Does Sedation Affect Examination of Esophagogastric Junction during Upper Endoscopy?

PURPOSE: During sedated esophagogastroduodenoscopy (EGD), patients may not be able to perform inspiration, which is necessary to examine the esophagogastric junction. Therefore sedation may affect diagnosis of gastroesophageal reflux-related findings. The aim of our study was to investigate the effect of sedation on diagnosis of gastroesophageal reflux-related findings during EGD. MATERIALS AND METHODS: This retrospective study evaluated 28914 patients older than 20 years who underwent EGD at our institution between January 2011 and December 2011. Ultimately, 1546 patients indicated for EGD for health check-up and symptom evaluation were included. RESULTS: There were 18546 patients who had diagnostic EGD: 10471 patients (56%) by non-sedated EGD and 8075 patients (43%) by sedated EGD. After statistical adjustment for age, sex, and body mass index, minimal change esophagitis, and hiatal hernia were significantly less frequently observed in the sedated EGD group [odds ratio (OR), 0.651; 95% confidence interval (CI), 0.586 to 0.722 and OR, 0.699; 95% CI, 0.564 to 0.866]. Nevertheless, there was no significant difference in other findings at the gastroesophageal junction, such as reflux esophagitis with Los Angeles classification A, B, C, and D or Barrett's esophagus, between the two groups. Similarly, there were no differences in early gastric cancer, advanced gastric cancer, and gastric ulcer occurrence. CONCLUSION: Sedation can impede the detection of minimal change esophagitis and hiatal hernia, but does not influence detection of reflux esophagitis of definite severity and Barrett's esophagus.

Clinical Improvement of Los Angeles Grade D Esophagitis with Proton Pump Inhibitor / 대한소화기학회지

No abstract available.

Prevalence and risk factors for reflux esophagitis in patients with chronic obstructive pulmonary disease

BACKGROUND/AIMS: Gastroesophageal reflux disease is one of the most common causes of chronic cough and is a potential risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the prevalence and risk factors for reflux esophagitis (RE) in COPD patients. METHODS: From our hospital database, between September 2006 and April 2010, we searched for subjects who were 40 years old or older and had undergone both postbronchodilator spirometry and esophagogastroduodenoscopy (EGD). COPD was defined as having a ratio of forced expiratory volume in 1 second to forced vital capacity < 0.7 in postbronchodilator spirometry and no abnormality causing airway obstruction, except emphysematous changes, on a chest X-ray. The diagnosis of RE was based on a mucosal break surrounding the distal esophageal sphincter through EGD. RESULTS: In total, 253 patients with COPD were enrolled. The prevalence of RE in COPD was 30% (76/253). Multiple logistic regression analyses revealed that age (odds ratio [OR], 0.950; 95% confidence interval [CI], 0.918 to 0.983; p = 0.003), smoking pack-years (OR, 1.015; 95% CI, 1.004 to 1.025; p = 0.006), and inhaled anticholinergics (OR, 0.516; 95% CI, 0.271 to 0.982; p = 0.044) were independently associated with RE in COPD patients. CONCLUSIONS: The prevalence of RE in our COPD patients was higher than that reported previously in the Korean general population. In COPD, smoking increased the risk of RE, whereas inhaled anticholinergics may be associated with a reduced risk of RE.

Current Status and Clinical Impact of Pediatric Endoscopy in Korea / 대한소화기학회지

BACKGROUND/AIMS: In pediatrics, endoscopic examination has become a common procedure for evaluation of gastrointestinal presentations. However, there are limited data on pediatric endoscopy in Korea. The aim of this study was to analyze the current status and clinical impacts of endoscopic examination in children and adolescents. METHODS: We retrospectively reviewed the medical records of outpatients who visited the tertiary hospital. Patients under 18 years of age who underwent endoscopy were included. Endoscopic findings were classified as specific and normal based on gross findings. Specific endoscopic findings were reflux esophagitis, peptic ulcers, and Mallory-Weiss tear. Other findings included acute gastritis classified according to the updated Sydney system. RESULTS: In 722 of 330,350 patients (0.2%), endoscopic examination (554 esophagogastroduodenoscopies [EGDs], 121 colonoscopies, 47 sigmoidoscopies) was performed between January 2008 and January 2013. In EGD, abdominal pain was the most frequent presentation (64.1%). The most common diagnosis was gastritis (53.2%), followed by reflux esophagitis. The frequency of peptic ulcer disease was 12.8%. Frequent symptoms leading to colonoscopic examination were abdominal pain, diarrhea, and hematochezia. In colonoscopy, a negative result was more likely in children younger than 7 years old. After the procedure, the diagnostic yield of EGD and colonoscopy was 88.1% and 45.8%, respectively, and the rate of change in management was 67.1%. CONCLUSIONS: In pediatrics, endoscopic examination was useful for the choice of therapeutic strategy and it would be a standard method for evaluation of gastrointestinal presentation.

