Helicobacter pylori and gastroesophageal reflux disease: a review of this intriguing relationship

Gastro‑oesophageal reflux disease in liver cirrhosis: Possible pathogenesis and clinical intervention (Review)

Oesophageal variceal bleeding is a common complication of decompensated liver cirrhosis (LC). Some studies have reported that reflux oesophagitis (RE) is a risk factor for upper gastrointestinal bleeding, and greatly impacts the quality of life. However, the frequency and mechanism of gastro-oesophageal reflux disease (GERD) in LC remain unclear. The present review explored the possible pathogenesis, and analysed the advantages and disadvantages of the interventional measures and the need for implementation of these measures. By combining the comprehensive terms associated with LC, GERD and RE, EMBASE, Medline/PubMed and the Cochrane Library were systematically searched. The underlying pathological mechanism of GERD in LC was summarized: Transient relaxation of the lower oesophageal sphincter, delayed gastric emptying, increased intra-abdominal pressure, increased intragastric pressure and excessive nitric oxide production destroyed the 'anti-reflux barrier', causing gastric content reflux. Proton pump inhibitors (PPIs) have been widely used empirically to lower the risk of oesophageal venous rupture and bleeding. However, long-term use of acid inhibitors in patients with LC may induce complications, such as spontaneous bacterial peritonitis. The metabolic half-life of PPIs is prolonged in patients with severe liver function impairment. Therefore, the indications for using acid inhibitors lack clarity. However, after endoscopic oesophageal variceal eradication, additional benefits may be gained from the long-term use of PPIs in small doses.

Prevalence and risk factors of endoscopically confirmed gastroesophageal reflux disease (GERD) in patients with liver cirrhosis

Background

Gastroesophageal reflux disease (GERD) is one of the most common diseases in modern civilization that originates basically from a disturbance in the structure and function of the lower esophageal sphincter (LES). Liver cirrhosis with or without esophageal varices (EV) may predispose to GERD, and GERD may precipitate rupture of esophageal varices. As variceal bleeding is a serious life-threatening complication of liver cirrhosis, GERD prevalence among cirrhotic patients is continuously subjected to research. We aimed to determine the prevalence of endoscopy-confirmed GERD in patients with liver cirrhosis and its possible risk factors. So, one hundred patients with HCV-related liver cirrhosis were consecutively enrolled in this study. They were subjected to history taking {including Reflux Disease Questionnaire}, thorough clinical examination, abdominal ultrasound, and lab investigations and then referred for upper endoscopy to screen for GERD and/or esophageal varices.

Results

GERD was endoscopically confirmed in 83 patients (83%) and the highest prevalence was in patients with Child B and C. Among 82 patients with esophageal varices, there were 68 patients who had endoscopic GERD (82.9%), and among 62 patients with ascites, there were 56 patients who had endoscopic GERD (90.3%).

Conclusion

We found a high prevalence of GERD (83%) among patients with liver cirrhosis. The severity of GERD was significantly related to the Child grade, the grade of varices, and the degree of ascites but ascites was the only significant risk factor for GERD development in cirrhotic patients.

Decreased risk for microscopic colitis and inflammatory bowel disease among patients with reflux disease

AIM

Previous studies have found an increased risk for microscopic colitis (MC) associated with proton pump inhibitors. In patients with ulcerative colitis (UC) or Crohn's disease (CD), proton pump inhibitors have been associated with an increased risk for IBD flares and impaired outcomes. The aim of this study was to test the epidemiological associations between gastro-oesophageal reflux disease (GERD) and MC, UC or CD in a large database.

METHOD

The Miraca Life Sciences Database is a national electronic repository of histopathological records of patients distributed throughout the entire USA. A case-control study evaluated whether the presence of Barrett's metaplasia, erosive oesophagitis on endoscopy or histological signs of reflux oesophagitis, clinical diagnosis of GERD or any GERD type affected the occurrence of MC, UC or CD among 228 506 subjects undergoing bidirectional endoscopy. Multivariate logistic regression analyses were used to calculate ORs and their 95% CI for the risk of MC, UC or CD associated with various types of GERD and were adjusted for age, sex and presence of Helicobacter pylori.

