Therapeutic effect of Wendan Decoction combined with mosapride on gastroesophageal reflux disease after esophageal cancer surgery

BACKGROUND Gastroesophageal reflux disease(GERD)is a common complication of esophageal cancer surgery that can affect quality of life and increase the risk of esophageal stricture and anastomotic leakage.Wendan Decoction(WDD)is a traditional Chinese herbal formula used to treat various gastrointestinal disorders,such as gastritis,functional dyspepsia,and irritable bowel syndrome.Mosapride,a prokinetic agent,functions as a selective 5-hydroxytryptamine 4 agonist,enhancing gastrointestinal motility.AIM To evaluate the therapeutic effects of WDD combined with mosapride on GERD after esophageal cancer surgery.METHODS Eighty patients with GERD were randomly divided into treatment(receiving WDD combined with mosapride)and control(receiving mosapride alone)groups.The treatment was conducted from January 2021 to January 2023.The primary outcome was improved GERD symptoms as measured using the reflux disease questionnaire(RDQ).The secondary outcomes were improved esophageal motility(measured using esophageal manometry),gastric emptying(measured using gastric scintigraphy),and quality of life[measured via the Short Form-36(SF-36)Health Survey].RESULTS The treatment group showed a notably reduced RDQ score and improved esophageal motility parameters,such as lower esophageal sphincter pressure,peristaltic amplitude,and peristaltic velocity compared to the control group.The treatment group showed significantly higher gastric emptying rates and SF-36 scores(in both physical and mental domains)compared to the control group.No serious adverse effects were observed in either group.CONCLUSION WDD combined with mosapride is an effective and safe therapy for GERD after esophageal cancer surgery.It can improve GERD symptoms,esophageal motility,gastric emptying,and the quality of life of patients.Further studies with larger sample sizes and longer follow-up periods are required to confirm these findings.

Endoscopic full-thickness plication along with argon plasma coagulation for treatment of proton pump inhibitor dependent gastroesophageal reflux disease

BACKGROUND Most endoscopic anti-reflux interventions for gastroesophageal reflux disease(GERD)management are technically challenging to practice with inadequate data to support it utility.Therefore,this study was carried to evaluate the effectiveness and safety newer endoscopic full-thickness fundoplication(EFTP)device along with Argon Plasma Coagulation to treat individuals with GERD.AIM To evaluate the effectiveness and safety newer EFTP device along with Argon Plasma Coagulation to treat individuals with GERD.METHODS This study was a single-center comparative analysis conducted on patients treated at a Noble Institute of Gastroenterology,Ahmedabad,hospital between 2020 and 2022.The research aimed to retrospectively analyze patient data on GERD symptoms and proton pump inhibitor(PPI)dependence who underwent EFTP using the GERD-X system along with argon plasma coagulation(APC).The primary endpoint was the mean change in the total gastroesophageal reflux disease health-related quality of life(GERD-HRQL)score compared to the baseline measurement at the 3-month follow-up.Secondary endpoints encompassed enhancements in the overall GERD-HRQL score,improvements in GERD symptom scores at the 3 and changes in PPI usage at the 3 and 12-month time points.RESULTS In this study,patients most were in Hill Class II,and over half had ineffective esophageal motility.Following the EFTP procedure,there were significant improvements in heartburn and regurgitation scores,as well as GERDHRQL scores(P<0.001).PPI use significantly decreased,with 82.6%not needing PPIs or prokinetics at end of 1 year.No significant adverse events related to the procedures were observed in either group.CONCLUSION The EFTP along with APC procedure shows promise in addressing GERD symptoms and improving patients'quality of life,particularly for suitable candidates.Moreover,the application of a lone clip with APC yielded superior outcomes and exhibited greater cost-effectiveness.

