Dolor torácico severo tras retención de cápsula inalámbrica de pH

La cápsula inalámbrica para medir el reflujo gastroesofágico o tambien conocida como cápsula de pHmetría, es una técnica utilizada en la monitorización ambulatoria del reflujo. Esta cápsula es introducida mediante una guía al esofágo y se coloca mediante un sistema de succión y anclaje a la mucosa esofágica. De alli, se comunica con un dispositivo externo mediante señales de radio para registrar la actividad del ácido gástrico en el esófago durante un período determinado de tiempo. A diferencia de la técnica convencional, que implica la inserción de un tubo a través de la nariz hasta el esófago, la cápsula inalámbrica puede ser una alternativa más cómoda y tolerable para los pacientes, lo que podría mejorar la adherencia al procedimiento. Sin embargo, algunos pacientes pueden presentar dolor torácico tras la colocación de la cápsula de pHmetría. Presentamos el caso de una mujer con cuadro clínico de reflujo gastroesofágico, con colocación capsula de pHmetría inalámbrica, lo cual generó dolor torácico severo que precisó la retirada de la cápsula vía endoscópica.

The wireless capsule to measure gastroesophageal reflux, also known as pH monitoring capsule, is a technique used in ambulatory reflux monitoring. This capsule is introduced through a guide into the esophagus and is placed using a suction system and anchored to the esophageal mucosa. From there, it communicates with an external device using radio signals to record the activity of gastric acid in the esophagus over a specified period of time. Unlike the conventional technique, which involves inserting a tube through the nose into the esophagus, the wireless capsule may be a more comfortable and tolerable alternative for patients, potentially improving adherence to the procedure. In some cases, patients may present chest pain after placement of the pH monitoring capsule, however there is little evidence about the etiology and management. We present the case of a woman with a clinical picture of gastroesophageal reflux, with pH monitoring capsule placement, which resulted in severe chest pain that required endoscopic capsule removal.

Sandifer syndrome: the mis-interpretable disorder

Sandifer syndrome (SS), a movement disorder which is characterised by spasmodic torsional dystonia with back arching and rigid opisthotonic posturing, negatively impacting predominantly the neck, back, and upper extremities. Symptomatic gastro-esophageal reflux disease, esophagitis, or the presence of a hiatal hernia are all associated with Sandifer syndrome. The cause of Sandifer syndrome being uncertain, lifestyle adjustments and modifications highlights as the appropriate mode of treatment. To treat the condition and help relax the baby after feeding, dietary changes or medications can be administered. The case report of a patient with Sandifer Syndrome is considered for observation. Upon arrival, the child was stable, and an Electro-encephalogram (EEG) test revealed nothing abnormal. The child was taking several Anti-epileptic drugs (AED’s), which were stopped in favour of Sodium valproate and Pyridoxine. An opinion from a Gastro-enterologist was sought in light of the epilepsy and possible Gastro-esophageal reflux disease (GERD), and they suggested a milk scan. Rantac was then started, and breastfeeds were thickened. Milk can indicate mild GERD and a reduction in episode frequency. So, sodium valproate was discontinued. Haemodynamically stable child was discharged from the hospital with Pyridoxine and Carnisure. Studies shows most cases of SS improve over time, within the first 24 months in general.

Sandifer syndrome: the mis-interpretable disorder

Sandifer syndrome (SS), a movement disorder which is characterised by spasmodic torsional dystonia with back arching and rigid opisthotonic posturing, negatively impacting predominantly the neck, back, and upper extremities. Symptomatic gastro-esophageal reflux disease, esophagitis, or the presence of a hiatal hernia are all associated with Sandifer syndrome. The cause of Sandifer syndrome being uncertain, lifestyle adjustments and modifications highlights as the appropriate mode of treatment. To treat the condition and help relax the baby after feeding, dietary changes or medications can be administered. The case report of a patient with Sandifer Syndrome is considered for observation. Upon arrival, the child was stable, and an Electro-encephalogram (EEG) test revealed nothing abnormal. The child was taking several Anti-epileptic drugs (AED’s), which were stopped in favour of Sodium valproate and Pyridoxine. An opinion from a Gastro-enterologist was sought in light of the epilepsy and possible Gastro-esophageal reflux disease (GERD), and they suggested a milk scan. Rantac was then started, and breastfeeds were thickened. Milk can indicate mild GERD and a reduction in episode frequency. So, sodium valproate was discontinued. Haemodynamically stable child was discharged from the hospital with Pyridoxine and Carnisure. Studies shows most cases of SS improve over time, within the first 24 months in general.

