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PloS One 2020To investigate the role of gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) in the development of dental disorders.
OBJECTIVES
To investigate the role of gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) in the development of dental disorders.
METHODS
The first outcome was review of the role of reflux in the development of dental disorders in adults. The second outcome was review of the potential pathophysiological mechanisms underlying the association between reflux and dental disorders. Three investigators screened publications for eligibility and exclusion based on predetermined criteria through a literature search conducted on PubMed, Cochrane Library, and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
RESULTS
From 386 publications, 24 studies were kept for analysis. Objective approaches were used in 16 studies to confirm GERD diagnosis. Pharyngeal reflux episodes (LPR) were considered in 2 studies. No study considered nonacid reflux. The study results supported a higher prevalence of dental erosion and caries in reflux patients compared with healthy individuals. Patients with dental erosion have a higher prevalence of reflux than controls. The pathophysiological mechanisms would involve changes in the saliva physiology. No study investigated the microbiota modifications related to reflux although the findings are supporting the critical role of microbiota change in the development of dental disorders. There is an important heterogeneity between studies about diagnostic methods and clinical outcome evaluation.
CONCLUSION
The involvement of reflux in the development of dental disorders is not formally demonstrated and requires future investigations considering pharyngeal acid and nonacid reflux episodes and in particular their potential impact on oral microbiota.
Topics: Dental Caries; Esophagitis, Peptic; Humans; Laryngopharyngeal Reflux; Prevalence; Risk Factors; Saliva
PubMed: 32797062
DOI: 10.1371/journal.pone.0237581 -
Clinical and Experimental Hepatology Dec 2022Endoscopic variceal ligation (EVL) is important for emergency as well as prophylactic management of esophageal varices. Early bleeding after EVL is associated with...
AIM OF THE STUDY
Endoscopic variceal ligation (EVL) is important for emergency as well as prophylactic management of esophageal varices. Early bleeding after EVL is associated with significant morbidity and mortality. Assessing the likelihood of early post-EVL bleeding and its determinants can help deciding therapeutic strategies for high-risk patients. The aim of the present meta-analysis was to identify predictors of early bleeding after EVL.
MATERIAL AND METHODS
A comprehensive search of the literature was conducted from 2000 to November 2021 for studies evaluating the incidence, predictors and outcome of post-EVL bleeding. Pooled odds ratios (OR), mean difference (MD) and their 95% confidence intervals (CI) were calculated for prognostic variables.
RESULTS
A total of 16 studies with data on 13,378 patients were included in the meta-analysis. Among 34 parameters, 14 parameters were assessed for association with early bleeding after EVL. Lower hemoglobin at admission (MD = 1.11, 95% CI: -1.91 to -0.31), higher MELD score (MD = 2.00, 95% CI: 0.51-3.50), associated gastric varices (OR = 5.99, 95% CI: 1.06-33.90), higher number of bands (MD = 0.49, 95% CI: 0.02-0.97), and peptic esophagitis (OR = 11.38, 95% CI: 1.21-106.81) were significantly associated with increased risk of bleeding. However, there was significant heterogeneity among the studies with respect to all the analyzed parameters.
CONCLUSIONS
Major predictors for early post-EVL bleeding in cirrhosis are admission hemoglobin level and MELD score, associated gastric varices, number of bands deployed during EVL, and peptic esophagitis on follow-up endoscopy. These risk factors may be useful for risk stratification after EVL in cirrhotics.
PubMed: 36683871
DOI: 10.5114/ceh.2022.123096 -
Acta Gastro-enterologica Belgica 2020Benign esophageal strictures are primarily treated with dilation therapy, but strictures can recur or can be unresponsive, requiring additional or repeated treatment....
BACKGROUND AND STUDY AIMS
Benign esophageal strictures are primarily treated with dilation therapy, but strictures can recur or can be unresponsive, requiring additional or repeated treatment. This study investigates the efficacy and safety of intralesional steroid injections in addition to dilation in comparison to dilation alone in patients with benign refractory or recurrent esophageal strictures.
METHODS
A systematic search was carried out in PubMed, using the search terms "Esophageal Stenosis"[Mesh] AND "Injections, Intralesional"[Mesh]. In addition, the reference list of all selected articles was searched manually for other relevant articles. All clinical trials and case series were considered.
RESULTS
This systematic review included four randomized controlled trials, six case series and two cohort studies, comprising 341 patients with benign esophageal strictures of different etiologies. A benefit of adding intralesional steroid injections to dilation in reducing the need for repeat dilation was seen in the subgroups of peptic, radiation-induced and corrosive strictures. Results were inconsistent for anastomotic strictures and too limited for strictures due to eosinophilic esophagitis, sclerotherapy or pill esophagitis. Complications were rare and of limited severity.
