[24-hour esophageal impedance-pH monitoring: technical aspects, indications and results]

Classical techniques like endoscopy and esophageal pH-metry are the gold standard to study patients with symptoms related to gastroesophageal reflux disease. Although these techniques have been useful over the years both for diagnosis and therapeutic guidance, there are still many patients with typical or atypical gastroesophageal reflux disease symptoms with normal endoscopy and pH-metry that do not respond adequately to antisecretory therapy. Ambulatory esophageal impedance-pH monitoring is a new technique that can be used to evaluate all types of gastroesophageal reflux, achieving higher rates of sensitivity and specificity than standard techniques. To precise the technical aspects of the esophageal impedancepH monitoring, indications and results of this technique in clinical practice. Literature revue of the esophageal impedance - pH monitoring. Combined multichannel intraluminal impedance and pH monitoring is a new technique that can be used to evaluate both bolus transport and all types of reflux [acid, weakly acidic and weakly alkaline], without radiation hazards. With this technique, higher rates of sensitivity and specificity than standard techniques are obtained in the diagnosis of pathological gastroesophageal reflux. The technique has also been used in the evaluation of atypical gastroesophageal reflux symptoms, in the assessment of the association of different patterns of reflux with symptoms, and in the evaluation of therapeutic outcome mainly in patients with refractory gastroesophageal reflux disease. The esophageal impedance represents real progress in understanding the different mechanisms involved in the pathophysiology of gastroesophageal reflux. This technique should also allow a better understanding of the responsibility of non-acid reflux in special clinical situations, such as patients resistant to antisecretory or extra-intestinal manifestations of gastroesophageal reflux

Sleep disorders in patients with gastroesophageal reflux disease: an open clinical and pH metric prospective study

Sleep disorders are frequent in patients with GERD. Severity of sleep disorders could be related to occurrence of nighttime symptoms, but the relationship between severity of GERD and the severity of sleep disorders is not well established. To identify the frequency of sleep disorders in patients with suspected GERD and the correlation between the severity of sleep disorders and pH metric parameters in these patients. We studied prospectively 50 patients with esophageal and supra-esophageal symptoms of GERD. 24-hour esophageal pH monitoring examination was performed in all patients. Standard survey was applied to determine the frequency and the severity of sleep disorders in these patients. We included 50 patients [10 men, 40 women], mean age 43.7 years [18-70]. Nighttime symptoms were present in 26 patients [52%]. Pathological acid gastro-esophageal reflux was diagnosed by 24-hour esophageal pH recording in 18 patients [36%], with nocturnal acid reflux in 19 patients [38%]. Sleep disorders were reported by 29 patients [58%]. Mean number of hours of sleep was 6.8 hours by night [4-9 hours]. Clinical factors associated with higher frequency of sleep disorders were occurrence of nighttime symptoms [p<0.0001] and duration of symptoms of GERD [53.2 +/- 41.4 months vs 26.0 +/- 18.1 months; p = 0.007], with no association with BMI, age and sex. pHmetric parameters associated with sleep disorders were pathological acid reflux [p<0.0001; OR [C195%] :28.3 [3.3-240.8]] and nocturnal acid reflux p<0.0001; OR[C195%1 :32.7 [3.8-279.2]]. Patients with sleep disorders had significant changes of pHmetric parameters compared to those without sleep disorders: Acid exposition time, numbers of reflux episodes, number of episodes longest than five minutes, duration of longest reflux episode and DeMeester score [respectively 6.1 +/- 8.8 vs 1.3 +/- 1.5 p = 0.01; 59.2 +/- 52.0 vs 20.7 +/- 21.6 p = 0.001; 3.1 +/- 6.1 vs 0.1 +/- 0.3 p = 0.03; 8.9 +/- 9.3 minutes vs 3.4 +/- 4.0 minutes p = 0.01; 24.0 +/- 33.2 vs 4.8 +/- 4.9 p = 0.01]. Number of hours of sleep was significantly lower in patients with pathological acid reflux [5.3 +/- 1.2 hours vs 7.6 +/- 1.7 hours, p<0.0001] and in patients with nocturnal acid reflux [5.2 +/- 1.1 hours vs 7.8 +/- 1.5 hours, p<0.0001]. Number of hours of sleep was strongly correlated with esophageal pH parameters Sleep disorders are frequent in patients with GERD symptoms. Severity of sleep disorders are strongly correlated with severity of global and nocturnal acid reflux as attested by 24-hour esophageal pH monitoring

