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Journal of Pediatric Gastroenterology... Jun 2016
Topics: Adolescent; Esophagitis, Peptic; Female; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration
PubMed: 26727657
DOI: 10.1097/MPG.0000000000000916 -
Expert Opinion on Pharmacotherapy Feb 2019Gastroesophageal reflux (GER), and its complicated form gastroesophageal reflux disease (GERD) is a common condition in infants and children. As GERD is often considered... (Review)
Review
INTRODUCTION
Gastroesophageal reflux (GER), and its complicated form gastroesophageal reflux disease (GERD) is a common condition in infants and children. As GERD is often considered to cause extra-oesophageal symptoms in children and in the absence of standardized diagnostic and treatment algorithm, many children are inappropriately exposed to empirical anti-reflux treatments, with Acid-Suppressive Medications (ASM); mostly proton pump inhibitors (PPIs).
AREAS COVERED
The authors summarize the pharmacological management of pediatric GERD and discuss the efficacy of PPIs as randomized controlled trials have failed to demonstrate their clinical efficacy in the pediatric population. They consider the controversies surrounding the use of PPIs in the pediatric population as increasing evidence suggests of, although controversially, an increased risk of adverse events such as infection of the respiratory or gastrointestinal tract. Esophagitis is a complication that has a significant impact on weight gain and growth, as well as on the quality of life, and in such case, the benefit of treatment largely outweighs the risk.
EXPERT OPINION
Clinicians should reserve ASM use for infants and children with proven esophagitis and avoid their routine use in patients with merely symptoms of GER. Treatment need and options must be frequently re-evaluated to reduce the risks associated with ongoing therapy.
Topics: Child; Esophagitis, Peptic; Gastroesophageal Reflux; Humans; Infant; Proton Pump Inhibitors; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 30496693
DOI: 10.1080/14656566.2018.1549224 -
World Journal of Gastroenterology Aug 2021Systemic sclerosis is a connective tissue disease that presents with significant gastrointestinal involvement, commonly in the esophagus. Dysphagia is a common clinical... (Review)
Review
Systemic sclerosis is a connective tissue disease that presents with significant gastrointestinal involvement, commonly in the esophagus. Dysphagia is a common clinical manifestation of systemic sclerosis and is strongly related to esophageal dysmotility. However, there are multiple other contributing factors in each step in the physiology of swallowing that may contribute to development of severe dysphagia. The oral phase of swallowing may be disrupted by poor mastication due to microstomia and poor dentition, as well as by xerostomia. In the pharyngeal phase of swallowing, pharyngeal muscle weakness due to concurrent myositis or cricopharyngeal muscle tightening due to acid reflux can cause disturbance. The esophageal phase of swallowing is most commonly disturbed by decreased peristalsis and esophageal dysmotility. However, it can also be affected by obstruction from chronic reflux changes, pill-induced esophagitis, or Candida esophagitis. Other contributing factors to dysphagia include difficulties in food preparation and gastroparesis. Understanding the anatomy and physiology of swallowing and evaluating systemic sclerosis patients presenting with dysphagia for disturbances in each step can allow for development of better treatment plans to improve dysphagia and overall quality of life.
Topics: Deglutition Disorders; Esophagitis, Peptic; Humans; Manometry; Quality of Life; Scleroderma, Systemic
PubMed: 34497445
DOI: 10.3748/wjg.v27.i31.5201 -
Journal of Pediatric Gastroenterology... Mar 2024Gastroesophageal reflux disease (GERD) is frequent and prolonged in esophageal atresia (EA) pediatric patients requiring routine use of proton pump inhibitors (PPIs).... (Meta-Analysis)
Meta-Analysis Review
Gastroesophageal reflux disease (GERD) is frequent and prolonged in esophageal atresia (EA) pediatric patients requiring routine use of proton pump inhibitors (PPIs). However, there are still controversies on the prophylactic use of PPIs and the efficacy of PPIs on GERD and EA complications in this special condition. The aim of the study is to assess the prophylactic use of PPIs in pediatric patients with EA and its complications. We, therefore, performed a systematic review including all reports on the subject from 1980 to 2022. We conducted meta-analysis of the pooled proportion of PPI-and no PPI groups using random effect model, meta-regression, and estimate heterogeneity by heterogeneity index I . Thirty-eight reports on the topic met the criteria selection, representing a cumulative 6044 patients with EA. Prophylactic PPI prescription during the first year of life does not appear to prevent GERD persistence at follow-up and is not associated with a significantly reduced rate of antireflux surgical procedures (ARP). PPIs improve peptic esophagitis and induce remission of eosinophilic esophagitis at a rate of 50%. Their effect on other GERD outcomes is uncertain. Evidence suggests that PPIs do not prevent anastomotic stricture, Barrett's esophagus, or respiratory complications. PPI use in EA can improve peptic and eosinophilic esophagitis but is ineffective on the other EA complications. Side effects of PPIs in EA are almost unknown.
