|
1
|
Pop RS, Pop D, Chiperi LE, Nechita VI, Man SC, Dumitrașcu DL. Utility of the Post-Reflux Swallow-Induced Peristaltic Wave Index and Mean Nocturnal Baseline Impedance for the Diagnosis of Gastroesophageal Reflux Disease Phenotypes in Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:773. [PMID: 39062223 PMCID: PMC11275132 DOI: 10.3390/children11070773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024]
Abstract
(1) Objectives: Assessment of novel impedance parameters such as the post-reflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI) have been proposed to enhance the accuracy of gastroesophageal reflux disease (GERD) diagnosis. We aimed to evaluate the clinical value of MNBI and the PSPW index in discerning different phenotypes of GERD in children. (2) Methods: We conducted a prospective, observational study that included 49 children aged 5-18 years, referred for MII-pH monitoring due to negative endoscopy and persisting gastroesophageal reflux symptoms despite acid-suppressant treatment. The PSPW index and MNBI were assessed along with conventional metrics. (3) Results: Using a receiver operating characteristic (ROC) curve analysis, MNBI (AUC 0.864) and the PSPW index (AUC 0.83) had very good performance in differentiating between non-erosive reflux disease (NERD) and functional phenotypes. The PSPW index (AUC 0.87) discriminated better between functional heartburn (FH) and reflux hypersensitivity (RH) compared to the MNBI (AUC 0.712). A PSPW cut-off value of 65% provided a sensitivity of 76.9% and a specificity of 90% in distinguishing FH and RH. The PSPW index (AUC 0.87) proved to have better performance than the MNBI (AUC 0.802) in differentiating between FH and non-FH patients. MNBI diagnosed FH with a sensitivity of 84% and a specificity of 80.6% at a cut-off value of 2563 Ω. (4) Conclusions: The PSPW index and MNBI are useful to distinguish between GERD phenotypes in pediatric patients.
Collapse
Affiliation(s)
- Radu Samuel Pop
- 3rd Department of Pediatrics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400217 Cluj-Napoca, Romania; (D.P.); (S.C.M.)
| | - Daniela Pop
- 3rd Department of Pediatrics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400217 Cluj-Napoca, Romania; (D.P.); (S.C.M.)
- 3rd Pediatric Clinic, Clinical Emergency Hospital for Children, 400217 Cluj-Napoca, Romania
| | - Lăcrămioara Eliza Chiperi
- Department of Pediatrics, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
| | - Vlad-Ionuț Nechita
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Sorin Claudiu Man
- 3rd Department of Pediatrics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400217 Cluj-Napoca, Romania; (D.P.); (S.C.M.)
- 3rd Pediatric Clinic, Clinical Emergency Hospital for Children, 400217 Cluj-Napoca, Romania
| | - Dan Lucian Dumitrașcu
- 2nd Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| |
Collapse
|
|
2
|
Fernandes YR. Unraveling the Dynamics of Esophageal Motility, Esophagitis Severity, and Age in GERD Patients: A Cross-Sectional Exploration. Cureus 2024; 16:e53979. [PMID: 38468980 PMCID: PMC10927278 DOI: 10.7759/cureus.53979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is characterized by prolonged exposure of the esophageal mucosa to gastric content, with esophageal motility playing a pivotal role in its pathophysiology. This study employs a cross-sectional design to investigate the interplay between esophageal motility, the severity of esophagitis, and age in individuals presenting with GERD symptoms. OBJECTIVE The primary objective is to assess proximal and distal esophageal contractions in individuals with GERD symptoms, exploring potential correlations with the severity of esophageal lesions and age. METHODS A total of 47 patients reporting heartburn and acid regurgitation underwent diagnostic investigations, including esophageal manometry, radiological examinations, and endoscopy. Patients were categorized into groups based on the presence and severity of esophagitis. Esophageal contractions were monitored using a manometric method at various distances from the UES after swallowing 5 mL of water. RESULTS Patients with severe esophagitis (SE) exhibited a reduced distal esophageal contraction amplitude compared to those without esophagitis (WE) or with moderate esophagitis (ME). No significant age-related differences were observed in esophageal contractions. Analyses included contraction amplitude, duration, area under the curve (AUC), and propagation time. CONCLUSION This study provides insights into the nuanced relationship between esophageal motility, esophagitis severity, and age in GERD patients. The findings highlight the significance of distal esophageal contractions in SE cases, suggesting potential implications for disease progression. Age did not emerge as a significant factor influencing esophageal motility in this patient cohort.
