AIM： To determine the effects of duodenogastric juice pH on the development of esophageal adenocarcinoma （EAC）. METHODS： An animal model of duodenogastroesophageal reflux was established using Sprague-Dawley （SD...AIM： To determine the effects of duodenogastric juice pH on the development of esophageal adenocarcinoma （EAC）. METHODS： An animal model of duodenogastroesophageal reflux was established using Sprague-Dawley （SD） rats undergoing esophagoduodenostomy （ED）. The development of EAC was investigated in rats exposed to duodenogastric juice of different pH. The rats were di- vided into three groups： Iow-pH group （group A）, high- pH group （group B） and a sham-operated group as a control （group C） （n = 30 rats in each group）. The inci- dence of esophagitis, Barrett＇s esophagus （BE）, intestinal metaplasia with dysplasia and EAC was observed 40 wk after the treatment. RESULTS： The incidence rate of esophagitis, BE, intestinal metaplasia with dysplasia and EAC was higher in groups A and B compared with the control group after 40 wk （P 〈 0.01）, being 96% and 100% （P 〉 0.05）, 88% and 82.4% （P 〉 0.05）, 20% and 52.1% （P 〈 0.05）, and 8% and 39% （P 〈 0.05）, respectively. CONCLUSION： Non-acidic refluxate increases the occurrence of intestinal metaplasia with dysplasia and EAC while the Iow-pH gastric juice exerts a protective effect in the presence of duodenal juice. The non-acid reflux is particularly important in the progression from BE to cancer. Therefore, control of duodenal reflux may be an important prophylaxis for EAC.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
Functional gastrointestinal disorders(FGIDs),including irritable bowel syndrome(IBS),functional dyspepsia(FD),and gastroesophageal reflux disease(GERD),present persistent diagnostic and therapeutic challenges due to s...Functional gastrointestinal disorders(FGIDs),including irritable bowel syndrome(IBS),functional dyspepsia(FD),and gastroesophageal reflux disease(GERD),present persistent diagnostic and therapeutic challenges due to symptom heterogeneity and the absence of reliable biomarkers.Artificial intelligence(AI)enables the integration of multimodal data to enhance FGID management through precision diagnostics and preventive healthcare.This minireview summarizes recent advancements in AI applications for FGIDs,highlighting progress in diagnostic accuracy,subtype classification,personalized interventions,and preventive strategies inspired by the traditional Chinese medicine concept of“treating the undiseased”.Machine learning and deep learning algorithms have demonstrated value in improving IBS diagnosis,refining FD neuro-gastrointestinal subtyping,and screening for GERD-related complications.Moreover,AI supports dietary,psychological,and integrative medicine-based interventions to improve patient adherence and quality of life.Nonetheless,key challenges remain,including data heterogeneity,limited model interpretability,and the need for robust clinical validation.Future directions emphasize interdisciplinary collaboration,the development of multimodal and explainable AI models,and the creation of patientcentered platforms to facilitate a shift from reactive treatment to proactive prevention.This review provides a systematic framework to guide the clinical application and theoretical innovation of AI in FGIDs.展开更多
BACKGROUND Non-erosive reflux disease(NERD),the main gastroesophageal reflux subtype,features reflux symptoms without mucosal damage.Anxiety links to visceral hypersensitivity in NERD,yet mechanisms and animal models ...BACKGROUND Non-erosive reflux disease(NERD),the main gastroesophageal reflux subtype,features reflux symptoms without mucosal damage.Anxiety links to visceral hypersensitivity in NERD,yet mechanisms and animal models are unclear.AIM To establish a translational NERD rat model with anxiety comorbidity via tail clamping and study corticotropin-releasing hormone(CRH)-mediated neuroimmune pathways in visceral hypersensitivity and esophageal injury.METHODS Sprague-Dawley(SD)and Wistar rats were grouped into sham,model,and modified groups(n=10 each).The treatments for the modified groups were as follows:SD rats received ovalbumin/aluminum hydroxide suspension+acid perfusion±tail