Clinical Predominance Disease of Traditional Chinese Medicine： Gastroesophageal Reflux Disease / 中国实验方剂学杂志

Gastroesophageal reflux disease （GERD） is a frequently and commonly occurring disease in clinic. In recent decades， with the development in pathophysiology and drug researches， modern medicine has achieved remarkable progress and results in diagnosis and treatment. However， the treatments for non-erosive reflux disease， refractory gastroesophageal reflux disease， proton pump inhibitor resistance， overlap of disease symptoms， and extraesophageal symptoms are limited and ineffective. Traditional Chinese medicine （TCM） was widely used in clinical practice， which has been proved effective in relieving symptoms and improving the quality of life. Sponsored by China Association of Chinese Medicine （CACM） and undertaken by the Spleen and Stomach Disease Branch of CACM， "the 12th Youth Salon of Clinical Predominance Disease Series （GERD）" invited 18 authoritative digestive experts of TCM and western medicine to discuss "the difficulties of clinical diagnosis and treatment of GERD and TCM advantages". The focus issues such as modern medical diagnosis and treatment achievements and contributions， improvement and maintenance of symptoms， response to overlapping disease symptoms， reduction and withdrawal of acid suppressors， and treatment of extra-esophageal symptoms were discussed in depth. TCM and western medicine exchanged and complemented each other's strengths， combing the difficulties of modern medical diagnosis and treatment， which clarified the positioning and advantages of TCM and provided guidance for clinical and scientific research.

Características clínicas e fatores associados à asma grave em Salvador, Brasil / Clinical features and associated factors with severe asthma in Salvador, Brazil

RESUMO Objetivo Descrever características clínicas e identificar fatores associados a maior gravidade da asma, em uma amostra de pacientes acompanhados em um centro de referência em Salvador. Métodos Estudo transversal de 473 adultos, acompanhados regularmente no Programa para Controle da Asma na Bahia (ProAR), reavaliados de forma sistemática entre 2013 e 2015. Os pacientes foram admitidos por preencher critérios anteriores de asma grave e reclassificados de acordo com a definição mais atual, proposta por um documento conjunto da European Respiratory Society/American Thoracic Society (ERS/ATS 2014). Resultados Foram reclassificados como portadores de asma grave pelos critérios da ATS/ERS (AG-ERS/ATS) 88/473 (18%). Destes, 87% eram mulheres, 48% obesos, com mediana do índice de massa corporal (IMC) de 29 kg/m2 (IQ 26-34), 99% tinham sintomas de rinite crônica e 83%, sintomas de doença do refluxo gastroesofágico (DRGE). Nenhum se declarou fumante atual. Os principais corticosteroides inalatórios utilizados foram beclometasona (88%) e budesonida (69%). A maioria relatou adequada adesão (77%) e a minoria das avaliações (0,6%) revelou erros graves na técnica inalatória. A mediana do volume expiratório forçado no primeiro segundo pós-broncodilatador (VEF1pós-BD) foi 67% do predito (IQ 55-80). A mediana do número de eosinófilos no sangue periférico foi menor nos pacientes com AG-ERS/ATS [209 células/mm3 (IQ 116-321)] do que nos demais pacientes estudados [258 células/mm3 (IQ 154-403)]. Sintomas de doença do refluxo gastroesofágico (DRGE) foram associados a mais gravidade [OR = 2,2; IC95% (1,2-4,2)]. Conclusões Neste grupo de pacientes, sintomas de RGE foram associados a AG-ERS/ATS e contagem de eosinófilos > 260 células/mm3 esteve associada a 42% menos chance de AG-ERS/ATS.

