Prevalence of gastroesophageal reflux disease in patients with asthma and chronic obstructive pulmonary disease

Background and Aim: It is speculated that the prevalence of gastroesophageal reflux disease (GERD) might increase with asthma or chronic obstructive pulmonary disease (COPD). The aim of the present study was to evaluate the prevalence of GERD in patients with asthma and COPD in an area representative of developing countries. Methods: A validated GERD questionnaire was conducted face‐to‐face with 308 consecutive asthma (240 women) and 133 COPD (35 women) patients in the tertiary referral pulmonary outpatient clinic, and 694 controls from the research area. Detailed histories of patients and pulmonary function tests were also recorded. Results: The prevalence of GERD (heartburn/regurgitation once a week or more) was 25.4%, 17.0%, 19.4% and occasional symptoms (less than weekly) were 21.2%, 16.3% and 27.0% of patients with asthma, COPD and controls, respectively. The prevalence was higher in the asthma group compared with the controls and the COPD group. No significant difference was found between the COPD group and the controls. Heartburn started following pulmonary disease in 24.1% of the asthma group, and 26.4% of the COPD group. The majority of additional symptoms were significantly higher in asthmatics compared with the controls. No difference was found in the consumption of pulmonary medications in asthmatic patients in groups with different symptom frequency. Heartburn was increased 13.8% by the consumption of inhaler medications. Conclusions: These results implicate that the prevalence of GERD in asthma and COPD are lower than in published reports in a tertiary referral center. These differences might be related to the characteristics of developing countries, increased consumption of powerful medications in GERD and pulmonary diseases, or methodological flaws in earlier studies.     

胃食管反流病相关危险因素研究

[目的]研究胃食管反流病(GERD)的相关危险因素。[方法]对420例消化科门诊患者行反流性疾病问卷表(RDQ)调查,以RDQ评分≥12分为GERD的诊断标准,其中60例列入GERD组,其余360例列入非GERD组,同时对2组对象的饮食和生活习惯进行问卷调查。[结果]GERD组中常吸烟、饮酒、喝咖啡、睡前进食的比例均明显高于非GERD组(P0.05),但常饮浓茶的比例在2组患者中差异无统计学意义(P0.05)。[结论]不良的饮食和生活习惯是诱发GERD的重要危险因素,重视改变不良生活方式可能减轻GERD的发生和发展。     

胃食管反流对老年男性慢性阻塞性肺部疾病患者肺功能的影响

目的探讨合并胃食管反流病(GERD)对老年男性慢性阻塞性肺部疾病(COPD)患者肺功能的影响。方法回顾性分析2002年2月至2016年1月在解放军总医院南楼临床部住院且具有完整肺功能和相关临床资料的COPD男性患者(≥65岁)158例。依据是否合并GERD分为两组:GERD组(n=41)和非GERD组(n=117)。比较两组患者的肺功能差异。结果GERD组患者中COPD的严重程度显著高于非GERD组,差异具有统计学意义(P0.05)。与非GERD组相比,GERD组患者的用力肺活量(FVC)、第1秒用力呼气容积(FEV_1)、最大呼气峰流速(PEF)、最大呼气中期流速(FEF_(25%-75%))、25%肺活量位用力呼气流速(FEF_(75%))、50%肺活量位用力呼气流速(FEF_(50%))和75%肺活量位用力呼气流速(FEF_(75%))均显著降低(P0.05)。结论合并GERD能够影响老年男性COPD患者的肺功能和疾病严重程度。     

特发性肺纤维化与胃食管反流的相关性研究

目的 探讨特发性肺纤维化(IPF)与胃食管反流的相关性,分析其临床特点.方法 选2011年1月至2013年10月中国医科大学附属第一医院住院或门诊IPF患者25例(IPF组),另选非IPF的间质性肺疾病患者23例作对照(非IPF组),两组患者行24 h食管pH值监测,分析胃食管反流特点及其临床特征.结果 胃食管反流阳性IPF组16例,非IPF组8例.IPF组DeMeester评分高于非IPF组,差异有统计学意义[(22.8±21.5)分比(15.7±14.0)分;P＜0.05].IPF组长反流(反流时间持续＞5 min)次数[(3.8±4.1)次]、反流指数(1.8±1.7)高于非IPF组[(2.1±2.1)次;1.3±1.2],但差异无统计学意义.IPF胃食管反流阳性者合计反流时间百分比(pH ＜4.0)[(9.2±5.1)％]、直立位反流时间百分比[(8.5±5.2)％]、仰卧位反流时间百分比[(10.8±10.7)％]、反流次数[(54.2±22.7)次]、长反流次数[(6.3±4.2)次]、最长反流时间[(14.5±15.3) nin]、反流指数(2.5±1.7)和DeMeester评分[(34.9±20.3)分]明显高于阴性者,差异有统计学意义(P值均＜0.05).DeMeester评分与胃食管反流病问卷(GerdQ)评分呈正相关(r=0.667,P＜0.01).IPF患者胃食管反流阳性者典型胃食管反流症状:烧心7例,反流6例,多于胃食管反流阴性者(烧心2例,反流1例).结论 IPF患者胃食管反流阳性率高,但往往缺少典型的胃食管反流症状.在不具备胃酸监测条件的医院,GerdQ可用于评价IPF患者是否存在胃食管反流.     