An overview of eosinophilic esophagitis in children

Based on the patient's age, eosinophilic esophagitis (EE) has different clinical manifestations. Infants and young children frequently have vague manifestations such difficulty eating, nausea, and discomfort in the abdomen. Despite having symptoms that resemble gastroesophageal reflux, children with EE, do not respond to intensive ant reflux medication. Dysphagia and food impaction became the most common symptoms in adults and adolescents. EE should also be considered when treating adults and children who continue to have heartburn. Pediatric and adult patients frequently have concurrent allergy disorders such asthma, rhinitis, and eczema, in addition to peripheral eosinophilia and increased total blood IgE levels. Mucosal oedema, furrows, exudates, corrugated bands, strictures, and the alleged "crepe paper sign" are some of the endoscopic characteristics of EE. EE is widely seen as a distinct condition from reflux disorder. According to current understanding, the former could be a symptom of eosinophilic gastroenteritis or be induced by cell-mediated food hypersensitivity. Reports back up the effectiveness of steroid treatment or food restriction. To ascertain the cause, enable early clinical identification, and enhance treatment, more research is required.

A cross-sectional study to evaluate the prevalence and risk factors of gastro-esophageal reflux disease among the undergraduate medical students of a tertiary-care Indian setting

Introduction: Gastro-esophageal reflux disease (GERD) is a condition characterized by the reflux of stomach contents into the esophagus, causing unpleasant symptoms and/or consequences like heartburn and acid regurgitation. GERD in the student stages can hurt their quality of life, college attendance, everyday activities, and overall well- being of the individual. Materials and Methods: This is a cross-sectional study that was conducted among medical students of a tertiary care setting from August 2021 to October 2021 for a three-month duration. A convenient sample of 458 participants from all the years of MBBS was included in this study. Results: A total of 458 medical students were made part of this study of which most of them (58.9%) were females and 41.1% were males. The average age among the study participants was 22 ± 2.3 years (range of 18–27 years). The average BMI of the individuals was 23.48 (range 14.58–32.41), with the majority (54.8%) of them having a normal BMI. Discussion: In our study, we found that the prevalence of GERD in the medical students of a rural Indian tertiary care setting was 24.2%, and was observed that irregular meal timings and consuming coffee and soft drinks are the crucial risk factors for developing GERD in the medical students in comparison to the general population. Conclusion: Medical students should be trained on proper eating habits, maintaining ideal body weight, good sleep hygiene, and avoiding drinking alcohol and smoking to lessen the burden of GERD.

Páncreas ectópico en antro gástrico asociado a síntomas de reflujo. Reporte de un caso / Ectopic pancreas in gastric antrum associated to reflux symptoms. Report of a case

RESUMEN El páncreas ectópico es una entidad poco común. Como tumor submucoso de origen congénito, frecuentemente presenta un curso asintomático, aunque con posibles complicaciones. Su diagnóstico de certeza se basa en la endoscopia, el ultrasonido endoscópico y la histología, que permiten adoptar una conducta expectante o quirúrgica. El paciente estudiado presentó un páncreas ectópico localizado en antro gástrico asociado a síntomas de reflujo gastroesofágico rebeldes a tratamiento, los cuales motivaron el estudio endoscópico, con el consecuente hallazgo de dicha entidad (AU).