CONCLUSION
Endoscopic dilation remains the first-line treatment, since its efficacy and safety are mostly satisfactory. In recurrent or refractory strictures, intralesional steroid injections are advised in peptic strictures and can be considered in radiation- induced, corrosive strictures and anastomotic strictures. It is recommended to restrict the steroid use to a maximum of three sessions and to consider alternative treatment if treatment effects remain insufficient.
Topics: Dilatation; Endoscopy; Eosinophilic Esophagitis; Esophageal Stenosis; Humans; Injections, Intralesional
PubMed: 33094591
DOI: No ID Found -
Alimentary Pharmacology & Therapeutics Oct 2021Conflicting results exist on the association between Helicobacter pylori infection and gastro-oesophageal reflux (GOR), and its complications, such as erosive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Conflicting results exist on the association between Helicobacter pylori infection and gastro-oesophageal reflux (GOR), and its complications, such as erosive oesophagitis (EO) and Barrett's oesophagus (BO).
AIMS
To explore the association of H. pylori infection with GOR symptoms and their complications METHODS: We searched Embase, PubMed, Web of Science and Scopus databases through December 2020 for relevant articles. Regarding the association between H. pylori and GOR symptoms (heartburn, regurgitation or reflux), we included observational studies comparing the prevalence of GOR symptoms between H. pylori-positive and -negative individuals. Concerning the association between H. pylori and complications of GOR, we included studies comparing the prevalence of EO or BO between H. pylori-positive and -negative individuals.
RESULTS
In total, 36 papers were eligible. Based on seven cross-sectional surveys, H. pylori infection was associated with a lower odds of GOR symptoms (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.61-0.90). However, in four case-control studies, H. pylori infection was not associated with odds of GOR symptoms (OR 1.10, 95% CI 0.85-0.1.43). In 26 cross-sectional studies in patients with GOR symptoms, the OR for EO was 0.70 (95% CI 0.58-0.84) in H. pylori-positive vs -negative cases. Based on nine cross-sectional studies in subjects with GOR complications, no significant association was found between H. pylori infection and either endoscopically-diagnosed (OR 1.84, 95% CI 0.67-5.02) or histologically confirmed (OR 0.85, 95% CI 0.60-1.20) BO.
CONCLUSIONS
Helicobacter pylori infection appears to be associated with a decreased odds of GOR symptoms and EO. In contrast, H. pylori infection did not seem to affect the odds of BO in patients with GER complications.
Topics: Cross-Sectional Studies; Esophagitis, Peptic; Gastroesophageal Reflux; Helicobacter Infections; Helicobacter pylori; Humans
PubMed: 34437710
DOI: 10.1111/apt.16585 -
BMC Surgery Aug 2019In theory, proximal gastrectomy with double-tract reconstruction (PG-DT) was superior to total gastrectomy (TG) in hematologic and nutritional outcomes. However, its... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
In theory, proximal gastrectomy with double-tract reconstruction (PG-DT) was superior to total gastrectomy (TG) in hematologic and nutritional outcomes. However, its clinical effects in proximal early gastric cancer (EGC) have been controversial.
METHODS
The purpose of this study was to investigate the outcomes of laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DT) for proximal EGC. For this systematic review and meta-analysis, we searched for articles published before December of 2018 in the following databases: PubMed, Web of Science, EBSCO, Medline, and Cochrane Library.
RESULTS
The results showed no significant difference in the anastomotic stenosis (OR = 0.91, 95%CI = 0.33-2.50, p = 0.85) and reflux esophagitis (OR = 1.87, 95%CI = 0.62-5.65, p = 0.27) between LPG-DT and laparoscopic total gastrectomy (LTG). The vitamin B12 supplementation rate in the LPG-DT group was lower than the LTG group (OR = 0.06, 95%Cl = 0.01-0.59, p = 0.02).
CONCLUSIONS
Due to comparable clinical effect, PG-DT is comparable to TG for patients with proximal EGC. In addition, LPG-DT not only appears superior to TG in terms of preventing vitamin B12 deficiency, but also does not increase the risk of anastomotic stricture and reflux esophagitis.
Topics: Anastomosis, Surgical; Constriction, Pathologic; Esophagitis, Peptic; Gastrectomy; Humans; Laparoscopy; Retrospective Studies; Stomach Neoplasms; Treatment Outcome; Vitamin B 12 Deficiency
PubMed: 31438918
DOI: 10.1186/s12893-019-0584-7