clamping(40 minutes/day for 7 days),while Wistar rats received fructose water+tail clamping.Esophageal pathology,visceral sensitivity,and behavior were assessed.Serum CRH,calcitonin gene-related peptide(CGRP),5-hydroxytryptamine(5-HT),and mast cell tryptase(MCT)and central amygdala(CeA)CRH mRNA were measured via ELISA and qRT-PCR.RESULTS Tail clamping induced anxiety,worsening visceral hypersensitivity(lower abdominal withdrawal reflex thresholds,P<0.05)and esophageal injury(dilated intercellular spaces and mitochondrial edema).Both models showed raised serum CRH,CGRP,5-HT,and MCT(P<0.01)and CeA CRH mRNA expression(P<0.01).Behavioral tests confirmed anxiety-like phenotypes.NERD-anxiety rats showed clinical-like symptom severity without erosion.CONCLUSION Tail clamping induces anxiety in NERD models,worsening visceral hypersensitivity via CRH neuroimmune dysregulation,offering a translational model and highlighting CRH as a treatment target.展开更多
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
The complex pathophysiology and diverse manifestations of esophageal disorders pose challenges in clinical practice,particularly in achieving accurate early diagnosis and risk stratification.While traditional approach...The complex pathophysiology and diverse manifestations of esophageal disorders pose challenges in clinical practice,particularly in achieving accurate early diagnosis and risk stratification.While traditional approaches rely heavily on subjective interpretations and variable expertise,machine learning(ML)has emerged as a transformative tool in healthcare.We conducted a comprehensive review of published literature on ML applications in esophageal diseases,analyzing technical approaches,validation methods,and clinical outcomes.ML demonstrates superior performance:In gastroesophageal reflux disease,ML models achieve 80%-90%accuracy in potential of hydrogen-impedance analysis and endoscopic grading;for Barrett’s esophagus,ML-based approaches show 88%-95% accuracy in invasive diagnostics and 77%-85% accuracy in non-invasive screening.In esophageal cancer,ML improves early detection and survival prediction by 6%-10% compared to traditional methods.Novel applications in achalasia and esophageal varices demonstrate promising results in automated diagnosis and risk stratification,with accuracy rates exceeding 85%.While challenges persist in data standardization,model interpretability,and clinical integration,emerging solutions in federated learning and explainable artificial intelligence offer promising pathways forward.The continued evolution of these technologies,coupled with rigorous validation and thoughtful implementation,may fundamentally transform our approach to esophageal disease management in the era of precision medicine.展开更多
When kidney function declines to a point where it can no longer maintain life and requires renal replacement therapy(i.e.renal transplant or dialysis),it is called end-stage renal disease(ESRD).Patients with ESRD ofte...When kidney function declines to a point where it can no longer maintain life and requires renal replacement therapy(i.e.renal transplant or dialysis),it is called end-stage renal disease(ESRD).Patients with ESRD often experience a range of gastrointestinal(GI)symptoms,with prevalence rates reported as high as 77%-79%.These symptoms and pathologies arise from various factors,including electrolyte imbalance,fluid imbalance,toxin buildup,uremia,medications,dietary and lifestyle restrictions,and the effects of dialysis.GI diseases in patients with renal failure can be further categorized into upper GI,small bowel,and lower GI issues.Common conditions include gastroesophageal reflux disease,nausea and vomiting,dysmotility within the esophagus and stomach,upper GI bleeding,peptic ulcer bleeding,angioectasia,irritable bowel syndrome,mesen-teric ischemia,angiodysplasia,diverticular disease,constipation,pancreatitis,and diseases associated with peritoneal dialysis peritonitis and peritoneal stenosis.This review assesses the existing literature on the different GI diseases among individuals with ESRD,shedding light on their pathophysiology and prevalence.展开更多