Collapse
Affiliation(s)
- Ygor R Fernandes
- General Surgery and Digestive Endoscopy, Escola Paulista de Medicina, Universidade Federal de São Paulo, Hospital São Paulo, São Paulo, BRA
| |
Collapse
|
|
3
|
Liu K, Evans J, Clayton S. Proximal reflux frequency not correlated with atypical gastroesophageal reflux disease (GERD) symptoms. Dis Esophagus 2023; 36:doac106. [PMID: 36572402 DOI: 10.1093/dote/doac106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/01/2022] [Indexed: 07/04/2023]
Abstract
Though most known for heartburn and regurgitation, gastroesophageal reflux disease (GERD) is attributed to countless atypical, extra-esophageal (EE) manifestations like cough and throat clearing. While GERD has been studied extensively, the relationship between reflux character and symptom manifestation remains poorly understood. The aim of this study was to examine proximal reflux frequency and its relationship with typical or atypical symptoms. 540 (75.1% female, 24.9% male) pH-impedance monitoring studies from the last 3-years were divided by symptom indication and retrospectively reviewed for proximal reflux frequency, total acid exposure time, mean nocturnal baseline impedance, and total reflux episodes in both abnormal and normal, and borderline studies. Baseline characteristics were also collected. Both total reflux events and mean proximal reflux frequency were found to differ significantly between those with typical versus atypical symptoms. Total reflux events [median (IQR)] were 43.5 (24.0-74.0) in typical patients and 35.0 (20.0-57.0) in atypical patients (P-value 0.0369). Proximal reflux frequency [median (IQR)] was 12.0 (4.0-19.0) typical and 7.0 (3.0-17.0) atypical (P-value 0.0348). Results for exclusively abnormal studies also favored typical patients but not significantly. Baseline characteristics and use of gastric acid control did not differ significantly. Proximal reflux frequency was observed to increase among those with typical GERD symptoms. Total acid reflux events were also significantly higher on average with typical patients. Our findings that proximal reflux frequency is reduced in patients with atypical symptoms compared with patients with typical symptoms suggest that proximal reflux exposure may play a significant role in the symptom presentation of typical classic heartburn and regurgitation symptoms. The differential diagnosis for atypical EE symptoms is vast and can be multifactorial. Our results indicate proximal reflux events may contribute to atypical EE symptoms less than previously reported.
