Asthma and gastroesophageal reflux disease: Effect of long-term pantoprazole therapy

AIM： To define the prevalence of gastroesophageal reflux disease （GERD） in mild persistent asthma and to value the effect of pantoprazole therapy on asthmatic symptoms.METHODS： Seven of thirty-four asthmatic patients without GERD served as the non-GERD control group. Twenty-seven of thirty-four asthmatic patients had GERD （7/27 also had erosive esophagitis, sixteen of them presented GERD symptoms. An upper gastrointestinal endoscopy was performed in all the subjects to obtain five biopsy specimens from the lower 5 cm of the esophagus. Patients were considered to have GERD when they had a dilation of intercellular space （DIS）〉0.74 μm at transmission electron microscopy. Patients with GERD were treated with pantoprazole, 80 mg/day. Forced expiratory volume in one second （FEV1） was performed at entry and after 6 mo of treatment. Asthmatic symptoms were recorded. The required frequency of inhaling rapid acting β2-agonists was self-recorded in the patients＇ diaries.RESULTS： Seven symptomatic patients presented erosive esophagitis. Among the 18 asymptomatic patients, 11 presented DIS, while all symptomatic patients showed ultrastructural esophageal damage. Seven asymptomatic patients did not present DIS. At entry the mean of FEV1 was 1.91 L in symptomatic GERD patients and 1.88 L in asymptomatic GERD patients. After the treatment, 25 patients had a complete recovery of DIS and reflux symptoms. Twenty-three patients presented a regression of asthmatic symptoms with normalization of FEV1. Four patients reported a significant improvement of symptoms and their FEV1 was over 80%.CONCLUSION： GERD is a highly prevalent condition in asthma patients. Treatment with pantoprazole （80 mg/day） determines their improvement and complete regression.

Effect of omeprazole on symptoms and ultrastructural esophageal damage in acid bile reflux

AIM: To value whether omeprazole could induce the healing of DIS and regression of symptoms in patients with DGER. METHODS: We enrolled 15 symptomatic patients with a pathological esophageal 24-h pH-metry and bilimetry. Patients underwent endoscopy and biopsies were taken from the distal esophagus. Specimens were analyzed at histology and transmission electron microscopy (TEM). Patients were treated with omeprazole 40 mg/d for 3 mo and then endoscopy with biopsies was repeated. Patients with persistent heartburn and/or with an incomplete recovery of DIS were treated for 3 more months and endoscopy with biopsies was performed. RESULTS: Nine patients had a non-erosive reflux disease at endoscopy (NERD) while 6 had erosive esophagitis (ERD). At histology, of the 6 patients with erosive esophagitis, 5 had mild esophagitis and 1 moderate esophagitis. No patients with NERD showed histological signs of esophagitis. After 3 mo of therapy, 13/15 patients (86.7%,P<0.01) showed a complete recovery of DIS and disappearance of heartburn. Of the 2 patients treated for 3 more months, complete recovery of DIS and heartburn were achieved in one. CONCLUSION: Three or 6 mo of omeprazole therapy led to a complete regression of the ultrastructural esophageal damage in 86.7% and in 93% of patients with DGER, NERD and ERD respectively. The ultrastructural recovery of the epithelium was accompanied by regression of heartburn in all cases.

Assessment of structural brain changes in patients with type 2 diabetes mellitus using the MRI-based brain atrophy and lesion index

Patients with type 2 diabetes mellitus(T2 DM) often have cognitive impairment and structural brain abnormalities.The magnetic resonance imaging(MRI)-based brain atrophy and lesion index can be used to evaluate common brain changes and their correlation with cognitive function,and can therefore also be used to reflect whole-brain structural changes related to T2 DM.A total of 136 participants(64 men and 72 women,aged 55–86 years) were recruited for our study between January 2014 and December 2016.All participants underwent MRI and Mini-Mental State Examination assessment(including 42 healthy control,38 T2 DM without cognitive impairment,26 with cognitive impairment but without T2 DM,and 30 T2 DM with cognitive impairment participants).The total and sub-category brain atrophy and lesion index scores in patients with T2 DM with cognitive impairment were higher than those in healthy controls.Differences in the brain atrophy and lesion index of gray matter lesions and subcortical dilated perivascular spaces were found between non-T2 DM patients with cognitive impairment and patients with T2 DM and cognitive impairment.After adjusting for age,the brain atrophy and lesion index retained its capacity to identify patients with T2 DM with cognitive impairment.These findings suggest that the brain atrophy and lesion index,based on T1-weighted and T2-weighted imaging,is of clinical value for identifying patients with T2 DM and cognitive impairment.Gray matter lesions and subcortical dilated perivascular spaces may be potential diagnostic markers of T2 DM that is complicated by cognitive impairment.This study was approved by the Medical Ethics Committee of University of South China(approval No.USC20131109003) on November 9,2013,and was retrospectively registered with the Chinese Clinical Trial Registry(registration No.Chi CTR1900024150) on June 27,2019.