Erosiones dentales en pacientes con diagnóstico de enfermedad por reflujo gastroesofágico en el Hospital Nacional Arzobispo Loayza / Dental erosions in patients with gastroesophageal reflux disease in national Hospital Arzobispo Loayza

INTRODUCCIÓN: La ERGE es considerada como la causa de morbilidad digestiva más frecuente en la población, siendo la erosión dental una manifestación extra esofágica en la cavidad bucal. OBJETIVOS: determinar la asociación entre erosiones dentales y esofagitis por reflujo gastroesofagico de acuerdo al grado de esofagitis, grado de erosion dental, sexo y edad. MATERIALES Y MÉTODOS: Estudio descriptivo, transversal, observacional y correlacional en 150 pacientes con ERGE diagnosticados endoscópicamente como esofagitis por reflujo gastroesofágico (graduados según clasificación de Los Angeles) en el Servicio de Gastroenterología del Hospital Arzobispo Loayza (2011-2012). Posterior a la endoscopia los pacientes fueron sometidos a una evaluación clínica dental a fin de investigar la presencia de erosiones dentales previa firma de consentimiento informado. RESULTADOS: Se obtuvo una prevalencia de 30% (45 pacientes) con erosiones dentales y ERGE, el 100% manifestó acidez en la boca y regurgitación ácida. Respecto al sexo, el femenino presentó un promedio de 2.35 erosiones en el sector anterior en la superficie palatina en grado 1 mientras que en el sexo masculino se encontró un promedio de 1.86 erosiones en el sector anterior de la superficie palatina en grado 2. De acuerdo a la edad se obtuvo un promedio de 3.50 erosiones en la superficie incisal grado 1 en el sector anterior en pacientes mayores de 70 años seguida de un promedio de 3.11 erosiones en la superficie palatina grado 1 en pacientes de 20 a 30 años. De acuerdo al total de superficies evaluadas el grupo etario comprendido entre 30 y 40 años conforman la mayoría de población afectada. Respecto al grado de esofagitis por reflujo gastroesofágico se encontró en el grupo de Esofagitis por reflujo Los Ángeles "D" un promedio de 6.0 erosiones en el sector anterior en la superficie palatina grado 2 y en el sector anterior en la superficie palatina grado 1 y en el grupo de pacientes con esofagitis Los Angeles "A" y "B" con promedios respectivos de 2.3 y 2.2 y en el sector anterior en la superficie incisal Grado 1. y esofagitis Los Angeles "D". Existe asociación significativa (p=0.002) entre el grado de esofagitis por reflujo gastroesofágico y grado de erosión dental. CONCLUSIONES: en el presente estudio se ha encontrado clara asociación entre el grado de las erosiones dentarias y el grado esofagitis por reflujo gastroesofágico. Las erosiones dentarias son más frecuentes en varones mayores de 70 años, en quienes las erosiones dentales se dieron en el sector anterior en la superficie incisal grado 1. Las superficies más erosionadas se encontraron en mujeres en el sector anterior en la superficie palatina grado 1. En pacientes con esofagitis por reflujo gastroesofágico Los Ángeles "A"," B" y "C" se observa mayor número de piezas dentarias erosionadas sea de grado 1 ó 2. Los síntomas: acidez en la boca y regurgitaciones ácidas que llegan hasta la boca son un indicador importante para la presencia de erosiones dentarias en pacientes con ERGE. La superficie palatina de las piezas antero superiores fueron las que tuvieron mayor presencia de erosiones en pacientes con ERGE.

