Avaliação da microbiota intestinal em adultos com esofagite erosiva / Assessment of the intestinal microbiota in adults with erosive esophagitis

ABSTRACT BACKGROUND: The intestinal microbiota influences the appropriate function of the gastrointestinal tract. Intestinal dysbiosis may be associated with a higher risk of esophageal lesions, mainly due to changes in gastroesophageal motility patterns, elevation of intra-abdominal pressure, and increased frequency of transient relaxation of the lower esophageal sphincter. OBJECTIVE: The aim of this study was to evaluate the intestinal microbiota in individuals with erosive esophagitis and in healthy individuals using metagenomics. METHODS: A total of 22 fecal samples from adults aged between 18 and 60 years were included. Eleven individuals had esophagitis (eight men and three women) and 11 were healthy controls (10 men and one woman). The individuals were instructed to collect and store fecal material into a tube containing guanidine solution. The DNA of the microbiota was extracted from each fecal samples and PCR amplification was performed using primers for the V4 region of the 16S rRNA gene. The amplicons were sequenced using the Ion Torrent PGM platform and the data were analyzed using the QIIME™ software version 1.8. Statistical analyses were performed using the Mann-Whitney non-parametric test and the ANOSIM non-parametric method based on distance matrix. RESULTS: The alpha-diversity and beta-diversity indices were similar between the two groups, without statistically significant differences. There was no statistically significant difference in the phylum level. However, a statistically significant difference was observed in the abundance of the family Clostridiaceae (0.3% vs 2.0%, P=0.032) and in the genus Faecaliumbacterium (10.5% vs 4.5%, P=0.045) between healthy controls and esophagitis patients. CONCLUSION: The findings suggest that reduced abundance of the genus Faecaliumbacterium and greater abundance of the family Clostridiaceae may be risk factors for the development of erosive esophagitis. Intervention in the composition of the intestinal microbiota should be considered as an adjunct to current therapeutic strategies for this clinical condition.

RESUMO CONTEXTO: A doença do refluxo gastroesofágico (DRGE) é uma das enfermidades mais comuns na prática clínica e possui fisiopatologia multifatorial. Disbiose da microbiota intestinal pode ter influência em mecanismos envolvidos nesta doença, como mudanças nos padrões motores gastrointestinais, elevação da pressão intra-abdominal e aumento da frequência de relaxamentos transitórios do esfíncter esofágico inferior. Contudo, a avaliação da microbiota intestinal, neste contexto, ainda é pouco documentada. OBJETIVO: Este estudo avaliou a microbiota bacteriana intestinal, em indivíduos com doença do refluxo gastroesofágico erosivo e em indivíduos saudáveis, utilizando técnicas de metagenômica. MÉTODOS: Estudo incluiu amostras fecais de 22 adultos, com idades entre 18 e 60 anos: 11 com esofagite erosiva (oito homens e três mulheres) e 11 controles saudáveis (dez homens e uma mulher). Os pacientes foram orientados a coletar e armazenar o material fecal em tubo contendo solução de guanidina. O DNA da microbiota foi extraído das amostras de fezes e amplificação por PCR foi realizada usando iniciadores para a região V4 do gene 16S rRNA. Os amplicons foram seqüenciados usando a plataforma Ion PGM Torrent e os dados foram analisados usando o software QIIME™ versão 1.8 (Quantitative Insights Into Microbial Ecology). Análise de estatística foi realizada utilizando-se o teste não paramétrico de Mann-Whitney e o teste ANOSIM, método não paramétrico baseado em matriz de distância. RESULTADOS: Os índices de alfa-diversidade e beta-diversidade foram semelhantes entre os dois grupos, sem diferença estatisticamente significante. Não houve diferença estatisticamente significante no nível de filo, classe e ordem. Entretanto, observou-se diferença estatisticamente significante na abundância da família Clostridiaceae (0,3% vs 2,0%, P=0,032) e no gênero Faecaliumbacterium (10,5% vs 4,5%, P=0,045) entre controles saudáveis e pacientes com DRGE erosiva, respectivamente. CONCLUSÃO: Os achados sugerem que menor abundância do gênero Faecaliumbacterium e maior abundância da família Clostridiaceae, nos pacientes com DRGE, podem influenciar na fisiopatologia desta doença.

