Comparative transcriptome analysis of candidate genes involved in chlorogenic acid biosynthesis during fruit development in three pear varieties of Xinjiang Uygur Autonomous Region / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Pear is one of the main fruits with thousands of years of cultivation history in China. There are more than 2000 varieties of pear cultivars around the world, including more than 1200 varieties or cultivars in China (Legrand et al., 2016). Xinjiang Uygur Autonomous Region is an important pear production region in China with 30 of varieties or cultivars. Pyrus sinkiangensis is the most popular variety, which is mainly distributed in Xinjiang (Zhou et al., 2018). Chlorogenic acid (CGA), p-coumaric acid, and arbutin are the main polyphenols in pear fruit, and their levels show great differences among different varieties (Li et al., 2014). CGA is a potential chemo-preventive agent, which possesses many important bioactivities including antioxidant, diabetes attenuating, and anti-obesity (Wang et al., 2021). Therefore, the specific CGA content of a variety is considered the embodiment of the functional nutritional value of pears.

Genome-wide identification of the Sec-dependent secretory protease genes in Erwinia amylovora and analysis of their expression during infection of immature pear fruit / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

The general secretory (Sec) pathway represents a common mechanism by which bacteria secrete proteins, including virulence factors, into the extracytoplasmic milieu. However, there is little information about this system, as well as its associated secretory proteins, in relation to the fire blight pathogen Erwinia amylovora. In this study, data mining revealed that E. amylovora harbors all of the essential components of the Sec system. Based on this information, we identified putative Sec-dependent secretory proteases in E. amylovora on a genome-wide scale. Using the programs SignalP, LipoP, and Phobius, a total of 15 putative proteases were predicted to contain the N-terminal signal peptides (SPs) that might link them to the Sec-dependent pathway. The activities of the predicted SPs were further validated using an Escherichia coli-based alkaline phosphatase (PhoA) gene fusion system that confirmed their extracytoplasmic property. Transcriptional analyses showed that the expression of 11 of the 15 extracytoplasmic protease genes increased significantly when E. amylovora was used to inoculate immature pears, suggesting their potential roles in plant infection. The results of this study support the suggestion that E. amylovora might employ the Sec system to secrete a suite of proteases to enable successful infection of plants, and shed new light on the interaction of E. amylovora with host plants.

Cinética da secagem de amostras de pera com geometrias distintas em secador solar (Pyrus L. ) / Drying kinetics of pear samples with different geometries in solar dryer

O objetivo do estudo foi realizar a desidratação de amostras de pera através da secagem solar e obter as respectivas curvas de secagem. As amostras foram submetidas à desidratação em dois tipos de geometrias, circulares com 1cm de espessura e em cubos com 1cm de comprimento. Os dados experimentais das curvas de secagem para as duas condições foram ajustados ao modelo matemático de secagem baseado na Segunda Lei de Fick. Os resultados mostram que a umidade do fruto é de aproximadamente 85%. As amostras apresentaram peso constante a partir de 18 horas de experimento para a geometria plana e a partir de 30 horas para a geometria cilíndrica. O coeficiente difusivo, obtido através da aplicação da Segunda Lei de Fick, para geometria plana foi de 6,4 x 10(-4)m2/s e para a geometria cilíndrica de 3,35 x 10(-4) m2/s.

Eugenia Klotzschiana O. Berg Fruits as New Sources of Nutrients: Determination of their Bioactive Compounds, Antioxidant Activity and Chemical Composition

