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/09/2021] [Indexed: 11/25/2022] Open
Abstract
Gastroesophageal reflux disease occurs when gastric contents flow back into the esophagus and produce symptoms. Recurrent wheezing affects the quality of life for the patient and family. The association of gastroesophageal reflux with recurrent wheezing is suggested by different studies. The purpose of this study was to explore this relationship and to evaluate the outcome after appropriate treatment.A retrospective study on 85 children with recurrent wheezing, admitted in a pediatric gastroenterology regional center in Romania was performed. 24-hour continuous esophageal pH monitoring was used to evaluate the presence of gastroesophageal reflux and the results were interpreted using the Boix Ochoa score. All patients with positive score received treatment with proton pump inhibitors and they were evaluated again after 2 months.Gastroesophageal reflux was present in 71 children (83.5%), while 14 (16.5%) had a negative score, with a statistic significance (χ2 = 6.88, P = .0086, 95% confidence interval). After 2 months treatment with proton pump inhibitors, the Boix Ochoa score was still positive in 15 patients (21.13%).Recurrent wheezing is a solid reason for evaluating the presence of gastroesophageal reflux by 24-hour continuous esophageal pH-metry. Adequate treatment of gastroesophageal reflux solves also the recurrent wheezing in the majority of patients.
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Affiliation(s)
| | | | - Ancuta Lupu
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Mihaela Moscalu
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | | | - Dragos Munteanu
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
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Zhu Y, Tang J, Shi W, Wang S, Wu M, Lu L, Zhang M, Wen S, Shi C, Yu L, Xu X. Can acid exposure time replace the DeMeester score in the diagnosis of gastroesophageal reflux-induced cough? Ther Adv Chronic Dis 2021; 12:20406223211056719. [PMID: 34777741 PMCID: PMC8586183 DOI: 10.1177/20406223211056719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022] Open
Abstract
Background: The objective of this study was to compare the predictive accuracy of the acid exposure time (AET) with the DeMeester score (DMS) for gastroesophageal reflux–induced cough (GERC). Methods: A total of 277 patients who underwent multichannel intraluminal impedance pH monitoring (MII-pH) were enrolled, and their clinical information and laboratory results were retrospectively analyzed. The diagnostic value of AET for GERC was compared with that of the DMS, symptom association probability (SAP), and symptom index (SI). Results: A total of 236 patients met the inclusion criteria, 150 patients (63.65%) were definitely diagnosed with GERC, including 111(74%) acid GERC and 39 (26%) nonacid GERC. The optimal cutoff value of AET for diagnosing GERC was AET > 4.8%, and its diagnostic value was equal to that of DMS > 14.7 (AUC = 0.827 versus 0.818, p = 0.519) and was superior to that of SAP (AUC = 0.827 versus 0.689, p = 0.000) and SI (AUC = 0.827 versus 0.688, p = 0.000). When using both DMS > 14.7 and AET > 4.8% or either of the two for the diagnosis of GERC, the diagnosis rate was not improved over using DMS > 14.7 alone. The diagnostic value of AET and DMS for acid GERC were both high and equivalent (AUC = 0.925 versus 0.922, p = 0.95). The optimal cutoff value of AET for diagnosing acid GERC was AET > 6.2%. Conclusion: AET and DMS are both equal in discriminating GERC. A GERC diagnosis should be considered when AET > 4.8%, whereas an acid GERC diagnosis should be considered when AET > 6.2%.
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Affiliation(s)
- Yiqing Zhu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Junjun Tang
- Department of Radiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wenbo Shi
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shengyuan Wang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mingyan Wu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lihua Lu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mengru Zhang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Siwan Wen
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Cuiqin Shi
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Li Yu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai 200065, China
| | - Xianghuai Xu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai 200065, China
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Gupta P, Sankar J, Kumar BK, Jat KR, Mukherjee A, Kapil A, Kabra SK, Lodha R. Twenty-Four-Hour Esophageal pH Measurement in Mechanically Ventilated Children: A Prospective Cohort Study. Pediatr Crit Care Med 2021; 22:e203-e212. [PMID: 33534390 DOI: 10.1097/pcc.0000000000002664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To assess the prevalence of gastroesophageal reflux in mechanically ventilated children using 24-hour esophageal pH-metry and its role as a risk factor for ventilator-associated pneumonia. DESIGN Prospective cohort study. SETTING PICU of a tertiary care hospital from North India. PATIENTS Mechanically ventilated children 1-15 years old in PICU from July 2015 to June 2017, excluding those receiving acid suppressants, known cases of gastroesophageal reflux disease, having upper gastrointestinal bleed. INTERVENTION Demographic details, baseline investigations, diagnosis, treatment details, and Pediatric Risk of Mortality III score were recorded at enrollment. Gastroesophageal reflux was evaluated using 24-hour esophageal pH-metry. Children were followed up for 7 days or 48 hours after extubation for development of ventilator-associated pneumonia using Centers for Disease Control and Prevention criteria. Pathologic acidic gastroesophageal reflux was defined as fall in esophageal pH less than 4 for more than 4% of total time, whereas pathologic alkaline gastroesophageal reflux as rise in esophageal pH greater than 7 for more than 17% of total time. MEASUREMENTS AND MAIN RESULTS Sixty-one children (median [interquartile range], age 73 mo [30-132 mo]; 44 boys [72%]) were enrolled. Median Pediatric Risk of Mortality III score was 10.0 (3-16). Median duration of ventilation was 6 days (3-9 d). Pathologic gastroesophageal reflux (acidic or alkaline) was present in 47 children (77%). Twelve children (19.7%) met criteria for pathologic acidic gastroesophageal reflux, whereas 44 children (72.1%) had pathologic alkaline gastroesophageal reflux; nine children (14.7%) had both pathologic acidic and alkaline gastroesophageal reflux. Of the enrolled children, 17 (27.9 %) developed ventilator-associated pneumonia. No patient had both pathologic acidic gastroesophageal reflux and ventilator-associated pneumonia. Of 17 children who developed ventilator-associated pneumonia, 12 (70.5%) had pathologic alkaline gastroesophageal reflux as compared to 32 children (72.7%) among the 44 children who did not develop ventilator-associated pneumonia (p = 0.87). CONCLUSIONS The current study shows high incidence of gastroesophageal reflux on 24-hour esophageal pH-metry in mechanically ventilated children with medical diagnoses. The significance of this finding and its impact on ventilator-associated pneumonia and other ventilator-associated events need to be examined in larger studies.
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Affiliation(s)
- Priyanka Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - B Kiran Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Aparna Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Manifestations of ENT Caused By Gastroesophageal Reflux Disease. ARS MEDICA TOMITANA 2021. [DOI: 10.2478/arsm-2021-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction. The presence of gastric reflux in the pharynx and larynx causes reflux laryngopharyngitis. The incidence of laryngopharyngeal reflux has increased dramatically in recent years, but with the introduction of flexible fiber optic esophagoscopy, evidence-based research on gastroesophageal reflux disease has evolved greatly. Laryngoscopy is the main investigation to be performed to establish the diagnosis of reflux.
Material and methods. This study is both retrospective and prospective, the first being performed on a group of 175 patients, who presented in the ENT outpatient clinic, within the County Emergency Clinical Hospital “St. Andrew the Apostle” Constanta.
The aim of this paper is to evaluate and compare the manifestations of ENT caused by reflux disease but also to establish the correct therapeutic conduct.
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Abstract
Gastroesophageal reflux disease (GERD) is a common chronic disorder in industrialized countries. Gastroesophageal reflux disease is one of the most frequent diseases encountered by primary care providers. The primary symptoms of GERD include heartburn, regurgitation, globus sensation, dysphagia, chest pain, and belching. If symptoms are left untreated, a major concern is complications and the potential risk of esophageal adenocarcinoma associated with GERD. With the increasing prevalence and incidence of GERD and the increasing cost of this disease, there is a need for advanced practice registered nurses to understand the nature of GERD including its pathophysiology, signs and symptoms, and treatment options to address the disease.
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10
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Yang J, Lee J, Lee H, Lee J, Youn YM, Choi JH, Kim YJ, Kang HS, Han KH, Kim SH, Kang KS. Is the Diagnostic Trial with Proton Pump Inhibitors Reasonable for School Age Children with Gastroesophageal Reflux Symptoms? Pediatr Gastroenterol Hepatol Nutr 2019; 22:511-517. [PMID: 31777716 PMCID: PMC6856512 DOI: 10.5223/pghn.2019.22.6.511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/30/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE On the basis of evidence, we aimed to reevaluate the necessity of the empirical proton pump inhibitor (PPI) trial for children with suspected gastroesophageal reflux disease (GERD). METHODS We analyzed the frequency of GERD in 85 school-age children with gastroesophageal reflux (GER) symptoms, who received 24-hour esophageal pH monitoring and/or upper endoscopy. According to the reflux index (RI), the children were classified into normal (RI <5%), intermediate (5%≤ RI <10%), or abnormal (RI ≥10%) groups. RESULTS Fifty six were female and 29 were male. Their mean age was 12.6±0.5 (±standard deviation) years (range: 6.8-18.6). The RI analysis showed that the normal group included 76 patients (89.4%), the intermediate group included 6 patients (7.1%), and the abnormal group included 3 patients (3.5%). The DeMeester score was 5.93±4.65, 14.68±7.86 and 40.37±12.96 for the normal, intermediate and abnormal group, respectively (p=0.001). The longest reflux time was 5.56±6.00 minutes, 9.53±7.84 minutes, and 19.46±8.35 minutes in the normal, intermediate, and abnormal group, respectively (p=0.031). Endoscopic findings showed reflux esophagitis in 7 patients. On the basis of the Los Angeles Classification of Esophagitis, 5 of these patients were included in group A, 1 patient, in group B and 1 patient, in group C. CONCLUSION The incidence of GERD was very low in school-age children with GER symptoms. Therefore, injudicious diagnostic PPI trials would be postponed until the actual prevalence of GERD is verified in future prospective studies.
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Affiliation(s)
- Jaeeun Yang
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Jieon Lee
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Hyunju Lee
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Juyeon Lee
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Young Mee Youn
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Jae Hong Choi
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Yoon-Joo Kim
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Hyun Sik Kang
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Kyoung Hee Han
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Seung Hyo Kim
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Ki-Soo Kang
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
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11
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Arevalo G, Sippey M, Martin-Del-Campo LA, He J, Ali A, Marks J. Post-POEM reflux: who's at risk? Surg Endosc 2019; 34:3163-3168. [PMID: 31628620 DOI: 10.1007/s00464-019-07086-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/21/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Per-Oral Endoscopic Myotomy (POEM) is a less invasive alternative to laparoscopic Heller myotomy for patients with achalasia. While a partial fundoplication is often performed concurrently with laparoscopic myotomy, an endoscopic approach does not offer this and leaves patients prone to post-operative reflux. The objectives of this study were to (1) identify patients with post-POEM reflux using BRAVO pH and endoscopic evaluations, and (2) investigate risk factors associated with post-POEM reflux and esophagitis to optimize patient selection for POEM and identify those who will benefit from a proactive approach to post-operative reflux management. METHODS A retrospective review of a prospectively collected database of patients who underwent POEM between January 2011 and July 2017 at a single institution was performed. Demographics along with pre-POEM and post-POEM variables were obtained. Univariate and multivariate analyses were performed, using p values ≤ 0.05 for statistical significance. RESULTS Forty-six patients were included, with a mean follow-up of 358 days. Mean age was 58 (19.2); 61% were female. Thirty-six patients underwent 48-h BRAVO pH testing after POEM, which revealed abnormal esophageal acid exposure in 15 patients (41.7%). There was a correlation between positive BRAVO results and presence of preoperative esophagitis (p = 0.02). Only 13% of patients had symptom-related reflux episodes based on the Symptom Associated Probability of the BRAVO study. Post-operative endoscopy revealed 6 patients with esophagitis, compared to 4 patients who had esophagitis on preoperative endoscopy. Only higher preoperative Eckardt score was significantly associated with endoscopic evidence of esophagitis post-POEM. CONCLUSIONS Reflux is common after POEM. A majority of patients with a positive BRAVO study are asymptomatic, which is concerning. Objective follow-up is of paramount importance with upper endoscopy and ambulatory pH monitoring being the gold standard. Elevated preoperative Eckardt score and esophagitis are associated with post-POEM reflux. This population warrants close surveillance.
