Unveiling the intricacies:Insight into gastroesophageal reflux disease

Gastroesophageal reflux disease(GERD)poses a substantial global health challenge,with prevalence rates exhibiting geographical variation.Despite its widespread recognition,the exact prevalence and associated risk factors remain elusive.This article comprehensively analyzed the global burden of GERD,shedding light on its risk factors,underlying pathophysiological mechanisms,current diagnostic modalities,evolving management strategies tailored to diverse patient profiles,and complex determinants contributing to treatment failures.A deeper comprehension of GERD is achieved by dissecting these intricate facets,paving the way for enhanced clinical management and improved patient outcomes.

Assessment of gastroesophageal reflux disease by serodiagnosis of Helicobacter pylori-related chronic gastritis stage

AIM:To evaluate the association of Helicobacter pylori(H.pylori)-related chronic gastritis stage with upper gastro-intestinal symptoms and gastro-eso-phageal reflux disease(GERD).METHODS:Subjects underwent upper gastrointestinal endoscopy,a questionnaire using a frequency scale for symptoms of GERD(FSSG),and measurements of serum H.pylori-antibody and pepsinogen(PG)levels.They were classified into the following 4 groups in terms of H.pylori-related chronic gastritis stage:Group A(n = 219),H.pylori(-)PG(-);Group B(n = 310),H.pylori(+)PG(-);Group C(n = 279),H.pylori(+)PG(+);and Group D(n = 17),H.pylori(-)PG(+).RESULTS:Reflux esophagitis occurred in 30.6% of Group A,14.5% of Group B,6.8% of Group C,and 0% of Group D(P < 0.001).Scores for acid reflux sympto-ms decreased significantly with chro-nic gastritis stage(from Group A to D)(P < 0.05),while scores for dysmotility symptoms did no-t differ significantly.The prevalence of nonerosive reflux disease(NERD)did not differ amo-ng groups.However,in subjects with GERD,the prevalence of NERD tended to increase with chronic gastritis stage(P = 0.081).CONCLUSION:Acid reflux sympto-ms and the prevalen-ce of reflux esophagitis can be assessed by measuring both serum H.pylori-antibody and PG levels.

Diagnosis and Treatment of Chronic Cough due toGastroesophageal Reflux Disease

Gastroesophageal reflux disease is one of most common causes of chronic cough. Medical history offers few clues as to the cause of cough induced by this disease. 24-h esophageal ph monitoring is considered as the most sensitive and specific test for the diagnosis. When it is unavailable or unsuitable, upper gastrointestinal endoscopy and barium esophagography can be used as an alternative examination. Combined multichannel intraluminal impedance and pH testing is promising because of its ability to detect non-acid reflux as well as acid reflux. Empiric therapy trial is a simple and cheap way to identify suspected patients. Drug therapy is effective in most of the patients, in which proton pump inhibitors is the most powerful. Antireflux surgery is the last choice,used only when intensive drug therapy fails. The definitive diagnosis of cough due to gastroesophageal reflux disease can be established only after cough improves or cc.npletely disappears with antireflux therapy.

Diagnostic value associated with the combination of saliva pepsin and microorganisms in functional heartburn and gastroesophageal reflux disease

Heartburn is a common symptom shared by both gastroesophageal reflux disease(GERD)and functional heartburn(FHB),which can make it challenging to differentiate between the two conditions.However,examining oral manifestations of GERD can be a cost-effective and readily available method to aid in this differentiation process.It may serve as a valuable tool in distinguishing GERD from FHB.

Thresholds of gastroesophagea reflux i the diagnosis of esophageal reflux diseases

AIMS To establish optimal thresholds of pH variation(pH fluc- tuations and reflux episodes)in separating physiological and pathological gastroesophageal reflux(GER),and to evaluate their significance in the diagnosis of GER disease. METHODS Twenty-four-hour intraesophageal pH monitoring and endoscopy were performed in 400 patients with GER symptoms and in 100 healthy controls. RESULTS The results showed that the percentages of the time with pH fluctuations in patients with and without esophagitis,and in healthy controls were,on average,12.65%,9.5% and 2. 76% in 24h,respectively,and the respective percentages of the time with reflux episodes in the same groups in 24h were,on average,3.12%,2.04% and 0.18%,respectively.Using a receiver-operating-characteristic curve analysis,<6.7% of the time with pH fluctuations and<0.1% of the time with reflux episodes were defined as the combined thresholds for physiologi- cal versus pathological reflux.The sensitivity of the combuned thresholds for the detection of GER patients with and without esophagitis was 96.7% and 90.0%,respectively,and their specificity for the diagnosis of patients with abnormal GER disease was 100%. CONCLUSIONS pH flucuations and reflux episodes,when e- valuated together,are more useful for classifying patients with GER and their combined thresholds yield higher diagnostic accura- cy in assessing patients with GER disease.

