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Li JZ, Broderick RC, Huang EY, Serra J, Wu S, Genz M, Sandler BJ, Jacobsen GR, Horgan S. Post Sleeve Reflux: indicators and impact on outcomes. Surg Endosc 2022; 37:3145-3153. [PMID: 35948805 DOI: 10.1007/s00464-022-09454-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Post-operative gastroesophageal reflux disease (GERD) remains a significant morbidity following sleeve gastrectomy (SG). We aim to evaluate the incidence and impact within a single center experience. MATERIALS AND METHODS A retrospective review of a prospectively maintained database was performed identifying laparoscopic or robotic SG patients. Primary outcomes included weight loss, rates of post-operative GERD (de-novo or aggravated), and re-intervention. Subgroup analysis was performed between patients with (Group 1) and without (Group 2) post-operative GERD. De-novo GERD and aggravated was defined as persistent GERD complaints or new/increased PPI usage in GERD naive or prior GERD patients, respectively. RESULTS 392 patients were identified between 2014 and 2019. Average demographics: age 42.3 (18-84) years, Charlson Comorbidity Index (CCI) 1.12 (0-10), and body mass index (BMI) 47.7 (28-100). 98% were performed laparoscopically. Average excess weight loss (EWL) was 51.0% and 46.4% at 1 and 2 years post-operatively. Average follow up was 516 (6-2694) days. 69 (17%) patients developed post operative de-novo or aggravated GERD. Group 1 had significantly higher EWL at 9 months (57% vs 47%, p 0.003). 13 (3%) patients required operative re-intervention for GERD and other morbidities: 4 RYGB conversions, 4 diagnostic laparoscopies, 3 HHR, 1 MSA placement. Group 1 had higher rates of post-operative intervention (14% vs 1%, p 0.0001). Subanalysis demonstrated that Group 1 had elevated preoperative DeMeester scores on pH testing (34.8 vs 18.9, p 0.03). De-novo GERD had an elevated post-operative total acid exposure when compared to aggravated GERD (12.7% vs 7.0% p 0.03). No significant differences were found between preoperative endoscopy findings, pre and postoperative total acid exposure, post-operative DeMeester scores, and high-resolution manometry values regarding de-novo/aggravated GERD development. CONCLUSION Preoperative DeMeester scores may serve as risk indicators regarding post-operative GERD. Outcomes such as reintervention remain elevated in post-operative GERD patients.
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Affiliation(s)
- Jonathan Z Li
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
| | - Ryan C Broderick
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Estella Y Huang
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Joaquin Serra
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Samantha Wu
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Michael Genz
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Bryan J Sandler
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Garth R Jacobsen
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Santiago Horgan
- Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California San Diego, MET Building, Lower Level, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
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Wang JL, Nan SS, Wang BQ, Wang C, Li ZX, Dou GX, Sun GB. Functional genetic variations of CYP2C19 promoter from patients with gastroesophageal reflux disease. Shijie Huaren Xiaohua Zazhi 2020; 28:1229-1234. [DOI: 10.11569/wcjd.v28.i24.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a chronic, progressive condition, and its prevalence is increasing worldwide. The risk factors for GERD are complex and the pathogenesis of GERD has not been fully elucidated. As acid-suppressive drugs, proton pump inhibitors (PPIs) are commonly used to treat GERD; after being metabolized by CYP2C19 in the human liver, the blood concentration of PPIs gradually decreases. Previous studies have shown that CYP2C19 gene polymorphism leads to considerable individual differences of PPIs in terms of metabolic rate and efficacy.
AIM To identify potential variations in CYP2C19 promoter from patients (normal metabolizers, NMs, *1/*1) with GERD, verify the activity of promoter with variations in HEK 293T, and analyze the correlation between variations in CYP2C19 promoter and PPI treatment effect for GERD in the Chinese population.
METHODS A total of 163 patients with sporadic GERD were collected. After diagnostic treatment with PPIs, the symptom score decreased by 50%, but the symptoms did not completely disappear in the study group (n = 82). In the control group (n = 81), the symptoms completely disappeared after treatment. The CYP2C19 genotype of all patients was detected as *1/*1. The PCR and Sanger sequencing were used to identify variations in the CYP2C19 promoter. The luciferase activities of pGL3 basic-CYP2C19 promoters with or without variation were detected by dual-luciferase assay.
RESULTS Three novel heterozygous variations were identified in the CYP2C19 gene promoters isolated from three NM patients with GERD: g.94761364 T>A, g.94762112 T>A, and g.94762514 G>T. Compared to the wild type, the transcriptional activity of the CYP2C19 promoter with g.94761364 T>A was significantly increased (P = 0.034).
CONCLUSION The transcriptional activity of the CYP2C19 promoter is significantly increased in the presence of g.94761364 T>A, which may further affect the metabolism and blood concentration of PPIs. This finding provides a new insight for the medication and treatment of GERD patients in the Chinese population.
