Gastroesophageal reflux disease(GERD)affects both adults and children,although the symptoms differ significantly between these groups.While adults typically experience heartburn and regurgitation,children may present ...Gastroesophageal reflux disease(GERD)affects both adults and children,although the symptoms differ significantly between these groups.While adults typically experience heartburn and regurgitation,children may present with more subtle signs,such as failure to thrive,chronic cough,wheezing,and Sandifer syn-drome.Diagnosing GERD in children necessitates a multifaceted approach due to the diverse symptomatology and challenges in communication.Clinical assess-ment serves as the cornerstone of diagnosis,supported by tools like pH moni-toring,esophageal impedance testing,and upper gastrointestinal endoscopy.Imaging studies,such as barium swallow,can also provide valuable insights into anatomical abnormalities and the extent of reflux.Treatment strategies for pe-diatric GERD include lifestyle adjustments,pharmacotherapy,and,in severe cases,surgical interventions.Lifestyle adjustments may involve changes in fee-ding patterns,positional therapy,and weight management.Pharmacological options range from acid suppression with proton pump inhibitors or histamine-2 receptor antagonists to surgical procedures like fundoplication for refractory cases.Personalized management is essential,considering the child’s age,sym-ptom severity,and the presence of complications.This article aims to offer a comprehensive understanding of pediatric GERD by utilizing current research to enhance clinical approaches and improve patient outcomes.展开更多
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 The rising global prevalence of gastroesophageal reflux disease(GERD)has been closely linked to lifestyle changes driven by globalization.GERD imposes a substantial public health burden,affecting quality of...BACKGROUND The rising global prevalence of gastroesophageal reflux disease(GERD)has been closely linked to lifestyle changes driven by globalization.GERD imposes a substantial public health burden,affecting quality of life and leading to potential complications.Early intervention through lifestyle modification can prevent disease onset;however,there is a lack of effective risk prediction models that emphasize primary prevention.AIM To develop and validate a GERD Risk Scoring System(GRSS)aimed at identifying high-risk individuals and promoting primary prevention strategies.METHODS A 45-item questionnaire encompassing major lifestyle and demographic risk factors was developed and validated.It was administered to healthy controls and GERD patients.Two regression models-one using continuous variables and another using categorized variables-were used to develop a computational prediction equation and a clinically applicable scoring scale.An independent validation cohort of 355 participants was used to assess model performance in terms of discrimination(C-index),calibration,sensitivity,specificity,internal consistency(Cronbach's alpha),and test-retest reliability(intraclass correlation coefficient,Bland-Altman analysis).RESULTS Significant associations were observed between GERD and key lifestyle factors.The derived GRSS equation and scoring scale demonstrated strong discriminative ability,with high sensitivity and specificity.The scoring system exhibited excellent internal consistency(Cronbach’s alpha)and strong test-retest reliability.The C-index indicated excellent predictive accuracy in both derivation and validation cohorts.CONCLUSION GRSS offers a novel and validated approach to GERD risk prediction,combining a robust equation for digital applications and a practical scale for clinical use.Its ability to accurately identify at-risk individuals supports a paradigm shift toward primary prevention,underscoring its significance in addressing the growing burden of GERD at the population level.展开更多
Gastroesophageal reflux disease(GERD)poses a substantial global health challenge,with prevalence rates exhibiting geographical variation.Despite its widespread recognition,the exact prevalence and associated risk fact...Gastroesophageal reflux disease(GERD)poses a substantial global health challenge,with prevalence rates exhibiting geographical variation.Despite its widespread recognition,the exact prevalence and associated risk factors remain elusive.This article comprehensively analyzed the global burden of GERD,shedding light on its risk factors,underlying pathophysiological mechanisms,current diagnostic modalities,evolving management strategies tailored to diverse patient profiles,and complex determinants contributing to treatment failures.A deeper comprehension of GERD is achieved by dissecting these intricate facets,paving the way for enhanced clinical management and improved patient outcomes.展开更多
BACKGROUND Esophageal hypersensitivity is an important cause of refractory gastroesophageal reflux disease,in which patients do not respond to standard acid-suppressive therapy and suffer from continuous noncardiac ch...BACKGROUND Esophageal hypersensitivity is an important cause of refractory gastroesophageal reflux disease,in which patients do not respond to standard acid-suppressive therapy and suffer from continuous noncardiac chest pain and regurgitation.The N-methyl-D-aspartate receptor(NMDAR)may play a crucial role in the deve-lopment of visceral hypersensitivity in functional gastrointestinal disorders.However,the specific mechanisms of visceral hypersensitivity in upper digestive tract diseases remain poorly understood.AIM To investigate the role of the NMDAR2B/protein kinase A(PKA)/cAMP-response element binding protein(CREB)signaling pathway in the development of esophageal neuropathic pain associated with gastroesophageal reflux disease(GERD).METHODS Thirty-six 6-week-old specific pathogen free rats were randomly assigned to six groups:the control,model,model+NMDAR agonist,model+NMDAR anta-gonist,model+PKA antagonist,and model+NMDAR antagonist+PKA agonist groups,with six rats in each group.The model was induced via an intraperitoneal injection of ovalbumin for sensitization along with local esophageal stimulation.Immunohistochemistry and Western blotting were utilized to assess the expression levels of NMDAR2B signaling pathway-related proteins in the cingulate gyrus,dorsal thalamus,spinal dorsal horn,and peripheral esophageal tissues.RT-PCR was used to measure the corresponding mRNA expression,and ELISA was used to determine the serum brain-derived neurotrophic factor(BDNF)concentration.Behavioral scoring was performed during balloon distention and acid perfusion of the lower esophagus.RESULTS Compared with the control group,the model group presented significantly increased expression levels of the NMDAR2B,PKA,CREB,BDNF,substance P,and calcitonin gene-related peptide proteins and mRNAs in the cingulate gyrus,dorsal thalamus,spinal dorsal horn,and lower esophagus(P<0.05).Compared with the model group,the model+NMDAR agonist group exhibited even higher expression levels of these proteins and mRNAs(P<0.05),whereas the model+NMDAR antagonist and model+PKA antagonist groups presented lower expression levels(P<0.05).The model+NMDAR antagonist+PKA agonist group presented higher expression levels than did the model+NMDAR antagonist group(P<0.05).The changes in the serum BDNF concentration and behavioral score during balloon distention and acid perfusion were consistent with these changes in expression.CONCLUSION The NMDAR2B signaling pathway plays a critical role in the development of neuropathic pain in GERD through the PKA/CREB/BDNF pathway.展开更多
The exact worldwide prevalence of gastroesophageal reflux disease(GERD)re-mains uncertain,despite its recognition as a common condition.This conundrum arises primarily from the lack of a standardized definition for GE...The exact worldwide prevalence of gastroesophageal reflux disease(GERD)re-mains uncertain,despite its recognition as a common condition.This conundrum arises primarily from the lack of a standardized definition for GERD.The gold standard diagnostic tests for GERD,such as pH impedance testing and endo-scopy,are cumbersome and impractical for assessing community prevalence.Consequently,most epidemiological studies rely on symptom-based screening tools.GERD symptoms can be both esophageal and extraesophageal,varying widely among individuals.This variability has led to multiple symptom-based definitions of GERD,with no consensus,resulting in prevalence estimates ranging from 5%to 25%worldwide.Most systematic reviews define GERD as experi-encing heartburn and/or regurgitation at least once weekly,yielding a calculated prevalence of 13.98%.In 2017,the global age-standardized prevalence of GERD was estimated at 8819 per 100000 people(95%confidence interval:7781-9863),a figure that has remained stable from 1990 to 2017.Prevalence increases with age,leading to more years lived with disability.GERD significantly impairs quality of life and can lead to multiple complications.Additionally,it imposes a severe economic burden,with the United States alone estimated to spend around 10 billion dollars annually on diagnosis and treatment.In summary,GERD preva-lence varies greatly by region and even within different areas of the same province.Determining the exact prevalence is challenging due to inconsistent diagnostic criteria.However,it is well-documented that GERD poses a significant global burden,affecting the quality of life of individuals and creating a substantial healthcare cost.展开更多