Globus pharyngeus:A review of its etiology,diagnosis and treatment

Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat.It is a commonly encountered clinical condition that is usually long-lasting,difficult to treat,and has a tendency to recur.Furthermore,due to the uncertain etiology of globus,it remains difficult to establish standard investigation and treatment strategies for affected patients. As a first step for managing globus,careful history taking and nasolaryngoscopy are essential.Given the benign nature of the condition and the recent notion that gastroesophageal reflux disease is a major cause of globus,empirical therapy with a high dose of proton pump inhibitors is reasonable for patients with typical globus.If patients are nonresponsive to this therapy, definitive assessments such as endoscopy,multichannel intraluminal impedance/pH monitoring,and ma-nometry should be considered.Speech and language therapy,anti-depressants,and cognitive-behavioral therapy can be helpful in patients whose symptoms persist despite negative investigations.

Dental evaluation is helpful in the differentiation of functional heartburn and gastroesophageal reflux disease

BACKGROUND Heartburn is identically the key symptom of both,gastroesophageal reflux disease(GERD)and functional heartburn(FHB),making the differential diagnosis resource-intensive.Oral manifestations of GERD can be easily examined;therefore,their exploration might be a cheap,widely available,and useful tool in the differentiation of GERD and FHB.AIM To evaluate the prevalence of dental erosions(DE)and periodontal diseases(PD)in patients with heartburn and their association with GERD and FHB.METHODS A total of 116[M/F:51/65,mean age:54(17-80)years]consecutive patients with heartburn were enrolled for detailed esophageal function and orodental examinations.RESULTS Dental disorders were detected in 89%(103/116).Patients with PD+DE had significantly more often pathologic reflux(90.0%vs 27.8%;P<0.05),higher esophagitis scores(1.8 vs 0.9;P<0.05),and a significantly different mean impedance curve(P=0.04)than those without any dental diseases.The opposite approach established that patients with GERD had significantly higher prevalence of DE and PD,especially if both were present(28.9%vs 2.0%;P<0.01),more severe PD(1.5 vs 1.0;P<0.01),and longer history of heartburn(15 years vs 9 years;P<0.01)than those with FHB.CONCLUSION The dental evaluation of patients with heartburn seems to be useful in the differential diagnosis of GERD and FHB.Among the studied parameters,the co-appearance of DE and PD seems to be the best predictor of GERD,whereas the absence of dental disorders was mostly observed in FHB.

Value of esophageal manometry and 24-hour pH monitoring in diagnosis of GERD

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Scaphoid metastasis as the first sign of occult gastroesophageal junction cancer:A case report

BACKGROUND Metastatic tumors of the hand are very rare.They are usually late manifestations of massive advanced malignancies.However,a small portion of acrometastases are indications of occult primary cancer.Here,we report an extremely rare case in which a scaphoid bone lesion was the initial manifestation and was found to be a metastasis from gastroesophageal junction(GEJ)cancer.CASE SUMMARY A 57-year-old male patient presented with ongoing left wrist pain and swelling after trauma.He was initially misdiagnosed with infection of the scaphoid bone and treated with antibiotics and anti-inflammatory drugs.Further radiographic investigations showed a scaphoid pathological fracture,indicating a metastatic tumor derived from the GEJ and/or right lung malignancies.Gastroscopy failed to identify the pathology of the mass at the GEJ,which grew in an exophytic pattern.A lung puncture biopsy was not performed because the patient refused the procedure.To relieve his wrist pain and obtain a definite pathology,we resected the scaphoid lesion.Based on the clinical and pathological results,the patient was finally diagnosed with multiple metastases of advanced GEJ adenocarcinoma.He underwent chemotherapy and died 6 mo after his initial presentation.CONCLUSION Despite the rareness of the disease,orthopedic surgeons should consider the possibility of metastasis to the bones of the hand when patients complain of persistent and progressive pain in the hand.