ABSTRACT Ectopic pancreas is a little common entity. As congenital-originated sub mucous tumor, it frequently presents an asymptomatic course, though with possible complications. Its definitive diagnosis is based in the endoscopy, endoscopic ultrasound and histology, allowing to adopt an expectant or surgical behavior. The current patient presented an unresponsive-to-treatment ectopic pancreas located in the gastric antrum associated to gastro-esophageal reflux symptoms. This motivated the endoscopic study consequently leading to finding this entity (AU).

A study of the symptoms of gastro oesophageal reflux disease and the associated risk factors in a tertiary care centre

Background: Gastro esophageal reflux disease is the commonest pathologies encountered by gastroenterologist in day to day practice. Longstanding and untreated gastro esophageal reflux disease can lead to many complications including adenocarcinoma. This study was conducted to evaluate the various symptoms and to analyze the lifestyle and dietary factors influencing gastro esophageal reflux disease which can be modified.Methods: Hundred patients with gastro-esophageal reflux disease of age more than 18 years were enrolled in the study. Various patient details including demographic details, lifestyle information and symptomatology data were analyzed and compared with complications.Results: Mean age of gastro esophageal reflux disease patients was 56.09±15.93 years. Gastro esophageal reflux disease is more prevalent in males than females. Gastro esophageal reflux disease is more frequent in BMI <25, greater number of co morbidities and in non-vegetarians.  Mean age of gastro esophageal reflux disease with complications was 67±11.53 years and without complications was 52.64±15.57 years. No strong association of smoking, alcohol, spicy foods, fried foods, citrus fruits, heavy meals, tea/coffee, aerated drinks, sleep disturbance and effect on work was identified in gastro esophageal reflux disease.Conclusions: Classical symptoms of gastro esophageal reflux disease were not present in all the patients. Higher age of the patient infers higher risk of complications. Daily episodes of heartburn, regurgitation and retrosternal chest pain implies higher risk of complications. Presence of Helicobacter pylori in gastro esophageal reflux disease patients signify higher risk of complications.

Acercamiento a la tos crónica en adultos / An approach to chronic cough

RESUMEN La tos crónica en los adultos puede ser causada por muchas causas, existen cuatro principales: el síndrome de tos de la vía aérea superior, enfermedad por reflujo gastroesofágico, reflujo laringofaríngeo, asma bronquial, y bronquitis eosinofílica no asmática. Todos los pacientes deben evaluarse clínicamente con espirometria, y comenzar con tratamiento empírico. Otras causas potenciales incluyen el uso de inhibidores de la enzima convertidora de la angiotensina, cambios medioambientales, uso del tabaco, enfermedad pulmonar obstructiva crónica, y la apnea obstructiva del sueño. La radiografía del tórax puede orientar hacia causas infecciosas, inflamatorias, y malignas. Los pacientes con tos crónica refractaria pueden remitirse a la consulta especializada de un neumólogo u otorrinolaringólogo, además de un ensayo terapéutico con gabapentin, pregabalin, y psicoterapia.

ABSTRACT Although chronic cough in adults can be caused by many etiologies, four conditions account for most cases: upper airway cough syndrome, gastro-esophageal reflux disease, also known as laryngo- pharyngeal reflux disease, bronchial asthma, and non-asthmatic eosinophilic bronchitis. All patients should be evaluated clinically with spirometry, and empiric treatment should be initiated. Other potential causes include angiotensin-converting enzyme inhibitor use, environmental triggers, tobacco use, chronic obstructive pulmonary disease, and obstructive sleep apnea. Chest radiography can rule out concerning infectious, inflammatory, and malignant thoracic conditions. Patients with refractory chronic cough should be referred to a pulmonologist or otolaryngologist in addition to a therapeutic trial of gabapentin, pregabalin, and psychotherapy.

