Gastroesophageal reflux disease(GERD)is present in up to 75%of patients with chronic refractory ear,nose,and throat(ENT)symptoms,and proton pump inhibitor(PPI)therapy induces symptom relief in the majority of these pa...Gastroesophageal reflux disease(GERD)is present in up to 75%of patients with chronic refractory ear,nose,and throat(ENT)symptoms,and proton pump inhibitor(PPI)therapy induces symptom relief in the majority of these patients.It has been suggested that endoscopic findings and quantification of esophageal acid exposure may help to predict the long-term outcome of medical therapy,but prospective studies that confirm this hypothesis are lacking.The aim of the present study was to investigate the relationship of endoscopic findings and quantification of reflux with long-term outcome in patients with reflux-related ENT symptoms.One hundred six consecutive patients with chronic refractory unexplained ENT symptoms underwent upper GI endoscopy,24-hr dual-channel esophageal pH and Bilitec(n = 35)monitoring,and esophageal manometry.Subsequently,all were treated with omeprazole,20 mg b.i.d.,and patients were followed at 2-week intervals until symptom relief.Four weeks later,omeprazole therapy was gradually decreased and the lowest effective omeprazole maintenance dose,if any,was determined.Eighty-one patients(49 men;mean age,50)experienced a clear or excellent therapeutic response after,on average,4 weeks of omeprazole,20 mg b.i.d.In 36 patients(44%;group A),PPI treatment could be stopped completely,27 patients(33%;group B)required a maintenance dose of omeprazole,20 mg/day,and 18 patients(22%;group C)required maintenance with omeprazole,40 mg/day.The prevalence of reflux esophagitis was significantly lower in group A patients,who also had significantly lower distal esophageal acid exposure,proximal esophageal acid exposure,and esophageal duodenogastroesophageal reflux exposure compared to groups B and C.Multivariate analysis identified the presence of esophagitis and pathological distal esophageal acid exposure as risk factors for the need of maintenance therapy.In patients with reflux-related ENT symptoms,initial findings on upper GI endoscopy and 24-hr pH-metry help to predict the need for maintenance therapy.展开更多
Objective: To determine prospectively the incidence of an inlet patch (IP) in children requiring esophagogastroduodenoscopy (EGD) and assess the prevalence of presenting symptoms between children with and without an I...Objective: To determine prospectively the incidence of an inlet patch (IP) in children requiring esophagogastroduodenoscopy (EGD) and assess the prevalence of presenting symptoms between children with and without an IP. Study design: All patients undergoing EGD in a 2-year period were assessed for the presence of an IPwith biopsy confirmation. IP, distal esophagus, and stomach biopsy specimens were blindly reviewed by a pathologist for the presence and degree of inflammation and intestinal metaplasia. Symptoms from children with and without an IP were compared. Results: From 407 EGDs done by a single endoscopist, 24 patients had confirmed IP (incidence of 5.9% ). The presence and degree of inflammation were always relatively greater in the columnar mucosa of the IP than in the antral/body gastric mucosa in the same patient (P = .0027)-Inflammation was similar in the squamous epithelium around the IP and in the distal esophagus (P = .46). Two patients had intestinalmetaplasia of the IP. The patients with IPs had a higher prevalence of respiratory symptoms than the control group (P = .03). Conclusions: Children with IPs may have a higher frequency of respiratory symptoms. Periodic surveillance should be performed in children with intestinal metaplasia of an IP.展开更多
文摘Gastroesophageal reflux disease(GERD)is present in up to 75%of patients with chronic refractory ear,nose,and throat(ENT)symptoms,and proton pump inhibitor(PPI)therapy induces symptom relief in the majority of these patients.It has been suggested that endoscopic findings and quantification of esophageal acid exposure may help to predict the long-term outcome of medical therapy,but prospective studies that confirm this hypothesis are lacking.The aim of the present study was to investigate the relationship of endoscopic findings and quantification of reflux with long-term outcome in patients with reflux-related ENT symptoms.One hundred six consecutive patients with chronic refractory unexplained ENT symptoms underwent upper GI endoscopy,24-hr dual-channel esophageal pH and Bilitec(n = 35)monitoring,and esophageal manometry.Subsequently,all were treated with omeprazole,20 mg b.i.d.,and patients were followed at 2-week intervals until symptom relief.Four weeks later,omeprazole therapy was gradually decreased and the lowest effective omeprazole maintenance dose,if any,was determined.Eighty-one patients(49 men;mean age,50)experienced a clear or excellent therapeutic response after,on average,4 weeks of omeprazole,20 mg b.i.d.In 36 patients(44%;group A),PPI treatment could be stopped completely,27 patients(33%;group B)required a maintenance dose of omeprazole,20 mg/day,and 18 patients(22%;group C)required maintenance with omeprazole,40 mg/day.The prevalence of reflux esophagitis was significantly lower in group A patients,who also had significantly lower distal esophageal acid exposure,proximal esophageal acid exposure,and esophageal duodenogastroesophageal reflux exposure compared to groups B and C.Multivariate analysis identified the presence of esophagitis and pathological distal esophageal acid exposure as risk factors for the need of maintenance therapy.In patients with reflux-related ENT symptoms,initial findings on upper GI endoscopy and 24-hr pH-metry help to predict the need for maintenance therapy.
文摘Objective: To determine prospectively the incidence of an inlet patch (IP) in children requiring esophagogastroduodenoscopy (EGD) and assess the prevalence of presenting symptoms between children with and without an IP. Study design: All patients undergoing EGD in a 2-year period were assessed for the presence of an IPwith biopsy confirmation. IP, distal esophagus, and stomach biopsy specimens were blindly reviewed by a pathologist for the presence and degree of inflammation and intestinal metaplasia. Symptoms from children with and without an IP were compared. Results: From 407 EGDs done by a single endoscopist, 24 patients had confirmed IP (incidence of 5.9% ). The presence and degree of inflammation were always relatively greater in the columnar mucosa of the IP than in the antral/body gastric mucosa in the same patient (P = .0027)-Inflammation was similar in the squamous epithelium around the IP and in the distal esophagus (P = .46). Two patients had intestinalmetaplasia of the IP. The patients with IPs had a higher prevalence of respiratory symptoms than the control group (P = .03). Conclusions: Children with IPs may have a higher frequency of respiratory symptoms. Periodic surveillance should be performed in children with intestinal metaplasia of an IP.
