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Pediatric Surgery International Aug 2019The relationship between reflux index (RI) and bolus exposure parameters in multichannel intraluminal impedance (MII) has not been examined sufficiently among children....
PURPOSE
The relationship between reflux index (RI) and bolus exposure parameters in multichannel intraluminal impedance (MII) has not been examined sufficiently among children. The significance of acid and bolus exposure in evaluating pediatric reflux disease (RD) was explored by focusing on mucosal lesions.
METHODS
We conducted MII-pH on 28 patients (median age 8 years) with suspected RD. We assessed relationships between RI and bolus exposure indices, and also compared acid and bolus exposures across patients grouped by endoscopic esophageal mucosal lesions.
RESULTS
RI correlated significantly with distal acid reflux events (r = 0.60), acid bolus exposure time (BET) (0.55), and bolus clearance time (BCT) (0.48). Significant differences were observed among the control, non-erosive RD (NERD), and erosive RD (ERD) groups in all acid and several bolus exposure indices (distal and proximal frequencies, and BCT), while no significant difference was apparent between NERD and ERD. Acid exposure tended to be more severe in high-grade than in low-grade ERD, while no similar tendency was found in any bolus parameters other than BCT.
CONCLUSIONS
MII-pH showed great potential for investigating the pathophysiology of pediatric RD, with RI revealing different correlations with variable bolus exposure indices. However, no specific parameters allowing precise discrimination between RDs or mucosal severities were identified.
Topics: Adolescent; Adult; Child; Child, Preschool; Electric Impedance; Esophageal pH Monitoring; Esophagoscopy; Female; Gastric Acid; Gastroesophageal Reflux; Humans; Infant; Intestinal Mucosa; Male; Severity of Illness Index; Young Adult
PubMed: 31144005
DOI: 10.1007/s00383-019-04490-5 -
Bailliere's Best Practice & Research.... Oct 2000The role of duodenogastro-oesophageal reflux (DGOR), once erroneously termed 'bile reflux', in causing oesophageal mucosal damage has been an area of interest in both... (Review)
Review
The role of duodenogastro-oesophageal reflux (DGOR), once erroneously termed 'bile reflux', in causing oesophageal mucosal damage has been an area of interest in both animal and human studies. However, due to the lack of appropriate techniques for accurately measuring DGOR, extrapolation of findings from animal studies to humans was difficult to make. The recent advent of the Bilitec system, an ambulatory bilirubin monitoring device, is increasing our knowledge of the specific role of DGOR in oesophageal diseases. Studies suggest that the DGOR without acid reflux may result in symptoms but unless acid reflux is present simultaneously, it does not cause oesophagitis. Therefore, our therapies should aim at reducing both DGOR and acid reflux. Studies show that this may be accomplished by anti-reflux surgery or the use of proton pump inhibitors, which, by reducing gastric volume, decrease the damaging potential of both acid and DGOR.
Topics: Anastomosis, Surgical; Animals; Anti-Ulcer Agents; Bile Acids and Salts; Duodenogastric Reflux; Enzyme Inhibitors; Fundoplication; Gastrectomy; Gastroesophageal Reflux; Humans; Prognosis
PubMed: 11003805
DOI: 10.1053/bega.2000.0120 -
Gastroenterology Clinics of North... Mar 2013Pharmacologic treatment of gastroesophageal reflux disease is based upon gastric acid suppression with proton pump inhibitors (PPIs). In many patients, symptoms persist... (Review)
Review
Pharmacologic treatment of gastroesophageal reflux disease is based upon gastric acid suppression with proton pump inhibitors (PPIs). In many patients, symptoms persist despite PPI treatment. For some, ongoing symptoms may be due to nonacid reflux. Accurate measurement of nonacid reflux is not possible with conventional ambulatory pH monitoring. Impedance-pH monitoring has advanced the ability to assess gastroesophageal reflux, because, in addition to detecting acid reflux, it enables measurement of nonacid reflux. This article discusses the principles of impedance-pH monitoring, catheter characteristics and placement, interpretation of studies, and clinical uses of this form of reflux monitoring.
