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 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 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 Reflux hypersensitivity(RH)constitutes roughly 14%of patients with heartburn and 34%of those with refractory heartburn,yet it is inadequately comprehended.AIM To investigate the clinical characteristics and...BACKGROUND Reflux hypersensitivity(RH)constitutes roughly 14%of patients with heartburn and 34%of those with refractory heartburn,yet it is inadequately comprehended.AIM To investigate the clinical characteristics and risk factors associated with RH.METHODS We conducted a retrospective analysis of 109 patients with RH and 384 healthy controls from three medical centers between January 2022 and December 2023.Comprehensive data encompassing symptoms,motility,impedance-pH monitoring,and psychological evaluations were collected.RESULTS RH patients encountered a greater frequency of weakly acidic reflux(WAR)events compared to acidic reflux or nonacidic reflux(NAR)events.Upright reflux time(1.22%)exceeds supine reflux time(0.54%)(P<0.05).Extraesophageal symptoms were more prevalent among younger patients and those with elevated NAR(P<0.05).The acidic reflux,WAR,NAR,and peristaltic contraction break length in male patients exceeded those in female patients(P<0.05).Age[odds ratio(OR)=5.633],hiatal hernia(OR=13.103),and anxiety(OR=17.342)constituted independent risk factors for RH.CONCLUSION WAR and NAR are pivotal in RH.Patients with increased NAR are more likely to experience extraesophageal symptoms.Age,hiatal hernia,and anxiety are significant independent risk factors for RH.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
BACKGROUND Occult pancreaticobiliary reflux(OPBR)is characterized by the absence of congenital anomalies at the pancreaticobiliary junction yet leads to altered bile composition and an increased incidence of gallbladd...BACKGROUND Occult pancreaticobiliary reflux(OPBR)is characterized by the absence of congenital anomalies at the pancreaticobiliary junction yet leads to altered bile composition and an increased incidence of gallbladder stones.AIM To explore the computed tomography(CT)imaging characteristics of gallbladder stones in patients diagnosed with OPBR.METHODS We analyzed 362 patients undergoing cholecystectomy(November 2020 to January 2022).Intraoperative bile samples were assayed for amylase(>110 U/L indicated OPBR).CT features,including stone density and visibility,were compared between 54 OPBR and 308 controls.Stone attenuation(HU)was measured under standardized conditions(uCT-780,120 kVp,160 mAs).Logistic regression and receiver operating characteristic curve analysis identified independent OPBR predictors,forming a validated nomogram.RESULTS OPBR patients exhibited significantly higher rates of CT-invisible stones(35.2%vs 12.3%)and uniform stones(87%vs 73.1%)along with lower overall stone density(P=0.01).Logistic regression identified stone visibility,uniformity,and density as independent predictors.A nomogram integrating these features with patient age achieved high diagnostic accuracy(area under the curve=0.71).CONCLUSION CT imaging distinctly identifies gallbladder stone density,indicating a heightened risk of OPBR in patients with uniform and CT-invisible stones.Such imaging is crucial for preoperative assessments to evaluate potential recurrent biliary pathologies post-cholecystectomy.展开更多
Per oral endoscopic myotomy(POEM)is rapidly emerging as the treatment of choice for achalasia cardia,but its success is marred by problematic reflux.Although symptomatic reflux rates are low and often comparable to th...Per oral endoscopic myotomy(POEM)is rapidly emerging as the treatment of choice for achalasia cardia,but its success is marred by problematic reflux.Although symptomatic reflux rates are low and often comparable to that after laparoscopic Hellers myotomy(LHM),a high incidence of pathologic reflux has been noted after POEM.This poses a dilemma as to what is true reflux,and in determining the indications and optimal endpoints for managing post-POEM reflux.The two pertinent reasons for the difference in reflux rates between LHM and POEM are the variation in length and location of myotomy and the absence of an anti-reflux procedure in POEM.Proton pump inhibitor remains the most sought-after treatment of POEM derived reflux.Nevertheless,modifications in the procedural technique of POEM and the addition of endoscopic fundoplication can probably emerge as a game changer.This article briefly reviews the incidence,causes,controversies,predictive factors,and management strategies related to post-POEM reflux.展开更多
As an emerging treatment,esophageal anti-reflux stent has gradually become the palliative treatment of choice for many digestive diseases due to its features of low trauma,high safety,and conformity to the physiologic...As an emerging treatment,esophageal anti-reflux stent has gradually become the palliative treatment of choice for many digestive diseases due to its features of low trauma,high safety,and conformity to the physiological and anatomical structure of the esophagus.This study presents a review of the latest clinical progress of esophageal anti-reflux stents to provide theoretical references for subsequent studies.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
