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Wu H, Li J, Li F, Lun W. Causal association of gastroesophageal reflux disease on irritable bowel syndrome: a two-sample Mendelian randomization study. Front Genet 2024; 15:1328327. [PMID: 38601073 PMCID: PMC11004226 DOI: 10.3389/fgene.2024.1328327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Background Recently, observational studies have reported that gastroesophageal reflux disease (GERD) is commonly associated with irritable bowel syndrome (IBS), but the causal relationship is unclear. Methods We conducted a two-sample Mendelian randomization study using summary data from genome-wide association studies (GWASs) to explore a causal relationship between GERD (N cases = 129,080) and IBS (N cases = 4,605) of European ancestry. Furthermore, the inverse-variance weighted (IVW) method and a series of sensitivity analyses were used to assess the accuracy and confidence of our results. Results We found a significant association of GERD with IBS (NSNP = 74; OR: 1.375; 95% CI: 1.164-1.624; p < 0.001). Reverse MR analysis showed no evidence of a causal association for IBS with GERD (NSNP = 6; OR: 0.996; 95% CI: 0.960-1.034; p = 0.845). Conclusion This study provides evidence that the presence of GERD increases the risk of developing IBS, and it is observed from the reverse MR results that IBS did not increase the risk of GERD.
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Affiliation(s)
- Huihuan Wu
- Department of Gastroenterology, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, Guangdong, China
| | - Jingwei Li
- Department of Gastroenterology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - FeiFei Li
- Department of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Weijian Lun
- Department of Gastroenterology, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, Guangdong, China
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2
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Marabotto E, Pasta A, Calabrese F, Ribolsi M, Mari A, Savarino V, Savarino EV. The Clinical Spectrum of Gastroesophageal Reflux Disease: Facts and Fictions. Visc Med 2024:1-8. [DOI: 10.1159/000536583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
<b><i>Background:</i></b> This review addresses the intricate spectrum of gastroesophageal reflux disease (GERD), a condition affecting 10–30% of the Western population. GERD is characterized by the backflow of gastric contents into the esophagus, causing typical and atypical symptoms. Its pathophysiology involves various factors such as hiatal hernia, esophageal motor disorders, and dietary triggers. The review explores the complexities of GERD spectrum, including nonerosive reflux disease (NERD), reflux hypersensitivity (RH), and functional heartburn (FH). <b><i>Summary:</i></b> The diagnostic process for GERD, based on the Lyon Consensus 2.0 criteria, encompasses clinical evaluation, endoscopy, and functional tests, including pH-impedance and wireless-pH monitoring. NERD, a significant subset of GERD, is defined by reflux symptoms and abnormal reflux burden without mucosal damage. RH, classified under functional esophageal disorders by Rome IV criteria, presents with typical esophageal symptoms associated with reflux but lacks of structural, inflammatory, or motor causes. FH is identified by heartburn with normal endoscopy, reflux testing, and esophageal manometry results. The management of RH and FH, focusing on reducing esophageal hypersensitivity, varies from standard GERD treatments. <b><i>Key Messages:</i></b> The review emphasizes the necessity of personalized treatment strategies due to the complexity and overlap of GERD subtypes. It highlights the importance of a multidisciplinary approach, involving gastroenterologists, psychologists, and other specialists, to improve patient outcomes and quality of life. The article underscores that understanding the distinctions and overlaps among NERD, RH, and FH is crucial for effective management, and the need for innovative approaches in diagnosis and treatment to address the unique challenges of each subtype.
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Labenz J, Anschütz M, Walstab J, Wedemeyer RS, Wolters H, Schug B. Heartburn relief with bicarbonate-rich mineral water: results of the randomised, placebo-controlled phase-III trial STOMACH STILL. BMJ Open Gastroenterol 2023; 10:bmjgast-2022-001048. [PMID: 36849190 PMCID: PMC9972411 DOI: 10.1136/bmjgast-2022-001048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/09/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE We assessed whether the bicarbonate-rich mineral water Staatl. Fachingen STILL is superior over conventional mineral water in relieving heartburn. DESIGN Multicentre, double-blind, randomised, placebo-controlled trial STOMACH STILL in adult patients with frequent heartburn episodes since ≥6 months and without moderate/severe reflux oesophagitis. Patients drank 1.5 L/day verum or placebo over the course of the day for 6 weeks. Primary endpoint was the percentage of patients with reduction of ≥5 points in the Reflux Disease Questionnaire (RDQ) score for 'heartburn'. Secondary endpoints included symptom reduction (RDQ), health-related quality of life (HRQOL, Quality of Life in Reflux and Dyspepsia (QOLRAD)), intake of rescue medication and safety/tolerability. RESULTS Of 148 randomised patients (verum: n=73, placebo: n=75), 143 completed the trial. Responder rates were 84.72% in the verum and 63.51% in the placebo group (p=0.0035, number needed to treat=5). Symptoms improved under verum compared with placebo for the dimension 'heartburn' (p=0.0003) and the RDQ total score (p=0.0050). HRQOL improvements under verum compared with placebo were reported for 3 of 5 QOLRAD domains, that is, 'food/drink problems' (p=0.0125), 'emotional distress' (p=0.0147) and 'vitality' (p=0.0393). Mean intake of rescue medication decreased from 0.73 tablets/day at baseline to 0.47 tablets/day in week 6 in the verum group, whereas in the placebo group it remained constant during the trial. Only three patients had treatment-related adverse events (verum: n=1, placebo: n=2). CONCLUSION STOMACH STILL is the first controlled clinical trial demonstrating superiority of a mineral water over placebo in relieving heartburn, accompanied by an improved HRQOL. TRIAL REGISTRATION NUMBER EudraCT 2017-001100-30.
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Affiliation(s)
| | - Maria Anschütz
- SocraTec R&D Concepts in Drug Research and Development GmbH, Oberursel, Germany
| | - Jutta Walstab
- SocraTec R&D Concepts in Drug Research and Development GmbH, Erfurt, Germany
| | - Ralph-Steven Wedemeyer
- SocraTec R&D Concepts in Drug Research and Development GmbH, Oberursel, Germany.,SocraMetrics GmbH, Erfurt, Germany
| | - Heiner Wolters
- Fachingen Heil- und Mineralbrunnen GmbH, Birlenbach OT Fachingen/Lahn, Germany
| | - Barbara Schug
- SocraTec R&D Concepts in Drug Research and Development GmbH, Oberursel, Germany.,SocraMetrics GmbH, Erfurt, Germany
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4
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A Breakthrough Point in Integrative Medical Research: Challenge of Treating Overlapping Symptoms in Functional Gastrointestinal Disorders. Chin J Integr Med 2022; 28:554-559. [PMID: 35610498 DOI: 10.1007/s11655-022-3534-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 11/03/2022]
Abstract
Functional gastrointestinal disorders (FGIDs) are common disorders that are characterized by persistent and recurring gastrointestinal symptoms. Many patients with FGIDs have overlapping symptoms, which impaired the quality of life and ability to work of patients, and left a considerable impact on health-care systems and society. Chinese medicines (CMs) are commonly utilized by many patients with FGIDs. This article discusses the current status of diagnosis and treatment of FGIDs, the advantages and characteristics of CM treatment, and how integrated medicine can make a breakthrough in FGIDs diagnosis and treatment.
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5
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Association between Gastrointestinal Diseases and Migraine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074018. [PMID: 35409704 PMCID: PMC8997650 DOI: 10.3390/ijerph19074018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 02/06/2023]
Abstract
Migraine is a common disease worldwide, and recent studies showed that the incidence of migraine was increased in patients with gastrointestinal (GI) diseases. In addition, preclinical evidence suggested a bidirectional relationship between the GI nervous system and the central nervous system called the gut−brain axis. This study aimed to determine the association between several high-prevalence GI diseases and migraine. Patients diagnosed with migraine or GI diseases were classified as the patient group at least twice a year. We included peptic ulcer disease, dyspepsia, inflammatory bowel disease, irritable bowel syndrome, and gastroesophageal disease as GI diseases. A total of 781,115 patients from the HIRA dataset were included in the study. The prevalence of migraine was about 3.5 times higher in patients with one or more GI diseases after adjusting for age, gender, and insurance type (adjusted odds ratio (ORadj = 3.46, 95% CI: 3.30−3.63, p < 0.001). In addition, the prevalence of migraine was increased as the number of comorbid GI diseases increased. The prevalence of GI disease was also higher in patients with medication for migraine, both preventive and acute treatment, compared to patients with either acute preventive or acute treatment. There was a statistically significant association between the prevalence of GI diseases and migraine, and the higher the number of accompanying GI diseases, the higher the correlation was in patients using both preventive and acute treatment drugs for migraine.
