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The Surgical Clinics of North America Oct 2011Millions of Americans are affected by gastroesophageal reflux disease (GERD) in many different ways. The magnitude of the problem of GERD was brought to light by the... (Review)
Review
Millions of Americans are affected by gastroesophageal reflux disease (GERD) in many different ways. The magnitude of the problem of GERD was brought to light by the ambulatory pH test, the introduction of minimally invasive surgery, and the advent of the many medications that are effective in acid suppression. Patients with GERD suffer from various consequences associated with the disease. However, interventions beyond medical therapy, such as laparoscopic fundoplication, provide satisfactory outcomes and definitive relief of acid reflux.
Topics: Fundoplication; Gastroesophageal Reflux; Humans; Laparoscopy
PubMed: 21889027
DOI: 10.1016/j.suc.2011.06.004 -
Alimentary Pharmacology & Therapeutics Dec 2000The role of acid in the pathogenesis of gastro-oesophageal reflux disease (GERD) has been extensively studied and is well accepted. The role, if any, of non-acid reflux,... (Review)
Review
The role of acid in the pathogenesis of gastro-oesophageal reflux disease (GERD) has been extensively studied and is well accepted. The role, if any, of non-acid reflux, in particular duodenogastro-oesophageal reflux, is much debated. The availability of new technology to detect non-acid reflux has heightened interest in this question. This article reviews the following: How do we define non-acid reflux? Does duodenogastro-oesophageal reflux (alone or in combination) cause oesophageal injury, symptoms or both? What is its role in complicated GERD? What methods are available to assess non-acid reflux? Does non-acid reflux need treatment and if so what modalities are available?
Topics: Animals; Barrett Esophagus; Bile Acids and Salts; Bilirubin; Electric Impedance; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration
PubMed: 11121901
DOI: 10.1046/j.1365-2036.2000.00875.x -
Nederlands Tijdschrift Voor Geneeskunde Nov 2008The introduction of proton pump inhibitors (PPIs) was a huge step forward in the treatment of gastric acid-related disorders such as reflux disease and gastric ulcers.... (Review)
Review
The introduction of proton pump inhibitors (PPIs) was a huge step forward in the treatment of gastric acid-related disorders such as reflux disease and gastric ulcers. Despite the strong effectiveness of PPIs, in a small number of patients reflux symptoms are not adequately relieved by these drugs. The amount of acid inhibition that can be achieved using a PPI depends on a number of different factors, such as Helicobacter pylori infection, genetic variation in metabolizing enzymes, and lack of compliance. Nocturnal gastric acid breakthrough does not appear to be important in the pathogenesis of therapy-resistant reflux symptoms. Not all reflux from the stomach into the oesophagus appears to be acidic. Episodes of non-acid reflux may also elicit typical reflux symptoms. This can be established by impedance measurements of the oesophagus. However, most patients whose symptoms do not respond satisfactorily to PPI therapy appear not to have reflux disease but instead be suffering from other conditions such as functional dyspepsia, aerophagy or rumination. Careful history-taking is pivotal in patients with reflux symptoms and should always precede additional investigations such as upper endoscopy and if necessary 24-hour reflux monitoring.
Topics: Anti-Ulcer Agents; Diagnosis, Differential; Electric Impedance; Gastric Acidity Determination; Gastroesophageal Reflux; Helicobacter Infections; Helicobacter pylori; Humans; Hydrogen-Ion Concentration; Medical History Taking; Patient Compliance; Proton Pump Inhibitors; Stomach Ulcer; Treatment Failure
PubMed: 19174935
DOI: No ID Found -
Journal of Paediatrics and Child Health 2009The aim of this study was to investigate the role of bile and acid reflux in the pathogenesis of reflux oesophagitis (RE) in children.
AIM
The aim of this study was to investigate the role of bile and acid reflux in the pathogenesis of reflux oesophagitis (RE) in children.
METHODS
A total of 44 patients aged 5-17 years with gastro-oesophageal reflux symptoms were enrolled. Simultaneous 24-h oesophageal Bilitec 2000 (Medtronic Instruments, Minneapolis, MN, USA) bilirubin monitoring and pH monitoring, in biopsy of oesophageal mucosa by gastro-endoscopy, were performed in all patients.