Collapse
Affiliation(s)
- Kelli Liu
- Department of Internal Medicine, University of California San Diego Medical Center, San Diego, USA
- Wake Forest School of Medicine, Winston-Salem, USA
| | - Joni Evans
- Department of Biostatistics and Data Science, Atrium Health-Wake Forest Baptist Medical Center, Winston-Salem, USA
| | - Steven Clayton
- Section of Gastroenterology, Department of Internal Medicine, Atrium Health-Wake Forest Baptist Medical Center, Winston-Salem, USA
| |
Collapse
|
|
4
|
|
|
5
|
Rosado-Arias Y, Toro-Monjaraz EM, Cervantes-Bustamante R, Zarate-Mondragon F, Cadena-Leon J, Ignorosa-Arellano K, Loredo-Mayer A, Ramírez-Mayans J. Low Mean Nocturnal Baseline Impedance is Associated With a Pathological Acid Exposure Time in Children. J Pediatr Gastroenterol Nutr 2022; 74:215-220. [PMID: 34694265 DOI: 10.1097/mpg.0000000000003331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The baseline impedance (BI) and the mean nocturnal baseline impedance (MNBI) serve as markers of mucosal integrity in patients with pathologic acid exposure time (AET). This work aims to investigate the association between the BI and MNBI with the AET in children. METHODOLOGY A retrospective study was performed in children ≤18 years old with suspicion of gastroesophageal reflux disease who underwent both endoscopy and pH-impedance monitoring (pH-MII). Esophagitis was graded according to the Los Angeles classification. The pathological AET was determined depending on the age (≥5% in patients >1 year and ≥10% in those ages ≤1 year). For the BI, 60 s measurements were taken every 4 h, and for the MNBI, 3 10 min measurements were taken between 1.00 and 3:00 am; then, they were averaged. The means of BI and MNBI were compared with each other, with the AET, and other variables. RESULTS Sixty-eight patients were included, 25% of patients presented pathological AET. The mean of the MNBI was higher than BI in channels 6 (2195 vs 1997 Ω, P = 0.011) and 5 (2393 vs 2228 Ω, P = 0.013). BI and MNBI at channel 6 were lower in patients with pathological AET than in those with normal AET (1573 vs 2138 Ω, P = 0.007) and (1592 vs 2396 Ω, P = 0.004), respectively. CONCLUSIONS Children with pathological AET had lower impedance values than those with normal AET. BI and MNBI measurements should be part of the routine MII-pH assessment in children.
Collapse
Affiliation(s)
- Yolainis Rosado-Arias
- Departement of Gastroenterology and Nutrition Department, at Instituto Nacional de Pediatria, Mexico, Mexico
| | | | | | | | | | | | | | | |
Collapse
|
|
6
|
Gök M, Gencdal G. The assessment of patients with non-erosive gastroesophageal reflux disease by using the Bravo® pH monitoring system. SANAMED 2022; 17:99-103. [DOI: 10.5937/sanamed17-39523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Background and aim: Gastroesophageal reflux disease (GERD) is a common disease in the world. GERD is always treated with drugs. The Bravo® wireless pH monitoring system is a good technique. The Bravo® may affect increasing the specificity and sensitivity in the diagnosis of GERD with its 48-hour recording feature. In this study, we aimed to assess the diagnostic performance of the Bravo® pH monitoring system in patients with non-erosive GERD. Materials and Methods: Patients with non-erosive reflux disease (normal endoscopy) whose symptoms persisted after PPI treatment (at least two months) were included in the study. All patients had upper gastrointestinal system endoscopies performed in our clinic between January 2013 and December 2019. All patients had a 48-hour Bravo® wireless pH monitoring record. Results: Twenty-three patients (M: 18 (78.3%; Age: 35.7 ± 11) were included in the study. All patients completed the 2-day recording protocol. During and after the procedure, no patient showed any adverse effects of the Bravo® procedure. We diagnosed GERD in 13 of 23 patients by Bravo® capsule. According to the Bravo® pH-meter recordings; Total time pH < 4 (minute) was 187 ± 190, the total number of refluxes was 90 ± 61, the percentage of time with pH < 4 was 7.1 ± 7.22, the number of long reflux events were 8.1 ± 8, the duration of the longest reflux episode during pH < 4 (minute) was 31 ± 49, the Demeester score was 20.8 ± 19.3 detected. Conclusion: Based on the results of the current study, the Bravo® pH monitoring system is a practical and effective diagnostic technique for non-erosive GERD. Further prospective studies would be useful for comparing the differences between 24-hour and 48-hour pH recording results.
Collapse
|
|
7
|
Maccora D, Parrilla C, Lanni V, Galli J, Longobardi Y, Valenza V. Oropharyngoesophageal Scintigraphy in a Case of Complex Swallowing Disorders After a Major Oral Surgery. Clin Nucl Med 2021; 46:999-1001. [PMID: 34735410 DOI: 10.1097/rlu.0000000000003712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT A 75-year-old woman had an occasional finding of a left tonsil mass for dysphagia, which resulted a high-grade squamous carcinoma. Therefore, the patient was sent to have a left pharyngectomy. After the pharyngectomy, the patient reported persistent swallowing disorders and nasal reflux. Consequently, she had an oropharyngoesophageal scintigraphy, demonstrating irregular oral and pharyngeal swallowing phases and confirming reflux episodes into the rhinopharynx and into the oropharynx. In line with these findings, the patient was send to rehabilitation; the abnormal functional mechanisms, previously identified by the scintigraphy, allowed to guide the speech therapy, with a progressive clinical improvement.
