Dietary habits and obesity indices in patients with gastro-esophageal reflux disease: a comparative cross-sectional study

Improving management in gastroesophageal reflux disease through leveraging WeChat platform for mobile health care: A randomized control trial

BACKGROUND

Gastroesophageal reflux disease (GERD) refers to a clinical condition characterized by gastric content reflux into the esophagus, causing symptoms like acid regurgitation and heartburn. While patient education is essential for GERD treatment, traditional educational models often struggle to effectively improve treatment outcomes.

METHODS

Between January 2021 and April 2022, we enrolled 257 patients and assessed their GERD knowledge. The patients were randomly assigned to either the WeChat group (60 participants) for health education via WeChat platform or the control group (60 participants) for conventional education only. GERD-Q scores were collected at 1, 3, and 6 months post-intervention, with compliance and satisfaction assessed at the study's conclusion.

RESULTS

The overall awareness rate of GERD among patients was approximately 22.3 %. The WeChat group showed better compliance than the control group in terms of adhering to a proper diet, taking medication on time, and engaging in moderate exercise (P < 0.05 for all). Furthermore, the WeChat group demonstrated significantly higher treatment effectiveness and satisfaction than the control group (P < 0.05 for all).

CONCLUSION

Patients have a relatively low level of knowledge regarding GERD. WeChat has the potential to facilitate lifestyle changes and improve compliance, treatment effectiveness, and treatment satisfaction among patients with gastroesophageal reflux disease.

Association between physical activity and risk of gastroesophageal reflux disease: A systematic review and meta-analysis

BACKGROUND

Lifestyle plays an important role in preventing and managing gastroesophageal reflux disease (GERD). In response to the conflicting results in previous studies, we performed a systematic review and meta-analysis to investigate this association.

METHODS

Relevant studies published until January 2023 were retrieved from 6 databases, and the prevalence of symptomatic gastroesophageal reflux (GER) or GERD was determined from the original studies. A random effects model was employed to meta-analyze the association by computing the pooled relative risk (RR) with 95% confidence intervals (95%CIs). Furthermore, subgroup and dose-response analyses were performed to explore subgroup differences and the association between cumulative physical activity (PA) time and GERD.

RESULTS

This meta-analysis included 33 studies comprising 242,850 participants. A significant negative association was observed between PA and the prevalence of symptomatic GER (RR = 0.74, 95%CI: 0.66-0.83; p < 0.01) or GERD (RR = 0.80, 95%CI: 0.76-0.84; p < 0.01), suggesting that engaging in PA might confer a protective benefit against GERD. Subgroup analyses consistently indicated the presence of this association across nearly all subgroups, particularly among the older individuals (RR<40 years:RR≥40 years = 0.85:0.69, p < 0.01) and smokers (RRsmoker:RRnon-smoker = 0.67:0.82, p = 0.03). Furthermore, a dose-response analysis revealed that individuals who engaged in 150 min of PA per week had a 72.09% lower risk of developing GERD.

CONCLUSION

Maintaining high levels of PA decreased the risk of GERD, particularly among older adults and smokers. Meeting the recommended PA level of 150 min per week may significantly decrease the prevalence of GERD.

Prevalence of Gastroesophageal Reflux Disease and Its Impact on the Quality of Life Among Obese Individuals in Al-Baha Region, Saudi Arabia

