Differences in oesophageal bolus transit between patients with and without erosive reflux disease

BACKGROUND: We determined any difference in oesophageal function between reflux patients with and without erosive esophagitis by the application of concurrent manometry and impedance. METHODS: Twenty patients with erosive esophagitis, 20 patients with non-erosive reflux disease, and 15 controls were included in this study. All subjects underwent studies with a catheter containing four impedance-measuring segments and five solid-state pressure transducers. Each subject received 10 liquid and 10 viscous boluses to be swallowed. RESULTS: Healthy controls had greater distal oesophageal peristaltic amplitude than both patient groups (p < 0.05). Normal oesophageal peristalsis was found more frequently in healthy controls than either of the patient groups (p < 0.05). Patients with erosive esophagitis exhibited a lower percentage of complete bolus transit compared to healthy controls and non-erosive reflux disease patients (both p < 0.05). Patients with erosive esophagitis had a longer total bolus transit time compared to healthy controls and non-erosive reflux disease patients (both p < 0.05). CONCLUSIONS: Erosive esophagitis is characterized by longer oesophageal bolus transit and fewer complete bolus transit than non-erosive reflux disease. The noted differences in oesophageal bolus transit may reflect a continuum of dysfunction secondary to increasing oesophageal mucosal damage.     

Barrett's食管、糜烂性食管炎及非糜烂性反流病发生机制的比较

目的:比较糜烂性食管炎(EE)、非糜烂性反流病(NERD)及Barrett's食管(BE)患者反流发生特点,探讨不同类型GERD的可能发病机制.方法:105例GERD患者根据胃镜及病理情况分为:EE组(35例)、BE组(34例)及NERD组(36例),对照组30例为健康志愿者.比较4组受检者食管测压与24 h食管pHT及胆汁反流同步监测结果的差异.结果:与对照组相比,GERD各组LES静息压均有不同程度减低,以EE组最明显(P<0.05).EE与BE组患者远段食管收缩波幅及有效蠕动百分比明显低于NERD组与对照组(均P<0.05).DeMeester评分等酸反流指标在EE组最高.BE组Abs>0.14时间百分比等长时间胆汁反流指标最高.NERD患者中仅52.8%存在病理性反流.各组中混合反流类型占各组病理性反流总人数的比例分别为68.57%(EE组)、84.38%(BE组)及63.15%(NERD组).结论:胃酸与胆汁的混合反流是GERD患者中最常见病理性反流类型,且对食管黏膜的损害较单纯酸或胆汁反流为重,胆汁反流在BE的发病机制中占有重要地位.     

非糜烂性反流病与糜烂性食管炎研究进展及相互关系探讨

非糜烂性反流病和糜烂性食管炎发病机制及转归存在较多争议,此综述结合目前研究进展,从食管黏膜改变、食管动力、食管酸暴露、精神心理状态、与功能性疾病关系、症状特点及治疗效果方面阐述两者特点,并探讨其相互关系.     

Heartburn severity underestimates erosive esophagitis severity in elderly patients with gastroesophageal reflux disease

BACKGROUND & AIMS: Gastroesophageal reflux disease is common in adults of all ages, but its complications are more frequent in elderly patients. Although heartburn is the most common symptom of reflux disease, it is unclear whether the severity of heartburn reliably indicates the severity of erosive esophagitis. We therefore assessed the relationship between age, severe heartburn symptoms, and severe erosive esophagitis. METHODS: This post hoc analysis of baseline data on the severity of both heartburn and erosive esophagitis pooled data from 5 prospective, randomized, controlled clinical trials that assessed the effect of proton pump inhibitors on healing of erosive esophagitis and symptom resolution. The clinical trials were conducted in 683 private and academic offices and hospital-based gastroenterology practices and involved 11,945 patients aged 18 years and older with gastroesophageal reflux disease and erosive esophagitis. RESULTS: A progressive increase in the prevalence of severe erosive esophagitis was observed with each decade of age, ranging from 12% in patients aged <21 years to 37% in patients aged >70 years. Among patients with severe esophagitis, severe heartburn was less frequent in the older age groups: ranging from 82% of patients aged <21 years to 34% of those aged >70 years. Each of these associations was statistically significant (P < 0.001). CONCLUSIONS: Although the prevalence of severe erosive esophagitis increases with age, the severity of heartburn is an unreliable indicator of the severity of erosive disease. More aggressive investigation and treatment may be necessary for elderly patients, regardless of the reported severity of heartburn.     