Four-dimensional flow magnetic resonance imaging for noninvasive diagnosis of clinically significant portal hypertension and high-risk gastroesophageal varices in patients with cirrhosis

Introduction:Noninvasive diagnoses of clinically significant portal hypertension(CSPH)and high-risk gastroesophageal varices are clinically relevant but challenging.Four-dimensional(4D)flow magnetic resonance imaging(MRI)provides comprehensive flow information and is a promising alternative.This study evaluated the efficacy of 4D flow MRI as a noninvasive method for diagnosing CSPH and high-risk varices in patients with liver cirrhosis.Methods:This prospective study enrolled consecutive patients diagnosed with liver cirrhosis at a tertiary referral center between October 2020 and March 2021.Each participant underwent abdominal 4D flow MRI.Hemodynamic parameters within the portal vein,including the average and peak flow velocities,normalized flow volume(Q_(normal)),and regurgitant fraction(R%),were extracted and compared between healthy individuals and patients with CSPH and between participants with high-and low-risk varices.Subsequently,these parameters were incorporated into a logistic regression(LR)model refined using L1 regularization and validated using five-fold cross-validation.The diagnostic efficacy was evaluated using receiver operating characteristic(ROC)curves.Results:Eighty-two participants were enrolled(71 patients diagnosed with liver cirrhosis and 11 healthy individuals serving as controls).Among hemodynamic parameters,patients with CSPH exhibited a notable increase in Q_(normal)of 0.66±0.19 ml*m^(2)/[cycle*kg](P=0.001)and an R%of 1.98(2.05)(P=0.002).Similarly,patients with high-risk varices showed a higher Q_(normal)of 0.61±0.15 ml*m^(2)/[cycle*kg](P<0.001)and R%of 1.88(2.81)(P=0.006).ROC analysis revealed an area under the curve(AUC)for Q_(normal)of 0.93 and 0.91 for R%for diagnosing CSPH,while the LR model showcased a superior AUC of 0.95.For high-risk varices,Q_(normal)and R%showed AUC values of 0.75 and 0.70,respectively,whereas the LR model showed a higher AUC of 0.84.Conclusion:As a noninvasive imaging modality,4D flow MRI exhibits considerable potential for the diagnosis of CSPH and high-risk gastroesophageal varices;thus,it may minimize the reliance on invasive procedures in patients with cirrhosis.

上海市胃食管反流病中医分级诊疗指南

胃食管反流病是临床常见病,在我国的患病率逐年上升,中医药诊治本病有一定的特色和优势,近年来也取得不少进展,但在基层医院中的应用推广仍不足.因此有必要制定市级中医分级诊疗方案以更好地指导临床实践.本指南由上海市中西医结合学会消化内镜专业委员会、上海市胃食管反流病中医专病联盟、上海市级医院消化内科临床能力促进与提升专科联盟组织我市本领域的有关专家组成专家委员会进行多轮讨论并投票,最终达成共识.

儿童慢性咳嗽病因及误诊原因分析

目的分析儿童慢性咳嗽的病因,以及儿童慢性咳嗽误诊的相关原因。方法选取2018年1月—2022年1月收治的曾误诊慢性咳嗽患儿53例,分析其病例资料。结果53例中男32例,女21例;年龄7~12岁;病程4~28个月;有过敏性鼻炎、鼻窦炎史15例,有家族哮喘史12例。53例以不同程度咳嗽为主诉就诊,夜间刺激性咳嗽31例,日间发作性咳嗽20例,日间及夜间均咳嗽2例;伴剑突下不适、胸骨后烧灼感、反酸、嗳气12例;有鼻后滴流感或日常有频繁清喉动作15例。误诊慢性支气管炎31例、慢性咽炎22例,予镇咳、化痰、抗感染等治疗,症状未见明显改善。后26例行肺功能、支气管激发试验及诱导痰检查确诊咳嗽变异性哮喘;15例鼻后滴流感或日常有频繁清喉动作,有过敏性鼻炎、鼻窦炎史,鼻咽镜见咽后壁有黏液附着,确诊上气道咳嗽综合征;12例咳嗽伴胸骨后烧灼感、反酸、嗳气,胃镜发现反流性食管炎表现,确诊胃食管反流性咳嗽。误诊时间3~20个月。53例确诊后予相应治疗预后良好。结论儿童慢性咳嗽的病因复杂,临床医师应熟知儿童慢性咳嗽的多系统表现、病因及诊断流程,注意详细询问病史及用药史,仔细查体,注意咳嗽的性质、咳嗽的昼夜规律、咳嗽诱发因素,认真病因诊断,及时行相关特异性检查,以及早明确诊断并治疗,改善患儿生活质量。