Background Gastroesophageal reflux disease (GERD) is a global gastrointestinal disorder, and obesity is a particular risk factor. Symptoms of GERD, such as heartburn and acid reflux, are caused by abnormal relaxation in the lower esophagus, causing gastric acid reflux. Persistent symptoms can affect the patient's quality of life (QOL) and can cause complications, such as esophageal adenocarcinoma. Management of GERD includes lifestyle changes, antacids, and anti-reflux surgery. Even though GERD is a common disease, few research has been carried out on it in Saudi Arabia. Aim This study aimed to estimate the prevalence of GERD and its associated risk factors among obese individuals in the Al-Baha region population and the effect of GERD on their QOL. Methods A cross-sectional study included 314 obese participants from the Al-Baha region. A questionnaire was filled out to measure the prevalence of GERD, risk factors, and effects on the QOL of the participants. Data were analyzed by the IBM SPSS Statistics for Windows, version 26.0 (released 2019, IBM Corp., Armonk, NY). Descriptive statistics and the chi-squared test were applied. Logistic regression analysis was used to determine the factors associated with the incidence of GERD. A p-value of <0.05 was considered statistically significant. Results A total of 314 patients who met our inclusion criteria completed the survey; 42% of them were women, the mean age of all patients was 35.3 ± 12.9 years, and 38.2% of the patients were diagnosed with GERD. Epigastric pain and burning sensation were the most common symptoms (44.9%). Five out of six domains in the QOL questionnaire showed more effects among GERD participants than non-GERD participants, and the results were statistically significant (p = 0.001). Logistic regression analysis showed that men are 1.8 times more likely than women to be diagnosed with GERD, and smokers have 2.6 times the risk of being diagnosed with GERD than non-smokers. Conclusion The present study showed a high prevalence of GERD among obese patients in the Al-Baha region, negatively affecting their QOL. Major risk factors included gender, smoking, dyslipidemia, and hypertension. Public health programs to raise awareness of these risk factors and lifestyle habits are necessary to improve QOL and prevent complications.

Management advice for patients with reflux-like symptoms: an evidence-based consensus

Patients with reflux-like symptoms (heartburn and regurgitation) are often not well advised on implementing individualised strategies to help control their symptoms using dietary changes, lifestyle modifications, behavioural changes or fast-acting rescue therapies. One reason for this may be the lack of emphasis in management guidelines owing to 'low-quality' evidence and a paucity of interventional studies. Thus, a panel of 11 gastroenterologists and primary care doctors used the Delphi method to develop consolidated advice for patients based on expert consensus. A steering committee selected topics for literature searches using the PubMed database, and a modified Delphi process including two online meetings and two rounds of voting was conducted to generate consensus statements based on prespecified criteria (67% voting 'strongly agree' or 'agree with minor reservation'). After expert discussion and two rounds of voting, 21 consensus statements were generated, and assigned strength of evidence and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) rating. Eleven statements achieved the strongest (100%) agreement: five are related to diet and include identification and avoidance of dietary triggers, limiting alcohol, coffee and carbonated beverages, and advising patients troubled by postprandial symptoms not to overeat; the remaining six statements concern advice around smoking cessation, weight loss, raising the head-of-the-bed, avoiding recumbency after meals, stress reduction and alginate use. The aim of developing the consensus statements is that they may serve as a foundation for tools and advice that can routinely help patients with reflux-like symptoms better understand the causes of their symptoms and manage their individual risk factors and triggers.

Elucidating the Link: Chronic Obstructive Pulmonary Disease and the Complex Interplay of Gastroesophageal Reflux Disease and Reflux-Related Complications

Background and Objective: Presenting chronic obstructive pulmonary disease (COPD) patients frequently report concurrent symptoms of gastroesophageal reflux disease (GERD). Few studies have shown a correlation between GERD and COPD. We aimed to examine the correlation between GERD and COPD as well as secondary related reflux complications, such as esophageal stricture, esophageal cancer, and Barrett's esophagus. Methods: This population-based analysis included 7,159,694 patients. Patients diagnosed with GERD with and without COPD were compared to those without GERD. The enrollment of COPD included centrilobular and panlobular emphysema and chronic bronchitis. Risk factors of COPD or GERD were used for adjustment. Bivariate analyses were performed using the chi-squared test or Fisher exact test (2-tailed) for categorical variables as appropriate to assess the differences in the groups. Results: Our results showed that COPD patients had a significantly higher incidence of GERD compared to those without COPD (27.8% vs. 14.1%, p < 0.01). After adjustment of demographics and risk factors, COPD patients had a 1.407 times higher risk of developing non-erosive esophagitis (p < 0.01), 1.165 higher risk of erosive esophagitis (p < 0.01), 1.399 times higher risk of esophageal stricture (p < 0.01), 1.354 times higher risk of Barrett's esophagus without dysplasia (p < 0.01), 1.327 times higher risk of Barrett's esophagus with dysplasia, as well as 1.235 times higher risk of esophageal cancer than those without COPD. Conclusions: Based on the evidence from this study, there are sufficient data to provide convincing evidence of an association between COPD and GERD and its secondary reflux-related complications.