OBJECTIVE:To evaluate the safety and efficacy of Hewei Jiangni recipe(和胃降逆方,HWJNR)for treating nonerosive gastroesophageal reflux(NERD)with cold-heat complex syndrome and to clarify its mechanism based on correla...OBJECTIVE:To evaluate the safety and efficacy of Hewei Jiangni recipe(和胃降逆方,HWJNR)for treating nonerosive gastroesophageal reflux(NERD)with cold-heat complex syndrome and to clarify its mechanism based on correlation analyses of intestinal flora and metabolites.METHODS:Seventy-two patients with NERD and the Traditional Chinese Medicine(TCM)syndrome of intermingled heat and cold were randomly assigned to either the TCM group or the Western Medicine group,each receiving 8 weeks of treatment.The primary outcome was the score of the gastroesophageal reflux disease questionnaire(GERD-Q).Additionally,10 healthy individuals were recruited.Mechanistic outcomes included correlation analyses of intestinal flora and metabolites in healthy individuals and NERD participants before and after treatment.RESULTS:After 8 weeks,the effectiveness rate was 90%in the TCM group and 86.67%in the Western Medicine group(P>0.05).Compared with omeprazole,the TCM group significantly improved quality of life and alleviated symptoms such as loss of appetite,fatigue,bowel sounds,and coldness in the hands and feet(P<0.05).Dysregulation of intestinal flora and metabolic pathways in NERD patients was restored to balance after TCM treatment,which appeared related to the TCM regulation of"cold and heat disorders."CONCLUSION:HWJNR was clinically as effective as omeprazole and demonstrated advantages in improving quality of life.展开更多
OBJECTIVE:To explore if Hewei Jiangni granule(和胃降逆颗粒,HWJNG)could regulate esophageal hypersensitivity via stromal interaction molecule 1(STIM1)/transient receptor potential vanilloid subfamily member 1(TRPV1)pat...OBJECTIVE:To explore if Hewei Jiangni granule(和胃降逆颗粒,HWJNG)could regulate esophageal hypersensitivity via stromal interaction molecule 1(STIM1)/transient receptor potential vanilloid subfamily member 1(TRPV1)pathway.METHODS:Qualitative analysis of HWJNG was analysis by high performance of liquid and gas chromatography.In vivo,animal model of non-erosive reflux disease(NERD)was established by fructose intake and restraint stress.HWJNG and Omeprazole were administered by gavage to the drug intervention group.Reflux and visceral hypersensitivity were analyzed by pathological changes,PH value test,mechanical paw withdrawal threshold,thermal withdrawal latency and mast cells(MCs)degranulation.In vitro,substance P(SP)-induced P815 cells and dorsal root ganglion(DRG)cells were cocultured.Expression in both mice and cells of STIM1,TRPV1,and esophageal visceral hypersensitivity-related gastrointestinal neurochemicals were validated by enzyme linked immunosorbent assays,quantitative realtime polymerase chain reaction(qRT-PCR)and Western blot.Moreover,overexpression and small interfering RNA against STIM1 were utilized to verify of the role of HWJNG in DRG cells.RESULTS:HWJNG significantly suppressed intercellular space widening,injury of mitochondrial,MCs degranulation,mechanical allodynia and heat neuropathic sensory and increased pH value of esophageal mucosa in NERD mice.HWJNG inhibited expression of visceral hypersensitivityrelated gastrointestinal neurochemicals in esophageal mucosa and activated P815 cells,and expression of the STIM1,TRPV1 and related neurotransmitters in DRG and DRG cells.STIM1 siRNA and HWJNG both reduced P815 cells adhesion to DRGs cells and Ca2+flow into the cytoplasmic space of DRG cells.Furthermore,HWJNG could reversed STIM1 overexpression induced upregulation of TRPV1.CONCLUSION:HWJNG suppressed intercellular space widening in NERD mice,stabilized MCs and restored neuronal hyperexcitability by regulating visceral hypersensitivity via STIM1/TRPV1 pathway.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
