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Scientific Reports Aug 2023Gastro-esophageal reflux disease (GERD) can cause erosive esophagitis (EE) and compromise the quality of life (QoL). We examined differences in symptom severity and QoL...
Gastro-esophageal reflux disease (GERD) can cause erosive esophagitis (EE) and compromise the quality of life (QoL). We examined differences in symptom severity and QoL according to EE severity grade. A follow-up study was conducted among GERD patients at the Nazareth Hospital in Israel. Patients underwent a baseline gastroscopy in 2014-2020 during which the EE grade was determined using the Los Angeles classification. Follow-up telephone interviews were conducted during 2019-2020 with a mean time interval of 18.9 months (SD = 14.9) after the baseline gastroscopy to assess GERD symptoms using the Reflux disease questionnaire (RDQ) and QoL using the GERD QoL questionnaire. The patients were interviewed in their native language (Arabic or Hebrew). Overall, 149 (66.4% males) patients were included; 50 had EE grades C/D and 99 had grades A/B. The mean age at baseline and follow-up was 44.6 years (SD = 15.1) and 46.2 years (SD = 14.9), respectively. Cronbach's alpha was 0.928 and 0.855 for the RDQ and QoL questionnaires, respectively. Patients with EE C/D grades had more severe symptoms than patients with EE A/B grades (P = 0.05), especially in regurgitation scores (P = 0.03). Females had more severe symptoms (overall) than males (adjusted OR = 2.34; 95% CI 1.12-4.90). Patients with the more severe esophagitis EE C/D group (adjusted OR = 1.98; 95% CI 0.93-4.24) and those who used PPIs treatment (adjusted OR = 2.19; 95% CI 0.95-5.01) reported more severe GERD symptoms. The number of schooling years was significantly associated with better QoL score (beta coefficient 1.33, P = 0.005) but not EE grade or GERD symptoms. Follow-up endoscopy conducted among 22 patients with EE grades C/D showed that 13 (59.1%) of these patients had normal endoscopic findings, 6 patients (27.3%) had a grade A EE, 1 patient (4.5%) had grade B, and 2 (9.1%) remained with grade C EE. The Arabic and Hebrew versions of the RDQ and QoL questionnaires were highly reliable. GERD symptoms severity was more profound among patients with more severe esophagitis. No significant association between EE grade and QoL; this negative result might be due to the improvement in esophagitis endoscopic findings among patients with C/D grade.
Topics: Female; Male; Humans; Esophagitis, Peptic; Prospective Studies; Quality of Life; Follow-Up Studies; Peptic Ulcer; Gastroesophageal Reflux
PubMed: 37634042
DOI: 10.1038/s41598-023-41332-w -
World Journal of Gastroenterology Jul 2022Proton pump inhibitors (PPIs), the most commonly used antisecretory medi-cations in the management of reflux illness, virtually eliminate elective surgery for ulcer... (Review)
Review
Proton pump inhibitors (PPIs), the most commonly used antisecretory medi-cations in the management of reflux illness, virtually eliminate elective surgery for ulcer disease, and relegate anti-reflux surgery to patients with gastroesophageal reflux disease (GERD) who are inadequately managed by medical therapy. However, PPI medications still leave some therapeutic demands of GERD unmet. Furthermore, up to 40%-55% of daily PPI users have chronic symptoms, due to PPI refractoriness. Potassium-competitive acid blockers (P-CABs) transcend many of the problems and limits of PPIs, delivering quick, powerful, and extended acid suppression and allowing for treatment of numerous unmet needs. Recently, it has become clear that compromised mucosal integrity plays a role in the etiology of GERD. As a result, esophageal mucosal protection has emerged as a novel and potential treatment approach. An increasing body of research demonstrates that when P-CABs are used as primary drugs or add-on drugs (to regular treatment), they provide a considerable extra benefit, particularly in alleviating symptoms that do not respond to PPI therapy.
Topics: Esophagitis, Peptic; Gastroesophageal Reflux; Humans; Potassium; Proton Pump Inhibitors
PubMed: 36161043
DOI: 10.3748/wjg.v28.i28.3608 -
Diseases of the Esophagus : Official... Sep 2023This study aimed to investigate the significance of Hill classification to predict esophagitis, Barrett's esophagus, gastroesophageal reflux disease (GERD)...