RESULTS
According to the diagnostic criteria of pathological acid reflux and pathological bile reflux, 10 of 44 cases (22.7%) had acid reflux, 10 (22.7%) had isolated bile reflux, 16 (36.4%) had mixed acid and bile reflux, and the other eight (18.2%) had no reflux. Significant difference was observed in the ratio of different patterns of reflux between the RE group (26 cases) and the non-erosive reflux disease (NERD) group (18 cases) (chi(2) = 9.096, P < 0.01). All the parameters of acid reflux in the RE group were higher significantly than that in the NERD group (P < 0.05 or P < 0.01). A total of 20 out of 26 cases (76.9%) with RE had oesophageal acid reflux as against six out of 18 cases (33.3%) in patients with NERD (P < 0.01). The difference of each parameter of bile reflux had not reached significance between the two groups.
CONCLUSIONS
Mixed reflux is the predominant form of reflux in the causation of oesophageal mucosal injury in children. Isolated bile reflux also plays a role in the development of RE, although only in patients without acid reflux.
Topics: Adolescent; Bile Reflux; Bilirubin; Child; Child, Preschool; Esophageal pH Monitoring; Esophagitis, Peptic; Esophagoscopy; Female; Gastroesophageal Reflux; Humans; Male; Monitoring, Ambulatory; Sensitivity and Specificity
PubMed: 19208069
DOI: 10.1111/j.1440-1754.2008.01431.x -
Epilepsy & Behavior : E&B Oct 2020Recent animal work and limited clinical data have suggested that laryngospasm may be involved in the cardiorespiratory collapse seen in sudden unexpected death in...
OBJECTIVE
Recent animal work and limited clinical data have suggested that laryngospasm may be involved in the cardiorespiratory collapse seen in sudden unexpected death in epilepsy (SUDEP). In previous work, we demonstrated in an animal model of seizures that laryngospasm and sudden death were always preceded by acid reflux into the esophagus. Here, we expand on that work by testing several techniques to prevent the acid reflux or the subsequent laryngospasm.
METHODS
In urethane anesthetized Long Evans rats, we used systemic kainic acid to acutely induce seizure activity. We recorded pH in the esophagus, respiration, electrocorticography activity, and measured the liquid volume in the stomach postmortem. We performed the following three interventions to attempt to prevent acid reflux or laryngospasm and gain insights into mechanisms: fasting animals for 12 h, severing the gastric nerve, and electrical stimulation of either the gastric nerve or the recurrent laryngeal nerve.
RESULTS
Seizing animals had significantly more liquid in their stomach. Severing the gastric nerve and fasting animals significantly reduced stomach liquid volume, subsequent acid reflux, and sudden death. Laryngeal nerve stimulation can reverse laryngospasm on demand. Seizing animals are more susceptible to death from stomach acid-induced laryngospasm than nonseizing animals are to artificial acid-induced laryngospasm.
SIGNIFICANCE
These results provide insight into the mechanism of acid production and sudden obstructive apnea in this model. These techniques may have clinical relevance if this model is shown to be similar to human SUDEP.
Topics: Animals; Electric Stimulation Therapy; Female; Gastroesophageal Reflux; Laryngismus; Rats; Rats, Long-Evans; Seizures; Sudden Unexpected Death in Epilepsy
PubMed: 32540771
DOI: 10.1016/j.yebeh.2020.107188 -
Journal of Cancer Research and Clinical... Sep 2023Studies have demonstrated that non-acid reflux (NAR) is associated with esophageal squamous cell carcinoma (ESCC). Esophageal dysmotility is associated with NAR but few...
BACKGROUND
Studies have demonstrated that non-acid reflux (NAR) is associated with esophageal squamous cell carcinoma (ESCC). Esophageal dysmotility is associated with NAR but few studies have focused on the esophageal motility of ESCC patients. We explored the relationship between ESCC, NAR and esophageal dysmotility with the aid of multichannel intraluminal impedance and pH (MII-pH) and high-resolution manometry (HRM).
METHODS
From Jan 2021 to Oct 2022, 20 patients with superficial ESCC were enrolled as the ESCC group, while 20 age and gender matched individuals without gastroesophageal reflux disease (GERD) symptoms and 20 age and gender matched patients with GERD symptoms were recruited as the control groups. Patients received 24 h MII-pH and HRM procedure before endoscopic submucosal dissection (ESD), and the data were then collected to identify the type of reflux and esophageal dysmotility.