Symptom relief in gastroesophageal reflux disease: a randomized, controlled comparison of pantoprazole and nizatidine in a mixed patient population with erosive esophagitis or endoscopy-negative reflux disease.

OBJECTIVES: Gastroesophageal reflux disease (GERD) in primary care practice presents symptomatically, and resources to distinguish promptly between erosive esophagitis and endoscopy-negative reflux disease (ENRD) are limited. It is therefore important to determine the roles of proton pump inhibitors and histamine-2-receptor antagonists for first-line symptom-based therapy in patients with erosive esophagitis and ENRD. The aim of this study was to compare pantoprazole 40 mg once daily versus nizatidine 150 mg b.i.d. in a mixed GERD patient population with ENRD or erosive esophagitis (Savary-Miller grades 1-3). METHODS: A 4-wk randomized, double-blind, parallel-group, multicenter study conducted in Canada. Eligible patients had experienced GERD symptoms > or = 4 times weekly for > 6 months. Patients were randomized to pantoprazole 40 mg once daily or nizatidine 150 mg b.i.d.. Endoscopy was performed before randomization and after 4 wk of therapy. RESULTS: Of 220 patients randomized to therapy, 208 were available for a modified intent-to-treat analysis. Erosive esophagitis was present in 125 patients; 35 patients were Helicobacter pylori positive. There was complete symptom relief after 7 days of therapy in 14% of patients on nizatidine and in 40% of those on pantoprazole (p < 0.0001), and after 28 days of treatment in 36% and 63% of patients, respectively (p < 0.0001). After 28 days of treatment, adequate heartburn control was reported by 58% of the nizatidine group and in 88% of the pantoprazole (p < 0.0001); erosive esophagitis healing rates were 44% for nizatidine and 79% for pantoprazole (p < 0.001). Rescue antacid was needed by a greater number of patients using nizatidine than of those using pantoprazole (p < 0.001). H. pylori infection was associated with an increased probability of erosive esophagitis healing. CONCLUSIONS: Pantoprazole once daily was superior to nizatidine b.i.d. in producing complete heartburn relief in a mixed population of GERD patients and in achieving erosion healing. The proportions of patients with complete symptom relief were greater with pantoprazole after 7 days of therapy than with nizatidine after 28 days. The present study data suggest that pantoprazole is a highly effective first-line therapy for the management of gastroesophageal reflux disease in a primary care practice setting.     

Cardiac autonomic regulation differentiates reflux disease with and without erosive esophagitis

OBJECTIVE: Impaired autonomic function has been observed in patients with gastroesophageal reflex disease (GERD), but little is known about autonomic function in patients with non-erosive reflux disease (NERD). The objective of this study was to investigate potential differences in autonomic function by means of heart rate variability in GERD patients with and without erosive esophagitis. MATERIAL AND METHODS: Thirty-five GERD patients and 20 healthy controls participated in the study. Seventeen subjects with NERD and 18 patients with erosive reflux disease (ERD) were identified based on typical reflux symptoms, endoscopic findings, and 24-h esophageal pH. Spectral analysis of heart rate variability was performed to calculate the low-frequency (LF) band, the high-frequency (HF) band, and the LF/HF ratio. RESULTS: No significant differences were found in age, gender, body mass index, or current tobacco use among the reflux patients and controls. The Helicobacter pylori status and severity of reflux symptoms were similar between the two groups. The HF band power was significantly lower in patients with ERD than in NERD patients (p < 0.01) and controls (p < 0.05). LF band power (%) and LF/HF ratio were significantly lower in the NERD patients compared with ERD patients (p < 0.05) and controls (p < 0.05). There was no statistically significant correlation between any heart rate variability parameter and symptom severity score in either the ERD or NERD group. CONCLUSIONS: Patients with ERD and NERD display a similar degree of symptom severity, but the pattern of autonomic function appears to differ between NERD and ERD.     

