[Esophageal motility and reflux characteristics in gastroesophageal reflux disease patients with or without extra-esophageal symptoms].

Objective: To investigate esophageal motility and reflux characteristics in gastroesophageal reflux disease (GERD) with and without extra-esophageal symptoms by high-resolution manometry and 24 h esophageal multichannel intraluminal impedance combined pH (MII-pH) monitoring. Methods: From February 2016 to June 2017, GERD patients with and without extra-esophageal symptoms were enrolled in this prospective controlled study. Esophageal HRM and 24 h MII-pH monitoring were performed. The differences in esophageal motility and reflux parameters were further analyzed between 30 GERD patients with extra-esophageal symptoms and 30 simple GERD patients. Results: The GERD symptom scores didn't show statistical difference between two groups. The GERD symptom scores didn't show statistical difference between two groups. The relaxation pressure of lower esophageal sphincter(LES), the integrated relaxation pressure, and the recovery time of upper esophageal sphincter(UES) of GERD patients with extra-esophageal symptoms were all lower than those of patients without extra-esophageal symptoms [(15±7) vs (21±11)mmHg, (8±3) vs (10±5)mmHg, (388±168) vs (492±170)ms, 1 mmHg=0.133 kPa], and the differences were statistically significant(all P<0.05). The main classification of esophageal motility type of GERD patients with extra-esophageal symptoms was mild esophageal motility disorders (27%, 8/30), and the occurrence of ineffective esophageal motivation was 20% (6/30), which were similar with simple GERD patients. The proximal reflux percentages of weak acid reflux and nonacid reflux, abnormal nonacid reflux in GERD patients with extra-esophageal symptoms were significantly higher than those in simple GERD patients [84.6% (73.2%, 100.0%) vs 75.0% (60.0%, 87.65%), P=0.048; 90.0% (45.8%, 100.0%) vs 0(0, 100.0%), P=0.017; 46.7% vs 3.3%, P=0.03]. Conclusions: The pathogenesis of GERD with extra-esophageal symptoms may be different from typical GERD. Increase of proximal esophageal reflux and abnormal nonacid reflux may all participate in the mechanisms of GERD with extra-esophageal symptoms.

Prevalência e fatores agravantes do sintoma de refluxo gastroesofágico em estudantes de medicina da Universida de Federal do Tocantins / Prevalence and aggravating factors of symptom of gastroesophageal reflux in medical students of the Federal University of Tocantins

Objetivos: Avaliar a prevalência e fatores agravantes do sintoma de pirose possivelmente associado a refluxo gastroesofágico, em estudantesde medicina da Universidade Federal do Tocantins (UFT).Métodos: Um estudo transversal avaliou questionários aplicados a estudantes do Curso de Medicina da Universidade Federal do Tocantinsentre 23/09/2013 e 04/10/2013. As variáveis analisadas foram faixa etária, sexo, índice de massa corporal, frequência de ocorrência dossintomas, percepção de fatores que agravam o sintoma de pirose, tabagismo e uso de medicamentos para aliviar sintomas de pirose. Paracalcular a prevalência, foi considerado como sintoma de refluxo gastroesofágico a ocorrência de pirose mais de uma vez por semana, mas osfatores agravantes foram pesquisados nos indivíduos que referiam ter tido o sintoma pelo menos uma vez na vida. A análise estatística incluiuas frequências absolutas e relativas das variáveis, bem como os intervalos de confiança de 95%.Resultados: Foram avaliados 186 estudantes, sendo que 160 (86,0%) referiram ter tido pirose em alguma ocasião. Naqueles que referiramtal sintoma, a faixa etária predominante foi de 21 a 25 anos (65,0%), sendo 51,3% do sexo masculino. O sintoma de pirose ocorrendo pelomenos uma vez por semana foi referido por 88 (47,3%) dos entrevistados, sendo uma vez por semana por 53 (28,5%) e mais de uma vez porsemana por 35 (18,8%). Considerando todos os 160 estudantes que referiam ter tido pirose em alguma ocasião, constatou-se piora do sintomana presença de alterações emocionais (67,5%), ingestão de alimentos gordurosos ou condimentados (63,7%) e bebidas alcoólicas (60,6%).Conclusões: Os estudantes de medicina em estudo apresentaram uma alta prevalência do sintoma pirose. O sintoma era agravado por ingestãode alimentos gordurosos ou condimentados, alterações emocionais e bebidas alcoólicas.

