Impact of ineffective esophageal motility on chemical clearance in patients with gastroesophageal reflux symptoms

2020 ◽  
Vol 33 (9) ◽  
Author(s):  
Hang Viet Dao ◽  
Tomoaki Matsumura ◽  
Tatsuya Kaneko ◽  
Satsuki Takahashi ◽  
Mamoru Tokunaga ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Esophageal Motility ◽  
Erosive Esophagitis ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility ◽  
Intraluminal Impedance ◽  
Significant Difference ◽  
Multichannel Intraluminal Impedance Ph ◽  
The Impact ◽  
The Relationship

Summary Ineffective esophageal motility (IEM) is the most common manometric abnormality in gastroesophageal reflux disease (GERD). However, the impact of IEM on esophageal chemical clearance has not been fully investigated. This study aimed to determine the impact of IEM on esophageal chemical clearance in patients with GERD. A total of 369 patients with GERD symptoms who underwent upper endoscopy and high-resolution manometry (HRM) test were retrospectively analyzed. The relationship between IEM and erosive esophagitis was examined. In addition, the impact of IEM on chemical clearance was examined in patients who underwent an additional combined multichannel intraluminal impedance–pH (MII–pH) test. Esophageal chemical clearance capability was evaluated via postreflux swallow-induced peristaltic wave (PSPW) index and acid clearance time (ACT). Of 369 patients, 181 (49.1%) had esophageal motility disorders, of which 78 (21.1%) had IEM. The proportion of IEM patients in those with erosive esophagitis and those without were 16.2% and 21.7%, respectively, and no significant difference was observed (P = 0.53). After excluding patients other than those with IEM and normal esophageal motility, 64 subsequently underwent MII–pH test. The median values of the PSPW index in the IEM and normal esophageal motility group were 11.1% (4.2%–20.0%) and 17.1% (9.8%–30.6%), respectively. The PSPW index was significantly lower in the IEM group than in the normal esophageal motility group (P < 0.05). The median ACT values in the IEM group and normal esophageal motility group were 125.5 (54.0–183.5) seconds and 60.0 (27.2–105.7) seconds, respectively. The ACT was significantly longer in the IEM group than in the normal esophageal motility group (P < 0.05). In conclusion, IEM was found to be associated with chemical clearance dysfunction as measured against the PSPW index and ACT. As this condition could be a risk factor for GERD, future treatments should be developed with a focus on chemical clearance.

Does Sleeve Gastrectomy Worsen Gastroesophageal Reflux Disease in Obese Patients? A Prospective Study

2021 ◽  
pp. 155335062110527
Author(s):  
Andrea Balla ◽  
Livia Palmieri ◽  
Diletta Corallino ◽  
Francesca Meoli ◽  
Maria Carlotta Sacchi ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Erosive Esophagitis ◽  
Surgical Indication ◽  
Hrql Score ◽  
Demeester Score ◽  
Significant Difference ◽  
The Impact

Background To evaluate the impact of laparoscopic sleeve gastrectomy (LSG) and gastric bypass (LGB) on gastroesophageal reflux disease (GERD). Methods GERD was evaluated by the Modified Italian Gastroesophageal reflux disease—Health-Related Quality of Life (MI-GERD-HRQL) questionnaire, pH-manometry, endoscopy, and Rx-esophagogram, before and 12 months after surgery. Based on these exams, patients without GERD underwent LSG, and patients with GERD underwent LGB. Results Thirteen and six patients underwent LSG and LGB, respectively. After LSG, the only statistically significant difference observed at pH-manometry was the median DeMeester score, from 5.7 to 22.7 (P = .0026). De novo GERD occurred in 6 patients (46.2%), with erosive esophagitis in one. The median MI-GERD-HRQL score improved from 3 to 0. Overall, nine patients underwent LGB, but three were lost to follow-up. Preoperative pH-manometry changed the surgical indication from LSG to LGB in 7 out of 9 patients (77.8%). Six patients who underwent LGB completed the study, and at pH-manometry, statistically significant differences were observed in the percentage of total acid exposure time, with the number of reflux episodes lasting >5 minutes and DeMeester score (P = .009). The median MI-GERD-HRQL score improved from 6.5 to 0. Statistically significant differences were not observed at endoscopy and Rx-esophagogram findings in both groups. Conclusions LSG has a negative impact on GERD, even in patients without preoperative GERD. LGB confirmed to be the intervention of choice in patients with GERD. Preoperative pH-manometry may identify patients with silent GERD, to candidate them to LGB rather than LSG. pH-manometry should be used more liberally to establish the correct surgical indication on objective grounds.

