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Current Gastroenterology Reports Jul 2020This narrative review focuses on the presentation, contributing factors, diagnosis, and treatment of non-acid reflux. We also propose algorithms for diagnosis and... (Review)
Review
PURPOSE OF REVIEW
This narrative review focuses on the presentation, contributing factors, diagnosis, and treatment of non-acid reflux. We also propose algorithms for diagnosis and treatment.
RECENT FINDINGS
There is a paucity of recent data regarding non-acid reflux. The recent Porto and Lyon consensus statements do not fully address non-acid reflux or give guidance on classification. However, recent developments in the lung transplantation field, as well as older data in the general population, argue for the importance of non-acid reflux. Extrapolating from the Porto and Lyon consensus, we generally classify pathologic non-acid reflux as impedance events > 80, acid exposure time < 4%, and positive symptom correlation on a standard 24-h pH/impedance test. Other groups not meeting this criteria also deserve consideration depending on the clinical situation. Potential treatments include lifestyle modification, increased acid suppression, alginates, treatment of esophageal hypersensitivity, baclofen, buspirone, prokinetics, and anti-reflux surgery in highly selected individuals. More research is needed to clarify appropriate classification, with subsequent focus on targeted treatments.
Topics: Algorithms; Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Esophageal pH Monitoring; Gastroesophageal Reflux; Humans; Lung Transplantation
PubMed: 32651702
DOI: 10.1007/s11894-020-00780-4 -
Brazilian Journal of Otorhinolaryngology 2023Airway reflux, a member of extra-esophageal reflux, has been linked to countless respiratory pathologies amongst children. The advent of novel instrumentation has... (Review)
Review
OBJECTIVE
Airway reflux, a member of extra-esophageal reflux, has been linked to countless respiratory pathologies amongst children. The advent of novel instrumentation has enabled the discovery of non-acid reflux which was postulated as the main culprit of airway reflux. The objective of this review is to outline the association between non-acid reflux and airway reflux in children.
METHODS
A comprehensive review of recent literature on non-acid reflux and airway reflux in children was conducted. Studies ranged from January 2010 till November 2021 were searched over a period of a month: December 2021.
RESULTS
A total of eleven studies were identified. All studies included in this review revealed a strong link between non-acid reflux and airway reflux in children. 6 of the included studies are prospective studies, 3 retrospective studies, 1 cross-section study, and type of study was not mentioned in 1 study. The most common reported respiratory manifestation of non-acid reflux in children was chronic cough (7 studies). Predominant non-acid reflux was noted in 4 studies. The total number of children in each study ranges from 21 to 150 patients. MII-pH study was carried out in all studies included as a diagnostic tool for reflux investigation.
CONCLUSION
Non-acid reflux is the culprit behind airway reflux as well as other myriads of extra-esophageal manifestations in children. Multicentre international studies with a standardized protocol could improve scientific knowledge in managing non-acid reflux in airway reflux amongst children.
Topics: Humans; Child; Esophageal pH Monitoring; Prospective Studies; Retrospective Studies; Electric Impedance; Gastroesophageal Reflux; Laryngopharyngeal Reflux
PubMed: 35659765
DOI: 10.1016/j.bjorl.2022.05.002 -
Digestive Diseases and Sciences Apr 2021
Topics: Asymptomatic Diseases; Electric Impedance; Esophageal pH Monitoring; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Proton Pump Inhibitors
PubMed: 32556966
DOI: 10.1007/s10620-020-06400-5 -
The New England Journal of Medicine Sep 1994
Review
Topics: Animals; Asthma; Gastroesophageal Reflux; Humans; Laryngitis; Pulmonary Fibrosis
PubMed: 8052276
DOI: 10.1056/NEJM199409083311007 -
Journal of Clinical Gastroenterology Feb 2016Gastroesophageal reflux disease is one of the commonest chronic conditions in the western world and its prevalence is increasing worldwide. The discovery of the acid... (Review)
Review
Gastroesophageal reflux disease is one of the commonest chronic conditions in the western world and its prevalence is increasing worldwide. The discovery of the acid pocket explained the paradox of acid reflux occurring more frequently in the postprandial period despite intragastric acidity being low due to the buffering effect of the meal. The acid pocket was first described in 2001 when it was detected as an area of low pH immediately distal to the cardia using dual pH electrode pull-through studies 15 minutes after a meal. It was hypothesized that there was a local pocket of acid close to the gastroesophageal junction that escapes the buffering effect of the meal, and that this is the source of postprandial acidic reflux. The presence of the acid pocket has been confirmed in other studies using different techniques including high-resolution pHmetry, Bravo capsule, magnetic resonance imaging, and scintigraphy. This review aims to describe what we know about the acid pocket including its length, volume, fluid constituents, and its relationship to the lower esophageal sphincter and squamocolumnar junction. We will discuss the possible mechanisms that lead to the formation of the acid pocket and examine what differences exist in patients who suffer from acid reflux. Treatments for reflux disease that affect the acid pocket will also be discussed.
Topics: Animals; Buffers; Capsule Endoscopy; Esophageal pH Monitoring; Esophagogastric Junction; Gastric Acid; Gastric Mucosa; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Magnetic Resonance Imaging; Postprandial Period; Predictive Value of Tests; Radionuclide Imaging; Risk Factors; Treatment Outcome
PubMed: 26535479
DOI: 10.1097/MCG.0000000000000439 -
The Cochrane Database of Systematic... Apr 2015Review withdrawn from Issue 4, 2015 as it is out of date. The editorial group responsible for this previously published document have withdrawn it from publication. (Review)
Review
Review withdrawn from Issue 4, 2015 as it is out of date. The editorial group responsible for this previously published document have withdrawn it from publication.