Aims: To evaluate the prevalence and aggravating factors of heartburn symptom possibly associated with gastroesophageal reflux in medicalstudents of the Federal University of Tocantins.Methods: A cross-sectional study evaluated questionnaires given to students of the Medical School of the Federal University of Tocantinsbetween 09/23/2013 and 10/04/2013. The analyzed variables were age, sex, body mass index, frequency of occurrence of symptoms, perceptionof factors that aggravate the symptom of heartburn, smoking, and use of drugs to relieve symptoms of heartburn. To calculate the prevalence,occurrence of heartburn more than once a week was considered as a symptom of gastroesophageal reflux, but the aggravating factors wereinvestigated in subjects who reported having had this symptom at least once in life. Statistical analysis included absolute and relative frequenciesof the variables as well as the confidence intervals of 95%.Results: At all 186 students were evaluated, of which 160 reported heartburn at some time. In those who reported such symptom, thepredominant age group was 21-25 years (65.0%), and 51.3% were male. The symptom of heartburn occurring at least once a week was reportedfor 88 (47.3%) of respondents, being 53 (28.5%) for once a week and 35 (18.8 %) for more than once a week. Considering all the 160 studentswho reported having had heartburn at some time, there was a worsening of symptoms in the presence of emotional disorders (67.5%), eatingfatty foods (63.7%) and alcoholic beverages (60.6% ).Conclusions: Medical students in the study showed a high prevalence of heartburn. This symptom was aggravated in most interviewees byintake of fatty or spicy foods, emotional changes, and alcoholic beverages.

Frecuencia de trastornos digestivos funcionales y enfermedad por reflujo gastroesofágico en pacientes con dispepsia no investigada que acuden al Hospital Nacional Cayetano Heredia, Lima, Perú / Frecuency of functional gastrointestinal disorders and esophageal reflux disease in adults with non investigated dyspepsia in the Hospital Nacional Cayetano Heredia, Lima, Peru

Objetivo: Evaluar la frecuencia de trastornos digestivos funcionales y enfermedad por reflujo gastroesofágico en pacientes adultos con dispepsia no investigada en un hospital docente localizado en Lima, Perú. Material y métodos: Estudio descriptivo realizado en el Hospital Nacional Cayetano Heredia, Lima, Perú. Se recolectaron los resultados de las endoscopías y de los cuestionarios para Trastorno Digestivo Funcional (TDF) y Enfermedad por Reflujo Gastro Esofágico (ERGE) aplicados a pacientes con criterios de selección que acudieron al servicio de gastroenterología desde julio hasta diciembre del 2011. Resultados: 110 pacientes participaron en el estudio, 70,9% fueron mujeres y la edad promedio fue 49,4 años (rango 20-77, DE: ±13,1). 82 pacientes (76,4%) presentaron algún TDF. El más común fue dispepsia funcional (71,8%), seguido por el trastorno por eructos (57,3%), trastorno por náuseas y vómitos (27,3%) y síndrome de intestino irritable (18,2%). 91 pacientes (82,7%) presentaron ERGE, siendo el síntoma más común la regurgitación (80,0%). Las endoscopias mostraron que 25 pacientes (22,7%) tenían alguna lesión estructural. Conclusiones: Se encontró una alta frecuencia de ERGE, trastorno por eructos, trastorno por nauseas y vómitos y síndrome de intestino irritable entre los pacientes con dispepsia no investigada. Además, se encontró una alta frecuencia de superposición de trastornos en un mismo paciente. Nuestros resultados sugieren la necesidad de reconocer los diferentes tipos de TDF para evitar el sub-diagnóstico de éstos desórdenes.

