Aim: Investigation of the prevalence of respiratory symptoms and diseases associated with gastroesophageal reflux disease (GERD). Patients and Methods: 299 subjects with GERD were submitted to upper gastrointestinal e...Aim: Investigation of the prevalence of respiratory symptoms and diseases associated with gastroesophageal reflux disease (GERD). Patients and Methods: 299 subjects with GERD were submitted to upper gastrointestinal endoscopy and 24-hour esophageal pH monitoring and a symptom analysis. Results: Chronic respiratory symptoms or diseases were present in 18%(56/299). Chronic cough was observed in 42/56 patients, while typical reflux symptoms such as heartburn and acid regurgitation were observed in 30/56 and 24/56 cases, respectively. The prevalence of airway diseases was chronic bronchitis 12/56, asthma 10/56, recurrent pneumonia 10/56, chronic sinusitis 7/56 and chronic laryngitis 1/56. In patients with respiratory complications pathologic acid reflux was established in 29/51 cases on the basis of the DeMeester score, while 17/51 had pathologic postprandial, nocturnal or diurnal reflux events. Upper gastrointestinal endoscopy revealed a normal esophageal mucosa in 6/56, Savary-Miller stage I esophagitis in 23/56, stage II in 15/56, stage III in 5/56 and stage IV in 6/56 patients. Conclusions: These investigations have demonstrated an abnormal 24-hour pH score in about half of the patients with GERD-associated respiratory complications, and indicated that short reflux events are characteristic of the reflux activity in one third of this population.展开更多
Our aims were to compare the specificity and sensitivity of the reflux index ( RI), Euler and Byrne score (EBS), and area under the curve (AUC) at pH < 4.0 in infants 1 year old for identifying pathologic gastroeso...Our aims were to compare the specificity and sensitivity of the reflux index ( RI), Euler and Byrne score (EBS), and area under the curve (AUC) at pH < 4.0 in infants 1 year old for identifying pathologic gastroesophageal reflux (GE- R) and to identify new cutoffs on formula feedings. We undertook a prospective investigation of extended pH monitoring (EPM) in 117 infants with symptoms of G ER. Infants were categorized as having pathologic reflux by three measures: RI ≥5%, EBS ≥50, or AUC pH< 4.0 or ≤21.3, as determined by receiver operating c haracteristic (ROC) curve analysis. Using the RI as a criterion, 27 infants (23 %) had pathologic reflux. When EBS and AUC were used, 65 (56%), and 67 (57%) respectively, were classified as having pathologic reflux. The specificities of RI,EBS, and AUC w ere 97.8, 100.0, and 100.0%, respectively, and the sensitivities were 93.0, 91. 5, and 94.4, respectively. A new cutoff value for RI of 2.1%was determined usin g ROC curve analysis to improve the specificity and sensitivity of RI to the abo ve values. The number of infants with pathologic GER is likely to be significant ly less using the traditional RI alone on formula feedings, however, the revised RI cutoff value and AUC analysis by computerized pH tracings can enhance the acc uracy on formula feedings.展开更多
Background: Although the wireless Bravo pH system is effective, some patients experience retrosternal sensations possibly caused by esophageal sensitivity that may complicate clinical application. Methods: Ambulatory ...Background: Although the wireless Bravo pH system is effective, some patients experience retrosternal sensations possibly caused by esophageal sensitivity that may complicate clinical application. Methods: Ambulatory pH of 40 consecutive patients with GERD who had erosive esophagitis or nonerosive reflux disease, were monitored for 2 days with the Bravo system. Results were stratified and compared on the basis of self-awareness of the intraesophageal capsule. Results: Path ologic acid reflux was diagnosed in 20 patients and normal reflux was diagnosed in 20 patients. Seventeen patients (42.5%) reported retrosternal discomfort, and 12 of them (70.6%) had normal reflux. Patients with retrosternal discomfort were less likely to have moderate endoscopic esophagitis, i.e., Los Angeles classification grades B, C, and D endoscopic esophagitis (p = 0.006), and were less likely to have significantly elevated esophageal acid exposure (p = 0.0036) than those who did not perceive the discomfort. Reported discomfort was not associated with age, gender, or the presence of endoscopic esophagitis. Conclusions: The negative correlation between Bravo-capsule-induced retrosternal discomfort and esophageal-acid exposure indicates modified mechanical afferent nerve function after long-term acid stimulation. Capsule-induced retrosternal discomfort in the presence of normal acid exposure suggests functional heartburn.展开更多