[Oesophageal motility abnormalities in systemic sclerosis: frequency and predictive factors]

Esophageal involvement is frequent during systemic sclerosis. It consists on esophageal motor abnormalities. Esophageal manometry is the gold standard for the diagnosis. To determine the frequency and the type of the esophageal motor abnormalities among patients presenting a systemic sclerosis; and to look for factors associated with a greater risk of theses disorders. A retrospective study relating to all the esophageal manometries carried out among patients presenting a systemic sclerosis was undertaken. During a 12 years period, 128 cases were studied. Esophageal motor abnormalities were found among 97 patients [76%]. Specific esophageal involvement was found among 52 patients [42%], and non specific motor abnormalities among 31 patients [24%]. The only associated factor with a specific esophageal involvement is occurrence of dysphagia. Esophageal motor abnormalities are frequent in patients with systemic sclerosis. They can be specific and nonspecific. Esophageal manometry should be systematically performed among these patients, even in the absence of dysphagia

[Proximal gastro-esophageal reflux monitoring in patients with suspected laryngopharyngealreflux disease]

To assess the frequency and associated actors of proximal acid reflux in patients with ENT manifestations of gastroesopliageal reflux disease, and to compare the pHmetric parameters in the distal and the proximal esophagus in these patients. We conducted an open-prospective study, including consecutive patients with chronic pharyngitis or laryngitis. Twenty four hour esophageal pH-monitoring was performed, using a double sensor catheter. Proximal reflux was defined according to the recently published recommendations. We studied 43 patients [17 men and 26 women], mean age 39,5 years [15- 67 years]. Distal reflux was detected in 35 patients [81%]. Proximal reflux was detected in 26 patients [60%]. Ratio of numbers of proximal to distal reflux episodes was 0.34 [0- 0.90]. The proximal reflux episodes were characterized by a small number of episodes exceeding 5 minutes [2.6 + 4.4 vs 10.8 + 9.1: p <0.0001]. a less duration of longest reflux episode [15.6 + 23.5 vs 50.2 + 61 6 minutes p< 0.0001] and better esophageal clearance [1.6 + 1 vs 2.5 + 1 minutes/reflux p = 0.006], associated with a significant correlation between numbers of proximal reflux episodes and distal acid exposure time[r = 0.52 p <0.0001]. Proximal reflux is frequent in patients is with chronic pharyngitis or laryngitis. Proximal reflux episodes are correlated to distal acid exposure and associated with a better esophageal clearance

[How can we optimize the performances of 24-hour esophageal pH-monitoring for the diagnosis of gastroesophageal reflux disease?]

24-hour pH esophageal monitoring represents the gold standard for the diagnosis of the gastro-esophageal reflux disease. However, it is associated certain limits, especially in front of particular situations. To describe the means which can improve quality of the pH metric procedure and its diagnostic performances, while insisting on simple and accessible means in current practice. Review of the literature. The improvement of the pH monitoring performances must be done by the specific study of the night period, especially in patients having respiratory symptoms. Among these patients, the treatment of the nocturnal gastro-esophageal reflux is associated with a considerable improvement of the quality of life. In addition, the examination must be well explained to the patient, with an aim of activating the markers of events as often as possible, since a good symptomatic agreement can be associated with normal acid exposure; defining the sensitive oesophagus. This entity is important to diagnose because of the effectiveness of PPI treatment. Lastly, in patients with ENT manifestations of gastro-esophageal reflux, the use of a probe with double channel is strongly recommended, for diagnosis of proximal reflux, which could explain the symptoms and which could be treated by high doses of PPI. The performances of 24-hour esophageal pH monitoring can be improved by simple means, of which the use will have to take account of the clinical context

[Nocturnal gastroesophageal reflux disease in asthmatics patients: a phmetric study about 81 cases]