RESULTS

The analysis revealed an inverse relationship between GERD and different types of inflammatory bowel disease. The inverse relationships applied similarly to MC (mean = 0.62, 95% CI: 0.58-0.66), UC (mean = 0.89, 95% CI: 0.81-0.97) and CD (mean = 0.76, 95% CI: 0.69-0.85). It also applied to different forms of GERD, with a trend towards more pronounced inverse relationships associated with Barrett's metaplasia or erosive oesophagitis than clinical diagnosis of GERD.

CONCLUSION

Gastro-oesophageal reflux disease is inversely associated with all forms of inflammatory bowel disease, such as MC, UC, or CD.

Effect of Helicobacter pylori eradication on reflux esophagitis therapy: a multi-center randomized control study

Background:

Helicobacter pylori (H. pylori) frequently colonizes the stomach. Gastroesophageal reflux disease (GERD) is a common and costly disease. But the relationship of H. pylori and GERD is still unclear. This study aimed to explore the effect of H. pylori and its eradication on reflux esophagitis therapy.

Methods:

Patients diagnosed with reflux esophagitis by endoscopy were enrolled; based on rapid urease test and Warth–Starry stain, they were divided into H. pylori positive and negative groups. H. pylori positive patients were randomly given H. pylori eradication treatment for 10 days, then esomeprazole 20 mg bid for 46 days. The other patients received esomeprazole 20 mg bid therapy for 8 weeks. After treatment, three patient groups were obtained: H. pylori positive eradicated, H. pylori positive uneradicated, and H. pylori negative. Before and after therapy, reflux symptoms were scored and compared. Healing rates were compared among groups. The χ² test and t-test were used, respectively, for enumeration and measurement data.

Results:

There were 176 H. pylori positive (with 92 eradication cases) and 180 negative cases. Healing rates in the H. pylori positive eradicated and H. pylori positive uneradicated groups reached 80.4% and 79.8% (P = 0.911), with reflux symptom scores of 0.22 and 0.14 (P = 0.588). Healing rates of esophagitis in the H. pylori positive uneradicated and H. pylori negative groups were, respectively, 79.8% and 82.2% (P = 0.848); reflux symptom scores were 0.14 and 0.21 (P = 0.546).

Conclusions:

Based on esomeprazole therapy, H. pylori infection and eradication have no significant effect on reflux esophagitis therapy.

Prevalence of benign gastric polyps in a large pathology database

AIMS

The aim of the study was to utilize a large national histopathology database for the analysis of the clinical epidemiology of gastric polyps.

METHODS

In a case-control study, 71,575 case subjects with gastric polyps were compared to 741,351 control subjects without gastric polyps.

RESULTS

Of all patients, 7.72% harboured fundic gland polyps, 1.79% gastric hyperplastic polyps, 0.09% gastric adenomas, and 0.06% type I neuroendocrine tumours. All types showed a clear-cut age-dependent rise. Reflux disease was significantly more common in patients with fundic gland polyps and significantly less common in patients with gastric adenomas or neuroendocrine tumours. Anaemia was more common in patients with gastric hyperplastic polyps, gastric adenomas, or neuroendocrine tumours. Helicobacter pylori was found significantly less frequently in all subjects with gastric polyps than in controls. Intestinal metaplasia and gastric atrophy were both more common in gastric adenoma and neuroendocrine tumours and less common in fundic gland polyps than in controls. Different polyp types tended to coincide in the same patients.

CONCLUSIONS

Gastric hyperplastic polyps appeared to mark the beginning of a progression from chronic gastritis to intestinal metaplasia and gastric atrophy, which leads to diminished gastric acid output and increased gastrin secretion. Gastric adenoma and neuroendocrine tumours reflect later stages of this process.

Effect of Helicobacter pylori infection on gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a common chronic disease of the digestive system. In recent years, due to the better understanding of Helicobacter pylori (H. pylori) and the wide clinical application of proton pump inhibitors, the rate of H. pylori infection is declining, while the incidence of GERD is increasing. This phenomenon suggests a possible relationship between H. pylori infection and the incidence of GERD. The pathogenesis of GERD is related to the dysfunction of the protective esophageal barrier, esophageal motility, gastric acidity and gastric emptying, and H. pylori infection may affect these factors to exert an impact on the incidence of GERD.