Abstract: The Cerrado is one of the world's biodiversity hotspots and Brazil's second largest biome. Many native species of the Brazilian Cerrado provide fruits that have unique sensory characteristics and high nutritional value. This study aimed at characterizing the pulp of Eugenia klotzschiana O. Berg, concerning its proximal composition, bioactive compound content and antioxidant activity. The pulp under study had high moisture (89.47 g kg-1) and caloric (96.07 kcal kg-1) values whereas its contents of protein (0.59 g kg-1) and lipids (2.35 g kg-1) were low. The cerrado pear pulp also had high iron content (16.5 mg kg -1) and dietary fiber (6.45 g kg-1), besides 0.034-0,055 mg kg-1 carotenoids, 8.66 mg kg-1 ascorbic acid and 0.66 mg kg-1 total chlorophyll. Total phenolic compounds (333.41-566.33 mg EAG kg-1) and flavonoids (225-50 mg EQ kg-1) were found by extraction methods named Method 1 (water) and Method 2 (acetone+methanol), respectively. Thus, the cerrado pear can be an alternative to improving nutrient intake and to providing sustainable use of the native flora in the Cerrado.

Genetic Diversity of the Pear Scab Fungus Venturia nashicola in Korea

Scab disease caused by Venturia nashicola is of agroeconomic importance in cultivation of Asian pear. However, little is known about the degree of genetic diversity in the populations of this pathogen. In this study, we collected 55 isolates from pear scab lesions in 13 major cultivation areas in Korea and examined the diversity using sequences of internal transcribed spacer (ITS) region, β-tubulin (TUB2), and translation elongation factor-1α (TEF-1α) genes as molecular markers. Despite a low level of overall sequence variation, we found three distinctive subgroups from phylogenetic analysis of combined ITS, TUB2, and TEF-1α sequences. Among the three subgroups, subgroup 1 (60% of isolates collected) was predominant compared to subgroup 2 (23.6%) or subgroup 3 (16.4%) and was distributed throughout Korea. To understand the genetic diversity among the subgroups, RAPD analysis was performed. The isolates yielded highly diverse amplicon patterns and none of the defined subgroups within the dendrogram were supported by bootstrap values greater than 30%. Moreover, there is no significant correlation between the geographical distribution and the subgroups defined by molecular phylogeny. Our data suggest a low level of genetic diversification among the populations of V. nashicola in Korea.

Thidiazuron (TDZ) increases fruit set and yield of 'Hosui' and 'Packham's Triumph' pear trees

ABSTRACT The low fruit set is one of the main factors leading to poor yield of pear orchards in Brazil. The exogenous application of thidiazuron (TDZ) and aminoethoxyvinilglycine (AVG) has shown promising results in some pear cultivars and other temperate fruit trees. The objective of this study was to evaluate the effect of TDZ and AVG on fruit set, yield, and fruit quality of 'Hosui' and 'Packham's Triumph' pears. The study was performed in a commercial orchard located in São Joaquim, SC. Plant material consisted of 'Hosui' and 'Packham's Triumph' pear trees grafted on Pyrus calleryana. Treatments consisted on different rates of TDZ (0 mg L-1, 20 mg L-1, 40 mg L-1 and 60 mg L-1) sprayed at full bloom for both cultivars. An additional treatment of AVG 60 mg L-1 was sprayed one week after full bloom in 'Hosui'. The fruit set, number of fruit per tree, yield, fruit weight, seed number, and fruit quality attributes were assessed. Fruit set and yield of both cultivars are consistently increased by TDZ, within the rates of 20 to 60 mg L-1. Besides, its application increased fruit size of 'Hosui' and did not negatively affect fruit quality attributes of both cultivars.

Pear pomace ethanol extract improves insulin resistance through enhancement of insulin signaling pathway without lipid accumulation