Objective: To assess the frequency of functional gastrointestinal disorders and gastroesophageal reflux disease in adults with uninvestigated dyspepsia in a general teaching hospital in Lima, Peru. Material and methods: Cross-sectional descriptive study performed at Hospital Nacional Cayetano Heredia Lima, Peru. Data was collected from questionnaires for Functional Gastrointestinal Disorders (FGID) based on Rome III criteria and from surveys for diagnosis of GERD applied to eligible patients who visited the gastroenterology unit from July to December 2011. Also, we collected the endoscopy’s reports. Results: Among 110 patients who participated in the study, 70.9% were female and the mean age was 49.4 years (range 2077, SD: ± 13.1). FGID was found in 82 subjects (74.6%) based on Rome III criteria. The most common FGID was functional dyspepsia (71.8%), followed by belching disorder (57.3%), nausea and vomiting disorder (27.3%) and irritable bowel syndrome (18.2%). Ninety-one patients (82.7%) were diagnosed of GERD, being the most common symptom regurgitation (80.0%). Structural abnormalities were found by upper endoscopy in 25 patients (22.7%). Conclusions: We found a high frequency of GERD, belching disorder, nausea and vomiting disorder and irritable bowel syndrome among adult patients with uninvestigated dyspepsia. In addition, we found a high frequency of overlapping disorders in the same patient. Our results suggest the necessity to recognize the different types of FGID in order to avoid the under diagnosis of common conditions in the outpatient setting.

Analysis of the characteristics of medicine taking in patients with gastroesophageal reflux disease in Beijing / 中华消化杂志

Objective To investigate the characteristics of medicine taking,the type and ratio of long-term medication and treatment satisfaction in patients with gastroesophageal reflux disease (GERD),to analyze the effects of GERD combined with functional bowel disease (FBD) on the treatment satisfaction,and to compare the changes of type of medication and treatment satisfaction in patients with GERD in recent years.Methods From April to June in 2011,the questionnaire survey was conducted in gastroenterology clinic of People's Hospital of Peking University.The incidence of typical GERD symptoms was investigated by a validated reflux disease questionnaire (RDQ),the score between one and five was considered there might be reflux symptoms and the score over 12 was diagnosed as GERD.FBD was diagnosed according to Rome Ⅲ criteria.The information of GERD related medication taking within one year before the survey,long-term medication taking (≥ 1 year)and the treatment satisfaction of patients whose RDQ score over zero was recorded and compared with the data collected in the same method in 2004.The chi-square test was performed for data statistical analyses with SPSS 17.0 software.Results Among 1074 patients who completed questionnaire survey in 2011,the percentage of patients with reflux symptoms was 32.7％ (351/1074),the percentage of diagnosed GERD was 10.0％ (107/1074),and GERD combined with FBD was 25.2％ (27/107) of GERD.A total of 304 cases (86.6％) of patients with reflux symptoms had information of medication taking; 78.0％ (237/304) of whom had taken GERD related medication within one year before the survey.The rate of GERD related medication taking especially proton pump inhibitor (PPI) and antiacid medication taking increased along with RDQ score (x2 =24.2,13.1 and 18.2,all P＜0.05).A total of 104 cases of GERD patients had information of medication taking; 88.5 ％ (92/104) GERD patients had taken GERD related medication within one year before the survey,52.9％ (55/104) GERD patients had taken PPI medication,30.8％ (32/104) needed long-term medication and 20.2％ (21/104) needed longterm PPI treatment.There was no significant difference in treatment satisfaction between different RDQ score ranges (x2 =3.3,P＞0.05).Among GERD patients who appraised the effects of treatment,the percentage of satisfied,acceptable and not satified with the treatment was 37.1％(26/70),48.6％ (34/70)and 14.3％(10/70),respectively.There was no significant difference in treatment satisfation between GERD with and without FBD (x2 =3.1,P＞0.05).In 2011,the rates of medication taking (88.5％,92/104) and PPI taking (52.9％,55/104) in GERD patients significantly increased compared with those in 2004 (57.3％,98/171; 7.6％,13/171,x2 =29.4,71.4,both P＜0.05).The percentage of treatment satisfaction in 2011(37.1％,26/70) increased compared with that in 2004(25.7％,18/70,x2 =12.8,P＜0.01).Conclusions Some of patients with GERD symptoms need long-term medication,especially PPI treatment.In recent years,the rate of medication taking in GERD patients increased in outpatients department,PPI taking significantly increased and the treatment satisfaction also increased.Maybe the treatment satisfaction is not affected by GERD combined with FBD.