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6
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Bouchoucha M, Deutsch D, Uong P, Mary F, Sabate JM, Benamouzig R. Characteristics of patients with overlap functional gastrointestinal disorders. J Gastroenterol Hepatol 2021; 36:2171-2179. [PMID: 33555092 DOI: 10.1111/jgh.15438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Functional gastrointestinal disorders (FGIDs) are frequently overlapped. The present study was designed to (i) search the clinical differences between patients with single FGID and overlap FGIDs and (ii) define the most common FGIDs associations to identify homogenous subgroups of patients. METHODS A total of 3555 outpatients with FGID filled out the Rome III adult diagnostic questionnaire, Bristol stool form, and four 10-point Likert scales to report the severity of constipation, diarrhea, bloating, and abdominal pain. An unsupervised algorithm was used to estimate the number of groups directly from the data. A classification tree separated patients into different subgroups, according to FGIDs. Multinomial logistic regression was used to characterize the groups of patients with overlap disorders. RESULTS Patients reported 3.3 ± 1.9 FGIDs (range 1-10, median = 3); 736 reported only one FGID, while 2819 reported more than one FGID (3.8 ± 1.7). Patients with single FGID had higher body mass index (P < 0.001), never report irritable bowel syndrome (IBS), and rarely report fecal incontinence and anorectal pain (< 1% for each disorder). The non-supervised clustering of the 2819 patients with overlap FGIDs divided this population into 23 groups, including five groups associated with only one disorder (IBS-diarrhea, dysphagia, functional constipation, levator ani syndrome, and IBS-unspecified). Ten groups were related to two overlap disorders and eight groups to three or more disorders. Three disorders were not explicitly associated with a given group: IBS-mixed, proctalgia fugax, and nonspecific anorectal pain. CONCLUSION Patients with FGID mostly report overlap disorders in a limited number of associations, each significantly associated with a few disorders.
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Affiliation(s)
- Michel Bouchoucha
- Department of Physiology, Université René Descartes, Paris V, Paris, France.,Department of Gastroenterology, Hôpital Avicenne, Bobigny, France
| | - David Deutsch
- Department of Gastroenterology, Hôpital Avicenne, Bobigny, France
| | - Panha Uong
- Department of Gastroenterology, Hôpital Avicenne, Bobigny, France
| | - Florence Mary
- Department of Gastroenterology, Hôpital Avicenne, Bobigny, France
| | - Jean-Marc Sabate
- Department of Gastroenterology, Hôpital Avicenne, Bobigny, France
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7
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Lee SW, Chang CS. Impact of Overlapping Functional Gastrointestinal Disorders on the Quality of Life in Patients With Gastroesophageal Reflux Disease. J Neurogastroenterol Motil 2021; 27:176-184. [PMID: 33795540 PMCID: PMC8026382 DOI: 10.5056/jnm19006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 05/04/2020] [Accepted: 01/02/2021] [Indexed: 12/13/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) and functional gastrointestinal disorders (FGIDs), including irritable bowel syndrome and functional dyspepsia, are common afflictions within the general population. Both conditions have a considerable impact on the daily health related quality of life (HRQoL) of affected individuals. Risk factors surrounding any impaired HRQoL in patients with GERD involve those of younger age, obesity, an increase in reflux symptom frequency, and overlapping FGIDs. The risk factors for subjects experiencing an overlap in FGIDs and GERD involve those who are female, younger age, cigarette smoking, non-erosive reflux disease, more GERD symptoms, and psychological performances including anxiety, somatization, and more frequent healthcareseeking behavior. The overlap of GERD and FGIDs is associated with a worsening of both physical and mental health, an increase in bothersome symptoms, impaired functional capacity, and a higher likelihood of consulting a physician. Acid secretion suppressors could offer therapeutic efficacy to some patients experiencing overlapping GERD and FGIDs.
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Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
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8
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Shetty A, Nasta A, Gupte A, Goel R. The role of upper gastrointestinal endoscopy in bariatric procedure selection: A case series and literature review. J Minim Access Surg 2021; 17:81-84. [PMID: 33353892 PMCID: PMC7945648 DOI: 10.4103/jmas.jmas_139_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Bariatric surgery leads to a significant improvement in obesity and associated comorbidities. Safe surgical outcomes are especially desirable in bariatric, as most patients perceive it as an aesthetic surgery, while an intestinal/gastric surgery may be associated with morbidity. A detailed pre-operative evaluation is required to avoid surgical surprises and post-operative complications. Besides other routine investigations, pre-surgery upper gastrointestinal (GI) endoscopy has always been a topic of debate. Some surgeons perform it routinely before the surgery, whereas others perform it selectively. It is mostly accepted that pre-operative diagnosis of gastro-oesophageal reflux disease could change the plan of surgery in favour of Roux-en-Y gastric bypass although similar consensus does not exist in favour of Sleeve gastrectomy if a gastric/duodenal pathology is detected pre-operatively in a planned roux-en-y gastric bypass patient. Aim: Through this case series, we want to highlight the role of routine pre-operative upper GI endoscopy in selecting the bariatric surgery. Cases: We present four cases, from amongst many others, where endoscopy changed the course of bariatric surgery. Conclusion: Upper GI endoscopy should be performed before bariatric surgery, even in asymptomatic patients, to avoid post-operative surprise/complication.
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Affiliation(s)
- Aashik Shetty
- Centre for Metabolic Surgery, Wockhardt Hospital, Mumbai, Maharashtra, India
| | - Amrit Nasta
- Centre for Metabolic Surgery, Wockhardt Hospital, Mumbai, Maharashtra, India
| | - Amit Gupte
- Department of Gastroenterology, Wockhardt Hospital, Mumbai, Maharashtra, India
| | - Ramen Goel
- Centre for Metabolic Surgery, Wockhardt Hospital, Mumbai, Maharashtra, India
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9
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Morozova YN, Pogromov AP, Mnatsakanyan MG, Tashchyan OV, Kolosova KY. Esophageal disorders in patients with irritable bowel syndrome. TERAPEVT ARKH 2020; 92:19-23. [DOI: 10.26442/00403660.2020.02.000483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 11/22/2022]
Abstract
Aim.To study the whole range of esophageal disorders in patients with irritable bowel syndrome (IBS) using high-tech methods.
Materials and methods.102 IBS patients (47 males, mean age 40.8, diagnosis of IBS was established according to Rome III criteria) with esophageal symptoms (heartburn, belching, globus sensation and noncardiac chest pain) were examined in gastroenterology department. All patients underwent endoscopy, with biopsies if required, X-ray examination of upper gastrointestinal tract; 24-hour pH-impedance monitoring;13C-urea breath test. Evaluation of esophageal symptoms was carried out on the basis of Rome IV criteria.
Results.21 (20.6%) individuals had esophagitis (ERD). According to 24-hour pH-monitoring data, 7 of them had overlap between GERD and functional esophageal disorders (FED). 27 (26.5%) individuals had nonerosive reflux disease (NERD). In 54 (52.9%) individuals endoscopy and pH-impedance monitoring data did not differ from normal, suggesting this group as group of patients with FED. There was no significant difference for age, sex and IBS subtypes in GERD, NERD and FED groups.
Conclusion.Comorbid esophageal disorders in patients with IBS are different and represented by organic diseases, FED and overlap between them. Methods such as 24-h pH-impedance measurement and esophageal manometry should be used to assess comorbid esophageal disorders in IBS patients.