This study aimed to investigate the significance of Hill classification to predict esophagitis, Barrett's esophagus, gastroesophageal reflux disease (GERD) symptomatology, and future prescriptions of proton pump inhibitors in clinical practice. A total of 922 patients (546 women and 376 men; mean age 54.3 [SD 18.4] years) who underwent gastroscopy between 2012 and 2015 were analyzed. Patient questionnaire regarding symptoms were compared with endoscopy findings. A medical chart review was done that focused on the prescription of PPIs, additional gastroscopies, and GERD surgery in a 3-year period before the index gastroscopy and in a 6-year period afterward. In patients naïve to PPI prescriptions (n = 466), Hill grade III was significantly associated with esophagitis (AOR 2.20; 95% CI 1.00-4.84) and > 2 PPI prescriptions 6 year after the index gastroscopy (AOR 1.95; 95% CI 1.01-3.75), whereas Hill grade IV was significantly associated with esophagitis (AOR 4.41; 95% CI 1.92-10.1), with Barrett's esophagus (AOR 12.7; 95% CI 1.45-112), with reported heartburn (AOR 2.28; 95% CI 1.10-4.74), and with >2 PPI prescriptions (AOR 2.16; 95% CI 1.02-4.55). In patients 'non-naïve' to PPI prescription (n = 556), only Hill grade IV was significantly associated with esophagitis, reported heartburn, and with >2 PPI prescriptions. The gastroscopic classification in Hill grades III and IV is important in clinical practice because they are associated with esophagitis, Barrett's esophagus, symptoms of GERD, and prescriptions of PPIs, whereas a differentiation between Hill grades I and II is not.
Topics: Male; Humans; Female; Middle Aged; Barrett Esophagus; Esophagitis, Peptic; Heartburn; Gastroesophageal Reflux; Proton Pump Inhibitors
PubMed: 36744860
DOI: 10.1093/dote/doad004 -
Digestive Diseases and Sciences May 2022The pathogenesis of gastroesophageal reflux disease (GERD) has not been resolved in detail. Esophageal epithelial cells provide resistance to acidic reflux via several...
BACKGROUND
The pathogenesis of gastroesophageal reflux disease (GERD) has not been resolved in detail. Esophageal epithelial cells provide resistance to acidic reflux via several mechanisms, many of which involve buffering acid with bicarbonate and transporting protons. Carbonic anhydrases (CAs) are enzymes that control the acid-base balance by catalyzing the reversible hydration of carbon dioxide to produce bicarbonate and hydrogen ions.
AIMS
We aimed to determine the immunohistochemical expression patterns of CAII, CAIX, and CAXII in the normal esophageal squamous epithelium and in patients with GERD.
METHODS
We evaluated 82 biopsy samples, including 26 with a histologically normal esophagus, 26 with histologically mild esophagitis, and 30 with severe esophagitis. Expression patterns of CAII, CAIX, and CAXII in the esophageal squamous epithelium were determined by immunohistochemical staining.
RESULTS
Cytoplasmic CAII expression was predominantly detected in the upper luminal part of the squamous epithelium and was significantly (p < 0.01) increased in GERD. Expression of CAIX was essentially membranous. The isozyme was constantly present in the peripapillary cells. In the interpapillary areas, clustered expression was observed to emerge and increase significantly (p < 0.01) in esophagitis. CAXII expression was the most abundant of the isozymes and was mainly membranous. In the normal squamous epithelium, CAXII expression was confined to the basal layer; in severe esophagitis, CAXII expression increased significantly in both basal (p < 0.05) and superficial (p < 0.01) halves of the epithelium.
CONCLUSIONS
We demonstrate upregulated expression of CAII, CAIX, and CAXII in GERD. The increase in expression likely contributes to esophageal epithelial resistance to acidic reflux.
Topics: Bicarbonates; Carbonic Anhydrase II; Carbonic Anhydrases; Carcinoma, Squamous Cell; Esophagitis; Esophagitis, Peptic; Gastroesophageal Reflux; Humans; Isoenzymes
PubMed: 33939141
DOI: 10.1007/s10620-021-06985-5 -
Journal of Comparative Effectiveness... Aug 202320 mg of vonoprazan (VPZ20) is recommended in most countries to treat erosive esophagitis (EE). Whether other doses of vonoprazan, such as 5 mg (VPZ5), 10 mg... (Meta-Analysis)
Meta-Analysis Review
20 mg of vonoprazan (VPZ20) is recommended in most countries to treat erosive esophagitis (EE). Whether other doses of vonoprazan, such as 5 mg (VPZ5), 10 mg (VPZ10), 20 mg (VPZ20), and 40 mg (VPZ40) are more effective is unknown. Three databases were electronically searched to identify studies published before November 2021. Network meta-analysis was performed using STATA 14.0. VPZ20 and VPZ40 were comparable to PPI, VPZ5 and VPZ10 in 4- and 8-week healing rates, and this was also detected in patients with refractory EE. All regimens resulted in similar treatment-emergent adverse events (TEAEs). However, VPZ40 ranked first for healing rate and TEAEs; however, VPZ20 ranked worst for TEAEs. Different doses of VPZ are comparable in efficacy and safety, but VPZ40 may be best in both effectiveness and safety.