Diagnosis and Management of Gastroesophageal Reflux Disease in Infants and Children: from Guidelines to Clinical Practice / 대한소아소화기영양학회지

The diagnosis and management of gastro-esophageal reflux (GER) and GER disease (GERD) in infants and children remains a challenge. Published guidelines and position papers, along with Embase, MEDLINE, and the Cochrane Database were reviewed and summarized with the intent to propose a practical approach and management of GER and GERD for healthcare providers and to standardize and improve the quality of care for infants and children. For this purpose, 2 algorithms were developed, 1 for infants < 12 months of age and the other for older children. None of the signs and symptoms of GER and GERD are specific and there is no gold standard diagnostic test or tool. Nutritional management is recommended as a first-line approach in infants, while in children, a therapeutic trial with antacid medication is advised for early management. The practical recommendations from this review are intended to optimize the management of GER in infants and older children and reduce the number of investigations and inappropriate use of medication.

Functional Gastrointestinal Disorders in Infancy: Impact on the Health of the Infant and Family / 대한소아소화기영양학회지

Functional gastrointestinal disorders (FGIDs) such as infantile colic, constipation and colic occur in almost half of the infants. The aim of this paper is to provide a critical and updated review on the management of FGIDs and their impact on the health of the infant and family to health care physicians. Guidelines and expert recommendations were reviewed. FGIDs are a frequent cause of parental concern, impairment in quality of life of infants and relatives, and impose a financial burden to families, health care, and insurance. Therefore, primary management of the FGIDs should be focused on improving the infants' symptoms and quality of life of the family. If more than parental reassurance is needed, available evidence recommends nutritional advice as it is an effective strategy and most of the time devoid of adverse effects. The role of healthcare providers in reassuring parents and proposing the correct behavior and nutritional intervention by avoiding inappropriate use of medication, is essential in the management of FGIDs.

Gender Specific Differences in Prevalence and Risk Factors for Gastro-Esophageal Reflux Disease

BACKGROUND: Gender-related factors might play an important role in the development of reflux esophagitis (RE) and symptomatic gastro-esophageal reflux disease (GERD). We aimed to evaluate the prevalence and risk factors for RE and symptomatic GERD and determine whether gender specific differences exist. METHODS: This study was conducted on a health cohort consisting of 10,158 participants who underwent comprehensive health screening. Lifestyles and gastrointestinal symptoms were investigated using a self-reported structured questionnaire. Questionnaires about menstrual status were added for the women. RESULTS: The prevalence of RE in men was significantly higher than that in women (10.6% vs. 2.0%, P < 0.001); however, symptomatic GERD showed predominance in women (6.2% vs. 2.5%, P < 0.001). Although the prevalence of RE gradually increased with the duration of menopause stratified by decade (P = 0.007), that of symptomatic GERD rapidly increased across the menopausal transit in women. Apart from common risk factors of obesity and current smoking for RE, over 70 years of age in women and hiatal hernia and hypertriglyceridemia in men were significant risk factors. In symptomatic GERD, high somatization was a common risk factor. Excessive alcohol drinking was a significant risk factor in men, but not in women. CONCLUSION: This study showed a predominance of RE in men, but a predominance of symptomatic GERD in women. In women, dynamic increase in the prevalence of GERD is closely related to the menopause conditions and its duration. There are specific risk factors for RE and symptomatic GERD according to gender differences.

Experiences of Prof.SUN Zhiguang on the Treatment of Overlap Syndrome in Gastro-esophageal Reflux Disease and Irritable Bowel Syndrome by Harmonizing Liver and Spleen and Regulating Qi / 浙江中医药大学学报

[Objective] To sum up professor SUN Zhiguang's experiences in the treatment of overlap syndrome in gastro-esophageal reflux disease and irritable bowel syndrome.[Method] Expound the academic perspective and clinical experience of Professor SUN Zhiguang in the treatment of this overlap syndrome from the etiology and pathogenesis,therapeutic principle and method,differential diagnosis and treatment,administer medical herbs and prescription,and one case.[Result] Professor SUN considers that exogenous and internal injuries are causes of GERD overlapping IBS,leading to spleen deficientcy and the liver depression.He points out that "incoordination between liver and spleen,disturbance of qi" is the basic pathogenesis of this disease.According to holistic concept,it should be treated by the principle of harmonizing liver and spleen,regulating qi,simultaneously treating stomach and bowl.It is divided into two types,depressing qi is important in the constipation-predominant,and regulating heat and cold is significant in the diarrheapredominant.[Conclusion] Professor SUN specializes in the treatment of the GERD overlapping IBS.This clinical experience has clinical significance.