Factors associated with residual gastroesophageal reflux disease symptoms in patients receiving proton pump inhibitor maintenance therapy

AIM To elucidate the factors associated with residual gastroesophageal reflux disease(GERD) symptoms in patients receiving proton pump inhibitor(PPI) maintenance therapy in clinical practice.METHODS The study included 39 GERD patients receiving maintenance PPI therapy. Residual symptoms were assessed using the Frequency Scale for Symptoms of GERD(FSSG) questionnaire and the Gastrointestinal Symptom Rating Scale(GSRS). The relationships between the FSSG score and patient background factors, including the CYP2C19 genotype, were analyzed.RESULTS The FSSG scores ranged from 1 to 28 points(median score: 7.5 points), and 19 patients(48.7%) had a score of 8 points or more. The patients' GSRS scores were significantly correlated with their FSSG scores(correlation coefficient = 0.47, P < 0.005). In erosive esophagitis patients, the FSSG scores of the CYP2C19 rapid metabolizers(RMs) were significantly higher than the scores of the poor metabolizers and intermediate metabolizers(total scores: 16.7 ± 8.6 vs 7.8 ± 5.4, P < 0.05; acid reflux-related symptom scores: 12 ± 1.9 vs 2.5 ± 0.8, P < 0.005). In contrast, the FSSG scores of the CYP2C19 RMs in the non-erosive reflux disease patients were significantly lower than those of the other patients(total scores: 5.5 ± 1.0 vs 11.8 ± 6.3, P < 0.05; dysmotility symptom-related scores: 1.0 ± 0.4 vs 6.0 ± 0.8, P < 0.01). CONCLUSION Approximately half of the GERD patients receiving maintenance PPI therapy had residual symptoms associated with a lower quality of life, and the CYP2C19 genotype appeared to be associated with these residual symptoms.

Increased prevalence of symptoms of gastroesophageal reflux diseases in type 2 diabetics with neuropathy

AIM:To analyze the prevalence of gastroesophageal reflux disease (GERD) related symptoms in patients with diabetes mellitus (DM) and to find out the relationship between diabetic neuropathy and the prevalence of GERD symptoms. METHODS:In this prospective questionnaire study, 150 consecutive type 2 diabetic patients attending the endocrine clinic were enrolled. A junior physician helped the patients to understand the questions. Patients were asked about the presence of five most frequent symptoms of GERD that included heartburn (at least 1/wk), regurgitation, chest pain, hoarseness of voice and chronic cough. Patients with past medical history of angina, COPD, asthma, cough due to ACEI or preexisting GERD prior to onset of diabetes and apparent psychiatric disorders were excluded from the survey. We further divided the patients into two groups based on presence or absence of peripheral neuropathy. Out of 150 patients, 46 had neuropathy, whereas 104 patients did not have neuropathy. Data are expressed as mean ± SD, and number of patients in each category and percentage of total patients in that group. Normal distributions between groups were compared with Student t test and the prevalence rates between groups were compared with Chi-square tests for significance. RESULTS:The average duration of diabetes were 12 ± 9.2 years and the average HbA1c level of this group was 7.7% ± 2.0%. The mean weight and BMI were 198 ± 54 lbs. and 32 ± 7.2 kg/m2. Forty percent (61/150) patients reported having at least one of the symptoms of GERD and thirty percent (45/150) reported having heartburn at least once a week. The prevalence of GERD symptoms is higher in patients with neuropathy than patients without neuropathy (58.7% vs 32.7%, P < 0.01). The prevalence of heartburn, chest pain and chronic cough are also higher in patients with neuropathy than in patients without neuropathy (43.5% vs 24%;10.9% vs 4.8% and 17.8% vs 6.7% respectively, P < 0.05).CONCLUSION:The prevalence of GERD symptoms in type 2 DM is higher than in the general population. Our data suggest that DM neuropathy may be an important associated factor for developing GERD symptoms.