Time trends of US hospitalization for esophageal disease

BACKGROUND AND AIMS

The occurrence of reflux disease seems to be rising in the United States. The aim of the present study was to follow the time trends of hospitalization for gastroesophageal reflux disease (GERD) and other esophageal disease during the past 4 decades.

METHODS

US hospital utilization data were available for individual years from 1970 to 2010 through the National Hospital Discharge Survey. Esophageal diagnoses were stratified by their ninth revision of the International Classification of Diseases codes. Annual hospitalizations were expressed as rates per 100,000 living US population.

RESULTS

GERD was by far the most common esophageal disorder resulting in hospitalization. However, in only 5% of instances did GERD-related diagnoses constitute the primary cause of hospitalization. Between 1970 and 2010 the rates of GERD-related hospitalizations increased in an exponential manner almost 10-fold. This rise affected both sex and all age groups alike. A 3-fold rise was noted in hospitalizations for esophageal adenocarcinoma. Other esophageal diagnoses, such as achalasia, dyskinesia, or stricture were characterized by falling or stable trends.

CONCLUSIONS

US hospitalization data show a continued exponential rise in the occurrence of GERD without any signs of leveling off. These trends are likely to represent ongoing changes in the underlying incidence and prevalence of the disease.

Association between Helicobacter pylori and Barrett's esophagus: a case-control study

OBJECTIVES

The estimated association between Helicobacter pylori and Barrett's esophagus (BE) has been heterogenous across previous studies. In this study, we aimed to examine the association between H. pylori and BE and to identify factors that may explain or modify this association.

METHODS

We conducted a case-control study in which we used screening colonoscopy controls recruited from primary care clinics as our primary control group in order to minimize selection bias. All participants underwent an esophagogastroduodenoscopy with gastric mapping biopsies. We used logistic regression to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to estimate the association between H. pylori and BE while controlling for confounders.

RESULTS

We identified 218 cases and 439 controls. The overall OR for the association between H. pylori and BE after controlling for age and white race was 0.55 (95% CI: 0.35-0.84). We observed an even stronger inverse association (OR: 0.28; 95% CI: 0.15, 0.50) among participants with corpus atrophy or antisecretory drug use ≥ 1 time per week (factors thought to lower gastric acidity), and no inverse association in patients without these factors (OR: 1.32; 95% CI: 0.66, 2.63).

CONCLUSIONS

The association between H. pylori and a decreased risk for BE appears to occur in patients with factors that would likely lower gastric acidity (corpus atrophy or taking antisecretory drugs at least once a week).

[The Mexican consensus on gastroesophageal reflux disease. Part I]

BACKGROUND

The changes, advances, and new discoveries regarding different aspects of gastroesophageal reflux disease (GERD) have made it necessary to update the Mexican Consensus published in 2002.

AIMS

To elaborate a new Mexican Consensus on GERD.

METHODS

The general project coordinators selected six GERD experts to carry out an extensive review of the literature for the purpose of elaborating statements on the principal aspects of GERD. These were then placed under the consideration of specialists in the study of this disease. Definitive approval by all participants was reached using the modified Delphi method with three rounds of anonymous and iterative voting. The following scale was employed: A- in complete agreement; B- in agreement, but with minor concerns; C- in agreement, but with major concerns; D- in disagreement, but with major concerns; E- in disagreement, but with minor concerns; or F- in complete disagreement. Consensus was declared when 67.00% or more of the participants concurred on a category of agreement (A, B, or C).

RESULTS

A consensus was reached on 160 of the statements upon completion of the voting rounds, with 90.00% concurrence for the majority of them.

CONCLUSIONS

The 2011 Mexican Consensus on Gastroesophageal Disease is a practical and up-to-date consultation tool, providing the opinion of Mexican experts on all the new information available about this disease. It allows there to be homogeneity in diagnostic and therapeutic criteria, all of which serves to benefit our patients.

