The concatenation of association between gastroesophageal reflux and obstructive adenotonsillar hypertrophy.

OBJECTIVES: Gastroesophageal reflux (GER) is frequently seen in patients with adenotonsillar hypertrophy. However, the sequential association between GER and adenotonsillar hypertrophy is unknown. This leads to unpredictable outcomes while treating patients of adenotonsillar hypertrophy with GER. The objective of this study is to evaluate the prevalence of GER and gastroesophageal reflux disease (GERD) in paediatric patients with obstructive adenotonsillar hypertrophy (OATH), and to assess the effect of adenotonsillectomy (AT) on GER as well as GERD. METHODS: In this prospective cohort study, consecutive pediatric patients with grade III/IV hypertrophy of adenoid or/and tonsillar tissue who were planned for AT were recruited after excluding comorbidities predisposing to GER. Symptoms of GERD using Gastro Esophageal Reflux Questionnaire for Young Children (GERQ-YC) and Reflux Indices (RI) obtained from 24-h ambulatory esophageal pH monitoring were evaluated in all patients pre-operatively and 12 weeks following AT. RESULTS: A total of 49 patients with OATH with average age of 6 years were included in this study. With a RI of >4.3% as the threshold for making the diagnosis of GER on esophageal pH monitoring, the prevalence of GER was 20.4%. The average RI preoperatively was 15.7% which reduced to 1.7% following AT (p = 0.004). Among the 10 patients with preoperative GER, 80% of the patients had no evidence of GER after surgery. New incidences of GER was not observed post operatively in this cohort. As per the GER symptom scoring system, 31% of the parents reported GERD pre-operatively which resolved completely in all patients following surgery. CONCLUSIONS: - In this study, the prevalence of GER proven by 24 h ambulatory esophageal pH monitoring is 20% in pediatric patients with OATH. Following AT, GER resolved in 80% of cases and was reduced substantially in the remaining cases in the subset of patients with pre-operative GER. The symptoms of GERD based on parents' recall of child's previous symptoms may not accurately represent presence of GER. Our results suggest that OATH can result in GER due to increased negative intra-thoracic pressure as a result of breathing against an obstructed upper airway and hence, GER subsides following surgical removal of the obstructive pathology. To establish this concatenational association of OATH and GER, larger studies are mandated.

The effect of dietary carbohydrate on gastroesophageal reflux disease.

BACKGROUND: Acid changes in gastroesophageal reflux with vary component in the food have less been studied, especially carbohydrate. We plan to clarify the effect of different carbohydrate density on low esophageal acid and reflux symptoms of patients with gastroesophgeal reflux disease. METHODS: Twelve patients (52 ± 12 years old; five female) with gastroesophageal reflux disease were recruited for the prospective crossover study. Each patient was invited for panendoscope, manometry and 24 h pH monitor. The two formulated liquid meal, test meal A: 500 ml liquid meal (containing 84.8 g carbohydrate) and B: same volume liquid meal (but 178.8 g carbohydrate) were randomized supplied as lunch or dinner. Reflux symptoms were recorded. RESULTS: There are significant statistic differences in more Johnson-DeMeester score (p = 0.019), total reflux time (%) (p = 0.028), number of reflux periods (p = 0.026) and longest reflux (p = 0.015) after high carbohydrate diet than low carbohydrate. Total reflux time and number of long reflux periods more than 5 min are significant more after high carbohydrate diet. CONCLUSION: More acid reflux symptoms are found after high carbohydrate diet. High carbohydrate diet could induce more acid reflux in low esophagus and more reflux symptoms in patients with gastroesophageal reflux disease.

Fundoplication for Gastroesophageal Reflux Disease: Tips for Success.

Gastroesophageal reflux disease affects almost 20% of the population in the United States. Today, proton pump inhibitors are the most frequently prescribed drugs, with an estimated cost of 10 billion dollars per year. Although these medications control heartburn in the majority of patients, other symptoms such as regurgitation and respiratory symptoms often are not controlled, particularly in patients with large hiatal hernias. In these patients a properly performed laparoscopic fundoplication controls esophageal and extraesophageal symptoms and avoids life-long medical therapy. Key elements for the success of a fundoplication are careful patient selection, a complete preoperative evaluation, and a properly executed operation.