Japanese apricot improves symptoms of gastrointestinal dysmotility associated with gastroesophageal reflux disease

AIM: To investigate the effects of Japanese apricot(JA) consumption on gastroesophageal reflux disease(GERD)-related symptoms.METHODS: Participants included individuals living in Minabe-cho,a well-known JA-growing region,who received specific medical check-ups by the local community health service in 2010.GERD-related symptoms were examined in 1303 Japanese individuals using a validated questionnaire,the Frequency Scale for Symptoms of GERD(FSSG),which consists of 7 questions associated with acid reflux symptoms and 5 questions asking about gastrointestinal dysmotility symptoms.Each question was answered using a 4-point scale,with higher scores indicating more severe GERDrelated symptoms.Subjects were divided into two groups according to their intake of dried and pickled JA: daily intake(≥ 1 JA daily)(392 subjects) and none oroccasional intake(< 1 JA daily)(911 subjects).FSSG scores were compared between subjects who consumed JA daily and those who did not.Next,subjects were stratified by age,gender and Helicobacter pylori(H.pylori) status for subanalyses.RESULTS: Those who ate JA daily were significantly older than those who did not(60.6 ± 10.5 years vs 56.0 ± 11.0 years,P < 0.001).Total FSSG scores were significantly lower in subjects with daily JA intake than in those with none or only occasional intake(2.13 ± 3.14 vs 2.70 ± 3.82,P = 0.005).In particular,subjects who consumed JA daily showed significantly improved FSSG dysmotility scores compared with subjects who did not(1.05 ± 1.58 vs 1.46 ± 2.11,P < 0.001).In contrast,the FSSG reflux score did not differ between subjects with and without daily intake of JA(1.08 ± 1.90 vs 1.24 ± 2.11,P = 0.177).Subanalysis indicated that improvement in dysmotility by JA intake was specifically observed in non-elderly(1.24 ± 1.68 vs 1.62 ± 2.22,P = 0.005) and H.pylori-negative subjects(0.99 ± 1.58 vs 1.57 ± 2.06,P < 0.001).GERD patients(total FSSG score ≥ 8) were less frequently observed among subjects with daily intake of JA as compared to those without daily intake of JA(6.1% vs 9.7%,P = 0.040).CONCLUSION: Daily JA intake may improve digestive dysmotility symptoms,resulting in relief of GERD symptoms.The effect is more obvious in non-elderly and H.pylori-negative subjects.

Disagreement between symptom-reflux association analysis parameters in pediatric gastroesophageal reflux disease investigation

AIM: To assess the agreement within 3 commonly used symptom-reflux association analysis (SAA) parameters investigating gastroesophageal reflux disease (GERD) in infants. METHODS: Twenty three infants with suspected GERD were included in this study. Symptom index (SI), Symptom sensitivity index (SSI) and symptom association probability (SAP) related to cough and irritability were calculated after 24 h combined pH/multiple intraluminal impedance (MII) monitoring. Through defined cutoff values, SI, SSI and SAP values are differentiated in normal and abnormal, whereas abnormal values point towards gastroesophageal reflux (GER) as the origin of symptoms. We analyzed the correlation and the concordance of the diagnostic classification of these 3 SAA parameters.RESULTS: Evaluating the GER-irritability association, SI, SSI and SAP showed non-identical classification of normal and abnormal cases in 39.2% of the infants. When irritability was taken as a symptom, there was only a poor inter-parameter association between SI and SSI, and between SI and SAP (Kendall’s tau b = 0.37, P < 0.05; Kendall’s tau b = 0.36, P < 0.05, respectively). Evaluating the GER-cough association, SI, SSI and SAP showed non-identical classification of normal and abnormal cases in 52.2% of the patients. When cough was taken as a symptom, only SI and SSI showed a poor inter-parameter association (Kendall’s tau b = 0.33, P < 0.05). CONCLUSION: In infants investigated for suspected GERD with pH/MII-monitoring, SI, SSI and SAP showed a poor inter-parameter association and important dis-agreements in diagnostic classification. These limitations must be taken into consideration when interpreting the results of SAA in infants.

Advances in diagnostic testing for gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) contributes substantially to morbidity and to costs in the United States health care system. The burden of this disease has resulted in attempts at improving diagnosis and characterizing patients. Numerous research and technical advances have enhanced our understanding of both the utility and limitations of a variety of diagnostic modalities. The purpose of this review is to highlight recent advances in GERD diagnostic testing and to discuss their implications for use in clinical practice. Topics addressed include esophageal pH monitoring, impedance testing, symptom association analyses, narrow-band imaging, and histopathology.