Topics: Humans; Child; Proton Pump Inhibitors; Esophageal Atresia; Eosinophilic Esophagitis; Gastroesophageal Reflux; Esophagitis, Peptic
PubMed: 38262739
DOI: 10.1002/jpn3.12115 -
Nihon Rinsho. Japanese Journal of... Aug 2016Hiatal hernia refers to conditions in which elements of the abdominal cavity, most com- monly the stomach, herniate through the esophageal hiatus into the mediastinum....
Hiatal hernia refers to conditions in which elements of the abdominal cavity, most com- monly the stomach, herniate through the esophageal hiatus into the mediastinum. Hiatal hernias (type I) are the most common type (85-95 %). Types II, III and IV are all varieties of paraesophageal hernias. In Makuuchi classification, sliding hiatal hernia is readily diag- nosed by endoscopy when greater than 3 cm in axial span. In western countries, it is diag- nosed when greater than 2cm. High-resolution manometry with pressure topography plotting allows for precise localization and quantification of the individual physiological elements of the esophagogastric junction. In recent study, anti-reflux mucosectomy(ARMS) could represent an effective anti-reflux procedure.
Topics: Esophagitis, Peptic; Esophagogastric Junction; Gastroesophageal Reflux; Hernia, Hiatal; Humans
PubMed: 30562439
DOI: No ID Found -
Clinical Otolaryngology : Official... Jan 2021The primary end point of this study was to evaluate the impact of bile acids on severity of laryngo-pharyngeal reflux (LPR) and the possible correlation with esophagitis... (Comparative Study)
Comparative Study Observational Study
OBJECTIVES
The primary end point of this study was to evaluate the impact of bile acids on severity of laryngo-pharyngeal reflux (LPR) and the possible correlation with esophagitis and upper airway malignancies. The second end point was to evaluate if salivary bile acids and molecules other than pepsin might serve as diagnostic biomarkers of LPR.
DESIGN
Observational prospective comparative study.
SETTING
Otorhinolaryngology unit of a tertiary hospital.
PARTICIPANTS
Sixty-two consecutive adult outpatients suspected of LPR.
MAIN OUTCOME MEASURES
Bile acids, bilirubin and pepsinogen I-II were measured in saliva. Patients underwent pH metry and based on the results of bile acids were subdivided as acid, mixed and alkaline LPR.
RESULTS
Significantly higher Reflux Findings Score (RFS) and Reflux Symptoms Index (RSI) were seen in patients with alkaline and mixed LPR compared to acid LPR. Salivary bile acids >1 µmol/L seem to be a reliable indicator of the severity of LPR. Compared to those without, patients with esophagitis or a history of upper airway malignancy have high concentrations of bile acids in saliva. Among the molecules studied, bile acids were the most suitable for diagnosis of LPR, with a sensitivity of 86% and a positive predictive value of 80.7%.
CONCLUSIONS
Our data suggest that high concentrations of bile acids are associated with higher values of RSI and RFS in LPR as well as a higher risk of esophagitis and history of upper airway malignancies. We finally observed that bile acids provided the best biometric parameters for diagnosis of LPR among the molecules tested.
Topics: Adult; Aged; Bile Acids and Salts; Biomarkers; Esophageal pH Monitoring; Esophagitis, Peptic; Female; Humans; Laryngopharyngeal Reflux; Male; Middle Aged; Pepsin A; Predictive Value of Tests; Prospective Studies; Saliva; Severity of Illness Index
PubMed: 32876387
DOI: 10.1111/coa.13643 -
Alimentary Pharmacology & Therapeutics Oct 2022Optimal ambulatory reflux monitoring methodology in symptomatic reflux patients continues to be debated.
BACKGROUND
Optimal ambulatory reflux monitoring methodology in symptomatic reflux patients continues to be debated.
AIMS
To utilise published literature and expert opinion to develop recommendation statements addressing use of ambulatory reflux monitoring in clinical practice METHODS: The RAND Appropriateness Method (RAM) was utilised among 17 experts with discussion, revision and two rounds of ranking of recommendation statements. Ambulatory reflux monitoring protocol, methodology and thresholds ranked as appropriate by ≥80% of panellists met the criteria for appropriateness.