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Affiliation(s)
- Gabriel Arevalo
- Department of Surgery, Case Western Reserve University/University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Lakeside Building, 7th Floor, Cleveland, OH, 44106, USA
| | - Megan Sippey
- Department of Surgery, Case Western Reserve University/University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Lakeside Building, 7th Floor, Cleveland, OH, 44106, USA.
| | - Luis A Martin-Del-Campo
- Department of Surgery, Case Western Reserve University/University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Lakeside Building, 7th Floor, Cleveland, OH, 44106, USA
| | - Jack He
- Department of Surgery, Case Western Reserve University/University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Lakeside Building, 7th Floor, Cleveland, OH, 44106, USA
| | - Ahmed Ali
- Department of Surgery, Case Western Reserve University/University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Lakeside Building, 7th Floor, Cleveland, OH, 44106, USA
| | - Jeffrey Marks
- Department of Surgery, Case Western Reserve University/University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Lakeside Building, 7th Floor, Cleveland, OH, 44106, USA
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12
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Wahba G, Neshkova E, Vuille-Lessard É, Bouin M. Is topical lidocaine beneficial before catheter insertion in esophageal manometry and ambulatory pH monitoring? Neurogastroenterol Motil 2019; 31:e13687. [PMID: 31321837 DOI: 10.1111/nmo.13687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/06/2019] [Accepted: 07/09/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Conventionally, topical anesthesia is applied to improve the tolerance of esophageal manometry (EM) and ambulatory pH monitoring (apH) but there is presently no evidence supporting this practice. We aimed to compare the tolerance of EM and apH with vs without topical lidocaine anesthesia. METHODS A prospective study was conducted at our center between January 2017 and January 2019. All patients who underwent EM or apH and completed a systematically distributed standardized patient survey were included. From January 2017 to June 2018, all patients had a viscous lidocaine solution applied before EM and apH ("lidocaine" group). After June 2018, we ceased applying any topical anesthesia ("no lidocaine" group). Patient-reported adverse effects and satisfaction scores were compared between these two patient groups. KEY RESULTS Two hundred forty-nine patient surveys were included. "Lidocaine" (n = 124) and "no lidocaine" (n = 125) groups were similar in age (56.9 ± 14.0 vs 56.0 ± 13.7; P = .77) and gender distributions (65.9% vs 63.3% female; P = .68). Patients in the "lidocaine" group were less likely to report pain during catheter insertion (33.6% vs 50.8%; P = .007, OR: 0.49 [95% CI 0.29-0.83]) and reported a lower overall pain score (2.82 ± 1.38 vs 3.20 ± 1.42 on 5; P = .04). There was a tendency toward increased global satisfaction with lidocaine application but that was not statistically significant (4.36 ± 1.05 vs 4.11 ± 1.13; P = .08). In subgroup analyses, female patients, younger patients, and patients who underwent EM were more likely to benefit from lidocaine application. CONCLUSIONS AND INFERENCES Application of topical lidocaine before esophageal motility tests reduces pain during catheter insertion and overall pain.
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Affiliation(s)
- George Wahba
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
| | | | | | - Mickael Bouin
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada
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13
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Kristobak BM, Crane KA. Retrieval of a Esophageal pH Monitoring Probe Dislodged Into the Laryngopharynx: A Case Report. A A Pract 2019; 13:1-3. [PMID: 30663994 DOI: 10.1213/xaa.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Esophageal pH monitoring via wireless probes is used to evaluate chest pain and atypical symptoms and diagnose gastroesophageal reflux. These probes are commonly placed during esophagogastroduodenoscopy performed by gastroenterologists in an ambulatory anesthesia setting. Dislodgment and aspiration of these probes can cause morbidity, require surgical removal, and involve the anesthesia provider in prolonged emergency care. We present a case of a probe dislodgment where aspiration was avoided and describe how retrieval of this device is different from typical hypopharyngeal foreign body removal.
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Affiliation(s)
- Benjamin M Kristobak
- From the Anesthesia Service, Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
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14
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Gómez-Escudero O, Coss-Adame E, Amieva-Balmori M, Carmona-Sánchez R, Remes-Troche J, Abreu-Abreu A, Cerda-Contreras E, Gómez-Castaños P, González-Martínez M, Huerta-Iga F, Ibarra-Palomino J, Icaza-Chávez M, López-Colombo A, Márquez-Murillo M, Mejía-Rivas M, Morales-Arámbula M, Rodríguez-Chávez J, Torres-Barrera G, Valdovinos-García L, Valdovinos-Díaz M, Vázquez-Elizondo G, Villar-Chávez A, Zavala-Solares M, Achem S. The Mexican consensus on non-cardiac chest pain. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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15
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Gómez-Escudero O, Coss-Adame E, Amieva-Balmori M, Carmona-Sánchez RI, Remes-Troche JM, Abreu Y Abreu AT, Cerda-Contreras E, Gómez-Castaños PC, González-Martínez MA, Huerta-Iga FM, Ibarra-Palomino J, Icaza-Chávez ME, López-Colombo A, Márquez-Murillo MF, Mejía-Rivas M, Morales-Arámbula M, Rodríguez-Chávez JL, Torres-Barrera G, Valdovinos-García LR, Valdovinos-Díaz MA, Vázquez-Elizondo G, Villar-Chávez AS, Zavala-Solares M, Achem SR. The Mexican consensus on non-cardiac chest pain. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2019; 84:372-397. [PMID: 31213326 DOI: 10.1016/j.rgmx.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/22/2019] [Accepted: 05/16/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Non-cardiac chest pain is defined as a clinical syndrome characterized by retrosternal pain similar to that of angina pectoris, but of non-cardiac origin and produced by esophageal, musculoskeletal, pulmonary, or psychiatric diseases. AIM To present a consensus review based on evidence regarding the definition, epidemiology, pathophysiology, and diagnosis of non-cardiac chest pain, as well as the therapeutic options for those patients. METHODS Three general coordinators carried out a literature review of all articles published in English and Spanish on the theme and formulated 38 initial statements, dividing them into 3 main categories: (i)definitions, epidemiology, and pathophysiology; (ii)diagnosis, and (iii)treatment. The statements underwent 3rounds of voting, utilizing the Delphi system. The final statements were those that reached >75% agreement, and they were rated utilizing the GRADE system. RESULTS AND CONCLUSIONS The final consensus included 29 statements. All patients presenting with chest pain should initially be evaluated by a cardiologist. The most common cause of non-cardiac chest pain is gastroesophageal reflux disease. If there are no alarm symptoms, the initial approach should be a therapeutic trial with a proton pump inhibitor for 2-4weeks. If dysphagia or alarm symptoms are present, endoscopy is recommended. High-resolution manometry is the best method for ruling out spastic motor disorders and achalasia and pH monitoring aids in demonstrating abnormal esophageal acid exposure. Treatment should be directed at the pathophysiologic mechanism. It can include proton pump inhibitors, neuromodulators and/or smooth muscle relaxants, psychologic intervention and/or cognitive therapy, and occasionally surgery or endoscopic therapy.
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Affiliation(s)
- O Gómez-Escudero
- Clínica de Gastroenterología, Endoscopia Digestiva y Motilidad Gastrointestinal «Endoneurogastro», Hospital Ángeles Puebla, Puebla, Puebla, México
| | - E Coss-Adame
- Departamento de Gastroenterología y Laboratorio de Motilidad Gastrointestinal, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México.
| | - M Amieva-Balmori
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana, Veracruz, Veracruz, México
| | - R I Carmona-Sánchez
- Unidad de Medicina Ambulatoria Christus Muguerza, San Luis Potosí, S.L.P., México
| | - J M Remes-Troche
- Laboratorio de Fisiología Digestiva y Motilidad Gastrointestinal, Instituto de Investigaciones Médico Biológicas, Universidad Veracruzana, Veracruz, Veracruz, México
| | - A T Abreu Y Abreu
- Gastroenterología y Fisiología Digestiva, Hospital Ángeles del Pedregal, Ciudad de México, México
| | - E Cerda-Contreras
- Medicina Interna, Gastroenterología y Motilidad Gastrointestinal, Hospital Médica Sur, Profesor de Medicina ITESM, Ciudad de México, México
| | | | - M A González-Martínez
- Departamento de Endoscopia, Laboratorio de Motilidad Gastrointestinal, Hospital de Especialidades CMN Siglo XXI IMSS, Ciudad de México, México
| | - F M Huerta-Iga
- Jefe de Endoscopia y Fisiología Digestiva, Hospital Ángeles Torreón, Torreón, Coahuila, México
| | - J Ibarra-Palomino
- Laboratorio de Motilidad Gastrointestinal, Área de Gastroenterología, Hospital Ángeles del Carmen, Guadalajara, Jalisco, México
| | - M E Icaza-Chávez
- Hospital Star Médica de Mérida, Profesora de Gastroenterología de la UNIMAYAB, Mérida, Yucatán, México
| | - A López-Colombo
- Dirección de Educación e Investigación en Salud, UMAE Hospital de Especialidades del Centro Médico Nacional «Manuel Ávila Camacho», Instituto Mexicano del Seguro Social, Puebla, Puebla, México
| | - M F Márquez-Murillo
- Cardiólogo Electrofisiólogo, Departamento de Electrocardiología, Instituto Nacional de Cardiología «Ignacio Chávez», Ciudad de México, México
| | - M Mejía-Rivas
- Gastroenterología, Endoscopia, Neurogastroenterología, Hospital «Vivien Pellas», Managua, Nicaragua
| | | | - J L Rodríguez-Chávez
- Gastroenterología y Neurogastroenterología, Hospital Puerta de Hierro, Guadalajara, Jalisco, México
| | - G Torres-Barrera
- Departamento de Gastroenterología, Hospital Universitario, Universidad Autónoma de Nuevo León, Profesor de cátedra, ITESM, Monterrey, Nuevo León, México
| | - L R Valdovinos-García
- Departamento de Gastroenterología y Laboratorio de Motilidad Gastrointestinal, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - M A Valdovinos-Díaz
- Departamento de Gastroenterología y Laboratorio de Motilidad Gastrointestinal, Instituto Nacional de Ciencias Médicas y Nutrición «Salvador Zubirán», Ciudad de México, México
| | - G Vázquez-Elizondo
- Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, OnCare Group, Monterrey, Nuevo León, México
| | - A S Villar-Chávez
- Gastroenterología y Motilidad Gastrointestinal, Hospital Ángeles Acoxpa, Ciudad de México, México
| | - M Zavala-Solares
- Unidad de Motilidad Gastrointestinal, Servicio de Gastroenterología, Hospital General de México «Dr. Eduardo Liceaga», Ciudad de México, México
| | - S R Achem
- Profesor de Medicina Interna y Gastroenterología, Facultad de Medicina, Mayo College of Medicine, Mayo Clinic, Jacksonville, Florida, Estados Unidos de América
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Neto RML, Herbella FAM, Schlottmann F, Patti MG. Does DeMeester score still define GERD? Dis Esophagus 2019; 32:5250774. [PMID: 30561585 DOI: 10.1093/dote/doy118] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/15/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022]
Abstract
Gastroesophageal reflux disease (GERD) clinical presentation may encompass a myriad of symptoms that may mimic other esophageal and extra-esophageal diseases. Thus, GERD diagnosis by symptoms only may be inaccurate. Upper digestive endoscopy and barium esophagram may also be misleading. pH monitoring must be added often for a definitive diagnosis. The DeMeester score (DMS) is a composite score of the acid exposure during a prolonged ambulatory pH monitoring that has been used since 1970s to categorize patients as GERD+ or GERD-. We showed in this review that DMS has some limitations and strengths. Although there is not a single instrument to precisely diagnose GERD in all of its variances, pH monitoring analyzed at the light of DMS is still a reliable method for scientific purposes as well as for clinical decision making. There are no data that show that acid exposure time is superior-or for that matter inferior-as compared to DMS.