Clinical characteristics of 326 cases of erosive esophagitis in healthy population undergoing health checkup in Eastern Zhejiang Province / 中华消化杂志

Objective To explore the incidence of asymptomatic erosive esophagitis (AEE) and clinical characteristics of symptoms of erosive esophagitis in healthy population undergoing health check-up.Methods From January 2012 to December 2015,at Ningbo Medical Treatment Center Lihuili Eastern Hospital,a total of 3 052 healthy people receiving routine health checkup and underwent gastroendoscopy were retrospectively analyzed.The demographic characteristics,endoscopic findings,reflux-related symptoms,metabolic syndrome and biochemical parameters were analyzed in AEE and symptomatic erosive esophagitis (SEE) patients.T test and Chi square test were performed for univariate analysis,and multivariate logistic regression analysis was used to compare differences between AEE and SEE patients.Results There were 326 cases of erosive esophagitis,and the incidence rate was 10.7％ (326/3 052).Among them,the incidence rate of AEE was 4.9％ (151/3 052),which accounted for 46.3％ (151/326) of erosive esophagitis;and the incidence rate of SEE was 5.7％ (175/3 052),and accounted for 53.7％ (175/326) of erosive esophagitis.About 98.2％ (320/326)of the patients were diagnosed with mild esophagitis (Los Angeles grade A or B).The results of univariate analysis indicated that,compared with AEE group,there were more smokers (31.8％,48/151 vs.45.7％,80/175) and more drinkers (27.8％,42/151 vs.41.7％,73/175),and higher body mass index (BMI) ((23.95± 2.32) kg/m2 vs.(24.53 ± 2.19) kg/m2) were in SEE group,and the differences were statistically significant (x2 =6.592 and 6.859,t =-2.351;all P ＜ 0.05).There were no significant differences between SEE group and AEE group in age,gender,esophageal hiatal hernia,metabolic syndrome and biochemical indicators (all P ＞ 0.05).The results of multivariate logistic regression analysis indicated that smoking (odds ratio (OR) =1.67,95％ confidence interval (CI) 1.05 to 2.65,P =0.030),alcohol drinking (OR =1.69,95％ CI 1.05 to 2.72,P =0.030) and high BMI (OR =1.11,95％ CI 1.00 to 1.23,P =0.044) were the independent risk factors of gastroesophageal reflux symptoms in patients with erosive esophagitis.Conclusions AEE is common in Chinese population,and the incidence is similar to SEE.Smoking,alcohol drinking and high BMI are the risk factors of reflux symptom in patients with erosive esophagitis.

Effect of Roux-en-Y gastric bypass in the control of erosive esophagitis

Introduction: Gastroesophageal reflux disease (GERD) is a multifactorial disease associated with environmental and genetic factors. Obesity is among the risk factors for its development, which also correlates with an increase in severity of clinical presentation and a higher incidence of complications associated with reflux. Methods: This historical cohort study included a sample of 249 patients who had undergone bariatric surgery using the Roux-en-Y gastric bypass technique at the Hospital São Vicente de Paulo, Passo Fundo, southern Brazil, from January 2014 to December 2015. Results: Of 249 patients, 77.9% (190 patients) were female and the mean age was 38 years. The occurrence of reflux esophagitis was 81.1% (196 patients) in the preoperative period and 31.3% (75 patients) in the postoperative period. With regard to bariatric treatment response to control moderate and severe esophagitis (grades B, C and D), there was a reduction in prevalence from 62 (25%) to 12 (5%) patients (p<0.05). Conclusions: Bariatric surgery using the Roux-en-Y gastric bypass technique is effective in the control of reflux esophagitis. Regression is observed mainly in cases of moderate and severe esophagitis. (AU)

Weight Loss as a Nonpharmacologic Strategy for Erosive Esophagitis: A 5-Year Follow-up Study