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10
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de Bortoli N, Chio TD, Mariani L, Savarino EV. Authors' reply. Ann Gastroenterol 2019; 32:319. [PMID: 31040634 PMCID: PMC6479651 DOI: 10.20524/aog.2019.0369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nicola de Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Nicola de Bortoli, Lucia Mariani), Italy
| | - Teresa Di Chio
- Pediatrics Unit, Department of Experimental and Clinical Medicine, University of Pisa (Teresa Di Chio), Italy
| | - Lucia Mariani
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Nicola de Bortoli, Lucia Mariani), Italy
| | - Edoardo V Savarino
- Gastroenterology Unit, Department Surgery, Oncology and Gastroenterology, University of Padua (Edoardo V. Savarino), Italy
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11
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Schmulson M, Frati-Munari A. Bowel symptoms in patients that receive proton pump inhibitors. Results of a multicenter survey in Mexico. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2018.05.011] [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: 02/07/2023] Open
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12
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de Bortoli N, Tolone S, Frazzoni M, Martinucci I, Sgherri G, Albano E, Ceccarelli L, Stasi C, Bellini M, Savarino V, Savarino EV, Marchi S. Gastroesophageal reflux disease, functional dyspepsia and irritable bowel syndrome: common overlapping gastrointestinal disorders. Ann Gastroenterol 2018; 31:639-648. [PMID: 30386113 PMCID: PMC6191868 DOI: 10.20524/aog.2018.0314] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 08/26/2018] [Indexed: 12/11/2022] Open
Abstract
Several studies have indicated an overlap between gastroesophageal reflux disease (GERD) and various functional gastrointestinal disorders (FGIDs). The overlapping conditions reported have mainly been functional dyspepsia (FD) and irritable bowel syndrome (IBS). The available literature is frequently based on symptomatic questionnaires or endoscopic procedures to diagnose GERD. Rarely, among patients with heartburn, pathophysiological evaluations have been considered to differentiate those with proven GERD from those without. Moreover, both GERD and IBS or FD showed enormous heterogeneity in terms of the criteria and diagnostic procedures used. The GERD-IBS overlap ranges from 3-79% in questionnaire-based studies and from 10-74% when GERD has been diagnosed endoscopically. The prevalence of functional dyspepsia (after normal upper endoscopy) is 12-15% and an overlap with GERD has been reported frequently. Only a few studies have considered a potential overlap between functional heartburn (FH) and IBS using a 24-h pH-metry or impedance-pH evaluation. Similar data has been reported for an overlap between FH and FD. Recently, a revision of the Rome criteria for esophageal FGIDs identified both FH and hypersensitive esophagus (HE) as potential functional esophageal disorders. This might increase the potential overlap between different FGIDs, with FH and HE rather than with GERD. The aim of the present review article was to appraise and discuss the current evidence supporting the possible concomitance of GERD with IBS and FD in the same patients and to evaluate how various GERD treatments could impact on the quality of life of these patients.
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Affiliation(s)
- Nicola de Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Nicola de Bortoli, Giulia Sgherri, Eleonora Albano, Linda Ceccarelli, Massimo Bellini, Santino Marchi), Caserta, Italy
| | - Salvatore Tolone
- Surgery Unit, Department of Surgery, University of Campania Luigi Vanvitelli, Caserta (Salvatore Tolone), Italy
| | - Marzio Frazzoni
- Division of Pathophysiology, Baggiovara Hospital, Modena (Marzio Frazzoni), Italy
| | - Irene Martinucci
- Division of Gastroenterology, Versilia Hospital, Lido di Camaiore-Lucca (Irene Martinucci), Italy
| | - Giulia Sgherri
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Nicola de Bortoli, Giulia Sgherri, Eleonora Albano, Linda Ceccarelli, Massimo Bellini, Santino Marchi), Caserta, Italy
| | - Eleonora Albano
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Nicola de Bortoli, Giulia Sgherri, Eleonora Albano, Linda Ceccarelli, Massimo Bellini, Santino Marchi), Caserta, Italy
| | - Linda Ceccarelli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Nicola de Bortoli, Giulia Sgherri, Eleonora Albano, Linda Ceccarelli, Massimo Bellini, Santino Marchi), Caserta, Italy
| | - Cristina Stasi
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence (Cristina Stasi), Italy
| | - Massimo Bellini
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Nicola de Bortoli, Giulia Sgherri, Eleonora Albano, Linda Ceccarelli, Massimo Bellini, Santino Marchi), Caserta, Italy
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa (Vincenzo Savarino), Italy
| | - Edoardo V. Savarino
- Gastroenterology Unit, Department Surgery, Oncology and Gastroenterology, University of Padua (Edoardo V. Savarino), Italy
| | - Santino Marchi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Nicola de Bortoli, Giulia Sgherri, Eleonora Albano, Linda Ceccarelli, Massimo Bellini, Santino Marchi), Caserta, Italy
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13
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Zatarain Valles A, Serrano Falcón B, Álvarez Sánchez Á, Rey Díaz-Rubio E. Independent factors associated with the impact of gastroesophageal reflux disease on health-related quality of life. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 111:94-100. [PMID: 30345782 DOI: 10.17235/reed.2018.5752/2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND although a number of factors have been associated with a deterioration in quality of life in gastroesophageal reflux disease, it is not known which has an independent influence. OBJECTIVE to evaluate factors independently associated with the impact of gastroesophageal reflux disease on health-related quality of life. METHODS a post-hoc analysis of a prospective cohort of patients diagnosed with gastroesophageal reflux disease was performed. The patients completed validated questionnaires to evaluate health-related quality of life (SF 36), gastroesophageal reflux disease (GERQ) and psychological factors (STAI and SCL 90R). RESULTS the study included 98 patients. The univariate analysis showed that a deterioration in the physical component of the SF36 was significantly associated with female gender, educational level, age, weight loss, severity of typical symptoms, supraesophageal symptoms and monthly income. The mental component was significantly associated with alcohol consumption, epigastric pain and lower scores on the STAI and SCL90 questionnaires. The multivariate analysis showed an independent association between the physical component of the SF36 and educational level (β = 0.29; p < 0.01), severity of symptoms (β = -0.38; p < 0.001), body mass index (β = -0.30; p < 0.005), state anxiety (β = 0.28; p < 0.01), female gender (β = -0.23; p < 0.05) and dyspepsia (β = -0.21; p < 0.05). Associated variables within the mental component included state anxiety (β = -0.39; p < 0.01) and depression (β = -0.32; p < 0.05). CONCLUSIONS the principal factors independently associated with a deterioration in health-related quality of life in patients with gastroesophageal reflux disease included the severity of typical symptoms and the presence of dyspepsia. There is also an additional impact of body mass index and the psychological component.
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Savarino V, Marabotto E, Zentilin P, Furnari M, Bodini G, De Maria C, Pellegatta G, Coppo C, Savarino E. The appropriate use of proton-pump inhibitors. Minerva Med 2018; 109. [DOI: 10.23736/s0026-4806.18.05705-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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15
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Savarino V, Tosetti C, Benedetto E, Compare D, Nardone G. Appropriateness in prescribing PPIs: A position paper of the Italian Society of Gastroenterology (SIGE) - Study section "Digestive Diseases in Primary Care". Dig Liver Dis 2018; 50:894-902. [PMID: 30093304 DOI: 10.1016/j.dld.2018.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/04/2018] [Accepted: 07/09/2018] [Indexed: 02/06/2023]
Abstract
The introduction of proton pump inhibitors (PPIs) into clinical practice about thirty years ago has greatly improved our therapeutic approach to acid-related diseases for their well-recognized efficacy and safety. Despite the well-defined indications, however, the use of PPIs continues to grow every year in both western and eastern countries and this phenomenon poses serious queries that include the onset of potential adverse effects and the increase in health care costs. The major reason explaining this worrying market expansion is the inappropriate use of PPIs. In order to re-establish a correct use of these effective drugs in daily clinical practice, the Italian Society of Gastroenterology (SIGE), nominated a panel of experts who reviewed the available clinical literature and produced a series of updated position statements on the use of PPIs in clinical practice.
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Affiliation(s)
| | | | | | - Debora Compare
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy
| | - Gerardo Nardone
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Italy.