Gastroesophageal reflux disease symptoms and associated factors among university students in Amhara region, Ethiopia, 2021: a cross-sectional study

INTRODUCTION

Gastroesophageal reflux disease (GERD) symptom is a relapsing chronic medical condition resulting from the reflux of gastric acid contents into the esophagus and throat or mouth. It interferes with social functioning, sleep, productivity, and quality of life. Despite this, the magnitude of GERD symptoms is not known in Ethiopia. Therefore, this study was conducted to determine the prevalence and associated factors of GERD symptoms among university students in the Amhara national regional state.

METHODS

An institutional-based cross-sectional study was employed in Amhara national regional state Universities, from April 1, 2021, to May 1, 2021. Eight hundred and forty-six students were included in the study. A stratified multistage sampling technique was employed. Data were collected by using a pretested self-administered questionnaire. Data were entered via Epi Data version 4.6.0.5 and analyzed by SPSS version-26 software. The bivariable and multivariable binary logistic regression analyses were used to determine the associated factors of GERD symptoms. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was calculated. Variables having a p-value of ≤ 0.05 were considered statistically significant.

RESULTS

The prevalence of GERD symptoms in this study was 32.1% (95% CI = 28.7-35.5%). Being in the age of 20-25 years (AOR = 1.74, 95%CI = 1.03-2.94), female (AOR = 1.67, 95% CI = 1.15-2.41), use of antipain (AOR = 2.47, 95% CI = 1.65-3.69) and soft drinks (AOR = 1.58, 95% CI = 1.13-2.20) were significantly associated with higher odds of GERD symptoms. Urban dwellers had less chance of having GERD symptoms (AOR = 0.67, 95% CI = 0.48-0.94).

CONCLUSION

Nearly one-third of university students are affected by GERD symptoms. Age, sex, residence, use of antipain, and consumption of soft drinks were significantly associated with GERD. Reducing modifiable risk factors such as antipain use and soft drink consumption among students is advisable to decrease the disease burden.

Role of Non-pharmacological Interventions and Weight Loss in the Management of Gastroesophageal Reflux Disease in Obese Individuals: A Systematic Review

With the increasing prevalence of obesity, the worldwide risk of gastroesophageal reflux disease (GERD) has also increased. Abdominal obesity increases intragastric pressure, disturbing the integrity of the gastroesophageal junction, thus facilitating reflux. Other than obesity, some lifestyle factors also cause GERD, including smoking, consumption of alcohol and caffeine, late-night meals, and high fat intake. This review study aimed to assess the impact of weight loss and lifestyle modifications on GERD. In this systematic review, the databases used were PubMed, PubMed Central (PMC), Science Direct, and Google Scholar. Boolean system and Medical Subject Headings (MeSH) strategy were used to form suitable keywords. Patients from the pediatric and geriatric populations were excluded from the study and quality assessment was done using different assessment tools. A positive association between obesity and GERD was found. It was also found that the long-term use of proton pump inhibitors (PPIs) causes complications, so lifestyle interventions should be used more than PPIs for treating GERD, especially in obese patients. We concluded that weight loss could lead to the resolution of gastroesophageal reflux disease, and therefore, conservative measures, including dietary modifications such as reducing the consumption of alcohol, caffeine, and chocolate, behavioral changes such as smoking cessation and elevation of the head of the bed, and weight loss, should be used as first-line management for GERD. Although awareness has increased regarding the adverse effects of proton pump inhibitors, future studies are required to assess these negative effects.