BACKGROUND/AIMS: Obesity is a risk factor for gastroesophageal reflux disease (GERD), with several studies demonstrating positive associations between body mass index (BMI) and GERD symptoms. However, little is known about the effect of BMI changes on erosive esophagitis (EE). In this study, we investigated whether BMI reduction could resolve EE. METHODS: A retrospective cohort study was performed to assess the natural course of EE according to changes in BMI. Participants undergoing health check-ups from 2006 to 2012 were enrolled, and 1,126 subjects with EE were included. The degree of esophagitis was measured by upper endoscopy and serially checked over a 5-year follow-up. Logistic regression and Cox proportional hazards models were used to investigate the association between BMI reduction and EE resolution. RESULTS: Substantial weight loss is associated with EE resolution. The adjusted odds ratio for EE resolution was 1.44 (95% confidence interval [CI], 1.09 to 1.92) among participants with a decrease in BMI compared to those with no decrease in BMI. The EE resolution rate was related to the degree of BMI reduction. The effect of weight loss on EE resolution was higher among subjects who lost more weight. Compared with subjects with no decrease in BMI, the hazard ratios for EE resolution were 1.09 (95% CI, 0.89 to 1.35), 1.31 (95% CI, 1.01 to 1.72) and 2.12 (95% CI, 1.44 to 3.12) in subjects with BMI reductions of ≤1, 1–2, and >2 kg/m2, respectively. CONCLUSIONS: EE resolution is associated with a decrease in BMI, and weight loss is potentially an effective GERD treatment.

Differences in the insulin resistance levels measured by HOMA-IR between patients with erosive and non-erosive gastroesophageal reflux disease / Journal of the ASEAN Federation of Endocrine Societies

Background@#Insulin resistance is the core of Metabolic Syndrome which carries a high risk for cardiovascular events. Insulin resistance had been reported to be higher in GERD patients than subjects without GERD, specifically in erosive esophagitis. @*Objective@#To compare the degree of insulin resistance, using HOMA-IR index, between erosive and non-erosive reflux disease. @*Methodology@#A cross-sectional study of 84 adult patients with GERD symptoms was conducted. The subjects were recruited consecutively between January 2017 and April 2017 at Cipto Mangunkusumo National Hospital in Jakarta. Gastroesophageal Reflux Disease Questionnaire (GERDQ) was used for subject recruitment. Homeostatic model assessment-insulin resistance (HOMA-IR) index was used to evaluate insulin sensitivity. Esophageal erosions were diagnosed using upper gastrointestinal endoscopy. Bivariate analysis was used to determine HOMA-IR difference between esophagitis and non-esophagitis group. @*Results@#The median of HOMA-IR in all subjects was 1.46 (0.32-13.85). Mann-Whitney test revealed that HOMA-IR index was higher in patients with erosive esophagitis [median 1.74 (0.35-13.85)] than those without erosive esophagitis [median 1.21 (0.32-10.78)] (p=0.05). @*Conclusion@#Insulin resistance is significantly higher in gastroesophageal reflux disease patients with esophageal erosions than in those without esophageal erosion.

Screening and Identifying Erosive Esophagitis in Children with Non-cardiac Chest Pain

Non-cardiac chest pain is a common disorder that leads to costly evaluations to distinguish it from cardiac pain. The present study aimed to clarify the clinical characteristics of erosive esophagitis in children with non-cardiac chest pain. Ninety nine patients (mean age, 9.55 ± 2.95 years, 49 girls) with non-cardiac chest pain were enrolled. Patients were classified into two groups: erosive esophagitis and non-erosive esophagitis-related non-cardiac chest pain by esophagogastroduodenoscopy. Children in the erosive esophagitis-related non-cardiac chest pain group were significantly older (10.95 ± 2.54 years vs. 8.52 ± 2.83 years). Multivariate logistic regression analysis identified the following predictors of gastroesophageal reflux: chest pain related to sleep (odds ratio = 18.05, 95% confidence interval: 3.18-102.49); unfavorable dietary habits (odds ratio = 7.11, 95% confidence interval: 1.53-32.87); chest pain related to food (odds ratio = 5.09, 95% confidence interval: 1.37-18.86); epigastric pain (odds ratio = 3.73, 95% confidence interval: 1.12-12.33); and nausea, vomiting, and/or regurgitation (odds ratio = 4.35, 95% confidence interval: 1.22-15.54). Gastroesophageal reflux disease should be considered first in children with non-cardiac chest pain. Children with gastroesophageal reflux disease should receive medical treatment and lifestyle modifications.

Research Progress on Relationship Between Gastroesophageal Flap Valve and Gastroesophageal Reflux Disease / 中国微创外科杂志

[Summary] The mechanisms of gastroesophageal reflux disease ( GERD) include abnormal antireflux function and esophageal mucosa attacked by regurgitation .Gastroesophageal flap valve ( GEFV) located in the gastroesophageal junction is one mechanism of the antireflux barrier .An increased GEFV grade is associated with an increased incidence of erosive esophagitis and Barrett ’ s epithelium.With abnormal esophageal acid exposure and prevalence of a mechanically defective sphincter , patients usually have severe symptoms and lower efficiency of medication .Therefore , GEFV is valued in the diagnosis and treatment of GERD .This review summarized the relationship between GEFV and GERD .