Bile reflux gastritis (BRG) is a gastro-intestinal condition especially characterized by the reflux of bile into the stomach, further leading to mucosal inflammation along with various other clinical manifestations. D...Bile reflux gastritis (BRG) is a gastro-intestinal condition especially characterized by the reflux of bile into the stomach, further leading to mucosal inflammation along with various other clinical manifestations. Despite its increasing recognition, BRG remains understudied, with limited understanding of its epidemiology, pathophysiology, and optimal therapeutic strategies. Present narrative review aimed to comprehensively examine the available literature on BRG, focusing on its prevalence, risk factors, pathophysiology, clinical presentation, diagnostic modalities, and available therapeutic strategies. A comprehensive literature search was conducted using PubMed, Embase, Google Scholar and Cochrane databases. Relevant studies were included based on predefined inclusion and exclusion criteria. A narrative synthesis was conducted to summarize and interpret the findings. The prevalence of BRG remains uncertain due to diagnostic challenges. Risk factors include impaired gastrointestinal motility, sphincteric dysfunction (pyloric sphincter and the lower oesophageal sphincter), biliary tract disease, and certain medications. The pathophysiology involves bile acid-induced mucosal injury, inflammation, and impaired gastric defence mechanisms. Clinical manifestations are often nonspecific. Diagnostic modalities primarily include endoscopy and bile acid reflux testing. Management strategies encompass lifestyle modifications, medical therapy, and in severe cases, surgery. BRG is a complex condition with significant clinical implications. Further research is needed to refine diagnostic criteria, elucidate pathophysiological mechanisms, and develop effective therapeutic interventions. Addressing knowledge gaps in epidemiology, risk factors, and long-term outcomes is crucial for improving patient care.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 reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated n...BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.AIM To determine the incidence of GERD,associated risk factors,and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endo-tracheal aspirates(ETA).METHODS This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024.ETA samples were collected at three intervals:Immediately post-intubation(Sample A),48 hours after intubation(Sample B),and just before extubation(Sample C).Pepsin concentration was measured using enzyme-linked immunosorbent assay.Clinical data,including hospital stay duration and feeding parameters,were correlated with pepsin levels.RESULTS Pepsin was detected in 76(78.4%)of Sample A,78(81.3%)of Sample B,and 47(68.1%)of Sample C.A significant positive correlation was found between pepsin levels and FiO_(2) in Sample B(r=0.203,P=0.047).Prolonged hospital stay was also associated with pepsin detection in Samples B and C(P<0.05).A negative correlation was observed between feeding amount and pepsin levels across all samples(P<0.05).CONCLUSION The incidence of GERD in full-term mechanically ventilated neonates is high,correlating with pepsin levels,FiO_(2),feeding intolerance,and hospital stay,highlighting the importance of early detection.展开更多
BACKGROUND Chinese surgeons often rely on intraoperative exploration of the esophageal hiatus to determine the need for concurrent type I hiatal hernia(HH)repair during laparoscopic sleeve gastrectomy.However,no stand...BACKGROUND Chinese surgeons often rely on intraoperative exploration of the esophageal hiatus to determine the need for concurrent type I hiatal hernia(HH)repair during laparoscopic sleeve gastrectomy.However,no standardized criteria for the esophageal hiatus size or indications for exploration exist in China.AIM To investigate normal anatomical parameter ranges of the esophageal hiatus in patients with obesity.METHODS A total of 158 patients,aged 20-49 years,was analyzed from January 2020 to June 2024.The patients were classified into the no reflux esophagitis(RE)no HH group(HHG),RE group,and type I HHG.The transverse and sagittal diameters and cross-sectional area of the esophageal hiatus were measured using multiplanar reconstruction of the computed tomography images.RESULTS Body mass index was positively correlated with area and transverse and sagittal diameters of the esophageal hiatus(r=0.72,0.69,and 0.54,respectively;P<0.01).In the no RE no HHG and RE group,the esophageal hiatus size in the subgroup with obesity was greater than that in the non-obesity subgroup(area:326.15±78 mm2 vs 208.12±64.44 mm2,transverse diameters:15.97±2.06 mm vs 13.37±1.99 mm,sagittal diameters:15.7±2.08 mm vs 11.73±2.08 mm;P<0.01).Patients with obesity showed no significant differences in esophageal hiatus size with or without RE or HH.CONCLUSION The esophageal hiatus size increased with body mass index and was larger in patients with obesity than in those without obesity.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 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