Metabolic risk factors are a significant cause of global burden among adults and adolescents,especially those with high BMIs.1 The prevalence of obesity in Kazakhstan is rapidly increasing,which reduces life expectanc...Metabolic risk factors are a significant cause of global burden among adults and adolescents,especially those with high BMIs.1 The prevalence of obesity in Kazakhstan is rapidly increasing,which reduces life expectancy.2,3 One common approach for treating obesity and its associated comorbidities is gastric bypass surgery.However,it is not without complications,and one of the most significant postoperative concerns is reflux esophagitis.Gastroesophageal reflux disease(GERD)is a prevalent problem among obese patients,and providing care is a significant factor in bariatric surgery.4 Roux-en-Y gastric bypass(RYGB)is frequently considered the preferable surgical treatment for individuals with GERD because of its efficacy in reducing reflux symptoms.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 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
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
基金Supported by the Key Project of Clinical Medicine,Ministry of Health,No. 20012130
文摘AIM： To determine the effects of duodenogastric juice pH on the development of esophageal adenocarcinoma （EAC）. METHODS： An animal model of duodenogastroesophageal reflux was established using Sprague-Dawley （SD） rats undergoing esophagoduodenostomy （ED）. The development of EAC was investigated in rats exposed to duodenogastric juice of different pH. The rats were di- vided into three groups： Iow-pH group （group A）, high- pH group （group B） and a sham-operated group as a control （group C） （n = 30 rats in each group）. The inci- dence of esophagitis, Barrett＇s esophagus （BE）, intestinal metaplasia with dysplasia and EAC was observed 40 wk after the treatment. RESULTS： The incidence rate of esophagitis, BE, intestinal metaplasia with dysplasia and EAC was higher in groups A and B compared with the control group after 40 wk （P 〈 0.01）, being 96% and 100% （P 〉 0.05）, 88% and 82.4% （P 〉 0.05）, 20% and 52.1% （P 〈 0.05）, and 8% and 39% （P 〈 0.05）, respectively. CONCLUSION： Non-acidic refluxate increases the occurrence of intestinal metaplasia with dysplasia and EAC while the Iow-pH gastric juice exerts a protective effect in the presence of duodenal juice. The non-acid reflux is particularly important in the progression from BE to cancer. Therefore, control of duodenal reflux may be an important prophylaxis for EAC.
文摘BACKGROUND Despite societal guidelines recommending targeted screening for Barrett’s esophagus(BE)and esophageal adenocarcinoma(EAC)in individuals with gastroesophageal reflux symptoms(GERS),screening adherence is suboptimal.Current screening approaches fail to identify individuals not seeking medical consultation for GERS or whose GERS are managed with‘over-the-counter’(OTC)acid suppressant therapies.AIM To assess patients’self-management and help-seeking behavior for GERS.METHODS This cross-sectional study collected data from the Dutch general population aged 18-75 years between January and April 2023 using a web-based survey.The survey included questions regarding self-management(e.g.,use of acid suppressant therapy with or without prescription)and help-seeking behavior(e.g.,consulting a primary care provider)for GERS.Simple random sampling was performed to select individuals within the target age group.In total,18156 randomly selected individuals were invited to participate.The study protocol was registered in ClinicalTrials.gov(identifier:NCT05689918).RESULTS Of the 18156 invited individuals,3214 participants(17.7%)completed the survey,of which 1572 participants(48.9%)reported GERS.Of these,904 participants(57.5%)had never consulted a primary care provider for these symptoms,of which 331 participants(36.6%)reported taking OTC acid suppressant therapy in the past six months and 100 participants(11.1%)fulfilled the screening criteria for BE and EAC according to the European Society of Gastrointestinal Endoscopy Guideline.CONCLUSION The population fulfilling the screening criteria for BE and EAC is incompletely identified,suggesting potential underutilization of medical consultation.Raising public awareness of GERS as a risk factor for EAC is needed.
基金Supported by The Natural Science Foundation of China,No.82374292the Plans for Major Provincial Science and Technology Projects of Anhui Province,No.202303a07020003the Innovation Team and Talents Cultivation Program of the National Administration of Traditional Chinese Medicine,No.ZYYCXTD-C-202401.