The diagnosis of gastroesophageal reflux(GERD)in children is a complex and challenging task that requires meticulous attention to detail and a deep un-derstanding of pediatric physiology.It is absolutely crucial to di...The diagnosis of gastroesophageal reflux(GERD)in children is a complex and challenging task that requires meticulous attention to detail and a deep un-derstanding of pediatric physiology.It is absolutely crucial to distinguish between the benign chalasia of infancy and the more serious pathologic GERD.Recent advancements have shown that Combined Multichannel Intraluminal Impedance and pondus hydrogenii measurement offer superior diagnostic accuracy.The role of nuclear scans in diagnosing GERD remains an area of ongoing research.The management of GERD in children follows a stepwise approach,starting with medical therapy and progressing to surgical intervention if necessary.展开更多
BACKGROUND Gastroesophageal junction(GEJ)or gastrointestinal stromal tumor(GIST)are located in unfavorable parts of the stomach,due to the anatomical complexity of these regions,protecting the cardia while ensuring R0...BACKGROUND Gastroesophageal junction(GEJ)or gastrointestinal stromal tumor(GIST)are located in unfavorable parts of the stomach,due to the anatomical complexity of these regions,protecting the cardia while ensuring R0 resection is a major challenge for surgeons.CASE SUMMARY Two cases of GEJ stromal tumors were reported.Abdominal computed tomography scans revealed that both tumors were located at the GEJ,close to the posterior wall,with one tumor measuring greater than 5 cm.Both patients successfully underwent robot-assisted laparoscopic wedge resection of the stomach.The surgeries achieved R0 resection while preserving the cardia sphincter and maximizing gastric tissue preservation.Postoperatively,no symptoms such as gastroesophageal reflux or cardia stenosis were observed.Case 1:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD34,CD117,and DOG1,and negative for SMA,desmin,S-100,and SDHB(normal expression).The Ki-67 proliferation index was approximately 5%.Case 2:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD117(++),CD34(++),DOG1(+++),and focal positivity for SMA.Negative for desmin,S-100(few cells positive),and SDHB(preserved expression).The Ki-67 proliferation index was approximately 10%.CONCLUSION The gastric tube-guided robotic-assisted laparoscopic resection is a safe and effective method for tumor resection while preserving the cardia,and it is worth further promotion in clinical practice.展开更多
BACKGROUND Budd-Chiari syndrome(BCS)is caused by obstruction of the hepatic veins or suprahepatic inferior vena cava,leading to portal hypertension and the development of gastroesophageal varices(GEVs),which are assoc...BACKGROUND Budd-Chiari syndrome(BCS)is caused by obstruction of the hepatic veins or suprahepatic inferior vena cava,leading to portal hypertension and the development of gastroesophageal varices(GEVs),which are associated with an increased risk of bleeding.Existing risk models for variceal bleeding in cirrhotic patients have limited applicability to BCS due to differences in pathophysiology.Radiomics,as a noninvasive technique,holds promise as a tool for more accurate prediction of bleeding risk in BCS-related GEVs.AIM To develop and validate a personalized risk model for predicting variceal bleeding in BCS patients with GEVs.METHODS We retrospectively analyzed clinical data from 444 BCS patients with GEVs in two centers.Radiomic features were extracted from portal venous phase computed tomography(CT)scans.A training cohort of 334 patients was used to develop the model,with 110 patients serving as an external validation cohort.LASSO Cox regression was used to select radiomic features for constructing a radiomics score(Radscore).Univariate and multivariate Cox regression identified independent clinical predictors.A combined radiomics+clinical(R+C)model was developed using stepwise regression.Model performance was assessed using the area under the receiver operating characteristic curve(AUC),calibration plots,and decision curve analysis(DCA),with external validation to evaluate generalizability.RESULTS The Radscore comprised four hepatic and six splenic CT features,which predicted the risk of variceal bleeding.Multivariate analysis identified invasive treatment to relieve hepatic venous outflow obstruction,anticoagulant therapy,and hemoglobin levels as independent clinical predictors.The R+C model achieved C-indices of 0.906(training)and 0.859(validation),outperforming the radiomics and clinical models alone(AUC:training 0.936 vs 0.845 vs 0.823;validation 0.876 vs 0.712 vs 0.713).DCA showed higher clinical net benefit across the thresholds.The model stratified patients into low-,medium-and high-risk groups with significant differences in bleeding rates(P<0.001).An online tool is available at https://bcsvh.shinyapps.io/BCS_Variceal_Bleeding_Risk_Tool/.CONCLUSION We developed and validated a novel radiomics-based model that noninvasively and conveniently predicted risk of variceal bleeding in BCS patients with GEVs,aiding early identification and management of high-risk patients.展开更多
BACKGROUND Abnormal gastric acid reflux into the esophagus causes symptoms of gastroeso-phageal reflux disease(GERD)such as heartburn and regurgitation and also leads to mucosal damage.This damage can further lead to ...BACKGROUND Abnormal gastric acid reflux into the esophagus causes symptoms of gastroeso-phageal reflux disease(GERD)such as heartburn and regurgitation and also leads to mucosal damage.This damage can further lead to complications such as Bar-rett’s esophagus and esophagitis.Conventional proton pump inhibitors(PPIs)often fail to reduce nocturnal acid production,leaving patients with unresolved symptoms that worsen at night and decreased satisfaction.Happi ER,a novel dual delayed-release(DDR)formulation of rabeprazole,aims to address these limitations by providing both immediate and prolonged acid suppression.AIM To evaluate the safety and effectiveness of rabeprazole DDR 20 mg capsule in patients with GERD.METHODS This study involved a multicenter,real-world,prospective,observational design over an eight-week period.A total of 1022 GERD patients were treated with rabeprazole DDR 20 mg capsules(Happi ER),as prescribed by their physicians.We included adult patients with confirmed GERD and persistent heartburn symptoms despite prior PPI use.Outcome measures included heartburn severity,frequency of night-time awakenings,use of rescue medications,and overall patient satisfaction.RESULTS Rabeprazole DDR 20 mg capsules(Happi ER)were shown to be highly effective in treating GERD symptoms.At the end of the study,the mean heartburn score improved significantly from 2.46±0.67 at baseline to 0.16±0.39(P<0.0001).The median number of night-time awakenings decreased to 0(P<0.0001).More than 93%of patients rated the therapy as“excellent”or“very good”,reflecting high satisfaction.No significant adverse effects were reported,and the safety profile was comparable to that of traditional PPIs.CONCLUSION By providing both rapid and sustained acid suppression,Happi ER effectively treats GERD,particularly with respect to night-time symptoms.Its safety and efficacy profile make it a viable option for individuals with mild-to-moderate GERD,significantly improving the quality of life and symptom management.展开更多
BACKGROUND Research thoroughly examining how gastroesophageal reflux disease(GERD)affects clinical presentations in patients with laryngopharyngeal reflux disease(LPRD)and exploring the associated triggers is limited....BACKGROUND Research thoroughly examining how gastroesophageal reflux disease(GERD)affects clinical presentations in patients with laryngopharyngeal reflux disease(LPRD)and exploring the associated triggers is limited.AIM To investigate the effect of comorbid GERD on the clinical characteristics of patients with LPRD and determine risk contributors.METHODS In total,150 patients with LPRD admitted between October 2022 and October 2024 were divided into the GERD(n=74)or non-GERD(n=76)group based on their comorbid GERD status.The clinical data collected included age,sex,body mass index(BMI),marital status,smoking,alcohol consumption,and eating habits in the 3-hour window before sleep.The following reflux-related symptoms were recorded:(1)Hoarseness/voice disorders;(2)Persistent throat clearing;(3)Excessive phlegm/postnasal drip;(4)Difficulty swallowing food or water;(5)Postprandial or supine coughing;(6)Breathing difficulties;(7)Bothersome cough;(8)Throat foreign body sensation;(9)Heartburn,chest pain;and(10)Stomach pain.The Reflux Symptom Index(RSI)and Reflux Finding Score(RFS)tools were used.Binary logistic regression identified contributors to GERD in LPRD.RESULTS Compared with the non-GERD group,the GERD group,with a notably higher BMI,included greater proportions of older patients,female patients,smokers,and alcohol users and a higher prevalence of bothersome cough,heartburn,chest pain,and stomach pain;however,excessive phlegm or postnasal drip was less common.Additionally,patients with LPRD and comorbid GERD had notably higher RSI and RFS scores.Age(P=0.017),sex(P=0.029),smoking(P=0.012),and alcohol consumption(P=0.036)were significant triggers for GERD comorbidity in LPRD.CONCLUSION Comorbid GERD exacerbates clinical manifestations of patients with LPRD.Advanced age,female sex,smoking,and alcohol consumption predispose patients with LPRD to GERD development.展开更多
