scholarly journals Features of the course and comparative characteristics of gastroesophageal reflux disease in pediatric patients with esophageal atresia after primary repair

2020 ◽  
pp. 24-29
Author(s):  
M.G. Aksionchyk ◽  
◽  
K.Y. Marakhousk ◽  
V.I. Averin ◽  
◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Esophageal Atresia ◽  
Reflux Disease ◽  
Pediatric Patients ◽  
Impedance Measurement ◽  
Index Number ◽  
Common Symptom ◽  
Esophageal Mucosa ◽  
Significant Difference

The aim is to evaluate clinical data and data of intraesophageal 24-hour pH/impedance measurement in pediatric patients with corrected esophageal atresia. Material and methods. A retrospective analysis was carried out on the basis of inpatient records of 43 pediatric patients with corrected esophageal atresia (CEA) aged from 1 to 14 years, who were examined at the State Institution «Republican Scientific and Practical Center of Pediatric Surgery» from November 2017 to March 2020. Average age of the group: 5.09±1.2 years, of which 23 boys (53.5%), 20 girls (46.5%). All patients with CEA underwent esophagogastroduodenoscopy (EGD) and intraesophageal 24-hour pH/impedance measurement while off acid-suppressive therapy. Results. Depending on the results of pH/impedance measurement, the patients with CEA were divided into two groups: CEA with gastroesophageal reflux disease (GERD) – 20 (54.1%) and CEA without GERD – 17 (45.9%). The most common symptom in patients with CEA was cough in both groups, in 26 (70.27%) children. Only in 4 out of 37 patients with CEA no symptoms during the time of the study were registered. Upper gastrointestinal tract endoscopy showed that 16 (43.2%) children with CEA had grade A esophagitis (according to the Los Angeles classification), 1 (2.7%) had gastric metaplasia of the esophageal mucosa, and 6 (16.2%) had chronic gastritis. EGD data did not reveal any significant differences between CEA patients with GERD and CEA patients without GERD (P=0.819). When comparing pH/impedance parameters, a significant difference (P<0.005) was obtained for the following parameters: reflux index, number of reflux episodes, distal mean nocturnal baseline impedance (MNBI) and duration of the longest reflux episode. In addition, the positive association of symptoms with episodes of refluxes (>95%) in the group of CEA patients without GERD was significantly higher than in CEA patients with GERD: 3/20 (15%) versus 8/17 (47.06%). Conclusions. The prevalence of GERD in patients with CEA in this study was 54.06%. Extraesophageal symptoms (in particular, cough) are prevalent in patients with CEA (70.3%). GERD can be asymptomatic in patients with CEA. In this study, 15% of CEA patients with confirmed GERD were asymptomatic. Patients with CEA in the study groups rarely had typical GERD symptoms (heartburn, regurgitation, chest pain and belching). The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institutions indicated in the article. Informed consent of parents and children was obtained for the research. The authors declare no conflicts of interest. Key words: corrected esophageal atresia, gastroesophageal reflux disease, esophagitis, children, esophageal 24-hour pH/impedance measurement.

scholarly journals THE EFFICACY OF THE DIFFERENT ENDOSCOPIC TREATMENTS VERSUS SHAM, PHARMACOLOGIC OR SURGICAL METHODS FOR CHRONIC GASTROESOPHAGEAL REFLUX DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

2018 ◽  
Vol 55 (3) ◽  
pp. 296-305 ◽  
Author(s):  
Martin Andrés CORONEL ◽  
Wanderley Marques BERNARDO ◽  
Diogo Turiani Hourneaux de MOURA ◽  
Eduardo Turiani Hourneaux de MOURA ◽  
Igor Braga RIBEIRO ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Meta Analysis ◽  
Short Term ◽  
Significant Difference ◽  
Objective Outcomes

ABSTRACT BACKGROUND: Endoscopic antireflux treatments for gastroesophageal reflux disease (GERD) are still evolving, and most of the published studies address symptom relief in the short-term. Objective - We aimed to perform a systematic review and meta-analysis focused on evaluating the efficacy of the different endoscopic procedures. METHODS: Search was restricted to randomized controlled trials (RCTs) on MedLine, Cochrane, SciELO, and EMBASE for patients with chronic GERD (>6 months), over 18 years old and available follow up of at least 3 months. The main outcome was to evaluate the efficacy of the different endoscopic treatments compared to sham, pharmacological or surgical treatment. Efficacy was measured by different subjective and objective outcomes. RESULTS: We analyzed data from 16 RCT, totaling 1085 patients. The efficacy of endoscopic treatments compared to sham and proton pump inhibitors (PPIs) treatment showed a significant difference up to 6 months in favor of endoscopy with no heterogeneity (P<0.00001) (I2: 0%). The subgroup analysis showed a statistically significant difference up to 6 months in favor of endoscopy: endoscopy vs PPI (P<0.00001) (I2: 39%). Endoscopy vs sham (P<0.00001) (I2: 0%). Most subjective and objective outcomes were statistically significant in favor of endoscopy up to 6 and 12 months follow up. CONCLUSION: This systematic review and meta-analysis shows a good short-term efficacy in favor of endoscopic procedures when comparing them to a sham and pharmacological or surgical treatment. Data on long-term follow up is lacking and this should be explored in future studies.