Factores promotores de reflujo gastro esofágico en pacientes con hernia hiatal / Promoting factors of gastro esophageal reflux in patients with hiatal hernia

Introducción: El esfínter esofágico inferior (EEI) hipotensivo, hernia hiatal (HH) e incremento de la distensibilidad de la unión esófago gástrica (DUGE) juegan un rol en la enfermedad de reflujo gastro esofágica (ERGE). Objetivos: determinar la relación sinérgica o independiente entre la ERGE, presión del EEI, HH y DUGE por impedancia planimétrica (IP). Pacientes y Métodos: Estudio prospectivo, de pacientes con ERGE sintomática y HH. El diagnóstico fue establecido por síntomas, endoscopia, manometría de alta resolución (MAR) pHmetría e impedancia multicanal de 24 horas. Se midió la longitud de la HH, presión del EEI y peristalsis del cuerpo esofágico. Todos los pacientes fueron a cirugía anti reflujo y corrección de la HH. Se valoró presión y DUEG por IP utilizando la sonda EndoFLIP ® al comienzo y final de la cirugía. El índice de distensibilidad (ID) es el resultado de la relación entre la DUEG/PEEI en 30 segundos. Resultados: Se evaluaron 68 pacientes, 45 mujeres, (42,34 ± 10,79 años). Las variables con asociación al ID inicial son: longitud de la HH (cms) (r=0,440; p<0,001), DUGE inicial (mm2/mmHg) (r=0,512; p<0,001), presión inicial (mmHg) (r=−0,320, p=0,006) y presión EEI medida por MAR (mmHg) (r=−0,465; p<0,001). Entre la presión inicial medida por IP y el ID inicial existe una relación no lineal. Se realizó análisis de regresión considerando el inverso de la presión inicial observando que el modelo es estadísticamente significativo sin colineinalidad. Se descartaron variables que no aportan información quedando constituido por 3 magnitudes: longitud de la HH, inverso de la presión inicial y distensibilidad inicial. Los datos se ajustaron a un modelo predictivo basado en análisis de regresión múltiple. Conclusión: Las variables longitud de la HH y distensibilidad inicial con valores bajos para el factor de inflación de varianza (FIV) indican que aportan información al modelo y que ésta es independiente de la aportada por el inverso de la presión inicial. En consecuencia, la presencia de HH, valores altos de DUGE y baja presión del EEI por si solas contribuyen al desarrollo y progresión de la ERGE ya que no son influenciables entre sí.

