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Medicine Nov 2021Gastroesophageal reflux disease occurs when gastric contents flow back into the esophagus and produce symptoms. Recurrent wheezing affects the quality of life for the...
Gastroesophageal reflux disease occurs when gastric contents flow back into the esophagus and produce symptoms. Recurrent wheezing affects the quality of life for the patient and family. The association of gastroesophageal reflux with recurrent wheezing is suggested by different studies. The purpose of this study was to explore this relationship and to evaluate the outcome after appropriate treatment.A retrospective study on 85 children with recurrent wheezing, admitted in a pediatric gastroenterology regional center in Romania was performed. 24-hour continuous esophageal pH monitoring was used to evaluate the presence of gastroesophageal reflux and the results were interpreted using the Boix Ochoa score. All patients with positive score received treatment with proton pump inhibitors and they were evaluated again after 2 months.Gastroesophageal reflux was present in 71 children (83.5%), while 14 (16.5%) had a negative score, with a statistic significance (χ2 = 6.88, P = .0086, 95% confidence interval). After 2 months treatment with proton pump inhibitors, the Boix Ochoa score was still positive in 15 patients (21.13%).Recurrent wheezing is a solid reason for evaluating the presence of gastroesophageal reflux by 24-hour continuous esophageal pH-metry. Adequate treatment of gastroesophageal reflux solves also the recurrent wheezing in the majority of patients.
Topics: Child; Esophagitis, Peptic; Female; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Male; Proton Pump Inhibitors; Quality of Life; Recurrence; Respiratory Sounds; Retrospective Studies
PubMed: 34964728
DOI: 10.1097/MD.0000000000027660 -
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 -
Ear, Nose, & Throat Journal May 2021Many studies on the relationship between gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) were based on symptoms, but there are few research on... (Comparative Study)
Comparative Study
OBJECTIVES
Many studies on the relationship between gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) were based on symptoms, but there are few research on it using reflux monitoring. This study was designed to investigate the relationship between GERD and LPR based on pH monitoring.
METHODS
All patients were scheduled for esophageal manometry and pH monitoring sequentially. They were stratified into 4 groups as no reflux disease, isolated GERD, isolated LPR (iLPR), and GERD combined with LPR (GERD&LPR) according to pH monitoring.
RESULTS
The incidence of LPR in GERD was 46.3%, while the probability of combining GERD in LPR was 52.7%. The reflux profile in the laryngopharynx showed a significant difference in the total reflux time (17.82 ± 18.4 vs 9.62 ± 9.58, = .023) and the percentage of total reflux time (1.31% ± 1.37% vs 0.71% ± .0.73%, = .023) between the GERD&LPR and iLPR groups.
CONCLUSION
Laryngopharyngeal reflux can be combined with GERD or it can exist as an independent diagnosis. In patients with GERD&LPR, the total reflux time and the percentage of reflux time in the laryngopharynx are higher than those in the iLPR group. Reflux episodes in the laryngopharynx of patients with GERD&LPR may be derived from GERD.
Topics: Adult; Aged; Esophageal pH Monitoring; Esophagus; Female; Gastroesophageal Reflux; Humans; Incidence; Laryngopharyngeal Reflux; Male; Manometry; Middle Aged
PubMed: 33170043
DOI: 10.1177/0145561320971915 -
Journal of Tissue Engineering and... Jun 2020The gastroesophageal junction has been of clinical interest for some time due to its important role in preventing reflux of caustic stomach contents upward into the... (Review)
Review
The gastroesophageal junction has been of clinical interest for some time due to its important role in preventing reflux of caustic stomach contents upward into the esophagus. Failure of this role has been identified as a key driver in gastroesophageal reflux disease, cancer of the lower esophagus, and aspiration-induced lung complications. Due to the large population burden and significant morbidity and mortality related to reflux barrier dysfunction, there is a pressing need to develop tissue engineering solutions which can replace diseased junctions. While good progress has been made in engineering the bodies of the esophagus and stomach, little has been done for the junction between the two. In this review, we discuss pertinent topics which should be considered as tissue engineers begin to address this anatomical region. The embryological development and adult anatomy and histology are discussed to provide context about the native structures which must be replicated. The roles of smooth muscle structures in the esophagus and stomach, as well as the contribution of the diaphragm to normal anti-reflux function are then examined. Finally, engineering considerations including mechanics and current progress in the field of tissue engineering are presented.
Topics: Esophagogastric Junction; Gastroesophageal Reflux; Humans; Tissue Engineering
PubMed: 32304170
DOI: 10.1002/term.3045 -
Journal of Gastrointestinal Surgery :... Oct 2011Antireflux surgery (ARS) for gastroesophageal reflux disease (GERD) is one of the most frequently performed major operations in children. Many studies have described the... (Review)
Review
BACKGROUND
Antireflux surgery (ARS) for gastroesophageal reflux disease (GERD) is one of the most frequently performed major operations in children. Many studies have described the results of ARS in children, however, with a wide difference in outcome. This study aims to systematically review the efficacy of pediatric ARS and its effects on gastroesophageal function, as measured by gastroesophageal function tests. This is the first systematic review comprising only prospective, longitudinal studies, minimizing the risk of bias.
METHODS
Three electronic databases (Medline, Embase, and the Cochrane Library) were searched for prospective studies reporting on ARS in children with GERD.
