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Arquivos de Gastroenterologia 2022Esophageal symptoms of gastroesophageal reflux are the same in functional heartburn, non-erosive disease, and erosive disease. Their patient-perceived intensity may be...
BACKGROUND
Esophageal symptoms of gastroesophageal reflux are the same in functional heartburn, non-erosive disease, and erosive disease. Their patient-perceived intensity may be related to gastroesophageal reflux intensity.
OBJECTIVE
To evaluate whether the symptoms in GERD patients are related to the intensity of gastroesophageal acid reflux.
METHODS
To test this hypothesis, 68 patients with heartburn (18 with functional heartburn, 28 with non-erosive reflux disease, and 22 with erosive reflux disease) had their symptoms evaluated by the Velanovich score (which mainly focuses on heartburn) and the Eating Assessment Tool (EAT-10) (which focuses on dysphagia). They were submitted to esophageal endoscopy and then, on another day, they answered the Velanovich and EAT-10 questionnaires and underwent manometry and 24-hour pHmetry (measured 5 cm proximal to the upper border of the lower esophageal sphincter).
RESULTS
The Velanovich score was higher in patients with non-erosive and erosive diseases than in those with functional heartburn. The mean EAT-10 score did not differ between functional heartburn, erosive, and non-erosive gastroesophageal reflux disease. Considering the threshold of ≥5 to define dysphagia, 4 (22%) patients with functional heartburn, 12 (43%) with non-erosive disease, and 9 (41%) with erosive disease had dysphagia (P=0.18). There was: a) a moderate correlation between the Velanovich and DeMeester score and between Velanovich score and the percentage of acid exposure time (AET); b) a weak correlation between EAT-10 and DeMeester score and between EAT-10 and acid exposure time.
CONCLUSION
There is a moderate positive correlation between heartburn and gastroesophageal reflux measurement. Dysphagia has a weak positive correlation with reflux measurement.
Topics: Deglutition Disorders; Endoscopy, Gastrointestinal; Esophageal Sphincter, Lower; Esophagitis, Peptic; Gastroesophageal Reflux; Heartburn; Humans
PubMed: 35830026
DOI: 10.1590/S0004-2803.202202000-34 -
Journal of Veterinary Internal Medicine May 2022Gastroesophageal reflux and regurgitation occurs in brachycephalic dogs, but objective assessment is lacking.
BACKGROUND
Gastroesophageal reflux and regurgitation occurs in brachycephalic dogs, but objective assessment is lacking.
OBJECTIVES
Quantify reflux in brachycephalic dogs using an esophageal pH probe and determine the association with scored clinical observations.
ANIMALS
Fifty-one brachycephalic dogs.
METHODS
Case review study. Signs of respiratory and gastrointestinal disease severity were graded based on owner assessment. An esophageal pH probe with 2 pH sensors was placed for 18-24 hours in brachycephalic dogs that presented for upper airway assessment. Proximal and distal reflux were indicated by detection of fluid with a pH ≤4. The median reflux per hour, percentage time pH ≤4, number of refluxes ≥5 minutes and longest reflux event for distal and proximal sensors were recorded. Association of preoperative respiratory and gastrointestinal grade, laryngeal collapse grade, and previous airway surgery with the distal percentage time pH ≤4 was examined using 1-way ANOVA.
RESULTS
A total of 43 of 51 dogs (84%; 95% confidence interval 72-92) displayed abnormal reflux with a median (range) distal percentage time pH ≤4 of 6.4 (2.5-36.1). There was no significant association between the distal percentage time pH ≤4 and respiratory grade, gastrointestinal grade, laryngeal collapse grade, or previous upper airway surgery.
CONCLUSIONS AND CLINICAL IMPORTANCE
The occurrence of reflux is not associated with owner-assessed preoperative respiratory and gastrointestinal grade, laryngeal collapse grade, and previous airway surgery. Esophageal pH measurement provides an objective assessment tool before and after surgery.
Topics: Animals; Craniosynostoses; Dog Diseases; Dogs; Gastroesophageal Reflux; Gastrointestinal Diseases; Hydrogen-Ion Concentration; Vomiting
PubMed: 35388526
DOI: 10.1111/jvim.16400 -
Current Opinion in Gastroenterology Nov 2022Autoimmune gastritis is characterized by atrophy of acid secreting parietal cells resulting in achlorhydria. Upper gastrointestinal symptoms are common in autoimmune... (Review)
Review
PURPOSE OF REVIEW
Autoimmune gastritis is characterized by atrophy of acid secreting parietal cells resulting in achlorhydria. Upper gastrointestinal symptoms are common in autoimmune gastritis and frequently result in prescriptions for acid suppressant medications despite the inability of the stomach to secrete acid. Evidence-based recommendations for management of gastrointestinal symptoms in autoimmune gastritis are lacking.