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Affiliation(s)
- R M L Neto
- Department of Surgery, Escola Paulista de Medicina, São Paulo, Brazil
| | - F A M Herbella
- Department of Surgery, Escola Paulista de Medicina, São Paulo, Brazil
| | - F Schlottmann
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - M G Patti
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, USA
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17
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Itskoviz D, Tamary H, Krasnov T, Yacobovich J, Sahar N, Zevit N, Shamir R, Ben-Bassat O, Leibovici Wiseman Y, Dickman R, Ringel Y, Dotan I, Goldberg Y, Morgenstern S, Levi Z. Endoscopic findings and esophageal cancer incidence among Fanconi Anemia patients participating in an endoscopic surveillance program. Dig Liver Dis 2019; 51:242-246. [PMID: 30249500 DOI: 10.1016/j.dld.2018.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The primary clinical characteristics of Fanconi Anemia (FA) include typical physical features, progressive bone marrow failure, and an increased incidence of neoplasms, including esophageal carcinoma. Currently, there are no data regarding endoscopic findings or the interval time to malignancy in these patients. Data about the contribution of Human Papilloma Virus (HPV) to esophageal carcinoma is conflicting. Our objective is to document the upper gastrointestinal (GI) findings at baseline, document cancer incidence, and evaluate the role of HPV among these cancers. METHODS We reviewed endoscopic and clinical data of FA subjects who participated in active surveillance before cancer diagnosis. Incident esophageal cancers were stained for HPV p16 protein. RESULTS Eight FA patients were included (men 62.5%; median age at first endoscopy 20 years, median endoscopies number: 5.5). At baseline, 8/8 had endoscopic evidence for reflux esophagitis. In 3/8 the reflux esophagitis was mild and in 5/8 it was moderate or severe. During the follow up time (median time 4.5 years 2/8 developed Barrett's esophagus and 2/8 patients had incident esophageal squamous cell carcinoma during follow up, at intervals of eight and eighteen months from the previous upper endoscopy. Both cancers stained negative for HPV P16. CONCLUSIONS FA subjects have both an extremely high risk for esophageal cancer within short intervals and a very high prevalence of reflux esophagitis with various severities. Active surveillance programs in specialized centers including annual upper endoscopies should be considered in these patients.
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Affiliation(s)
- David Itskoviz
- Gastroenterology Department, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hannah Tamary
- Pediatrics Hematology Unit, Schneider's Children Medical Center, Petach Tikva, Israel; Genetic Department, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tanya Krasnov
- Pediatric Hematology Laboratory, Felsenstein Medical Research Center, Beilinson Campus, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joannae Yacobovich
- Pediatrics Hematology Unit, Schneider's Children Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nadav Sahar
- Gastroenterology Department, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Noam Zevit
- Institue of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raanan Shamir
- Institue of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Offer Ben-Bassat
- Gastroenterology Department, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaara Leibovici Wiseman
- Gastroenterology Department, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ram Dickman
- Gastroenterology Department, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yehuda Ringel
- Gastroenterology Department, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Iris Dotan
- Gastroenterology Department, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Goldberg
- Genetic Department, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sara Morgenstern
- Pathology Department, Rabin Medical Center, Petach Tikva, Israel
| | - Zohar Levi
- Gastroenterology Department, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Taghvaei T, Kazemi A, Hosseini V, Hamidian M, Tirgar Fakheri H, Hashemi SA, Maleki I. Evaluation of the Additive Effect of Domperidone on Patients with Refractory Gastroesophageal Reflux Disease; A Randomized Double Blind Clinical Trial. Middle East J Dig Dis 2018; 11:24-31. [PMID: 31049179 PMCID: PMC6488498 DOI: 10.15171/mejdd.2018.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 11/12/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a common problem with annoying symptoms. It is associated with negative impact on quality of life. Prokinetic agents may be used in combination with acid suppression agents as an adjunctive in patients with GERD refractory to proton pump inhibitors (PPI) therapy, rather than as sole treatment. This study aimed to evaluate the efficacy of combination of PPI with domperidone (a prokinetic agent) compared with PPI alone in the treatment of patients with refractory GERD. METHODS This study was a double blind clinical trial on 29 patients with GERD refractory to PPI during the period of one month. By randomization, the patients were divided into two groups. Group A was treated by pantoprazole 40 mg twice daily and domperidone three times a day for a month, while group B was treated by pantoprazole 40 mg twice daily and placebo three times a day. In this study endoscopy was performed to evaluate the prevalence of erosive esophagitis, non-erosive reflux, and hiatal hernia. Manometry was conducted to study the prevalence of dysmotility. GERD symptom questionnaires including the Gastrointestinal Symptom Rating Scale (GSRS), Carlson Dennett, and the Medical Outcomes Study Short Form-36 health survey (SF36) were used before and after treatment for screening GERD and assessing treatment response. RESULTS There were 17 (58.62%) women and 12 (41.37%) men. The prevalence of erosive esophagitis and non-erosive reflux, was 10.34% and 89.66%, respectively. There was a significant difference comparing reflux symptoms before and after treatment between the two groups according to reflux and Carlson Dennett questionnaires. At the end of the study, symptoms of reflux significantly improved by treatment. Although, the quality of life questionnaire scores improved by treatment, there was no statistically significant difference in response to treatment between the two groups. CONCLUSION In this research, we showed that adding domperidone to PPI could not make any improvement in patients with refractory reflux regarding the quality of life and improving the symptoms.
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Affiliation(s)
- Tarang Taghvaei
- Associate Professor of Gastroenterology, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Arash Kazemi
- Assistant Professor of Gastroenterology, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Vahid Hosseini
- Associate Professor of Gastroenterology, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mehdi Hamidian
- Fellow of Gastroenterology, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hafez Tirgar Fakheri
- Professor of Gastroenterology, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyyed Abbas Hashemi
- Assistant Professor of Gastroenterology, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iradj Maleki
- Associate Professor of Gastroenterology, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Scerrino G, Inviati A, Di Giovanni S, Paladino NC, Di Giovanni S, Paladino NC, Di Paola V, Raspanti C, Melfa GI, Cupido F, Mazzola S, Porrello C, Bonventre S, Gullotta G. Long-term esophageal motility changes after thyroidectomy: associations with aerodigestive disorders. G Chir 2017; 37:193-199. [PMID: 28098054 DOI: 10.11138/gchir/2016.37.5.193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients undergoing thyroidectomy often complain aerodigestive disorders. In a previous study we showed the associations between voice impairment and proximal acid reflux, swallowing impairment and Upper Esophageal Sphyncter (UES) incoordination and the decrease in UES pressure in thirty-six patients observed before and soon afterwards uncomplicated thyroidectomy. This study investigated the state of post-thyroidectomy esophageal motility changes and its associations with these disorders after 18-24 months. PATIENTS AND METHODS The thirty-six patients prospectively recruited according to selection criteria (thyroid volume ≤60 ml, benign disease, age 18-65 years, previous neck surgery, thyroiditis, pre- or postoperative vocal cord palsy) underwent voice (VIS) and swallowing (SIS) impairment scores, esophageal manometry and pH monitoring once again. RESULTS After 18-24 months, both VIS and SIS recovered (respectively: p=0,022; p=0,0001); UES pressure increased (p=0,0001) nearing the preoperative values. The persistence of swallowing complaints were associated with the persistence of esophageal incoordination (p=0,03); the association between voice impairment and proximal acid reflux was confirmed (p<0,001). CONCLUSIONS Our study confirms that aerodigestive disorders after uncomplicated thyroidectomy, largely transient, are strictly connected with upper esophageal motility changes. In this viewpoint, the innervation of upper aerodigestive anatomical structures (larynx, pharynx, upper esophagus) and its variations should be focused.
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Lam C, Liu WF, Bel RD, Chan K, Miller L, Brown MC, Chen Z, Cheng D, Patel D, Xu W, Darling GE, Liu G. Polymorphisms of the FOXF1 and MHC locus genes in individuals undergoing esophageal acid reflux assessments. Dis Esophagus 2017; 30:1-7. [PMID: 26822871 DOI: 10.1111/dote.12456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gastroesophageal reflux disease (GERD) may lead to Barrett's esophagus (BE). Previously, a large genome-wide association study found two germline markers to be associated with BE, FOXF1 rs9936833 (C allele) and MHC rs9257809 (A allele). This study evaluated whether these two polymorphisms are associated with gastroesphageal acid reflux as measured by 24-hour pH testing. Patients with acid reflux symptoms referred for esophageal manometry and 24-hour pH monitoring at University Health Network (Toronto, ON) were enrolled. DNA extracted from blood was genotyped using a Taqman Polymerase Chain Reaction (PCR) assay. DeMeester scores of ≥14.7 or prior evidence of reflux esophagitis on endoscopy defined individuals with esophageal acid reflux. Logistic regression analysis, adjusted for clinical risk factors, was used to calculate odds ratios with 95% confidence intervals for each polymorphism in relation to the presence of acid reflux. Of 182 patients, the median age was 50 years and 62% were female; 95 (52%) met the definition of GERD. In the multivariable analysis, both FOXF1 rs9936833 (OR = 1.82; 95%CI: 1.12-2.96; P = 0.02) and MHC rs9257809 (OR = 9.36; 95%CI: 2.92-29.99; P < 0.001) remained significantly associated with presence of acid reflux. When both polymorphisms were placed in the same model, the adjusted ORs were 2.10 (95%CI: 1.24-3.53; P = 0.005) and 10.95 (95%CI: 3.32-36.09; P < 0.001), respectively. The association for risk allele C in FOXF1 rs9936833 and risk allele A in MHC rs9257809 with the presence of acid reflux suggests a potential pathophysiologic mechanism for the role of genetic influences in BE development.