Estudio de la motilidad esofágica en pacientes con esofagitis erosiva / Esophageal motility study in patients with erosive esophagitis

Introducción: el fallo de la barrera antirreflujo permite el desarrollo de la enfermedad por reflujo gastroesofágico. La manometría esofágica permite estudiar los factores de motilidad que conforman la barrera antirreflujo. Objetivo: caracterizar los factores de motilidad en pacientes con esofagitis erosiva, a partir de la tecnología y los programas desarrollados. Método: se realizó un estudio descriptivo y transversal de 210 pacientes con esofagitis erosiva, en los cuales se estudiaron los factores de motilidad a través de la manometría esofágica. Resultados: el patrón de motilidad obtenido demostró hipotonía en el esfínter esofágico inferior, inestabilidad de este, con una frecuencia importante de hernia hiatal y trastornos motores esofágicos de tipo severo. Conclusiones: el principal daño en la barrera antirreflujo se desarrolla desde los grados más leves de la enfermedad, sin una correspondencia real entre este y el grado de esofagitis erosiva. La importante afectación de la peristalsis puede constituir uno de los elementos que interviene en el inicio de la enfermedad(AU)

Introduction: failed anti-reflux barrier allows the development of gastroesophageal reflux disease. The motility factors making up the anti-reflux barrier may be studied through the esophageal manometry. Objective: to characterize motility factors in patients with erosive esophagitis by means of developed software and technologies. Methods: a descriptive cross-sectional study was carried out in patients with erosive esophagitis by analyzing the motility factors through esophageal manometry. Results: the resulting pattern showed unstable and hypotonic lower esophageal sphincter, significant frequency of hiatal hernia and severe esophageal motor disorders. Conclusions: the main damage observed in the anti-reflux barrier occurs from the mildest degrees of the disease, without real association between this one and the degree of erosive esophagitis. The significant effect on peristalsis may be one of the elements leading to the onset of the disease(AU)

Comparative study of pantoprazole and esomeprazole for erosive gastroesophageal reflux disease: a prospective study.

Background: The objective of this study was to compare the efficacy of pantoprazole and esomeprazole to heal and relief from erosive esophagitis (EE) disease related symptoms. Methods: One hundred and ten patients (IIT-patients) with EE were randomized to receive 8 weeks of 40 mg pantoprazole (n=55) twice before food for first 7 days followed by once daily and esomeprazole 40 mg (n=55) once daily. Daily changes in heartburn and reflux were assessed. Results: The mean heartburn score with esomeprazole is more rapidly decreased than with pantoprazole. There no mild significant differences between two groups in the rate healing of reflux esophagitis at week and 4 and 8. The LA grade severity compare with esomeprazole group is rapidly decreased compared with pantoprazole. Esomeprazole 40 mg provided significantly greater healing than pantoprazole 40 mg after 4 weeks of treatment in patients with EE (56.36% vs. 49.09 %). Esomeprazole-treated patients were healed after up to 8 weeks of treatment similar those treated with pantoprazole (94.54% vs. 70.90 %). Conclusion: Esomeprazole is more effective than pantoprazole for rapid relief of heartburn symptoms and acid reflux symptoms in patients with reflux esophagitis.

New and Future Drug Development for Gastroesophageal Reflux Disease

Medical therapy remains the most popular treatment for gastroesophageal reflux disease (GERD). Whilst interest in drug development for GERD has declined over the last few years primarily due to the conversion of most proton pump inhibitor (PPI)'s to generic and over the counter compounds, there are still numerous areas of unmet needs in GERD. Drug development has been focused on potent histamine type 2 receptor antagonist's, extended release PPI's, PPI combination, potassium-competitive acid blockers, transient lower esophageal sphincter relaxation reducers, prokinetics, mucosal protectants and esophageal pain modulators. It is likely that the aforementioned compounds will be niched for specific areas of unmet need in GERD, rather than compete with the presently available anti-reflux therapies.