BACKGROUND/OBJECTIVES: The anti-diabetic activity of pear through inhibition of α-glucosidase has been demonstrated. However, little has been reported about the effect of pear on insulin signaling pathway in obesity. The aims of this study are to establish pear pomace 50% ethanol extract (PPE)-induced improvement of insulin sensitivity and characterize its action mechanism in 3T3-L1 cells and high-fat diet (HFD)-fed C57BL/6 mice. MATERIALS/METHODS: Lipid accumulation, monocyte chemoattractant protein-1 (MCP-1) secretion and glucose uptake were measure in 3T3-L1 cells. Mice were fed HFD (60% kcal from fat) and orally ingested PPE once daily for 8 weeks and body weight, homeostasis model assessment of insulin resistance (HOMA-IR), and serum lipids were measured. The expression of proteins involved in insulin signaling pathway was evaluated by western blot assay in 3T3-L1 cells and adipose tissue of mice. RESULTS: In 3T3-L1 cells, without affecting cell viability and lipid accumulation, PPE inhibited MCP-1 secretion, improved glucose uptake, and increased protein expression of phosphorylated insulin receptor substrate 1 [p-IRS-1, (Tyr⁶³²)], p-Akt, and glucose transporter type 4 (GLUT4). Additionally, in HFD-fed mice, PPE reduced body weight, HOMA-IR, and serum lipids including triglyceride and LDL-cholesterol. Furthermore, in adipose tissue, PPE up-regulated GLUT4 expression and expression ratio of p-IRS-1 (Tyr⁶³²)/IRS, whereas, down-regulated p-IRS-1 (Ser³⁰⁷)/IRS. CONCLUSIONS: Our results collectively show that PPE improves glucose uptake in 3T3-L1 cells and insulin sensitivity in mice fed a HFD through stimulation of the insulin signaling pathway. Furthermore, PPE-induced improvement of insulin sensitivity was not accompanied with lipid accumulation.

A pictorial review of signature patterns living in musculoskeletal ultrasonography

The musculoskeletal system is mainly composed of the bones, muscles, tendons, and ligaments, in addition to nerves and blood vessels. The greatest difficulty in an ultrasonographic freeze-frame created by the examiner is recognition of the targeted structures without indicators, since an elephant's trunk may not be easily distinguished from its leg. It is not difficult to find descriptive ultrasonographic terms used for educational purposes, which help in distinguishing features of these structures either in a normal or abnormal anatomic condition. However, the terms sometimes create confusion when describing common objects, for example, in Western countries, pears have a triangular shape, but in Asia they are round. Skilled experts in musculoskeletal ultrasound have tried to express certain distinguishing features of anatomic landmarks using terms taken from everyday objects which may be reminiscent of that particular feature. This pictorial review introduces known signature patterns of distinguishing features in musculoskeletal ultrasound in a normal or abnormal condition, and may stir the beginners' interest to play a treasure-hunt game among unfamiliar images within a boundless ocean.

A pictorial review of signature patterns living in musculoskeletal ultrasonography

The musculoskeletal system is mainly composed of the bones, muscles, tendons, and ligaments, in addition to nerves and blood vessels. The greatest difficulty in an ultrasonographic freeze-frame created by the examiner is recognition of the targeted structures without indicators, since an elephant's trunk may not be easily distinguished from its leg. It is not difficult to find descriptive ultrasonographic terms used for educational purposes, which help in distinguishing features of these structures either in a normal or abnormal anatomic condition. However, the terms sometimes create confusion when describing common objects, for example, in Western countries, pears have a triangular shape, but in Asia they are round. Skilled experts in musculoskeletal ultrasound have tried to express certain distinguishing features of anatomic landmarks using terms taken from everyday objects which may be reminiscent of that particular feature. This pictorial review introduces known signature patterns of distinguishing features in musculoskeletal ultrasound in a normal or abnormal condition, and may stir the beginners' interest to play a treasure-hunt game among unfamiliar images within a boundless ocean.