First-week clinical responses to dexlansoprazole 60 mg and esomeprazole 40 mg for the treatment of grades A and B gastroesophageal reflux disease

AIM To compare the one-week clinical effects of single doses of dexlansoprazole and esomeprazole on grades A and B erosive esophagitis.METHODS We enrolled 175 adult patients with gastroesophageal reflux disease(GERD). The patients were randomized in a 1:1 ratio into two sequence groups to define the order in which they received single doses of dexlansoprazole(n = 88) and esomeprazole(n = 87) for an intention-to-treat analysis. The primary endpoints were the complete symptom resolution(CSR) rates at days 1, 3, and 7 after drug administration.RESULTS Thirteen patients were lost to follow-up, resulting in 81 patients in each group for the per-protocol analysis. The CSRs for both groups were similar at days 1, 3 and 7. In the subgroup analysis, the female patients achieved higher CSRs in the dexlansoprazole group than in the esomeprazole group at day 3(38.3% vs 18.4%, P = 0.046). An increasing trend toward a higher CSR was observed in the dexlansoprazole group at day 7(55.3% vs 36.8%, P = 0.09). In the esomeprazole group, female sex was a negative predictive factor for CSR on post-administration day 1 [OR =-1.249 ± 0.543; 95%CI: 0.287(0.099-0.832), P = 0.022] and day 3 [OR =-1.254 ± 0.519; 95%CI: 0.285(0.103-0.789), P = 0.016]. Patients with spicy food eating habits achieved lower CSRs on day 1 [37.3% vs 21.4%, OR =-0.969 ± 0.438; 95%CI: 0.380(0.161-0.896), P = 0.027]. CONCLUSION The overall CSR for GERD patients was similar at days 1-7 for both the dexlansoprazole and esomeprazole groups, although a higher incidence of CSR was observed on day 3 in female patients who received a single dose of dexlansoprazole.

Pulmonary or otolaryngologic extraesophageal manifestations in patients with gastroesophageal reflux disease

The extraesophageal manifestations of gastroesophageal reflux disease that are similar to a heart attack or gastric diseases are well known, while those categorized as pulmonary or otolaryngological are less known and less studied. In this article, we introduce this less known aspect of gastroesophageal reflux.

Do patients with gastroesophageal reflux disease and somatoform tendencies benefit from antireflux surgery?

BACKGROUND The clinical presentation of gastroesophageal reflux disease(GERD) shows a large symptom variation also in different intensities among patients. As several studies have shown, there is a large overlap in the symptomatic spectrum between proven GERD and other disorders such as dyspepsia, functional heartburn and/or somatoform disorders.AIM To prospectively evaluate the GERD patients with and without somatoform disorders before and after laparoscopic antireflux surgery.METHODS In a tertiary referral center for foregut surgery over a period of 3 years patients with GERD, qualifying for the indication of laparoscopic antireflux surgery, were investigated prospectively regarding their symptomatic spectrum in order to identify GERD and associated somatoform disorders. Assessment of symptoms was performed by an instrument for the evaluation of somatoform disorders[Somatoform Symptom Index(SSI) > 17]. Quality of life was evaluated by Gastrointestinal Quality of Life Index(GIQLI).RESULTS In 123 patients an indication for laparoscopic antireflux surgery was established and in 43 patients further medical therapy was suggested. The portion of somatoform tendencies in the total patient population was 20.48%(34 patients).Patients with a positive SSI had a preoperative GIQLI of 77(32-111). Patients with a normal SSI had a GIQLI of 105(29-140)(P < 0.0001). In patients with GERD the quality of life could be normalized from preoperative reduced values of GIQLI102(47-140) to postoperative values of 117(44-144). In patients with GERD and somatoform disorders, the GIQLI was improved from preoperative GIQLI 75(47-111) to postoperative 95(44-122)(P < 0.0043).CONCLUSION Patients with GERD and associated somatoform disorders have significantly worse levels of quality of life. The latter patients can also benefit from laparoscopic fundoplication, however they will not reach a normal level.