Zonulin is not increased in the cardiac and esophageal mucosa of patients with gastroesophageal reflux disease

Peptides ◽  
2009 ◽  
Vol 30 (6) ◽  
pp. 1082-1087 ◽  
Author(s):  
Thomas Wex ◽  
Klaus Mönkemüller ◽  
Doerthe Kuester ◽  
Lucia Fry ◽  
Arne Kandulski ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Esophageal Mucosa

scholarly journals Gastroesophageal reflux disease: new approaches to optimizing pharmacotherapy

2021 ◽  
pp. 30-37
Author(s):  
D. N. Andreev ◽  
A. V. Zaborovsky ◽  
E. G. Lobanova
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Barrier Properties ◽  
Nerve Fibers ◽  
Esophageal Mucosa ◽  
Mucosal Permeability ◽  
Other Substances ◽  
Maintenance Of Remission

Proton pump inhibitors (PPIs) are baseline drugs for induction and maintenance of remission in gastroesophageal reflux disease (GERD). PPIs have proven to be highly effective in healing esophageal mucosal lesions and relieving the symptoms of the disease in most cases. However, according to the literature data, the incidence rate of clinical ineffectiveness of PPIs in the form of partial or complete persistence of current symptoms during administration of standard doses of PPIs ranges from 10 to 40%. Optimization of GERD therapy in PPI refractory patients is a significant challenge. In most cases, experts advise to increase a dose / dosage frequency of PPIs, switch to CYP2C19-independent PPIs (rabeprazole, esomeprazole, dexlansoprazole), add an esophagoprotective or promotility agents to therapy. At the same time, these recommendations have a limited effect in some patients, which opens up opportunities for looking for new solutions related to the optimization of GERD therapy. Today there is growing evidence of the relevance of the role of disruption of the cytoprotective and barrier properties of the esophageal mucosa in the genesis of GERD and the formation of refractoriness. Intercellular contacts ensure the integrity of the barrier function of the esophageal mucosa to protect it from various exogenous intraluminal substances with detergent properties. Acid-peptic attack in patients with GERD leads to alteration of the expression of some tight junction proteins in epithelial cells of the esophageal mucosa. The latter leads to increased mucosal permeability, which facilitates the penetration of hydrogen ions and other substances into the submucosal layer, where they stimulate the terminals of nerve fibers playing a role in the induction and persistence of the symptoms of the disease. The above evidence brought up to date the effectiveness study of the cytoprotective drugs with tropism to the gastrointestinal tract, as part of the combination therapy of GERD.

scholarly journals GASTROESOPHAGEAL REFLUX DISEASE

2011 ◽  
Vol 18 (04) ◽  
pp. 693-696
Author(s):  
ABDUL RAZZAQ WARRAICH ◽  
DR. RAFFAD ◽  
CHAUDHRY MUHAMMAD SIDDIQ ◽  
Zaheer Iqbal ◽  
Mohammad Saeed Khokhar
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Rapid Urease Test ◽  
Common Symptom ◽  
Infection Frequency ◽  
Urease Test ◽  
H Pylori ◽  
Disease Study ◽  
Study Setting

Objective: To find the frequency of H pylori infection among the patients of gastroesophgeal reflex disease. Study design: Descriptive study. Setting: Department of Medicine, Unit-I, Services Hospital, Lahore. Subject & method: One hundred patients with gastroesophageal reflux disease (GERD) were included in this study. For detection and confirmation of helicobacter pylori, endoscopy with antral biopsy was done. Specimens were sent for histopathology, and rapid urease test was performed. Main outcome measures: Frequency of H pylori infection, frequency of regurgitation, dysphagia, nausea, vomiting and haemetemesis. Results: 100 patients who fulfilled the inclusion criteria were taken. There were 65 males and 35 females respectively. Their age ranged from 18 to 48 years. 39 (39%) patients were between 29-38 years while 23 (23%) were of 39-48 years. There were 38 (38%) patients between 18-28 years. The mean age of the patients was 31.79±7.56. 40 (40%) were found to be H. pylori positive on biopsy and rapid urease test, while 60 (60%) were H. pylori negative. The most common recorded symptom was chest pain/retrosternal burning (90%). Regurgitation (65%) and nausea (55%) were other common symptoms. Dysphagia and water-brash were present in 40% each. Vomiting (30%), abdominal pain (25%) and cough (20%) were the other symptoms. The least common symptom was haemetemesis (5%). Conclusions: A causal relationship between GERD and H. pylori infection could not be established. Therefore, routine H. pylori eradication in the treatment of patients with GERD is not recommended. 

scholarly journals Current advances in the treatment of gastroesophageal reflux disease: a focus on esophageal protection

