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Medicine Oct 2022Absent contractility is a rare esophageal motility disorder defined by high-resolution manometry which remains poorly understood in pathogenesis and management. We...
Absent contractility is a rare esophageal motility disorder defined by high-resolution manometry which remains poorly understood in pathogenesis and management. We investigated the clinical symptoms, upper gastrointestinal endoscopy findings, and lower esophageal sphincter (LES) characteristics in adult patients diagnosed with absent contractility on high resolution manometry and factors associated with erosive esophagitis that were found on endoscopy in these patients. A cross-sectional study was conducted in patients with absent contractility who were examined at the Institute of Gastroenterology and Hepatology, Vietnam between March 2018 and December 2020. Clinical symptoms, endoscopic findings, and LES metrics were collected and compared between individuals with and without erosive esophagitis. Logistic regression analysis was used to examine a variety of factors associated with erosive esophagitis. Among 7519 patients who underwent high resolution manometry, 204 (2.7%) were diagnosed with absent contractility. The mean age of the study sample was 45.9 years, 65.7% were women, and none had systemic sclerosis. The most common symptoms were regurgitation, belching, epigastric pain, and bloating. On endoscopy, 50% had erosive esophagitis, mostly Los Angeles grade A (42.9%). On manometry, 44.6% of the patients had LES hypotension and 68.1% had low integrated relaxation pressure in 4 seconds (IRP4s). Male sex (adjusted odds ratio = 2.01, 95% confidence interval: 1.04-3.89) and an IRP4s < 5 mm Hg (adjusted odds ratio = 2.21, 95% confidence interval: 1.12-4.37) were significantly associated with erosive esophagitis. Absent contractility was present in many patients without known systemic diseases. Erosive esophagitis was common and associated with male sex and low IRP4s.
Topics: Adult; Humans; Male; Female; Middle Aged; Esophageal Sphincter, Lower; Gastroesophageal Reflux; Cross-Sectional Studies; Manometry; Esophagitis; Peptic Ulcer; Endoscopy, Gastrointestinal
PubMed: 36316894
DOI: 10.1097/MD.0000000000031428 -
International Journal of Molecular... Jul 2018Melatonin is a tryptophan-derived molecule with pleiotropic activities which is produced in all living organisms. This "sleep" hormone is a free radical scavenger, which... (Review)
Review
Melatonin is a tryptophan-derived molecule with pleiotropic activities which is produced in all living organisms. This "sleep" hormone is a free radical scavenger, which activates several anti-oxidative enzymes and mechanisms. Melatonin, a highly lipophilic hormone, can reach body target cells rapidly, acting as the circadian signal to alter numerous physiological functions in the body. This indoleamine can protect the organs against a variety of damaging agents via multiple signaling. This review focused on the role played by melatonin in the mechanism of esophagoprotection, starting with its short-term protection against acute reflux esophagitis and then investigating the long-term prevention of chronic inflammation that leads to gastroesophageal reflux disease (GERD) and Barrett's esophagus. Since both of these condition are also identified as major risk factors for esophageal carcinoma, we provide some experimental and clinical evidence that supplementation therapy with melatonin could be useful in esophageal injury by protecting various animal models and patients with GERD from erosions, Barrett's esophagus and neoplasia. The physiological aspects of the synthesis and release of this indoleamine in the gut, including its release into portal circulation and liver uptake is examined. The beneficial influence of melatonin in preventing esophageal injury from acid-pepsin and acid-pepsin-bile exposure in animals as well as the usefulness of melatonin and its precursor, L-tryptophan in prophylactic and supplementary therapy against esophageal disorders in humans, are also discussed.
Topics: Adenocarcinoma; Animals; Barrett Esophagus; Esophageal Neoplasms; Esophagitis, Peptic; Esophagus; Humans; Melatonin; Models, Biological; Protective Agents
PubMed: 30011784
DOI: 10.3390/ijms19072033 -
Journal of Korean Medical Science Feb 2021The impact of reflux esophagitis on the decline of lung function has been rarely reported. This study was performed to evaluate the association between erosive reflux...
BACKGROUND
The impact of reflux esophagitis on the decline of lung function has been rarely reported. This study was performed to evaluate the association between erosive reflux esophagitis and lung function changes.
METHODS
We included patients with normal lung function who underwent esophagogastroduodenoscopy for health screening from a health screening center. Patients with persistent erosive reflux esophagitis on two discrete endoscopic examinations were designated as the erosive reflux esophagitis group. We also selected patients without erosive reflux esophagitis and matched them 1:4 with patients from the erosive reflux esophagitis group. We estimated annual forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC) changes from baseline and compared these estimates by the linear mixed regression model. We also estimated the biannual incidence of chronic obstructive pulmonary disease (COPD).