Topics: Humans; Proton Pump Inhibitors; Esophagitis, Peptic; Network Meta-Analysis; Pyrroles; Peptic Ulcer; Treatment Outcome
PubMed: 37470274
DOI: 10.57264/cer-2022-0165 -
Medicine Nov 2021The similarities and differences between acute esophageal necrosis and severe reflux esophagitis have not been elucidated. We compared Los Angeles classification Grade C... (Observational Study)
Observational Study
The similarities and differences between acute esophageal necrosis and severe reflux esophagitis have not been elucidated. We compared Los Angeles classification Grade C reflux esophagitis, Grade D reflux esophagitis, and acute esophageal necrosis to consider the similarities and differences between acute esophageal necrosis and severe reflux esophagitis.We retrospectively reviewed records of patients who underwent esophagogastroduodenoscopy at a tertiary referral center from January 2012 to December 2019. Data on patients diagnosed as Grade C reflux, Grade D reflux, or acute esophageal necrosis for the first time were extracted for analysis.A total of 213 patients were enrolled in the study, composed of 130 Grade C reflux, 74 Grade D reflux, and 9 acute esophageal necrosis patients. Compared to Grade C reflux patients, Grade D reflux and acute esophageal necrosis patients were more likely to be transfused (P = .013 and P = .011, respectively), to have duodenal ulcers (P = .025 and P = .049, respectively), and to have psychiatric illnesses (P = .022 and P = .018, respectively). Compared to both Grade C and D reflux, acute esophageal necrosis patients were more likely to present with shock (P = .003 and P < .001, respectively), have type 1 diabetes (P = .030 and P = .004, respectively), and present in winter (P < .001 and P < .001, respectively). Significant step-wise differences (Grade C < Grade D < acute esophageal necrosis) were observed in the need for admission (P < .001 and P = .009), coffee ground emesis (P < .001 and P = .022), and stigmata of hemorrhage on endoscopy (P = .002 and P < .001). Admission (P = .003) and coffee ground emesis (P = .003) independently predicted either Grade D reflux or acute esophageal necrosis over Grade C reflux on multivariate analysis.Shock, type 1 diabetes, and winter may predict acute esophageal necrosis, while the need for admission and coffee ground emesis may predict Grade D reflux or acute esophageal necrosis.
Topics: Aged; Aged, 80 and over; Diabetes Mellitus, Type 1; Endoscopy, Gastrointestinal; Esophagitis, Peptic; Female; Gastroesophageal Reflux; Gastrointestinal Hemorrhage; Hematemesis; Humans; Hyperplasia; Male; Middle Aged; Necrosis; Retrospective Studies
PubMed: 34871245
DOI: 10.1097/MD.0000000000027672 -
American Journal of Physiology.... Sep 2021Obesity is associated with gastroesophageal reflux disease (GERD) and its complications including reflux esophagitis, Barrett's esophagus, and esophageal adenocarcinoma.... (Review)
Review
Obesity is associated with gastroesophageal reflux disease (GERD) and its complications including reflux esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. Traditionally, these associations have been attributed to the mechanical effect of abdominal fat in increasing intra-abdominal pressure, thereby promoting gastroesophageal reflux and causing disruption of antireflux mechanisms at the esophagogastric junction. However, recent studies suggest that visceral adipose tissue (VAT) produces numerous cytokines that can cause esophageal inflammation and impair esophageal mucosal barrier integrity through reflux-independent mechanisms that render the esophageal mucosa especially susceptible to GERD-induced injury. In this report, we review mechanisms of esophageal mucosal defense, the genesis and remodeling of visceral adipose tissue during obesity, and the potential role of substances produced by VAT, especially the VAT that encircles the esophagogastric junction, in the impairment of esophageal mucosal barrier integrity that leads to the development of GERD complications.