Prevalence and Risk Factors of Upper Extremity Musculoskeletal Diseases among Farmers in Gyeongnam

OBJECTIVE: To evaluate the prevalence and risk factors of upper extremity musculoskeletal diseases (MSDs) among Korean farmers. METHODS: The study was carried out from June 2013 to August 2015 on 850 farmers and 203 non-farmers (controls) in Gyeongnam Province. Physical examinations were performed by rheumatologists, orthopedists, and rehabilitation specialists. Plain radiography, a nerve conduction examination, and magnetic resonance imaging were performed, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was used to assess upper extremity function. RESULTS: Thirty-four different types of upper extremity MSDs were detected in the 1,053 study subjects. The prevalence of any MSD in farmers was 8.96-fold higher than in control (p<0.001). The most obvious difference in prevalence between farmers and non-farmers was hand osteoarthritis (48.2% vs. 4.9%). Mean total DASH score was higher for farmers than non-farmers (14.29+/-13.66 vs. 10.03+/-10.85, p<0.001). Among farmers, myofascial pain syndrome, rotator cuff tear, and epicondylitis were more prevalent among overhead workers (growing persimmons, pears, and grapes) than in non-overhead workers (growing rice and upland crops). The following factors were associated with a rotator cuff tear; older age, overhead work, high waist circumference, and lower level of education. Hand osteoarthritis was found to be associated with older age, a female gender, high waist circumference, and longer total work time. CONCLUSION: The prevalence of upper extremity MSDs is much higher in farmers than non-farmers and greater still for farmers doing overhead work. Various factors contribute to the occurrence of upper extremity MSDs, and thus, the authors suggest an efficient preventive strategy, which involves consideration of type of work and risk factors, be established for farmers to reduce upper extremity MSDs.

Pear pomace water extract inhibits adipogenesis and induces apoptosis in 3T3-L1 adipocytes

Obesity occurs when a person's calorie intake exceeds the amount of energy burns, which may lead to pathologic growth of adipocytes and the accumulation of fat in the tissues. In this study, the effect and mechanism of pear pomace extracts on 3T3-L1 adipocyte differentiation and apoptosis of mature adipocytes were investigated. The effects of pear pomace extract on cell viability and the anti-adipogenic and proapoptotic effects were investigated via MTT assay, Oil red O staining, western blot analysis and apoptosis assay. 3T3-L1 preadipocytes were stimulated with DMEM containing 10% FBS, 0.5 mM 3-isobutyl-1-methylxanthine (IBMX), 5 microg/ml insulin and 1 microM dexamethasone for differentiation to adipocytes. 3T3-L1 cells were cultured with PBS or water extract of pear pomace. Water extract of pear pomace effectively inhibited lipid accumulations and expressions of PPAR-gamma and C/EBPalpha in 3T3-L1 cells. It also increased expression of p-AMPK and decreased the expression of SREBP-1c and FAS in 3T3-L1 cells. The induction of apoptosis was observed in 3T3-L1 cells treated with pear pomace. These results indicate that pear pomace water extract inhibits adipogenesis and induces apoptosis of adipocytes and thus can be used as a potential therapeutic substance as part of prevention or treatment strategy for obesity.

Influence of rootstocks on growth, yield, fruit quality and leaf mineral element contents of pear cv. 'Santa Maria' in semi-arid conditions