Introduction: The hypotensive lower esophageal sphincter (LES), hiatal hernia (HH) and the increase in the esophagogastric junction distensibility (EGJD) play a role in gastro esophageal refux disease (GERD). The episodes of reflux are associated with low pressure on the LES sphincter. Studies have shown that the EGJD is high in patients with HH and GERD and the more severe forms of GERD are invariably associated with the HH. Objectives: To determine if there is a sinergistc relationship between the HH, the LES pressure and the EGJD with the GERD through measurement by planimetric impedance (PI).Patients and methods: A prospective, study was conducted on patients with GERD and HH. The diagnosis was confirmed by symptoms, endoscopy, high-resolution manometry (HRM), pH metry and multichannel impedance of 24 hours. The length of the HH, pressure from the LES (LESP) and esophageal body peristalsis were measured. All patients underwent anti reflux surgery and HH correction surgery. Pressure and EGJD measurements were valued by (PI), using the Endoflip® system at the beginning and at the end of the surgery. Distensibility index (DI) is the result of the relationship between the EGJD/LESP in 30 seconds. Results: 68 patients: 45 women, (42,34 ± 10,79 years) were evaluated. The variables with association with the initial DI are: the length of HH (cms) (r=0,440; p<0,001), initial EGJD (mm2/mmHg) (r=0,512; p<0,001), the initial pressure (mmHg) (r=−0,320, p=0,006) and LESP measured by HRM (mmHg) (r=−0,465; p<0,001). Between the initial pressure measured by PI and the initial DI there is a nonlinear relationship or reverse. Due to this, regression analyzes were conducted considering the inverse of the initial pressure, and observing that the model is statistically significant and that it does not presents any collinearity. Those variables that do not provide information to the model were discarded, being then formed by three magnitudes: length of the HH, inverse of the initial pressure and initial distensibility. The data was adjusted later with a predictive model based on multiple regression analysis. Conclusion: The presence of the variables length of the HH and initial distensibility with low values for the variance inflation factor (VIF) indicate that they are providing information to the model and that it is independent of that provided by the inverse of the initial pressure. Accordingly, the presence of HH, high EGJD values and low pressure on the LES by themselves contribute to the development and progression of GERD since they are not influenced among them.

Correlation between Clinical Features, Endoscopic Findings and Histopathological Characteristics in Various Esophageal Lesions-A study of 200 Cases.

Background: The present study analyzed the correlation between clinical features, endoscopic findings and histopathological findings in esophageal lesions. Methods: A sample size of 200 patients was taken in the study conducted in Department of Pathology. Data for patient’s age, gender, clinical features (dysphagia, pain epigastrium, regurgitation, loss of weight, loss of appetite), site of biopsy (upper, middle and lower one third of esophagus), endoscopic appearance (erythema, ulceration, nodular and stricture) were analysed. Results: Frequency of various esophageal lesions both benign and malignant (esophagitis, benign lesions, dysplasia, Barrett’s esophagus, SCC-WD, SCC-MD, adenocarcinoma) was calculated in the study group. Finally, correlations were established between age, gender, above mentioned clinical features, endoscopic findings and final histopathological diagnosis of various esophageal lesions. It was concluded that GERD was the most common esophageal lesion and SCC was the commonest malignancy in our region, being more common in men, in old age group (41-60 years). SCC involved the middle esophagus while GERD, BE and adenocarcinoma involved the lower esophagus more commonly. A statically significant correlation was found between dysphagia, loss of weight and esophageal carcinoma. Conclusion: It was concluded that gastro-esophageal Reflux disease was the most common esophageal lesion and Squamous Cell Carcinoma was histopathologically the commonest esophageal malignancy in our region, being more common in men in the old age group (41-60 yrs).

Actualización sobre enfermedad por reflujo gastroesofágico en niños / GERD in children: an update

En los últimos diez años, la Enfermedad por Reflujo Gastroesofágico (ERGE) no presenta muchas variaciones en cuanto a su definición se refiere. Sin embargo, continúa causando una elevada morbilidad y mortalidad. Probablemente, de manera práctica, se podría decir que el RGE fisiológico no patológico usualmente se acompaña de regurgitación, y que en la ERGE, su síntoma principal de presentación es el vómito. En la ERGE, al igual que en la enfermedad ácido péptica, podríamos hablar de ciertos factores agresores y protectores, que pueden ocasionar daño dependiendo del predominio de cada uno de ellos. Los signos y síntomas de la ERGE en niños dependerán del grupo etario en estudio. Así como en neumología no todo niño que tiene sibilancias es un asmático, en gastroenterología no todo niño que vomita o regurgita es un RGE. Hoy en día, ya se conocen ciertas patologías y condiciones de tórpida evolución, que por su historia natural de la enfermedad y asociación con una mayor morbimortalidad se catalogan como ERGE refractario, cuyo pronóstico implica una diferente orientación terapéutica. La sensibilidad, especificidad y reproducibilidad es variable dependiendo del paraclínico solicitado para el estudio del niño con ERGE. El tratamiento del niño con ERGE incluye las medidas antireflujo, el manejo medicamentoso y el tratamiento quirúrgico.