INTRODUCTION: Gastroesophageal reflux disease (GERD) is considered as one of the most common digestive disease in the population, being the dental erosion a manifestation extra-esophageal in the oral cavity. OBJETIVES: investigate asociation between erosion and GERD according to esophagitis grade, erosion grade, sex and age. MATERIAL AND METHODS: descriptive, observational, and correlational study in 150 patients with endoscopically diagnosed GERD, grades of esophagitis according to the classification of Los Angeles, in the Department of Gastroenterology at Arzobispo Loayza Hospital (20112012). Patients after the procedure underwent a dental evaluation to investigate the presence of dental erosion by eroding tooth surface. RESULTS: We obtained a prevalence of 30% (45) patients with GERD and dental erosions of which 100% had symptoms consistent with acidity in the mouth and acid regurgitation. According to the sex the female sex showed an average of 2.35 erosions on the palatal surface in grade 1 and in male’s an average of 1.86 erosions on the palatal surface in grade 2. According to the age the highest average was 3.50 in the incisal erosion on the surface grade 1 in the anterior in patients older than 70 years followed by an average of 3.11 incisal erosion on the surface grade 1 in patients 20 to 30 years. According to the total areas assessed (by age) patients between 30 and 40 years were the most affected population. According to degree of esophagitis the follows were: an average of 6.0 erosions in the anterior palatal surface in grade 2 with esophagitis Los Angeles "D"; in the anterior palatal surface in Grade 1 with esophagitis Los Angeles "A" and "B" with respective averages of 2.3 and 2.2 and in the anterior incisal surface in Grade 1 with esophagitis Los Angeles "D". According to the Chi2 test exists a significant association (p = 0.002) between the degree of esophagitis and degree of dental erosion. CONCLUSIONS: A significant association exists between GERD and dental erosions. The presence and degree of dental erosion as predominant age occurred in patients older than 70 years in the previous Grade 1 incisal surface. According to the sex; eroded surface was predominant in females in the anterior sector palatal surface in grade 1.According to the degree of gastroesophageal reflux disease (esophagitis) is determined that the highest number of erosions was presented at the anterior sector on the palatal surface grade 2 with esophagitis Los Angeles "D". The symptoms compatible with heartburn and acid regurgitation in to the mouth that reaches to the oral cavity is an important indicator for the presence of dental erosions in patients with GERD. The tooth surface with the highest presence of dental erosions in patients with GERD was the palatal surface of anterior teeth.

Esofagitis por reflujo diagnostico histológico y su relación con variables clínicas y endoscópicas / Reflux esophagitis histologic diagnous and it`s relation with clinical and endoscopic variables

La relación entre índice de masa corporal elevados, la presencia de hernia hiatal y síntomas de reflujo han sido ampliamente asociadas al diagnostico de esofagitis por reflujo. Estudios recientes han demostrado la asociación del sobrepeso con la enfermedad de reflujo. En vista de esto nos propusimos realizar este estudio con el objetivo de demostrar la relación de la esofagitis por reflujo anatomopatologicamente diagnosticada asociada al índice de masa corporal calculado por el índice de Quetelet, los hallazgos endoscópicos de esofagitis según la clasificación de los Ángeles, y síntomas de reflujo referidos por los pacientes de la consulta del servicio de gastroenterología del Hospital “Carlos J. Bello” de la Cruz Roja Venezolana. Se tomo una muestra de 32 pacientes los cuales el 100% tienen diagnostico anatomopatologico de esofagitis por reflujo en un periodo comprendido entre noviembre 2009 y abril de 2010, de los cuales 26 eran del sexo femenino representando el 81,25% de la muestra y 6 del sexo masculino representando el 18,75% de la muestra. El 78,12% presentaron Hernia hiatal como diagnostico endoscópico y referían síntomas de reflujo gastroesofagico (Regurgitación y Pirosis). En cuanto al hallazgo endoscópico 56,25% presento diagnostico de esofagitis grado A y el 28,12% esofagitis grado B según la Clasificación de los Angeles. En cuanto al índice de masa corporal 32,5% presento IMC< de 24,99 Kg/mt2; el 35,4% presentó IMC>25 kg/mt2 y < de 29,99 Kg/mt2; y el 32,1% presento IMC> 30 kg/mt2. En conclusión el 67,5% de los pacientes presentaban IMC elevados.

The relation between elevated body mass index, and the presence of hiatal hernia and reflux symptoms had been widely associated with the diagnosis of GERD. Most recently lack of studies had demonstrated the association between overweight and GERD. In regard to this matter we proposed to make an study to demonstrate the relation of esophageal reflux disease diagnose by histopalogic finding and elevated body mass index calculated with the Quetelet index, endoscopic findings of esofaghitis clasificated by the Los Angeles classification, and reflux symptoms referred by the patients on the Consult of the Gastroenterology service from the Carlos J. Bello Hospital, Venezuelan Red Cross. It took a sample of 32 patients 100% of them with histopathology findings of reflux esophagitis taken from a time period between November 2009 to April 2010, distributed in 26 female patients (81,25%) and 6 male patients (18,75%). 78,12% had hiatal hernia, and referred gastro esophageal reflux symptoms (Regurgitation and pyrosis). Regard to Endoscopic findings 56.25% presented grade A esofaghitis, 28,12% Grade B esophagitis. Regard to Body mass index 32,5% presented a BMI: <24.99 Kg/ mt2; 35,4% BMI:>25 Kg/mt 2 and <29,99 Kg/mt2; 32,1% presented BMI>30 Kg/mt2. In conclusion 67,5% presented elevated BMI.

Clinico-pathological Profile of Oesophageal Dysphagia.