Topics: Electric Impedance; Esophageal pH Monitoring; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Sensitivity and Specificity
PubMed: 23452628
DOI: 10.1016/j.gtc.2012.11.003 -
The Medical Clinics of North America Jul 1991Gastroesophageal reflux disease, usually manifested by frequent heartburn, occurs in approximately 10% of our adult population. The presence of a hiatal hernia is... (Review)
Review
Gastroesophageal reflux disease, usually manifested by frequent heartburn, occurs in approximately 10% of our adult population. The presence of a hiatal hernia is usually associated with, but does not necessarily cause, LES dysfunction, allowing acid reflux to produce esophageal and aerodigestive symptoms. The mucosa can be extensively damaged and, ultimately, a columnar lining, termed Barrett's esophagus, a premalignant condition, can develop. Treatment with H2-antagonists has been nirvana to some patients, but has proved only partially helpful to others. Adjunctive agents may increase relief and may help heal erosive esophagitis in some patients, but side effects and cost limit their use. Maintenance therapy with full doses is required, as the relapse rate for this chronic condition is high. Omeprazole temporarily heals almost everyone with otherwise resistant GERD, but it is currently used only on a short-term basis unless surgery, eminently successful in well-selected patients, is contraindicated.
Topics: Gastroesophageal Reflux; Humans
PubMed: 2072796
DOI: 10.1016/s0025-7125(16)30421-7 -
Surgical Endoscopy May 2023One-Anastomosis Gastric Bypass (OAGB) is the third most common bariatric operation for patients with obesity worldwide. One concern about OAGB is the presence of acid...
Esophageal function and non-acid reflux evaluated by impedance-24 h-pH-metry, high-resolution manometry, and gastroscopy after one-anastomosis gastric bypass-outcomes of a prospective mid-term study.
BACKGROUND
One-Anastomosis Gastric Bypass (OAGB) is the third most common bariatric operation for patients with obesity worldwide. One concern about OAGB is the presence of acid and non-acid reflux in a mid- and long-term follow-up. The aim of this study was to objectively evaluate reflux and esophagus motility by comparing preoperative and postoperative mid-term outcomes.
SETTING
Cross-sectional study; University-hospital based.
METHODS
This study includes primary OAGB patients (preoperative gastroscopy, high-resolution manometry (HRM), and impedance-24 h-pH-metry) operated at Medical University of Vienna before 31st December 2017. After a mean follow-up of 5.1 ± 2.3 years, these examinations were repeated. In addition, history of weight, remission of associated medical problems (AMP), and quality of life (QOL) were evaluated.
RESULTS
A total of 21 patients were included in this study and went through all examinations. Preoperative weight was 124.4 ± 17.3 kg with a BMI of 44.7 ± 5.6 kg/m, total weight loss after 5.1 ± 2.3 years was 34.4 ± 8.3%. In addition, remission of AMP and QOL outcomes were very satisfactory in this study. In gastroscopy, anastomositis, esophagitis, Barrett´s esophagus, and bile in the pouch were found in: 38.1%, 28.3%, 9.5%, and 42.9%. Results of HRM of the lower esophageal sphincter pressure were 28.0 ± 15.6 mmHg, which are unchanged compared to preoperative values. Nevertheless, in the impedance-24 h-pH-metry, acid exposure time and DeMeester score decreased significantly to 1.2 ± 1.2% (p = 0.004) and 7.5 ± 8.9 (p = 0.017). Further, the total number of refluxes were equal to preoperative; however, the decreased acid refluxes were replaced by non-acid refluxes.
CONCLUSION
This study has shown decreased rates of acid reflux and increased non-acid reflux after a mid-term outcome of primary OAGB patients. Gastroscopy showed signs of chronic irritation of the gastrojejunostomy, pouch, and distal esophagus, even in asymptomatic patients. Follow-up gastroscopies in OAGB patients after 5 years may be considered.
Topics: Humans; Gastric Bypass; Gastroscopy; Quality of Life; Electric Impedance; Prospective Studies; Cross-Sectional Studies; Gastroesophageal Reflux; Hydrogen-Ion Concentration; Manometry; Obesity, Morbid
PubMed: 36693919
DOI: 10.1007/s00464-022-09857-9 -
Digestion 2014The mechanisms that cause acid reflux in patients with non-erosive reflux disease (NERD), including those that determine how acid extends proximally, are not yet clear.
BACKGROUND/AIMS
The mechanisms that cause acid reflux in patients with non-erosive reflux disease (NERD), including those that determine how acid extends proximally, are not yet clear.