文摘Functional gastrointestinal disorders(FGIDs),including irritable bowel syndrome(IBS),functional dyspepsia(FD),and gastroesophageal reflux disease(GERD),present persistent diagnostic and therapeutic challenges due to symptom heterogeneity and the absence of reliable biomarkers.Artificial intelligence(AI)enables the integration of multimodal data to enhance FGID management through precision diagnostics and preventive healthcare.This minireview summarizes recent advancements in AI applications for FGIDs,highlighting progress in diagnostic accuracy,subtype classification,personalized interventions,and preventive strategies inspired by the traditional Chinese medicine concept of“treating the undiseased”.Machine learning and deep learning algorithms have demonstrated value in improving IBS diagnosis,refining FD neuro-gastrointestinal subtyping,and screening for GERD-related complications.Moreover,AI supports dietary,psychological,and integrative medicine-based interventions to improve patient adherence and quality of life.Nonetheless,key challenges remain,including data heterogeneity,limited model interpretability,and the need for robust clinical validation.Future directions emphasize interdisciplinary collaboration,the development of multimodal and explainable AI models,and the creation of patientcentered platforms to facilitate a shift from reactive treatment to proactive prevention.This review provides a systematic framework to guide the clinical application and theoretical innovation of AI in FGIDs.
基金Supported by the National Key Specialty of Traditional Chinese Medicine(Spleen and Stomach Diseases),No.0500004National Natural Science Foundation of China,No.82205104 and No.82104850+1 种基金Hospital Capability Enhancement Project of Xiyuan Hospital,CACMS,No.XYZX0303-07the Fundamental Research Funds for the Central Public Welfare Research Institutes,Excellent Young Scientists Training Program of China Academy of Chinese Medical Sciences,No.ZZ16-YQ-002.
文摘BACKGROUND Non-erosive reflux disease(NERD),the main gastroesophageal reflux subtype,features reflux symptoms without mucosal damage.Anxiety links to visceral hypersensitivity in NERD,yet mechanisms and animal models are unclear.AIM To establish a translational NERD rat model with anxiety comorbidity via tail clamping and study corticotropin-releasing hormone(CRH)-mediated neuroimmune pathways in visceral hypersensitivity and esophageal injury.METHODS Sprague-Dawley(SD)and Wistar rats were grouped into sham,model,and modified groups(n=10 each).The treatments for the modified groups were as follows:SD rats received ovalbumin/aluminum hydroxide suspension+acid perfusion±tail clamping(40 minutes/day for 7 days),while Wistar rats received fructose water+tail clamping.Esophageal pathology,visceral sensitivity,and behavior were assessed.Serum CRH,calcitonin gene-related peptide(CGRP),5-hydroxytryptamine(5-HT),and mast cell tryptase(MCT)and central amygdala(CeA)CRH mRNA were measured via ELISA and qRT-PCR.RESULTS Tail clamping induced anxiety,worsening visceral hypersensitivity(lower abdominal withdrawal reflex thresholds,P<0.05)and esophageal injury(dilated intercellular spaces and mitochondrial edema).Both models showed raised serum CRH,CGRP,5-HT,and MCT(P<0.01)and CeA CRH mRNA expression(P<0.01).Behavioral tests confirmed anxiety-like phenotypes.NERD-anxiety rats showed clinical-like symptom severity without erosion.CONCLUSION Tail clamping induces anxiety in NERD models,worsening visceral hypersensitivity via CRH neuroimmune dysregulation,offering a translational model and highlighting CRH as a treatment target.
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.
基金Supported by the Central Funds Guiding the Local Science and Technology Development,No.202207AB110017Key Research and Development Program of Yunnan,No.202302AD080004+1 种基金Yunnan Academician and Expert Workstation,No.202205AF150023the Scientific and Technological Innovation Team in Kunming Medical University,No.CXTD202215.