Non-Esophageal symptoms cannot differentiate between erosive reflux esophagitis and non-erosive reflux disease in a referred population

Abstract

Background. Non-esophageal symptoms are highly prevalent in non-erosive reflux disease (NERD). However, their prevalence in erosive esophagitis (ErE) is unclear. The aims of this study were to compare patients with pH-positive NERD and ErE in terms of non-esophageal symptoms and to investigate whether such symptoms can differentiate between these two conditions. Material and methods. A prospective observational study of ErE and pH-positive NERD patients matched for age and gender with a nested case-control analysis. Symptoms were scored on validated scales. The association between the scale scores and diagnosis was evaluated in a random group comprising 67% of the total (group A) and was validated on the rest (group B). Results. 124 ErE and 248 pH-positive NERD patients were studied. In group A, pH-positive NERD patients scored higher than ErE patients on all symptom scales. Scores on chest, constipation, sleep and urinary symptoms scales were significantly associated with diagnosis. A composite weighted score on these scales was 41.5% sensitive and 86.0% specificity in the differentiation of ErE from pH-positive NERD patients. When applied to group B, the sensitivity and specificity of this score were 48.8% and 70.3%, respectively. Conclusions. Digestive and non-digestive symptoms occurred with a significant higher prevalence in pH-positive NERD compared with ErE patients. However a composite score on scales of constipation, chest, sleep and urinary symptoms was not enough sensitive and specific to differentiate these two conditions.     

Cardiac autonomic regulation differentiates reflux disease with and without erosive esophagitis

Objective. Impaired autonomic function has been observed in patients with gastroesophageal reflex disease (GERD), but little is known about autonomic function in patients with non-erosive reflux disease (NERD). The objective of this study was to investigate potential differences in autonomic function by means of heart rate variability in GERD patients with and without erosive esophagitis. Material and methods. Thirty-five GERD patients and 20 healthy controls participated in the study. Seventeen subjects with NERD and 18 patients with erosive reflux disease (ERD) were identified based on typical reflux symptoms, endoscopic findings, and 24-h esophageal pH. Spectral analysis of heart rate variability was performed to calculate the low-frequency (LF) band, the high-frequency (HF) band, and the LF/HF ratio. Results. No significant differences were found in age, gender, body mass index, or current tobacco use among the reflux patients and controls. The Helicobacter pylori status and severity of reflux symptoms were similar between the two groups. The HF band power was significantly lower in patients with ERD than in NERD patients (p<0.01) and controls (p<0.05). LF band power (%) and LF/HF ratio were significantly lower in the NERD patients compared with ERD patients (p<0.05) and controls (p<0.05). There was no statistically significant correlation between any heart rate variability parameter and symptom severity score in either the ERD or NERD group. Conclusions. Patients with ERD and NERD display a similar degree of symptom severity, but the pattern of autonomic function appears to differ between NERD and ERD.     

Health-related quality of life of patients with acute erosive reflux esophagitis

One thousand one hundred forty-five patients with acute erosive reflux esophagitis participating in an eight-week double-blind, multicenter study of lansoprazole 15 mg daily, lansoprazole 30 mg daily, omeprazole 20 mg daily, and placebo responded to a health-related quality of life (HRQoL) questionnaire at baseline and at two, four, and eight weeks. At baseline, there were no HRQoL differences among the four study groups. However, all three active treatment groups improved statistically significantly more than placebo on most HRQoL scales at each follow-up. There were no statistically significant differences among the three active treatment groups at week 2, although in most instances lansoprazole 30 mg showed slightly more improvement. After week 2, benefits in all the study groups leveled off and remained constant. Greater acid suppression appeared to result in greater improvement in terms of HRQoL.This research was funded by TAP Holdings Inc., Deerfield, Illinois.This study was presented in preliminary form for Digestive Disease Week, in San Diego, California, May 1995.     