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Lee YS, Jang BH, Ko SG, Chae Y. Comorbid risks of psychological disorders and gastroesophageal reflux disorder using the national health insurance service-National Sample Cohort: A STROBE-compliant article. Medicine (Baltimore) 2018; 97:e0153. [PMID: 29718833 PMCID: PMC6393012 DOI: 10.1097/md.0000000000010153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This study was performed to examine the comorbidity risks between psychological disorders, such as depression, and gastroesophageal reflux disease (GERD) using nationally representative data from a National Sample Cohort of the National Health Insurance Service in Korea.The National Health Insurance Service-National Sample Cohort (NHIS-NSC) database from 2010 to 2012 was used in this study. GERD patients were defined as those diagnosed with specific tests, with screened medication, and without any other gastrointestinal diseases. Propensity score matching for age, sex, and economic status was applied to form a control cohort. Incidence rate, relative risks, Cox proportional-hazards modeling, and Kaplan-Meier analysis were applied to examine the differences between the GERD and control cohorts with regard to the risk of subsequent psychological disorders.The results showed that patients in the GERD cohort (n = 9503) had significantly higher risks of psychological disorders than those without GERD (adjusted hazard ratio [HR] 1.25, 95% confidence interval [CI] 1.07-1.47, P = .006). Specifically, the risk of depressive disorder was significantly higher for patients in the GERD cohort than in the control cohort (adjusted HR 1.41, 95% CI 1.04-1.91, P = .027). Kaplan-Meier analysis showed that the estimated probability of psychological disorders was significantly higher in the GERD cohort compared with the control cohort (log-rank test, P = .007).This study suggested that GERD may be a risk factor for subsequent psychological disorders, specifically, depressive disorder. The results of this study in GERD patients compared with non-GERD patients in Korea suggested that psychological disorders and GERD may be inter-related.
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Affiliation(s)
- Ye-Seul Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seong-Gyu Ko
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Younbyoung Chae
- Acupuncture and Meridian Science Research Center, College of Korean Medicine
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Schmulson MJ, Frati-Munari AC. Bowel symptoms in patients that receive proton pump inhibitors. Results of a multicenter survey in Mexico. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2018; 84:44-51. [PMID: 29678362 DOI: 10.1016/j.rgmx.2018.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/20/2018] [Accepted: 02/23/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Proton pump inhibitors (PPIs) have been associated with small intestinal bacterial overgrowth (SIBO), which increases with prolonged PPI use, and SIBO has been associated with irritable bowel syndrome (IBS). OBJECTIVE The aim of the present study was to study the prevalence of bowel symptoms in patients treated with PPIs in Mexico. METHODS Gastroenterologists in 36 cities surveyed patients treated with PPIs, utilizing an ad hoc questionnaire to determine the presence of bowel symptoms and IBS. RESULTS Two hundred and fifteen physicians interviewed 1,851 patients. PPI indications were gastritis (48.8%), gastroesophageal reflux (38.5%), peptic ulcer (6.2%), and others (6.5%). A total of 77.5% of the patients received treatment for ≤6 months and 11.9% for ≥1 year. Symptoms were reported in 92.3% of the patients: abnormal bowel habits (90%), bloating (82%), abdominal pain (63%), flatulence (58%), and abdominal discomfort (53%). A total of 67.5% of the patients fit the Rome III criteria for IBS. Symptoms presented in 55.9% of the patients before PPI intake and in 44.1% of the patients after PPI use (P<.005). Constipation (63.8%) predominated in the former, and diarrhea (56.5%) in the latter (P<.0001). The treatments prescribed for managing those symptoms were antispasmodics, antibiotics, prokinetics, and antiflatulents, but patients stated greater satisfaction with antibiotics (mainly rifaximin) (P<.0001). CONCLUSION The association of PPIs with bowel symptoms and IBS is frequent in Mexico. Diarrhea and bloating predominate, and antibiotics produce the greatest treatment satisfaction, suggesting that SIBO or dysbiosis is the cause of the PPI-related bowel symptoms. However, that remains to be confirmed.
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Affiliation(s)
- M J Schmulson
- Laboratorio de Hígado, Páncreas y Motilidad (HIPAM)-Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Hospital General de México, Ciudad de México, México; Gastroenterología y Motilidad Gastrointestinal, Clínica Lomas Altas SC, Ciudad de México, México; Gastroenterología y Endoscopía en Práctica Médica-Centro Médico ABC, Ciudad de México, México.
| | - A C Frati-Munari
- Alfa Wassermann S.A. de C.V., Ciudad de México, México; Medicina interna, Hospital Médica Sur, Ciudad de México, México
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Yamasaki T, O'Neil J, Fass R. Update on Functional Heartburn. Gastroenterol Hepatol (N Y) 2017; 13:725-734. [PMID: 29339948 PMCID: PMC5763558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The definition of functional heartburn has been refined over the years. It is currently described, based upon Rome IV criteria, as typical heartburn symptoms in the presence of normal upper endoscopy findings (including normal biopsies), normal esophageal pH testing, and a negative association between symptoms and reflux events. Functional heartburn is very common, affecting women more than men, and with reflux hypersensitivity makes up the majority of heartburn patients who fail twice-daily proton pump inhibitor therapy. These disorders overlap with other functional gastrointestinal disorders and are often accompanied by psychological comorbidities. Diagnosis is made by using endoscopy with esophageal biopsies, wireless pH capsule, pH-impedance monitoring, and high-resolution esophageal manometry. Additional diagnostic tools that may be of value include magnification endoscopy, chromoendoscopy, narrow-band imaging, autofluorescence imaging, mucosal impedance, impedance baseline values, and histopathology scores. Functional heartburn is primarily treated with neuromodulators. Psychological intervention and complementary and alternative medicine may also play important roles in the treatment of these patients.
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Affiliation(s)
- Takahisa Yamasaki
- Dr Yamasaki is a research fellow at the Esophageal and Swallowing Center at MetroHealth Medical Center in Cleveland, Ohio and a visiting scholar at Case Western Reserve University in Cleveland, Ohio. Ms O'Neil is a medical student at Case Western Reserve University. Dr Fass is the medical director of the Digestive Health Center, director of the Division of Gastroenterology and Hepatology, and head of the Esophageal and Swallowing Center at MetroHealth Medical Center, as well as a professor of medicine at Case Western Reserve University
| | - Jessica O'Neil
- Dr Yamasaki is a research fellow at the Esophageal and Swallowing Center at MetroHealth Medical Center in Cleveland, Ohio and a visiting scholar at Case Western Reserve University in Cleveland, Ohio. Ms O'Neil is a medical student at Case Western Reserve University. Dr Fass is the medical director of the Digestive Health Center, director of the Division of Gastroenterology and Hepatology, and head of the Esophageal and Swallowing Center at MetroHealth Medical Center, as well as a professor of medicine at Case Western Reserve University
| | - Ronnie Fass
- Dr Yamasaki is a research fellow at the Esophageal and Swallowing Center at MetroHealth Medical Center in Cleveland, Ohio and a visiting scholar at Case Western Reserve University in Cleveland, Ohio. Ms O'Neil is a medical student at Case Western Reserve University. Dr Fass is the medical director of the Digestive Health Center, director of the Division of Gastroenterology and Hepatology, and head of the Esophageal and Swallowing Center at MetroHealth Medical Center, as well as a professor of medicine at Case Western Reserve University
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Park KS, Jee SR, Lee BE, Hong KS, Shin JE, Na SY, Kwon JG, Choi SC, Kim YS, Lee HS, Lee TH, Kim KO, Choi J, Moon HS, Kim YS, Park MI, Park SJ, Park SY, Hong SN. Nationwide Multicenter Study for Overlaps of Common Functional Gastrointestinal Disorders in Korean Patients With Constipation. J Neurogastroenterol Motil 2017; 23:569-577. [PMID: 28992677 PMCID: PMC5628990 DOI: 10.5056/jnm17033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/05/2017] [Accepted: 07/12/2017] [Indexed: 12/15/2022] Open
Abstract
Background/Aims In spite of increased concerns about the overlaps among the various functional gastrointestinal disorders (FGIDs), studies for the overlap between constipation and other common FGIDs are rare. Therefore, we investigated the patterns of overlaps between constipation and other common FGIDs. Methods This study was designed as a prospective nationwide multi-center questionnaire study using Rome III questionnaires for functional dyspepsia (FD), irritable bowel syndrome (IBS), and functional constipation (FC), as well as various questionnaires about patients' information, degree of symptoms, and quality of life. For the evaluation of gastroesophageal reflux disease (GERD), GERD-Q was used. Results From 19 centers, 759 patients with constipation were enrolled. The proportions of FC and IBS subtypes of constipation (IBS-C) were 59.4% and 40.6%, respectively. Among them, 492 (64.8%) showed no overlap. One hundred and thirty-six patients (17.9%) presented overlapping GERD, and 80 patients (10.5%) presented overlapping FD. Fifty one (6.7%) of patients were overlapped by both GERD and FD. Coincidental herniated nucleus pulposus (HNP) (P = 0.026) or pulmonary diseases (P = 0.034), reduced fiber intake (P = 0.013), and laxative use (P < 0.001) independently affected the rate of overlaps. These overlapping conditions negatively affected the constipation-associated quality of life, general quality of life, and degree of constipation. Conclusions The overlap of GERD or FD was common in patients with constipation. Coincidental HNP or pulmonary diseases, reduced fiber intake, and laxatives use were found to be independent associated factors for overlapping common FGIDs in Korean patients with constipation.