BACKGROUND Proximal gastrectomy for gastric cancer often leads to postoperative gastroeso-phageal reflux(GER).This study compares the impact of forearm anastomosis and posterior wall anastomosis techniques on GER in p...BACKGROUND Proximal gastrectomy for gastric cancer often leads to postoperative gastroeso-phageal reflux(GER).This study compares the impact of forearm anastomosis and posterior wall anastomosis techniques on GER in patients undergoing this procedure.AIM To identify the most effective method for reducing reflux symptoms while preserving gastrointestinal integrity and nutritional status.METHODS A retrospective evaluation was conducted on 60 patients who underwent proximal gastrectomy between December 2020 and December 2023,divided equally into two groups based on the anastomosis technique used(forearm or posterior wall).GER symptoms were assessed using the GER disease ques-tionnaire(GerdQ)preoperatively and on the first postoperative day.Biochemical markers[diamine oxidase(DAO),D-lactic acid,and endotoxin(ETX)]and nutritional indicators[serum ferritin(SF),prealbumin(PA),and albumin(ALB)]were measured to evaluate gastrointestinal barrier function and nutritional status.RESULTS Both groups showed significant improvements in GerdQ scores and reflux symptom scores post-treatment,with the observation group exhibiting greater reductions.Biochemical markers indicated enhanced gastrointestinal barrier function post-treatment in both groups,with notable increases in DAO,D-lactic,and ETX levels.Nutritional status indicators also demonstrated significant changes,with reductions in SF,PA,and ALB levels,suggesting an impact of treatment on inflammatory and nutritional status.CONCLUSION The forearm anastomosis technique appears to be more effective in reducing GER symptoms and preserving gastrointestinal health in patients undergoing proximal gastrectomy for gastric cancer compared to the posterior wall anastomosis technique.These preliminary findings advocate for further research to confirm the benefits and potentially standardize Forearm Anastomosis in surgical practice for gastric cancer.展开更多
BACKGROUND In recent years,endoscopic anti-reflux mucosal resection(ARMS)has demonstrated benefits,including good efficacy,ease of operation,low cost,and fewer complications;however,it is still in the exploratory stag...BACKGROUND In recent years,endoscopic anti-reflux mucosal resection(ARMS)has demonstrated benefits,including good efficacy,ease of operation,low cost,and fewer complications;however,it is still in the exploratory stage.AIM To evaluate the clinical efficacy of ARMS in patients with gastroesophageal reflux disease(GERD)and its effects on the gut microbiota.METHODS This single-center,retrospective,self-controlled study included 80 patients with GERD.All patients underwent endoscopic ARMS and were followed for at least 3 months after surgery.The primary outcome measures were changes in the gut microbiota before and after treatment and clinical efficacy.RESULTS After surgery,the counts of Escherichia coli and Staphylococcus aureus were significantly lower than those before surgery(P<0.05),whereas the counts of Bifidobacterium and Lactobacillus were significantly higher than those before surgery(P<0.05).Symptoms,such as reflux and heartburn,were markedly relieved postoperatively.The average Gerd Q score prior to surgery was 11.32±1.26 points,which decreased to 5.89±0.52 points 3 months after surgery.All patients used proton pump inhibitors before surgery,and the proportion of patients using proton pump inhibitors declined significantly postoperatively.Sixteen patients(20.0%)experienced surgery-related adverse reactions within 2 weeks to 1 month post-surgery.The incidence rates of postoperative esophageal stricture and delayed bleeding were 15.0%and 5.0%,respectively.CONCLUSION Endoscopic ARMS can effectively alleviate reflux symptoms,maintain gut microbiota balance,and improve gastrointestinal function in patients with GERD.展开更多
BACKGROUND Gastric cancer is a growing clinical challenge,particularly due to the increased risk of postoperative gastroesophageal reflux disease(GERD)following surgical treatment.traditional Chinese medicine(TCM),inc...BACKGROUND Gastric cancer is a growing clinical challenge,particularly due to the increased risk of postoperative gastroesophageal reflux disease(GERD)following surgical treatment.traditional Chinese medicine(TCM),including acupuncture and herbal medicine,has been proposed as an adjunctive therapy to promote gastrointestinal recovery and alleviate GERD symptoms.AIM To retrospectively study the clinical efficacy of modified Lou Bei Er Chen decoction combined with acupuncture in treating patients with GERD after radical gastrectomy due to gastric cancer.METHODS A retrospective study was conducted,including patients with gastric cancer or malignant tumors of the stomach from January 2019 to December 2023 in the Affiliated Taizhou People’s Hospital of Nanjing Medical University.Patients with a TCM diagnosis of qi depression and phlegm obstruction(n=128)were selected on the basis of prescription and treatment principles.They were then divided into a control group(n=61)and an observation group(n=67).The control group received treatment with Western medicine domperidone.The observation group were treated with Lou Bei Er Chen decoction orally,with acupuncture at specific RESULTS The observation group showed significantly shorter times for first flatus,defecation,bowel sound recovery,and initiation of nasogastric enteral nutrition than the control group(P<0.05).Upon treatment,the two groups demonstrated a significant reduction in gastrointestinal dysfunction scores,with a more significant reduction in the observation group(P<0.001).The GERD-Q scores significantly decreased after 8 weeks of treatment in the two groups(P<0.05),with a significant reduction in the observation group(P<0.05),compared with baseline.The TCM syndrome scores significantly decreased after 4 and 8 weeks of treatment in the two groups(P<0.05),with a significant reduction in the observation group(P<0.05).The effective rate of the observation group after 8 weeks of treatment was significantly higher than that after 4 weeks(χ2=13.648,P=0.003),and it was significantly higher than that of control group(χ2=13.879,P=0.003).CONCLUSION Lou Bei Er Chen decoction combined with acupuncture treatment can effectively alleviate clinical symptoms in patients GERD after gastric cancer surgery and improve their life quality.It is worthy of further promotion and application.展开更多
BACKGROUND Obesity is a significant global health concern,with laparoscopic sleeve gastrectomy(LSG)being the most commonly performed bariatric surgery in the Middle East,including Saudi Arabia,due to its simplicity an...BACKGROUND Obesity is a significant global health concern,with laparoscopic sleeve gastrectomy(LSG)being the most commonly performed bariatric surgery in the Middle East,including Saudi Arabia,due to its simplicity and effectiveness in achieving weight loss.However,the long-term effects of LSG on gastroesophageal reflux disease(GERD)and Barrett’s esophagus(BE)remain areas of active investigation.AIM To determine the prevalence of GERD and BE 5 years post-LSG in a Saudi Arabian population.METHODS A retrospective cohort study was conducted at a tertiary bariatric referral center in Saudi Arabia.Patients who underwent LSG 5 years prior and completed postoperative gastroscopy were included.Data on demographics,comorbidities,GERD symptoms,and endoscopic findings were extracted.GERD was defined clinically,esophagitis was graded per the Los Angeles classification,and BE was defined histologically.Multivariate logistic regression was used to identify predictors of GERD,endoscopic esophagitis(EE),and BE.RESULTS The study included 114 patients(mean age:44 years;61%female).GERD prevalence increased from 16%preoperatively to 64%5 years post-LSG,with 54%of cases representing de novo GERD.EE prevalence rose to 30%,with 23%of cases being de novo.BE was detected in 2.6%of patients,all presenting with short-segment BE without intestinal metaplasia.On univariate analysis,the pre-LSG body mass index was significantly associated with EE(P=0.038),and age was significantly associated with BE(P=0.037).However,on multivariate analysis,only hypertension was independently associated with GERD development(odds ratio=5.09;P=0.01).No factors were significantly associated with EE or BE on multivariate analysis.CONCLUSION This study highlights the significant increase in GERD and EE prevalence 5 years post-LSG,with a relatively low but notable incidence of BE.The findings underscore the need for long-term endoscopic surveillance,particularly for older patients,even in populations with lower baseline.展开更多