IRAK-M modulates expression of IL-10 and cell surface markers CD80 and MHC II after bacterial re-stimulation of tolerized dendritic cells

BACKGROUND

As essential components of the innate immune system, dendritic cells (DCs) can interact directly with pathogens as well as participate in the adaptive immune response. In cells closely related to DCs such as macrophages and monocytes, prior exposure to minute amounts of endotoxin can lead to a refractory period where subsequent exposure to higher doses fails to induce an inflammatory response; little research has investigated this effect on DCs. This study tested if murine bone marrow-derived dendritic cells (BM-DCs) respond to endotoxin- and bacterial sonicate-induced tolerance by decreased inflammatory and increased anti-inflammatory response, and the role of IRAK-M, an intracellular negative regulator of TLR signaling, in this tolerance.

RESULTS

Tolerized BM-DCs exhibited a significant drop in TNF-α and IL-12p70 production and increased IL-10 expression compared to untolerized cells. BM-DCs also showed the ability to develop heterotolerance, in which the LPS exposure alone was able to induce tolerance to Helicobacter pylori sonicate and TLR2 agonist Pam3Cys. Furthermore, the expression of IRAK-M was increased after restimulation of tolerized BM-DCs as determined qPCR and Western blot. IRAK-M exhibited a suppressive effect on surface expression of major histocompatibilty complex class II (MHC II) and CD80 in LPS-tolerized BM-DCs. IL-10 expression in bacterial sonicate-tolerized IRAK-M-/- BM-DCs was altered as compared to wild type BM-DCs, with tolerance-induced expression of IL-10 mitigated in tolerized IRAK-M-/- BM-DCs.

CONCLUSION

Along with endotoxin, bacterial sonicate is able to induce refractory tolerance in BM-DCs, and IRAK-M plays a role in modulating cell surface expression of MHC class II and CD80 and release of IL-10 during this tolerance.

Gastroesophageal reflux after anterior cervical surgery: a controlled, prospective analysis

STUDY DESIGN

Prospective controlled clinical study.

OBJECTIVE

To determine the incidence and severity of GERD in patients undergoing anterior cervical decompression and fusion (ACDF), using patients undergoing posterior lumbar decompression as a control group.

SUMMARY OF BACKGROUND DATA

The incidence gastroesophageal reflux disease (GERD) after anterior cervical decompression and fusion (ACDF) has not previously been studied.

METHODS

Patients undergoing either 1- or 2-level ACDF (n = 38) or posterior lumbar decompression surgery (control group, n = 56) were prospectively enrolled. Baseline patient characteristics were recorded. Intraoperative and postoperative medical records were reviewed. A validated GERD measurement tool (GERD Impact Scale, GIS) and a dysphagia questionnaire (including a dysphagia numeric rating score, range, 0-10) were administered preoperatively, and during the 2-week, 6-week, and 12-week postoperative visits.

RESULTS

Cervical patients had a significantly higher incidence of GERD at 2 weeks than the lumbar patients (78.9% vs. 42.9%, P = 0.001). Cervical patients had a higher incidence of GERD at 6 and 12 weeks as well, but these differences were not statistically significant. The change in GIS score from baseline was significantly higher in the cervical group at all follow-up time periods. On average, cervical patients required 1.2 doses of antacid medication in the postoperative period, compared to an average of 0.5 doses required by lumbar patients (P = 0.006). There was a significant correlation between the severity of dysphagia and the GIS score at 2 weeks, but no correlation at 6 or 12 weeks. Operative time did not correlate with the GIS score at any of the follow-up time periods. The number of surgical levels (i.e., one vs. two) and level of surgery (i.e., above C5-C6 vs. at or below C5-C6) had no effect on the GIS score.

CONCLUSION

Compared to the lumbar control group, patients in the cervical group had increased incidence, and severity of GERD-like symptoms in the early postoperative period.

Helicobacter pylori Serology Inversely Correlated With the Risk and Severity of Reflux Esophagitis in Helicobacter pylori Endemic Area: A Matched Case-Control Study of 5,616 Health Check-Up Koreans

BACKGROUND/AIMS

The role of Helicobacter pylori in gastroesophageal reflux disease remains still controversial and the effect of the organism on severity of reflux esophagitis have been rarely issued. The aim of this study was to investigate the relationship between H. pylori infection and reflux esophagitis, and especially the severity of reflux esophagitis.