误诊为支气管炎的胃食管反流病临床分析

目的探讨胃食管反流病(GERD)的临床特点、误诊原因及防范措施。方法回顾性分析2022年12月至2023年11月收治的被误诊为支气管炎的GERD 5例的临床资料。结果本组5例均以反复咳嗽为主诉就诊,咳嗽症状夜晚较严重,伴有胸闷、胸痛3例,咽痛2例,咳痰3例,气喘、睡眠障碍、呼吸急促各1例。5例均误诊为支气管炎,误诊时间15 d~3年。所有患者经24 h食管pH值监测、电子胃镜检查,1例给予质子泵抑制剂试验治疗症状有所改善,确诊为GERD。确诊后给予相应治疗后,随访症状完全消失,无复发。结论GERD临床表现复杂多样,尤其是食管外症状者,极易误诊为支气管炎。初诊医师应加强对该病食管外症状的了解,提高对于2种疾病的鉴别诊断能力,完善相关检查,提高确诊率,使患者及时得到正确的治疗。

胃食管反流病患者血清胃泌素17、胃蛋白酶原和多巴胺的水平及临床意义

目的探究血清胃泌素17、胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ及多巴胺在胃食管反流病(gastro-esophageal reflux disease,GERD)中的诊断价值。方法选取本院2022年3月至2023年3月收治的100例GERD患者为研究对象,另选取同期50例健康体检者为对照组。根据DeMeester积分将100例GERD患者分为3组,分别为轻度组(14~50分)、中度组(51~100分)及重度组(>100分),其中轻度组34例,中度组48例,重度组18例。使用酶联免疫法(enzyme-linked immunosorbent assay,ELISA)测定血清中胃泌素17、胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ及多巴胺水平。结果与对照组相比,GERD组患者血清胃泌素17及胃蛋白酶原Ⅰ水平显著升高(P<0.05),血清胃蛋白酶原Ⅱ及多巴胺水平显著降低(P<0.05);与轻度组患者相比,中度组患者血清胃泌素17及胃蛋白酶原Ⅰ水平显著升高(P<0.05),胃蛋白酶原Ⅱ及多巴胺水平显著降低(P<0.05);与中度组患者相比,重度组患者血清胃泌素17及胃蛋白酶原Ⅰ水平显著升高(P<0.05),胃蛋白酶原Ⅱ及多巴胺水平显著降低(P<0.05)。GERD患者血清胃泌素17及胃蛋白酶原Ⅰ水平与DeMeester评分呈显著正相关(P<0.05),血清胃蛋白酶原Ⅱ及多巴胺水平与DeMeester评分呈显著负相关(P<0.05)。血清胃泌素17、胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ及多巴胺联合诊断GERD的曲线下面积((Area Under Curve,AUC)为0.986,灵敏度为88.00%,特异性为98.00%,95%CI为0.9725~0.9987,高于任何一个单独指标的诊断效能。结论血清胃泌素17及胃蛋白酶原Ⅰ水平与GERD患者病程呈正相关,胃蛋白酶原Ⅱ及多巴胺水平与GERD患者病程呈负相关。上述4个指标联合检测对GERD的诊断具有较高的灵敏度及特异性,有望成为GERD新的辅助诊断方法。

激光共聚焦显微内镜在上消化道早癌和癌前病变中的应用进展

上消化道癌主要包括食管癌和胃癌,其发病率和死亡率高,早期发现可极大改善患者预后,提高5年生存率和生活质量。激光共聚焦显微内镜在上消化道早癌和癌前病变诊断方面有独特优势,可以实时诊断和光学活检,通过观察黏膜微观结构、细胞、亚细胞、微血管形态等进行体内组织学诊断。本文就激光共聚焦显微内镜在早期食管癌、胃癌和癌前病变中的应用进行系统阐述,以评价其临床应用价值和前景。

Clinical relevance of salivary pepsin detection in diagnosing gastroesophageal reflux disease subtypes