scholarly journals Prolonged Slow Expiration Technique and Gastroesophageal Reflux in Infants Under the Age of 1 Year

2021 ◽  
Vol 9 ◽  
Author(s):  
Laure Lievens ◽  
Yvan Vandenplas ◽  
Sylvie Vanlaethem ◽  
Filip Van Ginderdeuren
Keyword(s):  
Gastroesophageal Reflux ◽  
Ph Monitoring ◽  
Controlled Trial ◽  
Entire Group ◽  
Bronchial Obstruction ◽  
Intraluminal Impedance ◽  
Significant Difference ◽  
Before And After ◽  
Registration Number ◽  
Multichannel Intraluminal Impedance Ph

Background: The Prolonged Slow Expiration Technique (PSE) is an airway clearance technique (ACT) carried out in newborn children with bronchial obstruction and hypersecretion to clear away the mucus from the respiratory tract. Evidence about the effect of PSE on gastroesophageal reflux (GER) is currently lacking in the literature. This study aimed to evaluate the influence of PSE on GER in infants under the age of 1 year.Methods: Infants were observed using multichannel intraluminal impedance-pH monitoring (MII-pH) over 24 h. During monitoring, the participants were treated with one 20 min intervention of PSE in supine position, 2 h after feeding. In this controlled trial with intra-subject design, the number of reflux episodes (REs) during PSE were compared to 20 min before and after PSE.Results: Fifty infants younger than 1 year were screened of whom 22 had a pathological GER. For the entire group, no significant difference was seen in the total number of REs between before, during, or after the PSE treatment (P = 0.76). No significant difference in total REs was found between the three measuring points (P = 0.59) in the group of infants with an abnormal MII-pH (n = 22).Conclusion: PSE does not cause a significant difference in REs in infants younger than 1 year.Registration number: NCT03341585.

Appendectomy Does Not Increase the Risk of Future Emergence of Parkinson’s Disease: A Meta-analysis

2021 ◽  
pp. 000313482198903
Author(s):  
Mitsuru Ishizuka ◽  
Norisuke Shibuya ◽  
Kazutoshi Takagi ◽  
Hiroyuki Hachiya ◽  
Kazuma Tago ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Random Effects Models ◽  
Significant Difference ◽  
The Cochrane Library ◽  
The Impact ◽  
The Relationship ◽  
Observation Period

Objective To explore the impact of appendectomy history on emergence of Parkinson’s disease (PD). Background Although there are several studies to investigate the relationship between appendectomy history and emergence of PD, the results are still controversial. Methods We performed a comprehensive electronic search of the literature (the Cochrane Library, PubMed, and the Web of Science) up to April 2020 to identify studies that had employed databases allowing comparison of emergence of PD between patients with and those without appendectomy history. To integrate the impact of appendectomy history on emergence of PD, a meta-analysis was performed using random-effects models to calculate the risk ratio (RR) and 95% confidence interval (CI) for the selected studies, and heterogeneity was analyzed using I2 statistics. Results Four studies involving a total of 6 080 710 patients were included in this meta-analysis. Among 1 470 613 patients with appendectomy history, 1845 (.13%) had emergences of PD during the observation period, whereas among 4 610 097 patients without appendectomy history, 6743 (.15%) had emergences of PD during the observation period. These results revealed that patients with appendectomy history and without appendectomy had almost the same emergence of PD (RR, 1.02; 95% CI, .87-1.20; P = .83; I2 = 87%). Conclusion This meta-analysis has demonstrated that there was no significant difference in emergence of PD between patients with and those without appendectomy history.

The Effect of Ineffective Esophageal Motility on Gastroesophageal Reflux Disease

Digestion ◽  
2017 ◽  
Vol 95 (3) ◽  
pp. 221-228 ◽  
Author(s):  
Shingo Kasamatsu ◽  
Tomoaki Matsumura ◽  
Yuki Ohta ◽  
Shinsaku Hamanaka ◽  
Hideaki Ishigami ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Esophageal Motility ◽  
Ineffective Esophageal Motility

scholarly journals Multichannel intraluminal impedance-pH and psychometric properties in gastroesophageal reflux: systematic review

2020 ◽  
Vol 96 (6) ◽  
pp. 673-685
Author(s):  
Emília Silva Gonçalves ◽  
Maíra Seabra de Assumpção ◽  
Maria Fátima Correa Pimenta Servidoni ◽  
Elizete Aparecida Lomazi ◽  
José Dirceu Ribeiro
Keyword(s):  
Systematic Review ◽  
Gastroesophageal Reflux ◽  
Psychometric Properties ◽  
Multichannel Intraluminal Impedance ◽  
Intraluminal Impedance ◽  
Multichannel Intraluminal Impedance Ph