Risk factors for the severity of erosive esophagitis in Helicobacter pylori-negative patients with gastroesophageal reflux disease

BACKGROUND: The risk factors for the varying grades of erosive esophagitis (EE) severity could be better understood. For that reason. we evaluated the risk factors associated with EE in patients with gastroesophageal reflux disease. METHOD: We determined the presence and severity of EE (using the Los Angeles Classification) in patients with negative serology Helicobacterpylori who underwent esophagogastroduodenoscopy as part of screening in four prospective, multicenter, randomized, double-blind comparative trials of once-daily esomeprazole and omeprazole for the acute healing of erosive esophagitis. We also examined the baseline characteristics of enrolled patients, and identified risk factors for severe disease using a multivariable logistic regression model. RESULTS: Erosive esophagitis was documented in 6709 patients of a total of 10,294 patients who underwent endoscopy: of these. 34% had grade A. 39% had grade B. 20% had grade C. and 7% had grade D disease. The majority of patients were male (61%) and Caucasian (93%) with a mean age of 46 years. In the regression model, the following were significant independent risk factors for severe (grades C and D) versus mild erosive esophagitis (grades A and B): severe heartburn (adjusted odds ratio 1.79); prolonged heartburn > 5 years in duration (1.16); obesity (1.21); the presence of hiatus hernia (2.13); male gender (1.97); and Caucasian ethnicity (1.53). CONCLUSION: In this large sample of patients with predominantly H. pylori-negative gastroesophageal reflux disease, risk factors for severe erosive esophagitis were the duration and severity of heartburn, and obesity.     

十年2088例反流性食管炎临床分析

目的分析研究我院10年来内镜诊断的反流性食管炎(RE)病例,评估10年来RE发病情况及与相关疾病的关系.方法1995年1月至2004年12月经胃镜诊断的2088例原发性RE,按洛杉矶分类进行分级,评估RE发病情况,分析患者年龄、性别和伴发疾病的关系.结果原发性RE占胃镜检查总人数的4.1%,男性多于女性(4.7%比3.2%,P=0.00),平均年龄55.34岁,男性发病年龄早于女性[(54.37±15.53)岁比(57.40±13.88)岁,P＜0.01].10年间年原发性RE检出率和发病年龄上升;随年龄增长RE检出率升高,病变程度加重.轻度的(A、B级)占大多数(82.5%),在RE分级上男女差异无统计学意义(P＞0.05).RE患者Hp阳性率低于受检人群(23.5%比42.3%,P＜0.01).Hp阳性RE检出率低于阴性(2.9%比4.7%,P＜0.01).Hp阳性与阴性RE在RE分级上差异无统计学意义(P＞0.05).结论过去10年间,RE患病率和发病年龄逐步上升,轻度的占大多数.RE人群Hp阳性率低于一般人群.     

Relationship between acceleration of gastric emptying and oesophageal acid exposure in patients with endoscopy-negative gastro-oesophageal reflux disease