METHODS

We performed a cross-sectional case-control study of 5,616 subjects undergoing both upper endoscopy and H. pylori serology during health Check-up (2,808 cases vs age- and sex-matched controls). Smoking, alcohol, body mass index and waist circum - ference were added to a multiple regression model.

RESULTS

Prevalence of H. pylori infection was lower in cases with reflux esophagitis than in controls (38.4% vs 58.2%, P < 0.001) and negative associations with H. pylori infection continued across the grade of esophagitis (46.7% in Los Angeles classification M [LA-M], 34.3% in LA-A or LA-B and 22.4% in LA-C or LA-D, P < 0.001). Positive serology for H. pylori independently reduced the risk of reflux esophagitis (adjusted OR, 0.44; 95% CI, 0.39-0.49). Notably, the negative associations continued across the grade of esophagitis with adjusted ORs of 0.63 in LA-M, 0.36 in LA-A or LA-B and 0.20 in LA-C or LA-D (P < 0.001).

CONCLUSIONS

In a age-sex matched Korean, H. pylori seropositivity was independently and inversely associated with the risk and severity of reflux esophagitis, suggesting the organism may have a protective role against gastroesophageal reflux disease.

The role of Helicobacter pylori infection in gastro-oesophageal reflux in Iranian children

BACKGROUND

The relationship between Helicobacter pylori and gastro-oesophageal reflux disease (GORD) in children is controversial.

AIM

To determine the role of H. pylori infection and GORD in children living in a region which is endemic for H. pylori infection.

METHODS

A cross-sectional study was undertaken in 263 children aged 3-18 years, all of whom had symptoms of GORD and underwent upper gastro-intestinal endoscopy. H. pylori status was determined by conventional rapid urease test and Giemsa staining of antral and cardiac biopsies. Biopsies of the oesophagus and gastric mucosa were obtained from the lower oesophagus, the antrum and cardia according to standard protocol.

RESULTS

Of the 263 patients, 81 (31·5%) had GORD and 162 (61·5%) had gastritis. There were 59 H. pylori-infected patients (22·4%) and 204 were uninfected. H. pylori infection was detected in 52 (88·1%) of the antral and 10 (1·9%) of the cardiac biopsies. Three (5·1%) of the biopsies revealed infection of both antrum and cardia and in seven (11·8%) only the cardia was infected. The prevalence of H. pylori infection among patients with GORD (13/83, 15%) was significantly lower than in those without GORD (46/180, 26%) (OR 0·54, CI 0·27-0·93, p<0·05). The prevalence of H. pylori infection among those with gastritis (48/162, 30%) was significantly higher than in those without gastritis (11/101, 10·8%) (OR 3·44, CI 1·69-7·015, p<0·001).

CONCLUSION

H. pylori infection might protect against GORD.

Gastroesophageal reflux in cirrhotic patients without esophageal varices

AIM: To evaluate the esophageal motility and abnormal acid and bile reflux incidence in cirrhotic patients without esophageal varices (EV).

METHODS: Seventy-eight patients with liver cirrhosis without EV confirmed by upper gastroesophageal endoscopy and 30 healthy control volunteers were prospectively enrolled in this study. All the patients were evaluated using a modified protocol including Child-Pugh score, upper gastrointestinal endoscopy, esophageal manometry, simultaneous ambulatory 24-h esophageal pH and bilirubin monitoring. All the patients and volunteers accepted the manometric study.

RESULTS: In the liver cirrhosis group, lower esophageal sphincter pressure (LESP, 15.32 ± 2.91 mmHg), peristaltic amplitude (PA, 61.41 ± 10.52 mmHg), peristaltic duration (PD, 5.32 ± 1.22 s), and peristaltic velocity (PV, 5.22 ± 1.11 cm/s) were all significantly abnormal in comparison with those in the control group (P < 0.05), and LESP was negatively correlated with Child-Pugh score. The incidence of reflux esophagitis (RE) and pathologic reflux was 37.18% and 55.13%, respectively (vs control, P < 0.05). And the incidence of isolated abnormal acid reflux, bile reflux and mixed reflux was 12.82%, 14.10% and 28.21% in patients with liver cirrhosis without EV.