Introduction: Dysphagia can cause significant morbidity and mortality, especially in the elderly and the paediatric population. The study was undertaken to determine the clinico-pathological profile of the patients diagnosed with oesophageal dysphagia in a rural tertiary care hospital of India. Methods: This cross sectional, descriptive study was carried out in the ENT Department of Rural Medical College and Pravara Rural Hospital, Loni, Maharashtra. Patients attending the ENT Out Patient Department during 2009 and later diagnosed as cases of oesophageal dysphagia formed the statistical sample. Results: Out of 61 patients, 37 were male and 24 female. Majority of the patients belonged to age group 41-50 years (24.6%), were farmer by occupation (31.1%) and belonged to middle socioeconomic status (34.4%). Pain (throat, retrosternal or epigastric) was the most common (70.5%) presenting complaint. For 39.3% study subjects, the presenting complaint was 3 to 6 months old. Barium swallow study revealed a positive finding in 74.1% (n=40/54) patients, with carcinoma of oesophagus (27.8%) as the most common aetiology, followed by motility disorders and benign strictures. Oesophagoscopy detected lesions in 49 (90.74%) cases and like barium swallow, it also detected carcinoma oesophagus as the most common cause of oesophageal dysphagia. Reflux oesophagitis was the most common form of the oesophagitis and the microbiological examination and culture of samples of 14 patients diagnosed with any form of oesophagitis showed Candida albicans in 21.4%. Conclusion: Dysphagia is a common presenting complaint in the ENT clinic. There is a male preponderance with incidence of malignancy rising with age. Barium swallow may be used as the first line of investigation; however, oesophagoscopy gives a better diagnosis.

A study on the diagnosis of minimal endoscopic lesions in nonerosive reflux esophagitis using computed virtual chromoendoscopy (FICE) / Estudo sobre o diagnóstico de lesões endoscópicas mínimas na esofagite de refluxo não-erosiva usando cromoendoscopia virtual (FICE)

CONTEXT: Gastroesophageal reflux disease is very prevalent in the world. Endoscopically it can be classified as nonerosive when there is no mucosal erosive lesion on endoscopy. The presence of endoscopic minimal lesions is included in the Los Angeles classification for reflux disease. Virtual chromoendoscopy Fuji Intelligent Color Enhancement (FICE) is an endoscopic technique that enhances detection of small lesions of the digestive tract. OBJECTIVE: To evaluate whether the use of FICE improves the diagnosis of minimal lesions on endoscopy, and to assess the association of symptoms with minimal lesions in patients with nonerosive reflux disease. METHODS: One hundred fifty-five patients were enrolled, 62 with typical reflux symptoms and 93 without esophageal symptoms. The patients had normal esophageal endoscopy or minimal lesions. Each patient was examined initially by conventional video endoscopy and then using FICE. RESULTS: Among 155 patients, 113 had a normal conventional endoscopy and 42 had minimal lesions. Sixty-two patients had typical reflux symptoms, and 93 other symptoms unrelated to reflux. In 104 patients, the esophageal mucosa was normal for both conventional endoscopy and FICE, in 42 patients both techniques showed minimal lesions, in 9 patients conventional endoscopy was normal and minimal lesions were shown by FICE. The height and circumference of minimal lesions were greater using FICE than that measured by conventional endoscopy. There was a significant association of the presence of minimal lesions with male gender, but not with alcoholism, smoking, anti-inflammatory drugs and age. The diagnosis of minimal lesions was observer-dependent, both in conventional endoscopy as using FICE. CONCLUSIONS: The use of FICE improves the diagnosis of minimal lesions as compared to conventional videoendoscopy, although this diagnosis remains observer-dependent. There was no association between the presences of minimal lesions with reflux symptoms.

CONTEXTO: A doença do refluxo gastroesofágico é muito prevalente no mundo. Endoscopicamente pode ser classificada como não-erosiva quando não há lesões erosivas da mucosa à endoscopia. A presença de lesões mínimas à endoscopia está incluída na classificação de Los Angeles para a doença do refluxo. A cromoendoscopia virtual "Fuji Intelligent Color Enhancement" (FICE) é uma técnica endoscópica que melhora a detecção de lesões pequenas do trato digestório. OBJETIVO: Avaliar se o uso de FICE melhora o diagnóstico de lesões mínimas à endoscopia, e avaliar a associação de lesões mínimas com a sintomatologia em pacientes com doença do refluxo não-erosiva. MÉTODOS: Cento e cinquenta e cinco pacientes foram incluídos no estudo, sendo 62 com sintomas típicos de refluxo e 93 sem sintomas esofágicos. Os pacientes apresentavam esôfago normal ou lesões mínimas à endoscopia. Cada paciente era examinado inicialmente pela videoendoscopia convencional e em seguida usando FICE. RESULTADOS: Entre os 155 pacientes, 113 tiveram endoscopia convencional normal e 42 tinham lesões mínimas. Sessenta e dois pacientes tinham sintomas típicos de refluxo e 93 outros sintomas não relacionados a este. Em 104 pacientes a mucosa esofágica era normal tanto pela endoscopia convencional como pelo FICE, em 42 pacientes ambas as técnicas demonstraram lesões mínimas, em 9 pacientes a endoscopia convencional foi normal e o FICE diagnosticou lesões mínimas. A altura e a circunferência das lesões mínimas foram maiores quando observadas com FICE do que pela endoscopia convencional. Houve associação significante da presença de lesões mínimas com o gênero masculino, mas não com etilismo, tabagismo, o uso de antiinflamatórios e idade. O diagnóstico de lesões mínimas foi observador-dependente, tanto na endoscopia convencional quanto usando FICE. CONCLUSÕES: O uso de FICE melhora o diagnóstico de lesões mínimas. Entretanto, este diagnóstico é observador-dependente. Não houve associação da presença de lesões mínimas com sintomas de refluxo.