Background:Gastroesophageal reflux disease(GERD)is heterogeneous with a varied symptom spectrum and reflux profiles.Its definite diagnosis often requires invasive tools including endoscopy or reflux monitoring.The aim of this study was to investigate the clinical relevance of salivary pepsin detection as a non-invasive screening tool to diagnose GERD of different subtypes.Methods:A total of 77 patients with suspected GERD symptoms and 12 asymptomatic controls were analysed.All participants performed symptom evaluation,upper endoscopy,esophageal manometry,and 24-hour multichannel intraluminal impedance-dual pH probe monitoring.Saliva was self-collected across three different time points:at early fasting,postprandially,and at symptom occurrence.Salivary pepsin levels were measured via Peptest.The optimal threshold of salivary pepsin for diagnosing distal or proximal reflux was determined according to a receiver-operating characteristic curve.Results:The average salivary pepsin concentration of suspected GERD patients was significantly higher than that of controls(100.63[68.46,141.38]vs 67.90[31.60,115.06]ng/mL,P=0.044),although no difference was found among patients with different symptom spectrums.The distal reflux group had a higher average pepsin concentration than non-reflux patients(170.54[106.31,262.76]vs 91.13[63.35,127.63]ng/mL,P=0.043),while no difference was observed between the distal reflux group and the proximal reflux group.The optimal cut-off value of salivary pepsin concentration for diagnosing pathological distal reflux was 157.10 ng/mL,which was higher than that for diagnosing pathological proximal reflux(122.65 ng/mL).The salivary pepsin concentration was significantly correlated with distal and proximal reflux parameters.Conclusions:Salivary pepsin measurement can help in identifying true GERD with pathological distal reflux or proximal reflux,regardless of different symptom spectrums.A higher threshold should be applied for diagnosing distal reflux than for proximal reflux.

胃食管反流病辨证分型与食管24小时pH值及胆汁监测的相关性分析

目的:探讨食管24小时pH值及胆汁监测与胃食管反流病(GERD)中医证型之间的关系。方法:对95例GERD患者进行辨证分型,并分别行内镜检查、食管24小时pH值及胆汁监测。结果:肝胃郁热型占69.47%,该型以酸反流、混合反流为主,其酸反流次数、DeMeester评分、胆红素大于或小于0.14的时间百分比均显著高于其他证型(P<0.05)。实证内镜下的炎症程度重于虚证,虚证较少出现病理性反流。结论:GERD的中医辨证分型以肝胃郁热型为主,该型与酸反流、混合反流密切相关,推测肝胆失于疏泄,胃气上逆可能与食管下段括约肌松弛导致的酸反流及混合反流有关。

胃食管反流病问卷在胃食管反流病诊断中的价值

目的探讨胃食管反流病问卷(GerdQ)在诊断胃食管反流病(GERD)中的价值。方法对消化内科门诊具有典型烧心、反酸等症状的患者进行问卷调查。GERD的诊断标准为内镜证实反流性食管炎(RE)及质子泵抑制剂(PPI)治疗试验阳性,并与GerdQ积分情况进行比较,计算出诊断GERD最佳临界值。结果 GerdQ积分以7分为临界值,其诊断的敏感性和特异性最佳,分别为91.52%和87.70%,Youden指数达到最大值0.79,ROC曲线下面积(Az)为0.81,对GERD患者诊断的阳性符合率为90.69%,阴性符合率为88.76%,GerdQ积分高低与RE严重程度无明显相关性。结论 GerdQ可作为初步诊断GERD的工具。

唾液胃蛋白酶检测对胃食管反流病的诊断价值

目的探讨唾液中胃蛋白酶水平对胃食管反流病(gastroesophageal reflux disease,GERD)的诊断价值。方法纳入GERD症状评分>8分的患者,依据胃镜检查及24 h食管pH-阻抗监测结果,将患者分为GERD组和非GERD组,依据食管高分辨测压分为食管动力减退亚组和食管动力正常亚组。收集各组患者的唾液,应用酶联免疫吸附法进行胃蛋白酶检测。结果GERD组50例,非GERD组68例,空腹唾液胃蛋白酶含量分别为(11.4±2.3)ng/ml及(5.6±1.4)ng/ml,两组比较,差异有统计学意义(P<0.05)。食管动力减退亚组及食管动力正常亚组的唾液胃蛋白酶含量差异无统计学意义(P>0.05)。以空腹唾液胃蛋白酶含量>3.6 ng/ml为诊断标准,诊断GERD的敏感性为72.0%,特异性为76.0%。结论唾液中胃蛋白酶浓度的检测可辅助诊断GERD,食管动力对唾液胃蛋白酶含量无影响。