METHODS
Concurrent esophageal manometry and pH monitoring were performed for 3 h after a meal in 13 patients with NERD, 12 with mild reflux esophagitis (RE), and 13 healthy subjects (HS).
RESULTS
Transient lower esophageal sphincter (LES) relaxation (TLESR) was the major mechanism of acid reflux in all three groups. LES pressure did not differ between the groups. At 2 cm above the LES, there were no differences between the three groups in the number of TLESR-related acid reflux episodes, rate of TLESRs and rate of acid reflux during TLESR. However, at 7 cm above the LES, the rate of acid reflux during TLESRs was significantly higher in patients with NERD (mean ± SEM 42.3 ± 4.8) than in those with mild RE (28.0 ± 3.8) and HS (10.8 ± 2.5).
CONCLUSIONS
TLESRs are the sole motor events underlying acid reflux episodes in patients with NERD. Acid extends proximally more readily in patients with NERD than in HS and those with mild RE.
Topics: Adult; Aged; Esophageal Sphincter, Lower; Esophagitis, Peptic; Female; Gastric Acid; Gastroesophageal Reflux; Humans; Male; Manometry; Middle Aged; Muscle Relaxation
PubMed: 25196607
DOI: 10.1159/000365588 -
The Journal of Family Practice Mar 2003Heartburn on 2 or more days a week warrants medical attention, as patients are likely to suffer from gastroesophageal reflux disease (GERD). Chronic GERD can lead to the... (Review)
Review
Heartburn on 2 or more days a week warrants medical attention, as patients are likely to suffer from gastroesophageal reflux disease (GERD). Chronic GERD can lead to the development of complications including erosive esophagitis, stricture formation, and Barrett's esophagus, which increases the risk of esophageal adenocarcinoma. A trial with a proton pump inhibitor (PPI) is the quickest and most cost-effective way to diagnose GERD, and is at least as sensitive as 24-hour intra-esophageal pH monitoring. As PPIs only bind to actively secreting proton pumps, they should be dosed 30 to 60 minutes before a meal. Despite these recommendations, a recent survey of over 1000 US primary care physicians found that 36% instructed their patients to take a PPI with or after a meal or did not specify the timing of dosing. The patients who will have the best response to surgical therapy for GERD are those who had clearly documented acid reflux with typical symptoms, and who have responded to PPI treatment. Unfortunately, the same survey found that most physicians recommend antireflux surgery for patients in whom medical therapy has failed.
Topics: Clinical Trials as Topic; Digestive System Surgical Procedures; Esophagoscopy; Gastroesophageal Reflux; Gastrointestinal Agents; Humans; Practice Guidelines as Topic; Risk Reduction Behavior
PubMed: 12620183
DOI: No ID Found -
Gut Dec 2012The risk for acidic reflux is mainly determined by the position of the gastric acid pocket. It was hypothesised that compounds affecting proximal stomach tone might... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The risk for acidic reflux is mainly determined by the position of the gastric acid pocket. It was hypothesised that compounds affecting proximal stomach tone might reduce gastro-oesophageal reflux by changing the acid pocket position.
OBJECTIVE
To study the effect of azithromycin (Azi) on acid pocket position and acid exposure in patients with gastro-oesophageal reflux disease (GORD).
METHODS
Nineteen patients with GORD were included, of whom seven had a large hiatal hernia (≥3 cm) (L-HH) and 12 had a small or no hiatal hernia (S-HH). Patients were randomised to Azi 250 mg/day or placebo during 3 days in a crossover manner. On each study day, reflux episodes were detected using concurrent high-resolution manometry and pH-impedance monitoring after a standardised meal. The acid pocket was visualised using scintigraphy, and its position was determined relative to the diaphragm.
RESULTS
Azi reduced the number of acid reflux events (placebo 8.0±2.2 vs Azi 5.6±1.8, p<0.01) and postprandial acid exposure (placebo 10.5±3.8% vs Azi 5.9±2.5%, p<0.05) in all patients without affecting the total number of reflux episodes. Acid reflux occurred mainly when the acid pocket was located above, or at the level of, the diaphragm, rather than below the diaphragm. Treatment with Azi reduced hiatal hernia size and resulted in a more distal position of the acid pocket compared with placebo (below the diaphragm 39% vs 29%, p=0.03). Azi reduced the rate of acid reflux episodes in patients with S-HH (38% to 17%) to a greater extent than in patients with L-HH (69% to 62%, p=0.04).