Comparación de la endoscopia de alta resolución con magnificación y fice y la endoscopia de alta resolución en el diagnóstico de enfermedad de reflujo erosiva / Comparison of high resolution endoscopy and magnification endoscopy fice and high resolution in the diagnosis of erosive reflux disease

La enfermedad por reflujo gastroesofágico es una enfermedad crónica del esófago, su diagnóstico clínico está basado en sus síntomas, pero la endoscopia determina dos entidades clínicas. El 50 por ciento de los pacientes con enfermedad por reflujo gastroesofágico tienen enfermedad por reflujo gastroesofágico y esofagitis. El objetivo de este trabajo es demostrar que la endoscopia de alta resolución con magnificación y Fuji intelligent color enhancement, tienen un mayor porcentaje diagnóstico de enfermedad por reflujo gastroesofágico, tienen enfermedad por reflujo gastroesofágico y esofagitis cuando se compara con la endoscopia de alta resolución. Materiales y métodos: Se realizó endoscopia de alta resolución y endoscopia de alta resolución con magnificación y Fuji intelligent color enhancement a 50 pacientes con el diagnóstico clínico de enfermedad por reflujo gastroesofágico. Se comparó con un grupo control de 50 pacientes. Resultados: La endoscopia de alta resolución dio un 70 por ciento de diagnóstico de enfermedad por reflujo gastroesofágico tienen enfermedad por reflujo gastroesofágico y esofagitis y la endoscopia de alta resolución con magnificación y fuji intelligent color enhancement dio un 98 por ciento de diagnóstico de enfermedad por reflujo gastroesofágico tienen enfermedad por reflujo gastroesofágico y esofagitis (P=0,0002), estadísticamente significativa. Conclusión: La endoscopia de alta resolución con magnificación y fuji intelligent color enhancement, es el método endoscópico de elección, para diagnosticar la existencia de enfermedad por reflujo gastroesofágico tienen enfermedad por reflujo gastroesofágico y esofagitis, en los pacientes con diagnóstico clínico de enfermedad por reflujo gastroesofágico

The gastroesophageal reflux disease (GERD) is a chronic illness of the esophagus, where the clinical diagnosis is based on their symptoms, but the Endoscopy determines two clinical entities. 50 percent of the patients with gastroesophageal reflux disease has esophagitis. The Objective of this trial was demonstrate that the High Resolution Endoscopy with Magnification and Fuji Intelligent Color Enhancement (FICE) had a major percentage diagnosis of ERGEE, when it was compared with the High Resolution Endoscopy. Materials and Methods: It was performed High Resolution Endoscopy and High Resolution Endoscopy with Magnification and Fuji intelligent color enhancement to 50 patients with the clinical diagnosis of gastroesophageal reflux disease, and it was compared with a control group of 50 patients. Results: The high resolution endoscopy demonstrated 70 percent of diagnosis of gastroesophageal reflux disease has esophagitis and the high resolution endoscopy with magnification and Fuji intelligent color enhancement reported 98 percent of diagnosis of gastroesophageal reflux disease has esophagitis (P=0.0002), statistically significant. There was not significant statistical difference in the control group. Conclusion: The high resolution endoscopy with magnification and Fuji intelligent color enhancement was the method of choice to evaluate the existence of gastroesophageal reflux disease has esophagitis, in patients with clinical diagnosis of gastroesophageal reflux disease

Comparision between Proximal Gastrectomy and Total Gastrectomy in Early Gastric Cancer / 대한소화기학회지