Impact of gastroesophageal reflux control through tailored proton pump inhibition therapy or fundoplication in patients with Barrett's esophagus

AIM To determine the impact of upwards titration of proton pump inhibition(PPI) on acid reflux, symptom scores and histology, compared to clinically successful fundoplication.METHODS Two cohorts of long-segment Barrett's esophagus(BE) patients were studied. In group 1(n = 24), increasing doses of PPI were administered in 8-wk intervals until acid reflux normalization. At each assessment, ambulatory 24 h p H recording, endoscopy with biopsies and symptom scoring(by a gastroesophageal reflux disease health related quality of life questionnaire, GERD/HRLQ) were performed. Group 2(n = 30) consisted of patients with a previous fundoplication. RESULTS In group 1, acid reflux normalized in 23 of 24 patients, resulting in improved GERD/HRQL scores(P = 0.001), which were most pronounced after the starting dose of PPI(P < 0.001). PPI treatment reached the same level of GERD/HRQL scores as after a clinically successful fundoplication(P = 0.5). Normalization of acid reflux in both groups was associated with reduction in papillary length, basal cell layer thickness, intercellular space dilatation, and acute and chronic inflammation of squamous epithelium. CONCLUSION This study shows that acid reflux and symptom scores co-vary throughout PPI increments in long-segment BE patients, especially after the first dose of PPI, reaching the same level as after a successful fundoplication. Minor changes were found among GERD markers at the morphological level.

Chronic gastrointestinal symptoms and quality of life in the Korean population

AIM: To evaluate the prevalence of chronic gastroin-testinal symptoms and their impact on health-related quality of life (HRQOL) in the Korean population. METHODS: A cross-sectional survey, using a reliable and valid Rome Ⅱ based questionnaire, was per-formed on randomly selected residents, between 18 and 69 years in age. All respondents were interviewed at their homes or offices by a team of interviewers. The impact of chronic gastrointestinal symptoms on HRQOL was assessed using the Korean version of the 36-item Short-Form general health survey (SF-36). RESULTS: Of the 1807 eligible subjects, 1417 (78.4%: male 762; female 655) were surveyed. Out of the respondents, 18.6% exhibited at least one chronic gastrointestinal symptom. The prevalence of gastro- esophageal reflux disease (GERD), defined as heart- burn and/or acid regurgitation experienced at least weekly, was 3.5% (95% CI, 2.6-4.5). The prevalence of uninvestigated dyspepsia, irritable bowel syndrome (IBS) and chronic constipation based on Rome Ⅱ cri- teria were 11.7% (95% CI, 10.1-13.5), 2.2% (95%CI, 1.5-3.1), and 2.6% (95% CI, 1.8-3.5) respectively. Compared with subjects without chronic gastrointesti- nal symptoms (n = 1153), those with GERD (n = 50), uninvestigated dyspepsia (n = 166) and IBS (n = 31) had signifi cantly worse scores on most domains of the SF-36 scales. CONCLUSION: The prevalence of GERD, uninvesti-gated dyspepsia and IBS were 3.5%, 11.7% and 2.2% respectively, in the Korean population. The health- related quality of life was signifi cantly impaired in sub-jects with GERD, uninvestigated dyspepsia and IBS in this community.

Laryngopharengeal Reflux in Gastroesophageal Reflux Disease: Does “Silent Laryngopharengeal Reflux” Really Exist?