CONCLUSION
Azi reduces acid reflux episodes and oesophageal acid exposure. This effect was associated with a smaller hiatal hernia size and a more distal position of the acid pocket, further indicating the importance of the acid pocket in the pathogenesis of GORD.
CLINICAL TRIAL REGISTRATION
http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1970 NTR1970.
Topics: Aged; Azithromycin; Cross-Over Studies; Double-Blind Method; Drug Administration Schedule; Female; Gastric Acid; Gastroesophageal Reflux; Gastrointestinal Agents; Hernia, Hiatal; Humans; Linear Models; Logistic Models; Male; Middle Aged; Treatment Outcome
PubMed: 22267599
DOI: 10.1136/gutjnl-2011-300926 -
The American Journal of Gastroenterology Jul 2016Running is the most popular form of exercise in the United States. Gastroesophageal reflux (GER) is common during exercise and may affect performance. Previous studies...
Running is the most popular form of exercise in the United States. Gastroesophageal reflux (GER) is common during exercise and may affect performance. Previous studies have focused on increased intra-abdominal pressure as a major determinant of acid reflux during physical exertion. In this issue, Herregods et al. examined the mechanisms of GER in healthy volunteers using simultaneous high-resolution manometry and pH impedance testing performed while running. Novel observations afforded by the utilization of state-of-the-art technology include the importance of transient lower esophageal sphincter relaxation ("belch reflex") and transient formation of hiatal hernia during exercise. The findings are provocative and lend credence to commonsense strategies to minimize the consequences of belching in runners.
Topics: Esophageal Sphincter, Lower; Esophageal pH Monitoring; Gastroesophageal Reflux; Humans; Manometry; Muscle Relaxation; Running; Sports Medicine
PubMed: 27356820
DOI: 10.1038/ajg.2016.221 -
The Clinical Respiratory Journal Apr 2015Little is known about non-acid gastroesophageal reflux-induced chronic cough (GERC). The purpose of the study is to explore the clinical characteristics of non-acid GERC. (Comparative Study)
Comparative Study
BACKGROUND AND OBJECTIVE
Little is known about non-acid gastroesophageal reflux-induced chronic cough (GERC). The purpose of the study is to explore the clinical characteristics of non-acid GERC.
METHODS
Clinical symptoms, cough symptom score, capsaicin cough sensitivity, gastroesophageal reflux diagnostic questionnaire (GerdQ) score, findings of multichannel intraluminal impedance-pH monitoring (MII-pH) and response to pharmacological anti-reflux therapy were retrospectively reviewed in 38 patients with non-acid GERC and compared with those of 49 patients with acid GERC.
RESULTS
Non-acid GERC had the similar cough character, cough symptom score, and capsaicin cough sensitivity to acid GERC. However, non-acid GERC had less frequent regurgitation (15.8% vs 57.1%, χ(2) = 13.346, P = 0.000) and heartburn (7.9% vs 32.7%, χ(2) = 7.686, P = 0.006), and lower GerdQ score (7.4 ± 1.4 vs 10.6 ± 2.1, t = -6.700, P = 0.003) than acid GERC. Moreover, MII-pH revealed more weakly acidic reflux episodes, gas reflux episodes and a higher symptom association probability (SAP) for non-acid reflux but lower DeMeester score, acidic reflux episodes and SAP for acid reflux in non-acid GERC than in acid GERC. Non-acid GERC usually responded to the standard anti-reflux therapy but with delayed cough resolution or attenuation when compared with acid GERC. Fewer patients with non-acid GERC needed an augmented acid suppressive therapy or treatment with baclofen.
CONCLUSIONS
There are some differences in the clinical manifestations between non-acid and acid GERC, but MII-pH is essential to diagnose non-acid GERC.
Topics: Adult; Anti-Ulcer Agents; Baclofen; Capsaicin; Chronic Disease; Cough; Domperidone; Esophageal pH Monitoring; Female; Gastroesophageal Reflux; Humans; Male; Middle Aged; Muscle Relaxants, Central; Omeprazole; Retrospective Studies; Surveys and Questionnaires
PubMed: 24898575
DOI: 10.1111/crj.12124