BACKGROUND/AIMS: The purpose of this study was to evaluate clinical outcome of proximal and total gastrectomy regarding reflux esophagitis, nutritional state, and anemia in early gastric cancer. METHODS: 94 patients with early gastric cancer were included from January 2001 to January 2007 at Chungnam National University Hospital. Of whom 40 patients (31 men and 9 woman) had proximal gastrectomy (PG) and 54 patients (44 men and 10 woman) had total gastrectomy (TG). We reviewed all their medical and surgical record with surveying for gastrointestinal symptoms and reflux symptoms over the phone. RESULTS: There were no significant differences between basic, surgical, and histopathologic characteristics. Bile reflux symptoms and heart burn symptoms were more common and severe in the TG group. The incidences of endoscopically detected reflux esophagitis were about 60% in the TG group and about 30% in the PG group. The hemoglobin levels were significantly higher in the PG group after the operation and were gradually decreased in the TG as the time went. The levels of laboratory variables such as total protein, albumin, and total cholesterol were lower in the TG group than in the PG group after the operation. However, stoma stricture after operation developed in the PG group more often than in the TG group, and esophageal balloon dilatations were performed more frequently in the PG group. CONCLUSIONS: PG is favorable for proximal early gastric cancer in terms of reduced reflux esophagitis, anemia, and malnutrition except the stricture at esophagogastrostomy site.

The Prevalence and Clinical Characteristics of Reflux Esophagitis in Koreans and Its Possible Relation to Metabolic Syndrome

The prevalence of reflux esophagitis is increasing in Korea. To estimate the prevalence and clinical characteristics of reflux esophagitis in healthy subjects, we retrospectively examined the medical records of healthy subjects undergoing a routine check-up from October 2004 to September 2005. A total of 6,082 (3,590 men, mean age 44+/-10 yr) subjects were enrolled in this study. The prevalence of reflux esophagitis in healthy subjects was 10.5%. According to the univariate analysis, male sex (odds ratio [OR] 3.49, 95% confidence interval [CI] 2.84-4.30), smoking history (OR 1.91, 95% CI 1.60-2.28), body mass index (BMI) >30 kg/m2 (OR 2.13, 95% CI 1.37-3.33), total cholesterol >250 mg/dL (OR 1.50, 95% CI 1.05-2.14), low-density lipoprotein (LDL) cholesterol > or =160 mg/dL (OR 1.52, 95% CI 1.08-2.14), triglyceride > or =150 mg/dL (OR 1.92, 95% CI 1.61-2.30), high blood pressure (BP) (OR 1.46, 95% CI 1.20-1.76), and fasting glucose > or =110 mg/dL (OR 1.45, 95% CI 1.13-1.86) were significantly associated with reflux esophagitis (all p<0.05). However, age, alcohol drinking and Helicobacter pylori infection were not associated with reflux esophagitis. In conclusiosn, significant relationships of reflux esophagitis with obesity, low high-density lipoprotein (HDL) cholesterol, high triglyceride, high BP, and elevated fasting glucose suggested that reflux esophagitis might represent the disease spectrum of the metabolic syndrome.

A Prospective Multicenter Study on the Prevalence and Symptoms of Erosive Reflux Esophagitis in Secondary and Tertiary Hospitals in Korea / 대한소화기학회지

BACKGROUND/AIMS: Recent studies suggest that the prevalence of erosive esophagitis (EE) is increasing in Asia. The aims of this study were to determine the prevalence of EE among outpatients visiting gastroenterology clinics of secondary and tertiary hospitals in Korea, and to analyze their symptoms. METHODS: From May to July 2003, outpatients undergoing their first upper gastrointestinal endoscopies after visiting gastroenterology clinics in secondary and tertiary hospitals in Korea were enrolled. Prevalence of EE was calculated from their endoscopic findings, and symptoms were analyzed from the validated symptom questionnaire. RESULTS: Among 4,275 cases from 24 hospitals, 506 (11.8%) had EE. Among 836 cases with predominantly typical GERD symptoms, EE was diagnosed in 140 (16.7%). Among 530 cases having predominantly typical GERD symptoms with a frequency of at least twice a week or with a significant impact on their daily lives, EE was found in 104 (19.6%). The prevalence of EE was positively associated with males irrespective of age, old aged (> or =65 years) females, predominantly typical GERD symptoms at least twice a week, and the numbers of typical GERD symptoms. The severity of GERD symptoms did not affect the prevalence of EE. The most common typical and atypical GERD symptoms in cases with EE were regurgitation and epigastric soreness, respectively. CONCLUSIONS: The prevalence of EE among outpatients visiting gastroenterology clinics in Korea was 11.8%. Independent factors associated with increased prevalence of EE were males irrespective of age, old aged (> or =65 years) females, number of typical GERD symptoms, and frequent typical GERD symptoms.