Clinical analysis of 39 cases of senile chronic cough caused by GER / 中国基层医药

Objective To discuss the diagnosis and treatment by primary care physicians to chronic cough caused by SGER .Methods The data of 39 patients′clinical feature ,therapeutic method and curative effect were ret-rospectively analyzed .Results By explanation and education ,together with treatment of PPI and gastrointestinal mo-tility drugs,29(74.3%) patients′symptom alleviated in 3 weeks;25(64.1%) patients′symptom completely disap-peared in 8 weeks,and 7(18.1%) obviously alleviated.Another 4 patients,with the feeling of pharynx itching,was positively controlled by taking hydrotalcite chewable tablet .Conclusion Changing diet ,adjusting sleeping ,dispelling harmful habit together with PPI and gastrointestinal motility drugs will do good effect to chronic cough caused by SGER.

Research on correlation of the self-management level and the quality of life in elderly patients with gastro esophageal reflux disease / 中华行为医学与脑科学杂志

Objective To investigate the level of self-management behaviors and the quality of life with gastro esophageal reflux disease(GERD) patients,and analyze the correlation between self-management level and quality of life.Methods A total of 372 GERD patients were investigated by using Self-management Behavior Scale and Mos 36-item Short Form (SF-36) Health Survey.Results The level of self-management behaviors in GERD patients was relatively low.The total score of quality of life was (48.75±7.59) and the scores of the level of self-management behaviors was (5.13±0.59).Correlation analysis showed that there was positive correlation between quality of life and self-management behaviors(r=0.423,P＜0.01).Conclusion To promote the patients' health status,nursing staff should take measures to strengthen patient health education on the level of self-management behaviors for GERD patients.

Is There a Difference in the Prevalence of Gastroesophageal Reflux Disease between Peritoneal Dialysis and Hemodialysis Patients? / 대한소화기학회지

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is a common upper gastrointestinal disorder in patients with chronic kidney disease (CKD). However, little is known about the prevalence of GERD in dialysis patients. The aim of the present study was to investigate the difference in the prevalence of GERD in peritoneal dialysis and hemodialysis patients. METHODS: From July 2010 to August 2011, peritoneal dialysis patients (n=30) and hemodialysis patients (n=38) were enrolled. The prevalences of GERD were assessed at a single center with endoscopic findings and interviews using a questionnaire. Also, risk factors of GERD were evaluated. RESULTS: The prevalences of GERD in peritoneal dialysis and hemodialysis patients were 33.3% and 39.5% (p=0.748), respectively. The prevalences of erosive reflux esophagitis (ERD) in peritoneal dialysis and hemodialysis patients were 16.7% and 23.7% (p=0.477), respectively. The prevalences of nonerosive reflux disease (NERD) in peritoneal dialysis and hemodialysis patients were 16.7% and 13.2% (p=0.685), respectively. The prevalences of GERD, ERD and NERD were higher than those of the general population. The risk factor for GERD was age in hemodialysis patients. CONCLUSIONS: The prevalence of GERD in dialysis patients was higher than that in the general population. However, there was no significant difference between peritoneal dialysis and hemodialysis patients.

Esofagitis eosinofílica en adultos, una entidad clínico-patológica emergente / Eosinophilic esophagitis in adults, an emerging clinicopathological entity