Reflujo gastroesofágico y esofagitis erosiva / GASTROESOPHAGEAL REFLUX AND EROSIVE ESOPHAGITIS

Objetivo: Determinar la frecuencia de esofagitis erosiva asociada a la sintomatología de reflujo gastroesofágico. Métodos: Se realizó un estudio prospectivo, descriptivo, transversal. Con una población de 153 pacientes con síntomas de enfermedad por reflujo gastroesofágico. La muestra se conformó con los pacientes en los que se evidenció esofagitis erosiva durante la endoscopia digestiva superior, en el periodo comprendido entre noviembre y diciembre 2012 en el Hospital Dr. Miguel Pérez Carreño, Caracas Venezuela. Resultados: 45 pacientes (29,4%) presentaron esofagitis erosiva, siendo en su mayoría de sexo femenino y edad entre 35 a 65 años. No hubo relación de frecuencia y severidad de pirosis con esofagitis erosiva, tampoco en cuanto al IMC o tiempo de evolución de los síntomas. La relación entre la presencia de síntomas nocturnos y hernia hiatal si fue estadísticamente significativa (p=0,034). Conclusiones: los resultados obtenidos son similares a las estadísticas conocidas a nivel mundial del porcentaje de esofagitis erosiva en pacientes con síntomas de ERGE. La mayoría de los pacientes se corresponden al sexo femenino, con un IMC normal y dentro del grupo adulto contemporáneo.

Objective: To determine the frequency of erosive esophagitis associated with gastroesophageal reflux symptoms. Methods: We performed a prospective, descriptive, transversal study. Our population were 153 patients with symptoms of gastroesophageal reflux disease, the sample comprises those patients whose erosive esophagitis was evident during upper endoscopy gastrointestinal in the period between November and December 2012 in the Hospital Dr. Miguel Perez Carreño, Caracas Venezuela. Results: 45 patients (29,4%) had erosive esophagitis, of these the majority were female and between 35-65 years old. No relationship was found between the frequency and severity of heartburn with erosive esophagitis. Niether with respect to BMI or duration of symptoms. The relationship between the presence of hiatal hernia and nocturnal symptoms was statistically significant (p=0,034). Conclusions: There is a relation between the results obtained and the known worldwide statistics on the percentage of patients with erosive GERD. The presence of hiatal hernia and nocturnal symptoms was significant. Most patients were female, with a normal BMI group and within the adult contemporary ages.

Irritable Bowel Syndrome Is Associated With Gastroesophageal Reflux Symptom but Not Erosive Esophagitis

BACKGROUND/AIMS: Although several studies have suggested overlaps between gastroesophageal reflux symptom and irritable bowel syndrome (IBS), the studies for the association between erosive esophagitis and IBS are rare. The aim of this study was to evaluate the association among IBS, non-erosive reflux disease (NERD), and erosive esophagitis. METHODS: A total of 2,769 participants completed questionnaires and underwent esophagogastroduodenoscopy and colonoscopy. IBS was diagnosed by Rome III; NERD was defined as heartburn or acid regurgitation occurring at least once per week without erosive esophagitis. Erosive esophagitis was defined by Los Angeles classification. Psychological distress was evaluated with modified 4 dimensions from revised Hopkins symptom checklist 90. RESULTS: Psychological distress was associated with both IBS and NERD, but not with erosive esophagitis. IBS was associated with somatization (adjusted OR, 2.88; 95% CI, 1.55-5.36; P < 0.001), anxiety (adjusted OR, 2.82; 95% CI, 1.36-5.88; P = 0.005), and hostility (adjusted OR, 2.06; 95% CI, 1.10-3.87; P = 0.024) and NERD was associated with somatization (adjusted OR, 5.65; 95% CI, 2.92-10.98; P < 0.001) and anxiety (adjusted OR, 3.29; 95% CI, 1.47-7.34; P = 0.004). Erosive esophagitis was associated with somatization (adjusted OR, 2.69; 95% CI, 1.26-7.91; P < 0.001). Hiatal hernia and male sex were related with erosive esophagitis but not with IBS or NERD. H. pylori had an inverse relationship with erosive esophagitis, but had no association with IBS. Whereas IBS was positively associated with NERD (adjusted OR, 2.72; 95% CI, 1.84-4.03; P < 0.001), it had no association with erosive esophagitis. CONCLUSIONS: IBS shared many risk factors with NERD but not with erosive esophagitis. It partially explains why IBS was associated with NERD, but not with erosive esophagitis.