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Affiliation(s)
- Kyung Sik Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | | | - Bong Eun Lee
- Pusan National University School of Medicine, Busan, Korea
| | | | - Jeong Eun Shin
- Dankook University College of Medicine, Cheonan, Chungnam, Korea
| | - Soo-Young Na
- Jeju National University School of Medicine, Jeju, Korea
| | - Joong Goo Kwon
- Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Suck Chei Choi
- Wonkwang University School of Medicine, Iksan, Jeonbuk, Korea
| | - Yong Sung Kim
- Department of Internal Medicine and Wonkwang Digestive Disease Research Institute, Wonkwang University Sanbon Hospital, Gunpo, Gyeonggi-do, Korea
| | - Hyun Seok Lee
- Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae Hee Lee
- Soonchunhyang University College of Medicine, Seoul, Korea
| | - Kyeong Ok Kim
- Yeungnam University College of Medicine, Daegu, Korea
| | | | - Hee Seok Moon
- Chungnam National University School of Medicine, Daejeon, Korea
| | - Yeon Soo Kim
- Hallym University College of Medicine, Chuncheon, Gangwon-do, Korea
| | - Moo In Park
- Kosin University College of Medicine, Busan, Korea
| | | | | | - Sung Noh Hong
- Sungkyunkwan University School of Medicine, Seoul, Korea
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Fujishiro M, Kushiyama A, Yamazaki H, Kaneko S, Koketsu Y, Yamamotoya T, Kikuchi T, Sakoda H, Suzuki R, Kadowaki T. Gastrointestinal symptom prevalence depends on disease duration and gastrointestinal region in type 2 diabetes mellitus. World J Gastroenterol 2017; 23:6694-6704. [PMID: 29085214 PMCID: PMC5643290 DOI: 10.3748/wjg.v23.i36.6694] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/12/2017] [Accepted: 06/01/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To unravel relationships between gastrointestinal (GI) symptoms impairing quality of life (QOL) and clinical profiles of diabetes mellitus (DM) patients.
METHODS We enrolled 134 outpatients with type 2 DM. Mean age was 64.7 years, mean body mass index was 24.7 kg/m2, mean glycated hemoglobin was 7.1%, and mean DM duration was 13.7 years. GI symptom-related QOL was determined using the Izumo scale, based on five factors, i.e., heartburn, gastralgia, postprandial fullness, constipation and diarrhea. The sum of scores obtained for the three questions in each domain was calculated, and subjects with a score of 5 or higher were considered to be symptomatic with impaired QOL. JMP Clinical version 5.0 was used for all statistical analyses.
RESULTS Lower abdominal symptoms were found to be more frequent than those affecting the upper abdomen. Diabetic duration and medications showed associations with GI symptoms. We identified differences in peak prevalences of the five symptoms. Gastralgia (P = 0.02 vs 10-14 years) and total GI symptoms (P = 0.01 and P = 0.02 vs 5-9 years and 10-14 years, respectively) peaked at a diabetes duration of 15-19 years. Heartburn (P = 0.004) and postprandial fullness (P = 0.03) tended to increase with disease duration. Constipation and diarrhea showed bimodal peaks, with the first early and the second late (e.g., P = 0.03 at 15-19 years vs 10-14 years for diarrhea) in the disease course. Finally, GI symptoms showed clustering that reflected the region of the GI tract affected, i.e., constipation and diarrhea had similar frequencies (P < 0.0001).
CONCLUSION Our study highlights the importance of questioning patients about QOL impairment due to abdominal symptoms, especially in the early and the late periods of diabetes.
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Affiliation(s)
- Midori Fujishiro
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
| | - Akifumi Kushiyama
- Division of Diabetes and Metabolism, Institute for Adult Diseases, Asahi Life Foundation, Tokyo 103-0002, Japan
| | - Hiroki Yamazaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
| | - Sunao Kaneko
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
| | - Yuko Koketsu
- Department of Diabetes and Metabolic Diseases, Shinko Hospital, Kobe 651-0072, Japan
| | - Takeshi Yamamotoya
- Department of Medical Science, Graduate School of Medicine, University of Hiroshima, Hiroshima 734-8553, Japan
| | - Takako Kikuchi
- Division of Diabetes and Metabolism, Institute for Adult Diseases, Asahi Life Foundation, Tokyo 103-0002, Japan
| | - Hideyuki Sakoda
- Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kiyotakecho Kihara, Miyazaki 889-1692, Japan
| | - Ryo Suzuki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
| | - Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo 113-8655, Japan
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Tenca A, de Bortoli N, Mauro A, Frazzoni M, Savarino E, Massironi S, Russo S, Bertani L, Marchi S, Penagini R. Esophageal chemical clearance and baseline impedance values in patients with chronic autoimmune atrophic gastritis and gastro-esophageal reflux disease. Dig Liver Dis 2017; 49:978-983. [PMID: 28487082 DOI: 10.1016/j.dld.2017.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 04/01/2017] [Accepted: 04/05/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The factors influencing new markers of gastro-esophageal reflux disease detected by impedance-pH monitoring - mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave (PSPW) index - need to be evaluated. AIM To compare endoscopy-negative heartburn with chronic autoimmune atrophic gastritis (CAAG). MATERIALS AND METHODS 24 patients with CAAG, 25 with non-erosive reflux disease (NERD) and 25 with functional heartburn (FH) were included. In all patients the main impedance-pH monitoring parameters were calculated. RESULTS CAAG and NERD patients had a number of reflux events (non-acid ones being more common among the former group) which was higher than that found in FH (p<0.001). MNBI decreased progressively in FH (>3000Ohm), CAAG (>2000Ohm) and NERD (<1000Ohm) patients (p=0.0046). The PSPW index was similar between CAAG and NERD patients but significantly lower in comparison to FH (p<0.0001). CONCLUSION Patients with CAAG have evidence of non-acid reflux based on the high number of reflux events and confirmed by low values of MNBI and PSPW index. MNBI is a strong marker of acid/non-acid reflux-induced mucosal damage, whereas the PSPW index can reliably discriminate patients with reflux from those with FH, independently of the acidity of refluxate.
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Affiliation(s)
- Andrea Tenca
- Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Clinic of Gastroenterology, Department of Internal Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Nicola de Bortoli
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Aurelio Mauro
- Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Marzio Frazzoni
- Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Sara Massironi
- Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Salvatore Russo
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Lorenzo Bertani
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Santino Marchi
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Hosseini M, Salari R, Shariatmaghani S, Birjandi B, Salari M. Gastrointestinal symptoms associated with gastroesophageal reflux disease, and their relapses after treatment with proton pump inhibitors: A systematic review. Electron Physician 2017; 9:4597-4605. [PMID: 28848636 PMCID: PMC5557141 DOI: 10.19082/4597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 01/25/2017] [Indexed: 12/12/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) is a common functional gastrointestinal disorder with significant effects on the quality of life. The burden of GERD is soaring in Asia. Preventing symptom relapse is a therapeutic goal in GERD patients. Since proton pump inhibitors (PPI) are the first-line treatment of GERD, drug failure has become a major problem in the treatment procedure. We reviewed the literature in order to find articles related to comorbidities and symptoms affecting GERD from 1980 to 2015 via PubMed and Google Scholar using keywords such as ‘Gastroesophageal reflux disease’, ‘Gastrointestinal symptoms’ and Boolean operators (such as AND, OR, NOT). Due to the cost of PPI therapy and the high rate of GERD relapse after PPI therapy, demand for continuing this type of treatment is decreasing. Thus, we need to discover new approaches to treat the disease and also investigate the relationship between the treatment of GERD and its comorbidities and symptoms such as functional constipation.