Collapse
Affiliation(s)
- Daria Maccora
- From the Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore
| | - Claudio Parrilla
- Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, UOC di Otorinolaringoiatria
| | - Valerio Lanni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | | | - Ylenia Longobardi
- Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, UOC di Otorinolaringoiatria
| | | |
Collapse
|
|
8
|
Tuma F, Aljazeeri J, Khorgami Z, Khaitan L. The level of impaired esophageal bolus transit measured by multichannel intraluminal impedance: Cross-sectional study. Ann Med Surg (Lond) 2021; 65:102277. [PMID: 33996046 PMCID: PMC8099495 DOI: 10.1016/j.amsu.2021.102277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Esophageal motility disorders (EMDs) are often diagnosed manometrically, yet the underlying pathology is not always clear. Esophageal function testing (EFT), which incorporates manometry and multichannel intraluminal impedance (MII), is considered a useful tool in the assessment of EMDs. OBJECTIVE This study aims to assess the most likely level of impaired bolus transit within the esophagus which may help further localize and characterize EMDs. METHODS In a retrospective study design, we reviewed consecutive EFTs over a period of 12 months. Data included diagnosis, presenting symptoms, and EFT results of liquid and viscous swallows. Each patient underwent 10 liquid and 10 viscous swallows, and bolus transit is measured at 5, 10, 15 and 20 cm above the gastroesophageal junction (GEJ). We recorded the initial level of impaired bolus transit for each swallow. RESULTS A total of 2358 swallows in 118 patients was included for analysis. Of these, 837 swallows (35.5%) were incompletely transmitted. The proportions of impaired bolus transit were 39%, 41%, 15.6%, 4.4% at 20 cm, 15 cm, 10 cm, and 5 cm above the GEJ, respectively. The common symptoms at presentation were dysphagia (47%), heartburn (44%), chest pain (24.6%) and regurgitation (18%). The mean lower esophageal sphincter (LES) pressure was 24 ± 13.9 mmHg whereas the mean contraction amplitude was 84 ± 46.6 mmHg. CONCLUSION In patients with abnormal esophageal clearance, the most likely levels of impaired bolus transit are 15 and 20 cm above the GEJ. These levels of the esophagus should be a focus of attention in future studies evaluating the pathophysiology of esophageal dysmotility.
Collapse
Affiliation(s)
- Faiz Tuma
- Central Michigan University College of Medicine. Saginaw, Michigan, USA
| | - Jafar Aljazeeri
- University of Pittsburgh Medical Center (UPMC) Pinnacle. Pennsylvania, USA
| | - Zhamak Khorgami
- University of Oklahoma College of Medicine. Tulsa, Oklahoma, USA
| | - Leena Khaitan
- Case Western Reserve University. Cleveland, Ohio, USA
| |
Collapse
|
|
9
|
Yodice M, Mignucci A, Shah V, Ashley C, Tadros M. Preoperative physiological esophageal assessment for anti-reflux surgery: A guide for surgeons on high-resolution manometry and pH testing. World J Gastroenterol 2021; 27:1751-1769. [PMID: 33967555 PMCID: PMC8072189 DOI: 10.3748/wjg.v27.i16.1751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/18/2021] [Accepted: 03/25/2021] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is one of the most commonly encountered digestive diseases in the world, with the prevalence continuing to increase. Many patients are successfully treated with lifestyle modifications and proton pump inhibitor therapy, but a subset of patients require more aggressive intervention for control of their symptoms. Surgical treatment with fundoplication is a viable option for patients with GERD, as it attempts to improve the integrity of the lower esophageal sphincter (LES). While surgery can be as effective as medical treatment, it can also be associated with side effects such as dysphagia, bloating, and abdominal pain. Therefore, a thorough pre-operative assessment is crucial to select appropriate surgical candidates. Newer technologies are becoming increasingly available to help clinicians identify patients with true LES dysfunction, such as pH-impedance studies and high-resolution manometry (HRM). Pre-operative evaluation should be aimed at confirming the diagnosis of GERD, ruling out any major motility disorders, and selecting appropriate surgical candidates. HRM and pH testing are key tests to consider for patients with GERD like symptoms, and the addition of provocative measures such as straight leg raises and multiple rapid swallows to HRM protocol can assess the presence of underlying hiatal hernias and to test a patient’s peristaltic reserve prior to surgery.