ABSTRACT Objective To describe the clinical features and to identify factors associated with significant severe asthma in samples of patients followed in a reference center in Salvador. Methods A cross-sectional study of 473 adults, regularly followed in the "Asthma Control Program" in Bahia (Programa de Controle da Asma e da Rinite Alérgica na Bahia (ProAR)), reassessed systematically between 2013 and 2015. The patients were admitted for meeting previous criteria of severe asthma and were reclassified according to the most current definition proposed by a joint document of the "European Respiratory Society/American Thoracic Society" (ERS/ATS) (ERS/ATS 2014). Results Only 88/473 (18%) were reclassified as having severe asthma by ERS/ATS criteria (SA-ERS/ATS). Among these patients, 87% were women, 48% obese, with a median Body Mass Index (BMI) of 29 kg·m2 (IQ 26-34), furthermore, 99% had symptoms of chronic rhinitis and 83% had symptoms of Gastroesophageal Reflux Disease (GERD). None of the 88 patients claimed to be current smokers. The most frequently corticosteroids were beclomethasone dipropionate (BDP) (88%) and budesonide (BUD) (69%). The majority of the evaluations reported adequate adherence (77%), however, the minority (0,6%) detected serious errors in inhalation techniques. The median Forced Expiratory Volume (FEV1) associated with post-bronchodilator test (post-BD) was 67% predicted (IQ 55-80). The median number of eosinophils in the peripheral blood was lower in patients with SA-ERS/ATS (258 cells/mm3 (IQ 116-321) than in the other patients studied [258 cells/mm3 (IQ 154-403)]. Gastroesophageal reflux symptoms were associated with a higher severity [OR = 2.2 95% CI (1.2-4.2)]. Conclusion In this group of patients, symptoms of GERD were associated with SA-ERS/ATS and eosinophil count > 260 cells/mm3 were associated 42% with less chance SA-ERS/ATS

Acid Suppression in Neonates: Friend or Foe?

Medications that reduce gastric acid secretion are commonly prescribed for treating gastroesophageal reflux disease. However,several studies have shown that these medications are not very effective, and are associated with adverse effects. This articlediscusses the physiology of gastric acid secretion, clinical indications and pharmacology of acid suppressing medications, andpossible adverse effects of these medications

Expression of nitric oxide synthase in esophageal mucosa of patients with gastroesophageal reflex disease / 西安交通大学学报(医学版)

Objective To compare the expression of nitric oxide synthase (NOS ) in patients with gastroesophageal reflex disease (GERD)and healthy controls.Methods The distribution and relative protein amount of two NOS subtypes (nNOS and iNOS)were determined with immunohistological method,and their mRNA levels were measured with real-time PCR method.Results The nNOS and iNOS were mostly distributed in the cytoplasm in epithelia of esophageal mucosa.The nNOS and iNOS in reflux esophagitis (RE)were significantly higher than in non-erosive reflux disease (NERD)patients and healthy controls (P <0.05 ).The mRNA levels of nNOS and iNOS were also significantly higher in RE patients than in NERD patients and healthy controls (P <0.05).Conclusion The expressions of nNOS and iNOS were increased in the esophagus of RE patients,which may be related to the effects of NO on the onset of GERD.

Laringitis crónica asociada a reflujo gastroesofágico: La perspectiva del gastroenterólogo / Reflux laryngitis: a Gastroenterologist's perspective

La enfermedad por reflujo gastroesofágico (ERGE) es una causa frecuente de consulta en gastroenterología. La ERGE tiene manifestaciones digestivas y extradigestivas. Las manifestaciones extradigestivas que con mayor frecuencia se asocian a ERGE son la tos crónica, laringitis crónica y dolor torácico. La laringitis crónica, definida como la inflamación de la laringe que persiste por más de unas semanas, se asocia de manera frecuente a ERGE en la práctica clínica. Sin embargo, en varios estudios donde se utilizó la monitoría de pH esofágico como herramienta diagnóstica, no se encontró una clara asociación entre laringitis crónica y reflujo. Además, estudios en los que se manejaron inhibidores de bomba de protones en pacientes con sospecha de laringitis crónica por reflujo, mostraron una alta tasa de fracaso terapéutico, ya que en la gran mayoría de los casos, los síntomas persistían a pesar de una adecuada inhibición de la secreción ácida. Consideramos que aunque la ERGE puede ser la responsable de algunos episodios de laringitis crónica, no es la enfermedad que está asociada con mayor frecuencia, y en muchos de los casos en los que se ha descartado razonablemente la ERGE como responsable de los síntomas, deben investigarse de manera exhaustiva otras causas.

Gastroesophageal reflux disease (GERD) is a frequent cause of consultations with gastroenterologists. Extra-digestive symptoms such as chronic coughing, laryngitis and chest pain are frequently associated with GERD. Chronic laryngitis is one of the symptoms most often associated with GERD, yet various studies which have used monitoring esophageal pH as a diagnostic tool have not found any clear association between chronic laryngitis and reflux. Moreover, studies which have treated patients suspected of having chronic laryngitis caused by reflux with proton pump inhibitors (PPIs) have had had rates of therapeutic failures. Symptoms continue to persist in these patients despite adequate inhibition of acid secretion. To date, no evidence exists of the association between chronic laryngitis and GERD, much less evidence of a causal relation. We consider that, although GERD may be responsible for some episodes of chronic laryngitis, it is not the illness most frequently associated with it, and in the many cases in which GERD has been reasonably ruled out, other potential causes must be investigated.