Aim: To determine the frequency of gastroesophageal reflux disease on 24-hour esophageal pH monitoring in asthmatics patients and to evaluate the clinical and pHmetric characteristics of nocturnal reflux in these patients

Methods: We conducted a retrospective study based on results of 24-hour esophageal pH monitoring during a 10-year period in asthmatics patients with or without digestive symptoms of gastroesophageal reflux disease

Results: We studied 81 patients [37 men, 44 women; mean age: 32 years]. Gastroesophageal reflux was found in 42 patients [52%]. Nocturnal reflux was observed in 35 patients [43%], mostly in association with pathological reflux in the total period [32 cases]. Presence of digestive symptoms was the only associated factor to gastroesophageal reflux during 24-hour, in nocturnal or in diurnal period. Compared to the diurnal period, the nocturnal period was characterized by fewer number of reflux episodes [22.69 + 23 vs 70.16 + 56.15; p<0.001], more longer duration of reflux episodes [25.92 + 23.34 minutes vs 15.52 + 16.27 minutes; p=0.02], fewer respiratory symptoms [2.24 + 1.89 vs 6.18 + 4.12; p=0.01] and better symptomatic correlation [13/17: 76% vs 9/24:37%; p=0.02]

Conclusion: Gastroesophageal reflux disease is frequent in asthma. Nocturnal reflux is associated with overall reflux on the 24 hour examination. Nocturnal period is characterized by more longer reflux episodes and better symptomatic correlation

[Findings of 24-hour esophageal pH monitoring in patients with respiratory and otorhinolaryngologic manifestations of gastroesophageal reflux disease]

We conducted a retrospective study on 24-hour esophageal pH monitoring performed to patients with non allergic asthma, chronic cough and chronic pharyngitis or laryngitis. We studied 168 patients. On 24-hour esophageal pH monitoring, gastroesophageal reflux was detected in 67 cases [40%], more frequently in patients with chronic cough and asthma than in patients with chronic pharyngitis or laryngitis. A statistically significant increase in all the pH metric parameters, except for the number of reflux episodes, was found in asthmatic patients compared to patients with chronic pharyngitis or laryngitis. Comparison of the pH metric parameters in patients with gastroesophageal reflux disease revealed that the number of reflux episodes of more than five minutes and the duration of longest reflux episodes were higher in asthmatic patients than in patients with chronic cough. Gastroesophageat reflux disease is more frequent in asthma and chronic cough than in chronic pharyngitis or laryngitis. Reflux episodes in chronic cough are shorter than these in asthma. This difference should explain the different severity between the two situations

[ pathophysiology of irritable bowel syndrome]

The irritable bowel syndrome [IBS] is a frequent gastrointestinal disorder [10 -15% of the population].It is characterized by chronic abdominal pain with modification in the bowel habits. The diagnosis is based of ROME II criteria. The pathophysiology of the SII remains unknown. It result from visceral hypersensitivity with anomalies of the digestive motility. These anomalies are secondary of dysfunction of the brain - gut axis modulated by environmental and the psychosocial factors. The understanding of the pathophysiological mechanisms of the SII and in particular the function of the brain-gut axis will permit a better handling of the patients. Indeed, the present knowledge of the neurotransmitter implied in the communication between the central nervous system and the digestive tract are currently the basis of the new therapies aimed to modulate the mechanisms implicated in the causation of the several symptoms of IBS. These novel pharmacotherapy should reduce the indirect societal and costs of IBS

Genetique des maladies inflammatoires cryptogenetiques de l'intestin

The inflammatory bowel disease [IBD] are multifactorial diseases involving the interaction of genetic and environmental factors. In genetic terms, the IBD are polygenic and multigenic disorders with incomplete penetrance. In the late decade, investigators have applied the complementary techniques of genome-wide scanning and candidate gene analysis to search susceptibility genes. The IBD susceptibility regions, widely replicated, are in chromosomes 16 [IBD1], 12 [IBD2] and 6 [IBD3]. Recently, a signification have been reported with crohn's disease and NOD2/ CARD15 gene. This gene is an appropriate candidate gene because its localization and function. More studies is necessary to confirm this association, search an other variants of this gene and other candidate gene. This studies provide best comprehension of the disease pathogenesis and deliver clinical application