文摘The complex pathophysiology and diverse manifestations of esophageal disorders pose challenges in clinical practice,particularly in achieving accurate early diagnosis and risk stratification.While traditional approaches rely heavily on subjective interpretations and variable expertise,machine learning(ML)has emerged as a transformative tool in healthcare.We conducted a comprehensive review of published literature on ML applications in esophageal diseases,analyzing technical approaches,validation methods,and clinical outcomes.ML demonstrates superior performance:In gastroesophageal reflux disease,ML models achieve 80%-90%accuracy in potential of hydrogen-impedance analysis and endoscopic grading;for Barrett’s esophagus,ML-based approaches show 88%-95% accuracy in invasive diagnostics and 77%-85% accuracy in non-invasive screening.In esophageal cancer,ML improves early detection and survival prediction by 6%-10% compared to traditional methods.Novel applications in achalasia and esophageal varices demonstrate promising results in automated diagnosis and risk stratification,with accuracy rates exceeding 85%.While challenges persist in data standardization,model interpretability,and clinical integration,emerging solutions in federated learning and explainable artificial intelligence offer promising pathways forward.The continued evolution of these technologies,coupled with rigorous validation and thoughtful implementation,may fundamentally transform our approach to esophageal disease management in the era of precision medicine.
文摘When kidney function declines to a point where it can no longer maintain life and requires renal replacement therapy(i.e.renal transplant or dialysis),it is called end-stage renal disease(ESRD).Patients with ESRD often experience a range of gastrointestinal(GI)symptoms,with prevalence rates reported as high as 77%-79%.These symptoms and pathologies arise from various factors,including electrolyte imbalance,fluid imbalance,toxin buildup,uremia,medications,dietary and lifestyle restrictions,and the effects of dialysis.GI diseases in patients with renal failure can be further categorized into upper GI,small bowel,and lower GI issues.Common conditions include gastroesophageal reflux disease,nausea and vomiting,dysmotility within the esophagus and stomach,upper GI bleeding,peptic ulcer bleeding,angioectasia,irritable bowel syndrome,mesen-teric ischemia,angiodysplasia,diverticular disease,constipation,pancreatitis,and diseases associated with peritoneal dialysis peritonitis and peritoneal stenosis.This review assesses the existing literature on the different GI diseases among individuals with ESRD,shedding light on their pathophysiology and prevalence.
基金Supported by Fundamental Research Funds for the Central Universities:Research on the Mechanism of Hewei Jiangni Recipe on Nonerosive Gastroesophageal Reflux Based on the Correlation Analysis of Gut Microbiota and Metabolites (No. 2020-JYB-ZDGG-128)National Natural Science Foundation of China:Exploring the Molecular Mechanism of "Hewei Jiangni Fang" Intervention in Nonerosive Reflux Disease Esophageal Hypersensitivity from the Perspective of Mas-related Gene X2/Stromal Interaction Molecule 1/Cell Adhesion Molecule 1 Pathway Regulation of Mast Cell/Dorsal Root Ganglion Communication Based on the "Xinkai-Kujiang" Method (No. 82374401)
文摘OBJECTIVE:To evaluate the safety and efficacy of Hewei Jiangni recipe(和胃降逆方,HWJNR)for treating nonerosive gastroesophageal reflux(NERD)with cold-heat complex syndrome and to clarify its mechanism based on correlation analyses of intestinal flora and metabolites.METHODS:Seventy-two patients with NERD and the Traditional Chinese Medicine(TCM)syndrome of intermingled heat and cold were randomly assigned to either the TCM group or the Western Medicine group,each receiving 8 weeks of treatment.The primary outcome was the score of the gastroesophageal reflux disease questionnaire(GERD-Q).Additionally,10 healthy individuals were recruited.Mechanistic outcomes included correlation analyses of intestinal flora and metabolites in healthy individuals and NERD participants before and after treatment.RESULTS:After 8 weeks,the effectiveness rate was 90%in the TCM group and 86.67%in the Western Medicine group(P>0.05).Compared with omeprazole,the TCM group significantly improved quality of life and alleviated symptoms such as loss of appetite,fatigue,bowel sounds,and coldness in the hands and feet(P<0.05).Dysregulation of intestinal flora and metabolic pathways in NERD patients was restored to balance after TCM treatment,which appeared related to the TCM regulation of"cold and heat disorders."CONCLUSION:HWJNR was clinically as effective as omeprazole and demonstrated advantages in improving quality of life.