RESULTS
In total, 17 eligible studies were identified, reporting on a total of 1,280 children. The median success rate after ARS was 86% (57-100%). The success rate in neurologically impaired children was worse in one study, but similar in another study compared to normally developed children. Different surgical techniques (total versus partial fundoplication, or laparoscopic versus open approach) showed similar reflux recurrence rates. However, less postoperative dysphagia was observed after partial fundoplication and laparoscopic ARS was associated with less pain medication and a shorter hospital stay. Complications of ARS varied from minimal postoperative complications to severe dysphagia and gas bloating. The reflux index (RI), obtained by 24-h pH monitoring (n = 8) decreased after ARS. Manometry, as done in three studies, showed no increase in lower esophageal sphincter pressure after ARS. Gastric emptying (n = 3) was reported either unchanged or accelerated after ARS. No studies reported on barium swallow x-ray, endoscopy, or multichannel intraluminal impedance monitoring before and after ARS.
CONCLUSION
ARS in children shows a good overall success rate (median 86%) in terms of complete relief of symptoms. Efficacy of ARS in neurologically impaired children may be similar to normally developed children. The outcome of ARS does not seem to be influenced by different surgical techniques, although postoperative dysphagia may occur less after partial fundoplication. However, these conclusions are bound by the lack of high-quality prospective studies on pediatric ARS. Similar studies on the effects of pediatric ARS on gastroesophageal function are also very limited. We recommend consistent use of standardized assessment tests to clarify the effects of ARS on gastroesophageal function and to identify possible risk factors for failure of ARS in children.
Topics: Age Factors; Child; Fundoplication; Gastroesophageal Reflux; Humans; Treatment Outcome
PubMed: 21800225
DOI: 10.1007/s11605-011-1644-1 -
Arquivos de Gastroenterologia Dec 2012Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Its... (Review)
Review
CONTEXT
Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Its pathophysiology, diagnosis and treatment have frequently been analyzed but it is interesting to review some aspects of the GERD refractory patients to the proton pump inhibitors treatment. The treatment encompasses behavioral measures and pharmacological therapy. The majority of the patients respond well to proton pump inhibitors treatment but 20%-42% of them may not do so well. Patients who are unresponsible to 4-8 weeks' treatment with proton pump inhibitors (omeprazole, pantoprazole, rabeprazole, lansoprazole, esomeprazole, pantoprazole-Mg) might have so-called refractory GERD.
RESULTS
In some cases the patients are not real refractory because either they do not have GERD or the disease was not correctly treated, but the term refractory is still employed. Although debatable, the Brazilian GERD Consensus based upon evidences recommends as first step in the diagnosis, the upper digestive endoscopy to exclude the diagnosis of peptic ulcer and cancer and in some cases identify the presence of esophageal mucosa erosions.
CONCLUSIONS
The main causes of the so-called refractory GERD are: (1) functional heartburn; (2) low levels of adherence to proton pump inhibitors treatment; (3) inadequate proton pump inhibitors dosage; (4) wrong diagnosis; (5) co-morbidities and pill-induced esophagitis; (6) genotypic differences; (7) nonacid gastroesophageal reflux; (8) autoimmune skin diseases; (9) eosinophilic esophagitis.
Topics: Diagnostic Errors; Endoscopy, Gastrointestinal; Gastroesophageal Reflux; Humans; Medication Adherence; Proton Pump Inhibitors; Treatment Failure
PubMed: 23329226
DOI: 10.1590/s0004-28032012000400012 -
Minerva Gastroenterologica E Dietologica Sep 2017
Topics: Esophageal pH Monitoring; Gastroesophageal Reflux; Humans; Obesity; Proton Pump Inhibitors
PubMed: 28673070
DOI: 10.23736/S1121-421X.17.02401-1 -
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 -
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 Postgraduate Medicine 2019Gastroesophageal reflux disease (GERD) is one of the common gastrointestinal disorders worldwide. Recent epidemiologic studies have suggested that use of statins may... (Meta-Analysis)
Meta-Analysis
BACKGROUND/OBJECTIVES
Gastroesophageal reflux disease (GERD) is one of the common gastrointestinal disorders worldwide. Recent epidemiologic studies have suggested that use of statins may lower the risk of GERD although the results from different studies were inconsistent. This systematic review and meta-analysis were conducted with the aim to summarize all available data.
METHODS
A systematic literature review was performed using MEDLINE and EMBASE database from inception to December 2017. Cohort, case-control, and cross-sectional studies that compared the risk of GERD among statin users versus nonusers were included. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.
RESULTS
A total of 4 studies (1 case control, 1 cohort, and 2 cross-sectional studies) with 14,505 participants met the eligibility criteria and were included in the meta-analysis. The risk of GERD among statin users was numerically lower than nonusers with the pooled OR of 0.89 but the result did not achieve statistical significance (95% CI, 0.60-1.33). The statistical heterogeneity in this study was moderate (I = 54%).
CONCLUSIONS
The current meta-analysis found that the risk of GERD was numerically lower among statin users although the pooled result did not reach statistical significance. Therefore, more studies are still needed to further clarify this potential benefit of statins.
Topics: Aged; Case-Control Studies; Cross-Sectional Studies; Female; Gastroesophageal Reflux; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Middle Aged; Odds Ratio; Risk Factors
PubMed: 31603078
DOI: 10.4103/jpgm.JPGM_271_18