RESULTS
In total, 1,050 patients (210 patients with erosive reflux esophagitis, and 840 matched controls) were included. The median follow-up duration for spirometry was six years. In patients with erosive reflux esophagitis, mild reflux esophagitis (A grade) was most common (165 patients, 78.6%). The adjusted annual FEV₁ change in patients with erosive reflux esophagitis was -51.8 mL/yr, while it decreased by 46.8 mL/yr in controls ( = 0.270). The adjusted annual FVC decline was similar between the two groups (-55.8 vs. -50.5 mL/yr, = 0.215). The estimated COPD incidence during the follow-up period was not different between the erosive reflux esophagitis and control groups.
CONCLUSION
In patients with normal lung function, the presence of erosive reflux esophagitis did not affect the annual declines in FEV₁ or FVC.
Topics: Adult; Case-Control Studies; Endoscopy, Digestive System; Esophagitis, Peptic; Female; Humans; Lung; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Retrospective Studies; Severity of Illness Index; Spirometry; Vital Capacity
PubMed: 33527781
DOI: 10.3346/jkms.2021.36.e29 -
Annals of Medicine Dec 2020Recent prevalence and trends of gastric/duodenal ulcer (GU/DU) and reflux esophagitis (RE) are inadequate.
INTRODUCTION
Recent prevalence and trends of gastric/duodenal ulcer (GU/DU) and reflux esophagitis (RE) are inadequate.
METHODS
We reviewed the records of consecutive 211,347 general population subjects from 1991 to 2015.
RESULTS
During the 25 years, the prevalence of GU and DU has gradually decreased (from 3.0% to 0.3% and from 2.0% to 0.3%) whereas that of RE has markedly increased (from 2.0% to 22%). The prevalence of (HP) infection has decreased from 49.8% (in 1996) to 31.2% (in 2010). Multivariable logistic regression analyses demonstrated that HP infection was positively associated with GU/DU and negatively associated with RE with statistical significance. The panel data analyses showed that reduced rate of HP infection is proportionally correlated with decrease of GU/DU and inversely correlated with increase of RE. It is further suggested other latent factors should be important for changed prevalence of these three acid-related diseases. Age-period-cohort analysis indicated the significant association of older age, male gender, and absence of HP infection with RE.
CONCLUSIONS
The prevalence of GU and DU has gradually decreased whereas that of RE has markedly increased in Japan. Inverse time trends of peptic ulcer and reflux esophagitis are significantly associated with reduced prevalence of HP infection. KEY MESSAGES The prevalence of gastric and duodenal ulcer has gradually decreased whereas that of reflux esophagitis has markedly increased in Japan. The prevalence of infection in Japan has greatly decreased from 49.8% to 31.2% during the 14 years (from 1996 to 2010). Inverse time trends of peptic ulcer and reflux esophagitis are associated with reduced prevalence of infection with statistical significance.
Topics: Adult; Aged; Aged, 80 and over; Antibodies, Bacterial; Duodenal Ulcer; Endoscopy, Gastrointestinal; Esophagitis, Peptic; Female; Helicobacter Infections; Helicobacter pylori; Humans; Japan; Male; Middle Aged; Prevalence; Retrospective Studies; Stomach Ulcer; Time Factors; Young Adult
PubMed: 32536216
DOI: 10.1080/07853890.2020.1782461 -
BMC Gastroenterology Feb 2021Erosive reflux esophagitis caused a large clinical spectrum of symptoms. Our aim was to assess the prevalence of extra-esophageal symptoms in individuals with and those...
INTRODUCTION
Erosive reflux esophagitis caused a large clinical spectrum of symptoms. Our aim was to assess the prevalence of extra-esophageal symptoms in individuals with and those without erosive esophagitis in Albania.
METHODS
A case-control study was conducted at the Regional Hospital of Durres, the second main district in Albania, a transitional country in South Eastern Europe, including 248 patients with erosive esophagitis (aged 46.5 ± 16.3 years) and 273 controls (aged 46.4 ± 16.0 years; response rate: 70%) enrolled during the period January 2013-June 2014. Both cases and controls underwent upper endoscopy. Information on socio-demographic characteristics and lifestyle factors was also collected. Binary logistic regression was used to assess the association of erosive esophagitis and extra-esophageal symptoms.
