Percutaneous endoscopic gastrostomy and gastro-oesophageal reflux in neurologically impaired children

AIM:To investigate the effects of percutaneous endoscopic gastrostomy(PEG) feeding on gastro-oesophageal reflux(GOR) in a group of these children using combined intraluminal pH and multiple intraluminal impedance(pH/MII) . METHODS:Ten neurologically impaired children underwent 12 h combined pH/MII procedures at least 1 d before and at least 12 d after PEG placement. METHODS:Prior to PEG placement(pre-PEG) a total of 183 GOR episodes were detected,156(85.2%) were non-acidic.After PEG placement(post-PEG) a to...     

The effect of fundoplication on proliferative and anti-apoptotic activity of esophageal mucosa in gastroesophageal reflux disease: 4-year follow-up study

OBJECTIVE: The capacity of fundoplication to prevent esophageal adenocarcinoma is controversial. Development of cancer is associated with proliferation and anti‐apoptosis, for which little data exist as to their response to fundoplication. Therefore, we wanted to clarify the effect of fundoplication on the magnitude of Ki‐67 and B‐cell lymphoma 2 (Bcl‐2) during 48 months of follow up. METHODS: Ki‐67 and Bcl‐2 were assessed quantitatively from biopsies of the esophagogastric junction (EGJ) and from the distal and proximal esophagus of 20 patients with gastroesophageal reflux disease (GERD) treated by fundoplication. An upper gastrointestinal endoscopy was performed preoperatively and postoperatively at 6 months for 20 patients and 48 months for 16 patients, respectively. Ki‐67 and Bcl‐2 were compared to those of 7 controls. RESULTS: Compared to the preoperative level, Ki‐67 was elevated in the distal (P = 0.012) and proximal (P = 0.007) esophagus at 48 months. Compared to control values, Ki‐67 was lower at 6 months in the EGJ (P = 0.037) and the proximal esophagus (P = 0.003) and higher at 48 months in the distal esophagus (P = 0.002). Compared to control values, Bcl‐2 was lower at 6 months in the EGJ (P = 0.038). Correlations between Ki‐67 and Bcl‐2 were positive in the EGJ (P > 0.001) and in the distal (P = 0.001) and proximal esophagus (P = 0.013). CONCLUSION: Proliferative activity after fundoplication increased during long‐term follow up in the distal esophagus despite a normal fundic wrap and objective healing of GERD.     

Benign surgical diseases of the gastro-oesophageal junction

This article discusses the investigation and management of gastro-oesophageal reflux disease, para-oesophageal hernias and achalasia.     

炎症反应介导胃食管反流病诱发心房颤动的机制研究

目的：探讨炎症因子在胃食管反流病（GERD）和房颤（AF）患者食管粘膜中的表达及其在AF发生中的意义。方法：按照纳入、排除标准选取2017年1月至2018年6月间在新疆维吾尔自治区人民医院住院收治的65例患者设为研究组。同期完成体检的15例健康受试者设为健康对照组。研究组均行GERDQ评分、24h动态心电图、24h pH监测、高分辨率食管测压监测并内镜下取食管齿状线上3cm处的局部黏膜作为标本,后续采用HE染色、免疫组化、RT-PCR、ELISA等方法分析组织炎症程度、炎症因子（IL-6、IL-8、IL-1β、TNF-α及Hs CRP）的表达及血液中的释放浓度。结果：根据患者的临床表现,GERDQ评分、内镜等检查,分为GERD合并AF组（AF组）、GERD不合并AF组（非AF组）和对照组。AF组和非AF组患者中合并高血压,合并高血脂,合并2型糖尿病的情况,在两组之间无明显统计差异（P>0.05）。GERDQ评分在AF组3~7分、8~10分、11~14分及15~18分等评分范围均明显高于非AF组,具有统计学意义（P<0.01）。食管24h pH监测发现,AF组弱酸反流（4相似文献   

Clinical impact of gastroesophageal reflux disease in patients with subacute/chronic cough