Prevalence of gastroesophageal reflux disease(GERD)has shown an upward trend over the years.Even though patients with GERD have a poor quality of life,the current treatment options are highly limited.In recent years,h...Prevalence of gastroesophageal reflux disease(GERD)has shown an upward trend over the years.Even though patients with GERD have a poor quality of life,the current treatment options are highly limited.In recent years,however,the development of anti-reflux mucosal intervention(ARMI),a novel strategy for treating GERD,has provided hope to such patients.ARMI comprises three main steps:Anti-reflux mucosectomy,anti-reflux mucosal ablation,and peroral endoscopic cardial constriction.ARMI involves the constriction of the pericardial mucosa through endoscopic surgery so as to reduce the damage caused by the reflux of gastric contents.This study compares different ARMI techniques,their therapeutic efficacy in treating GERD,indications and contraindications,endoscopic operational procedures,perioperative management,and adverse events,in an attempt to provide clinical guidance.展开更多
Objective:Although bariatric surgeries are widely performed around the world,patients frequently experience the recurrence of pre-existing gastroesophageal reflux disease(GERD)symptoms or develop new symptoms,some of ...Objective:Although bariatric surgeries are widely performed around the world,patients frequently experience the recurrence of pre-existing gastroesophageal reflux disease(GERD)symptoms or develop new symptoms,some of which are resistant to medical treatment.This study investigates the effect and outcome of magnetic sphincter augmentation(MSA),a minimally invasive treatment for GERD,in this population.Methods:A thorough search of the PubMed,Cochrane,Scopus,Web of Science,and Google Scholar databases from inception until June 6,2024 was performed to retrieve relevant studies that evaluated the effects of MSA on the GERD health-related quality of life(GERD-HRQL)score and the reduction in proton pump inhibitor(PPI)use in patients who underwent bariatric surgery.The“meta”package in RStudio version 2023.12.0 t 369 was used.Results:A total of eight studies were included in the systematic review and seven studies were included in the meta-analysis.MSA significantly reduced the GERD-HRQL score(MD?27.55[95%CI:30.99 to24.11],p<0.01)and PPI use(RR?0.23[95%CI:0.16 to 0.33],p<0.01).Conclusion:MSA is a viable treatment option for patients with GERD symptoms who undergo bariatric surgery.This approach showed promising results in terms of reducing the GERD-HRQL score and reducing the use of PPI.展开更多
BACKGROUND Gene expression of inflammatory cytokines may take part in the pathophysiology of different forms of gastroesophageal reflux disease(GERD).AIM To explore gene expression of inflammatory cytokines in esophag...BACKGROUND Gene expression of inflammatory cytokines may take part in the pathophysiology of different forms of gastroesophageal reflux disease(GERD).AIM To explore gene expression of inflammatory cytokines in esophageal mucosa in patients with erosive esophagitis(EE)and non-erosive forms of GERD(NERD)and its association with data of esophageal multichannel intraluminal impedancepH(MII-pH)measurements.METHODS This was a single-center prospective study.Esophageal mucosa samples were taken from the lower part of the esophagus during endoscopy.Expression of interleukin(IL)-1β,IL-10,IL-18,tumor necrosis factorα(TNFA),toll-like receptor 4(TLR4),GATA binding protein 3(GATA3),differentiation cluster 68(CD68)andβ-2 microglobulin genes in esophageal mucosa was assessed with ImmunoQuantex assays.MII-pH measurements were performed on all the participants.Diagnosis of GERD was confirmed by the results of the MII-pH data.Based on the endoscopy,patients were allocated to the groups of EE and NERD.The control group consisted of non-symptomatic subjects with normal endoscopy and MII-pH results.We used nonparametric statistics to compare the differences between the groups.Association of expression of the mentioned genes with the results of the MII-pH data was assessed with Spearman’s rank method.RESULTS Data from 60 patients with GERD and 10 subjects of the control group were available for the analysis.Higher expression of IL-18(5.89±0.4 vs 5.28±1.1,P=0.04)and GATA3(2.92±0.86 vs 2.23±0.96,P=0.03)was found in the EE group compared to NERD.Expression of IL-1β,IL-18,TNFA,and TLR4 was lower(P<0.05)in the control group compared to EE and NERD.Esophageal acid exposure correlated with the expression of IL-1β(Spearman’s rank r=0.29),IL-18(r=0.31),TNFA(r=0.35),GATA3(r=0.34),TLR4(r=0.29),and CD68(r=0.37).Mean esophagealрНcorrelated inversely with the expression of IL-18,TNFA,GATA3,TLR4,and CD68.No association of gene expression with the number of gastroesophageal refluxes was found.CONCLUSION In patients with EE,local expression of IL-18 and GATA3 was higher compared to subjects with NERD.Esophageal acid exposure correlated directly with expression of IL-1β,IL-18,TNFA,TLR4,CD68,andβ-2 microglobulin genes.Inverse correlation was revealed between expression of IL-18,TNFA,GATA3,TLR4,and CD68 and mean esophageal pH.展开更多
Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of gastric contents into the esophagus leads to troublesome symptoms and/or complications. Heartburn is the cardinal symptom, often a...Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of gastric contents into the esophagus leads to troublesome symptoms and/or complications. Heartburn is the cardinal symptom, often associated with regurgitation. In patients with endoscopy-negative heartburn refractory to proton pump inhibitor (PPI) therapy and when the diagnosis of GERD is in question, direct reflux testing by impedance-pH monitoring is warranted. Laparoscopic fundoplication is the standard surgical treatment for GERD. It is highly effective in curing GERD with a 80% success rate at 20-year follow-up. The Nissen fundoplication, consisting of a total (360°) wrap, is the most commonly performed antireflux operation. To reduce postoperative dysphagia and gas bloating, partial fundoplications are also used, including the posterior (Toupet) fundoplication, and the anterior (Dor) fundoplication. Currently, there is consensus to advise laparoscopic fundoplication in PPI-responsive GERD only for those patients who develop untoward side-effects or complications from PPI therapy. PPI resistance is the real challenge in GERD. There is consensus that carefully selected GERD patients refractory to PPI therapy are eligible for laparoscopic fundoplication, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained. For this purpose, impedance-pH monitoring is regarded as the diagnostic gold standard.展开更多
Gastroesophageal reflux disease(GERD)is a common gastrointestinal disorder with an increasing prevalence.GERD develops when the reflux of stomach contents causes troublesome typical and atypical symptoms and/or compli...Gastroesophageal reflux disease(GERD)is a common gastrointestinal disorder with an increasing prevalence.GERD develops when the reflux of stomach contents causes troublesome typical and atypical symptoms and/or complications.Several risk factors of GERD have been identified and evaluated over the years,including a considerable amount of genetic factors.Multiple mechanisms are involved in the pathogenesis of GERD including:(1)motor abnormalities,such as impaired lower esophageal sphincter(LES)resting tone,transient LES relaxations,impaired esophageal acid clearance and delayed gastric emptying;and(2)anatomical factors,such as hiatal hernia and obesity.Genetic contribution seems to play a major role in GERD and GERD-related disorders development such Barrett's esophagus and esophageal adenocarcinoma.Twin and family studies have revealed an about 31%heritability of the disease.Numerous single-nucleotide polymorphisms in various genes like FOXF1,MHC,CCND1,anti-inflammatory cytokine and DNA repair genes have been strongly associated with increased GERD risk.GERD,Barrett'sesophagus and esophageal adenocarcinoma share several genetic loci.Despite GERD polygenic basis,specific genetic loci such as rs10419226 on chromosome 19,rs2687201 on chromosome 3,rs10852151 on chromosome 15 and rs520525 on the paired related homeobox 1 gene have been mentioned as potential risk factors.Further investigation on the risk genes may elucidate their exact function and role and demonstrate new therapeutic approaches to this increasingly common disease.展开更多
文摘Gastroesophageal reflux disease(GERD)affects both adults and children,although the symptoms differ significantly between these groups.While adults typically experience heartburn and regurgitation,children may present with more subtle signs,such as failure to thrive,chronic cough,wheezing,and Sandifer syn-drome.Diagnosing GERD in children necessitates a multifaceted approach due to the diverse symptomatology and challenges in communication.Clinical assess-ment serves as the cornerstone of diagnosis,supported by tools like pH moni-toring,esophageal impedance testing,and upper gastrointestinal endoscopy.Imaging studies,such as barium swallow,can also provide valuable insights into anatomical abnormalities and the extent of reflux.Treatment strategies for pe-diatric GERD include lifestyle adjustments,pharmacotherapy,and,in severe cases,surgical interventions.Lifestyle adjustments may involve changes in fee-ding patterns,positional therapy,and weight management.Pharmacological options range from acid suppression with proton pump inhibitors or histamine-2 receptor antagonists to surgical procedures like fundoplication for refractory cases.Personalized management is essential,considering the child’s age,sym-ptom severity,and the presence of complications.This article aims to offer a comprehensive understanding of pediatric GERD by utilizing current research to enhance clinical approaches and improve patient outcomes.