Collapse
Affiliation(s)
- Michael Yodice
- Department of Gastroenterology, Albany Medical College, Albany, NY 12208, United States
| | - Alexandra Mignucci
- Department of Gastroenterology, Albany Medical College, Albany, NY 12208, United States
| | - Virali Shah
- Department of Gastroenterology, Albany Medical College, Albany, NY 12208, United States
| | - Christopher Ashley
- Section of Gastroenterology, Stratton VA Medical Center, Albany, NY 12208, United States
| | - Micheal Tadros
- Department of Gastroenterology, Albany Medical Center, Schenectady, NY 12309, United States
| |
Collapse
|
|
10
|
Cui Y, Cui Y. [Intraoperative Aspiration]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 23:393-401. [PMID: 32429641 PMCID: PMC7260386 DOI: 10.3779/j.issn.1009-3419.2020.101.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
术中误吸是外科手术中常见的肺部并发症，麻醉和体位是导致术中误吸的主要因素。近年来，围手术期肺保护已受到外科和麻醉医师的广泛关注，如何加速术后康复进程，减少相关并发症发生，显著改善患者预后已成为当前外科治疗的主要目标。本文将以术中误吸为重点，从解剖、病理生理、表现、诊断、处理和预防等方面展开综述。
Collapse
Affiliation(s)
- Yiyao Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
| | - Yong Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China
| |
Collapse
|
|
11
|
Lievens L, Vandenplas Y, Vanlaethem S, Van Ginderdeuren F. Prolonged Slow Expiration Technique and Gastroesophageal Reflux in Infants Under the Age of 1 Year. Front Pediatr 2021; 9:722452. [PMID: 34568241 PMCID: PMC8456092 DOI: 10.3389/fped.2021.722452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The Prolonged Slow Expiration Technique (PSE) is an airway clearance technique (ACT) carried out in newborn children with bronchial obstruction and hypersecretion to clear away the mucus from the respiratory tract. Evidence about the effect of PSE on gastroesophageal reflux (GER) is currently lacking in the literature. This study aimed to evaluate the influence of PSE on GER in infants under the age of 1 year. Methods: Infants were observed using multichannel intraluminal impedance-pH monitoring (MII-pH) over 24 h. During monitoring, the participants were treated with one 20 min intervention of PSE in supine position, 2 h after feeding. In this controlled trial with intra-subject design, the number of reflux episodes (REs) during PSE were compared to 20 min before and after PSE. Results: Fifty infants younger than 1 year were screened of whom 22 had a pathological GER. For the entire group, no significant difference was seen in the total number of REs between before, during, or after the PSE treatment (P = 0.76). No significant difference in total REs was found between the three measuring points (P = 0.59) in the group of infants with an abnormal MII-pH (n = 22). Conclusion: PSE does not cause a significant difference in REs in infants younger than 1 year. Registration number: NCT03341585.