Factors that Impact Day-to-Day Esophageal Acid Reflux Variability and Its Diagnostic Significance for Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a common disease affecting a significant number of adults both globally and in the USA. GERD is clinically diagnosed based on patient-reported symptoms, and the gold standard for diagnosis is ambulatory reflux monitoring, a tool particularly utilized in the common scenario of non-response to therapy or atypical features. Over the past 20 years, there has been a shift toward extending the duration of reflux monitoring, initially from 24 to 48 h and more recently to 96 h, primarily based on a demonstrated increase in diagnostic yield. Further, multiple studies demonstrate clinically relevant variability in day-to-day acid exposure levels in nearly 30% of ambulatory reflux monitoring studies. For these reasons, an ongoing clinical dilemma relates to the optimal activities patients should engage in during prolonged reflux monitoring. Thus, the aims of this review are to detail what is known about variability in daily acid exposure, discuss factors that are known to influence this day-to-day variability (i.e., sleep patterns, dietary/eating habits, stress, exercise, and medications), and finally provide suggestions for patient education and general GERD management to reduce variation in esophageal acid exposure levels.

Dietary Intake in Relation to the Risk of Reflux Disease: A Systematic Review

Gastroesophageal reflux disease (GERD) is a chronic condition which has a high global prevalence. Dietary intake is considered to be a contributing factor for GERD. However, scientific evidence about the effect of diet on the risk of GERD is controversial. This systematic review was conducted to address this issue. A comprehensive structured search was performed using the MEDLINE, Scopus, and Web of Science databases up to August 2020, in accordance with the PRISMA statement. No restrictions were set in terms of language, time of publication, or study location. Study selection and data abstraction was conducted independently by two authors, and risk of bias was assessed using a modified Quality in Prognosis Studies Tool. Eligible studies evaluating the impact of food and dietary pattern on GERD were included in qualitative data synthesis. After excluding duplicate, irrelevant, and low quality studies, 25 studies were identified for inclusion: 5 case-control studies, 14 cross-sectional studies, and 6 prospective studies. This review indicates that high-fat diets, carbonated beverages, citrus products, and spicy, salty, and fried foods are associated with risk of GERD.

Non-surgical animal model of gastroesophageal reflux disease by overeating induced in mice

Previous animal models of gastroesophageal reflux disease (GERD) were not physiological and required a variety of surgical procedures. Therefore, the animal model developed by conditions that are similar to the pathogenesis of GERD is necessary. The aim is to establish a non-surgical animal model with GERD caused by overeating induced in mice. To induce mice to overeat, we designed dietary control protocols including repetitive fasting and feeding. The esophageal tissues were evaluated with GERD markers to prove the establishment of a GERD animal model. Mice fasted every other day (group 2) showed more pronounced overeating feature and demonstrated evident changes similar to the macroscopic and microscopic findings of GERD, the expressions of inducible nitric oxide synthase and substance P were stronger. The higher frequency of fasting and overeating could cause GERD effectively. The dietary control can make mice overeat, which elicits the change of lower esophageal mucosa similar to GERD. Thus, the overeating-induced mouse may be used as a GERD mouse model.

Dietary and Lifestyle Factors Related to Gastroesophageal Reflux Disease: A Systematic Review