RECENT FINDINGS
The most common symptoms in patients with autoimmune gastritis are dyspepsia, heartburn, and regurgitation. Gastroesophageal reflux should be confirmed by pH-impedance testing and is typically weakly acid or alkaline. Therapy for reflux focuses on mechanical prevention of reflux (i.e., elevation of the head of the bed and alginates) or when severe, antireflux surgery. The etiology of dyspepsia in autoimmune gastritis is unclear and largely unstudied. In the first half of the 20th century, oral administration of acid to "aid digestion" was widely used with reported success. However, randomized, placebo-controlled trials are lacking. Here, we provide suggestions for attempting gastric acidification therapy.
SUMMARY
Upper GI symptoms are common in autoimmune gastritis. Their pathogenesis and therapy remain incompletely understood. Acid suppressant medications are useless and should be discontinued. A trial of acid replacement therapy is recommended especially in the form of placebo-controlled trials.
Topics: Alginates; Dyspepsia; Gastritis; Gastroesophageal Reflux; Heartburn; Humans
PubMed: 36165039
DOI: 10.1097/MOG.0000000000000878 -
Cirugia Y Cirujanos 2024The endoscopic treatment of gastroesophageal reflux disease (GERD) has evolved significantly in the past 20 years. Current practices include devices specifically... (Review)
Review
The endoscopic treatment of gastroesophageal reflux disease (GERD) has evolved significantly in the past 20 years. Current practices include devices specifically designed for GERD. Newer techniques aim to use less extra equipment, to be less costly, and to use accessories readily available in endoscopy units, as well as using standard endoscopes to apply such techniques. It is of utmost importance to properly select the patients for endoscopic therapy, and it should be done in a multidisciplinary approach.
Topics: Gastroesophageal Reflux; Humans; Esophagoscopy; Fundoplication; Patient Selection; Endoscopy, Gastrointestinal
PubMed: 38782380
DOI: 10.24875/CIRU.24000101 -
Journal of Veterinary Internal Medicine Jan 2023Salivary bile acids are used to diagnose extraesophageal reflux (EER) and to evaluate the risk of reflux aspiration that is associated with respiratory diseases in dogs.
BACKGROUND
Salivary bile acids are used to diagnose extraesophageal reflux (EER) and to evaluate the risk of reflux aspiration that is associated with respiratory diseases in dogs.
OBJECTIVES
To study total bile acid (TBA) concentrations in saliva and in bronchoalveolar lavage fluid (BALF) to investigate EER and reflux aspiration in dogs with respiratory diseases and in healthy dogs.
ANIMALS
Thirty-one West Highland White Terriers (WHWTs) with idiopathic pulmonary fibrosis (IPF), 12 dogs with inflammatory airway disease (IAD), 6 dogs with recurrent pneumonia (RP), 26 brachycephalic dogs (BD), 27 healthy WHWTs (HW), 52 healthy dogs (HD). All privately-owned dogs.
METHODS
Saliva and BALF were collected from dogs in each group.
RESULTS
Salivary TBA concentrations were higher in IPF (median 0.1692 μM, interquartile range [IQR] 0.1115-0.2925 μM, Cohen's d 3.4, 95% confidence interval [CI] 2.2-4.0, P < .001) and BD (0.0256 μM, IQR 0.0086-0.0417 μM, d 0.5, CI -0.1 to 1.1, P = .003) compared to HD (0 μM, IQR not quantifiable [n.q.]-0.0131 μM). Bronchoalveolar lavage fluid TBA concentrations were higher in IPF (0.0117 μM, IQR 0.0048-0.0361 μM, d 0.5, CI 0-1.1, P < .001) compared to HD (0 μM, IQR n.q.-0.0074 μM).
CONCLUSION AND CLINICAL IMPORTANCE
Extraesophageal reflux and reflux aspiration occur in healthy dogs and those with respiratory diseases.
Topics: Dogs; Animals; Dog Diseases; Idiopathic Pulmonary Fibrosis; Respiratory Tract Diseases; Bronchoalveolar Lavage Fluid; Gastroesophageal Reflux; Bile Acids and Salts
PubMed: 36655626
DOI: 10.1111/jvim.16622 -
Neurogastroenterology and Motility Jan 2023The comparative efficacy and safety of medical therapies for gastro-esophageal reflux symptoms in endoscopy-negative reflux disease is unclear. We conducted a network... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The comparative efficacy and safety of medical therapies for gastro-esophageal reflux symptoms in endoscopy-negative reflux disease is unclear. We conducted a network meta-analysis to evaluate efficacy and safety of proton pump inhibitors (PPIs), histamine-2-receptor antagonists, potassium-competitive acid blockers (PCABs), and alginates in patients with endoscopy-negative reflux disease.