Background: Gastroesophageal reflux disease (GERD) is a disorder resulting from the reversed flow of gastroduodenal contents into the esophagus, and producing different symptoms, while laryngopharyngeal reflux (LPR) is a disorder resulting from the reversed flow of gastric contents into the hypopharynx. The aim of this work is to evaluate LPR in cases of GERD. Methods: The present study was performed on fifty GERD patients diagnosed by gastroscope. LPR was assessed by reflux symptoms score (RSI) and reflux finding score (RFS). Accordingly, patients are classified into: Group I = 25 patients with manifest LPR, and Group II = 25 control patients without LPR symptoms. Results: GERD accounts for 17.4% of attendants of gastroscope unit, where manifest LPR accounts for 29.1% of GERD cases recording mean RSI and RFS 16.48 and 8.44 respectively. Silent LPR accounts for 8% recording mean RFS 7. Conclusion: There is a significant direct proportional relationship between severity of GERD and the RSI and RFS (p = 0.015 and 0.005 respectively).

Association of upper gastrointestinal symptoms with functional and clinical characteristics in the elderly

AIM:To evaluate the prevalence of upper gastrointestinal symptoms and their association with clinical and functional characteristics in elderly outpatients.METHODS:The study involved 3238 outpatients ≥ 60 years consecutively enrolled by 107 general practitioners.Information on social,behavioral and demographic characteristics,function in the activities of daily living (ADL),co-morbidities and drug use were collected by a structured interview.Upper gastrointestinal symptom data were collected by the 15-items upper gastro-intestinal symptom questionnaire for the elderly,a validated diagnostic tool which includes the following five symptom clusters:(1) abdominal pain syndrome;(2) reflux syndrome;(3) indigestion syndrome;(4) bleeding;and (5) non-specific symptoms.Presence and severity of gastrointestinal symptoms were analyzed through a logistic regression model.RESULTS:3100 subjects were included in the final analysis.The overall prevalence of upper gastrointestinal symptoms was 43.0%,i.e.cluster (1) 13.9%,(2) 21.9%,(3) 30.2%,(4) 1.2%,and (5) 4.5%.Upper gastrointestinal symptoms were more frequently reported by females (P < 0.0001),with high number of co-morbidities (P < 0.0001),who were taking higher number of drugs (P < 0.0001) and needed assistance in the ADL.Logistic regression analysis demonstrated that female sex (OR=1.39,95% CI:1.17-1.64),disability in the ADL (OR=1.47,95% CI:1.12-1.93),smoking habit (OR=1.29,95% CI:1.00-1.65),and body mass index (OR=1.06,95% CI:1.04-1.08),as well as the presence of upper (OR=3.01,95% CI:2.52-3.60) and lower gastroenterological diseases (OR=2.25,95%CI:1.70-2.97),psychiatric (OR=1.60,95% CI:1.28-2.01) and respiratory diseases (OR=1.25,95% CI:1.01-1.54) were significantly associated with the presence of upper gastrointestinal symptoms.CONCLUSION:Functional and clinical characteristics are associated with upper gastrointestinal symptoms.A multidimensional comprehensive evaluation may be useful when approaching upper gastrointestinal symptoms in older subjects.

Improvement in symptoms after H_2-receptor antagonist-based therapy for eradication of H pylori infection

AIM: To investigate the therapeutic effects of triple therapy combining lafutidine with clarithromycin and amoxicillin on H pylori infection and the resolution of gastroesophageal symptoms after eradication. METHODS: We conducted a randomized, multicenter, open-label controlled trial to compare the effective-ness of a triple therapy of lafutidine, clarithromycin, and amoxicillin (lafutidine group) with that of a triple therapy of lansoprazole, clarithromycin, and amoxicillin (lansopra- zole group) in patients with H pylori infection. The study group comprised 22 patients with gastric ulcers and 18 patients with duodenal ulcers who had H pylori infection. RESULTS: H pylori eradication rates were similar in the lafutidine group (14/20, 70%) and the lansoprazole group (14/20, 70%). Gastroesophageal reflux and ab-dominal symptoms improved after eradication therapy in both groups, whereas abdominal discomfort, diarrhea, and constipation were unchanged. H pylori status had no apparent effect on improvement of gastroesophageal reflux or abdominal symptoms after treatment. Adverse events were similar in both groups. CONCLUSION: The triple therapy including lafutidine is equivalent to triple therapy including lansoprazole in terms of H pylori eradication rates and improvement in gastroesophageal reflux and abdominal symptoms.These results are attributed to the fact that lafutidine has strong, continuous antisecretory activity, unaffected by CYP2C19 polymorphisms.