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 Gastroesophageal reflux disease has been shown to contribute to allograft injury and rejection outcomes in lung transplantation through a proposed mechanism of aspiration,inflammation,and allograft injury.T...BACKGROUND Gastroesophageal reflux disease has been shown to contribute to allograft injury and rejection outcomes in lung transplantation through a proposed mechanism of aspiration,inflammation,and allograft injury.The value of pre-transplant reflux testing in predicting reduction in pulmonary function after lung transplantation is unclear.We hypothesized that increased reflux burden on pre-transplant reflux testing is associated with pulmonary function decline following lung transplant.AIM To assess the relationship between pre-transplant measures of reflux and pulmonary function decline in lung transplant recipients.METHODS This was a retrospective cohort study of lung transplant recipients who underwent pre-transplant reflux testing with 24-hour pH-impedance off acid suppression at a tertiary center in 2007-2016.Patients with pre-transplant fundoplication were excluded.Time-to-event analysis was performed using Cox proportional hazards models to assess associations between reflux measures and reduction in forced expiratory volume in 1 second(FEV1)of≥20%post-transplant.Patients not meeting endpoint were censored at time of post-transplant fundoplication,last clinic visit,or death,whichever was earliest.RESULTS Seventy subjects(58%men,mean age:56 years)met the inclusion criteria.Interstitial lung disease represented the predominant pulmonary diagnosis(40%).Baseline demographics were similar between groups and were not associated with pulmonary decline.The clinical endpoint(≥20%FEV1 decline)was reached in 18 subjects(26%).In time-to-event univariate analysis,FEV1 decline was associated with increased acid exposure time(AET)[hazard ratio(HR)=3.49,P=0.03]and increased proximal acid reflux(HR=3.34,P=0.04)with confirmation on Kaplan-Meier analysis.Multivariate analysis showed persistent association between pulmonary decline and increased AET(HR=3.37,P=0.04)when controlling for potential confounders including age,body mass index,and sex.Subgroup analysis including only patients with FEV1 decline showed that all subjects with abnormal AET progressed to bronchiolitis obliterans syndrome.CONCLUSION Increased reflux burden on pre-transplant testing was associated with significant pulmonary function decline posttransplant.Pre-transplant reflux assessment may provide clinically relevant information in the prognostication and management of transplant recipients.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
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
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 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 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.
基金Supported by the Foundation of the Second Affiliated Hospital of Xi’an Jiaotong University,No.YJ(ZD)202301.
文摘BACKGROUND Reflux hypersensitivity(RH)constitutes roughly 14%of patients with heartburn and 34%of those with refractory heartburn,yet it is inadequately comprehended.AIM To investigate the clinical characteristics and risk factors associated with RH.METHODS We conducted a retrospective analysis of 109 patients with RH and 384 healthy controls from three medical centers between January 2022 and December 2023.Comprehensive data encompassing symptoms,motility,impedance-pH monitoring,and psychological evaluations were collected.RESULTS RH patients encountered a greater frequency of weakly acidic reflux(WAR)events compared to acidic reflux or nonacidic reflux(NAR)events.Upright reflux time(1.22%)exceeds supine reflux time(0.54%)(P<0.05).Extraesophageal symptoms were more prevalent among younger patients and those with elevated NAR(P<0.05).The acidic reflux,WAR,NAR,and peristaltic contraction break length in male patients exceeded those in female patients(P<0.05).Age[odds ratio(OR)=5.633],hiatal hernia(OR=13.103),and anxiety(OR=17.342)constituted independent risk factors for RH.CONCLUSION WAR and NAR are pivotal in RH.Patients with increased NAR are more likely to experience extraesophageal symptoms.Age,hiatal hernia,and anxiety are significant independent risk factors for RH.
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.
基金Supported by Key Specialty Construction Project of Shanghai Pudong New Area Health Commission,No.PWZzk2022-17Shanghai East Hospital Clinical Research Project,No.DFLC2022019the Featured Clinical Discipline Project of Shanghai Pudong District,No.PWYts2021-06.
