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Journal of Gastroenterology Apr 2022In Japan, with the increasing prevalence of gastroesophageal reflux disease (GERD) and growing public interest, the Japanese Society of Gastroenterology issued... (Review)
Review
In Japan, with the increasing prevalence of gastroesophageal reflux disease (GERD) and growing public interest, the Japanese Society of Gastroenterology issued Evidence-based Clinical Practice Guidelines for GERD (1st edition) in 2009 and a revised 2nd edition in 2015. A number of studies on GERD were subsequently conducted in Japan and abroad, and vonoprazan, a potassium-competitive acid blocker (P-CAB), became available for the first time in Japan in February 2015. The revised 3rd edition (Japanese edition), which incorporates new findings and information, was published in April 2021. These guidelines are summarized herein, particularly sections related to the treatment of GERD. The important clinical issues addressed in the present revision are (i) the introduction of treatment algorithms that classify GERD into reflux esophagitis and non-erosive reflux disease, (ii) the clarification of treatment algorithms based on to the severity of reflux esophagitis, and (iii) the positioning of vonoprazan in the treatment for GERD. The present guidelines propose vonoprazan as the initial/maintenance treatment for severe reflux esophagitis. They also recommend vonoprazan or PPI as an initial treatment for mild reflux esophagitis and recommended PPI and proposed vonoprazan as maintenance treatment. These updated guidelines offer the best clinical strategies for GERD patients in Japan and hope that they will be of global use for the diagnosis and treatment for GERD.
Topics: Esophagitis, Peptic; Evidence-Based Practice; Gastroenterology; Gastroesophageal Reflux; Humans; Proton Pump Inhibitors
PubMed: 35226174
DOI: 10.1007/s00535-022-01861-z -
Pediatric Clinics of North America Jun 2017Gastroesophageal reflux (GER) is a normal physiologic process. It is important to distinguish GER from GER disease (GERD) since GER does not require treatment. Although... (Review)
Review
Gastroesophageal reflux (GER) is a normal physiologic process. It is important to distinguish GER from GER disease (GERD) since GER does not require treatment. Although a diagnosis of GERD can largely be based on history and physical alone, endoscopy and pH impedance studies can help make the diagnosis when there in atypical presentation. In children and adolescents, lifestyle changes and acid suppression are first-line treatments for GERD. In infants, acid suppression is not effective, but a trial of hydrolyzed formula can be considered, as milk protein sensitivity can be difficult to differentiate from GER symptoms.
Topics: Adolescent; Child; Diagnosis, Differential; Electric Impedance; Endoscopy; Esophagitis, Peptic; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Infant
PubMed: 28502434
DOI: 10.1016/j.pcl.2017.01.003 -
Digestive Diseases and Sciences May 2022Gastroesophageal reflux disease (GERD) has consistently been the most frequently diagnosed gastrointestinal malady in the USA. The mainstay of therapy has traditionally... (Review)
Review
Gastroesophageal reflux disease (GERD) has consistently been the most frequently diagnosed gastrointestinal malady in the USA. The mainstay of therapy has traditionally been medical management, including lifestyle and dietary modifications as well as antacid medications. In those patients found to be refractory to medical management or with a contraindication to medications, the next step up has been surgical anti-reflux procedures. Recently, though innovative advancements in therapeutic endoscopy have created numerous options for the endoscopic management of GERD, in this review, we discuss the various endoscopic therapy options, as well as suggested strategies we use to recommend the most appropriate therapy for patients.
Topics: Anti-Ulcer Agents; Endoscopy; Esophagitis, Peptic; Fundoplication; Gastroesophageal Reflux; Humans; Treatment Outcome
PubMed: 35258754
DOI: 10.1007/s10620-022-07390-2 -
The Veterinary Clinics of North... Jan 2021Esophagitis in cats and dogs is a consequence of increased exposure of the esophageal mucosa to gastroduodenal reflux. Causes can include anesthesia-related reflux,... (Review)
Review
Esophagitis in cats and dogs is a consequence of increased exposure of the esophageal mucosa to gastroduodenal reflux. Causes can include anesthesia-related reflux, frequent vomiting, or lodged foreign bodies. An exception is eosinophilic esophagitis, an emerging primary inflammatory disease of the esophagus with a presumed allergic etiology. Reflux esophagitis owing to lower esophageal sphincter incompetence is often suspected; a tentative diagnosis can be made by endoscopic assessment, wireless esophageal pH-monitoring, or histologic examination. Because it can be difficult to distinguish diet-responsive upper gastrointestinal disease from esophagitis, response to treatment with gastric acid suppressants is needed to confirm the tentative diagnosis.
Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Esophagitis, Peptic
PubMed: 33187619
DOI: 10.1016/j.cvsm.2020.08.003 -
Journal of Gastroenterology Jul 2017Reflux esophagitis damages the squamous epithelium that normally lines the esophagus, and promotes replacement of the damaged squamous lining by the intestinal... (Review)
Review
Reflux esophagitis damages the squamous epithelium that normally lines the esophagus, and promotes replacement of the damaged squamous lining by the intestinal metaplasia of Barrett's esophagus, the precursor of esophageal adenocarcinoma. Therefore, to prevent the development of Barrett's metaplasia and esophageal adenocarcinoma, the pathogenesis of reflux esophagitis must be understood. We have reported that reflux esophagitis, both in a rat model and in humans, develops as a cytokine-mediated inflammatory injury (i.e., cytokine sizzle), not as a caustic chemical injury (i.e., acid burn), as traditionally has been assumed. Moreover, reflux induces activation of hypoxia inducible factor (HIF)-2α, which enhances the transcriptional activity of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) causing increases in pro-inflammatory cytokines and in migration of T lymphocytes, an underlying molecular mechanism for this cytokine-mediated injury. In some individuals, reflux esophagitis heals with Barrett's metaplasia. A number of possibilities exist for the origin of the progenitor cells that give rise to this intestinal metaplasia including those of the esophagus, the proximal stomach, or the bone marrow. However, intestinal cells are not normally found in the esophagus, the stomach, or the bone marrow. Thus, the development of Barrett's intestinal metaplasia must involve some molecular reprogramming of key developmental transcription factors within the progenitor cell, a process termed transcommitment, which may be initiated by the noxious components of the gastric refluxate. This review will highlight recent studies on the pathogenesis of reflux esophagitis and on reflux-related molecular reprogramming of esophageal squamous epithelial cells in the pathogenesis of Barrett's metaplasia.
Topics: Animals; Barrett Esophagus; Basic Helix-Loop-Helix Transcription Factors; CDX2 Transcription Factor; Cell Transdifferentiation; Cellular Reprogramming; Cytokines; Epithelial Cells; Esophagitis, Peptic; Hedgehog Proteins; Hepatocyte Nuclear Factor 3-beta; Humans; NF-kappa B; Proto-Oncogene Proteins c-akt; SOX9 Transcription Factor; SOXB1 Transcription Factors; Signal Transduction; Stem Cells; Transcription Factors
PubMed: 28451845
DOI: 10.1007/s00535-017-1342-1 -
The British Journal of General Practice... Sep 2003
Topics: Esophageal Diseases; Esophagitis, Peptic; Esophagogastric Junction; Humans; Pharyngeal Diseases
PubMed: 15103872
DOI: No ID Found -
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 -
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 -
Digestion 2016Eradication of Helicobacter pylori causes improvement of gastric atrophy and intestinal metaplasia. Gastric acid secretion levels in corpus predominant gastritis... (Review)
Review
Eradication of Helicobacter pylori causes improvement of gastric atrophy and intestinal metaplasia. Gastric acid secretion levels in corpus predominant gastritis increase after eradication. These changes can increase the risk of reflux esophagitis and low-dosage aspirin ulcers. Although eradication may reduce the overall risk of gastric cancer, a certain degree of risk remains, related to the extent of atrophy and intestinal metaplasia. Many post-eradication gastric cancers are the early depressed type, with low levels of epithelial atypia, and therefore can be difficult to distinguish endoscopically from benign erosion. Further research is required in this area.
Topics: Esophagitis, Peptic; Gastric Mucosa; Gastritis, Atrophic; Gastroesophageal Reflux; Helicobacter Infections; Helicobacter pylori; Humans; Japan; Metaplasia; Narrow Band Imaging; Peptic Ulcer; Risk; Stomach Neoplasms
PubMed: 26788997
DOI: 10.1159/000441667