We performed this review to clarify which dietary and lifestyle factors are related to gastroesophageal reflux disease. Through a systematic search of the PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), and Chinese BioMedical Literature (CBM) databases, we identified articles with clear definitions of GERD, including nonerosive gastroesophageal reflux disease (NERD), reflux esophagitis (RE) and Barrett’s esophagus (BE), that included dietary and lifestyle factors as independent factors affecting the onset of GERD (expressed as odds ratios (ORs) or relative risks (RRs) and 95% confidence intervals (CIs)). Due to heterogeneity among the studies, we used descriptive statistical analyses to analyze and synthesize each outcome based on the disease type. In total, 72 articles were included, conducted in ten Western countries (26 articles in total) and nine Eastern countries (46 articles in total). We categorized dietary factors into 20 items and lifestyle factors into 11 items. GERD is related to many irregular dietary and lifestyle habits (such as a habit of midnight snacking: OR=5.08, 95% CI 4.03–6.4; skipping breakfast: OR=2.7, 95% CI 2.17–3.35; eating quickly: OR=4.06, 95% CI 3.11–5.29; eating very hot foods: OR=1.81, 95% CI 1.37–2.4; and eating beyond fullness: OR=2.85, 95% CI 2.18–3.73). Vegetarian diets (consumption of nonvegetarian food (no/yes); OR=0.34, 95% CI 0.211–0.545) and no intake of meat (OR=0.841, 95% CI 0.715–0.990) were negatively related to GERD, while meat (daily meat, fish, and egg intake: OR=1.088, 95% CI 1.042-1.135) and fat (high–fat diet: OR=7.568, 95% CI 4.557–8.908) consumption were positively related to GERD. An interval of less than three hours between dinner and bedtime (OR=7.45, 95% CI 3.38–16.4) was positively related to GERD, and proper physical exercise (physical exercise >30 minutes (>3 times/week): OR=0.7, 95% CI 0.6–0.9) was negatively correlated with GERD. Smoking (OR=1.19, 95% CI 1.12–1.264), alcohol consumption (OR=1.278, 95% CI 1.207–1.353) and mental state (poor mental state: OR=1.278, 95% CI 1.207–1.353) were positively correlated with GERD. RE (vitamin C: OR=0.46, 95% CI=0.24–0.90) and BE (vitamin C: OR=0.44,95% CI 0.2-0.98; vitamin E: OR=0.46, 95% CI 0.26–0.83) were generally negatively correlated with antioxidant intake. In conclusion, many dietary and lifestyle factors affect the onset of GERD, and these factors differ among regions and disease types. These findings need to be further confirmed in subsequent studies.

Study on the relationship of depression, anxiety, lifestyle and eating habits with the severity of reflux esophagitis

Background

The etiology of reflux esophagitis (RE) is multi-factorial. This study analyzed the relationship of depression, anxiety, lifestyle and eating habits with RE and its severity and further explored the impact of anxiety and depression on patients’ symptoms and quality of life.

Methods

From September 2016 to February 2018, a total of 689 subjects at Xuanwu Hospital Capital Medical University participated in this survey. They were divided into the RE group (patients diagnosed with RE on gastroscopy, n = 361) and the control group (healthy individuals without heartburn, regurgitation and other gastrointestinal symptoms, n = 328). The survey included general demographic information, lifestyle habits, eating habits, comorbidities, current medications, the gastroesophageal reflux disease (GERD) questionnaire (GerdQ), the Patient Health Questionnaire-9 depression scale and the General Anxiety Disorder-7 anxiety scale.

Results

The mean age and sex ratio of the two groups were similar. Multivariate logistic regression analysis identified the following factors as related to the onset of RE (p < 0.05): low education level; drinking strong tea; preferences for sweets, noodles and acidic foods; sleeping on a low pillow; overeating; a short interval between dinner and sleep; anxiety; depression; constipation; history of hypertension; and use of oral calcium channel blockers. Ordinal logistic regression analysis revealed a positive correlation between sleeping on a low pillow and RE severity (p = 0.025). Depression had a positive correlation with the severity of symptoms (r_s = 0.375, p < 0.001) and patients’ quality of life (r_s = 0.306, p < 0.001), whereas anxiety showed no such association.

Conclusions

Many lifestyle factors and eating habits were correlated with the onset of RE. Notably, sleeping on a low pillow was positively correlated with RE severity, and depression was positively related to the severity of symptoms and patients’ quality of life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12876-021-01717-5.