BACKGROUND: Rootstocks play an essential role to determining orchard performance of fruit trees. Pyrus communisand Cydonia oblonga are widely used rootstocks for European pear cultivars. The lack of rootstocks adapted to different soil conditions and different grafted cultivars is widely acknowledged in pear culture. Cydonia rootstocks (clonal) and Pyrus rootstocks (seedling or clonal) have their advantages and disadvantages. In each case, site-specific environmental characteristics, specific cultivar response and production objectives must be considered before choosing the best rootstock. In this study, the influence of three Quince (BA 29, Quince A = MA, Quince C = MC) and a local European pear seedling rootstocks on the scion yield, some fruit quality characteristics and leaf macro (N, P, K, Ca and Mg) and micro element (Fe, Zn, Cu, Mn and B) content of 'Santa Maria' pear (Pyrus communis L.) were investigated. RESULTS: Trees on seedling rootstock had the highest annual yield, highest cumulative yield (kg tree(-1)), largest trunk cross-sectional area (TCSA), lowest yield efficiency and lowest cumulative yield (ton ha(-1)) in the 10th year after planting. The rootstocks had no significant effect on average fruit weight and fruit volume. Significantly higher fruit firmness was obtained on BA 29 and Quince A. The effect of rootstocks on the mineral element accumulation (N, K, Ca, Mg, Fe, Zn, Cu, Mn and B) was significant. Leaf analysis showed that rootstocks used had different mineral uptake efficiencies throughout the early season. CONCLUSION: The results showed that the rootstocks strongly affected fruit yield, fruit quality and leaf mineral element uptake of 'Santa Maria' pear cultivar. Pear seedling and BA 29 rootstock found to be more prominent in terms of several characteristics for 'Santa Maria' pear cultivar that is grown in highly calcareous soil in semi-arid climate conditions. We determined the highest N, P (although insignificant), K, Ca, Mg, Fe and Cu mineral element concentrations on the pear seedling and BA 29 rootstocks. According to the results, we recommend the seedling rootstock for normal density plantings (400 trees ha(-1)) and BA 29 rootstock for high-density plantings (800 trees ha(-1)) for 'Santa Maria' pear cultivar in semi-arid conditions.

Antioxidant activities and nutritional characteristics of smoked duck marinated in natural curing agent / 한국영양학회지

PURPOSE: This study investigated the question of whether the addition of natural ingredients (pear fermented solution, celery powder, vitamin C) in curing agents may influence antioxidant activities and nutritional characteristics of smoked duck. METHODS: Smoked duck samples with general or natural curing agent containing three additive ingredients were examined to determine total polyphenol contents, antioxidant activities, pH, TBARS, and food additives residue (nitrite ion, antioxidant, sodium glutamate). RESULTS: Smoked duck with natural curing agent showed a higher level of total polyphenol content and antioxidant activities than smoked duck using general curing agent (p < 0.05). The pH and TBARS of smoked duck were significantly decreased by the addition of natural curing ingredients compared to those of smoked duck using general curing agent (p < 0.05). The residues of food additives were not detected in smoked duck using natural curing agent. CONCLUSION: Findings suggest that the addition of pear fermented solution, celery powder, and vitamin C in natural duck curing agent may improve the antioxidant activities and nutritional characteristics of smoked duck and provides health benefits.

Factors Associated with Fruit and Vegetable Consumption of Subjects Having a History of Stroke: Using 5th Korea National Health and Nutrition Examination Survey (2010, 2011) / 대한지역사회영양학회지

OBJECTIVES: Intake of fruits and vegetables has protective effects against stroke attack. This study intended to examine the status of consuming fruits and vegetables and to find out which factors may influence the frequency of consumption of fruits and vegetables in individuals with a history of stroke. METHODS: The data of 208 subjects from 5th (2010, 2011) Korea National Health and Nutrition Examination Survey (KNHNES) who reported a stroke diagnosis was used for analysis. To identify major factors influencing the consumption of fruits and vegetables, a classification-tree analysis was carried out. RESULTS: Among those who reported a stroke diagnosis, the frequencies of consumption of fruits and vegetables were influenced by their age, place of residence (urban or rural), economic status, educational level, occupation, number of family members, frequency of eating out, and having meals (breakfast or lunch) with family members. Two factors from fruits and three factors from vegetables were generated by exploratory factor analyses. Urban residents ate fruits and vegetables more frequently in all factors than rural residents. Eating frequencies of 'seasonal fruits (orange, apple, strawberry, melon, pear and watermelon)', 'easily-accessible fruits (persimmon, tangerine, grape, peach, banana)', and 'Western-style vegetables (cabbage, mushroom, carrot, tomato, spinach)' were influenced by the socioeconomic status. Eating frequencies of 'Korean-style vegetables (bean sprout, radish leaves, pumpkin/squash, sea weed)', 'preserved vegetables (Korean cabbage, radish, laver, cucumber)' were influenced by having breakfast with amily members. CONCLUSIONS: The results of this study suggested that by eating more fruits and vegetables, more preventive effects against secondary stroke attack are expected in stroke patients who live in the rural areas and who do not eat breakfast with family members. In addition, more outreach and education programs are needed for them.