文摘BACKGROUND Occult pancreaticobiliary reflux(OPBR)is characterized by the absence of congenital anomalies at the pancreaticobiliary junction yet leads to altered bile composition and an increased incidence of gallbladder stones.AIM To explore the computed tomography(CT)imaging characteristics of gallbladder stones in patients diagnosed with OPBR.METHODS We analyzed 362 patients undergoing cholecystectomy(November 2020 to January 2022).Intraoperative bile samples were assayed for amylase(>110 U/L indicated OPBR).CT features,including stone density and visibility,were compared between 54 OPBR and 308 controls.Stone attenuation(HU)was measured under standardized conditions(uCT-780,120 kVp,160 mAs).Logistic regression and receiver operating characteristic curve analysis identified independent OPBR predictors,forming a validated nomogram.RESULTS OPBR patients exhibited significantly higher rates of CT-invisible stones(35.2%vs 12.3%)and uniform stones(87%vs 73.1%)along with lower overall stone density(P=0.01).Logistic regression identified stone visibility,uniformity,and density as independent predictors.A nomogram integrating these features with patient age achieved high diagnostic accuracy(area under the curve=0.71).CONCLUSION CT imaging distinctly identifies gallbladder stone density,indicating a heightened risk of OPBR in patients with uniform and CT-invisible stones.Such imaging is crucial for preoperative assessments to evaluate potential recurrent biliary pathologies post-cholecystectomy.
文摘Per oral endoscopic myotomy(POEM)is rapidly emerging as the treatment of choice for achalasia cardia,but its success is marred by problematic reflux.Although symptomatic reflux rates are low and often comparable to that after laparoscopic Hellers myotomy(LHM),a high incidence of pathologic reflux has been noted after POEM.This poses a dilemma as to what is true reflux,and in determining the indications and optimal endpoints for managing post-POEM reflux.The two pertinent reasons for the difference in reflux rates between LHM and POEM are the variation in length and location of myotomy and the absence of an anti-reflux procedure in POEM.Proton pump inhibitor remains the most sought-after treatment of POEM derived reflux.Nevertheless,modifications in the procedural technique of POEM and the addition of endoscopic fundoplication can probably emerge as a game changer.This article briefly reviews the incidence,causes,controversies,predictive factors,and management strategies related to post-POEM reflux.
基金National College Students’Innovative Entrepreneurial Training Plan Program Funded Project(Project No.:2024118400010)。
文摘As an emerging treatment,esophageal anti-reflux stent has gradually become the palliative treatment of choice for many digestive diseases due to its features of low trauma,high safety,and conformity to the physiological and anatomical structure of the esophagus.This study presents a review of the latest clinical progress of esophageal anti-reflux stents to provide theoretical references for subsequent studies.
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.
文摘Bile reflux gastritis (BRG) is a gastro-intestinal condition especially characterized by the reflux of bile into the stomach, further leading to mucosal inflammation along with various other clinical manifestations. Despite its increasing recognition, BRG remains understudied, with limited understanding of its epidemiology, pathophysiology, and optimal therapeutic strategies. Present narrative review aimed to comprehensively examine the available literature on BRG, focusing on its prevalence, risk factors, pathophysiology, clinical presentation, diagnostic modalities, and available therapeutic strategies. A comprehensive literature search was conducted using PubMed, Embase, Google Scholar and Cochrane databases. Relevant studies were included based on predefined inclusion and exclusion criteria. A narrative synthesis was conducted to summarize and interpret the findings. The prevalence of BRG remains uncertain due to diagnostic challenges. Risk factors include impaired gastrointestinal motility, sphincteric dysfunction (pyloric sphincter and the lower oesophageal sphincter), biliary tract disease, and certain medications. The pathophysiology involves bile acid-induced mucosal injury, inflammation, and impaired gastric defence mechanisms. Clinical manifestations are often nonspecific. Diagnostic modalities primarily include endoscopy and bile acid reflux testing. Management strategies encompass lifestyle modifications, medical therapy, and in severe cases, surgery. BRG is a complex condition with significant clinical implications. Further research is needed to refine diagnostic criteria, elucidate pathophysiological mechanisms, and develop effective therapeutic interventions. Addressing knowledge gaps in epidemiology, risk factors, and long-term outcomes is crucial for improving patient care.
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.