Application and clinical significance of 24-hour multichannel intraluminal impedance-pH monitoring in gastroesophageal reflux disease / 中国综合临床

Objective To investigate the application and clinical significance of 24-hour multichannel intraaluminal impedance-pH (MII-pH) monitoring in gastroesophageal reflux disease (GERD).Methods Fiftythree patients with GERD were enrolled in this study according to the Montreal consensus (consulting for twice reflux a week or above) from July 2011 to June 2012.Patients were divided into erosive esophagitis (EE,n =25)group and non-erosive reflux disease (NERD,n =28) group after endoscopy and MII-pH monitoring.Fifteen healthy volunteers were recruited as the normal controls.The change of pH and MII-pH parameters were compared among the three groups and the significance of the change was investigated.Results Twenty-four-hour pH monitoring showed that all the acid reflux events in the EE and the NERD groups were significantly higher than those in the control group (P ＜ 0.05).MII-pH monitoring showed that the frequencies of total reflux,acid reflux,weakly acidic reflux and percentage of acid reflux in the GERD group were higher than in the control group (total reflux:83 (54,118) vs.62 (44,111) vs.42 (20,70),P =0.003 ; acid reflux:45 (25,79) vs.22 (11,45) vs.3(1,10),P =0.000 ;weakly acidic reflux:36(18,47) vs.43(21,82) vs.23(11,43),P =0.001 ;percentage of acid reflux:53％ (37％,81％) vs.32％ (13％,48％) vs.11％ (1％,23％),P =0.002).The frequency and percentage of acid reflux in the EE group were higher than those in the NERD group (P =0.000)The percentage of weakly acidic reflux in the NERD group was higher than in the EE group (66％ (43％,79％) vs.46％ (21％,57％),P ＜0.01).The frequencies of liquid reflux and mixed reflux in the GERD groups were higher than those in the control group (22 (12,40) vs.18 (12,26) vs.9 (4,18) ; 54 (39,79) vs.42 (25,77) vs.29(14,48) ;P ＜0.01).The frequency of gas reflux in the control group was higher than in the GERD group (86(56,207) vs.31 (14,62) vs.34 (15,119),P ＜ 0.01).The frequency and percentage of proximal reflux in the GERD group were significantly higher than in the control group (28(18,41) vs.16(12,34) vs.3 (2,9) ; 33％ (22％,49％) vs.29％ (22％,35％) vs.11％ (6％,22％),P ＜ 0.001).The percentage of symptom positive index in patients with acid reflux,non-acidic reflux and total reflux in the EE group were 36.0％ (9/25),20.0％ (5/25) and 56.0％ (14/25) respectively which were higher than in the NERD group (21.4％ (6/28),14.3％ (4/28) and 35.7％ (10/28)).Conclusion MII-pH monitoring can detect more reflux events.Acid reflux plays an important role in GERD.The detective rate of GERD will be elevated when combined with MII-pH monitoring in the diagnosis.MII-pH monitoring has a distinct advantage in diagnosing GERD.

Increased Incidence of Endoscopic Erosive Esophagitis in Solid Organ Transplant Recipients

BACKGROUND/AIMS: Solid organ transplant recipients frequently report gastrointestinal symptoms, especially heartburn or dyspepsia. However, the prevalence of endoscopic erosive esophagitis (EE) and associated risk factors after transplantation are unknown. The aim of this study was to determine whether there was a high incidence of endoscopic findings of EE in solid organ transplant recipients. METHODS: This retrospective case-control study included 256 of 3,152 solid organ transplant recipients who underwent sequential screening upper endoscopic examinations and an equal number of controls. RESULTS: Forty-four (17.2%) and 16 (6.2%) cases of EE were detected in the solid organ transplant and control groups, respectively (p<0.001). In the multivariate analysis, transplantation was significantly associated with EE (odds ratio [OR], 6.48; 95% confidence interval, 2.74 to 15.35). Factors such as old age (OR, 1.17), the presence of a hiatal hernia (OR, 5.84), an increased duration of immunosuppression (OR, 1.07), and the maintenance administration of mycophenolate mofetil (OR, 4.13) were independently associated with the occurrence of EE in the solid organ transplant recipients. CONCLUSIONS: A significant increase in the incidence of endoscopically detected EE was observed in solid organ transplant recipients. This increased incidence was associated with the type and duration of the immunosuppressive therapy.