Evaluation of esophageal high-resolution manometry combined with 24-hour pH monitor in detecting endoscopy-negative chest pain of esophageal origin / 中华消化内镜杂志

Objective To investigate esophageal high-resolution manometry (HRM) combined with 24-hour pH monitor in detecting endoscopy-negative chest pain of esophageal origin.Methods Test results of esophageal HRM combined with 24-hour pH monitor from 40 patients with recurring chest pain of esophageal origin were retrospectively analyzed.Results In 40 patients,27 (67.5％) were diagnosed as gastroesophageal reflux disease with an average DeMeester scores at 18.3 ± 3.4,including 19 patients with esophageal body dismotility and 11 with reduced lower esophageal sphincter pressure (LESP) at a mean reduction of 5.7 mm Hg.There were 6 cases (15.0％) of achalasia,in which 1 (2.5％) was type Ⅰ and 5 (12.5％)was type Ⅱ,with an average relaxation ratio of lower esophageal sphincter (RRLES) at (30.1 ± 2.3) ％.There were 4 cases of diffuse esophageal spasm (DES),with an average contraction frontal velocity (CFV) of 12.3 ± 2.4 cm ·s-1 and abnormal contraction waves in esophageal body,spontaneous synchronous contraction waves were observed in 3 of 4 patients LESP increased in 1 patient with DES and remained normal in other 3.RRLES decreased in 2 cases with DES and remained normal in other 2.There were 2 cases (5.0％)of nutcracker esophagus,with an average distal contractile integral at 6745.5 ± 175.2 mm Hg·cm-1 ·s-1 and an average CFV at 4.3 ±0.4 cm·s-1.There was 1 case (2.5％) with absence of esophageal peristalsis,with a low LESP at 2 mmHg and DeMeester scores at 38.3.The patient was finally diagnosed as systemic sclerosis according to esophageal biopsy and other auxiliary examination.Conclusion HRM combined with 24-hour pH monitor is valuable in detecting endoscopy-negative chest pain of esophageal origin.

The Significance of Gastroesophageal Reflux Disease (GERD) Symptoms in Patients with Reflux Esophagitis / 대한소화관운동학회지

BACKGROUND/AIMS: The relationship between the symptoms and severity of GERD may be difficult to prove. The intensity and frequency of reflux induced symptoms are poor predictors of the presence or severity of an endoscopic mucosal break. The aim of this study was to determine which factors can be predicted by the presence of GERD symptoms among esophageal sensitivity to acid, abnormal acid reflux, and severity of esophagitis in pateints with reflux esophagitis. METHODS: Fourty-four patients who were diagnosed with reflux esophagitis by an endoscopy at a tertiary medical facility, were given a validated questionnaire, and underwent an acid perfusion test, 24 hr ambulatory esophageal pH monitoring, and esophageal manometry. These patients were divided into a symptomatic group and asymptomatic group according to the questionaire. Comparisons between the two groups for each factor were analyzed by Chi-square. RESULT: Of 44 patients, 26 had symptoms and 18 did not. The positive and equivocal rates of the acid perfusion test were not different between the symptomatic and asymptomatic groups (47% vs. 39%). The abnormal reflux rate (DeMeester score > 14.72) from pH monitoring was significantly higher in the symptomatic group than in the asymptomatic group (65% vs. 28%, p < 0.05). The severity of esophagitis, presence of a hiatal hernia, and abnormal esophageal manometric findings were not different between the two groups. CONCLUSION: It would be impossible to predict esophageal sensitivity to acid, severity of the esophagitis grade, and the presence of hiatal hernia with GERD symptoms, but it could be possible to predict abnormal gastroesophageal reflux.

Patterns of Gastroesophageal Reflux and Esophageal Motility in Patients with Mild Reflux Esophagitis / 대한소화기내시경학회지

BACKGROUND AND AIMS: The major complications of reflux esophagitis are stricture formation and Barrett's esophagus. In Korea, the incidence of these complications is low and most patients with reflux esophagitis undergo a mild clinical course. The purpose of this study was to investigate patterns of acid reflux and esophageal motility in mild reflux esophagitis in Korea. METHODS: Using conventional manometry and 24-hour ambulatory pH monitoring, we were investigated esophageal motility and patterns of gastroesophageal reflux in 41 patients with reflux esophagitis Savary-Miller (S-M) Ib using on endoscopy. The total supine, and upright reflux periods, as well as frequency and duration of reflux episodes were determined from the 24-hour pH monitoring record using standard software. Pathologic reflux was defined when the percentage of the total time with pH less than 4 (acid exposure time) exceeded 4%. RESULTS: Pathologic reflux was observed in 17 patients (41.5%), who were categorized into upright refluxers (70.6%), supine refluxers (11.8%), and combined refluxers (17.6%). Patients with reflux esophagitis did not differ in lower esophageal sphincter pressure from the normal subjects. There were two patients (4.9%) with a lower esophageal pressure > or =10 mmHg and four patients (9.8%) with hiatal hernia. Failed peristalsis was seen in 4 patients (9.8%). CONCLUSIONS: A high proportion of upright reflux and low incidence of esophageal peristaltic dysfunction may contribute to the low incidence of stricture formation and Barrett's esophagus in patients with mild reflux esophagitis in Korea.