Topics: Gastroesophageal Reflux; Gastrointestinal Agents; Histamine H2 Antagonists; Hoarseness; Humans; Proton Pumps
PubMed: 25874797
DOI: 10.1002/14651858.CD005054.pub3 -
The American Journal of Gastroenterology Jul 2013The nadir esophageal pH of reflux observed during pH monitoring in the postprandial period is often more acidic than the concomitant intragastric pH. This paradox... (Review)
Review
The nadir esophageal pH of reflux observed during pH monitoring in the postprandial period is often more acidic than the concomitant intragastric pH. This paradox prompted the discovery of the "acid pocket", an area of unbuffered gastric acid that accumulates in the proximal stomach after meals and serves as the reservoir for acid reflux in healthy individuals and gastroesophageal reflux disease (GERD) patients. However, there are differentiating features between these populations in the size and position of the acid pocket, with GERD patients predisposed to upward migration of the proximal margin onto the esophageal mucosa, particularly when supine. This upward migration of acid, sometimes referred to as an "acid film", likely contributes to mucosal pathology in the region of the squamocolumnar junction. Furthermore, movement of the acid pocket itself to a supradiaphragmatic location with hiatus hernia increases the propensity for acid reflux by all conventional mechanisms. Consequently, the acid pocket is an attractive target for GERD therapy. It may be targeted in a global way with proton pump inhibitors that attenuate acid pocket development, or with alginate/antacid combinations that colocalize with the acid pocket and displace it distally, thereby demonstrating the potential for selective targeting of the acid pocket in GERD.
Topics: Alginates; Antacids; Esophagogastric Junction; Gastric Acid; Gastric Acidity Determination; Gastroesophageal Reflux; Hernia, Hiatal; Humans; Magnetic Resonance Imaging; Postprandial Period; Proton Pump Inhibitors
PubMed: 23629599
DOI: 10.1038/ajg.2013.132 -
Digestive Diseases and Sciences Jul 2022Gastroesophageal reflux disease (GERD) is a common disease affecting a significant number of adults both globally and in the USA. GERD is clinically diagnosed based on... (Review)
Review
Gastroesophageal reflux disease (GERD) is a common disease affecting a significant number of adults both globally and in the USA. GERD is clinically diagnosed based on patient-reported symptoms, and the gold standard for diagnosis is ambulatory reflux monitoring, a tool particularly utilized in the common scenario of non-response to therapy or atypical features. Over the past 20 years, there has been a shift toward extending the duration of reflux monitoring, initially from 24 to 48 h and more recently to 96 h, primarily based on a demonstrated increase in diagnostic yield. Further, multiple studies demonstrate clinically relevant variability in day-to-day acid exposure levels in nearly 30% of ambulatory reflux monitoring studies. For these reasons, an ongoing clinical dilemma relates to the optimal activities patients should engage in during prolonged reflux monitoring. Thus, the aims of this review are to detail what is known about variability in daily acid exposure, discuss factors that are known to influence this day-to-day variability (i.e., sleep patterns, dietary/eating habits, stress, exercise, and medications), and finally provide suggestions for patient education and general GERD management to reduce variation in esophageal acid exposure levels.
Topics: Adult; Esophageal pH Monitoring; Gastroesophageal Reflux; Heartburn; Humans; Monitoring, Ambulatory
PubMed: 35441274
DOI: 10.1007/s10620-022-07496-7 -
British Journal of Community Nursing Aug 2004Gastro-oesophageal reflux disease (GORD) is a common disease that is likely to increase in prevalence as the population becomes steadily more obese. Although generally... (Review)
Review
Gastro-oesophageal reflux disease (GORD) is a common disease that is likely to increase in prevalence as the population becomes steadily more obese. Although generally benign reflux can, if untreated, lead to severe complications. This article describes the symptoms and diagnosis of acid reflux and GORD, and reviews currently available treatments ranging from lifestyle modification to surgery.
Topics: Antacids; Barrett Esophagus; Endoscopy, Digestive System; Esophagitis; Fundoplication; Gastroesophageal Reflux; Histamine H2 Antagonists; Humans; Life Style; Nonprescription Drugs; Proton Pump Inhibitors
PubMed: 15365470
DOI: 10.12968/bjcn.2004.9.8.15353 -
Acta Bio-medica : Atenei Parmensis Dec 2018The manifestations of gastroesophageal reflux disease (GERD) have been recently classified into either esophageal or extra-esophageal syndromes. Clinical history,... (Review)
Review
The manifestations of gastroesophageal reflux disease (GERD) have been recently classified into either esophageal or extra-esophageal syndromes. Clinical history, questionnaire data and response to antisecretory therapy are insufficient to make a conclusive diagnosis of GERD. Endoscopy had a low sensitivity. Recently, the availability of multichannel intraluminal impedance and pH-monitoring (MII-pH) has modified the diagnostic approach towards atypical manifestations of GERD. There is a rising consensus that this technique should be considered as the gold standard for GERD diagnosis. Gastrin 17 (G-17) has been proposed as a non-invasive marker of GERD, due to the negative feedback between acid and the hormone. G17 levels seem able to identify patients with acid and non-acid reflux.
Topics: Bilirubin; Body Fluids; Chest Pain; Diagnosis, Differential; Electric Impedance; Esophageal pH Monitoring; Gastrins; Gastroesophageal Reflux; Humans; Manometry; Monitoring, Ambulatory; Proton Pump Inhibitors; Symptom Assessment
PubMed: 30561415
DOI: 10.23750/abm.v89i8-S.7963