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.
文摘BACKGROUND The rising global prevalence of gastroesophageal reflux disease(GERD)has been closely linked to lifestyle changes driven by globalization.GERD imposes a substantial public health burden,affecting quality of life and leading to potential complications.Early intervention through lifestyle modification can prevent disease onset;however,there is a lack of effective risk prediction models that emphasize primary prevention.AIM To develop and validate a GERD Risk Scoring System(GRSS)aimed at identifying high-risk individuals and promoting primary prevention strategies.METHODS A 45-item questionnaire encompassing major lifestyle and demographic risk factors was developed and validated.It was administered to healthy controls and GERD patients.Two regression models-one using continuous variables and another using categorized variables-were used to develop a computational prediction equation and a clinically applicable scoring scale.An independent validation cohort of 355 participants was used to assess model performance in terms of discrimination(C-index),calibration,sensitivity,specificity,internal consistency(Cronbach's alpha),and test-retest reliability(intraclass correlation coefficient,Bland-Altman analysis).RESULTS Significant associations were observed between GERD and key lifestyle factors.The derived GRSS equation and scoring scale demonstrated strong discriminative ability,with high sensitivity and specificity.The scoring system exhibited excellent internal consistency(Cronbach’s alpha)and strong test-retest reliability.The C-index indicated excellent predictive accuracy in both derivation and validation cohorts.CONCLUSION GRSS offers a novel and validated approach to GERD risk prediction,combining a robust equation for digital applications and a practical scale for clinical use.Its ability to accurately identify at-risk individuals supports a paradigm shift toward primary prevention,underscoring its significance in addressing the growing burden of GERD at the population level.
文摘Gastroesophageal reflux disease(GERD)poses a substantial global health challenge,with prevalence rates exhibiting geographical variation.Despite its widespread recognition,the exact prevalence and associated risk factors remain elusive.This article comprehensively analyzed the global burden of GERD,shedding light on its risk factors,underlying pathophysiological mechanisms,current diagnostic modalities,evolving management strategies tailored to diverse patient profiles,and complex determinants contributing to treatment failures.A deeper comprehension of GERD is achieved by dissecting these intricate facets,paving the way for enhanced clinical management and improved patient outcomes.
基金Supported by the National Major Project of Science and Technology for the Prevention and Control of the"Four Major Chronic Diseases",No.2024ZD0520903National Natural Science Foundation of China,No.82004324+4 种基金the Training Program for High-caliber Talents of Clinical Research at Affiliated Hospitals of SHUTCMthe Training Project for Xinglin Young and Middle-Aged Talents of Shanghai University of Traditional Chinese Medicine,No.SHUTCM HR(2020)23the Project of National Famous Traditional Chinese Medicine Expert(Shengliang Zhu)Inheritance Studio,No.NATCM HR(2022)75the Zhu Shengliang Academic Experience Research Studio Project of Shanghai Famous Traditional Chinese Medicine,No.SHGZS-202203the Shanghai High-Level Talent Leadership Plan for Traditional Chinese Medicine,No.ZY(2021-2023)-0403.
文摘BACKGROUND Esophageal hypersensitivity is an important cause of refractory gastroesophageal reflux disease,in which patients do not respond to standard acid-suppressive therapy and suffer from continuous noncardiac chest pain and regurgitation.The N-methyl-D-aspartate receptor(NMDAR)may play a crucial role in the deve-lopment of visceral hypersensitivity in functional gastrointestinal disorders.However,the specific mechanisms of visceral hypersensitivity in upper digestive tract diseases remain poorly understood.AIM To investigate the role of the NMDAR2B/protein kinase A(PKA)/cAMP-response element binding protein(CREB)signaling pathway in the development of esophageal neuropathic pain associated with gastroesophageal reflux disease(GERD).METHODS Thirty-six 6-week-old specific pathogen free rats were randomly assigned to six groups:the control,model,model+NMDAR agonist,model+NMDAR anta-gonist,model+PKA antagonist,and model+NMDAR antagonist+PKA agonist groups,with six rats in each group.The model was induced via an intraperitoneal injection of ovalbumin for sensitization along with local esophageal stimulation.Immunohistochemistry and Western blotting were utilized to assess the expression levels of NMDAR2B signaling pathway-related proteins in the cingulate gyrus,dorsal thalamus,spinal dorsal horn,and peripheral esophageal tissues.RT-PCR was used to measure the corresponding mRNA expression,and ELISA was used to determine the serum brain-derived neurotrophic factor(BDNF)concentration.Behavioral scoring was performed during balloon distention and acid perfusion of the lower esophagus.RESULTS Compared with the control group,the model group presented significantly increased expression levels of the NMDAR2B,PKA,CREB,BDNF,substance P,and calcitonin gene-related peptide proteins and mRNAs in the cingulate gyrus,dorsal thalamus,spinal dorsal horn,and lower esophagus(P<0.05).Compared with the model group,the model+NMDAR agonist group exhibited even higher expression levels of these proteins and mRNAs(P<0.05),whereas the model+NMDAR antagonist and model+PKA antagonist groups presented lower expression levels(P<0.05).The model+NMDAR antagonist+PKA agonist group presented higher expression levels than did the model+NMDAR antagonist group(P<0.05).The changes in the serum BDNF concentration and behavioral score during balloon distention and acid perfusion were consistent with these changes in expression.CONCLUSION The NMDAR2B signaling pathway plays a critical role in the development of neuropathic pain in GERD through the PKA/CREB/BDNF pathway.