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Affiliation(s)
- C Lam
- Department of Medical Biophysics and Medicine, Princess Margaret Hospital-University Health Network, University of Toronto, Toronto, Ontario, Canada.,School of Medicine, University of Nottingham, Nottingham, UK
| | - W F Liu
- Department of Medical Biophysics and Medicine, Princess Margaret Hospital-University Health Network, University of Toronto, Toronto, Ontario, Canada.,Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - R D Bel
- Biostatistics Department, Princess Margaret Hospital-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - K Chan
- Department of Medical Biophysics and Medicine, Princess Margaret Hospital-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - L Miller
- Department of Surgery (Thoracic Surgery), Toronto General Hospital-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - M C Brown
- Department of Medical Biophysics and Medicine, Princess Margaret Hospital-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Z Chen
- Department of Medical Biophysics and Medicine, Princess Margaret Hospital-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - D Cheng
- Department of Medical Biophysics and Medicine, Princess Margaret Hospital-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - D Patel
- Department of Medical Biophysics and Medicine, Princess Margaret Hospital-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - W Xu
- Biostatistics Department, Princess Margaret Hospital-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - G E Darling
- Department of Surgery (Thoracic Surgery), Toronto General Hospital-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - G Liu
- Department of Medical Biophysics and Medicine, Princess Margaret Hospital-University Health Network, University of Toronto, Toronto, Ontario, Canada
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21
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Chen JW, Baker JR, Compton JM, McDermott M, Rubenstein JH. Accuracy of the Air Flow Sphincter Locator system in identifying the lower esophageal sphincter for placement of pH catheters. Dis Esophagus 2017; 30:1-5. [PMID: 27862648 DOI: 10.1111/dote.12507] [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] [Indexed: 12/11/2022]
Abstract
The Air Flow Sphincter Locator (AFSL) is marketed as an alternative method to manometry for localizing the lower esophageal sphincter (LES) for pH probe placement. Such a system is desirable due to the additional time, cost, and discomfort associated with dual nasal intubation, but its accuracy has never been assessed. To assess the accuracy of the AFSL in localizing the LES. Fifty consecutive outpatients presenting for pH and manometry studies were included. The upper border of the LES was determined using HRM and the AFSL by two technicians independently. LES locations measured by technicians using AFSL versus manometry, as well as the manometrically determined LES locations by technicians versus MDs were compared. Differences in LES locations determined by HRM as read by MDs versus technicians were small; none were >3 cm, and 92% were within 2 cm. Comparison between LES locations determined by technicians using HRM versus the AFSL revealed that 52% had a difference of 2-3cm and 32% had a difference of >3 cm. Hiatal hernia was associated with a difference in LES location of >3 cm. Excluding patients with hiatal hernia, nonetheless, still produced a >3 cm difference in 24% of studies. Prior reports have suggested that a difference greater than +/-3 cm in pH probe placement is considered unacceptable for clinical studies. Based on our study, the AFSL placed the LES outside of this range in 32% of patients, and may be particularly inaccurate in the setting of a hiatal hernia. This suggests that the device may not be an acceptable alternative to manometry in determining LES location for pH probe placement.
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Affiliation(s)
- Joan W Chen
- Division of Gastroenterology and Hepatology, University of Michigan Health Systems, Ann Arbor, Michigan, USA
| | - Jason R Baker
- Division of Gastroenterology and Hepatology, University of Michigan Health Systems, Ann Arbor, Michigan, USA
| | - Jessica M Compton
- Division of Gastroenterology and Hepatology, University of Michigan Health Systems, Ann Arbor, Michigan, USA
| | - Mark McDermott
- Division of Gastroenterology and Hepatology, University of Michigan Health Systems, Ann Arbor, Michigan, USA
| | - Joel H Rubenstein
- Division of Gastroenterology and Hepatology, University of Michigan Health Systems, Ann Arbor, Michigan, USA
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Salvador R, Pesenti E, Gobbi L, Capovilla G, Spadotto L, Voltarel G, Cavallin F, Nicoletti L, Valmasoni M, Ruol A, Merigliano S, Costantini M. Postoperative Gastroesophageal Reflux After Laparoscopic Heller-Dor for Achalasia: True Incidence with an Objective Evaluation. J Gastrointest Surg 2017; 21:17-22. [PMID: 27364725 DOI: 10.1007/s11605-016-3188-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/12/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The most common complication after laparoscopic Heller-Dor (LHD) is gastroesophageal reflux disease (GERD). The present study aimed (a) to analyze the true incidence of postoperative reflux by objectively assessing a large group of LHD patients and (b) to see whether the presence of typical GERD symptoms correlates with the real incidence of postoperative reflux. METHODS After LHD, patients were assessed by means of a symptom score, endoscopy, esophageal manometry, and 24-h pH monitoring. Patients were assigned to three groups: those did not accept to perform 24-h pH monitoring (group NP); those with normal postoperative pH findings (group A); and those with pathological postoperative acid exposure (group B). RESULTS Four hundred sixty-three of the 806 LHD patients agreed to undergo follow-up 24-h pH monitoring. Normal pH findings were seen in 423 patients (group A, 91.4 %), while 40 (8.6 %) had a pathological acid exposure (group B). The median symptom scores were similar: 3.0 (IQR 0-8) in group A and 6.0 (IQR 0-10) in group B (p = 0.29). At endoscopy, the percentage of esophagitis was also similar (11 % in group A, 19 % in group B; p = 0.28). CONCLUSIONS This study demonstrated that, after LHD was performed by experienced surgeons, the true incidence of postoperative GERD is very low. The incidence of this possible complication should be assessed by pH monitoring because endoscopic findings and symptoms may be misleading.
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Affiliation(s)
- Renato Salvador
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy.
| | - Elisa Pesenti
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy
| | - Laura Gobbi
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy
| | - Giovanni Capovilla
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy
| | - Lorenzo Spadotto
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy
| | - Guerrino Voltarel
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy
| | - Francesco Cavallin
- Surgical Oncology Unit, Veneto Institute of Oncology (IOV IRCCS), Padova, Italy
| | - Loredana Nicoletti
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy
| | - Michele Valmasoni
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy
| | - Alberto Ruol
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy
| | - Stefano Merigliano
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy
| | - Mario Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy
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Lupu VV, Ignat A, Paduraru G, Ciubara A, Moscalu M, Marginean CO, Burlea M. Correlation between the different pH-metry scores in gastroesophageal reflux disease in children. Medicine (Baltimore) 2016; 95:e3804. [PMID: 27367982 PMCID: PMC4937896 DOI: 10.1097/md.0000000000003804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The 24-hour esophageal pH-metry is the most widely used method to diagnose the gastroesophageal reflux disease (GERD). The study compares the different scores obtained during the 24-hour esophageal pH-metry. A retrospective study over 5 years including 234 children (1 month and 18 years old) admitted in a pediatric gastroenterology regional center in Northeast Romania, with suspicion of GERD. They underwent 24- hour esophageal pH-metry, and the scores obtained (Boix-Ochoa, DeMeester, Johnson-DeMeester) were compared. Out of the 234 children, 172 (73.50%) had positive Boix-Ochoa score and 62 (26.50%) had normal Boix-Ochoa score (<11.99). Based on the DeMeester score, 149 children (63.68%) were positive and 85 (36.32%) were negative. The correlation of the Demeester score with the Boix-Ochoa score was very high (r = 0.978, P < < 0.01, 95% confidence interval). Considering the Johnson-DeMeester score, 120 cases (51.28%) had GERD and 114 (48.72%) did not. The correlation of the Johnson-DeMeester score with the Boix-Ochoa score was still high (r = 0.94, P < < 0.01, 95% 95% confidence interval). As considered until now, the Boix-Ochoa score is the most accurate score to be used in pediatrics for the diagnosis of GERD. The use of the different scores-Boix-Ochoa, DeMeester, Johnson-DeMeester-showed a high sensitivity and specificity of the pH-metry measurements applied to the study lot, but the last score has a higher risk of false-negative results.
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Affiliation(s)
- Vasile Valeriu Lupu
- Pediatrics Department, University of Medicine and Pharmacy “Gr. T. Popa
- Vth Pediatrics Clinic, “St. Mary” Children Emergency Hospital
| | - Ancuţa Ignat
- Pediatrics Department, University of Medicine and Pharmacy “Gr. T. Popa
- Correspondence: Dr Ancuţa Ignat, str. Universitatii, nr. 16, Iasi 700115, Romania (e-mail: )
| | - Gabriela Paduraru
- Pediatrics Department, University of Medicine and Pharmacy “Gr. T. Popa
- Vth Pediatrics Clinic, “St. Mary” Children Emergency Hospital
| | | | - Mihaela Moscalu
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy, “Gr. T. Popa”, Iasi, Romania
| | | | - Marin Burlea
- Pediatrics Department, University of Medicine and Pharmacy “Gr. T. Popa
- Vth Pediatrics Clinic, “St. Mary” Children Emergency Hospital
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24
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Lavorini F, Chellini E, Bigazzi F, Surrenti E, Fontana GA. The Clinical Value of Deflation Cough in Chronic Coughers With Reflux Symptoms. Chest 2016; 149:1467-72. [PMID: 26836929 DOI: 10.1016/j.chest.2016.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 11/27/2015] [Accepted: 01/06/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Patients with deflation cough (DC), the cough-like expulsive effort(s) evoked by maximal lung emptying during a slow vital capacity maneuver, also present symptoms of gastroesophageal reflux. DC can be inhibited by prior intake of antacids. We wished to assess DC prevalence and association between DC and chemical characteristics of refluxate in patients with gastroesophageal reflux symptoms. METHODS A total of 157 consecutive outpatients underwent DC assessment and 24-h multichannel intraluminal impedance pH (MII-pH) monitoring; 93/157 also had chronic cough. Patients performed two to four slow vital capacity maneuvers and DC was detected aurally. Subsequently, they underwent 24-h MII-pH monitoring, the outcomes of which were defined as abnormal when acid or non-acid reflux events were > 73. RESULTS DC occurred in 46/157 patients, 18 of whom had abnormal MII-pH outcomes; 28 of the remaining 111 patients without DC also had abnormal MII-pH findings. Thus, in the patients as a group, there was no association between DC and MII-pH outcomes. DC occurred in 40/93 of the chronic coughers; 15 of whom had acid reflux. All but 2 of the 53 patients without DC had normal MII-pH outcomes (P < .001), and the negative predictive value of DC for excluding acid reflux was 96.2%. At follow-up, 65% of coughers showed significant improvement after treatment. CONCLUSIONS The overall prevalence of DC was 29%, increasing to 43% in chronic coughers in whom the absence of DC virtually excludes acid reflux. Therefore, DC assessment may represent a useful screening test for excluding acid reflux in chronic coughers with reflux symptoms.
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Affiliation(s)
- Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elisa Chellini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Bigazzi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elisabetta Surrenti
- Digestive Pathophysiology and Motility Unit, Careggi University Hospital, Florence, Italy
| | - Giovanni A Fontana
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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25
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Lee AL, Goldstein RS. Gastroesophageal reflux disease in COPD: links and risks. Int J Chron Obstruct Pulmon Dis 2015; 10:1935-49. [PMID: 26392769 PMCID: PMC4574848 DOI: 10.2147/copd.s77562] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
COPD is a long-term condition associated with considerable disability with a clinical course characterized by episodes of worsening respiratory signs and symptoms associated with exacerbations. Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal conditions in the general population and has emerged as a comorbidity of COPD. GERD may be diagnosed by both symptomatic approaches (including both typical and atypical symptoms) and objective measurements. Based on a mix of diagnostic approaches, the prevalence of GERD in COPD ranges from 17% to 78%. Although GERD is usually confined to the lower esophagus in some individuals, it may be associated with pulmonary microaspiration of gastric contents. Possible mechanisms that may contribute to GERD in COPD originate from gastroesophageal dysfunction, including altered pressure in the lower esophageal sphincter (which normally protect against GERD) and changes in esophageal motility. Proposed respiratory contributions to the development of GERD include respiratory medications that may alter esophageal sphincter tone and changes in respiratory mechanics, with increased lung hyperinflation compromising the antireflux barrier. Although the specific cause and effect relationship between GERD and COPD has not been fully elucidated, GERD may influence lung disease severity and has been identified as a significant predictor of acute exacerbations of COPD. Further clinical effects could include a poorer health-related quality of life and an increased cost in health care, although these factors require further clarification. There are both medical and surgical options available for the treatment of GERD in COPD and while extensive studies in this population have not been undertaken, this comorbidity may be amenable to treatment.