Laringitis por reflujo: La perspectiva del otorrinolaringólogo / Reflux laryngitis: an Otolaryngologist's perspective

La laringitis por reflujo es una patología reconocida como una de las manifestaciones extradigestivas del reflujo gastroesofágico que se ha convertido en uno de los motivos de consulta más frecuentes en la práctica del otorrinolaringólogo. En esta revisión buscamos exponer el punto de vista del otorrinolaringólogo frente a esta enfermedad y mostrar la controversia que aún existe sobre su fisiopatología, diagnóstico y tratamiento.

Reflux laryngitis is recognized as an extra-digestive manifestation of gastroesophageal reflux. It has become one of the most frequent reasons patients consult with otolaryngologists. In this review we present the otolaryngologist's point of view on this disease, and discuss the continuing controversy about its pathophysiology, diagnosis and treatment.

Stability indicating high performance thin-layer chromatographic method for simultaneous estimation of pantoprazole sodium and itopride hydrochloride in combined dosage form / 药物分析学报

A specific, precise and stability indicating high-performance thin-layer chromatographic method for simultaneous estimation of pantoprazole sodium and itopride hydrochloride in pharmaceutical formulations was developed and validated. The method employed TLC aluminium plates precoated with silica gel 60F254 as the stationary phase. The solvent system consisted of methanol:water:ammonium acetate; 4.0:1.0:0.5 (v/v/v). This system was found to give compact and dense spots for both itopride hydrochloride (Rf value of 0.55±0.02) and pantoprazole sodium (Rf value of 0.85 ± 0.04). Densitometric analysis of both drugs was carried out in the reflectance-absorbance mode at 289 nm. The linear regression analysis data for the calibration plots showed a good linear relationship with R2=0.9988± 0.0012 in the concentration range of 100-400 ng for pantoprazole sodium. Also, the linear regression analysis data for the calibration plots showed a good linear relationship with R2=0.9990±0.0008 in the concentration range of 200-1200 ng for itopride hydrochloride. The method was validated for specificity, precision, robustness and recovery. Statistical analysis proves that the method is repeatable and selective for the estimation of both the said drugs. As the method could effectively separate the drug from its degradation products, it can be employed as a stability indicating method.

Papilomatosis esofágica y respiratoria: Reporte de un caso y revisión de la literatura

La papilomatosis esofágica es una enfermedad de baja incidencia, en su mayoría presentándose como lesiones aisladas de tercio distal de esófago, en pacientes asintomáticos que son sometidos a endoscopia digestiva superior por estudio de dispepsia o, evidenciadas al momento de realización de autopsias. Existen sólo 5 casos de papilomatosis esofágica diseminada reportados en la literatura. El tratamiento de estas lesiones no se encuentra estandarizado debido a su baja frecuencia, lo que no ha permitido la realización de estudios clínicos controlados. Existen reportes de remisión espontánea; se suele sugerir la observación de las lesiones en pacientes asintomáticos. En los pacientes sintomáticos, se recomienda el uso de terapias ablativas endoscópicas (con la desventaja de una elevada tasa de recurrencia de las lesiones), y el tratamiento quirúrgico es generalmente reservado para aquellos pacientes que no responden sintomáticamente al tratamiento endoscópico.

The esophageal papillomatosis is a low incidence disease, mostly appearing as isolated lesions of the esophagus distal third, in asymptomatic patients who are undergoing upper endoscopy for the study of dyspepsia, evidenced when conducting autopsies. There are only 5 cases of disseminated esophageal papillomatosis reported in the literature. Treatment of these lesions is not standardized because of their low frequency, which has not allowed the conduct of controlled clinical trials, however, there are reports of spontaneous remission. In asymptomatic patients observation of the injury is often suggested. In symptomatic patients, we recommend the use of endoscopic ablative therapies (with the disadvantage of a high rate of recurrence of the injury), and surgical treatment is usually reserved to those patients who do not respond symptomatically to endoscopic therapy.

Professor Wang Qingqi's Clinical Experiences in Treating GERD / 中华中医药杂志

This article explored professor Wang Qingqi's clinical experiences in treating gastroesophageal reflux disease(GERD) with traditional Chinese medicine(TCM).According to clinical observation,the key pathogenesis of GERD is abnormal rising and falling of vital energy,presenting in the five aspects of incoordination between the gallbladder and stomach,incoordination between the liver and stomach,stagnation of liver-qi with deficiency of the spleen,weakness of the spleen and stomach and qi-stagnancy and blood stasis.It will get a good curative effect when adopting the TCM methods of acrid-release and bitter-downbearing therapy,worm-like paired Chinese material medica and the opposite complementary relationship therapy.