The Relationship of Gastrin, Pepsinogen, and Helicobacter pylori in Erosive Reflux Esophagitis / 대한소화기학회지

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) infection is known as a major cause of atrophic gastritis and is associated with serum gastrin, pepsinogen, and gastric acid secretion. There is still a controversial association between gastroesophageal reflux disease and H. pylori infection. This study was designed to investigate the relationship among serum gastrin, pepsinogen, and H. pylori infection in the erosive reflux esophagitis (ERD) patients. METHODS: Patients who were diagnosed as ERD by one gastroenterologist at the Kangnam St. Marys hospital were prospectively enrolled. The persons without ERD in the control group were matched for age and sex. We examined the gastrin, pepsinogen I (PG I), PG II, PG I/II ratio, and H. pylori infection. RESULTS: Forty five patients were enrolled in ERD group and 66 persons in control group. The H. pylori infection rate in ERD group was lower than that in the control group (11.1% vs. 43.9%, p<0.001). PG I/II ratio in ERD group was higher than that in the control group (7.0+/-3.1 vs. 5.3+/-2.6, p=0.003). The PG II (p=0.016) and gastrin (p=0.029) in ERD group were lower than those in the control group. BMI in ERD group was higher than that in the control group (24.5 vs. 23.1 kg/m(2), p=0.013). CONCLUSIONS: The H. pylori infection rate in ERD group was lower and PG I/II ratio was higher than that in the control group. Reflux esophagitis is thought to be reversely associated with the atrophy of gastric mucosa.

Relação entre o tamanho da hérnia hiatal e a gravidade da esofagite de refluxo / Relationship between hiatal hernia size and reflux esophagitis severity

Objetivo: Avaliar por parâmetros endoscópicos a relação do tamanho da hérnia hiatal (HH) com a gravidade da esofagite de refluxo (ER). Métodos: Foram revistas 3.001 endoscopias digestivas altas. Utilizou-se como critério de inclusão a presença concomitante de HH e ER. Para o diagnóstico endoscópico da HH considerou-se a elevação da linha Z a 2cm ou mais acima do pinçamento diafragmático. Para a caracterização macroscópica da ER, foram adotadas as classificações de Los Angeles e Savary-Miller. Resultados: Os critérios de inclusão foram preenchidos por 408 pacientes. Os resultados foram reunidos em cinco grupos distintos segundo os critérios de Los Angeles e Savary-Miller para a ER. Comparando-se as médias dos tamanhos das hérnias hiatais, não houve diferença estatisticamente significante entre os grupos um (ER não erosiva) e dois (LA A/ SM I), que evidenciaram ER leve e HHs de pequeno volume (médias 2,6 e 2,8cm, respectivamente). Entre os grupos três (LA BI SM II) e quatro (LA CI SM III), que apresentaram ER moderada e HHs de volume moderado (médias 3,2 e 3,6cm, respectivamente), também não houve diferença estatística. O grupo cinco (LA DI SM IV), estatisticamente diferente dos demais (p < 0,001), apresentou HHs volumosas (média de 4,9cm) e ER grave. Conclusão: As ERs mais graves apresentaram HHs mais volumosas, sendo seu tamanho diretamente proporcional ao da gravidade da ER.

Spontaneous endobroncheal erosion of a bullet - an uncommon presentation of gunshot trauma in remote past

A case of unknown bullet trauma to the lung, in remote past, presented with hemoptysis which was mislabeled as hematemesis. Once labeled, a number of physicians, one after the other, kept on treating her for that symptom. She also consulted a number of specialties and was treated for reflux esophagitis, tuberculosis etc. Meanwhile her x-ray chest revealed a foreign body which was treated as an artifact first, and proved to be a bullet on CT scan. Thoracotomy had to be performed to remove the pathologic right lower lobe of lung

Aspectos atuais da abordagem da esofagite de refluxo complicada em crianças e adolescentes / Management of severe reflux esophagitis in children: current aspects

A esofagite é uma das principais complicações da doença do refluxo gastroesofágico (DRGE) em crianças e adolescentes e, quanto maior sua gravidade, maior a dificuldade de tratamento. O relaxamento transitório e inadequado do esfíncter esofágico infe- rior é o principal mecanismo etiopatogênico da DRGE e a presença de ácido é fator essencial para a ocorrência das lesões esofágicas. O surgimento dos inibidores de bomba de prótons (IBP) revolucionou o tratamento das doenças cloridopépticas e a supressão farmacológica da secreção ácida gástrica com estas drogas passou a ser a terapêutica de escolha para a esofagite de refluxo. Os achados endoscópicos de erosões e/ou ulcerações na mucosa esofágica caracterizam esofagite de refluxo complicada, cujo tratamento torna-se mais complexo, em virtude da dificulda- de de cicatrização das lesões, maior risco de complicações, pequena resposta ao uso dos antagonistas dos receptores H2 da histamina e necessidade de manutenção a longo prazo para evitar recidiva da doença. Embora o omeprazol seja usado há mais de 15 anos na população pediátrica, ainda há escassez de dados na literatura quanto ao manejo ideal da esofagite péptica complicada e quanto à dose efetiva desta droga para uso nestes pacientes. Estudos pediátricos, até o momento, mostram ampla varia- ção da dose do omeprazol e sugerem monitoração mais precisa do tratamento clínico da esofagite de refluxo infantil, principal- mente através da pHmetria esofágica de 24 horas. A cirurgia anti- refluxo apresenta altas taxas de morbidade e insucesso após o procedimento e deve ser reservada somente para os casos refra- tários ao tratamento clínico otimizado.