Topics: Barrett Esophagus; Esophageal Mucosa; Esophagitis, Peptic; Esophagus; Gastroesophageal Reflux; Humans; Obesity
PubMed: 34405732
DOI: 10.1152/ajpgi.00199.2021 -
The Korean Journal of Gastroenterology... Mar 2024Obesity increases gastroesophageal reflux disease through several factors. As a result, Barrett's esophagus, esophageal adenocarcinoma, and gastroesophageal junctional... (Review)
Review
Obesity increases gastroesophageal reflux disease through several factors. As a result, Barrett's esophagus, esophageal adenocarcinoma, and gastroesophageal junctional gastric cancer are increasing. Existing studies usually defined obesity by body mass index and analyzed the correlation. Recently, more studies have shown that central obesity is a more important variable in upper gastrointestinal diseases related to gastroesophageal reflux. Studies have reported that weight loss is effective in reducing gastroesophageal reflux symptoms. Obesity also affects functional gastrointestinal diseases. A significant correlation was shown in upper abdominal pain, reflux, vomiting, and diarrhea rather than lower abdominal diseases.
Topics: Humans; Barrett Esophagus; Esophageal Neoplasms; Gastroesophageal Reflux; Adenocarcinoma; Esophagitis, Peptic; Obesity
PubMed: 38522850
DOI: 10.4166/kjg.2024.015 -
Lakartidningen Sep 2023Gastroesophageal reflux disease (GERD) is characterized by regurgitation of gastric juices into the esophagus. This has an erosive effect on the mucosa with accompanying... (Review)
Review
Gastroesophageal reflux disease (GERD) is characterized by regurgitation of gastric juices into the esophagus. This has an erosive effect on the mucosa with accompanying symptoms, such as heartburn, acid regurgitation and positional-/exertion--induced chest pain. The associated inflammation in the multi-layered squamous epithelium of the esophagus (esophagitis) can usually be seen macroscopically at gastroscopy and is always possible to demonstrate microscopically as well-characterized changes. GERD is abundant in the adult population in the Western world, and the incidence appears to be increasing. Serious manifestations of GERD include the appearance of esophageal injury (esophagitis) and columnar lined esophagus (Barrett's esophagus) and, in rare cases, peptic stricture. The glandular-transformed (metaplastic) mucosa carries its clinical significance by constituting the basis for continued cell transformation (development of dysplasia), which eventually might lead to esophageal adenocarcinoma (EAC). EAC is an aggressive form of cancer whose incidence continues to increase in particular in the Western part of the world. In this article the potential mechanisms for the development of the metaplastic glandular epithelium and its progression to dysplasia and cancer is reviewed. In addition, recommendations are given on how important signals about future risks can be captured and managed and how these risks can be minimized and preferably prevented.
Topics: Adult; Humans; Barrett Esophagus; Esophageal Neoplasms; Esophagitis; Gastroesophageal Reflux; Chest Pain
PubMed: 37746770
DOI: No ID Found -
Chinese Clinical Oncology Oct 2022Over the past 30 years, the prevalence of upper third gastric cancer (GC) and gastroesophageal junction (GEJ) cancer has increased. Total gastrectomy with D2 lymph node... (Review)
Review
Over the past 30 years, the prevalence of upper third gastric cancer (GC) and gastroesophageal junction (GEJ) cancer has increased. Total gastrectomy with D2 lymph node dissection is the standard surgical treatment for non-early (T2 or higher) upper third and GEJ cancers, but total gastrectomy often results in post-gastrectomy syndrome (5-50%), consisting of weight loss, dumping syndrome, and anemia. Proximal gastrectomy (PG) has the potential to avoid these postoperative problems by preserving stomach function. However, PG has historically been discouraged by surgeons owing to the high incidence of postoperative reflux esophagitis (20-65%), anastomotic stenosis, and decreased quality of life. In recent years, anti-reflux reconstruction techniques, such as the double flap technique and double-tract reconstruction, have been developed to be performed after PG, and evidence has emerged that these techniques not only reduce the incidence of postoperative reflux esophagitis but also decrease postoperative weight loss and prevent anemia. Prospective studies are underway to determine whether PG with anti-reflux techniques improves patient-reported quality of life. In the present work, we reviewed available evidence for the use of PG for GC and GEJ cancer, including oncologically appropriate patient selection for PG, potential functional benefits of PG over TG, and various types of reconstructions that can be performed after PG, as well as future research on the use of PG.
Topics: Humans; Stomach Neoplasms; Esophagitis, Peptic; Quality of Life; Prospective Studies; Gastrectomy; Postoperative Complications; Weight Loss; Treatment Outcome; Retrospective Studies
PubMed: 36336898
DOI: 10.21037/cco-22-82