CONCLUSION: Cirrhotic patients without EV presented esophageal motor disorders and mixed acid and bile reflux was the main pattern; the cirrhosis itself was an important causative factor.

The favourable effect of Helicobacter pylori eradication therapy in patients with recurrent angina-like chest pain and non-responsive to proton pump inhibitors - a preliminary study

INTRODUCTION

The outcome of Helicobacter pylori (Hp) eradication therapy from the aspect of prevention of chest pain recurrence is still uncertain. The aim of this study was to assess the influence of Hp eradication therapy on the risk of hospitalization due to acute coronary syndrome.

MATERIAL AND METHODS

The analysis was carried out in 63 consecutive patients with recurrent retrosternal symptoms: 28 (44%) with significant coronary artery narrowing in coronarography not qualified for revascularization by an invasive cardiologist, and 35 (56%) with no obstructive coronary artery lesions. In 33 (52%) of the patients, Hp infection was found and standard eradication therapy with omeprazole (2 × 20 mg), amoxicillin (2 × 1 g) and metronidazole (2 × 500 mg) was recommended. The mean follow-up period was 977 ±249 days.

RESULTS

Chest pain requiring hospitalization because of unstable angina within the follow-up period was observed in 9 (27%) of the Hp-infected individuals and in 15 (50%) subjects in whom a urease test and histology did not confirm this infection (p = 0.055). The recommendation of Hp-eradication treatment was a significant factor prolonging the hospitalization-free period, both in the two Kaplan-Meier curve analyses (Cox's F test = 1.96; p = 0.049) and the Cox proportional hazard model (beta = -1.18; p = 0.045), but was weaker than the effect of the non-obstructive coronary angiogram (beta = -1.45; p = 0.03).

CONCLUSIONS

The recommendation of Hp-eradication therapy may prolong the hospitalization-free period for patients with recurrent chest pain.

Environmental - lifestyle related factors

The prevalence of gastro-oesophageal reflux disease (GORD) has been increasing worldwide. This increase is likely associated with the increased prevalence of obesity, the ageing of the population and the decreased prevalence of Helicobacter pylori (Hp) infection. These different environmental factors interact with GORD pathogenesis in a potentially negative way. Oesophago-gastric junction (OGJ) competence, oesophageal clearance mechanisms and reflux causticity are involved in GORD pathophysiology. Obesity alters GORD pathogenesis by disrupting the OGJ and increasing intragastric pressure. Additionally, the number of transient lower oesophageal sphincter relaxations is potentially increased in obese patients. The potential effect of obesity on oesophageal peristalsis and the implication of impaired oesophageal clearance in GORD pathogenesis are still to establish. Ageing also plays an important role in GORD pathogenesis by decreasing lower oesophageal sphincter pressure and impairing oesophageal clearance. However a link between these abnormalities and an increased acid oesophageal exposure has not yet been demonstrated in the elderly. The role of H. pylori and its eradication remain controversial. The type of Hp gastritis may explain the controversial effect. Hp with antral predominant gastritis is responsible for an increased gastric acid secretion and thus promotes GORD. On the opposite spectrum, Hp with diffuse gastritis induces a gastric atrophy and in this particular case, the Hp eradication may restore acid secretion and lead to a more caustic refluxate in patients with predisposing conditions for GORD. The association of GORD and the type of Hp gastritis remains to be confirmed.

Gastroesophageal reflux disease: From pathophysiology to treatment

This review focuses on the pathophysiology of gastroesophageal reflux disease (GERD) and its implications for treatment. The role of the natural anti-reflux mechanism (lower esophageal sphincter, esophageal peristalsis, diaphragm, and trans-diaphragmatic pressure gradient), mucosal damage, type of refluxate, presence and size of hiatal hernia, Helicobacter pylori infection, and Barrett’s esophagus are reviewed. The conclusions drawn from this review are: (1) the pathophysiology of GERD is multifactorial; (2) because of the pathophysiology of the disease, surgical therapy for GERD is the most appropriate treatment; and (3) the genesis of esophageal adenocarcinoma is associated with GERD.