基金National Natural Science Foundation of China:Study on the Molecular Mechanism of the Regulation of Crypt Goblet Cell Pyroptosis and Exocytosis to Repair Ulcerative Colitis Mucus Barrier by the Method of Clearing and Opening the Xuanfu from the Perspective of"Xuanfu-Crypt"(No.82305143),and National Natural Science Foundation of China:Exploring the Molecular Mechanism of"Hewei Jiangni Fang"Intervention in Non-erosive Reflux Disease Esophageal Hypersensitivity from the Perspective of Mas-related Gene X2/Stromal Interaction Molecule 1/Cell Adhesion Molecule 1 Pathway Regulation of Mast Cell/Dorsal Root Ganglion Communication based on the"Xinkai-Kujiang"Method(No.82374401)。
文摘OBJECTIVE:To explore if Hewei Jiangni granule(和胃降逆颗粒,HWJNG)could regulate esophageal hypersensitivity via stromal interaction molecule 1(STIM1)/transient receptor potential vanilloid subfamily member 1(TRPV1)pathway.METHODS:Qualitative analysis of HWJNG was analysis by high performance of liquid and gas chromatography.In vivo,animal model of non-erosive reflux disease(NERD)was established by fructose intake and restraint stress.HWJNG and Omeprazole were administered by gavage to the drug intervention group.Reflux and visceral hypersensitivity were analyzed by pathological changes,PH value test,mechanical paw withdrawal threshold,thermal withdrawal latency and mast cells(MCs)degranulation.In vitro,substance P(SP)-induced P815 cells and dorsal root ganglion(DRG)cells were cocultured.Expression in both mice and cells of STIM1,TRPV1,and esophageal visceral hypersensitivity-related gastrointestinal neurochemicals were validated by enzyme linked immunosorbent assays,quantitative realtime polymerase chain reaction(qRT-PCR)and Western blot.Moreover,overexpression and small interfering RNA against STIM1 were utilized to verify of the role of HWJNG in DRG cells.RESULTS:HWJNG significantly suppressed intercellular space widening,injury of mitochondrial,MCs degranulation,mechanical allodynia and heat neuropathic sensory and increased pH value of esophageal mucosa in NERD mice.HWJNG inhibited expression of visceral hypersensitivityrelated gastrointestinal neurochemicals in esophageal mucosa and activated P815 cells,and expression of the STIM1,TRPV1 and related neurotransmitters in DRG and DRG cells.STIM1 siRNA and HWJNG both reduced P815 cells adhesion to DRGs cells and Ca2+flow into the cytoplasmic space of DRG cells.Furthermore,HWJNG could reversed STIM1 overexpression induced upregulation of TRPV1.CONCLUSION:HWJNG suppressed intercellular space widening in NERD mice,stabilized MCs and restored neuronal hyperexcitability by regulating visceral hypersensitivity via STIM1/TRPV1 pathway.
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 Ministry of Education and Science of the Republic of Kazakhstan(Grant No.AP23490186).
文摘Metabolic risk factors are a significant cause of global burden among adults and adolescents,especially those with high BMIs.1 The prevalence of obesity in Kazakhstan is rapidly increasing,which reduces life expectancy.2,3 One common approach for treating obesity and its associated comorbidities is gastric bypass surgery.However,it is not without complications,and one of the most significant postoperative concerns is reflux esophagitis.Gastroesophageal reflux disease(GERD)is a prevalent problem among obese patients,and providing care is a significant factor in bariatric surgery.4 Roux-en-Y gastric bypass(RYGB)is frequently considered the preferable surgical treatment for individuals with GERD because of its efficacy in reducing reflux symptoms.
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.
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.
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.