Patients with Helicobacter pylori infection have less severe gastroesophageal reflux disease: a study using endoscopy, 24-hour gastric and esophageal pH metry.

Background and aim The relationship between gastroesophageal reflux disease (GERD) and Helicobacter pylori is controversial. We evaluated endoscopic, 24-h gastric and esophageal acid profile among patients with GERD in relation to H. pylori, as the latter might alter gastric acid secretion. Methods Patients with GERD (n=123), who were not on acid-suppressive drugs, and had not received anti-H. pylori therapy, underwent gastroduodenoscopy and tests for H. pylori detection. Esophageal manometry, 24-h pH metry, serum pepsinogen-I (PG-I), PG-II and gastrin-17 ELISA were done in all these patients. Univariate and multivariate analyses were performed to assess independent predictors for erosive esophagitis (EE). Results Of 123 patients (mean age 40.5 [13.1] years, 85 [69.1%] men), 59 (47.9%) had H. pylori infection. EE was more common in H. pylori non-infected than infected (49 vs. 32, p<0.001). Among patients older than 40 years, absence of H. pylori was associated with lower esophageal pH and longer reflux (p=0.02 and p<0.001, respectively). PG-I/PG-II ratio was lower in H. pylori infected subjects (p <0.001). In patients with higher LA grade of esophagitis, elevated PG-I levels and PG-I/PG-II ratio were associated with more acidic stomach (p=0.04 and p=0.01, respectively). Multivariate analyses showed low gastrin-17 (p=0.016), higher age (p=0.013), hiatus hernia (p=0.004) and absence of H. pylori (p=0.03) were independent predictors for risk of EE. Conclusion H. pylori infection is associated with less acidic stomach and less severe GERD. Low gastrin-17, higher age, hiatus hernia and absence of H. pylori were the best predictors for EE risk.

Prevalence and Risk Factor of Erosive Esophagitis Observed in Korean National Cancer Screening Program

Prevalence of erosive esophagitis (EE) has been increasing in Korea. The purpose of this study was to estimate prevalence of EE among low socioeconomic population in Korea and to investigate risk factors for EE. We reviewed the medical records of 7,278 subjects who were examined by upper endoscopy in the Korean National Cancer Screening Program at Chung-Ang University Yong-san Hospital from March 2003 to March 2008. The study population included subjects > or = 40 yr of age who were Medicaid recipients and beneficiaries in the National Health Insurance Corporation. Multivariate analysis was used to determine risk factors for EE. Prevalence of EE was 6.7% (486/7,278). According to the LA classification system, LA-A in 344 subjects, LA-B in 135 subjects, and LA-C and D in 7 subjects. In multivariate analysis, age > or = 60 yr, male sex, BMI > or = 25, current smoking, alcohol consumption, fasting glucose level > or = 126 mg/dL, and endoscopic hiatal hernia were significant risk factors for EE. The prevalence of EE in low socioeconomic Korean population is similar to that in personal annual medical check-ups. Risk factors for EE among them include old age, male sex, BMI > or = 25, current smoking, alcohol consumption, fasting glucose level > or = 126 mg/dL, and hiatal hernia.

Gastroesophageal Reflux Disease in Type II Diabetes Mellitus With or Without Peripheral Neuropathy

BACKGROUND/AIMS: Patients with type II diabetes mellitus (DM) were known to have higher prevalence of gastroesophageal reflux disease (GERD). Recent studies have shown that neuropathy has positive role on the development of GERD in type II DM, although its pathogenesis has not been fully understood yet. The aim of this study was to investigate whether neuropathy really contribute to the development of GERD and typical GERD symptoms in patients with type II DM in Korea. METHODS: One hundred and nineteen patients with type II DM who had given informed consents were enrolled. All patients underwent electromyography to check the presence of peripheral neuropathy, face-to-face interview to evaluate their typical GERD symptoms and esophagogastroduodenoscopy to look for the presence of erosive esophagitis. Ninety-five patients were finally included for this study and they were divided according to the presence or absence of the peripheral neuropathy. RESULTS: The mean age of 95 patients was 59.3 +/- 9.1 years and the mean disease duration of DM was 9.3 +/- 5.9 years. Typical GERD symptoms were similarly found in both groups with and without peripheral neuropathy (23.6% vs 22.8%, P = 0.921). Erosive esophagitis was more prevalent in patients with neuropathy than in those without neuropathy (31.5% vs 10.5%, P = 0.022). CONCLUSIONS: In patients with type II DM, peripheral neuropathy is an independent risk factor for the erosive esophagitis. However, peripheral neuropathy did not contribute to the presence of the typical GERD symptoms.