RESULTS
Prevalence of esophageal dysmotility was significantly different among the three groups, 75.0% in the ESCC group, 35.0% in the non-GERD group and 70.0% in the GERD group (P = 0.029). NAR episodes at 15 cm above the lower esophageal sphincter (LES) in the ESCC group were significantly higher than that in the non-GERD group (6.5 (3.5-9.3) vs 1.0 (0.8-4.0), P = 0.001) and were similar with that in the GERD group (6.5 (3.5-9.3) vs 5.5 (3.0-10.5), P > 0.05). NAR episodes at 5 cm above LES was significantly higher in the ESCC group than that in the non-GERD group (38.0 (27.0-60.0) vs 18.0 (11.8-25.8), P = 0.001) and was significantly higher than that in the GERD group (38.0 (27.0-60.0) vs 20.0 (9.8-30.5)), P = 0.010). Prevalence of pathologic non-acid reflux was significantly different among the three groups, 30.0% in the ESCC group, 0.0% in the non-GERD group and 10.0% in the GERD group (P < 0.001).
CONCLUSION
Our study found NAR and esophageal dysfunction frequently occur in ESCC patients. NAR and esophageal dysmotility may be associated with ESCC.
CLINICAL TRIAL REGISTRATION NUMBER
ChiCTR2200061456.
Topics: Humans; Esophageal Motility Disorders; Esophageal Neoplasms; Esophageal pH Monitoring; Esophageal Squamous Cell Carcinoma; Gastroesophageal Reflux; Male; Female
PubMed: 37074455
DOI: 10.1007/s00432-023-04772-5 -
Acta Paediatrica (Oslo, Norway : 1992) Mar 2024Infant gastroesophageal reflux is mostly benign; however, when associated with complications like failure to thrive, it may be indicative of gastroesophageal reflux... (Review)
Review
AIM
Infant gastroesophageal reflux is mostly benign; however, when associated with complications like failure to thrive, it may be indicative of gastroesophageal reflux disease. There are currently several unmet needs pertaining to the management of infant gastroesophageal reflux (disease). Reflux in infants is mostly composed of breast milk or formula, so this population is significantly different to older children and adults. The objective of this Delphi consensus was to establish recommendations based on published literature and the experience of clinical experts in paediatric gastroenterology in the context of infant gastroesophageal reflux (disease).
METHODS
The Delphi methodology was used to obtain a consensus on 18 statements relating to clinical aspects of infant gastroesophageal reflux (disease).
RESULTS
The expert panel comprising paediatric gastroenterology clinical specialists reached a consensus for all statements by means of an online, anonymised voting system.
CONCLUSION
It was highlighted that there is generally low awareness of or adherence to guidelines in clinical practice and that acid suppression therapy should not be indicated for non-acid reflux, which constitutes a significant proportion of total gastroesophageal reflux episodes among infants. Furthermore, it was emphasised that there is an unmet medical need for therapy for some symptomatic infants with non-acid reflux disease.
Topics: Infant; Child; Female; Humans; Adolescent; Consensus; Gastroesophageal Reflux
PubMed: 38116947
DOI: 10.1111/apa.17074 -
Alimentary Pharmacology & Therapeutics Dec 2007Oesophageal pH monitoring has been used for three decades to study gastro-oesophageal reflux, but it does not allow detection of non-acid reflux episodes. (Review)
Review
BACKGROUND
Oesophageal pH monitoring has been used for three decades to study gastro-oesophageal reflux, but it does not allow detection of non-acid reflux episodes.
AIM
To discuss the techniques by which non-acid reflux can be measured and to evaluate the clinical relevance of such measurements.
METHODS
Review of the literature on non-acid reflux monitoring.