Esophagitis is the main complication of gastroesophageal reflux disease (GERO) in children and the treatment is very difficult. Transient relaxations of lower esophageal sphincter are the princi- pal ethyopathogenic mechanism of GERO, with acid as one of the factors that takes to esophageal erosions. The blockage of gastric acid secretion by proton pump inhibitors (PPI) revolutionized the treatment of peptic esophagitis and becomes the therapy of choice. Endoscopic features of esophageal erosions and ulcerations characterize severe reflux esophagitis and the management may be more oriented because of severe grades of esophageal lesions, poor outcome, no response to H2-receptor antagonists and prolonged use of PPI. Oespite of omeprazole use for more than 15 years in pediatric population, there are few data about the ideal management for severe reflux esophagitis and about the effective omeprazole dosage in children. Pediatric studies show wide variation of the omeprazole dosage and recommend optimized medical therapy, including continuous esophageal pH monitoring. Antireflux surgery is attended by a high morbidity and failure rate and remain the treatment of choice only for refractory cases.

Gastro-oesophageal reflux disease in Sudan: a clinical endoscopic and histopathological study.

This study was conducted to assess the frequency of gastroesophageal reflux disease (GERD) and Barrett's esophagus among Sudanese patients with clinical symptoms of heartburn. One hundred and five patients were included in the study; forty seven patients had evidence of reflux oesophagitis, 61.7% of whom had grade B oesophagitis according to the modified Los Angeles classification and 10.6% had Barrett's oesophagus. 78.7% of the biopsies from the esophageal cardia revealed presenced of inflammation (Carditis). Dysplasia was documented in 21.3% of these biopsies. Helicobacter pylori was detected 59.6% of gastrooesophageal reflux disease patients and 56.8% of patients with carditis. However, 80% of patients with Barrett oesophagus were positive for Helicobacter pylori. It was concluded that gastro-oesophageal reflux disease affects all age groups with males being affected more than females and Helicobacter pylori infection did not play a major role in gastro-oesophageal reflux disease orits complications.

Diagnóstico de esofagite de refluxo em lactentes: a histologia do esôfago distal deve complementar a endoscopia digestiva alta / Diagnosis of reflux esophagitis in infants: histology of the distal esophagus must complement upper gastrointestinal endoscopy

OBJETIVO: O objetivo deste estudo foi o de validar os resultados do exame de endoscopia digestiva alta contra a histologia do esôfago distal para o diagnóstico da esofagite de refluxo em lactentes. MÉTODOS: Foram revisados os prontuários de 167 pacientes (88 do sexo masculino e 79 do sexo feminino) com idade de 38 a 364 dias, encaminhados para investigação de esofagite de refluxo no período de janeiro de 1995 a dezembro de 2000. Analisou-se a associação entre as variáveis nominais (presença ou ausência de esofagite) e ordinais (graus de esofagite) através da comparação entre os resultados da endoscopia digestiva alta e histologia. RESULTADOS: A endoscopia digestiva alta, quando comparada à histologia, apresentou sensibilidade de 45 por cento, especificidade de 71 por cento, valores preditivos positivo de 89 por cento e negativo de 21 por cento, e acurácia de 50 por cento. Verificou-se baixa concordância entre os achados endoscópicos e histológicos na endoscopia digestiva alta normal ou na esofagite grau I (eritema leve ao nível da transição epitelial, apagamento, friabilidade e perda do brilho da mucosa) (p = 0,10). A endoscopia digestiva alta normal não identificou 79,2 por cento dos pacientes com esofagite histológica. Entre os pacientes com esofagite grau I à endoscopia digestiva alta, 12,1 por cento não apresentaram alterações histológicas. CONCLUSÕES: Concluiu-se que, enquanto a endoscopia digestiva alta apresentou especificidade de 71 por cento, não atingiu sensibilidade aceitável (45 por cento) para justificar sua realização sem biópsia; e que a presença de esofagite grau I (não-erosiva) na endoscopia digestiva alta não aumentou a capacidade deste exame de prever a anormalidade histológica.