Three Cases of Gastroesophageal Reflux Disease Treated by Laparoscopic Fundoplication / 대한소화기내시경학회지

Medical treatment so far takes the major portion in the treatment of gastroesophageal reflux disease (GERD). Histamine-2 receptor antagonists, proton pump inhibitors and antacids, which are used in the medical treatment of GERD, decreases intragastric acidity, and therefore decreases acid reflux. However, recurrences are frequently observed after the cessation of medication. On the other hand, fundoplication, the surgical management of GERD, aims for physiologic reconstruction of esophagogastric junction, and for correcting the pathogenetic cause of GERD. But fundoplication is linked to risks related to surgery and general anesthesia. Laparoscopic funcoplication minimizes these risks. We recently experienced three cases of GERD improved by laparoscopic 270o fundoplication. One patient was intolerant of long-term proton pump inhibitor treatment, and two patients had hiatal hernia, and one of them showed failure to medical treatment. This report describes these three cases with a brief review of literatures survey.

A Study of Esophageal Acidity and Motility Change after a Gastrectomy for Stomach Cancer

PUPOSE: Some patients develop gastroesophageal reflux disease (GERD) after a gastrectomy for stomach cancer. Therefore, we conducted this research to gain an understanding of esophageal acidity and motility change. MATERIALS AND METHODS: From July 2002 to March 2004, the cases of 15 randomized patients with stomach cancer who underwent a radical subtotal gastrectomy (RSG) with Billroth I(B-I) reconstruction (n=12) or a radical total gastrectomy (RTG) with Roux-en-Y (R-Y) gastroenterostomy (n=3) were analyzed. We investigated the clinical values of the ambulatory 24-hour pH monitoring and esophageal manometry in these patients, just before discharge from the hospital after an operation. RESULTS: GERD was present in three patients (20%). Compared with two reconstructive procedures, 3 of the 12 patients in the RSG with B-I group had GERD; however, none of RTG with R-Y group had GERD. Compared with pathologic stage, 2 of 9 patients in stage I, 1 of 2 patients in stage II, none of 3 patients in stage III, and none of 1 patient in stage IV had GERD. Esophageal manometry was performed in 10 patients. Nonspecific esophageal motility disorder (NEMD) was present in 7 patients. CONCLUSION: Some patients had GERD as a complication following a gastrectomy for stomach cancer. We suspect that the postoperative esophageal symptom is due to not only bile reflux but also gastroesophageal acid reflux. Therefore, careful observation is recommended for the detection of GERD.

The Etiologic Diseases and Diagnostic Usefulness of Color Doppler Ultrasonography in Children with Chronic Coughs

PURPOSE: The objectives of this study were to investigate the causes of chronic cough and to establish the appropriate diagnostic approach to chronic cough in children. METHODS: One hundred and thirty two cases of chronic cough were prospectively evaluated. They visitors to pediatric chronic cough clinics at Kang-nam saint Mary's Hospital of Catholic University from August 2000 to July 2001 for 12 months. Careful history taking by questionnaire, physical examination, radiologic studies of chest and sinus, hematologic and immunologic studies, allergic skin tests, and methacholine challenge tests were performed. Color doppler(CD) ultrasonography were performed and compared with simultaneous 24 Hr. esophageal pH monitoring to diagnose gastroesophageal reflux disease(GERD). RESULTS: Age distributions were demonstrated that nine in infants, 82 in early childhood, 38 in late childhood, and three in adolescence. Common causes of chronic cough were bronchial asthma in 40 cases, chronic sinusitis in 22 cases, GERD in seven cases, bronchial asthma combined with sinusitis in 28 cases, bronchial asthma combined with GERD in 14 cases, psychogenic cough in two. cases, foreign body in one case, chronic bronchitis in one case, and bronchiolitis in one case. Comparing with 24 Hr. pH monitoring, sensitivity, specificity, positive predictive value and negative predictive values of CD ultrasonography were 88%, 69%, 85 %, and 73% respectively. CONCLUSION: The most common causes of chronic cough in children were bronchial asthma, sinusitis and GERD in order. We suggest that CD ultrasonography can be used as a good, convenient screening method for patients with suspected GERD in outpatient settings.