RESULTS
Patients with erosive esophagitis had a higher prevalence of excessive alcohol consumption, smoking, sedentarity, non-Mediterranean diet and obesity compared to their control counterparts (9% vs. 5%, 70% vs. 49%, 31% vs. 17%, 61% vs. 49% and 22% vs. 9%, respectively). Upon adjustment for all socio-demographic characteristics and lifestyle/behavioral factors, there was evidence of a strong association of erosive esophagitis with chronic cough (OR = 3.2, 95% CI = 1.7-5.8), and even more so with laryngeal disorders (OR = 4.4, 95% CI = 2.6-7.5). In all models, the association of erosive esophagitis with any extra-esophageal symptoms was strong and mainly consistent with each of the symptoms separately (fully-adjusted model: OR = 4.6, 95% CI = 2.9-7.3).
CONCLUSION
Our findings indicate that the prevalence of extra-esophageal symptoms is higher among patients with erosive esophagitis in a transitional country characterized conventionally by employment of a Mediterranean diet.
Topics: Adult; Albania; Case-Control Studies; Esophagitis; Esophagitis, Peptic; Gastroesophageal Reflux; Humans; Middle Aged; Risk Factors
PubMed: 33593300
DOI: 10.1186/s12876-021-01658-z -
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 -
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 -
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 Royal College of Surgeons... Jan 2022Intestinal intussusception is uncommon in adults. As a retroperitoneal structure, gastroduodenal intussusception is extremely rare. The leading cause of intussusception...
Intestinal intussusception is uncommon in adults. As a retroperitoneal structure, gastroduodenal intussusception is extremely rare. The leading cause of intussusception is reported to be a tumour, either benign or malignant. The case presented may be the first of gastroduodenal intussusception resulting from severe peptic ulcer. A 64-year-old man was admitted with epigastralgia, appetite loss and melena for 1 week. He had history of peptic ulcer and reflux esophagitis for 9 years, caused by infection; eradication therapy had been performed 5 years previously. This time, an abdominal computed tomography scan showed duodenogastric intussusception and gastric outlet obstruction. Preoperative biopsy failed for complete obstruction; thus, the patient underwent Whipple procedure for complete resection under impression of malignancy. The postoperative course was uneventful. Pathological findings for the specimen showed gastric and duodenal ulcer. Progressive peptic ulcer after eradication therapy is rarely seen, and eradication therapy is used widely to treat infection. The eradication rate is extremely high in Taiwan for lower first-line antibiotic as clarithromycin resistance is low due to a policy restricting antimicrobial usage. Early eradication therapy is highly recommended for patients with infection. We emphasise the importance of regular follow-up for the non-significant correlation of severity of gastric ulcer with clinical symptoms. When ulceration progresses or non-invasive treatments fail early surgical interventions should be applied to these anatomic alterations.
Topics: Duodenal Ulcer; Humans; Intussusception; Male; Middle Aged; Stomach Diseases
PubMed: 34730406
DOI: 10.1308/rcsann.2021.0067 -
Journal of Nippon Medical School =... 2017Reflux esophagitis is characterized by excessive esophageal acid exposure. To treat reflux esophagitis, it is necessary to reduce excessive esophageal acid exposure to... (Review)
Review
Reflux esophagitis is characterized by excessive esophageal acid exposure. To treat reflux esophagitis, it is necessary to reduce excessive esophageal acid exposure to within the normal range. The first-line drug for the treatment of reflux esophagitis is a standard-dose proton-pump inhibitor (PPI), which is also recommended by the Evidence-based Clinical Practice Guidelines 2015 for gastroesophageal disease of the Japanese Society of Gastroenterology. It has been reported that the response to a standard dose of PPI in patients with mild reflux esophagitis is 90-100%, and that in patients with severe reflux esophagitis is 80-85%. However, PPI-resistant reflux esophagitis has been increasing. When the standard dose of PPI is not effective, modification of the lifestyle with PPI therapy, switching to another PPI, or a change in the administration method (before meals), as well as double-dose PPI (in divided doses), may be effective. In addition, vonoprazan (potassium-competitive acid blocker), which has rapid and potent acid-suppressive effects, became available in February 2015 in Japan. In the clinical trial data, vonoprazan is very effective for reflux esophagitis. However, clinical data on vonoprazan are still insufficient. The establishment of a new treatment for reflux esophagitis taking advantage of the rapid and potent acid-suppressive effects is awaited.
Topics: Clinical Trials as Topic; Drug Administration Schedule; Drug Resistance; Drug Substitution; Esophagitis, Peptic; Gastroenterology; Humans; Japan; Life Style; Practice Guidelines as Topic; Proton Pump Inhibitors; Pyrroles; Severity of Illness Index; Societies, Medical; Sulfonamides; Treatment Outcome
PubMed: 29142181
DOI: 10.1272/jnms.84.209