文摘The exact worldwide prevalence of gastroesophageal reflux disease(GERD)re-mains uncertain,despite its recognition as a common condition.This conundrum arises primarily from the lack of a standardized definition for GERD.The gold standard diagnostic tests for GERD,such as pH impedance testing and endo-scopy,are cumbersome and impractical for assessing community prevalence.Consequently,most epidemiological studies rely on symptom-based screening tools.GERD symptoms can be both esophageal and extraesophageal,varying widely among individuals.This variability has led to multiple symptom-based definitions of GERD,with no consensus,resulting in prevalence estimates ranging from 5%to 25%worldwide.Most systematic reviews define GERD as experi-encing heartburn and/or regurgitation at least once weekly,yielding a calculated prevalence of 13.98%.In 2017,the global age-standardized prevalence of GERD was estimated at 8819 per 100000 people(95%confidence interval:7781-9863),a figure that has remained stable from 1990 to 2017.Prevalence increases with age,leading to more years lived with disability.GERD significantly impairs quality of life and can lead to multiple complications.Additionally,it imposes a severe economic burden,with the United States alone estimated to spend around 10 billion dollars annually on diagnosis and treatment.In summary,GERD preva-lence varies greatly by region and even within different areas of the same province.Determining the exact prevalence is challenging due to inconsistent diagnostic criteria.However,it is well-documented that GERD poses a significant global burden,affecting the quality of life of individuals and creating a substantial healthcare cost.
文摘The diagnosis of gastroesophageal reflux(GERD)in children is a complex and challenging task that requires meticulous attention to detail and a deep un-derstanding of pediatric physiology.It is absolutely crucial to distinguish between the benign chalasia of infancy and the more serious pathologic GERD.Recent advancements have shown that Combined Multichannel Intraluminal Impedance and pondus hydrogenii measurement offer superior diagnostic accuracy.The role of nuclear scans in diagnosing GERD remains an area of ongoing research.The management of GERD in children follows a stepwise approach,starting with medical therapy and progressing to surgical intervention if necessary.
基金Supported by Jiangsu Provincial Administration of Traditional Chinese Medicine,No.MS2023017 and No.SLJ0311the Jiangsu Provincial Health Commission,No.ZDXK202251.
文摘BACKGROUND Gastroesophageal junction(GEJ)or gastrointestinal stromal tumor(GIST)are located in unfavorable parts of the stomach,due to the anatomical complexity of these regions,protecting the cardia while ensuring R0 resection is a major challenge for surgeons.CASE SUMMARY Two cases of GEJ stromal tumors were reported.Abdominal computed tomography scans revealed that both tumors were located at the GEJ,close to the posterior wall,with one tumor measuring greater than 5 cm.Both patients successfully underwent robot-assisted laparoscopic wedge resection of the stomach.The surgeries achieved R0 resection while preserving the cardia sphincter and maximizing gastric tissue preservation.Postoperatively,no symptoms such as gastroesophageal reflux or cardia stenosis were observed.Case 1:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD34,CD117,and DOG1,and negative for SMA,desmin,S-100,and SDHB(normal expression).The Ki-67 proliferation index was approximately 5%.Case 2:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD117(++),CD34(++),DOG1(+++),and focal positivity for SMA.Negative for desmin,S-100(few cells positive),and SDHB(preserved expression).The Ki-67 proliferation index was approximately 10%.CONCLUSION The gastric tube-guided robotic-assisted laparoscopic resection is a safe and effective method for tumor resection while preserving the cardia,and it is worth further promotion in clinical practice.
基金Supported by Natural Science Foundation of Henan Province,China,No.232300420232Henan Provincial Key Research and Development Project,No.231111313500.
文摘BACKGROUND Budd-Chiari syndrome(BCS)is caused by obstruction of the hepatic veins or suprahepatic inferior vena cava,leading to portal hypertension and the development of gastroesophageal varices(GEVs),which are associated with an increased risk of bleeding.Existing risk models for variceal bleeding in cirrhotic patients have limited applicability to BCS due to differences in pathophysiology.Radiomics,as a noninvasive technique,holds promise as a tool for more accurate prediction of bleeding risk in BCS-related GEVs.AIM To develop and validate a personalized risk model for predicting variceal bleeding in BCS patients with GEVs.METHODS We retrospectively analyzed clinical data from 444 BCS patients with GEVs in two centers.Radiomic features were extracted from portal venous phase computed tomography(CT)scans.A training cohort of 334 patients was used to develop the model,with 110 patients serving as an external validation cohort.LASSO Cox regression was used to select radiomic features for constructing a radiomics score(Radscore).Univariate and multivariate Cox regression identified independent clinical predictors.A combined radiomics+clinical(R+C)model was developed using stepwise regression.Model performance was assessed using the area under the receiver operating characteristic curve(AUC),calibration plots,and decision curve analysis(DCA),with external validation to evaluate generalizability.RESULTS The Radscore comprised four hepatic and six splenic CT features,which predicted the risk of variceal bleeding.Multivariate analysis identified invasive treatment to relieve hepatic venous outflow obstruction,anticoagulant therapy,and hemoglobin levels as independent clinical predictors.The R+C model achieved C-indices of 0.906(training)and 0.859(validation),outperforming the radiomics and clinical models alone(AUC:training 0.936 vs 0.845 vs 0.823;validation 0.876 vs 0.712 vs 0.713).DCA showed higher clinical net benefit across the thresholds.The model stratified patients into low-,medium-and high-risk groups with significant differences in bleeding rates(P<0.001).An online tool is available at https://bcsvh.shinyapps.io/BCS_Variceal_Bleeding_Risk_Tool/.CONCLUSION We developed and validated a novel radiomics-based model that noninvasively and conveniently predicted risk of variceal bleeding in BCS patients with GEVs,aiding early identification and management of high-risk patients.
文摘BACKGROUND Abnormal gastric acid reflux into the esophagus causes symptoms of gastroeso-phageal reflux disease(GERD)such as heartburn and regurgitation and also leads to mucosal damage.This damage can further lead to complications such as Bar-rett’s esophagus and esophagitis.Conventional proton pump inhibitors(PPIs)often fail to reduce nocturnal acid production,leaving patients with unresolved symptoms that worsen at night and decreased satisfaction.Happi ER,a novel dual delayed-release(DDR)formulation of rabeprazole,aims to address these limitations by providing both immediate and prolonged acid suppression.AIM To evaluate the safety and effectiveness of rabeprazole DDR 20 mg capsule in patients with GERD.METHODS This study involved a multicenter,real-world,prospective,observational design over an eight-week period.A total of 1022 GERD patients were treated with rabeprazole DDR 20 mg capsules(Happi ER),as prescribed by their physicians.We included adult patients with confirmed GERD and persistent heartburn symptoms despite prior PPI use.Outcome measures included heartburn severity,frequency of night-time awakenings,use of rescue medications,and overall patient satisfaction.RESULTS Rabeprazole DDR 20 mg capsules(Happi ER)were shown to be highly effective in treating GERD symptoms.At the end of the study,the mean heartburn score improved significantly from 2.46±0.67 at baseline to 0.16±0.39(P<0.0001).The median number of night-time awakenings decreased to 0(P<0.0001).More than 93%of patients rated the therapy as“excellent”or“very good”,reflecting high satisfaction.No significant adverse effects were reported,and the safety profile was comparable to that of traditional PPIs.CONCLUSION By providing both rapid and sustained acid suppression,Happi ER effectively treats GERD,particularly with respect to night-time symptoms.Its safety and efficacy profile make it a viable option for individuals with mild-to-moderate GERD,significantly improving the quality of life and symptom management.