METHODS
We searched MEDLINE, EMBASE, EMBASE Classic, and the Cochrane central register of controlled trials from inception to February 1, 2022. We included randomized controlled trials (RCTs) comparing efficacy of all drugs versus each other, or versus a placebo, in adults with endoscopy-negative reflux disease. Results were reported as pooled relative risks with 95% confidence intervals to summarize effect of each comparison tested, with treatments ranked according to P-score.
KEY RESULTS
We identified 23 RCTs containing 10,735 subjects with endoscopy-negative reflux disease. Based on failure to achieve complete relief of symptoms between ≥2 and <4 weeks, omeprazole 20 mg o.d. (P-score 0.94) ranked first, with esomeprazole 20 mg o.d. or 40 mg o.d. ranked second and third. In achieving adequate relief, only rabeprazole 10 mg o.d. was significantly more efficacious than placebo. For failure to achieve complete relief at ≥4 weeks, dexlansoprazole 30 mg o.d. (P-score 0.95) ranked first, with 30 ml alginate q.i.d. combined with omeprazole 20 mg o.d., and 30 ml alginate t.i.d. second and third. In terms of failure to achieve adequate relief at ≥4 weeks, dexlansoprazole 60 mg o.d. ranked first (P-score 0.90), with dexlansoprazole 30 mg o.d. and rabeprazole 20 mg o.d. second and third. All drugs were safe and well-tolerated.
CONCLUSIONS & INFERENCES
Our results confirm superiority of PPIs compared with most other drugs in treating endoscopy-negative reflux disease. Future RCTs should aim to better classify patients with endoscopy-negative reflux disease, and to establish the role of alginates and PCABs in achieving symptom relief in both the short- and long-term.
Topics: Adult; Humans; Gastrointestinal Agents; Rabeprazole; Dexlansoprazole; Heartburn; Network Meta-Analysis; Gastroesophageal Reflux; Proton Pump Inhibitors; Omeprazole; Endoscopy, Gastrointestinal; Alginates; Treatment Outcome
PubMed: 36153790
DOI: 10.1111/nmo.14469 -
Journal of Internal Medicine Feb 2021Gastroesophageal reflux disease (GERD) is a common disorder, and empirical proton pump inhibitor (PPI) treatment is often the first step of management; however, up to... (Review)
Review
Gastroesophageal reflux disease (GERD) is a common disorder, and empirical proton pump inhibitor (PPI) treatment is often the first step of management; however, up to 40% of patients remain symptomatic despite PPI treatment. Refractory reflux refers to continued symptoms despite an adequate trial of PPI, and management remains challenging. The differential diagnosis is important; other oesophageal (e.g. eosinophilic oesophagitis) and gastroduodenal disorders (e.g. functional dyspepsia) should be ruled out, as this changes management. A combination of clinical assessment, endoscopic evaluation and in selected cases oesophageal function testing can help characterize patients with refractory reflux symptoms into oesophageal phenotypes so appropriate therapy can be more optimally targeted. Medical options then may include adding a H2 receptor antagonist, alginates, baclofen or antidepressant therapy, and there is emerging evidence for bile acid sequestrants and diaphragmatic breathing. The demonstration of a temporal association of symptoms with reflux events on pH-impedance testing (reflux hypersensitivity) serves to focus the management on modulating oesophageal perception and reducing the reflux burden, or identifies those with no obvious pathophysiologic abnormalities (functional heartburn). Anti-reflux surgery based on randomized controlled trial evidence has a role in reflux hypersensitivity or continued pathological acid reflux despite PPI in carefully considered, fully worked up cases that have failed medical therapy; approximately two of three cases will respond but there is a small risk of complications. In patients with persistent volume reflux despite medical therapy, given the lack of alternatives, anti-reflux surgery is a consideration. Promising newer approaches include endoscopic techniques. This review aims to summarize current diagnostic approaches and critically evaluates the evidence for the efficacy of available treatments.
Topics: Alginates; Antidepressive Agents; Baclofen; Bile Acids and Salts; Breathing Exercises; Diagnosis, Differential; Endoscopy, Gastrointestinal; Gastroesophageal Reflux; Gastrointestinal Agents; Histamine H2 Antagonists; Humans; Hydrogen-Ion Concentration; Muscle Relaxants, Central; Phenotype; Proton Pump Inhibitors
PubMed: 32691466
DOI: 10.1111/joim.13148 -
Neurogastroenterology and Motility Dec 2022Nocturnal gastroesophageal reflux symptoms have a major impact on sleep quality and are associated with complicated gastroesophageal reflux disease (GERD). We performed... (Review)
Review
BACKGROUND
Nocturnal gastroesophageal reflux symptoms have a major impact on sleep quality and are associated with complicated gastroesophageal reflux disease (GERD). We performed a systematic review to assess the data on the effectiveness of the currently available interventions for the treatment of nocturnal reflux symptoms.