A study on dietary habits and food intakes in adults aged 50 or older according to depression status / 한국영양학회지

PURPOSE: This study was conducted in order to analyze the dietary habits and food intake status according to the prevalence of depression in adults. METHODS: A total of 496 subjects, 224 men and 272 women aged 50 to 100 years were recruited from more than 13 cities in Korea. The questionnaires consisted of general characteristics, dietary life status, food intakes, the mean mini dietary assessment and satisfaction with food-related life questionnaire of the subjects to ask according to the degree of depression. Depression status was evaluated according to the Korean form of the Geriatric Depression Scale (K-GDS). RESULTS: All subjects were divided into depression or normal groups; the prevalence of depression was 13.8% (male) and 23.9% (female). People aged 65 or older were more likely to have higher prevalence of depression and to be bereaved. People in the depression group had poor appetite, almost never dined-out, and ate alone. The food intake of miscellaneous cereals, beans, tofu, chicken/duck meat, cabbage, carrot/amber, fungi, apple, pear, strawberry, grapes, and banana was significantly higher in the normal group compared with the depression group. In particular, significantly higher intake of vegetables and fruits was observed in the normal group. In addition, subjects in the depression group ate more fatty meat and were more dissatisfied with food-related life than those in the normal group. CONCLUSION: The results of this study imply that the prevalence of depression may affect the dietary habits, food intake, and dietary behaviors in the older adult population.

Effects of medicinal herb water extracts on expression of hepatic glucokinase, pyruvate dehydrogenase and acetyl-CoA carboxylase mRNA

We studied the anti-diabetic effects of medicinal herb water extracts on expression of hepatic glucokinase (GCK), pyruvate dehydrogenase (PDH), and acetyl-CoA carboxylase (ACC) mRNA. The medicinal herbs used for experiments were Cornus officinalis (CO), Paeonia suffruticosa Andrews (PSA), Discorea japonica Thunb. (DJ), Rehmannia glutinosa (RG), Lycium chinense (LC), and Pyrus pyrifolia (PP). For GCK mRNA expression, CO, RG, and LC water extracts exhibited a more effective activity than other extracts. Cells treated with RG and LC water extracts showed an increase in expression of PDH mRNA to 191% and 124%, respectively, compared to control. Expression of ACC mRNA was significantly higher in LC water extract. These data indicate that CO, RG, and LC water extracts stimulates expression of hepatic GCK, PDH, and ACC mRNA.

[Evaluation of viscosity of traditional medicinal antihyperglycemic plant extracts and relationship with glucose diffusion in vitro]

One of the mechanisms in reducing blood glucose is preventing the digestive absorbtion of glucose. The aim of this study was to investigate the viscosity and impact some plants useful in reducing the glucose and their effects on decreased glucose movmentvia via dialysis bag in vitro. Eleven traditional antihyperglycemic plants Liquid extracts were prepared after confirmation. The viscosity of the plant extracts was measured using viscometer. Different concentration [6.25, 12.5, 25, 50 g/l] of the extracts were addad to dialysis bag content D - glucose 0.22 M. Dialysis bag having only D - glucose 0.22 M was considered as control. The Liquid glucose concentration out of dialysis bag in room temperature was measured in time interval during 24 hours using the glucose oxidase method. The area under the glucose curve [AUC] was calculated using trapezium rule and AUC of different groups were compared. Highest viscosity was belonging to Pyrus biosseriana 50 g/l [1.69 mpas] and Securigera securidaca [1.46 mpas]. Decreased glucose movement from dialysis bag considering AUC was related to extracts of 50 g/l of Eucalyptus globulues [% 82]. Decreased glucose movment were extract concentration dependent but in the each extract concentration decreased glucose movement was less than control. The extracts of the traditional antihyperglycemic plants reduce the glucose diffusion in laboratory model. It seem that viscosity is effective in the decrease glucose movment, but this was not observed in case of Eucalyptus globulues extract, that probably another reason has a role in this relation