Bidirectional association between GERD and rheumatoid arthritis: two longitudinal follow-up studies using a national sample cohort

Several previous studies have suggested a relationship between GERD and RA. However, no study has investigated the bidirectional relationship between GERD and RA. This study aimed to evaluate the causal relationships between rheumatoid arthritis (RA) and gastroesophageal reflux disease (GERD). Participants aged ≥ 20 years old in the Korean Health Insurance Review and Assessment Service-National Sample Cohort from 2002 to 2013 were enrolled. In study I, 132,140 GERD participants were 1:2 matched with 264,280 control I participants. In study II, 6615 RA participants were 1:4 matched with 26,460 control II participants. Both control I and control II groups were matched with their study groups for age, sex, income, and region of residence. The occurrence of RA (study I) and GERD (study II) were followed up in both the study and control groups. The hazard ratios (HRs) of GERD for RA (study I) and of RA for GERD (study II) were analysed using stratified Cox-proportional hazards models. In study I, 0.8% (1,034/132,140) of the GERD group and 0.5% (1,290/264,280) of the control I group had RA (P < 0.001). The GERD group demonstrated a 1.49-fold higher adjusted HR than did the control I group (95% confidence interval (95% CI) = 1.37-1.62, P < 0.001). In study II, 22.5% (1,490/6,615) of the RA group and 15.2% (4,034/26,460) of the control II group had GERD (P < 0.001). The RA group showed a 1.46-fold higher adjusted HR than did the control II group (95% CI = 1.38-1.55, P < 0.001). GERD and RA have bidirectional associations in Korean adult population. Key Points • Several previous studies have suggested a relationship between gastroesophageal reflux disease (GERD) and rheumatoid arthritis (RA). • However, no study has investigated the bidirectional relationship between GERD and RA. • This is the first study to present a bidirectional relationship between GERD and RA. • GERD and RA have bidirectional relations with each other.

Tongue diagnosis indices for gastroesophageal reflux disease: A cross-sectional, case-controlled observational study

Traditional Chinese medicine tongue diagnosis can mirror the status of the internal organ, but evidence is lacking regarding the accuracy of tongue diagnosis to gastroesophageal reflux disease (GERD). This study was to investigate the association between GERD and tongue manifestation, and whether tongue imaging could be initial diagnosis of GERD noninvasively.We conducted a cross-sectional, case-controlled observational study at Kaohsiung Chang Gung Memorial Hospital in Taiwan from January 2016 to September 2017. Participants aged over 20 years old with GERD were enrolled and control group without GERD were matched by sex. Tongue imaging were acquired with automatic tongue diagnosis system, then followed by endoscope examination. Nine tongue features were extracted, and a receiver operating characteristic (ROC) curve, analysis of variance, and logistic regression were used.Each group enrolled 67 participants. We found that the saliva amount (P = .009) and thickness of the tongue's fur (P = .036), especially that in the spleen-stomach area (%) (P = .029), were significantly greater in patients with GERD than in those without. The areas under the ROC curve of the amount of saliva and tongue fur in the spleen-stomach area (%) were 0.606 ± 0.049 and 0.615 ± 0.050, respectively. Additionally, as the value of the amount of saliva and tongue fur in the spleen-stomach area (%) increased, the risk of GERD rose by 3.621 and 1.019 times, respectively. The tongue fur in the spleen-stomach area (%) related to severity of GERD from grade 0 to greater than grade B were 51.67 ± 18.72, 58.10 ± 24.60, and 67.29 ± 24.84, respectively.The amount of saliva and tongue fur in the spleen-stomach area (%) might predict the risk and severity of GERD and might be noninvasive indicators of GERD. Further large-scale, multi-center, randomized investigations are needed to confirm the results.Trial registration: NCT03258216, registered August 23, 2017.