RESULTS
Prolonged (96-h recommended) wireless pH monitoring off proton pump inhibitor (PPI) was identified as the appropriate diagnostic tool to assess the need for acid suppression in patients with unproven gastro-oesophageal reflux disease (GERD) and persisting typical reflux symptoms despite once-daily PPI. Acid exposure time (AET) <4.0% on all days of monitoring with negative reflux-symptom association excludes GERD and does not support ongoing PPI treatment. Conversely, AET >6.0% across ≥2 days is conclusive evidence for GERD and supports treatment for GERD, while AET >10% across ≥2 days identifies severe acid burden that supports escalation of anti-reflux treatment. In previously proven GERD, impedance-pH monitoring on PPI is helpful in defining refractory GERD and mechanisms of continued symptoms; the presence of <40 reflux events, AET <2.0% and a negative reflux-symptom association does not support escalation of anti-reflux treatment. In contrast, AET > 4.0% and positive reflux-symptom association support escalation of anti-reflux treatment, including use of invasive therapeutics.
CONCLUSIONS
Statements meeting appropriateness for average clinical care have been identified when utilising reflux monitoring in patients with typical reflux symptoms and PPI non-response.
Topics: Humans; Esophageal pH Monitoring; Esophagitis, Peptic; Gastroesophageal Reflux; Proton Pump Inhibitors
PubMed: 35971888
DOI: 10.1111/apt.17180 -
Gastrointestinal Endoscopy Nov 2021
Topics: Esophagitis, Peptic; Gastroesophageal Reflux; Humans
PubMed: 34462117
DOI: 10.1016/j.gie.2021.06.007 -
Digestive Diseases and Sciences Aug 2016Esophageal adenocarcinoma and its precursor Barrett's esophagus have been rapidly increasing in incidence for half a century, for reasons not adequately explained by... (Review)
Review
Esophageal adenocarcinoma and its precursor Barrett's esophagus have been rapidly increasing in incidence for half a century, for reasons not adequately explained by currently identified risk factors such as gastroesophageal reflux disease and obesity. The upper gastrointestinal microbiome may represent another potential cofactor. The distal esophagus has a distinct microbiome of predominantly oral-derived flora, which is altered in Barrett's esophagus and reflux esophagitis. Chronic low-grade inflammation or direct carcinogenesis from this altered microbiome may combine with known risk factors to promote Barrett's metaplasia and progression to adenocarcinoma.
Topics: Adenocarcinoma; Barrett Esophagus; Dysbiosis; Esophageal Neoplasms; Esophagitis, Peptic; Esophagus; Gastroesophageal Reflux; Humans; Microbiota; Obesity; Precancerous Conditions; Risk Factors
PubMed: 27068172
DOI: 10.1007/s10620-016-4155-9 -
Annals of the New York Academy of... Dec 2018Although the prevalence of gastroesophageal reflux disease (GERD) used to be lower in East Asia as compared to Western countries, it has recently been increasing, most... (Review)
Review
Although the prevalence of gastroesophageal reflux disease (GERD) used to be lower in East Asia as compared to Western countries, it has recently been increasing, most likely due to the socioeconomic development in the East. The prevalence of both GERD and functional gastrointestinal disorders (FGIDs) ranges between 10% and 25% worldwide and there are distinct subgroups of patients with overlapping of GERD and FGIDs. However, the true prevalence of an overlap between GERD and FGIDs can be determined only when a formal pathophysiological evaluation has been performed. Nocturnal reflux symptoms have a significant impact on patients' sleep quality and quality of life. Although proton pump inhibitors (PPIs) can improve both reflux and sleep-related symptoms, the relationship between nocturnal reflux events and sleep disturbance is not fully understood. GERD plays an important role in the pathogenesis of lung fibrosis, and PPIs or fundoplication may decrease the likelihood of pulmonary exacerbation or even improve pulmonary function. Refractory reflux symptoms without esophagitis have become one of the most common presentations of GERD in gastroenterology clinics. There are several new medical therapies, and endoscopic as well as laparoscopic techniques that have been increasingly used in these patients. The selection of options should be tailored and individualized based on the pathophysiology of refractory GERD.
Topics: Esophagitis, Peptic; Fundoplication; Gastroesophageal Reflux; Humans; Laparoscopy; Proton Pump Inhibitors; Quality of Life; Sleep Wake Disorders
PubMed: 29766521
DOI: 10.1111/nyas.13850