文摘Aim: Investigation of the prevalence of respiratory symptoms and diseases associated with gastroesophageal reflux disease (GERD). Patients and Methods: 299 subjects with GERD were submitted to upper gastrointestinal endoscopy and 24-hour esophageal pH monitoring and a symptom analysis. Results: Chronic respiratory symptoms or diseases were present in 18%(56/299). Chronic cough was observed in 42/56 patients, while typical reflux symptoms such as heartburn and acid regurgitation were observed in 30/56 and 24/56 cases, respectively. The prevalence of airway diseases was chronic bronchitis 12/56, asthma 10/56, recurrent pneumonia 10/56, chronic sinusitis 7/56 and chronic laryngitis 1/56. In patients with respiratory complications pathologic acid reflux was established in 29/51 cases on the basis of the DeMeester score, while 17/51 had pathologic postprandial, nocturnal or diurnal reflux events. Upper gastrointestinal endoscopy revealed a normal esophageal mucosa in 6/56, Savary-Miller stage I esophagitis in 23/56, stage II in 15/56, stage III in 5/56 and stage IV in 6/56 patients. Conclusions: These investigations have demonstrated an abnormal 24-hour pH score in about half of the patients with GERD-associated respiratory complications, and indicated that short reflux events are characteristic of the reflux activity in one third of this population.
文摘Our aims were to compare the specificity and sensitivity of the reflux index ( RI), Euler and Byrne score (EBS), and area under the curve (AUC) at pH < 4.0 in infants 1 year old for identifying pathologic gastroesophageal reflux (GE- R) and to identify new cutoffs on formula feedings. We undertook a prospective investigation of extended pH monitoring (EPM) in 117 infants with symptoms of G ER. Infants were categorized as having pathologic reflux by three measures: RI ≥5%, EBS ≥50, or AUC pH< 4.0 or ≤21.3, as determined by receiver operating c haracteristic (ROC) curve analysis. Using the RI as a criterion, 27 infants (23 %) had pathologic reflux. When EBS and AUC were used, 65 (56%), and 67 (57%) respectively, were classified as having pathologic reflux. The specificities of RI,EBS, and AUC w ere 97.8, 100.0, and 100.0%, respectively, and the sensitivities were 93.0, 91. 5, and 94.4, respectively. A new cutoff value for RI of 2.1%was determined usin g ROC curve analysis to improve the specificity and sensitivity of RI to the abo ve values. The number of infants with pathologic GER is likely to be significant ly less using the traditional RI alone on formula feedings, however, the revised RI cutoff value and AUC analysis by computerized pH tracings can enhance the acc uracy on formula feedings.
文摘Background: Although the wireless Bravo pH system is effective, some patients experience retrosternal sensations possibly caused by esophageal sensitivity that may complicate clinical application. Methods: Ambulatory pH of 40 consecutive patients with GERD who had erosive esophagitis or nonerosive reflux disease, were monitored for 2 days with the Bravo system. Results were stratified and compared on the basis of self-awareness of the intraesophageal capsule. Results: Path ologic acid reflux was diagnosed in 20 patients and normal reflux was diagnosed in 20 patients. Seventeen patients (42.5%) reported retrosternal discomfort, and 12 of them (70.6%) had normal reflux. Patients with retrosternal discomfort were less likely to have moderate endoscopic esophagitis, i.e., Los Angeles classification grades B, C, and D endoscopic esophagitis (p = 0.006), and were less likely to have significantly elevated esophageal acid exposure (p = 0.0036) than those who did not perceive the discomfort. Reported discomfort was not associated with age, gender, or the presence of endoscopic esophagitis. Conclusions: The negative correlation between Bravo-capsule-induced retrosternal discomfort and esophageal-acid exposure indicates modified mechanical afferent nerve function after long-term acid stimulation. Capsule-induced retrosternal discomfort in the presence of normal acid exposure suggests functional heartburn.