Association between Lifestyle and Gastroesophageal Reflux Disease Questionnaire Scores: A Cross-Sectional Study of 37 442 Chinese Adults

The aim of this study was to investigate the distribution characteristics of GerdQ results in a Chinese population and the association between lifestyle and GerdQ scores. Among the 37 442 individuals enrolled from September 2009 to March 2016, 7 449 (19.89%) had a GerdQ score of ≥8 points and 29 993 (80.11%) had a GerdQ score of <8 points. The percentage of men with suspected GERD was significantly higher than the percentage of women with suspected GERD (χ 2 = 111.571, P ≤ 0.001), and the prevalence of GERD was higher in the young and middle-aged populations than in the elderly population. The prevalence of GERD increased gradually with weight gain (χ 2 = 145.227, P ≤ 0.001). With regard to lifestyle, the prevalence of GERD in the subjects who smoked (χ 2 = 119.361, P ≤ 0.001), consumed alcohol excessively, lacked physical activity (χ 2 = 86.916, P ≤ 0.001), and had an excessive intake of oil, meat, fish, and eggs showed an ascending trend (χ 2 = 105.388, P ≤ 0.001). In contrast, an adequate intake of vegetables (≥300 g/d) and fruit (≥200 g/d) was associated with a significantly lower incidence of GERD. Suspected GERD is very common in individuals undergoing health examinations. Unhealthy lifestyles are closely related to the high incidence of suspected GERD. GerdQ scores can play a role in screening for GERD.

Esophageal Motor Dysfunctions in Gastroesophageal Reflux Disease and Therapeutic Perspectives

Gastroesophageal reflux disease (GERD) is a very common disease, and the prevalence in the general population has recently increased. GERD is a chronic relapsing disease associated with motility disorders of the upper gastrointestinal tract. Several factors are implicated in GERD, including hypotensive lower esophageal sphincter, frequent transient lower esophageal sphincter relaxation, esophageal hypersensitivity, reduced resistance of the esophageal mucosa against the refluxed contents, ineffective esophageal motility, abnormal bolus transport, deficits initiating secondary peristalsis, abnormal response to multiple rapid swallowing, and hiatal hernia. One or more of these mechanisms result in the reflux of stomach contents into the esophagus, delayed clearance of the refluxate, and the development of symptoms and/or complications. New techniques, such as 24-hour pH and multichannel intraluminal impedance monitoring, multichannel intraluminal impedance and esophageal manometry, high-resolution manometry, 3-dimensional high-resolution manometry, enoscopic functional luminal imaging probe, and 24-hour dynamic esophageal manometry, provide more information on esophageal motility and have clarified the pathophysiology of GERD. Proton pump inhibitors remain the preferred pharmaceutical option to treat GERD. The ideal target of GERD treatment is to restore esophageal motility and reconstruct the anti-reflux mechanism. This review focuses on current advances in esophageal motor dysfunction in patients with GERD and the influence of these developments on GERD treatment.

Personal, academic and stress correlates of gastroesophageal reflux disease among college students in southwestern Saudi Arabia: A cross-section study

Background

Gastroesophageal reflux disease (GERD) is a worldwide prevalent gastrointestinal disorder which has negative impacts on quality of life, health and economy. The aims of this study were to assess the prevalence of GERD among college students in southwestern Saudi Arabia and to evaluate its personal, academic and stress correlates.

Materials and methods

Through a cross-sectional study design, a self-reported questionnaire was distributed between a representative sample of students in health and non-health care colleges in southwestern Saudi Arabia. The questionnaire included data for personal characteristics, academic study, and Arabic versions of GERD questionnaire (GerdQ) and Cohen's Perceived Stress Scale.

Results

Out of 2878 studied students, GERD was reported by 28.6% and 36.6% of students in health and non-health care colleges respectively with an overall prevalence rate of 33.18%. It was associated with impacts on daily life in 17.2% of students. By multivariable regression analysis, GERD was significantly higher among males (aOR = 1.44, 95% CI:117–1.65), ex-smokers (aOR = 1.87), current smokers (aOR = 1.71), non-health care students (aOR = 1.36) and those exposed to high perceived stress (aOR = 1.30).

