Clinical Characteristics of Gastroesophageal Reflux Disease Patients With Laryngopharyngeal Symptoms / 胃肠病学

Background: The laryngopharyngeal symptoms of gastroesophageal reflux disease (GERD) include hoarseness, foreign body sensation, chronic cough, dysphagia, etc. Its pathogenic mechanisms and reflux characteristics may be different from those of GERD patients simply with typical esophageal symptoms. Aims: To explore the clinical characteristics of GERD patients complicated with laryngopharyngeal symptoms. Methods: Fifty-nine patients having a gastroesophageal reflux disease questionnaire (GerdQ) score ≥8 and abnormal reflux identified by 24 h esophageal impedance-pH monitoring were selected from the outpatients at the First Affiliated Hospital of Nanjing Medical University from January 2019 to December 2021. Twenty-nine cases simply with typical esophageal symptoms were allocated into typical symptom group, and 30 cases complicated with laryngopharyngeal symptoms were allocated into laryngopharyngeal reflux (LPR) group. The general information, results of gastroscopy, 24 h esophageal impedance - pH monitoring and esophageal manometry, as well as the efficacy of proton pump inhibitor (PPI) were collected and compared between the two groups. Results: The proportion of esophagitis in GERD patients in typical symptom group was significantly increased than that in LPR group (P<0.05), while the values of mean nocturnal baseline impedance at 7-3 cm above lower esophageal sphincter (LES) were significantly lower (all P<0.05). Compared with typical symptom group, increased frequency of weak acid reflux, prolonged mean acid clearance time, higher LES relaxation rate, lower velocity of peristaltic waves at 11-7 cm above LES, and poor efficacy of PPI treatment were observed in LPR group (all P<0.05). The severity of heartburn was positively correlated with the percentage of total acid exposure time and DeMeester score (all P<0.05); while the severity of foreign body sensation was positively correlated with the frequency of weak acid reflux and mean time of acid clearance (all P<0.05). Conclusions: The esophageal mucosal injury was mild in GERD patients complicated with laryngopharyngeal symptoms. Laryngopharyngeal symptoms are more likely to be associated with the decreased acid clearance capacity due to esophageal body dysmotility. Strengthened acid suppression therapy should be recommended.

Esophageal Acid Clearance During Random Swallowing Is Faster in Patients with Barrett's Esophagus Than in Healthy Controls

BACKGROUND/AIMS: Impaired esophageal acid clearance may be a contributing factor in the pathogenesis of Barrett’s esophagus. However, few studies have measured acid clearance as such in these patients. In this explorative, cross-sectional study, we aimed to compare esophageal acid clearance and swallowing rate in patients with Barrett’s esophagus to that in healthy controls. METHODS: A total of 26 patients with histology-confirmed Barrett’s esophagus and 12 healthy controls underwent (1) upper endoscopy, (2) an acid clearance test using a pH-impedance probe under controlled conditions including controlled and random swallowing, and (3) an ambulatory pH-impedance measurement. RESULTS: Compared with controls and when swallowing randomly, patients cleared acid 46% faster (P = 0.008). Furthermore, patients swallowed 60% more frequently (mean swallows/minute: 1.90 ± 0.74 vs 1.19 ± 0.58; P = 0.005), and acid clearance time decreased with greater random swallowing rate (P 0.3). CONCLUSIONS: More frequent swallowing and thus faster acid clearance in Barrett’s esophagus may constitute a protective reflex due to impaired mucosal integrity and possibly acid hypersensitivity. Despite these reinforced mechanisms, acid clearance ability seems to be overthrown by repeated, retrograde acid reflux, thus resulting in increased esophageal acid exposure and consequently mucosal changes.

The significance of blood lactic acid level and lactic acid clearance in evaluating the prognosis of septic shock / 中国基层医药

Objective To explore the significance of blood lactic acid level and lactic acid clearance in evaluating the prognosis of septic shock.Methods The blood lactic acid concentration of 64 patients with septic shock EICU ICU admission 1h inside,6,12,24 and 48h was recorded,and the lactic acid clearance was calculated 12 hours after treatment,and according to lactic acid clearance of outcome,64 patients were divided into two groups,live group and death group;Then compared blood lactic acid level and lactic acid clearance between the two groups.Results The blood lactic acid concentration of live group and death group when enter the ICU was (7.2 ±5.4)mmol/L,(9.2 ±5.6)mmol/L respectivly,and was higher than normal,and of live group after 6h began to fall,and it reached normal level after 24h [ (2.2 ± 1.3 ) mmol/L ],but of death group after 48 h [ ( 8.0 ± 3.8 ) mmol/L ] was still significantly higher than normal,until death.There was significant difference between the two groups (t =3.7816,3.8257,7.5263,4.5875,5.8765,all P ＜ 0.05 ).The lactic acid clearance of death group after 12 hours was (5.83 ±3.92)mmol/L,and significantly lower than that of live group[ ( 14.32 ±2.68) mmol/L] (t =6.2565,P ＜0.05).Conclusion Blood lactic acid concentration was positively related to the prognosis of patients with septic shock,and dynamic response of disease progression by detecting lactic acid clearance rate could be early,sensitive,quantitative indicators to determine the severity of critical illness.