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Affiliation(s)
- Mousalreza Hosseini
- M.D., Gastroenterologist, Assistant Professor, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roshanak Salari
- Ph.D. of Drug Control, Assistant Professor, Department of Traditional Persian Pharmacy, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Somayeh Shariatmaghani
- M.D., Internist, Assistant Professor, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Batul Birjandi
- M.D., Internist, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Salari
- M.D., Internist, Assistant Professor, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Savarino V, Dulbecco P, de Bortoli N, Ottonello A, Savarino E. The appropriate use of proton pump inhibitors (PPIs): Need for a reappraisal. Eur J Intern Med 2017; 37:19-24. [PMID: 27784575 DOI: 10.1016/j.ejim.2016.10.007] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 12/12/2022]
Abstract
The advent of powerful acid-suppressive drugs, such as proton pump inhibitors (PPIs), has revolutionized the management of acid-related diseases and has minimized the role of surgery. The major and universally recognized indications for their use are represented by treatment of gastro-esophageal reflux disease, eradication of Helicobacter pylori infection in combination with antibiotics, therapy of H. pylori-negative peptic ulcers, healing and prophylaxis of non-steroidal anti-inflammatory drug-associated gastric ulcers and control of several acid hypersecretory conditions. However, in the last decade, we have witnessed an almost continuous growth of their use and this phenomenon cannot be only explained by the simple substitution of the previous H2-receptor antagonists, but also by an inappropriate prescription of these drugs. This endless increase of PPI utilization has created an important problem for many regulatory authorities in terms of increased costs and greater potential risk of adverse events. The main reasons for this overuse of PPIs are the prevention of gastro-duodenal ulcers in low-risk patients or the stress ulcer prophylaxis in non-intensive care units, steroid therapy alone, anticoagulant treatment without risk factors for gastro-duodenal injury, the overtreatment of functional dyspepsia and a wrong diagnosis of acid-related disorder. The cost for this inappropriate use of PPIs has become alarming and requires to be controlled. We believe that gastroenterologists together with the scientific societies and the regulatory authorities should plan educational initiatives to guide both primary care physicians and specialists to the correct use of PPIs in their daily clinical practice, according to the worldwide published guidelines.
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Affiliation(s)
- Vincenzo Savarino
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
| | - Pietro Dulbecco
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Nicola de Bortoli
- Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Andrea Ottonello
- Department of Surgical and Diagnostic Integrated Sciences, University of Genoa, Genoa, Italy
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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24
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de Bortoli N, Frazzoni L, Savarino EV, Frazzoni M, Martinucci I, Jania A, Tolone S, Scagliarini M, Bellini M, Marabotto E, Furnari M, Bodini G, Russo S, Bertani L, Natali V, Fuccio L, Savarino V, Blandizzi C, Marchi S. Functional Heartburn Overlaps With Irritable Bowel Syndrome More Often than GERD. Am J Gastroenterol 2016; 111:1711-1717. [PMID: 27644732 DOI: 10.1038/ajg.2016.432] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 08/05/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We aimed to evaluate the prevalence of irritable bowel syndrome (IBS) in patients with typical reflux symptoms as distinguished into gastroesophageal reflux disease (GERD), hypersensitive esophagus (HE), and functional heartburn (FH) by means of endoscopy and multichannel intraluminal impedance (MII)-pH monitoring. The secondary aim was to detect pathophysiological and clinical differences between different sub-groups of patients with heartburn. METHODS Patients underwent a structured interview based on questionnaires for GERD, IBS, anxiety, and depression. Off-therapy upper-gastrointestinal (GI) endoscopy and 24 h MII-pH monitoring were performed in all cases. In patients with IBS, fecal calprotectin was measured and colonoscopy was scheduled for values >100 mg/kg to exclude organic disease. Multivariate logistic regression analysis was performed to identify independent risk factors for FH. RESULTS Of the 697 consecutive heartburn patients who entered the study, 454 (65%) had reflux-related heartburn (GERD+HE), whereas 243 (35%) had FH. IBS was found in 147/454 (33%) GERD/HE but in 187/243 (77%) FH patients (P<0.001). At multivariate analysis, IBS and anxiety were independent risk factors for FH in comparison with reflux-related heartburn (GERD+HE). CONCLUSIONS IBS overlaps more frequently with FH than with GERD and HE, suggesting common pathways and treatment. HE showed intermediate characteristic between GERD and FH.
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Affiliation(s)
- Nicola de Bortoli
- Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Leonardo Frazzoni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Edoardo V Savarino
- Department of Surgery, Oncology and Gastroenterology, Division of Gastroenterology, University of Padua, Padua, Italy
| | - Marzio Frazzoni
- Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy
| | - Irene Martinucci
- Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy
| | | | - Salvatore Tolone
- Department of Surgery, Division of Surgery, Second University of Naples, Naples, Italy
| | | | - Massimo Bellini
- Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Elisa Marabotto
- Department of Internal Medicine (DIMI), Division of Gastroenterology, University of Genoa, Genoa, Italy
| | - Manuele Furnari
- Department of Internal Medicine (DIMI), Division of Gastroenterology, University of Genoa, Genoa, Italy
| | - Giorgia Bodini
- Department of Internal Medicine (DIMI), Division of Gastroenterology, University of Genoa, Genoa, Italy
| | - Salvatore Russo
- Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Lorenzo Bertani
- Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Veronica Natali
- Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Vincenzo Savarino
- Department of Internal Medicine (DIMI), Division of Gastroenterology, University of Genoa, Genoa, Italy
| | - Corrado Blandizzi
- Department of Internal Medicine, Division of Pharmacology and Chemotherapy, University of Pisa, Pisa, Italy
| | - Santino Marchi
- Department of Translational Research and New Technology in Medicine and Surgery, Division of Gastroenterology, University of Pisa, Cisanello Hospital, Pisa, Italy
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Kim YS, Kim N, Kim GH. Sex and Gender Differences in Gastroesophageal Reflux Disease. J Neurogastroenterol Motil 2016; 22:575-588. [PMID: 27703114 PMCID: PMC5056567 DOI: 10.5056/jnm16138] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 12/13/2022] Open
Abstract
It is important to understand sex and gender-related differences in gastroesophageal reflux disease (GERD) because gender-related biologic factors might lead to better prevention and therapy. Non-erosive reflux disease (NERD) affects more women than men. GERD symptoms are more frequent in patients with NERD than in those with reflux esophagitis. However, men suffer pathologic diseases such as reflux esophagitis, Barrett’s esophagus (BE), and esophageal adenocarcinoma (EAC) more frequently than women. The prevalence of reflux esophagitis is significantly increased with age in women, especially after their 50s. The mean age of EAC incidence in women is higher than in men, suggesting a role of estrogen in delaying the onset of BE and EAC. In a chronic rat reflux esophagitis model, nitric oxide was found to be an aggravating factor of esophageal injury in a male-predominant way. In addition, the expression of esophageal occludin, a tight junction protein that plays an important role in the esophageal defense mechanism, was up-regulated in women. This explains the male predominance of reflux esophagitis and delayed incidence of BE or EAC in women. Moreover, the symptoms such as heartburn, regurgitation, and extra-esophageal symptoms have been more frequently reported by women than by men, suggesting that sex and gender play a role in symptom perception. Differential sensitivity with augmented symptoms in women might have diagnostic and therapeutic influence. Furthermore, recent studies have suggested that hormone replacement therapy has a protective effect against esophageal cancer. However, an anti-inflammatory role of estrogen remains compelling, which means further study is necessary in this area.