Conclusion

GERD is a prevalent problem among college students in southwestern Saudi Arabia as it affects about one third of the students. Considering high prevalence of GERD, associated daily life impacts, young age of the studied subject and the risk of future complications, this condition could represent a challenging health and economic problem. The risk of GERD is higher among; males, smokers, former smokers, non-health care colleges students and subjects exposed to high perceived stress.

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GERD affects about one third of college students in southwestern Saudi Arabia.

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GERD is associated with daily life impacts in about one fifth of the students.

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GERD could represent a challenging health and economic problem.

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GERD is significantly associated with high perceived stress.

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Risk of GERD is higher among male students, smokers and non-health care students.

Development of scores assessing the refluxogenic potential of diet of patients with laryngopharyngeal reflux

OBJECTIVE

To develop clinical tools assessing the refluxogenic potential of foods and beverages (F&B) consumed by patients with laryngopharyngeal reflux (LPR).

METHODS

European experts of the LPR Study group of the Young-Otolaryngologists of the International Federation of Oto-rhino-laryngological societies were invited to identify the components of Western European F&B that would be associated with the development of LPR. Based on the list generated by experts, four authors conducted a systematic review to identify the F&B involved in the development of esophageal sphincter and motility dysfunctions, both mechanisms involved in the development of gastroesophageal reflux disease and LPR. Regarding the F&B components and the characteristics identified as important in the development of reflux, experts developed three rational scores for the assessment of the refluxogenic potential of F&B, a dish, or the overall diet of the patient.

RESULTS

Twenty-six European experts participated to the study and identified the following components of F&B as important in the development of LPR: pH; lipid, carbohydrate, protein composition; fiber composition of vegetables; alcohol degree; caffeine/theine composition; and high osmolality of beverage. A total of 72 relevant studies have contributed to identifying the Western European F&B that are highly susceptible to be involved in the development of reflux. The F&B characteristics were considered for developing a Refluxogenic Diet Score (REDS), allowing a categorization of F&B into five categories ranging from 1 (low refluxogenic F&B) to 5 (high refluxogenic F&B). From REDS, experts developed the Refluxogenic Score of a Dish (RESDI) and the Global Refluxogenic Diet Score (GRES), which allow the assessment of the refluxogenic potential of dish and the overall diet of the LPR patient, respectively.

CONCLUSION

REDS, RESDI and GRES are proposed as objective scores for assessing the refluxogenic potential of F&B composing a dish or the overall diet of LPR patients. Future studies are needed to study the correlation between these scores and the development of LPR according to impedance-pH study.

Visceral fat thickness of erosive and non-erosive reflux disease subjects in Indonesia's tertiary referral hospital

BACKGROUND

There has been an increasing number of reports regarding the correlation between obesity and gastroesophageal reflux disease (GERD). Visceral fat thickness is thought to be a risk factor for GERD and its severity. Several studies have conflicting results, so this study aimed to determine visceral fat thickness difference between erosive and non-erosive reflux disease.

METHODS

A cross-sectional study of 56 adult subjects with GERD symptoms was held at Cipto Mangunkusumo National General Hospital between April and November 2018. Gastroesophageal Reflux Disease Questionnaires (GERDQ) were utilized to determine the presence of GERD. Ultrasonography was used to determine visceral fat thickness. Esophageal erosions were diagnosed using upper gastrointestinal endoscopy. The difference in visceral fat thickness between esophagitis and non-esophagitis group was analysed using T-test.

RESULTS

From 56 total subjects, 55.4% have erosive reflux disease (ERD), in which were dominated by subjects with grade A esophagitis (64.5%) based on Los Angeles Classification of Esophagitis (LA classifications). There was no significant difference of visceral fat thickness between non-erosive reflux disease (NERD) and ERD (p = 0,831). There was, however, an increasing trend of visceral fat thickness with the advancing severity of esophagitis, although statistical significance was not reached.

CONCLUSION

Visceral fat thickness as measured by ultrasonography has no significant difference between NERD and ERD.