文摘BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.AIM To determine the incidence of GERD,associated risk factors,and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endo-tracheal aspirates(ETA).METHODS This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024.ETA samples were collected at three intervals:Immediately post-intubation(Sample A),48 hours after intubation(Sample B),and just before extubation(Sample C).Pepsin concentration was measured using enzyme-linked immunosorbent assay.Clinical data,including hospital stay duration and feeding parameters,were correlated with pepsin levels.RESULTS Pepsin was detected in 76(78.4%)of Sample A,78(81.3%)of Sample B,and 47(68.1%)of Sample C.A significant positive correlation was found between pepsin levels and FiO_(2) in Sample B(r=0.203,P=0.047).Prolonged hospital stay was also associated with pepsin detection in Samples B and C(P<0.05).A negative correlation was observed between feeding amount and pepsin levels across all samples(P<0.05).CONCLUSION The incidence of GERD in full-term mechanically ventilated neonates is high,correlating with pepsin levels,FiO_(2),feeding intolerance,and hospital stay,highlighting the importance of early detection.
文摘BACKGROUND Chinese surgeons often rely on intraoperative exploration of the esophageal hiatus to determine the need for concurrent type I hiatal hernia(HH)repair during laparoscopic sleeve gastrectomy.However,no standardized criteria for the esophageal hiatus size or indications for exploration exist in China.AIM To investigate normal anatomical parameter ranges of the esophageal hiatus in patients with obesity.METHODS A total of 158 patients,aged 20-49 years,was analyzed from January 2020 to June 2024.The patients were classified into the no reflux esophagitis(RE)no HH group(HHG),RE group,and type I HHG.The transverse and sagittal diameters and cross-sectional area of the esophageal hiatus were measured using multiplanar reconstruction of the computed tomography images.RESULTS Body mass index was positively correlated with area and transverse and sagittal diameters of the esophageal hiatus(r=0.72,0.69,and 0.54,respectively;P<0.01).In the no RE no HHG and RE group,the esophageal hiatus size in the subgroup with obesity was greater than that in the non-obesity subgroup(area:326.15±78 mm2 vs 208.12±64.44 mm2,transverse diameters:15.97±2.06 mm vs 13.37±1.99 mm,sagittal diameters:15.7±2.08 mm vs 11.73±2.08 mm;P<0.01).Patients with obesity showed no significant differences in esophageal hiatus size with or without RE or HH.CONCLUSION The esophageal hiatus size increased with body mass index and was larger in patients with obesity than in those without obesity.
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.
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.
文摘BACKGROUND Gastroesophageal reflux disease has been shown to contribute to allograft injury and rejection outcomes in lung transplantation through a proposed mechanism of aspiration,inflammation,and allograft injury.The value of pre-transplant reflux testing in predicting reduction in pulmonary function after lung transplantation is unclear.We hypothesized that increased reflux burden on pre-transplant reflux testing is associated with pulmonary function decline following lung transplant.AIM To assess the relationship between pre-transplant measures of reflux and pulmonary function decline in lung transplant recipients.METHODS This was a retrospective cohort study of lung transplant recipients who underwent pre-transplant reflux testing with 24-hour pH-impedance off acid suppression at a tertiary center in 2007-2016.Patients with pre-transplant fundoplication were excluded.Time-to-event analysis was performed using Cox proportional hazards models to assess associations between reflux measures and reduction in forced expiratory volume in 1 second(FEV1)of≥20%post-transplant.Patients not meeting endpoint were censored at time of post-transplant fundoplication,last clinic visit,or death,whichever was earliest.RESULTS Seventy subjects(58%men,mean age:56 years)met the inclusion criteria.Interstitial lung disease represented the predominant pulmonary diagnosis(40%).Baseline demographics were similar between groups and were not associated with pulmonary decline.The clinical endpoint(≥20%FEV1 decline)was reached in 18 subjects(26%).In time-to-event univariate analysis,FEV1 decline was associated with increased acid exposure time(AET)[hazard ratio(HR)=3.49,P=0.03]and increased proximal acid reflux(HR=3.34,P=0.04)with confirmation on Kaplan-Meier analysis.Multivariate analysis showed persistent association between pulmonary decline and increased AET(HR=3.37,P=0.04)when controlling for potential confounders including age,body mass index,and sex.Subgroup analysis including only patients with FEV1 decline showed that all subjects with abnormal AET progressed to bronchiolitis obliterans syndrome.CONCLUSION Increased reflux burden on pre-transplant testing was associated with significant pulmonary function decline posttransplant.Pre-transplant reflux assessment may provide clinically relevant information in the prognostication and management of transplant recipients.
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.
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.