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Affiliation(s)
- Annemarie L Lee
- West Park Healthcare Centre, University of Toronto, Toronto, ON, Canada ; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada ; Institute for Breathing and Sleep, Austin Hospital, Melbourne, VIC, Australia
| | - Roger S Goldstein
- West Park Healthcare Centre, University of Toronto, Toronto, ON, Canada ; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada ; Department of Medicine, University of Toronto, Toronto, ON, Canada
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26
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Jones EL, Meara MP, Schwartz JS, Hazey JW, Perry KA. Gastroesophageal reflux symptoms do not correlate with objective pH testing after peroral endoscopic myotomy. Surg Endosc 2015; 30:947-52. [PMID: 26123332 DOI: 10.1007/s00464-015-4321-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/09/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Peroral endoscopic myotomy (POEM) is an emerging treatment for esophageal achalasia. Postoperative reflux has been found in a significant number of patients, but it is unknown whether subjective reports of reflux correlate with objective pH testing. The purpose of this study was to compare the objective rate of reflux with standardized reflux symptom scales after POEM. Our hypothesis was that subjective symptoms would not correlate with objective measurement of reflux. METHODS AND PROCEDURES Data on all patients undergoing POEM were collected prospectively between August 2012 and June 2014 and included demographics, objective testing (48-h pH probe, manometry, endoscopy), as well as gastroesophageal reflux disease health-related quality of life (GERD-HRQL), GERD symptom scale (GERSS), and antacid use. RESULTS Forty-three patients underwent POEM during the study period. The mean age was 53.5 ± 17.4 years with a BMI of 29.6 ± 8.4 kg/m(2), and 27 (63%) were male. Forty-two patients (98%) completed at least 6 months of follow-up, and 26 (60%) underwent repeat pH measurement. Dysphagia scores improved from 4 (0-5) at baseline to 0 (0-3) (p < 0.001). On follow-up pH testing, 11 (42%) were normal and 15 (58%) had elevated DeMeester scores. Postoperative GERSS or GERD-HRQL scores did not correlate with DeMeester scores on Spearman's rank-order tests (r = 0.02, p = 0.93 and r = 0.04, p = 0.50, respectively). Postoperative PPI use was not significantly associated with normal or abnormal pH testing: 5 of 7 (71%) patients who were taking PPIs postoperatively had abnormal DeMeester scores compared to 9 of 18 (50%) of patients who were not taking PPIs (p = 0.332). CONCLUSIONS Peroral endoscopic myotomy provides excellent dysphagia relief for patients with achalasia, but is associated with a high rate of reflux on pH testing postoperatively. Subjective symptoms are not a reliable indicator of postoperative reflux. Routine pH testing should be considered in all patients following POEM.
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Affiliation(s)
- Edward L Jones
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, N729 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA.
| | - Michael P Meara
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, N729 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Jennifer S Schwartz
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, N729 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Jeffrey W Hazey
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, N729 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
| | - Kyle A Perry
- Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, N729 Doan Hall, 410 W 10th Ave, Columbus, OH, 43210, USA
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27
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More art than science: impedance analysis prone to interpretation error. J Gastrointest Surg 2015; 19:987-92. [PMID: 25876531 DOI: 10.1007/s11605-015-2809-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 03/19/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Impedance monitoring for reflux evaluation does not have standardized scoring, which can confound interpretation between observers. We investigated the variability of impedance testing interpretation between physicians and computer software. METHODS Raw impedance data from 38 patients that underwent impedance monitoring at a tertiary referral center between 2008 and 2013 were collected. Two physicians and computer software each analyzed the same impedance dataset for reflux activity and symptom-reflux correlation. RESULTS Normalized reflux activity interpretations did not differ between physicians and the computer for acid or non-acid reflux. However, for weakly acidic reflux, there was significant difference between physicians (p < 0.01) and between physician and computer (p < 0.01). In analyzing all reflux, significant variability existed between physicians (p < 0.01) but not between physician and computer. Variability in interpretation altered diagnosis in 24 % of patients when comparing between physicians, 18 % of patients when comparing both physicians to the computer, and an additional 24 % of cases when comparing a single physician to the computer. Symptom-reflux correlation differed in 7 % of physician-physician comparisons versus 8 % of computer-physician comparisons. CONCLUSION Impedance testing analysis is subject to marked variability between physicians and computer software, making impedance prone to interpretation error that can lead to differences in diagnosis and management.
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28
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Patcharatrakul T, Gonlachanvit S. Gastroesophageal reflux symptoms in typical and atypical GERD: roles of gastroesophageal acid refluxes and esophageal motility. J Gastroenterol Hepatol 2014; 29:284-90. [PMID: 23926926 DOI: 10.1111/jgh.12347] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM To determine the roles of gastroesophageal acid reflux (GER) and esophageal dysmotility on typical and atypical GERD symptoms. METHODS Two hundred thirty-six patients (159 females, age 47 ± 14 years) with typical and atypical GERD symptom(s) for > 3 months underwent standard water perfused esophageal manometry (EM) and 24 h esophageal pH studies during off therapy. RESULTS Eighty seven and 93 patients had positive lower esophageal pH tests and abnormal EM, respectively. Patients with positive lower esophageal pH test were significantly older (50 ± 13 vs 45 ± 13 years, P < 0.005) and had higher prevalence of acid regurgitation symptoms than patients with negative test (56/87 vs 72/149, P < 0.05). Patients with positive upper esophageal pH test (n = 67) also had significantly higher prevalence of acid regurgitation symptoms (43/67 vs 74/152, P < 0.05). Prevalence of other upper gastrointestinal and respiratory symptoms were similar between patients with positive and negative upper and lower pH test. Patients with abnormal EM were significantly older (49 ± 14 vs 45 ± 13 years, P < 0.05) and had higher prevalence of chronic cough than patients with normal EM(30/93 vs 26/143, P < 0.05). In patients with positive pH tests, the prevalence of dysphagia, chronic cough, and hoarseness of voice were significantly higher in patients with abnormal than those with normal EM (18/31 vs 18/56, P < 0.05; 12/31 vs 6/56, P < 0.005 and 19/31 vs 18/56, P < 0.01, respectively). Whereas in patients with negative lower pH tests, only the prevalence of heartburn was significantly lower in patients with normal than those with abnormal EM (26/87 vs 30/62, P < 0.05). CONCLUSIONS Acid regurgitation but not heartburn was associated with GER. Esophageal dysmotility had no significant effect on acid regurgitation symptom but associated with chronic cough, hoarseness of voice, and dysphagia only in patients with abnormal esophageal acid exposure.
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Affiliation(s)
- Tanisa Patcharatrakul
- Gastrointestinal Motility Research Unit, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Lim CH, Choi MG, Baeg MK, Moon SJ, Kim JS, Cho YK, Park JM, Lee IS, Kim SW, Choi KY. Symptom characteristics and psychosomatic profiles in different spectrum of gastroesophageal reflux disease. Gut Liver 2013; 8:165-9. [PMID: 24672658 PMCID: PMC3964267 DOI: 10.5009/gnl.2014.8.2.165] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/04/2013] [Accepted: 05/07/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND/AIMS Gastroesophageal reflux disease (GERD) is diagnosed based on symptoms of heartburn and regurgitation but is a heterogeneous condition which can be subclassified according to endoscopy and esophageal reflux monitoring. The aim of this study was to identify differences in demographic characteristics and reflux symptom patterns among patients with various spectrum of GERD. METHODS Patients having weekly heartburn or acid regurgitation were classified into four pathophysiological subgroups according to endoscopy and pH monitoring: reflux esophagitis (RE), endoscopy-negative reflux disease with pathological reflux (PR+), hypersensitive esophagus (HE), and normal acid exposure with negative symptom association (pH-). RESULTS A total of 195 patients were enrolled. The numbers of patients in the subgroups were: RE, 39.0%; PR+, 20.0%; HE, 10.3%; and pH-, 30.8%. Grossly, reflux symptom patterns and relieving/exacerbating factors did not differ between subgroups. Prevalence of extraesophageal syndrome was higher in patients with PR+ than in other groups. Overlapping functional dyspepsia was common in all groups. The SCL-90-R depression score was higher in PR+ patients than in RE patients (p<0.05). CONCLUSIONS Demographic characteristics and reflux symptom patterns cannot differentiate pH- group from GERD subtypes. Esophageal pH monitoring could be considered for the initial evaluation of GERD in the tertiary referral setting.
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Affiliation(s)
- Chul-Hyun Lim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Myung-Gyu Choi
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Myong Ki Baeg
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung Jin Moon
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jin Su Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yu Kyung Cho
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae Myung Park
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - In Seok Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang Woo Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyu Yong Choi
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Hirota M, Nakajima K, Souma Y, Mikata S, Iwase K, Demura K, Takahashi T, Yamasaki M, Miyata H, Kurokawa Y, Takiguchi S, Mori M, Doki Y. Assistive esophagoscopy during laparoscopic surgery for intra-thoracic stomach. Esophagus 2013. [DOI: 10.1007/s10388-013-0367-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
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Scerrino G, Inviati A, Di Giovanni S, Paladino NC, Di Paola V, Lo Re G, Almasio PL, Cupido F, Gulotta G, Bonventre S. Esophageal Motility Changes after Thyroidectomy; Possible Associations with Postoperative Voice and Swallowing Disorders. Otolaryngol Head Neck Surg 2013; 148:926-32. [DOI: 10.1177/0194599813482299] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Swallowing and voice impairment are common after thyroidectomy. We evaluated short-term functional changes in esophageal motility in a series of patients who had undergone total thyroidectomy. Several studies have investigated these symptoms by means of interviews or questionnaires. Study Design Prospective study. Setting Academic research. Materials and Methods Thirty-six consenting patients were prospectively recruited. Eligibility criteria were thyroid volume ≤60 mL, benign disease, and age between 18 and 65 years. Exclusion criteria were previous neck surgery, severe thyroiditis, hyperthyroidism, and pre- or postoperative vocal cord palsy. Voice impairment score, swallowing impairment score, lower esophageal sphincter pressure, esophageal motility, upper esophageal pressure, and coordination were evaluated preoperatively and 30 to 45 days after surgery. Results Postoperative swallowing impairment (appearance or worsening of dysphagia) was found in 20% of patients and voice impairment in more than 30%. Both preoperative and postoperative esophageal motility were similar. All patients showed an average decrease of 25% in upper esophageal pressure, although the pressure was within normal range. Swallowing alterations were associated with upper esophageal incoordination ( P < .03), and proximal acid reflux was significantly associated with voice impairment ( P < .02). Conclusion After uncomplicated thyroidectomy, decreased upper esophageal pressure may explain both pharyngeal (dysphagia) and laryngeal (vocal impairment) exposure to acid. In the future, proton pump inhibitor therapy protocols should be evaluated.