Collapse
Affiliation(s)
- Laure Lievens
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yvan Vandenplas
- KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sylvie Vanlaethem
- Physiotherapy Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Filip Van Ginderdeuren
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
|
12
|
Wu TC, Lu CN, Hu WL, Wu KL, Chiang JY, Sheen JM, Hung YC. Tongue diagnosis indices for gastroesophageal reflux disease: A cross-sectional, case-controlled observational study. Medicine (Baltimore) 2020; 99:e20471. [PMID: 32702810 PMCID: PMC7373596 DOI: 10.1097/md.0000000000020471] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Traditional Chinese medicine tongue diagnosis can mirror the status of the internal organ, but evidence is lacking regarding the accuracy of tongue diagnosis to gastroesophageal reflux disease (GERD). This study was to investigate the association between GERD and tongue manifestation, and whether tongue imaging could be initial diagnosis of GERD noninvasively.We conducted a cross-sectional, case-controlled observational study at Kaohsiung Chang Gung Memorial Hospital in Taiwan from January 2016 to September 2017. Participants aged over 20 years old with GERD were enrolled and control group without GERD were matched by sex. Tongue imaging were acquired with automatic tongue diagnosis system, then followed by endoscope examination. Nine tongue features were extracted, and a receiver operating characteristic (ROC) curve, analysis of variance, and logistic regression were used.Each group enrolled 67 participants. We found that the saliva amount (P = .009) and thickness of the tongue's fur (P = .036), especially that in the spleen-stomach area (%) (P = .029), were significantly greater in patients with GERD than in those without. The areas under the ROC curve of the amount of saliva and tongue fur in the spleen-stomach area (%) were 0.606 ± 0.049 and 0.615 ± 0.050, respectively. Additionally, as the value of the amount of saliva and tongue fur in the spleen-stomach area (%) increased, the risk of GERD rose by 3.621 and 1.019 times, respectively. The tongue fur in the spleen-stomach area (%) related to severity of GERD from grade 0 to greater than grade B were 51.67 ± 18.72, 58.10 ± 24.60, and 67.29 ± 24.84, respectively.The amount of saliva and tongue fur in the spleen-stomach area (%) might predict the risk and severity of GERD and might be noninvasive indicators of GERD. Further large-scale, multi-center, randomized investigations are needed to confirm the results.Trial registration: NCT03258216, registered August 23, 2017.
Collapse
Affiliation(s)
- Tzu-Chan Wu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Cheng-Nan Lu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Wen-Long Hu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
- Fooyin University College of Nursing, Kaohsiung
- Kaohsiung Medical University College of Medicine
| | - Keng-Liang Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine
| | - John Y. Chiang
- Department of Computer Science and Engineering, National Sun Yat-sen University, Taiwan
| | - Jer-Ming Sheen
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Yu-Chiang Hung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| |
Collapse
|
|
13
|
Magnetic sphincter augmentation is an effective treatment for atypical symptoms caused by gastroesophageal reflux disease. Surg Endosc 2019; 34:4909-4915. [PMID: 31792691 DOI: 10.1007/s00464-019-07278-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/14/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether magnetic sphincter augmentation (MSA) could effectively treat patients with gastroesophageal reflux disease (GERD) who suffer primarily from atypical symptoms due to laryngopharyngeal reflux (LPR). MSA has been shown to treat typical symptoms of GERD with good success, but its effect on atypical symptoms is unknown. METHODS A retrospective review of a prospectively maintained institutional review board-approved database was conducted for all patients who underwent MSA between January 2015 and December 2018. All patients had objective confirmation of GERD from ambulatory pH monitoring off anti-reflux medications (DeMeester score > 14.7). Symptoms were assessed preoperatively and at 1 year postoperatively using GERD Health-Related Quality of Life (GERD-HRQL) and Reflux Symptom Index (RSI) questionnaires. RESULTS There were 86 patients (38 males; 48 females) with a median age of 51.5 years. Total GERD HRQL scores improved from a mean of 38.79 to 6.53 (p < 0.01) and RSI scores improved from a mean of 20.9 to 8.1 (p < 0.01). Atypical symptoms evaluated from the RSI questionnaire include hoarseness, throat clearing, postnasal drip, breathing difficulties, and cough. All atypical symptoms were significantly improved at 1 year following MSA (p < 0.01). All three typical symptoms of heartburn, dysphagia, and regurgitation were significantly improved based on pre and postoperative GERD HRQL questionnaires (p < 0.02). Ninety-one percent of patients were off their PPI and dissatisfaction with their current therapy decreased from 95% preoperatively to 13% postoperatively. CONCLUSION MSA is an effective treatment for typical and atypical GERD symptoms.