2019 ◽  
Vol 91 (8) ◽  
pp. 4-11 ◽  
Author(s):  
I V Maev ◽  
D N Andreev ◽  
Yu A Kucheryavyy ◽  
R I Shaburov
Keyword(s):  
Molecular Weight ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Mucous Membrane ◽  
Reflux Disease ◽  
Barrier Function ◽  
Poloxamer 407 ◽  
Low Molecular Weight ◽  
Esophageal Mucosa ◽  
Refractory Gerd

Gastroesophageal reflux disease (GERD) is characterized by high morbidity and a significant decrease in the quality of life of patients, and is a major risk factor for esophageal adenocarcinoma. Nowadays, antisecretory therapy with proton pump inhibitors (PPI) is the "gold standard" of conservative treatment of GERD, but in some cases this therapy is unsuccessful. According to various studies, the prevalence of refractory GERD can reach 30-40%. The latest scientific data in the field of genetics and pathophysiology of GERD demonstrate that a disruption of the barrier function of the esophageal mucosa and an increase of its permeability can be the leading causes of refractoriness. Thus, the optimal therapy for patients with GERD should not only suppress the secretion of hydrochloric acid, but also restore the barrier function of the mucous membrane, providing an esophagoprotective effect. To achieve these goals, Alfasoxx was developed, which consists of a mixture of low molecular weight hyaluronic acid and low molecular weight chondroitin sulfate dissolved in a bioadhesive carrier (poloxamer 407). The clinical efficacy of this product has been confirmed by three prospective, randomized, placebo - controlled trials. Alfasoxx has a healing and restorative effect towards the esophageal epithelium and due to high ability for bioadhesion provides long - term protection of the mucous membrane of the esophagus. Combination therapy for GERD with the use of PPI and an esophagoprotector offers new perspectives for the treatment of patients with GERD.

scholarly journals Resistance of the Esophageal Mucosa in Patients with GERD: the Dialogue Between Clinician and Pathologist

2021 ◽  
Vol 17 (4) ◽  
pp. 34-39
Author(s):  
I.V. Matoshina ◽  
◽  
M.M. Fedorin ◽  
M.A. Livzan ◽  
S.I. Mozgovoy
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Pathological Process ◽  
Mucosal Barrier ◽  
Esophageal Mucosa ◽  
Mucosal Protection ◽  
Natural Factor ◽  
Immunological Mechanisms ◽  
Functional Components

Gastroesophageal reflux disease (GERD) is the most common of all acid-related diseases, it is recognized as the leading cause of esophageal adenocarcinoma. The natural factor of protection against aggressive refluxate components is the integrity of the esophageal mucosa, which performs a barrier function with the participation of a number of mechanical, chemical and immunological mechanisms. Their damage under the regular influence of acidic or mixed reflux causes the development of the pathological process. The review was prepared to systematize knowledge of the main components of mucosal barrier of the esophagus providing resistance of mucosa under conditions of GERD. The literature was searched in Embase, PubMed, and Google Scholar using the keywords: gastroesophageal reflux disease, mucosal protection, esophageal mucosa epithelium, dense contact proteins, epithelial protection, esophagoprotection. The main structural and functional components of esophageal mucosal protection were emphasized

Do Eosinophil Numbers Differentiate Eosinophilic Esophagitis from Gastroesophageal Reflux Disease?

2010 ◽  
Vol 134 (6) ◽  
pp. 815-825
Author(s):  
Muriel Genevay ◽  
Laura Rubbia-Brandt ◽  
Anne-Laure Rougemont
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Eosinophilic Esophagitis ◽  
Reflux Disease ◽  
Eosinophilic Infiltration ◽  
Treatment Modalities ◽  
Esophageal Mucosa ◽  
American Gastroenterological Association ◽  
National Library

Abstract Context.—Although the healthy esophageal mucosa contains no eosinophils, eosinophilic infiltration is observed in 2 major clinicopathologic settings: gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EE). The prevalence of EE is increasing in many countries, and this increase seems only partly to be due to a better awareness of the pathology, following the relatively recent description of EE. Gastroesophageal reflux disease and EE represent 2 entities that do not respond to the same treatment modalities and, thus, need to be distinguished. However, diagnostic criteria of EE have been defined arbitrarily, and the more recent articles tend to prove that the overlap with GERD is probably greater than initially believed, leading the authors to advise strict exclusion of GERD before considering the diagnosis of EE. Objectives.—To provide pathologists with the currently proposed histologic criteria of GERD and EE, to stress the need to combine these criteria with clinical data and endoscopic findings, and to outline the remaining controversies. Data Sources.—This review is based on selected articles identified by a PubMed (US National Library of Medicine, Bethesda, Maryland) search of the literature in English for GERD and EE, a recent review by the American Gastroenterological Association (Bethesda), the Proceedings of the First International Gastrointestinal Eosinophil Research Symposium, and the authors' experience. Conclusions.—Proper identification of the etiology of eosinophilic infiltration of the esophagus allows accurate medical or surgical treatment and follow-up. Eosinophilic esophagitis and GERD diagnoses require integration of the histologic findings with the clinical and endoscopic data.

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