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Affiliation(s)
- Gregorio Scerrino
- Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - Angela Inviati
- Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - Silvia Di Giovanni
- Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | | | - Valentina Di Paola
- Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Lo Re
- Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi, Radiology Service, University of Palermo, Palermo, Italy
| | - Piero Luigi Almasio
- Gastrointestinal & Liver Unit, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Francesco Cupido
- Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - Gaspare Gulotta
- Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - Sebastiano Bonventre
- Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
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Gastroesophageal reflux disease and antireflux surgery-what is the proper preoperative work-up? J Gastrointest Surg 2013; 17:14-20; discussion p. 20. [PMID: 23090280 DOI: 10.1007/s11605-012-2057-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 10/11/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many surgeons feel comfortable performing antireflux surgery (ARS) on the basis of symptomatic evaluation, endoscopy, and barium esophagography. While esophageal manometry is often obtained to assess esophageal peristalsis, pH monitoring is rarely considered necessary to confirm the diagnosis of gastroesophageal reflux disease (GERD). AIMS The aim of this study was to analyze the sensitivity and specificity of symptoms, endoscopy, barium esophagography, and manometry as compared to pH monitoring in the preoperative evaluation of patients for ARS. PATIENTS AND METHODS One hundred and thirty-eight patients were referred for ARS with a diagnosis of GERD based on symptoms, endoscopy, and/or barium esophagography. Barium esophagography, esophageal manometry, and ambulatory 24-h pH monitoring were performed preoperatively in every patient. RESULTS Four patients were found to have achalasia and were excluded from the analysis. Based on the presence or absence of gastroesophageal reflux on pH monitoring, the remaining 134 patients were divided into two groups: GERD+ (n = 78, 58 %) and GERD- (n = 56, 42 %). The groups were compared with respect to the incidence of symptoms, presence of reflux and hiatal hernia on esophagogram, endoscopic findings, and esophageal motility. There was no difference in the incidence of symptoms between the two groups. Within the GERD+ group, 37 patients (47 %) had reflux at the esophagogram and 41 (53 %) had no reflux. Among the GERD- patients, 17 (30 %) had reflux and 39 (70 %) had no reflux. A hiatal hernia was present in 40 and 32 % of patients, respectively. Esophagitis was found at endoscopy in 16 % of GERD+ patients and in 20 % of GERD- patients. Esophageal manometry showed no difference in the pressure of the lower esophageal sphincter or quality of peristalsis between the two groups. CONCLUSIONS The results of this study showed that (a) symptoms were unreliable in diagnosing GERD, (b) the presence of reflux or hiatal hernia on esophagogram did not correlate with reflux on pH monitoring, (c) esophagitis on endoscopy had low sensitivity and specificity, and (d) manometry was mostly useful for positioning the pH probe and rule out achalasia. Ambulatory 24-h pH monitoring should be routinely performed in the preoperative work-up of patients suspected of having GERD in order to avoid unnecessary ARS.
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Mendez BM, Davis CS, Weber C, Joehl RJ, Fisichella PM. Gastroesophageal reflux disease in lung transplant patients with cystic fibrosis. Am J Surg 2012; 204:e21-6. [PMID: 22921151 DOI: 10.1016/j.amjsurg.2012.07.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 07/10/2012] [Accepted: 07/10/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) in lung transplant patients is being increasingly investigated because of its reported association with chronic rejection. However, information concerning the characteristics of GERD in cystic fibrosis (CF) patients is scarce. METHODS We compared esophageal pH monitoring, manometry, gastric emptying studies, and barium swallow of 10 lung transplant patients with CF with those of 78 lung transplant patients with other end-stage pulmonary diseases. RESULTS In lung transplant patients with CF, the prevalence of GERD was 90% (vs 54% controls, P = .04), of whom 70% had proximal reflux (vs 29% controls, P = .02). CONCLUSIONS Lung transplant patients with CF have a significantly higher prevalence and proximal extent of GERD than do other lung transplant recipients. These data suggest that CF patients in particular should be routinely screened for GERD after transplantation to identify those who may benefit from antireflux surgery, especially given the risks of GERD-related aspiration and chronic allograft injury.
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Affiliation(s)
- Bernardino M Mendez
- Department of Surgery, Loyola University Chicago, Stritch School of Medicine, Maywood, IL 60153, USA
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The prevalence and extent of gastroesophageal reflux disease correlates to the type of lung transplantation. Surg Laparosc Endosc Percutan Tech 2012; 22:46-51. [PMID: 22318059 DOI: 10.1097/sle.0b013e31824017d4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence is increasingly convincing that lung transplantation is a risk factor of gastroesophageal reflux disease (GERD). However, it is still not known if the type of lung transplant (unilateral, bilateral, or retransplant) plays a role in the pathogenesis of GERD. STUDY DESIGN The records of 61 lung transplant patients who underwent esophageal function tests between September 2008 and May 2010, were retrospectively reviewed. These patients were divided into 3 groups based on the type of lung transplant they received: unilateral (n=25); bilateral (n=30), and retransplant (n=6). Among these groups we compared: (1) the demographic characteristics (eg, sex, age, race, and body mass index); (2) the presence of Barrett esophagus, delayed gastric emptying, and hiatal hernia; and (3) the esophageal manometric and pH-metric profile. RESULTS Distal and proximal reflux were more prevalent in patients with bilateral transplant or retransplant and less prevalent in patients after unilateral transplant, regardless of the cause of their lung disease. The prevalence of hiatal hernia, Barrett esophagus, and the manometric profile were similar in all groups of patients. CONCLUSIONS Although our data show a discrepancy in prevalence of GERD in patients with different types of lung transplantation, we cannot determine the exact cause for these findings from this study. We speculate that the extent of dissection during the transplant places the patients at risk for GERD. On the basis of the results of this study, a higher level of suspicion of GERD should be held in patients after bilateral or retransplantation.
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Fisichella PM, Davis CS, Lundberg PW, Lowery E, Burnham EL, Alex CG, Ramirez L, Pelletiere K, Love RB, Kuo PC, Kovacs EJ. The protective role of laparoscopic antireflux surgery against aspiration of pepsin after lung transplantation. Surgery 2011; 150:598-606. [PMID: 22000170 DOI: 10.1016/j.surg.2011.07.053] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 07/11/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND The goal of this study was to determine, in lung transplant patients, if laparoscopic antireflux surgery (LARS) is an effective means to prevent aspiration as defined by the presence of pepsin in the bronchoalveolar lavage fluid (BALF). METHODS Between September 2009 and November 2010, we collected BALF from 64 lung transplant patients at multiple routine surveillance assessments for acute cellular rejection, or when clinically indicated for diagnostic purposes. The BALF was tested for pepsin by enzyme-linked immunosorbent assay (ELISA). We then compared pepsin concentrations in the BALF of healthy controls (n = 11) and lung transplant patients with and without gastroesophageal reflux disease (GERD) on pH-monitoring (n = 8 and n = 12, respectively), and after treatment of GERD by LARS (n = 19). Time to the development of bronchiolitis obliterans syndrome was contrasted between groups based on GERD status or the presence of pepsin in the BALF. RESULTS We found that lung transplant patients with GERD had more pepsin in their BALF than lung transplant patients who underwent LARS (P = .029), and that pepsin was undetectable in the BALF of controls. Moreover, those with more pepsin had quicker progression to BOS and more acute rejection episodes. CONCLUSION This study compared pepsin in the BALF from lung transplant patients with and without LARS. Our data show that: (1) the detection of pepsin in the BALF proves aspiration because it is not present in healthy volunteers, and (2) LARS appears effective as a measure to prevent the aspiration of gastroesophageal refluxate in the lung transplant population. We believe that these findings provide a mechanism for those studies suggesting that LARS may prevent nonallogenic injury to the transplanted lungs from aspiration of gastroesophageal contents.
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Affiliation(s)
- P Marco Fisichella
- Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL 60153, USA.
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Is there a role for dynamic swallowing MRI in the assessment of gastroesophageal reflux disease and oesophageal motility disorders? Eur Radiol 2011; 22:364-70. [PMID: 21894565 DOI: 10.1007/s00330-011-2258-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 08/23/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To evaluate the diagnostic value of dynamic MRI swallowing in patients with symptoms of Gastroesophageal Reflux Disease (GERD). METHODS Thirty-seven patients (17 m/20f) with typical signs of GERD underwent MR swallowing in the supine position at 1.5 T with a phased-array body coil. Using dynamic, gradient echo sequences (B-FFE) in the coronal, sagittal and axial planes, the bolus passages of buttermilk spiked with gadolinium chelate were tracked. MRI, pH-metry and manometry were performed within 31 days and results were compared. RESULTS MRI results were concordant with pH-metry in 82% (23/28) of patients diagnosed with abnormal oesophageal acid exposure by pH-metry. Five patients demonstrated typical symptoms of GERD and had positive findings with pH monitoring, but false negative results with MRI. In four of six patients (67%), there was a correct diagnosis of oesophageal motility disorder, according to manometric criteria, on dynamic MRI. The overall accuracy of MRI diagnoses was 79% (27/34). A statistically significant difference was found between the size of hiatal hernia, grade of reflux in MRI, and abnormal acid exposure on pH-monitoring. CONCLUSIONS MR fluoroscopy may be a promising radiation-free tool in assessing the functionality and morphology of the GE junction. KEY POINTS • Swallowing MRI can assess anatomy and function of the gastroesophageal-junction • Swallowing MRI can help identifying reflux and motility disorders • Definition of the size of hiatal hernias is possible in all three planes in MR. • Short duration of swallowing MRI enables its application in routine clinical practice.
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Fisichella PM, Davis CS, Gagermeier J, Dilling D, Alex CG, Dorfmeister JA, Kovacs EJ, Love RB, Gamelli RL. Laparoscopic antireflux surgery for gastroesophageal reflux disease after lung transplantation. J Surg Res 2011; 170:e279-86. [PMID: 21816422 DOI: 10.1016/j.jss.2011.05.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 05/12/2011] [Accepted: 05/24/2011] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although gastroesophageal reflux disease (GERD) is highly prevalent in lung transplantation, the pathophysiology of GERD in these patients is unknown. We hypothesize that the pathophysiology of GERD after lung transplantation differs from that of a control population, and that the 30-d morbidity and mortality of laparoscopic antireflux surgery (LARS) are equivalent in both populations. METHODS We retrospectively compared the pathophysiology of GERD and the 30-d morbidity and mortality of 29 consecutive lung transplant patients with 23 consecutive patients without lung transplantation (control group), all of whom had LARS for GERD between November 2008 and May 2010. RESULTS Both groups had a similar prevalence of endoscopic esophagitis and Barrett's esophagus , comparable manometric profiles, and similar prevalence of abnormal peristalsis. However, hiatal hernia was more common in controls than in lung transplant patients (57% versus 24%; P = 0.04). Lung transplant patients had a higher prevalence and severity of proximal GERD (65% versus 33%; P = 0.04). The 30-d morbidity and mortality following LARS were similar in both groups regardless of the higher surgical risk of lung transplants (median ASA class: 3 versus 2 for controls, P < 0.001). CONCLUSIONS These results show that despite similar manometric profiles, lung transplant patients are more prone to proximal reflux than the general population with GERD; the prevalence of endoscopic esophagitis and Barrett's esophagus is the same in both groups of patients; a hiatal hernia is uncommon after lung transplantation; and the morbidity and mortality of LARS are the same for lung transplant patients as the general population with GERD.
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Affiliation(s)
- P Marco Fisichella
- Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois, USA.