Dilated intercellular spaces in gastroesophageal reflux disease patients and the changes of intercellular spaces after omeprazole treatment

Background Gastroesophageal reflux disease （GERD） is a common disorder. Dilation of intercellular spaces of esophageal epithelium has been revealed at transmission electron microscopy both in the rabbit acid-perfused esophagus and in esophageal biopsies from GERD patients. This study aimed to observe the changes of the intercellular spaces of squamous epithelium of lower esophagus in patients with GERD and the changes of intercellular spaces of patients with erosive esophagitis （EE） before and after omeprazole treatment. Methods Outpatients having GERD symptoms for more than 3 months and volunteers were collected. All of them underwent gastroendoscopy and 24-hour ambulatory pH monitoring. Biopsies were taken from the lower esophagus （2 cm above Z-line） for electron microscope examination. Five healthy volunteers, six non-erosive reflux disease （NERD） patients, and five EE patients were enrolled. Intercellular spaces of GERD patients and controls were calculated. Then we selected 20 patients with EE diagnosed by gastroendoscopy. All of them were treated with omeprazole （Losec, 20 mg bid） for 4 weeks then underwent gastroendoscopy again. Biopsies were taken from 2 cm above Z-line for electron microscope examination. All the patients completed the questionnaire about reflux symptoms before and after treatment. Results Intercellular spaces of esophageal epithelial cell in volunteers, NERD patients and EE patients were （0.37±0.07）μm, （1.31±0.08）μm, and （1.33±0.14）μm, respectively, with significant differences between the control group and the NERD group （P=0.000）. In the 20 EE patients, the mean intercellular space before treatment was （1.14±0.15） μm After treatment the intercellular space was （0.51±0.18）μm, a significant difference compared with pre-treatment measurements （P=0.000）. Conclusions Dilated intercellular spaces （DIS） were seen in both NERD and EE cases. The dilated intercellular spaces of esophaaeal epithelium in EE patients could be recovered after a short time nf treatment with omeprazole.

Real-variable characterizations of anisotropic product Musielak-Orlicz Hardy spaces

Let A :=(A_1, A_2) be a pair of expansive dilations and φ : R^n×R^m×[0, ∞) → [0, ∞) an anisotropic product Musielak-Orlicz function. In this article, we introduce the anisotropic product Musielak-Orlicz Hardy space H~φ_A(R^n× R^m) via the anisotropic Lusin-area function and establish its atomic characterization, the g-function characterization, the g_λ~*-function characterization and the discrete wavelet characterization via first giving out an anisotropic product Peetre inequality of Musielak-Orlicz type. Moreover, we prove that finite atomic decomposition norm on a dense subspace of H~φ_A(R^n× R^m) is equivalent to the standard infinite atomic decomposition norm. As an application, we show that, for a given admissible triplet(φ, q, s), if T is a sublinear operator and maps all(φ, q, s)-atoms into uniformly bounded elements of some quasi-Banach spaces B, then T uniquely extends to a bounded sublinear operator from H~φ_A(R^n× R^m) to B. Another application is that we obtain the boundedness of anisotropic product singular integral operators from H~φ_A(R^n× R^m) to L~φ(R^n× R^m)and from H~φ_A(R^n×R^m) to itself, whose kernels are adapted to the action of A. The results of this article essentially extend the existing results for weighted product Hardy spaces on R^n× R^m and are new even for classical product Orlicz-Hardy spaces.