Collapse
|
|
14
|
Leung AK, Hon KL. Gastroesophageal reflux in children: an updated review. Drugs Context 2019; 8:212591. [PMID: 31258618 PMCID: PMC6586172 DOI: 10.7573/dic.212591] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 12/14/2022] Open
Abstract
Background Gastroesophageal reflux is a common disorder in pediatrics. Clinicians should be familiar with the proper evaluation and management of this condition. Objective To provide an update on the current understanding, evaluation, and management of gastroesophageal reflux in children. Methods A PubMed search was performed with Clinical Queries using the key term ‘gastroesophageal reflux’. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the English literature and the pediatric age group. Results Regurgitation is the most frequent symptom of gastroesophageal reflux and is present in nearly all cases. Gastroesophageal reflux occurs normally in infants, is often physiological, peaks at 4 months of age, and tends to resolve with time. Gastroesophageal reflux disease occurs when gastric contents reflux into the esophagus or oropharynx and produce troublesome symptom(s) and/or complication(s). A thorough clinical history and a thorough physical examination are usually adequate for diagnosis. When the diagnosis is ambiguous, diagnostic studies may be warranted. A combined esophageal pH monitoring and multichannel intraluminal esophageal electrical impedance device is the gold standard for the diagnosis of gastroesophageal reflux disease if the diagnosis is in doubt. In the majority of cases, no treatment is necessary for gastroesophageal reflux apart from reassurance of the benign nature of the condition. Treatment options for gastroesophageal reflux disease are discussed. Conclusion In most cases, no treatment is necessary for gastroesophageal reflux apart from reassurance because the condition is benign and self-limiting. Thickened feedings, postural therapy, and lifestyle changes should be considered if the regurgitation is frequent and problematic. Pharmacotherapy should be considered in the treatment of more severe gastroesophageal reflux disease for patients who do not respond to conservative measures. Proton pump inhibitors are favored over H2-receptor antagonists because of their superior efficacy. Antireflux surgery is indicated for patients with significant gastroesophageal reflux disease who are resistant to medical therapy.
Collapse
Affiliation(s)
- Alexander Kc Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong.,PICU, The Hong Kong Children's Hospital, Kowloon, Hong Kong
| |
Collapse
|
|
15
|
Hançerlioğlu S, Yıldırım Y, Bor S. Validity and reliability of the Quality of Life in Reflux and Dyspepsia (QoLRAD) questionnaire in patients with gastroesophageal reflux disease for the Turkish population. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2019; 30:511-516. [PMID: 31144656 PMCID: PMC6565356 DOI: 10.5152/tjg.2019.18689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/22/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND/AIMS Gastroesophageal reflux disease negatively affects quality of life. The aim is to improve quality of life because of high recurrence rate. There is a strong need for patient-reported outcome measures. The present study aimed to evaluate the validity and reliability of the Quality of Life in Reflux and Dyspepsia Questionnaire (QoLRAD) to adopt it into Turkish. MATERIALS AND METHODS A total of 142 patients with complaints of heartburn or regurgitation once a week or commonly diagnosed with 24-hour intraesophageal impedance-pH monitoring and/or upper gastrointestinal endoscopy were included in this study. Sociodemographic Data Collection Form, QoLRAD-TR, and Short Form-36 (SF-36) were applied to patients who were off proton pump inhibitors. RESULTS The Cronbach's alpha coefficient value of the questionnaire was 0.97, and the intraclass correlation coefficient (ICC) value of the result of test-retest method was between 0.97 (Vitality) and 0.99 (Eating/Drinking Disorders). There was a positive correlation between all subdomains of QoLRAD-TR and SF-36 scales. The lowest correlation (0.10) was between Emotional Distress and Role-emotional Limitations, and the highest (0.34) was between Energy and Vitality. CONCLUSION The QoLRAD test measuring quality of life, except some subdomains in our study that we performed on patients diagnosed with GERD, was found to be valid and reliable.