Clinical Analysis of the Belsey Mark IV Operation in Hiatal Hernia with Gastroesophageal Reflux and Achalasia / 대한흉부외과학회지

Background :The incidence of gastroesophageal reflux disease(GERD)is increasing recently, but medical management for GERD has many limitations.Therefore,variable surgical treatments have been introduced. MATERIAL AND METHOD: A retrospective study was done in 10 patients who underwent the Belsey Mark IV operation at Korea university Guro hospital between 1996 and 2001.Preoperative diagnoses were hiatal hernia with gasroesophageal reflux in 8 patients and achalasia in 2 patients. RESULT: Mean age of the patients was 54.3 +/- 19.0 years.Belsey Mark IV operation was performed on patients where preoperative medical failed and mean hospital days were 13.1 +/- 2.6 days.We routinely practiced follow-up endoscopy on postoperative 3rd,6th,9th,and 12th months.After remission for reflux and esophagitis,they were transferred to internal medicine department.Six patients of hiatal hernia with reflux (one patient who lost follow-up and the other patient who didn't practice the follow-up endoscopy due to short postoperative follow-up period were excluded)had lowered endoscopic gradings and two patients of achalasia did not complained of reflux symptoms,postoperatively.We experienced 10%operation failure rate. CONCLUSION: We experienced satisfactory operation results with Belsey Mark IV in hiatal hernia with GERD and achalasia patients.

The Clinical Spectrum of Gastroesophagel Reflux Disease in Korea / 대한소화관운동학회지

BACKGROUND/AIM: Heartburn, which was the most common symptom of reflux disease, was unreliably interpreted by Korean patients. Our aim was to evaluate the clinical spectrum of gastroesophageal reflux disease(GERD) in Korea. METHODS: Patients who were diagnosed by an endoscopy or ambulatory pH monitoring at a tertiary medical facility were given a validated questionnaire and the clinical spectrums were prospectively investigated. RESULTS: Seventy one patients were included. Heartburn was occurring in 39 patients and the frequency of heartburn on two or more days a week were found in only 12 patients. Negative impact of reflux symptoms on health related well being were found in 16 patients. The reflux related atypical symptoms were hoarseness(55%), globus sensation(45%), cough(25%), and chest pain(20%). Twenty two patients complained of epigastric pain or discomfort more than 6 times a year, with 13 patients listing abdominal pain as the most bothersome one. The clinical spectrums were not different between endoscopy negative patients and those with esophagitis. CONCLUSIONS: Typical reflux symptoms are absent in a substantial proportion of Korean patients with GERD. True dyspepsia could result from gastroesophageal reflux. GERD needs to be clarified in patients with chronic laryngeal symptoms, cough or chest pain.

The Prevalences of Gastrointestinal Symptoms in a Rural Community in Korea / 대한소화관운동학회지

BACKGROUND/AIMS: Chronic gastrointestinal (GI) symptoms are believed to be common in the general population, but there is a lack of data from Korea. The aim of this study was to estimate the prevalence of chronic gastrointestinal symptoms in a rural community in Korea by using the Bowel Symptom Questionnaire (BSQ), which was based on the multinational diagnostic Rome criteria for functional bowel disorders, as a measure of GI symptoms. METHODS: A cross-sectional survey, using a reliable and valid questionnaire based on the fulfillment of the Rome criteria, was performed in a densely populated district in a Korean rural community on the residents aged 18-69 yr (mean 48 +/- 14 yr). 95.5% responded (n=420). All respondents were interviewed at their home or offices by a team of interviewers. RESULTS: Two thirds of Korean rural residents experience gastrointestinal symptoms and one fifth of them visit a clinic or hospital at least once a year. Prevalences of weekly heartburn, gastroesophageal reflux disease, dyspepsia, irritable bowel syndrome (IBS), and chronic constipation were 5.2% (95% confidence interval [CI], 3.1-7.4), 2.6% (95% CI, 1.1-4.2), 15.5% (95% CI, 11.9-19.0), 8.6% (95% CI, 5.8-11.3), and 24.3% (95% CI, 20.1-28.5) respectively. The prevalence of dyspepsia was 25%, taking medication usage into consideration. Ulcer-like dyspepsia (11.2%) was the most common subtype and 40% of the subjects with dyspepsia were classified into more than one subtype of dyspesia. There was an overlap between subjects with IBS and dyspepsia with 6.1% of dypeptics having IBS and 11.1% of IBS patients having dypepsia. CONCLUSIONS: The prevalence of GERD was low in Korea compared with that of the Western contries. The prevalences of dyspepsia and IBS were similar to those of the Western countries. The most common gastrointestinal symptom in a rural community in Korea is dyspepsia.