Extreme childhood obesity is associated with increased risk for gastroesophageal reflux disease in a large population-based study

OBJECTIVE

Gastroesophageal reflux disease (GERD) may link the obesity epidemic to an array of adverse health outcomes including chronic esophageal inflammation and, consequentially, to pathophysiological changes of the esophagus. Although obesity and GERD are associated in adults, data in children are scarce and inconclusive. The aim of this study is to investigate whether, similar to adults, obesity is associated with GERD in youth.

METHODS

For this population-based, cross-sectional study, measured weight and height and diagnosis of GERD were extracted from electronic medical records of 690 321 patients, aged 2-19 years, who were enrolled in an integrated prepaid health plan between 2007 and 2008. Weight class (normal weight, overweight, moderate and extreme obesity) was assigned based on body mass index-for-age.

RESULTS

Overall, GERD was diagnosed in 1.5% of boys and 1.8% of girls (P<0.001). Moderately and extremely obese children, aged 6-11 years, were more likely to have a diagnosis of GERD compared with normal weight (OR 1.16, 95% CI: 1.02-1.32 and 1.32, 95% CI: 1.13-1.56, respectively). Children aged 12-19 years showed similar associations (OR 1.16, 95% CI: 1.07-1.25 and 1.40, 95% CI: 1.28-1.52, respectively). These associations remained with adjustment for sex and race/ethnicity. By contrast, obesity was not related to increased odds for GERD in children aged 2-5 years of age.

CONCLUSIONS

The association between childhood obesity and GERD may have important implications for their future risk of GERD-associated diseases, such as esophageal adenocarcinoma.

High prevalence of reflux esophagitis among upper endoscopies in Chinese patients with chronic liver diseases

Background

Reflux esophagitis (RE) is increasing in prevalence in China. There are very few studies on the prevalence and factors related to RE in patients with chronic liver diseases. The aims of this study were to determine the prevalence of RE by endoscopy in patients with chronic liver diseases and the possible related predictors of RE.

Methods

A total of 1,280 patients with chronic liver disease and 29 patients with acute hepatitis A or E were prospectively evaluated. There were 879 and 401 patients with liver cirrhosis or chronic hepatitis, respectively. RE was classified by endoscopy according to the Los Angeles classification scheme.

Results

RE was diagnosed in 36.4% (469/1280) of the chronic liver disease patients, which was significantly higher than in the acute hepatitis patients (10.3% [3/29], P < 0.001). RE accounted for 43.0%, 9.7%, and 60.2% of patients with liver cirrhosis, chronic hepatitis(mild and medium), and liver failure, respectively. A high prevalence of RE existed in patients with liver failure and/or Child B and C liver cirrhosis, with typical symptoms of RE in 21.3% of the patients (100/469). There was a significant relationship between gender, age, ascites, and RE.

Conclusions

The high prevalence of RE among upper endoscopies of patients with severe chronic liver disease was demonstrated. Asymptomatic RE was more common in cirrhotic and liver failure patients. The role of RE in variceal bleeding, however, needs to be demonstrated.

Gastroesophageal reflux disease: medical or surgical treatment?

Background. Gastroesophageal reflux disease is a common condition with increasing prevalence worldwide. The disease encompasses a broad spectrum of clinical symptoms and disorders from simple heartburn without esophagitis to erosive esophagitis with severe complications, such as esophageal strictures and intestinal metaplasia. Diagnosis is based mainly on ambulatory esophageal pH testing and endoscopy. There has been a long-standing debate about the best treatment approach for this troublesome disease. Methods and Results. Medical treatment with PPIs has an excellent efficacy in reversing the symptoms of GERD, but they should be taken for life, and long-term side effects do exist. However, patients who desire a permanent cure and have severe complications or cannot tolerate long-term treatment with PPIs are candidates for surgical treatment. Laparoscopic antireflux surgery achieves a significant symptom control, increased patient satisfaction, and complete withdrawal of antireflux medications, in the majority of patients. Conclusion. Surgical treatment should be reserved mainly for young patients seeking permanent results. However, the choice of the treatment schedule should be individualized for every patient. It is up to the patient, the physician and the surgeon to decide the best treatment option for individual cases.