BackgroundWhile gastroesophageal reflux disease (GERD) is one of the commonest causes of subacute/chronic cough along with cough-variant asthma (CVA) and rhinosinusitis, its clinical impact remains unknown. Therefore, we sought to investigate the impact of GERD in patients with subacute/chronic cough.MethodsBetween April 2012 and March 2018, a total of 312 patients presenting subacute or chronic cough lasting for ≥3 weeks [median cough duration, 4.9 (0.7–434) months] underwent diagnostic tests. GERD symptoms and cough-specific QoL were evaluated through the Frequency Scale for Symptoms of Gastroesophageal reflux (FSSG) and the Japanese version of the Leicester Cough Questionnaire (J-LCQ). According to the FSSG domains, patients with GERD were arbitrarily categorized into 3 groups; acid-reflux predominant, dysmotility predominant, and pauci-symptoms groups, respectively.ResultsThe average scores of J-LCQ was 12.5 (SD3.7). One hundred-forty three were diagnosed as having GERD-related cough based on classical reflux symptoms including heartburn and characteristic triggers of cough such as phonation, rinsing, lying, and eating. Most of them (89.8%) had other causative diseases including CVA. Cough lasted longer (p = 0.019) and required a longer time until alleviation (p = 0.003) in patients with GERD than in those without GERD. They also scored lower J-LCQ than counterpart group (p < 0.0001). In terms of symptom stratification, dysmotility predominant group showed significant more response to specific GERD treatments than the remnants (p = 0.002).ConclusionsThese results indicate that GERD is associated with the aggravation of other causes including CVA. Particularly, dysmotility symptoms may be potential therapeutic target for GERD-related cough.     

Diagnosis and management of GERD before and after lung transplantation

The strong association between gastroesophageal reflux disease (GERD) and the development and progression of pulmonary diseases has been suggested, and GERD has been focused on as a potential cause and thus a target for prevention and/or therapy. Because GERD is curable, the proper diagnosis and management of underlying GERD would theoretically improve the outcomes. This article reviews the existing literature and discusses the strategy to manage GERD in patients with end-stage pulmonary diseases before and after lung transplantation.     

High-resolution manometry: an atlas of esophageal motility disorders and findings of GERD using esophageal pressure topography

High-resolution manometry (HRM) has now become widely available and currently is moving into mainstream clinical practice. This article provides an HRM-related atlas of esophageal motility disorders focused on dysphagia and gastroesophageal reflux disease (GERD). Although there is some overlap between esophageal motor disorders associated with dysphagia and the defects and esophageal motor function that would predispose the patient to more severe GERD, this review is organized to differentiate the distinct pathophysiologic components of the two disease groups. A section on impaired bolus transit is also included to highlight the important aspect of impaired clearance in the pathogenesis of GERD.     

抗反流手术治疗老年食管裂孔疝合并胃食管反流病对阻塞性睡眠呼吸暂停的影响

目的 分析老年食管裂孔疝（HH）合并胃食管反流病（GERD）患者中阻塞性睡眠呼吸暂停（OSA）的患病情况,并探索抗反流手术（腹腔镜下食管裂孔疝修补术联合胃底折叠术）治疗老年GERD合并HH对OSA的影响。 方法 根据多导睡眠监测（PSG）结果,将77例HH合并GERD患者分为OSA组,和非OSA组。对所研究指标进行差异性及相关性分析。结果 OSA组患者AHI、ODI、LAT、ESS评分、血清IL-8、TNF-α水平高于非OSA组,LSaO2低于非OSA组,差异有统计学意义（P＜0.05）;血清TNF-α水平与AHI、ODI、LAT正相关,与LSaO2负相关（r = 0.647、0.579、0.477、- 0.312,P均＜0.05）;血清IL-8水平与AHI、ODI正相关,与LSaO2负相关（r = 0.422、0.501、- 0.330,P均＜0.05）;与术前相比,术后AHI、ODI、LSaO2、LAT、ESS评分、GERD-Q评分、血清IL-8、TNF-α水平有改善,差异均有统计学意义（P＜0.05）;手术前后血清TNF-α差值与AHI、ODI、LAT差值正相关,与LSaO2差值负相关（r =0.329、0.408、0.529,- 0.312,P均＜0.05）;手术前后IL-8差值与AHI、ODI、LAT差值正相关,与LSaO2差值负相关（r =0.343、0.371、0.350,- 0.330,P均＜0.05）。结论 老年GERD合并HH患者OSA的患病率较高,男女患病比例接近,以轻中度OSA为主。通过抗反流手术治疗不仅能够改善患者反流症状,也能改善OSA的病情及相关炎症反应,术后需针对OSA进行随访和治疗。