The influence of purine content in diet on serum uric acid of old males / 中华内分泌代谢杂志

Eleven old male patients with hyperuricemia were collected ( hyperuricemia group,65-90 years old ).10 healthy middle-aged males ( middle-aged group,30-40 years old) and 10 healthy old males ( older group 60-70 years old ) with normal blood uric acid level were used as controls.All of the subjects were given low purine content diet ( 250 mg/d ) for 3 days followed by high purine content diet ( 800 mg/d ) consecutively for another three days.The samples of fasting blood and 24 h urine were collected for assay.The results showed that there were no significant changes of serum uric acid ( UA ) concentration in three groups after low purine content diet.But the levels of serum UA in three groups all increased significantly after high purine content diet,and the change was higher in hyperuricemia group than middle-aged group [ ( 507.7 ± 108.1 vs 378.9 ± 80.1 ) μmol/L,P＜0.05 ].24 h urine uric acid excretion in three groups was all significantly decreased after low purine content diet and increased after high purine content diet.After high purine content diet,24 h urine uric acid was lower in hyperuricemia group than middle-aged group [ ( 2.99 ± 1.21 vs 3.62 ± 1.02 ) mmol/24 h,P＜0.05 ].Blood urea nitrogen levels in all subjects decreased after low purine content diet and increased after high purine content diet ( P＜0.05 or P＜0.01 ).Creatinine clearance rate in hyperuricemia group was decreased after high purine content diet compared with baseline [ (75.3 ± 20.3 vs 80.7 ±20.0) ml/min ],and there were no significant changes in other groups after low and high purine content diet.24 h urine protein in hyperuricemia group was higher than middle-aged group ( P＜0.05 ),and increased after high purine content diet with significant difference ( P＜0.05 ).These results suggest that high purine content diet and decreased by renal uric acid clearance mainly contribute to hyperuricemia in old people.

Esophageal acid clearance in patients with ineffective esophageal motility / 대한내과학회지

BACKGROUND: Failed or hypotensive peristalsis, two of the diagnostic criteria for NEMD, correlates with impaired anterograde propulsion and retrograde escape of esophageal contents. The aim of this study was to evaluate esophageal acid clearance (EAC) in patients with ineffective esophageal motility (IEM). METHODS: Of 252 patients performing esophageal manometry and ambulatory esophageal pH monitoring, 51 patients with normal motility and acid reflux and 40 patients with IEM and acid reflux were included. RESULTS: The amplitude of peristaltic waves in the proximal and distal esophagus and lower esophageal sphincter pressure was lower significantly in patients with IEM than those with normal motility. Percentage of time of pH<4 in total, upright, and supine period and number of reflux episodes was not different in both. Supine EAC was significantly increased in patients with IEM when compared to those with normal motility. Upright EAC was not different in both. CONCLUSION: We concluded supine EAC is increased in patients with IEM. Since IEM is frequently associated with gastroesophageal reflux disease (GERD), a more intensive therapy must be needed. We propose IEM can be as a specific entity of primary esophageal motility disorder, especially in patients with GERD.

Potential role of ineffective esophageal motility in pathogenesis of gastroesophageal reflux disease / 中国实用内科杂志

Objective To explore the potential role of ineffective esophageal motility(IEM) in the pathogenesis of gastroesophageal reflux disease(GERD).Methods The esophageal manometry and ambulatory pH monitoring findings from patients with GERD were analyzed to identify the prevalence of IEM in patients with GERD.And comparison of esophageal acid exposure,esophageal acid clearance (EAC) and endoscopic esophagitis in GERD patients with IEM were made.Results Of 86 patients with GERD,59 (68.6%) were found to have nonspecific esophageal motility disorder (NEMD);55 of the 59 (93.2%)patients with NEMD met the diagnostic criteria for IEM.The overall incidence of IEM in GERD patients was 63.95%.Patients with IEM demonstrated significant increase in total,upright and recumbent mean percentage of time of pH

Esophageal Motility and Acid Clearance in Patients with Esophageal Varices / 대한소화기내시경학회지

The presense of the esophageal varices might have a partial machanical obstruction and cushion effect on esophageal lumen due to blood within the varices. It may affect on the motility and acid clearance in the esophagus. The aim of this study was to evaluate the acid clearance and the esophageal motility according to the degree of the varices in patients with esophageal varices. We have performed esophageal manometry and acid clearance test in 41 patients with esophageal varices. Esophageal motility disorder was abserved in 29.4% of patients with esophageal varices. The number of swallowing for acid clearance was significantly increased in patients with esophageal varices than control group(23.5 +/- 14.1 Vs 6.1 +/- 1.6, p=0.004). However, there was no significant corelation with form, location, and redcolor sign of the varices. In conclusion, patients with esophageal varices accompanied esophageal motility disorders and delayed acid clearance. This results might be a useful referance data for changes in esophageal motility before and after treatment of esophageal varices.