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Affiliation(s)
- Young Sun Kim
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Nayoung Kim
- Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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Savarino E, Martinucci I, Furnari M, Romana C, Pellegatta G, Moscatelli A, Bodini G, Marabotto E, Savarino V, de Bortoli N, Blandizzi C. Vonoprazan for treatment of gastroesophageal reflux: pharmacodynamic and pharmacokinetic considerations. Expert Opin Drug Metab Toxicol 2016; 12:1333-1341. [PMID: 27428571 DOI: 10.1080/17425255.2016.1214714] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Irene Martinucci
- Division of Gastroenterology, Department of Internal Medicine, University of Pisa, Pisa, Italy
| | - Manuele Furnari
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Chiara Romana
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Gaia Pellegatta
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Alessandro Moscatelli
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Giorgia Bodini
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Elisa Marabotto
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Vincenzo Savarino
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Nicola de Bortoli
- Division of Gastroenterology, Department of Internal Medicine, University of Pisa, Pisa, Italy
| | - Corrado Blandizzi
- Division of Pharmacology and Chemotherapy, University of Pisa, Pisa, Italy
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de Bortoli N, Ottonello A, Zerbib F, Sifrim D, Gyawali CP, Savarino E. Between GERD and NERD: the relevance of weakly acidic reflux. Ann N Y Acad Sci 2016; 1380:218-229. [DOI: 10.1111/nyas.13169] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/04/2016] [Accepted: 06/13/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Nicola de Bortoli
- Division of Gastroenterology, Department of Translational Research and New Technology in Medicine and Surgery; University of Pisa; Pisa Italy
| | - Andrea Ottonello
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology; University of Padua; Padua Italy
| | - Frank Zerbib
- Department of Gastroenterology; CHU Bordeaux and Bordeaux University; Bordeaux France
| | - Daniel Sifrim
- Barts and the London School of Medicine and Dentistry; Queen Mary University of London; United Kingdom
| | - C. Prakash Gyawali
- Division of Gastroenterology; Washington University School of Medicine; St. Louis Missouri
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology; University of Padua; Padua Italy
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de Bortoli N, Martinucci I, Bertani L, Russo S, Franchi R, Furnari M, Tolone S, Bodini G, Bolognesi V, Bellini M, Savarino V, Marchi S, Savarino EV. Esophageal testing: What we have so far. World J Gastrointest Pathophysiol 2016; 7:72-85. [PMID: 26909230 PMCID: PMC4753191 DOI: 10.4291/wjgp.v7.i1.72] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 12/02/2015] [Accepted: 01/04/2016] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is a common disorder of the gastrointestinal tract. In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of GERD. High-resolution manometry (HRM) permits greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. Moreover, HRM has been found to be more reproducible and sensitive than conventional water-perfused manometry to detect the presence of transient lower esophageal sphincter relaxation. Esophageal 24-h pH-metry with or without combined impedance is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and pH monitoring can detect acid and non-acid reflux events. EndoFLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. In the coming years, laryngopharyngeal symptoms could be evaluated with up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal pH-metry. Future studies are required of these techniques to evaluate their diagnostic accuracy and usefulness, although the available data are promising.
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de Bortoli N, Martinucci I, Savarino E, Franchi R, Bertani L, Russo S, Ceccarelli L, Costa F, Bellini M, Blandizzi C, Savarino V, Marchi S. Lower pH values of weakly acidic refluxes as determinants of heartburn perception in gastroesophageal reflux disease patients with normal esophageal acid exposure. Dis Esophagus 2016; 29:3-9. [PMID: 25212408 DOI: 10.1111/dote.12284] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Multichannel impedance pH monitoring has shown that weakly acidic refluxes are able to generate heartburn. However, data on the role of different pH values, ranging between 4 and 7, in the generation of them are lacking. The aim of this study was to evaluate whether different pH values of weakly acidic refluxes play a differential role in provoking reflux symptoms in endoscopy-negative patients with physiological esophageal acid exposure time and positive symptom index and symptom association probability for weakly acidic refluxes. One hundred and forty-three consecutive patients with gastroesophageal reflux disease, nonresponders to proton pump inhibitors (PPIs), were allowed a washout from PPIs before undergoing: upper endoscopy, esophageal manometry, and multichannel impedance pH monitoring. In patients with both symptom index and symptom association probability positive for weakly acidic reflux, each weakly acidic reflux was evaluated considering exact pH value, extension, physical characteristics, and correlation with heartburn. Forty-five patients with normal acid exposure time and positive symptom association probability for weakly acidic reflux were identified. The number of refluxes not heartburn related was higher than those heartburn related. In all distal and proximal liquid refluxes, as well as in distal mixed refluxes, the mean pH value of reflux events associated with heartburn was significantly lower than that not associated. This condition was not confirmed for proximal mixed refluxes. Overall, a low pH of weakly acidic reflux represents a determinant factor in provoking heartburn. This observation contributes to better understand the pathophysiology of symptoms generated by weakly acidic refluxes, paving the way toward the search for different therapeutic approaches to this peculiar condition of esophageal hypersensitivity.
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Affiliation(s)
- N de Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - I Martinucci
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - E Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - R Franchi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - L Bertani
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - S Russo
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - L Ceccarelli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - F Costa
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - M Bellini
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - C Blandizzi
- Division of Pharmacology and Chemotherapy, Department of Internal Medicine, University of Pisa, Pisa, Italy
| | - V Savarino
- Division of Gastroenterology, Department of Internal Medicine DIMI, University of Genova, Genoa, Italy
| | - S Marchi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy
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Diagnosis and Management of Functional Heartburn. Am J Gastroenterol 2016; 111:53-61; quiz 62. [PMID: 26729546 DOI: 10.1038/ajg.2015.376] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/14/2015] [Indexed: 02/06/2023]
Abstract
Heartburn is among the most common gastrointestinal symptoms presenting to both generalist physicians and gastroenterologists. Heartburn that does not respond to traditional acid suppression is a diagnostic and therapeutic dilemma. In the era of high utilization of proton pump inhibitors, a substantial proportion of patients presenting to the gastroenterologist with chronic symptoms of heartburn do not have a reflux-mediated disease. Subjects without objective evidence of reflux as a cause of their symptoms have "functional heartburn". The diagnostic role of endoscopy, reflux and motility testing in functional heartburn (FH) patients is discussed. Lifestyle modifications, pharmacological interventions, and alternative therapies for FH are also presented. Recognition of patients with FH allows earlier assignment of these patients to different treatment algorithms, which may allow greater likelihood of success of treatment, diminished resource utilization and improved quality of life. Further data on this large and understudied group of patients is necessary to allow improvement in treatment algorithms and a more evidence-based approach to care of these patients.
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Cai ST, Wang LY, Sun G, Peng LH, Guo X, Wang WF, Yang YS. Overlap of gastroesophageal reflux disease and functional bowel disorders in the general Chinese rural population. J Dig Dis 2015; 16:395-9. [PMID: 25997996 DOI: 10.1111/1751-2980.12262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This study aimed to investigate the prevalence of the overlap between gastroesophageal reflux disease (GERD) and functional bowel disorders (FBD) in the general population in rural areas in China. METHODS A population-based cross-sectional study was conducted in six villages in Nanmazhuang area in Lankao County (Henan Province, China) from December 2010 to October 2011. The GERD questionnaire (GerdQ) and Rome III criteria were used for the diagnosis of GERD and FBD and to determine the prevalence of GERD-FBD overlap. RESULTS The response rate to the questionnaires of the patients was 91.5%. In all, 2950 of 3700 residents with a mean age of 42.4 ± 16.8 years were included. Among them, 4.8% were diagnosed with GERD and 4.6% with FBD. The proportion of respondents with FBD was significantly higher in the GERD group than that in the non-GERD group (25.53% vs 3.60%, P < 0.05). The prevalence of GERD in the FBD group was significantly higher than that in the non-FBD group (26.28% vs 3.73%, P < 0.05). The prevalence of GERD-FBD overlap in the general rural population was 1.22%. Logistic regression analysis indicated that anxiety was an independent predictor for the GERD-FBD overlap in GERD and FBD (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02-1.09 and OR 1.06, 95% CI 1.02-1.10, respectively). CONCLUSION GERD-FBD overlap is more common than expected by chance in the general rural population, and anxiety is significantly related to the overlap.