Retrospective evaluation of patients of gastroesophageal reflux disease treated with laparoscopic Nissen's fundoplication.

AIMS: To evaluate retrospectively the outcome of laparoscopic fundoplication in a cohort of patients with typical symptoms of gastroesophageal reflux disease (GERD). MATERIALS AND METHODS: Forty-two patients with typical symptoms of GERD, who were operated for laparoscopic Nissen's fundoplication from March 2001 to August 2008, were studied. The study was limited to patients with positive findings on upper gastrointestinal (GI) endoscopy done by us and "typical" symptoms (heartburn, regurgitation, and dysphagia) of GERD. Laparoscopic Nissen's fundoplication was performed when clinical assessment suggested adequate oesophageal motility and length. Only one patient who had negative endoscopic findings underwent a 24-h pH monitoring before surgery. Outcome measures included assessment of the relief of the primary symptom responsible for surgery in the early postoperative period; the patient's evaluation of outcome, and quality of life after surgery. RESULTS: Relief of the primary symptom responsible for surgery was achieved in 95.24% of patients at a mean follow-up of 28 months. Thirty-five patients were asymptomatic, two had minor gastrointestinal symptoms not requiring medical therapy, three patients had gastrointestinal symptoms requiring medical therapy/Proton Pump Inhibitors (PPI) and in two patients the symptoms worsened after surgery. There were no deaths. Clinically significant complications occurred in six patients. Median hospital stay was 3 days, decreasing from 6 days in the first 10 patients to 3 days in the last 10 patients. CONCLUSIONS: Laparoscopic Nissen's fundoplication is the choice of operation for clinically symptomatic GERD patients.

TCM-WM treatment of reflux esophagitis in 60 cases / 中国基层医药

Objective To observe treatment efficacy of chinese and western medicine treatment for reflux esophagitis. Methods 60 cases with reflux esophagitis were divided into treatment group and control group,treated for 1 month. Results Treatment group the total effective rate was 96. 67%, control group, the total effective rate was 86. 67%. Treatment group and control group treatment results were significantly different( P < 0. 05 ), the difference has statistical significance. The results showed that the treatment group was significantly better than the control group. Conclusion TCM-WM treatment of reflux esophagitis, symptoms could be markedly improved, worthy of further prmotion.

The Diagnostic Strategy in Gastroesophageal Reflux Disease and the Role of Acid Inhibition Therapeutic Test / 中国医师杂志

14,and/or pH4% of the total time at 24-hour esophageal pH metry were considered to be pathologic acid reflux(GERD).All patients underwent a diagnostic test by receiving lansoprazloe 30mg or placebo twice daily for 7 days through a cross-over design.A symptom reduction of over 75% was considered positive.Results 18(17%) cases of esophagitis were found in 104 patients by endoscopy.83(80%) patients experienced a typical symptom hearburn.87(84%) patients showed pathologic acid reflux detected from pH metry and they were considered to be GERD.85(82%) of 104 patients had positive result in therapeutic test.There was a significant correlation between both the diagnosis obtained from a trial of lansoprazole and the diagnosis obtained from pH metry(P