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Kushner PR, Peura DA. Review of proton pump inhibitors for the initial treatment of heartburn: is there a dose ceiling effect? Adv Ther 2011; 28:367-88. [PMID: 21484335 DOI: 10.1007/s12325-011-0013-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Indexed: 12/17/2022]
Abstract
Proton pump inhibitors (PPIs) are widely used in clinical practice. However, concerns have been expressed about their long-term use, particularly with regard to bone health, Clostridium difficile infections, and drug interactions with platelet aggregation inhibitors. There has been limited guidance for clinicians concerning appropriate dose selection of PPIs for the initial treatment of heartburn. This review explored whether published clinical trials provide evidence of a ceiling above which higher PPI doses do not provide additional clinical benefit over the lowest approved dose. All articles of randomized, controlled clinical trials in nonerosive gastroesophageal reflux disease (GERD) in which the effects of two or more doses of the same PPI on symptomatic relief of heartburn were quantified as a study endpoint were identified and analyzed through PubMed searches up to the end of September 2010. The majority of trials evaluated provided no evidence that higher PPI doses were superior to the lowest approved dose for the initial treatment of heartburn. There were no clinically relevant findings with respect to dose dependence and safety outcomes in these studies. Efficacy outcomes from the trials suggest there may be a dose ceiling effect and highlight the need for further research on the use of the lowest effective PPI doses as an appropriate strategy in the initial treatment of uncomplicated heartburn. Observational studies and some meta-analyses have suggested that long-term PPI pharmacotherapy might be associated with safety concerns, which necessitate the periodic evaluation of therapeutic benefit in terms of symptom resolution and regimen tolerability. However, evidence to date suggests that use of the lowest effective dose for the indication is not associated with significant adverse events, particularly in the short term. Clinical practice suggests that patients requiring long-term treatment should be maintained on the lowest dose necessary to control symptoms, and monitored for potentially confounding factors that may lead to safety concerns.
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Shah N, Force SD, Mitchell PO, Lin E, Lawrence EC, Easley K, Qian J, Ramirez A, Neujahr DC, Gal A, Leeper K, Pelaez A. Gastroesophageal reflux disease is associated with an increased rate of acute rejection in lung transplant allografts. Transplant Proc 2011; 42:2702-6. [PMID: 20832573 DOI: 10.1016/j.transproceed.2010.05.155] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Accepted: 05/12/2010] [Indexed: 12/20/2022]
Abstract
PURPOSE Gastric fundoplication (GF) for gastroesophageal reflux disease (GERD) may protect against the progression of chronic rejection in lung transplant (LT) recipients. However, the association of GERD with acute rejection episodes (ARE) is uncertain. This study sought to identify if ARE were linked to GERD in LT patients. METHODS This single-center retrospective observational study, of patients transplanted from January 1, 2000, to January 31, 2009, correlated results of pH probe testing for GERD with ARE (≥International Society for Heart and Lung Transplantation A1 or B1). We compared the rates of ARE among patients with GERD (DeMeester Score > 14.7) versus without GERD as number of ARE per 1,000 patient-days after LT. Patients undergoing GF prior to LT were excluded. RESULTS The analysis included 60 LT subjects and 9,249 patient-days: 33 with GERD versus 27 without GERD. We observed 51 ARE among 60 LT recipients. The rate of ARE was highest among patients with GERD: 8.49 versus 2.58, an incidence density ratio (IDR) of 3.29 (P = .00016). Upon multivariate negative binomial regression modeling, only GERD was associated with ARE (IDR 2.15; P = .009). Furthermore, GERD was associated with multiple ARE (36.4% vs 0%; P < .0001) and earlier onset compared with patients without GERD: ARE proportion at 2 months was 0.55 versus 0.26 P = .004). CONCLUSION In LT recipients, GERD was associated with a higher rate, multiple events, and earlier onset of ARE. The efficacy of GF to reduce ARE among patients with GERD needs further evaluation.
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Affiliation(s)
- N Shah
- Emory University School of Medicine, Atlanta, Georgia 30322, USA
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Novais PA, Lemme EMO. 24-h pH monitoring patterns and clinical response after achalasia treatment with pneumatic dilation or laparoscopic Heller myotomy. Aliment Pharmacol Ther 2010; 32:1257-65. [PMID: 20955445 DOI: 10.1111/j.1365-2036.2010.04461.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The most effective treatment for achalasia is pneumatic dilation or myotomy. The best option is still controversial and incidence of complications could help choosing. Gastro-oesophageal reflux (GER) is the most frequent complication after treatment for achalasia. The 24-h pH monitoring (24-h pH) is the best method to evaluate true GER. AIM To analyse the 24-h pH patterns after treatment, correlating with therapeutic success. METHODS Untreated patients with achalasia were randomized to pneumatic dilation or laparoscopic Heller myotomy with fundoplication (LHM+Fp) and evaluated with clinical/manometric results and 24-h pH. RESULTS Ninety-four patients were analysed pre-treatment and 85 post-treatment. Clinical success was 73.8% in pneumatic dilation group and 88.3% in LHM+Fp group (P = 0.08). The incidence of GER was 31% in pneumatic dilation, and 4.7% in LHM+Fp (P = 0.001). The occurrence of hypotensive lower oesophageal sphincter (LES) was 53.3% in patients who developed GER and 28.6% in patients with 24-h pH suggesting fermentation (P = 0.019). The rates of dysphagia resolution in patients with 24-h pH of GER and fermentation were respectively 86.7% and 85.7% (P = 0.89). CONCLUSIONS True GER 24-h pH is more frequent after pneumatic dilation for achalasia, and it is associated with a hypotensive LES. A 24-h pH suggestive of fermentation or true GER is not associated with worse clinical/manometric results.
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Affiliation(s)
- P A Novais
- Federal University of Rio de Janeiro, Clementino Fraga Filho University Hospital, Brazil.
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Davis CS, Shankaran V, Kovacs EJ, Gagermeier J, Dilling D, Alex CG, Love RB, Sinacore J, Fisichella PM. Gastroesophageal reflux disease after lung transplantation: pathophysiology and implications for treatment. Surgery 2010; 148:737-44; discussion 744-5. [PMID: 20727564 DOI: 10.1016/j.surg.2010.07.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 07/07/2010] [Indexed: 01/11/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is thought to be a risk factor for the development or progression of chronic rejection after lung transplantation. However, the prevalence of GERD and its risk factors, including esophageal dysmotility, hiatal hernia and delayed gastric emptying after lung transplantation, are still unknown. In addition, the prevalence of Barrett's esophagus, a known complication of GERD, has not been determined in these patients. The purpose of this study was to determine the prevalence and extent of GERD, as well as the frequency of these risk factors and complications of GERD in lung transplant patients. METHODS Thirty-five consecutive patients underwent a combination of esophageal function testing, upper endoscopy, barium swallow, and gastric emptying scan after lung transplantation. RESULTS In this patient population, the prevalence of GERD was 51% and 22% in those who had been retransplanted. Of patients with GERD,36% had ineffective esophageal motility (IEM), compared with 6% of patients without GERD (P = .037). No patient demonstrated hiatal hernia on barium swallow. The prevalence of delayed gastric emptying was 36%. The prevalence of biopsy-confirmed Barrett's esophagus was 12%. CONCLUSION Our study shows that, after lung transplantation, more than half of patients had GERD, and that GERD was more common after retransplantation. IEM and delayed gastric emptying are frequent in patients with GERD. Hiatal hernia is rare. The prevalence of Barrett's esophagus is not negligible. We conclude that GERD is highly prevalent after lung transplantation, and that delayed gastric emptying and Barrett's esophagus should always be suspected after lung transplantation because they are common risks factors and complications of GERD.
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Affiliation(s)
- Christopher S Davis
- Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL 60153, USA
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Bandeira CD, Rubin AS, Cardoso PFG, Moreira JDS, Machado MDM. Prevalence of gastroesophageal reflux disease in patients with idiopathic pulmonary fibrosis. J Bras Pneumol 2010; 35:1182-9. [PMID: 20126919 DOI: 10.1590/s1806-37132009001200004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 08/12/2009] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine the prevalence of gastroesophageal reflux disease (GERD) and to evaluate its clinical presentation, as well as the esophageal function profile in patients with idiopathic pulmonary fibrosis (IPF). METHODS In this prospective study, 28 consecutive patients with IPF underwent stationary esophageal manometry, 24-h esophageal pH-metry and pulmonary function tests. All patients also completed a symptom and quality of life in GERD questionnaire. RESULTS In the study sample, the prevalence of GERD was 35.7%. The patients were then divided into two groups: GERD+ (abnormal pH-metry; n = 10) and GERD- (normal pH-metry; n = 18). In the GERD+ group, 77.7% of the patients presented at least one typical GERD symptom. The pH-metry results showed that 8 (80%) of the GERD+ group patients had abnormal supine reflux, and that the reflux was exclusively in the supine position in 5 (50%). In the GERD+ and GERD- groups, respectively, 5 (50.0%) and 7 (38.8%) of the patients presented a hypotensive lower esophageal sphincter, 7 (70.0%) and 10 (55.5%), respectively, presenting lower esophageal dysmotility. There were no significant differences between the groups regarding demographic characteristics, pulmonary function, clinical presentation or manometric findings. CONCLUSIONS The prevalence of GERD in the patients with IPF was high. However, the clinical and functional characteristics did not differ between the patients with GERD and those without.
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Ayazi S, Hagen JA, Zehetner J, Oezcelik A, Abate E, Kohn GP, Sohn HJ, Lipham JC, Demeester SR, Demeester TR. Proximal esophageal pH monitoring: improved definition of normal values and determination of a composite pH score. J Am Coll Surg 2010; 210:345-50. [PMID: 20193899 DOI: 10.1016/j.jamcollsurg.2009.12.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 12/06/2009] [Accepted: 12/08/2009] [Indexed: 01/26/2023]
Abstract
BACKGROUND Patients with respiratory and laryngeal symptoms are commonly referred for evaluation of reflux disease as a potential cause. Dual-probe pH monitoring is often performed, although data on normal acid exposure in the proximal esophagus are limited because of the small number of normal subjects and inconsistent placement of the proximal pH sensor in relation to the upper esophageal sphincter. We measured proximal esophageal acid exposure using dual-probe pH and calculated a composite pH score in a large number of asymptomatic volunteers to better define normal values. STUDY DESIGN Eighty-one normal subjects free of reflux, laryngeal, or respiratory symptoms were recruited. All had video esophagraphy to exclude hiatal hernia. Esophageal pH monitoring was performed using 1 of 3 different dual-probe catheters with sensors spaced 10, 15, or 18 cm apart. The standard components of esophageal acid exposure were measured, excluding meal periods. A composite pH score for the proximal esophagus was calculated using these components. RESULTS The final study population consisted of 59 (49% male) subjects, with a median age of 27 years. All had normal distal esophageal acid exposure and no hiatal hernia. The 95(th) percentile values for the percent time the pH was < 4 for the total, upright, and supine periods were 0.9%, 1.2%, and 0.4%, respectively. The 95(th) percentile for the number of reflux episodes was 24 and for the calculated proximal esophageal composite pH score was 16.4. CONCLUSIONS In a large population of normal subjects, we have defined the normal values and calculated a composite pH score for proximal esophageal acid exposure. The total percent time pH < 4 was similar to previously published normal values, but the number of reflux episodes was greater.