Collapse
Affiliation(s)
- Sadık Hançerlioğlu
- Department of Internal Medicine Nursing, Ege University School of Nursing, İzmir, Turkey
| | - Yasemin Yıldırım
- Department of Internal Medicine Nursing, Ege University School of Nursing, İzmir, Turkey
| | - Serhat Bor
- Department of Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| |
Collapse
|
|
16
|
Roark R, Sydor M, Chatila AT, Umar S, Guerra RDL, Bilal M, Guturu P. Management of gastroesophageal reflux disease. Dis Mon 2019; 66:100849. [PMID: 30798984 DOI: 10.1016/j.disamonth.2019.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastroesophageal reflux disease (GERD) continues to be one of the most prevalent gastrointestinal tract disorders. Management of GERD is individualized for each patient depending on severity of symptoms, complications of GERD and patient/physician preference. The different management options include life style modification, pharmacological therapy, minimally invasive procedures and surgery. The final decision regarding management should be made based on an individualized patient centered approach on a case-by-case basis in consultation with a multidisciplinary team including primary care physician, gastroenterologist and surgeon. We provide a comprehensive review for the management of GERD.
Collapse
Affiliation(s)
- Russell Roark
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Michael Sydor
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Ahmed T Chatila
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Shifa Umar
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, United States
| | - Ramiro De La Guerra
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, United States
| | - Mohammad Bilal
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA.
| | - Praveen Guturu
- Division of Gastroenterology & Hepatology, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA
| |
Collapse
|
|
17
|
Seo HS, Choi M, Son SY, Kim MG, Han DS, Lee HH. Evidence-Based Practice Guideline for Surgical Treatment of Gastroesophageal Reflux Disease 2018. J Gastric Cancer 2018; 18:313-327. [PMID: 30607295 PMCID: PMC6310769 DOI: 10.5230/jgc.2018.18.e41] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 12/21/2018] [Accepted: 12/21/2018] [Indexed: 12/13/2022] Open
Abstract
The prevalence of gastroesophageal reflux disease (GERD) is increasing in Korea, and physicians, including surgeons, have been focusing on its treatment. Indeed, in Korea, medical treatment using a proton pump inhibitor is the mainstream treatment for GERD, while awareness of surgical treatment is limited. Accordingly, to promote the understanding of surgical treatment for GERD, the Korean Anti-Reflux Surgery Study Group published the Evidence-Based Practice Guideline for the Surgical Treatment of GERD. The guideline consists of 2 sections: fundamental information such as the definition, symptoms, and diagnostic tools of GERD and a recommendation statement about its surgical treatment. The recommendations presented 5 debates regarding fundoplication: 1) comparison of the effectiveness of medical and surgical treatments, 2) effectiveness of surgical treatment in cases of refractory GERD, 3) effectiveness of surgical treatment of extraesophageal symptoms, 4) comparison of effectiveness between total and partial fundoplication, and 5) effectiveness of fundoplication in cases of hiatal hernia. The present guideline is the first to demonstrate the efficacy of the surgical treatment GERD in Korea.
Collapse
Affiliation(s)
- Ho Seok Seo
- Guideline Committee of Korean Anti-Reflux Surgery (KARS) Study Group.,Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Miyoung Choi
- Division of Health Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Sang-Yong Son
- Guideline Committee of Korean Anti-Reflux Surgery (KARS) Study Group.,Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Min Gyu Kim
- Guideline Committee of Korean Anti-Reflux Surgery (KARS) Study Group.,Department of Surgery, Hanyang University Guri Hospital, Hanyang University School of Medicine, Seoul, Korea
| | - Dong-Seok Han
- Guideline Committee of Korean Anti-Reflux Surgery (KARS) Study Group.,Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea
| | - Han Hong Lee
- Guideline Committee of Korean Anti-Reflux Surgery (KARS) Study Group.,Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|