虎符铜砭刮痧联合PDCA循环护理在胃食管反流病患者中的应用

目的探讨对胃食管反流病患者实施虎符铜砭刮痧结合PDCA循环护理的效果。方法选择2020年6月至2022年6月期间南京市中医院收治的150例胃食管反流病患者,根据数字随机法将其分为对照组和观察组,每组75例。对照组给予PDCA循环护理进行干预,观察组给予PDCA循环护理结合虎符铜砭刮痧进行干预。比较2组患者干预前后的护理效果。结果干预4周及8周后,观察组的焦虑自评量表、抑郁自评量表和反流性疾病问卷评分均低于对照组,健康状况调查问卷评分均高于对照组(P均<0.05);干预4周及8周后,观察组的肿瘤坏死因子-α和超敏C反应蛋白水平均低于对照组,胃动素和胃泌素水平均高于对照组(P均<0.05);干预8周后,2组的上述评分和指标均优于干预前及干预4周后(P均<0.05)。结论对胃食管反流病患者应用虎符铜砭刮痧联合PDCA循环护理进行干预,能够有效缓解患者的临床症状和心理状态,改善其血清炎症因子和胃肠激素水平,且提升其生活质量。

胃食管反流样症状患者质子泵抑制剂使用的规范性与合理性分析

目的分析消化内科门诊胃食管反流样症状患者口服质子泵抑制剂(PPIs)的规范性与合理性,为临床提供参考。方法选取2017年7月1日~2022年12月31日消化内科门诊以胃食管反流样症状为主诉且完善内镜检查及食管24 h pH值监测的患者200例,统计患者PPIs的使用情况,分析PPIs用药的合理性和规范性。结果200例患者中,使用PPIs患者有182例,其中102例(56.04%)患者长期服用PPIs时间超过3个月,服用的PPIs中以雷贝拉唑钠肠溶胶囊占比较重,其次为奥美拉唑肠溶胶囊、艾司奥美拉唑肠溶胶囊、泮托拉唑钠肠溶胶囊、兰索拉唑肠溶片;182例患者中有111例不合理用药者(占比60.99%),包括71例预防用药不合理者(占比39.01%)和40例治疗用药不合理者(占比21.98%);111例不合理用药的症状分布中以反流、烧心为主要症状的有63例,占比较重,为56.76%,其次为胸骨后不适、嗳气、腹痛、咳嗽等相关症状;182例使用过PPIs患者中,幽门螺杆菌感染者有74例(40.66%),仅12例(6.59%)在服用PPIs前进行了^(13)C呼气试验的检测,明确了有无幽门螺杆菌感染。结论某院普遍存在PPIs药物不合理应用现象,因此,应加强PPIs的科普与规范化使用。

Radiofrequency treatment on respiratory symptoms due to gastroesophageal reflux disease

Background Diagnosis and treatment for respiratory symptoms （RSs） of gastroesophageal reflux disease （GERD） is more difficult than that for common esophageal symptoms. The goal of this study was to evaluate the efficacy and safety of radiofrequency （RF） treatment on RSs of GERD in a preliminary 12-month follow-up observation.

Non-erosive and uncomplicated erosive reflux diseases:Difference in physiopathological and symptom pattern

