BACKGROUND Despite societal guidelines recommending targeted screening for Barrett’s esophagus(BE)and esophageal adenocarcinoma(EAC)in individuals with gastroesophageal reflux symptoms(GERS),screening adherence is su...BACKGROUND Despite societal guidelines recommending targeted screening for Barrett’s esophagus(BE)and esophageal adenocarcinoma(EAC)in individuals with gastroesophageal reflux symptoms(GERS),screening adherence is suboptimal.Current screening approaches fail to identify individuals not seeking medical consultation for GERS or whose GERS are managed with‘over-the-counter’(OTC)acid suppressant therapies.AIM To assess patients’self-management and help-seeking behavior for GERS.METHODS This cross-sectional study collected data from the Dutch general population aged 18-75 years between January and April 2023 using a web-based survey.The survey included questions regarding self-management(e.g.,use of acid suppressant therapy with or without prescription)and help-seeking behavior(e.g.,consulting a primary care provider)for GERS.Simple random sampling was performed to select individuals within the target age group.In total,18156 randomly selected individuals were invited to participate.The study protocol was registered in ClinicalTrials.gov(identifier:NCT05689918).RESULTS Of the 18156 invited individuals,3214 participants(17.7%)completed the survey,of which 1572 participants(48.9%)reported GERS.Of these,904 participants(57.5%)had never consulted a primary care provider for these symptoms,of which 331 participants(36.6%)reported taking OTC acid suppressant therapy in the past six months and 100 participants(11.1%)fulfilled the screening criteria for BE and EAC according to the European Society of Gastrointestinal Endoscopy Guideline.CONCLUSION The population fulfilling the screening criteria for BE and EAC is incompletely identified,suggesting potential underutilization of medical consultation.Raising public awareness of GERS as a risk factor for EAC is needed.展开更多
BACKGROUND Non-erosive reflux disease(NERD),the main gastroesophageal reflux subtype,features reflux symptoms without mucosal damage.Anxiety links to visceral hypersensitivity in NERD,yet mechanisms and animal models ...BACKGROUND Non-erosive reflux disease(NERD),the main gastroesophageal reflux subtype,features reflux symptoms without mucosal damage.Anxiety links to visceral hypersensitivity in NERD,yet mechanisms and animal models are unclear.AIM To establish a translational NERD rat model with anxiety comorbidity via tail clamping and study corticotropin-releasing hormone(CRH)-mediated neuroimmune pathways in visceral hypersensitivity and esophageal injury.METHODS Sprague-Dawley(SD)and Wistar rats were grouped into sham,model,and modified groups(n=10 each).The treatments for the modified groups were as follows:SD rats received ovalbumin/aluminum hydroxide suspension+acid perfusion±tail clamping(40 minutes/day for 7 days),while Wistar rats received fructose water+tail clamping.Esophageal pathology,visceral sensitivity,and behavior were assessed.Serum CRH,calcitonin gene-related peptide(CGRP),5-hydroxytryptamine(5-HT),and mast cell tryptase(MCT)and central amygdala(CeA)CRH mRNA were measured via ELISA and qRT-PCR.RESULTS Tail clamping induced anxiety,worsening visceral hypersensitivity(lower abdominal withdrawal reflex thresholds,P<0.05)and esophageal injury(dilated intercellular spaces and mitochondrial edema).Both models showed raised serum CRH,CGRP,5-HT,and MCT(P<0.01)and CeA CRH mRNA expression(P<0.01).Behavioral tests confirmed anxiety-like phenotypes.NERD-anxiety rats showed clinical-like symptom severity without erosion.CONCLUSION Tail clamping induces anxiety in NERD models,worsening visceral hypersensitivity via CRH neuroimmune dysregulation,offering a translational model and highlighting CRH as a treatment target.展开更多
文摘BACKGROUND Despite societal guidelines recommending targeted screening for Barrett’s esophagus(BE)and esophageal adenocarcinoma(EAC)in individuals with gastroesophageal reflux symptoms(GERS),screening adherence is suboptimal.Current screening approaches fail to identify individuals not seeking medical consultation for GERS or whose GERS are managed with‘over-the-counter’(OTC)acid suppressant therapies.AIM To assess patients’self-management and help-seeking behavior for GERS.METHODS This cross-sectional study collected data from the Dutch general population aged 18-75 years between January and April 2023 using a web-based survey.The survey included questions regarding self-management(e.g.,use of acid suppressant therapy with or without prescription)and help-seeking behavior(e.g.,consulting a primary care provider)for GERS.Simple random sampling was performed to select individuals within the target age group.In total,18156 randomly selected individuals were invited to participate.The study protocol was registered in ClinicalTrials.gov(identifier:NCT05689918).RESULTS Of the 18156 invited individuals,3214 participants(17.7%)completed the survey,of which 1572 participants(48.9%)reported GERS.Of these,904 participants(57.5%)had never consulted a primary care provider for these symptoms,of which 331 participants(36.6%)reported taking OTC acid suppressant therapy in the past six months and 100 participants(11.1%)fulfilled the screening criteria for BE and EAC according to the European Society of Gastrointestinal Endoscopy Guideline.CONCLUSION The population fulfilling the screening criteria for BE and EAC is incompletely identified,suggesting potential underutilization of medical consultation.Raising public awareness of GERS as a risk factor for EAC is needed.
基金Supported by the National Key Specialty of Traditional Chinese Medicine(Spleen and Stomach Diseases),No.0500004National Natural Science Foundation of China,No.82205104 and No.82104850+1 种基金Hospital Capability Enhancement Project of Xiyuan Hospital,CACMS,No.XYZX0303-07the Fundamental Research Funds for the Central Public Welfare Research Institutes,Excellent Young Scientists Training Program of China Academy of Chinese Medical Sciences,No.ZZ16-YQ-002.
文摘BACKGROUND Non-erosive reflux disease(NERD),the main gastroesophageal reflux subtype,features reflux symptoms without mucosal damage.Anxiety links to visceral hypersensitivity in NERD,yet mechanisms and animal models are unclear.AIM To establish a translational NERD rat model with anxiety comorbidity via tail clamping and study corticotropin-releasing hormone(CRH)-mediated neuroimmune pathways in visceral hypersensitivity and esophageal injury.METHODS Sprague-Dawley(SD)and Wistar rats were grouped into sham,model,and modified groups(n=10 each).The treatments for the modified groups were as follows:SD rats received ovalbumin/aluminum hydroxide suspension+acid perfusion±tail clamping(40 minutes/day for 7 days),while Wistar rats received fructose water+tail clamping.Esophageal pathology,visceral sensitivity,and behavior were assessed.Serum CRH,calcitonin gene-related peptide(CGRP),5-hydroxytryptamine(5-HT),and mast cell tryptase(MCT)and central amygdala(CeA)CRH mRNA were measured via ELISA and qRT-PCR.RESULTS Tail clamping induced anxiety,worsening visceral hypersensitivity(lower abdominal withdrawal reflex thresholds,P<0.05)and esophageal injury(dilated intercellular spaces and mitochondrial edema).Both models showed raised serum CRH,CGRP,5-HT,and MCT(P<0.01)and CeA CRH mRNA expression(P<0.01).Behavioral tests confirmed anxiety-like phenotypes.NERD-anxiety rats showed clinical-like symptom severity without erosion.CONCLUSION Tail clamping induces anxiety in NERD models,worsening visceral hypersensitivity via CRH neuroimmune dysregulation,offering a translational model and highlighting CRH as a treatment target.