RESULTS
Ambulatory oesophageal impedance monitoring (using a catheter with ring electrodes) allows one to detect all types of gastro-oesophageal reflux, acid as well as non-acid. Measurement of intra-oesophageal bilirubin concentration also detects reflux irrespective of the pH, but only when there is bilirubin in the gastric juice and technical short-comings limit the applicability of this technique. In untreated subjects, about 50% of reflux episodes are non-acid (nadir pH > 4). In patients on acid inhibition, up to 95% of reflux episodes are non-acid. Treatment with an acid inhibitor leads to a significant decrease in the incidence of acid reflux episodes, but not to a reduction in the total number of reflux episodes. This shift is associated with a shift in symptoms from heartburn to regurgitation. With impedance monitoring, the temporal association between symptoms that persist during inhibition of acid secretion and non-acid reflux events can be demonstrated. In a proportion of patients with chronic cough, the coughing episodes are preceded by non-acid reflux.
CONCLUSIONS
Intraluminal impedance monitoring of gastro-oesophageal reflux is a feasible technique, which provides clinically important information about the relationships between symptoms and non-acid reflux events.
Topics: Bilirubin; Cough; Esophageal pH Monitoring; Gastroesophageal Reflux; Humans; Monitoring, Ambulatory
PubMed: 18081643
DOI: 10.1111/j.1365-2036.2007.03527.x -
Digestive Diseases (Basel, Switzerland) 2009The advent of pH impedance monitoring has allowed assessment of the role of weakly acidic reflux, in addition to the traditionally considered acid reflux, in the... (Review)
Review
The advent of pH impedance monitoring has allowed assessment of the role of weakly acidic reflux, in addition to the traditionally considered acid reflux, in the pathophysiology of gastroesophageal reflux disease. Typical reflux symptoms studied off proton pump inhibitor (PPI) therapy are mainly associated with acid reflux events, while weakly acidic reflux is only significantly associated with symptom occurrence when assessed on PPI therapy. A major role in weakly acidic reflux in the absence of acid suppressive therapy has only been established for reflux-related cough. Further studies are needed to address the impact of weakly acidic reflux on the management and therapeutic choices in gastroesophageal reflux disease patients with symptoms that persist on PPI therapy. There is a lack of outcomes studies addressing the issue of reflux inhibitors and surgery for weakly acidic reflux that persists in patients on PPIs.
Topics: Drug Resistance; Esophageal pH Monitoring; Gastric Acid; Gastroesophageal Reflux; Humans; Proton Pump Inhibitors; Treatment Failure
PubMed: 19439962
DOI: 10.1159/000210105 -
World Journal of Gastroenterology Oct 2013To determine whether an increased number and duration of non-acid reflux events as measured using the multichannel intraluminal impedance pH (MII-pH) is linked to...
AIM
To determine whether an increased number and duration of non-acid reflux events as measured using the multichannel intraluminal impedance pH (MII-pH) is linked to gastroparesis (GP).
METHODS
A case control study was conducted in which 42 patients undergoing clinical evaluation for continued symptoms of gastroesophageal reflux disease (both typical and atypical symptoms) despite acid suppression therapy. MII-pH technology was used over 24 h to detect reflux episodes and record patients' symptoms. Parameters evaluated in patients with documented GP and controls without GP by scintigraphy included total, upright, and supine number of acid and non-acid reflux episodes (pH < 4 and pH > 4, respectively), the duration of acid and non-acid reflux in a 24-h period, and the number of reflux episodes lasting longer than 5 min.
RESULTS
No statistical difference was seen between the patients with GP and controls with respect to the total number or duration of acid reflux events, total number and duration of non-acid reflux events or the duration of longest reflux episodes. The number of non-acid reflux episodes with a pH > 7 was higher in subjects with GP than in controls. In addition, acid reflux episodes were more prolonged (lasting longer than 5 min) in the GP patients than in controls; however, these values did not reach statistical significance. Thirty-five patients had recorded symptoms during the 24 h study and of the 35 subjects, only 9% (n = 3) had a positive symptom association probability (SAP) for acid/non-acid reflux and 91% had a negative SAP.
CONCLUSION
The evaluation of patients with a documented history of GP did not show an association between GP and more frequent episodes of non-acid reflux based on MII-pH testing.
Topics: Adult; Aged; Case-Control Studies; Drug Resistance; Female; Gastric Acidity Determination; Gastroesophageal Reflux; Gastrointestinal Motility; Gastroparesis; Humans; Male; Middle Aged; Proton Pump Inhibitors; Risk Factors; Time Factors; Treatment Failure; Young Adult
PubMed: 24115816
DOI: 10.3748/wjg.v19.i37.6193