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Affiliation(s)
- Shun Tian Cai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Li Ying Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Gang Sun
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Li Hua Peng
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Xu Guo
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Wei Feng Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Yun Sheng Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
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Furnari M, de Bortoli N, Martinucci I, Bodini G, Revelli M, Marabotto E, Moscatelli A, Del Nero L, Savarino E, Giannini EG, Savarino V. Optimal management of constipation associated with irritable bowel syndrome. Ther Clin Risk Manag 2015; 11:691-703. [PMID: 26028974 PMCID: PMC4425337 DOI: 10.2147/tcrm.s54298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a common chronic functional disorder of the gastrointestinal tract, meanly characterized by recurrent abdominal pain or discomfort and altered bowel habit. It is a complex disorder involving biological, environmental, and psychosocial factors. The diagnosis is achieved according to the Rome III criteria provided that organic causes have been excluded. Although IBS does not constitute a life-threatening condition, it has a remarkable prevalence and profoundly reduces the quality of life with burdening socioeconomic costs. One of the principal concerns about IBS is the lack of effective therapeutic options. Up to 40% of patients are not satisfied with any available medications, especially those suffering from chronic constipation. A correct management of IBS with constipation should evolve through a global approach focused on the patient, starting with careful history taking in order to assess the presence of organic diseases that might trigger the disorder. Therefore, the second step is to examine lifestyle, dietary habits, and psychological status. On these bases, a step-up management of disease is recommended: from fiber and bulking agents, to osmotic laxative drugs, to new molecules like lubiprostone and linaclotide. Although new promising tools for relief of bowel-movement-related symptoms are being discovered, a dedicated doctor-patient relationship still seems to be the key for success.
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Affiliation(s)
- Manuele Furnari
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
- Correspondence: Manuele Furnari, Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, 6, 16132 Genoa, Italy, Tel +39 010 353 8956, Fax +39 010 353 8956, Email
| | - Nicola de Bortoli
- Division of Gastroenterology, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Irene Martinucci
- Division of Gastroenterology, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giorgia Bodini
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Matteo Revelli
- Department of Radiology, San Bartolomeo Hospital, Sarzana, Italy
| | - Elisa Marabotto
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Alessandro Moscatelli
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Lorenzo Del Nero
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Edoardo G Giannini
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Vincenzo Savarino
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
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Goh KL, Choi MG, Hsu WPI, Chun HJ, Mahachai V, Kachintorn U, Leelakusolvong S, Kim N, Rani AA, Wong BC, Wu J, Chiu CT, Chu R, Shetty V, Bocobo JC, Chan MM, Lin JT. Unmet treatment needs of gastroesophageal reflux disease in Asia: gastroesophageal reflux disease in Asia Pacific survey. J Gastroenterol Hepatol 2014; 29:1969-75. [PMID: 24990817 DOI: 10.1111/jgh.12655] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Data on patient satisfaction with proton pump inhibitor (PPI) therapy for gastroesophageal reflux disease (GERD) are scarce in Asia. The perspectives of Asian patients with GERD and their satisfaction with PPI therapy were investigated. METHODS The GERD in Asia Pacific Survey (GAPS) was conducted from December 2011 to March 2012. Patients aged 21-55 years with self-reported doctor-diagnosed GERD, who had experienced symptoms in the previous 12 months, and were currently taking PPIs were enrolled. After a pilot study, a questionnaire was completed by respondents from six Asian countries during face-to-face interviews. RESULTS A total of 450 patients with GERD participated in the GAPS. Although the respondents generally complied with treatment, response to therapy was only partially successful. Most respondents indicated that PPIs eliminated pain (72%), took effect within 30 min (76%), provided sustained relief (73%), and provided nocturnal relief (77%). However, 45% of respondents reported limited improvement in nocturnal symptoms, and 49% continued to take adjunctive therapy to manage their symptoms. After treatment, respondent's "well-being" had improved. However, GERD still had a negative impact on well-being for 76% of respondents after treatment, compared with 94% before treatment. CONCLUSIONS Asian patients reported a negative impact of GERD on their daily lives. Many respondents continued to experience symptoms despite reporting good compliance with PPI therapy, emphasizing the shortcomings of currently available therapy for GERD. This survey is the first to highlight Asian patients' perspectives of GERD and PPI therapy, and provides a platform for further evaluation.
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Affiliation(s)
- Khean Lee Goh
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Vakil N, Niklasson A, Denison H, Rydén A. Symptom profile in partial responders to a proton pump inhibitor compared with treatment-naïve patients with gastroesophageal reflux disease: a post hoc analysis of two study populations. BMC Gastroenterol 2014; 14:177. [PMID: 25304129 PMCID: PMC4287106 DOI: 10.1186/1471-230x-14-177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/28/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Partial response to proton pump inhibitor (PPI) therapy poses a healthcare challenge. This study aimed to compare symptom profiles in partial PPI responders and treatment-naïve patients with gastroesophageal reflux disease (GERD). METHODS A post hoc analysis of data from two studies was performed. Partial PPI responders with GERD (n = 580; NCT00703534) had frequent (≥ 3 days/week) heartburn and/or regurgitation despite PPI therapy; patients with no improvement were excluded. Treatment-naïve patients with GERD (diagnosed by endoscopy and pH-metry; n = 203; NCT00291746) had frequent (≥ 3 days/week) upper gastrointestinal symptoms. The Gastrointestinal Symptom Rating Scale (GSRS) was completed by all patients at study entry and by treatment-naïve patients after PPI therapy. RESULTS The highest (mean [95% confidence interval]) discomfort scores were reported in the Reflux (heartburn, regurgitation), Indigestion, and Abdominal pain domains of the GSRS, both in partial PPI responders (4.3 [4.2-4.4], 3.7 [3.6-3.8], and 3.4 [3.3-3.5], respectively) and in treatment-naïve patients (3.5 [3.3-3.7], 3.6 [3.4-3.7], and 3.1 [3.0-3.3], respectively). Partial PPI responders reported more discomfort than treatment-naïve patients in the Reflux, Abdominal pain, and Constipation domains (4.3 [4.2-4.4] vs. 3.5 [3.3-3.7], 3.4 [3.3-3.5] vs. 3.1 [3.0-3.3], and 2.5 [2.4-2.6] vs. 2.1 [1.9-2.2], respectively). All GSRS domain scores improved in treatment-naïve patients following PPI therapy. CONCLUSIONS Symptom patterns in partial PPI responders were similar to those in treatment-naïve patients with GERD, but partial PPI responders experienced more severe reflux, abdominal pain, and constipation than did treatment-naïve patients.
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Affiliation(s)
- Nimish Vakil
- University of Wisconsin School of Medicine and Public Health, Aurora Summit Hospital, 36500 Aurora Drive, Summit WI 53066, USA.
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Effects of transcranial direct current stimulation on esophageal motility in patients with gastroesophageal reflux disease. Clin Neurophysiol 2014; 125:1840-6. [DOI: 10.1016/j.clinph.2013.12.110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 12/19/2013] [Accepted: 12/24/2013] [Indexed: 12/18/2022]
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Fass R. Functional heartburn. Gastroenterol Hepatol (N Y) 2014; 10:381-383. [PMID: 25013390 PMCID: PMC4080874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Ronnie Fass
- Professor of Medicine Case Western Reserve University Director, Division of Gastroenterology Head, Esophageal Center MetroHealth Medical Center Cleveland, Ohio
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Savarino E, Zentilin P, Furnari M, Bodini G, Marabotto E, Savarino V. Not All Patients With Non-erosive Reflux Disease Share Psychological Distress as Main Mechanism of Disease. J Neurogastroenterol Motil 2014; 20:129-30. [PMID: 24466456 PMCID: PMC3895601 DOI: 10.5056/jnm.2014.20.1.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Patrizia Zentilin
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Manuele Furnari
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
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Hilal R, Mitchell P, Guerra Jr. E, Burnett BP. Case Series of 10 Drug-Refractory IBS Patients Who Respond to Oral Serum-Derived Bovine Immunoglobulin/Protein Isolate (SBI). ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojgas.2014.410046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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