文摘BACKGROUND Research thoroughly examining how gastroesophageal reflux disease(GERD)affects clinical presentations in patients with laryngopharyngeal reflux disease(LPRD)and exploring the associated triggers is limited.AIM To investigate the effect of comorbid GERD on the clinical characteristics of patients with LPRD and determine risk contributors.METHODS In total,150 patients with LPRD admitted between October 2022 and October 2024 were divided into the GERD(n=74)or non-GERD(n=76)group based on their comorbid GERD status.The clinical data collected included age,sex,body mass index(BMI),marital status,smoking,alcohol consumption,and eating habits in the 3-hour window before sleep.The following reflux-related symptoms were recorded:(1)Hoarseness/voice disorders;(2)Persistent throat clearing;(3)Excessive phlegm/postnasal drip;(4)Difficulty swallowing food or water;(5)Postprandial or supine coughing;(6)Breathing difficulties;(7)Bothersome cough;(8)Throat foreign body sensation;(9)Heartburn,chest pain;and(10)Stomach pain.The Reflux Symptom Index(RSI)and Reflux Finding Score(RFS)tools were used.Binary logistic regression identified contributors to GERD in LPRD.RESULTS Compared with the non-GERD group,the GERD group,with a notably higher BMI,included greater proportions of older patients,female patients,smokers,and alcohol users and a higher prevalence of bothersome cough,heartburn,chest pain,and stomach pain;however,excessive phlegm or postnasal drip was less common.Additionally,patients with LPRD and comorbid GERD had notably higher RSI and RFS scores.Age(P=0.017),sex(P=0.029),smoking(P=0.012),and alcohol consumption(P=0.036)were significant triggers for GERD comorbidity in LPRD.CONCLUSION Comorbid GERD exacerbates clinical manifestations of patients with LPRD.Advanced age,female sex,smoking,and alcohol consumption predispose patients with LPRD to GERD development.
文摘BACKGROUND Proximal gastrectomy for gastric cancer often leads to postoperative gastroeso-phageal reflux(GER).This study compares the impact of forearm anastomosis and posterior wall anastomosis techniques on GER in patients undergoing this procedure.AIM To identify the most effective method for reducing reflux symptoms while preserving gastrointestinal integrity and nutritional status.METHODS A retrospective evaluation was conducted on 60 patients who underwent proximal gastrectomy between December 2020 and December 2023,divided equally into two groups based on the anastomosis technique used(forearm or posterior wall).GER symptoms were assessed using the GER disease ques-tionnaire(GerdQ)preoperatively and on the first postoperative day.Biochemical markers[diamine oxidase(DAO),D-lactic acid,and endotoxin(ETX)]and nutritional indicators[serum ferritin(SF),prealbumin(PA),and albumin(ALB)]were measured to evaluate gastrointestinal barrier function and nutritional status.RESULTS Both groups showed significant improvements in GerdQ scores and reflux symptom scores post-treatment,with the observation group exhibiting greater reductions.Biochemical markers indicated enhanced gastrointestinal barrier function post-treatment in both groups,with notable increases in DAO,D-lactic,and ETX levels.Nutritional status indicators also demonstrated significant changes,with reductions in SF,PA,and ALB levels,suggesting an impact of treatment on inflammatory and nutritional status.CONCLUSION The forearm anastomosis technique appears to be more effective in reducing GER symptoms and preserving gastrointestinal health in patients undergoing proximal gastrectomy for gastric cancer compared to the posterior wall anastomosis technique.These preliminary findings advocate for further research to confirm the benefits and potentially standardize Forearm Anastomosis in surgical practice for gastric cancer.
文摘BACKGROUND In recent years,endoscopic anti-reflux mucosal resection(ARMS)has demonstrated benefits,including good efficacy,ease of operation,low cost,and fewer complications;however,it is still in the exploratory stage.AIM To evaluate the clinical efficacy of ARMS in patients with gastroesophageal reflux disease(GERD)and its effects on the gut microbiota.METHODS This single-center,retrospective,self-controlled study included 80 patients with GERD.All patients underwent endoscopic ARMS and were followed for at least 3 months after surgery.The primary outcome measures were changes in the gut microbiota before and after treatment and clinical efficacy.RESULTS After surgery,the counts of Escherichia coli and Staphylococcus aureus were significantly lower than those before surgery(P<0.05),whereas the counts of Bifidobacterium and Lactobacillus were significantly higher than those before surgery(P<0.05).Symptoms,such as reflux and heartburn,were markedly relieved postoperatively.The average Gerd Q score prior to surgery was 11.32±1.26 points,which decreased to 5.89±0.52 points 3 months after surgery.All patients used proton pump inhibitors before surgery,and the proportion of patients using proton pump inhibitors declined significantly postoperatively.Sixteen patients(20.0%)experienced surgery-related adverse reactions within 2 weeks to 1 month post-surgery.The incidence rates of postoperative esophageal stricture and delayed bleeding were 15.0%and 5.0%,respectively.CONCLUSION Endoscopic ARMS can effectively alleviate reflux symptoms,maintain gut microbiota balance,and improve gastrointestinal function in patients with GERD.
文摘BACKGROUND Gastric cancer is a growing clinical challenge,particularly due to the increased risk of postoperative gastroesophageal reflux disease(GERD)following surgical treatment.traditional Chinese medicine(TCM),including acupuncture and herbal medicine,has been proposed as an adjunctive therapy to promote gastrointestinal recovery and alleviate GERD symptoms.AIM To retrospectively study the clinical efficacy of modified Lou Bei Er Chen decoction combined with acupuncture in treating patients with GERD after radical gastrectomy due to gastric cancer.METHODS A retrospective study was conducted,including patients with gastric cancer or malignant tumors of the stomach from January 2019 to December 2023 in the Affiliated Taizhou People’s Hospital of Nanjing Medical University.Patients with a TCM diagnosis of qi depression and phlegm obstruction(n=128)were selected on the basis of prescription and treatment principles.They were then divided into a control group(n=61)and an observation group(n=67).The control group received treatment with Western medicine domperidone.The observation group were treated with Lou Bei Er Chen decoction orally,with acupuncture at specific RESULTS The observation group showed significantly shorter times for first flatus,defecation,bowel sound recovery,and initiation of nasogastric enteral nutrition than the control group(P<0.05).Upon treatment,the two groups demonstrated a significant reduction in gastrointestinal dysfunction scores,with a more significant reduction in the observation group(P<0.001).The GERD-Q scores significantly decreased after 8 weeks of treatment in the two groups(P<0.05),with a significant reduction in the observation group(P<0.05),compared with baseline.The TCM syndrome scores significantly decreased after 4 and 8 weeks of treatment in the two groups(P<0.05),with a significant reduction in the observation group(P<0.05).The effective rate of the observation group after 8 weeks of treatment was significantly higher than that after 4 weeks(χ2=13.648,P=0.003),and it was significantly higher than that of control group(χ2=13.879,P=0.003).CONCLUSION Lou Bei Er Chen decoction combined with acupuncture treatment can effectively alleviate clinical symptoms in patients GERD after gastric cancer surgery and improve their life quality.It is worthy of further promotion and application.
文摘BACKGROUND Obesity is a significant global health concern,with laparoscopic sleeve gastrectomy(LSG)being the most commonly performed bariatric surgery in the Middle East,including Saudi Arabia,due to its simplicity and effectiveness in achieving weight loss.However,the long-term effects of LSG on gastroesophageal reflux disease(GERD)and Barrett’s esophagus(BE)remain areas of active investigation.AIM To determine the prevalence of GERD and BE 5 years post-LSG in a Saudi Arabian population.METHODS A retrospective cohort study was conducted at a tertiary bariatric referral center in Saudi Arabia.Patients who underwent LSG 5 years prior and completed postoperative gastroscopy were included.Data on demographics,comorbidities,GERD symptoms,and endoscopic findings were extracted.GERD was defined clinically,esophagitis was graded per the Los Angeles classification,and BE was defined histologically.Multivariate logistic regression was used to identify predictors of GERD,endoscopic esophagitis(EE),and BE.RESULTS The study included 114 patients(mean age:44 years;61%female).GERD prevalence increased from 16%preoperatively to 64%5 years post-LSG,with 54%of cases representing de novo GERD.EE prevalence rose to 30%,with 23%of cases being de novo.BE was detected in 2.6%of patients,all presenting with short-segment BE without intestinal metaplasia.On univariate analysis,the pre-LSG body mass index was significantly associated with EE(P=0.038),and age was significantly associated with BE(P=0.037).However,on multivariate analysis,only hypertension was independently associated with GERD development(odds ratio=5.09;P=0.01).No factors were significantly associated with EE or BE on multivariate analysis.CONCLUSION This study highlights the significant increase in GERD and EE prevalence 5 years post-LSG,with a relatively low but notable incidence of BE.The findings underscore the need for long-term endoscopic surveillance,particularly for older patients,even in populations with lower baseline.