AIM:To investigate differences in the physiopathological findings(manometry and pH monitoring) and symptoms between cases of non-erosive reflux disease(NERD) and erosive reflux disease(ERD) found positive at 24 h pH monitoring. METHODS:For a total of 670 patients who underwent 24 h pH monitoring,esophageal manometry and upper endoscopy were retrospectively evaluated,assessing the reflux symptoms,manometric characteristics of the lower esophageal sphincter(LES) and esophageal body and the presence or absence of esophagitis and hiatal hernia. Typical and atypical symptoms were also evaluated. For inclusion in the study,patients had to have NERD or ERD and be found positive on pH monitoring(NERD+) . Patients with Gastroesophageal reflux disease(GERD) complicated by stenosis,ulcers or Barrett's esophagus were ruled out. RESULTS:214 patients were involved in the study,i.e. 107 cases of NERD+ and 107 of ERD. There were no significant gender-or age-related differences between the two groups. The ERD group had more cases of hiatal hernia(P = 0.02) and more acid reflux,both in terms of number of reflux episodes(P = 0.01) and as a percentage of the total time with a pH < 4(P = 0.00) ,when upright(P = 0.007) and supine(P = 0.00) . The NERD+ cases had more reflux episodes while upright(P = 0.02) and the ERD cases while supine(P = 0.01) . The LES pressure was higher in cases of NERD+(P = 0.03) while the amplitude and duration of their esophageal peristaltic waves tended to be better than in the ERD group(P >0.05) . The NERD+ patients presented more often with atypical symptoms(P = 0.01) . CONCLUSION:The NERD+ patients' fewer reflux episodes and the fact that they occurred mainly while in the upright position(unlike the cases of ERD) may be two factors that do not favor the onset of esophagitis. The frequently atypical symptoms seen in patients with NERD+ need to be accurately evaluated for therapeutic purposes because patients with GERD and atypical symptoms generally respond only partially to medical and surgical treatments.

Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy:Role of faecal immunochemical test

BACKGROUND Faecal immunochemical test(FIT)has been recommended to assess symptomatic patients for colorectal cancer(CRC)detection.Nevertheless,some conditions could theoretically favour blood originating in proximal areas of the gastrointestinal tract passing through the colon unmetabolized.A positive FIT result could be related to other gastrointestinal cancers(GIC).AIM To assess the risk of GIC detection and related death in FIT-positive symptomatic patients(threshold 10μg Hb/g faeces)without CRC.METHODS Post hoc cohort analysis performed within two prospective diagnostic test studies evaluating the diagnostic accuracy of different FIT analytical systems for CRC and significant colonic lesion detection.Ambulatory patients with gastrointestinal symptoms referred consecutively for colonoscopy from primary and secondary healthcare,underwent a quantitative FIT before undergoing a complete colonoscopy.Patients without CRC were divided into two groups(positive and negative FIT)using the threshold of 10μg Hb/g of faeces and data from follow-up were retrieved from electronic medical records of the public hospitals involved in the research.We determined the cumulative risk of GIC,CRC and upper GIC.Hazard rate(HR)was calculated adjusted by age,sex and presence of significant colonic lesion.RESULTS We included 2709 patients without CRC and a complete baseline colonoscopy,730(26.9%)with FIT≥10μgr Hb/gr.During a mean time of 45.5±20.0 mo,a GIC was detected in 57(2.1%)patients:An upper GIC in 35(1.3%)and a CRC in 14(0.5%).Thirty-six patients(1.3%)died due to GIC:22(0.8%)due to an upper GIC and 9(0.3%)due to CRC.FIT-positive subjects showed a higher CRC risk(HR 3.8,95%CI:1.2-11.9)with no differences in GIC(HR 1.5,95%CI:0.8-2.7)or upper GIC risk(HR 1.0,95%CI:0.5-2.2).Patients with a positive FIT had only an increased risk of CRC-related death(HR 10.8,95%CI:2.1-57.1)and GIC-related death(HR 2.2,95%CI:1.1-4.3),with no differences in upper GIC-related death(HR 1.4,95%CI:0.6-3.3).An upper GIC was detected in 22(0.8%)patients during the first year.Two variables were independently associated:anaemia(OR 5.6,95%CI:2.2-13.9)and age≥70 years(OR 2.7,95%CI:1.1-7.0).CONCLUSION Symptomatic patients without CRC have a moderate risk increase in upper GIC,regardless of the FIT result.Patients with a positive FIT have an increased risk of post-colonoscopy CRC.