METHODS
We searched PubMed, EMBASE, and the Cochrane Library. All prospective, controlled, and uncontrolled clinical trials in adult patients describing interventions (lifestyle modifications, surgical and pharmacological) for nocturnal gastroesophageal reflux symptoms were assessed for eligibility. A narrative descriptive summary of findings is presented together with summary tables for study characteristics and quality assessment.
KEY RESULTS
The initial reference search yielded 3067 citations; 66 citations were screened in full text, of which 31 articles were included. Studies on lifestyle modifications include head of bed elevation (n = 5), prolonging dinner-to-bed time (n = 2), and promoting left lateral decubitus position (n = 2). Placebo-controlled clinical trials investigating proton pump inhibitors (PPIs) (n = 11) show success rates ranging from 34.4% to 80.8% in the PPI group versus 10.4%-51.7% in the placebo group. Laparoscopic fundoplication is reserved for severe disease only. There is insufficient evidence for a recommendation on the use of nasal continuous positive airway pressure (nCPAP), hypnotics, baclofen and adding bedtime H2 receptor antagonists for reducing nocturnal reflux. CONCLUSION INFERENCES: A sequential treatment strategy, including head of bed elevation, prolonging dinner-to-bed time, promoting left lateral decubitus position and treatment with acid-suppressive medication is recommended for nocturnal gastroesophageal reflux symptoms. Currently, there is insufficient evidence for the use of nCPAP, hypnotics, baclofen and adding bedtime H2 receptor antagonists.
Topics: Adult; Humans; Histamine H2 Antagonists; Baclofen; Prospective Studies; Gastroesophageal Reflux; Proton Pump Inhibitors; Treatment Outcome; Hypnotics and Sedatives
PubMed: 35445777
DOI: 10.1111/nmo.14385 -
Australian Journal of General Practice Nov 2022Noncardiac chest pain (NCCP) is a diagnosis usually made after cardiac investigations have failed to demonstrate a specific diagnosis to explain either a single episode...
BACKGROUND
Noncardiac chest pain (NCCP) is a diagnosis usually made after cardiac investigations have failed to demonstrate a specific diagnosis to explain either a single episode or recurrent episodes of chest pain.
OBJECTIVE
The aim of this article is to describe the major causes and management of NCCP, with a focus on gastrointestinal conditions.
DISCUSSION
Despite its generally benign prognosis, NCCP is a cause of significant morbidity and can be responsible for a high personal cost and healthcare burden. NCCP is commonly associated with gastrointestinal conditions, including gastro-oesophageal reflux disease and oesophageal spasm. However, the differential diagnosis extends to musculoskeletal, neurological and psychiatric conditions, and the broad range of causes of the syndrome, which are not mutually exclusive, means that clinicians need to remain vigilant for changes in clinical pattern.
Topics: Humans; Chest Pain; Gastroesophageal Reflux; Diagnosis, Differential; Mental Disorders
PubMed: 36309997
DOI: 10.31128/AJGP-06-22-6467 -
Current Opinion in Gastroenterology Jul 2022Rome IV experts have proposed that gastroesophageal reflux disease (GERD) should be diagnosed only in patients with abnormal esophageal acid exposure, and that reflux... (Review)
Review
PURPOSE OF REVIEW
Rome IV experts have proposed that gastroesophageal reflux disease (GERD) should be diagnosed only in patients with abnormal esophageal acid exposure, and that reflux hypersensitivity (RH) and functional heartburn (FH) both should be considered functional conditions separate from GERD. Although past and recent evidence support that FH can be completely distinguished from GERD, the concept that RH is not GERD is highly questionable. This review attempts to provide current data on these issues.
RECENT FINDINGS
Many recent investigations have provided new data on the different pathophysiological features characterizing RH and FH. Major differences have emerged from analyses of impedance-pH monitoring studies using the novel impedance metrics of baseline impedance (an index of mucosal integrity) and the rate of postreflux swallow-induced peristaltic waves (a reflection of the integrity of esophageal chemical clearance).
SUMMARY
The better ability to interpret impedance-pH tracings together with earlier data on the different prevalence of microscopic esophagitis in RH and FH patients, and recent studies documenting poor therapeutic efficacy of pain modulators and good results of antireflux surgery for RH support recategorization of RH within the GERD world. Further research is needed to correctly phenotype patients who have heartburn without mucosal breaks, and to guide their effective management.
Topics: Esophageal Diseases; Esophageal pH Monitoring; Gastroesophageal Reflux; Heartburn; Humans
PubMed: 35762702
DOI: 10.1097/MOG.0000000000000846