Sugar composition and glycemic indices of frequently consumed fruits in Korea

Fruits are generally recommended for a balanced meal, as they are good sources of vitamins, minerals, and fiber, which may improve blood glucose control. However, fruits have simple sugars with a wide glycemic index (GI) range. The purpose of this study was to analyze the sugar content and composition and to determine the glycemic indices of the most frequently consumed fruits in Korea, including apple, tangerine, pear, water melon, persimmon, grape, oriental melon, and peach. The sugar content and composition of the fruits were analyzed by high performance anion-exchange chromatography (Dinonex model DX-600). The GI of the fruits was measured in 13 healthy subjects (seven females and six males) after permission was received from the University Hospital institutional review board (KHU-IRB 1114-06). The subjects consumed 50 g of glucose as a reference and carbohydrate portions of eight fruits. Blood samples were collected at 0, 30, 60, 90, and 120 min after consuming the fruits. The GI values for the fruits were calculated by expressing the increase in the area under the blood glucose response curve for each subject. As a result, the total sugar contents of 100 g fruits were: grape (13.9 g), apple (12.3 g), persimmon (11.9 g), oriental melon (11.2 g), watermelon (9.3 g), tangerine (8.9 g), peach (8.6 g), and pear (8.3 g). The GI values of the fruits were as follows: GI value of peach (56.5 +/- 14.17), watermelon (53.5 +/- 18.07), oriental melon (51.2 +/- 18.14), tangerine (50.4 +/- 15.16), grape (48.1 +/- 14.05), persimmon (42.9 +/- 18.92), pear (35.7 +/- 14.38), and apple (33.5 +/- 11.92). These findings will help individuals choose fruit for controlling blood sugar.

Bravo 48-hour Wireless pH Monitoring in Patients With Non-cardiac Chest Pain. Objective Gastroesophageal Reflux Disease Parameters Predict the Responses to Proton Pump Inhibitors

BACKGROUND/AIMS: In patients with non-cardiac chest pain (NCCP), gastroesophageal reflux disease (GERD) is the commonest cause and ambulatory pH is of great value in identifying these patients. However, parameters in the context of predicting therapeutic response are still unknown. By extending the monitoring period, we could better evaluate the best evidence for GERD association. Our aims were (1) to compare the outcomes of 48-hour pH monitoring to 24-hour and (2) to determine whether objective parameters could predict the treatment success in patients with NCCP using Bravo pH system. METHODS: Pathological esophageal acid reflux (PEAR) and positive symptom index (SI) were calculated after 24-hour and compared to the 48-hour study. Evidence suggestive of GERD diagnosis was considered if PEAR and/or SI (+) were present on each different day. After pH study, all patients received proton pump inhibitor twice a day for 4 weeks. Treatment success was determined at the end of therapy. RESULTS: Thirty-two patients with NCCP participated. GERD was identified in 20 (62.5%) patients; 17 (53.1%) had PEAR, 3 (9.4%) SI (+) and 7 (22%) both. Twelve (41%) patients exhibited PEAR values on day 1, while 17 after 2 days; a 12.1% gain. SI (+) was found in 6 patients (18.8%) on day 1 and in 4 more on day 2, a gain of 12.5%. Significantly higher proportion of patients with GERD indicators showed improvement compared to those without (90% vs 16.7%, P < 0.005). CONCLUSIONS: In patients with NCCP, 48-hour pH measurement identified GERD as the cause of NCCP with an increased yield by almost 12% compared to 12 hours. Objective GERD parameters could predict response to antireflux therapy.