The prevalence of non-acidic reflux and its relation with heartburn symptoms in patients with gastroesophageal reflux disease / 中华消化杂志

Objective To investigate the prevalence of non-acidic reflux in patients with gastroesophageal reflux disease and its correlation extent with heartburn symptom by 24-hour combined multichannel intraluminal impedance-pH (MII-pH) monitoring. Methods Consecutive patients with chief complain of heartburn in gastrointestinal specialty clinic were enrolled. Patients were divided into erosive esophagitis (EE) group, non-erosive reflux disease (NERD) group after upper gastrointestinal endoscope, further diagnosed with 24-hour combined MII-pH monitoring and rabeprazole test. The MII-pH parameters were compared in these two groups. Results 36 cases of EE and 62 of NERD were enrolled. There was significant difference in acidic reflux frequency and acidic reflux time percentage between these two groups (P=0. 001 and 0. 002). The frequency of non-acidic reflux in EE and NERD groups was 37.3% (663/1777) and 44.3% (1220/2754) respectively (x2 =21. 723,P = 0. 000). The percentage of heartburn symptom positive index in patients with acidic reflux, non-acidic reflux , and total reflux in EE group was 36.1 % (13/36), 19.4 % (7/36) and 55.6%(20/36) respectively, while in NERD group was 27. 4% (17/62), 6.4 % (4/62) and 33.8% (21/62).Conclusion The percentage of non-acidic reflux in EE and NERD groups was 37.3% and 44.3%respectively, and the non-acidic reflux was highly related to heartburn symptom.

Short Segment Hiatal Hernia: Is It a Clinically Significant Entity?

INTRODUCTION: Hiatal hernia (HH) is a well-known contributory factor of gastroesophageal reflux disease (GERD). However, studies on the clinical significance of simple small HH are lacking. We conducted a study to clarify the clinical significance of short segment HH (SSHH) in relation to GERD. METHODS: 4,592 consecutive cases (male/female: 2,076/2,516, median age: 49 years) examined with diagnostic esophagogastroduodenoscopy for the first time were enrolled. During the insertion of endoscope, presence of HH was determined and the length was measured, if present. The relationships between gender, age, presence of erosive esophagitis, and columnar-lined esophagus (CLE) and the lengths of HH were analyzed. RESULTS: Among 4,592 cases, HH was present in 428 cases (9.3%); SSHH was found in 255 cases (5.6%) and long segment HH (LSHH) in 173 cases (3.8%). HH was more frequent among males and patients with LSHH tended to be older. Erosive esophagitis was observed in 4.8%, 22.0%, and 37.0% of no HH, SSHH, and LSHH group, respectively (p <0.05). CLE was observed in 14.4%, 36.5%, and 24.3% of no HH, SSHH, and LSHH group, respectively (p <0.05). CONCLUSIONS: SSHH is not a clinically silent and "innocent entity," but rather a condition with a significant pathologic significance similar to LSHH in regard to GERD.

Differences in Clinical Characteristics between Patients with Non-Erosive Reflux Disease and Erosive Esophagitis in Korea

Gastroesophageal reflux disease (GERD) is caused by abnormal reflux of gastric contents into the esophagus. GERD can be divided into two groups, erosive esophagitis and non-erosive reflux disease (NERD). The aim of this study was to compare the clinical characteristics of patients with erosive esophagitis to those with NERD. All participating patients underwent an upper endoscopy during a voluntary health check-up. The NERD group consisted of 500 subjects with classic GERD symptoms in the absence of esophageal mucosal injury during upper endoscopy. The erosive esophagitis group consisted of 292 subjects with superficial esophageal erosions with or without typical symptoms of GERD. Among GERD patients, male gender, high body mass index, high obesity degree, high waist-to-hip ratio, high triglycerides, alcohol intake, smoking and the presence of a hiatal hernia were positively related to the development of erosive esophagitis compared to NERD. In multivariated analysis, male gender, waist-to-hip ratio and the presence of a hiatal hernia were the significant risk factors of erosive esophagitis. We suggest that erosive esophagitis was more closely related to abdominal obesity.