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Affiliation(s)
- Shahin Ayazi
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Chan K, Liu G, Miller L, Ma C, Xu W, Schlachta CM, Darling G. Lack of correlation between a self-administered subjective GERD questionnaire and pathologic GERD diagnosed by 24-h esophageal pH monitoring. J Gastrointest Surg 2010; 14:427-36. [PMID: 20066567 DOI: 10.1007/s11605-009-1137-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 12/07/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Self-reported reflux symptoms do not always correspond to pathologic gastroesophageal reflux disease (GERD). We evaluated whether GERD-related symptoms in the self-reported Mayo-GERD questionnaire (GERDQ) were correlated with current gold standard definitions of pathologic GERD. METHODS Three hundred thirty-six consecutive consenting individuals with GERD symptoms referred for 24-h esophageal pH monitoring completed a baseline GERDQ. Univariate and multivariate analyses identified questions that were most associated with percent total time pH<4 at distal probe (DT) >4% or DeMeester score (DS) >or=14.7, two accepted definitions of pathologic GERD. A risk score was created from these analyses, followed by generation of receiver operating characteristic curves and determination of C-statistics, sensitivity, and specificities at various cut points, with prespecified minimal values of each that would be required to meet the definition of "potential clinical utility." RESULTS Forty-nine percent of patients were found to have pathologic GERD; half the patients (not necessarily those with pathologic GERD) described suffering from severe or very severe heartburn or acid regurgitation in the past year. Univariate logistic regression analysis identified six of 22 key GERD questions that were significantly related to DT or DS, in addition to age and gender. Three questions (duration of symptoms, nocturnal heartburn, hiatal hernia) along with age and gender remained significant in multivariate analyses. A risk score (RS) was created from these five questions separately for DT and DS. For DT, the C-statistic for RS was 0.75, and at the optimal cut point of >or=6 that maximizes sensitivity (SS) and specificity (SP), SS was 68% and SP was 72%. For DS, the C-statistic was 0.73, and at the optimal cut point, SS was 82%and SP 60%. When considering other cut points, the rare extreme case of very low RS (<or=2) was strongly predictive of lack of pathologic GERD: for DT, SS 100%/SP 18%, negative predictive value (NPV) 100%; and for DS, SS 97%, SP 25%, NPV 88%. However, only 10-15% of patients referred for pH testing had RS scores of <or=2. CONCLUSION Self-reported prolonged history of GERD-like symptoms, nocturnal heartburn, history of a hiatus hernia, and male gender were associated with abnormal 24-h esophageal pH monitoring. However, these factors lack clinical utility to predict pathologic GERD in patients referred for pH testing. We found that 51% of patients with severe GERD symptoms do not have true pathological GERD on objective testing. The clinical implications of this study are significant in that treatment with acid-suppressing medication in such patients would be inappropriate.
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Affiliation(s)
- Kevin Chan
- Department of Medical Biophysics and Medicine, Princess Margaret Hospital/Ontario Cancer Institute, Toronto, ON, Canada
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Indrio F, Riezzo G, Raimondi F, Cavallo L, Francavilla R. Regurgitation in healthy and non healthy infants. Ital J Pediatr 2009; 35:39. [PMID: 20003194 PMCID: PMC2796655 DOI: 10.1186/1824-7288-35-39] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 12/09/2009] [Indexed: 12/15/2022] Open
Abstract
Uncomplicate regurgitation in otherwise healthy infants is not a disease. It consists of milk flow from mouth during or after feeding. Common causes include overfeeding, air swallowed during feeding, crying or coughing; physical exam is normal and weight gain is adequate. History and physical exam are diagnostic, and conservative therapy is recommended. Pathologic gastroesophageal reflux or gastroesophageal reflux disease refers to infants with regurgitation and vomiting associated with poor weight gain, respiratory symptoms, esophagitis. Reflux episodes occur most often during transient relaxations of the lower esophageal sphincter unaccompanied by swallowing, which permit gastric content to flow into the esophagus. A minor proportion of reflux episodes occurs when the lower esophageal sphincter fails to increase pressure during a sudden increase in intraabdominal pressure or when lower esophageal sphincter resting pressure is chronically reduced. Alterations in several protective mechanisms allow physiologic reflux to become gastroesophageal reflux disease; diagnostic approach is both clinical and instrumental: radiological series are useful to exclude anatomic abnormalities; pH-testing evaluates the quantity, frequency and duration of the acid reflux episodes; endoscopy and biopsy are performed in the case of esophagitis. Therapy with H2 receptor antagonists and proton pump inhibitors are suggested.
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Affiliation(s)
- Flavia Indrio
- Department of Pediatrics, University of Bari Policlinico Piazza G.Cesare, 70124 Bari, Italy
| | - Giuseppe Riezzo
- Laboratory of Experimental Pathophysiology, National Institute for Digestive Diseases, I.R.C.C.S. "Saverio de Bellis" Via Turi, 14, 70013 Castellana Grotte (Bari), Italy
| | - Francesco Raimondi
- Department of Pediatrics, University Federico II Policlinico Via S Pansini, 12, 80100 Naples, Italy
| | - Luciano Cavallo
- Department of Pediatrics, University of Bari Policlinico Piazza G.Cesare, 70124 Bari, Italy
| | - Ruggiero Francavilla
- Department of Pediatrics, University of Bari Policlinico Piazza G.Cesare, 70124 Bari, Italy
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Acute development of gastroesophageal reflux after radiofrequency catheter ablation of atrial fibrillation. Heart Rhythm 2009; 6:1457-62. [DOI: 10.1016/j.hrthm.2009.06.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 06/15/2009] [Indexed: 01/07/2023]
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Fathi H, Moon T, Donaldson J, Jackson W, Sedman P, Morice AH. Cough in adult cystic fibrosis: diagnosis and response to fundoplication. Cough 2009; 5:1. [PMID: 19149907 PMCID: PMC2634760 DOI: 10.1186/1745-9974-5-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 01/18/2009] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Gastroesophageal reflux is one of the most common causes of chronic cough in the general population. Reflux occurs frequently in patients with cystic fibrosis (CF). We undertook laparoscopic Nissen fundoplication in adult CF patients with a clinical diagnosis of reflux cough who had failed conventional medical therapies. OBJECTIVE We determined the response to the surgical route in the treatment of intractable reflux cough in CF. METHOD Patients with refractory cough were assessed by 24 h pH monitoring and oesophageal manometry. Pre-and post-operation cough, lung function and exacerbation frequency were compared. Cough was assessed by the Leicester Cough Questionnaire (LCQ), lung function by spirometry and exacerbation frequency was defined by comparing the postoperative epoch with a similar preoperatively. RESULTS Significant abnormalities of oesophageal function were seen in all patients studied. 6 patients (2 females), with the mean age of 34.5 years consented to surgery. Their mean number of reflux episodes was 144.4, mean DeMeester score was 39.2, and mean lower oesophageal sphincter pressure 12.4 mmHg. There was a small change in the FEV1 from 1.03 L to 1.17 (P = 0.04), and FVC improved from 2.62 to 2.87 (P = 0.05). Fundoplication lead to a marked fall in cough with the total LCQ score increasing from 11.9 to 18.3 (P = 0.01). Exacerbation events were reduced by 50% post operatively. CONCLUSION Whilst there is an obvious attention to respiratory causes of cough in CF, reflux is also a common cause. Fundoplication is highly effective in the control of reflux cough in CF. Significant reduction in exacerbation frequency may indicate that reflux with possible aspiration is a major unrecognised contributor to airway disease.
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Affiliation(s)
- Hosnieh Fathi
- Cardiovascular and Respiratory Studies, Hull York Medical School, University of Hull, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK
| | - Tanya Moon
- Cardiovascular and Respiratory Studies, Hull York Medical School, University of Hull, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK
| | - Jo Donaldson
- Dietetics Department, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK
| | - Warren Jackson
- Gastro-Intestinal Physiology Laboratory, Castle Hill Hospital, Cottingham, East Yorkshire, HU16 5JQ, UK
| | - Peter Sedman
- Division of Upper Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - Alyn H Morice
- Cardiovascular and Respiratory Studies, Hull York Medical School, University of Hull, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK
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Efficacy and safety of omeprazole in Japanese patients with nonerosive reflux disease. J Gastroenterol 2009; 43:670-8. [PMID: 18807128 DOI: 10.1007/s00535-008-2214-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2008] [Accepted: 05/01/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is increasing awareness of nonerosive reflux disease (NERD) as a disease requiring treatment in Japan. This randomized, double-blind, placebo-controlled, parallel-group study was conducted to investigate the efficacy and safety of omeprazole 10 mg and 20 mg once daily in Japanese patients with NERD. METHODS Patients with heartburn for at least 2 days a week during the month before entry into the study and no endoscopic signs of a mucosal break (grade M or N according to Hoshihara's modification of the Los Angeles classification) were randomly assigned to one of three groups (omeprazole 10 mg or 20 mg, or placebo) once daily for 4 weeks. RESULTS Overall, 355 patients were enrolled, of whom 284 were randomly assigned to one of the three groups (omeprazole 10 mg, n = 96; omeprazole 20 mg, n = 93; placebo, n = 95). The rate of complete resolution of heartburn in week 4 was significantly higher in patients treated with omeprazole 10 mg [32.3%, 95% confidence interval (CI), 22.9%-41.6%] or 20 mg (25.8%, 95% CI, 16.9%-34.7%) than in the placebo group (12.0%, 95% CI, 5.3%-18.6%). No significant difference between the two omeprazole groups was observed. The rate of complete resolution of heartburn by omeprazole was similar between patients with grade M and those with grade N esophagus. Omeprazole also increased the rate of sufficient relief from heartburn. Omeprazole was well tolerated. CONCLUSIONS Omeprazole 10 mg or 20 mg once daily is effective and well tolerated in patients with NERD regardless of their endoscopic classification.
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Ayazi S, Lipham JC, Portale G, Peyre CG, Streets CG, Leers JM, Demeester SR, Banki F, Chan LS, Hagen JA, Demeester TR. Bravo catheter-free pH monitoring: normal values, concordance, optimal diagnostic thresholds, and accuracy. Clin Gastroenterol Hepatol 2009; 7:60-7. [PMID: 18976965 DOI: 10.1016/j.cgh.2008.08.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 08/05/2008] [Accepted: 08/08/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The Bravo pH capsule is a catheter-free intraesophageal pH monitoring system that avoids the discomfort of an indwelling catheter. The objectives of this study were as follows: (1) to obtain normal values for the first and second 24-hour recording periods using a Bravo capsule placed transnasally 5 cm above the upper border of the lower esophageal sphincter determined by manometry and to assess concordance between the 2 periods, (2) to determine the optimal discriminating threshold for identifying patients with gastroesophageal reflux disease (GERD), and (3) to validate this threshold and to identify the recording period with the greatest accuracy. METHODS Normal values for a manometrically positioned, transnasally inserted Bravo capsule were determined in 50 asymptomatic subjects. A test population of 50 subjects (25 asymptomatic, 25 with GERD) then was monitored to determine the best discriminating thresholds. The thresholds for the first, second, and combined (48-hour) recording periods then were validated in a separate group of 115 patients. RESULTS In asymptomatic subjects, the values measured using a manometrically positioned Bravo pH capsule were similar between the first and second 24-hour periods of recording. The highest level of accuracy with Bravo was observed when an abnormal composite pH score was obtained in the first or second 24-hour period of monitoring. CONCLUSIONS Normal values for esophageal acid exposure were defined for a manometrically positioned, transnasally inserted, Bravo pH capsule. An abnormal composite pH score, obtained in either the first or second 24-hour recording period, was the most accurate method of identifying patients with GERD.
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Affiliation(s)
- Shahin Ayazi
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA
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Ayazi S, Leers JM, Oezcelik A, Abate E, Peyre CG, Hagen JA, DeMeester SR, Banki F, Lipham JC, DeMeester TR, Crookes PF. Measurement of gastric pH in ambulatory esophageal pH monitoring. Surg Endosc 2008; 23:1968-73. [DOI: 10.1007/s00464-008-0218-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 09/02/2008] [Accepted: 10/01/2008] [Indexed: 12/22/2022]
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