P173 HIGH-RESOLUTION MANOMETRIC FINDINGS AFTER MAGNETIC SPHINCTER AUGMENTATION

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Carlo Galdino Riva ◽  
Stefano Siboni ◽  
Veronica Lazzari ◽  
Marco Sozzi ◽  
Emanuele Asti ◽  
...  
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Symptom Relief ◽  
Rank Test ◽  
Barium Swallow ◽  
Upper Gastrointestinal Endoscopy ◽  
Magnetic Sphincter Augmentation ◽  
Hrql Score ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility

Abstract Aim The aim of this study was to evaluate esophageal motility before and after Magnetic Sphincter Augmentation (MSA) for medically refractory Gastro-Esophageal Reflux Disease (GERD). Background and Methods MSA (LINX® Reflux Management System) is intended for patients with chronic GERD with incomplete symptom relief from proton-pump inhibitors (PPI) and abnormal acid exposure. A prospectively collected database of patients who underwent MSA between 2007 and 2019 was queried. All patients who completed pre- and post-operative high-resolution manometry (HRM) were included in the study. Additional investigations included Health-Related Quality of Life (GERD-HRQL) questionnaire, Functional Outcome Swallowing Scale (FOSS), upper gastrointestinal endoscopy, barium swallow, and 24-96 hours pH-study. Data were analyzed using Wilcoxon signed rank test and McNemar test. Results Forty-five patients met the inclusion criteria. The median follow-up was 10 months (IQR 6). Compared to baseline, there was a statistically significant reduction in PPI use (p=0.000), rate of heartburn (p=0.000), regurgitation (p=0.008), and extra-esophageal symptoms (p=0.000). Only three (6.7%) patients required dietary changes. The GERD-HRQL score significantly improved (p=0.000). There was a significant increase in the Lower Esophageal Sphincter (LES) competency, including LES length (p=0.004) and Esophago-gastric Contractile Integral ((EGJ-CI) (p=0.000). A significant increase in integrated relaxation pressure (IRP) (p=0.000), mean Distal Contractile Integral (DCI) (p=0.008) and intrabolus pressure (p=0.000) was also found. Thirteen (28.9%) patients presented pre-operative Ineffective Esophageal Motility (IEM) and five of them resolved postoperatively. Two patients (4.4%) developed IEM after surgery: both had IRP and DCI values within normal limits, and one of them complained of dysphagia. However, the GERD-HRQL score recovered in both patients. Conclusion MSA was clinically effective in relieving both typical and atypical GERD symptoms. LES competency increased after MSA. EGJ outflow obstruction was uncommon and not associated with symptoms. Finally, ineffective esophageal motility may reverse to normal after MSA.

scholarly journals A-44 ImPACT of Amnesia Related Concussions Across Developmental Stages

2020 ◽  
Vol 35 (5) ◽  
pp. 640-640
Author(s):  
K Unjia ◽  
R Bennett ◽  
L Lashley
Keyword(s):  
Retrograde Amnesia ◽  
Sports Medicine ◽  
Developmental Stages ◽  
Future Research ◽  
Age Group ◽  
Adolescent Athletes ◽  
Significant Difference ◽  
The Impact ◽  
The Relationship ◽  
One Way Anova

Abstract Objective This study aimed to examine the relationship between developmental stages and concussions that resulted in amnesia as measured by ImPACT. Method Participants were selected from an archival de-identified sports medicine ImPACT database. The sample (N = 4,200) was primarily male (62.2%) student athletes with ages ranging from 10 to 25 years. Participants were divided into three groups: Young athletes (n = 1,400), Adolescent (n = 1,400), and Adult (n = 1,400). A One-Way ANOVA was conducted to determine the relationship between age group and prevalence of concussions resulting in anterograde or retrograde amnesia. Results The One-Way ANOVA revealed significant differences between age group and anterograde F(2,4197) = 107.449, p < .001 and retrograde amnesia F(2,4197) = 82.949, p < .001. Bonferroni pairwise comparison revealed the adolescent athlete group experienced more concussions that result in both anterograde and retrograde amnesia compared to young and adult athletes. There was no significant difference between young and adult athletes. Additionally, there is a significant difference regarding total games missed following concussion F(2,4197) = 117.723, p < .001, with adolescent athletes missing more games compared to young and adult athletes. Conclusions The findings of this study suggest adolescent athletes tend to experience more amnesia-related concussions compared to young and adult athletes. Additionally, adolescent athletes miss more games following these types of concussions. This study highlights the impact that certain types of concussions have on athletes across the developmental stages. Future research should analyze the cognitive effects of various types of concussions across the developmental stages.

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