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Affiliation(s)
- Jue-Lei Wang
- Department of Gastroenterology, The Fifth Central Hospital of Tianjin, Tianjin 300450, China
| | - Shou-Shan Nan
- Department of Gastroenterology, The Fifth Central Hospital of Tianjin, Tianjin 300450, China
| | - Bai-Qing Wang
- Department of Gastroenterology, The Fifth Central Hospital of Tianjin, Tianjin 300450, China
| | - Chao Wang
- Department of Gastroenterology, The Fifth Central Hospital of Tianjin, Tianjin 300450, China
| | - Zhao-Xia Li
- Department of Gastroenterology, The Fifth Central Hospital of Tianjin, Tianjin 300450, China
| | - Guang-Xian Dou
- Department of Gastroenterology, The Fifth Central Hospital of Tianjin, Tianjin 300450, China
| | - Guang-Bin Sun
- Department of Gastroenterology, The Fifth Central Hospital of Tianjin, Tianjin 300450, China
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Chandran S, Raman R, Kishor M, Nandeesh HP. The effectiveness of mindfulness meditation in relief of symptoms of depression and quality of life in patients with gastroesophageal reflux disease. Indian J Gastroenterol 2019; 38:29-38. [PMID: 30864012 DOI: 10.1007/s12664-019-00940-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/10/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The role of psychological comorbidities in patients with gastroesophageal reflux disease (GERD), a common condition, still remains incompletely understood. Depression may intensify the symptoms and lower quality of life in these patients. In this study, we looked at the effectiveness of mindfulness-based stress reduction (MBSR) in relieving the symptoms of depression and the health-related quality of life of these patients. METHODS A longitudinal, interventional open-label study was carried out on 60 patients with GERD and 60 controls. Zung Self-Rating Depression Scale (ZSDS) was used for assessing depression before and after the intervention. The GERD-Health-Related Quality of Life (GERD-HRQL) questionnaire was used to assess the health-related quality of life and the Freiburg Mindfulness Inventory (FMI) to quantify the amount of mindfulness over the study period. The correlation between the above variables was analyzed. RESULT Compared with the group not receiving MBSR, the group receiving MBSR showed a greater decrease in the levels of depression indicated by changes in the ZSDS (p < 0.001). According to the GERD-HRQL questionnaire, mental health and social functioning significantly correlated with symptoms of depression and reduction in the levels of distress and in the improvement in health-related quality of life were greater in the group receiving MBSR (p < 0.001). CONCLUSION Depressive symptoms adversely influence GERD, reducing the overall quality of life. MBSR can be an effective modality in the alleviation of these symptoms and in reduction in the levels of distress in GERD patients.
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Affiliation(s)
- Suhas Chandran
- Department of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore-Bangalore Road, Bannimantap, Mysuru, 570 015, India.
| | - Rajesh Raman
- Department of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore-Bangalore Road, Bannimantap, Mysuru, 570 015, India
| | - M Kishor
- Department of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore-Bangalore Road, Bannimantap, Mysuru, 570 015, India
| | - H P Nandeesh
- Department of Gastroenterology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore-Bangalore Road, Bannimantap, Mysuru, 570 015, India
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Faruqui AA. Gastroesophageal Reflux Disease Associated With Anxiety: Efficacy and Safety of Fixed Dose Combination of Amitriptyline and Pantoprazole. Gastroenterology Res 2017; 10:301-304. [PMID: 29118871 PMCID: PMC5667696 DOI: 10.14740/gr898e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/05/2017] [Indexed: 01/24/2023] Open
Abstract
Background The aim of the study was to evaluate the efficacy and tolerability of fixed dose combination of amitriptyline and pantoprazole in gastroesophageal reflux disease (GERD) associated with anxiety. Methods A non-randomized, open-labeled, non-comparative, multi-center study was conducted in a total of 99 patients (77 men and 22 women, mean age 44.16 ± 11.53 years). Each patient was administered a fixed dose combination of amitriptyline 10 mg and pantoprazole 40 mg once a day, for 4 weeks. GERD questionnaire, hospital anxiety and depression score (HADS) and SF-8 questionnaire (short-form health survey) were performed at baseline and at the end of study as assessment tools. Results At the end of study, data were extractable only in 96 patients because three patients were dropped out due to loss of follow-up at week 4. GERD symptoms and anxiety score reduced significantly (P < 0.0001) at week 4 compared to baseline. SF-8 score also improved significantly (P < 0.0001) at week 4. There were no adverse events reported. Conclusion Amitriptyline and pantoprazole combination was found to be effective and safe for management in GERD patients with coexisting anxiety.
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Affiliation(s)
- Arif A Faruqui
- Department of Pharmacology, A 504, Rizvi Mahal, Opp. K.B. Bhabha Hospital, Waterfield Road, Bandra West 400050, India.
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