Background: Eosinophilic esophagitis (EE) is a clinicopathologic primary disease of the esophagus, characterized by dense eosinophilic infiltration and it is currently identified as an emerging global entity capable of producing dysphagia and food impaction in adults. Objective: Review of the literature and analysis of the current evidence related to eosinophilic esophagitis in adults. Methods: An electronic search was performed in PubMed to identify relevant literature regarding epidemiology, pathogenesis, clinical presentation, diagnosis, treatment and prognosis of EE. The MeSH terms: ‘Eosinophilic esophagitis’ AND ‘adults’, were used including studies from 1975 to 2012, in English and Spanish written papers. Results: A total of 467 articles were identified in PubMed, where 374 correspond to adults. Eighty percent of the papers were published during the last six years, being mostly case reports or series. Although the pathogenesis is unknown, our review suggests a multifactorial cause, with an altered immune response and genetic component associated to it. At the same time, it was found that adult patients often have a long history of intermittent dysphagia or food impaction. Currently, there is no established consensus for histological diagnosis; however, eosinophilic infiltration of 15 per high power field is accepted. The most commonly used treatment in adults is topical corticosteroids. Although EE is a chronic disease, it does not seem to have a significant impact on morbimortality. Conclusions: Eosinophilic esophagitis is a chronic inflammatory disease with immunoallergic compromise, which requires clinical and histological diagnosis. A multidisciplinary approach to understand its natural history is suggested, thus developing future therapeutic approaches.

Introducción: La esofagitis eosinofílica (EE) es una enfermedad clínico-patológica primaria del esófago, caracterizada por infiltración eosinofílica densa y actualmente identificada como una entidad emergente a nivel mundial, capaz de producir disfagia e impactación alimentaria en adultos. Objetivo: Revisión de la literatura y análisis de la evidencia actual de EE en el adulto. Metodología: Se realizó una búsqueda electrónica en PubMed para identificar literatura relevante sobre epidemiología, patogenia, presentación clínica,diagnóstico, tratamiento y pronóstico. Se utilizaron los términos MeSH: ‘Eosinophilic esophagitis’ AND ‘adults’, incluyendo estudios publicados desde 1975 a 2012, en idiomas inglés y español. Resultados: Un total de 467 artículos se identificaron en PubMed, donde 374 corresponden a adultos. Durante los últimos seis años se publicó el 80 por ciento de ellos, siendo en su mayoría informes de casos o series de casos. Aunque la patogenia es desconocida, la presente revisión sugiere que es multifactorial, con alteración de la respuesta inmune y componente genético. Se encontró que los pacientes adultos presentan frecuentemente una larga historia de disfagia o impactación alimentaria. Actualmente, no existe un consenso establecido para el diagnóstico histológico, sin embargo, la infiltración eosinofílica de 15/campo de gran aumento es aceptada. El tratamiento más comúnmente indicado en adultos son los corticoesteroides tópicos. Aunque la EE es una patología crónica, no parece impactar significativamente la morbimortalidad. Conclusiones: La EE es una enfermedad inflamatoria crónica con compromiso inmunoalérgico, que requiere un diagnóstico clínico e histológico. Se sugiere un enfoque multidisciplinario con el fin de comprender su historia natural, desarrollando así futuros enfoques terapéuticos.

Long term medical management of gastro-esophageal reflux disease: How long and when to consider surgery.

Gastro-esophageal reflux disease is a chronic, long standing disease. Spontaneous remission of GERD is rare and conservative management including life style modification measures is unlikely to relieve symptoms. Majority of patients with reflux disease require long term acid suppressants. Proton pump inhibitors are the choice of drugs in management of these patients. The end point of treatment is not clear. Duration of treatment is individual based. The symptoms may be intermittent or on most days of the week. The treatment is therefore either a short course which may be for 8 to 12 weeks or 6 months, or continuous, intermittent or ‘ondemand’ basis. The maintenance therapy is with the lowest proton pump inhibitor (PPI) dose necessary for adequate symptom relief. Whether long term PPI actually alters the natural history of reflux disease other than to reduce the incidence of peptic stricture is not known. Reported adverse effects due to PPI include Clostridium difficile colitis and bacterial gastroenteritis, osteoporosis, and vitamin B12 deficiency. Anti-reflux surgery is indicated for youngsters, those not willing for long term PPI i.e. for years, large volume refluxers, especially the supine refluxers and bile refluxers.