基金Supported by National Natural Science Foundation of China,No.82200613Shanghai“Rising Stars of Medical Talents”Youth Development Program,No.SHWSRS(2025)_071+3 种基金The Healthcare Talents Youth Program of Shanghai Pudong New Area,No.2025PDWSYCQN-03Shanghai Municipal Health Commission,No.2024ZDXK0001the Medical Discipline Construction Project of Pudong Health Committee of Shanghai,No.PWZxq2022-6,No.2024-PWXZ-07,and No.2025PDWSYCBJ-01Shanghai East Hospital's Key Clinical Disciplines and Specialty Departments,No.2024-DFZD-005.
文摘Prevalence of gastroesophageal reflux disease(GERD)has shown an upward trend over the years.Even though patients with GERD have a poor quality of life,the current treatment options are highly limited.In recent years,however,the development of anti-reflux mucosal intervention(ARMI),a novel strategy for treating GERD,has provided hope to such patients.ARMI comprises three main steps:Anti-reflux mucosectomy,anti-reflux mucosal ablation,and peroral endoscopic cardial constriction.ARMI involves the constriction of the pericardial mucosa through endoscopic surgery so as to reduce the damage caused by the reflux of gastric contents.This study compares different ARMI techniques,their therapeutic efficacy in treating GERD,indications and contraindications,endoscopic operational procedures,perioperative management,and adverse events,in an attempt to provide clinical guidance.
文摘Objective:Although bariatric surgeries are widely performed around the world,patients frequently experience the recurrence of pre-existing gastroesophageal reflux disease(GERD)symptoms or develop new symptoms,some of which are resistant to medical treatment.This study investigates the effect and outcome of magnetic sphincter augmentation(MSA),a minimally invasive treatment for GERD,in this population.Methods:A thorough search of the PubMed,Cochrane,Scopus,Web of Science,and Google Scholar databases from inception until June 6,2024 was performed to retrieve relevant studies that evaluated the effects of MSA on the GERD health-related quality of life(GERD-HRQL)score and the reduction in proton pump inhibitor(PPI)use in patients who underwent bariatric surgery.The“meta”package in RStudio version 2023.12.0 t 369 was used.Results:A total of eight studies were included in the systematic review and seven studies were included in the meta-analysis.MSA significantly reduced the GERD-HRQL score(MD?27.55[95%CI:30.99 to24.11],p<0.01)and PPI use(RR?0.23[95%CI:0.16 to 0.33],p<0.01).Conclusion:MSA is a viable treatment option for patients with GERD symptoms who undergo bariatric surgery.This approach showed promising results in terms of reducing the GERD-HRQL score and reducing the use of PPI.
基金Supported by Ministry of Science and Higher Education,No.FGMF-2022-0005 and No.0410-2020-0007。
文摘BACKGROUND Gene expression of inflammatory cytokines may take part in the pathophysiology of different forms of gastroesophageal reflux disease(GERD).AIM To explore gene expression of inflammatory cytokines in esophageal mucosa in patients with erosive esophagitis(EE)and non-erosive forms of GERD(NERD)and its association with data of esophageal multichannel intraluminal impedancepH(MII-pH)measurements.METHODS This was a single-center prospective study.Esophageal mucosa samples were taken from the lower part of the esophagus during endoscopy.Expression of interleukin(IL)-1β,IL-10,IL-18,tumor necrosis factorα(TNFA),toll-like receptor 4(TLR4),GATA binding protein 3(GATA3),differentiation cluster 68(CD68)andβ-2 microglobulin genes in esophageal mucosa was assessed with ImmunoQuantex assays.MII-pH measurements were performed on all the participants.Diagnosis of GERD was confirmed by the results of the MII-pH data.Based on the endoscopy,patients were allocated to the groups of EE and NERD.The control group consisted of non-symptomatic subjects with normal endoscopy and MII-pH results.We used nonparametric statistics to compare the differences between the groups.Association of expression of the mentioned genes with the results of the MII-pH data was assessed with Spearman’s rank method.RESULTS Data from 60 patients with GERD and 10 subjects of the control group were available for the analysis.Higher expression of IL-18(5.89±0.4 vs 5.28±1.1,P=0.04)and GATA3(2.92±0.86 vs 2.23±0.96,P=0.03)was found in the EE group compared to NERD.Expression of IL-1β,IL-18,TNFA,and TLR4 was lower(P<0.05)in the control group compared to EE and NERD.Esophageal acid exposure correlated with the expression of IL-1β(Spearman’s rank r=0.29),IL-18(r=0.31),TNFA(r=0.35),GATA3(r=0.34),TLR4(r=0.29),and CD68(r=0.37).Mean esophagealрНcorrelated inversely with the expression of IL-18,TNFA,GATA3,TLR4,and CD68.No association of gene expression with the number of gastroesophageal refluxes was found.CONCLUSION In patients with EE,local expression of IL-18 and GATA3 was higher compared to subjects with NERD.Esophageal acid exposure correlated directly with expression of IL-1β,IL-18,TNFA,TLR4,CD68,andβ-2 microglobulin genes.Inverse correlation was revealed between expression of IL-18,TNFA,GATA3,TLR4,and CD68 and mean esophageal pH.
文摘Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of gastric contents into the esophagus leads to troublesome symptoms and/or complications. Heartburn is the cardinal symptom, often associated with regurgitation. In patients with endoscopy-negative heartburn refractory to proton pump inhibitor (PPI) therapy and when the diagnosis of GERD is in question, direct reflux testing by impedance-pH monitoring is warranted. Laparoscopic fundoplication is the standard surgical treatment for GERD. It is highly effective in curing GERD with a 80% success rate at 20-year follow-up. The Nissen fundoplication, consisting of a total (360°) wrap, is the most commonly performed antireflux operation. To reduce postoperative dysphagia and gas bloating, partial fundoplications are also used, including the posterior (Toupet) fundoplication, and the anterior (Dor) fundoplication. Currently, there is consensus to advise laparoscopic fundoplication in PPI-responsive GERD only for those patients who develop untoward side-effects or complications from PPI therapy. PPI resistance is the real challenge in GERD. There is consensus that carefully selected GERD patients refractory to PPI therapy are eligible for laparoscopic fundoplication, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained. For this purpose, impedance-pH monitoring is regarded as the diagnostic gold standard.
文摘Gastroesophageal reflux disease(GERD)is a common gastrointestinal disorder with an increasing prevalence.GERD develops when the reflux of stomach contents causes troublesome typical and atypical symptoms and/or complications.Several risk factors of GERD have been identified and evaluated over the years,including a considerable amount of genetic factors.Multiple mechanisms are involved in the pathogenesis of GERD including:(1)motor abnormalities,such as impaired lower esophageal sphincter(LES)resting tone,transient LES relaxations,impaired esophageal acid clearance and delayed gastric emptying;and(2)anatomical factors,such as hiatal hernia and obesity.Genetic contribution seems to play a major role in GERD and GERD-related disorders development such Barrett's esophagus and esophageal adenocarcinoma.Twin and family studies have revealed an about 31%heritability of the disease.Numerous single-nucleotide polymorphisms in various genes like FOXF1,MHC,CCND1,anti-inflammatory cytokine and DNA repair genes have been strongly associated with increased GERD risk.GERD,Barrett'sesophagus and esophageal adenocarcinoma share several genetic loci.Despite GERD polygenic basis,specific genetic loci such as rs10419226 on chromosome 19,rs2687201 on chromosome 3,rs10852151 on chromosome 15 and rs520525 on the paired related homeobox 1 gene have been mentioned as potential risk factors.Further investigation on the risk genes may elucidate their exact function and role and demonstrate new therapeutic approaches to this increasingly common disease.