Objective. A delay in gastric emptying has been reported in patients with gastro-oesophageal reflux disease (GORD), but its role in increasing the number of reflux episodes is still debated. The aim of this study was to assess the relationship between acceleration of gastric emptying and gastro-oesophageal reflux in patients with endoscopy-negative GORD and pathological oesophageal acid exposure. Material and methods. Twelve patients (7 M, age range 24–65 years) underwent 6-h postprandial (2.1 MJ meal) combined gastric emptying by real-time ultrasonography and intra-oesophageal pH monitoring after cisapride (20 mg b.i.d.) and placebo for 3 days, on two separate occasions at least 7 days apart in double-blind randomized order. Gastric emptying after placebo was also measured in 12 healthy volunteers (7 M, age range 25–54 years). Results. In the patients’ group, the area under the emptying time curve was greater (p<0.01), and half and total emptying times prolonged (p<0.01) compared to the healthy subjects, 115 min (mean)±6 (SEM) versus 86±6 and 232 min±16 versus 160±7, respectively. Cisapride accelerated both half- and total gastric emptying (p<0.02): ?22 min (mean); ?10 to ?34 (95% CI) and ?48 min; ?10 to ?85, respectively, decreased both percentage of time at pH?p<0.01) and number of reflux episodes (p<0.05). However, no relationship was found between changes in gastric emptying and in the reflux variables by linear regression analysis (R²<0.005). Conclusion. The emptying rate of the whole stomach is not a major determinant of gastro-oesophageal reflux.     

Relationship between acceleration of gastric emptying and oesophageal acid exposure in patients with endoscopy-negative gastro-oesophageal reflux disease

OBJECTIVE: A delay in gastric emptying has been reported in patients with gastro-oesophageal reflux disease (GORD), but its role in increasing the number of reflux episodes is still debated. The aim of this study was to assess the relationship between acceleration of gastric emptying and gastro-oesophageal reflux in patients with endoscopy-negative GORD and pathological oesophageal acid exposure. MATERIAL AND METHODS: Twelve patients (7 M, age range 24-65 years) underwent 6-h postprandial (2.1 MJ meal) combined gastric emptying by real-time ultrasonography and intra-oesophageal pH monitoring after cisapride (20 mg b.i.d.) and placebo for 3 days, on two separate occasions at least 7 days apart in double-blind randomized order. Gastric emptying after placebo was also measured in 12 healthy volunteers (7 M, age range 25-54 years). RESULTS: In the patients' group, the area under the emptying time curve was greater (p<0.01), and half and total emptying times prolonged (p<0.01) compared to the healthy subjects, 115 min (mean)+/-6 (SEM) versus 86+/-6 and 232 min+/-16 versus 160+/-7, respectively. Cisapride accelerated both half- and total gastric emptying (p<0.02): -22 min (mean); -10 to -34 (95% CI) and -48 min; -10 to -85, respectively, decreased both percentage of time at pH < 4 (p<0.01) and number of reflux episodes (p<0.05). However, no relationship was found between changes in gastric emptying and in the reflux variables by linear regression analysis (R2<0.005). CONCLUSION: The emptying rate of the whole stomach is not a major determinant of gastro-oesophageal reflux.     

急性糜烂性食管炎56例内镜及临床分析

急性食管黏膜损伤在临床上并非少见,其病因及临床表现多样,胃镜检查是确定诊断的主要手段.在2006年6月至2009年6月我院做的24000多例患者的胃镜检查中,发现急性糜烂性食管炎56例,发病年龄以中、青年多见,损伤部位多发生于食管下段,现将其胃镜所见及临床资料分析如下.     

Laryngopharyngeal reflux in patients with reflux esophagitis

AIM： To assess the prevalence of laryngopharyngeal reflux （LPR） in patients with reflux esophagitis and disclose factors contributing to the development of LPR.
METHODS： A total of 167 patients who proved to have reflux esophagitis by endoscopy were enrolled. They received laryngoscopy to grade the reflux findings for the diagnosis of LPR. We used validated questionnaires to identify the presence of laryngopharyngeal symptoms, and stringent criteria of inclusion to increase the specificity of laryngoscopic findings. The data of patients were analyzed statistically to find out factors related to LPR.
RESULTS： The prevalence rate of LPR in studied subjects with reflux esophagitis was 23.9%. Age, hoarseness and hiatus hernia were factors significantly associated with LPR. In 23 patients with a hiatus hernia, the group with LPR was found to have a lower trend of esophagitis grading.
CONCLUSION： Laryngopharyngeal reflux is present in patients with reflux esophagitis, and three predicting factors were identified. However, the development of LPR might be different from that of reflux esophagitis. The importance of hiatus hernia deserves further study.