反流性疾病问卷表在军人胃食管反流病中的诊断价值

[目的]探讨反流性疾病问卷表(RDQ)在军人胃食管反流病(GERD)中的诊断价值。[方法]采用多阶段、分层、整群随机抽样的方法对驻闽某部军人进行反流性疾病问卷调查,记录被调查者过去4周内烧心、非心源性胸痛、反酸和反流4种症状出现的频率和程度积分,以RDQ评分≥12分作为GERD的诊断标准,计算军人中GERD的患病率,同时分析经电子胃镜检查证实为反流性食管炎(RE)患者的RDQ评分情况。[结果]研究得出军人GERD的患病率为6.77%,经胃镜检查420例中明确诊断为RE 60例(RE组)和内镜检查正常360例(非RE组)的RDQ评分差异有统计学意义(P0.01),说明评分与发生RE之间有较大关联。[结论]RDQ评分量表可以作为初步诊断军人GERD的一个良好的筛选试验。     

The relationship between gastroesophageal reflux disease and obstructive sleep apnea

There has been an accumulating body of research concerning the extraesophageal complications of gastroesophageal reflux disease over the past decade. Given the cardiological, pulmonological, laryngeal, and dental aspects of such complications, an interdisciplinary approach is required. The most recognized manifestations are noncardiac chest pain, bronchial asthma, chronic bronchitis, chronic cough, and posterior laryngitis, as well as the acidic damage of dental enamel. This article focuses on the potential relationship between reflux disease and obstructive sleep apnea, which has been raised only more recently. Because of the decrease of primary peristalsis and the reduced production of saliva, as well as the diminished acid and volume clearance of the esophagus, sleeping can be considered as a risk factor of the reflux event by itself. Moreover, it should also be taken into account that the transdiphragmatic pressure increases in parallel with the growing intrathoracic pressure generated during obstructive apnea episodes. This has a non-negligible effect on the phrenoesophageal ligament, which is connected to the lower esophageal sphincter. Repetition of the pressure changes results in insufficiency of the cardia. While this pressure change produces a considerable suction effect, further reducing the clearing mechanism of the gastric volume, lower esophageal sphincter insufficiency can directly lead to reflux disease. The challenge for gastroenterologists is to gain further insight into this relationship and to play a more active role in the complex therapy of the disease, as well as to develop a new diagnostic approach towards the severe forms of gastroesophageal reflux disease.     

慢性阻塞性肺病与胃食管反流病

目的：了解慢性阻塞性肺病(COPD)患者中胃食管反流病(GERD)的发生率及探讨GERD与COPD的关系。方法：从医院门诊收集89例COPD患者[第1秒用力呼气量(FEV_1)=1．37±0．53],同时选取88例非COPD患者为对照组,所有病例完成反流性疾病诊断问卷、慢性黏液高分泌症(CMH)问卷和肺功能检查。结果：COPD组中GERD发生率为18%,对照组为16%。气道阻塞严重(根据肺功能判断)的COPD患者没有更高的GERD发生率,各不同严重程度的COPD患者的GERD发生率分别为11%(轻度)、24%(中度)、11%(重度)和19%(极重度)。气促程度严重的COPD患者中GERD发生率较气促程度轻者升高(29%比15%,P=0．19)。有CMH的患者中27%表现GERD,而无CMH患者中仅8%表现GERD(P＜0．05)。结论：本研究发现COPD患者中GERD的发生率没有明显增高,但气促症状严重的患者表现较高的GERD发病率。CMH与GERD有显著的相关性,提示CMH的潜在作用及在治疗有CMH的COPD患者时需考虑GERD影响。     

Psychometric and methodological characteristics of a culturally adjusted gastroesophageal reflux disease questionnaire

Population-based data regarding the prevalence of gastroesophageal reflux disease (GERD) in Turkey is lacking. Therefore, a valid and reliable instrument for population-based study of GERD is important. The purpose of the study is to establish the feasibility, reproducibility, reliability and validity of the Turkish version of the GERD questionnaire. The study sample of 630 people was randomly recruited from the 20- to 65-year-old-population of Menderes, Izmir. Face to face interviews were conducted using the Turkish GERD questionnaire. The questionnaire was translated into Turkish, and then test-retest reliability of the study was carried out with 25 individuals. Internal reliability was measured using Cronbach's alpha. Additionally, a validity study was performed at the gastroenterology outpatient clinic at Ege University, Faculty of Medicine (45 people). This Turkish GERD questionnaire was easily understood and completed in a reasonable time by members of the population for whom the survey was intended. For all questions (omitting the demographic questions) kappa statistics were calculated; the median kappa for the outpatient assessment was 0.82. The sensitivity of the questionnaire concerning heartburn was strong and the specificity of the test was weak. By calculating Cronbach's alpha coefficient, we estimated the internal consistency or the reliability of each component. The Cronbach's alpha coefficients were above 0.70. This instrument can be used for large-scale population based studies in Turkey.     

Diagnosis of gastroesophageal reflux disease using a new questionnaire

BACKGROUND AND AIM: An early and accurate evaluation by a general practitioner is needed to screen out non-gastroesophageal reflux disease (GERD) patients. A recent questionnaire (QUEST) highlighted problems with specificity and complexity, so the aim of the present study was to design a simplified questionnaire. METHODS: When admitted to hospital to undergo an upper gastrointestinal endoscopy for suspected GERD, 333 patients completed a 50-item questionnaire requiring 'yes/no' answers to different combinations of questions relating to symptoms of upper gastrointestinal tract conditions (e.g. GERD, ulcers and functional dyspepsia) and psychosomatic symptoms. The endoscopic diagnosis was then correlated with the rate of positive answers to each question. RESULTS: Based on the analysis of the 50 items, the 8-10 questions most often answered affirmatively by each of the GERD and non-GERD groups were chosen for the simplified questionnaire. Three draft questionnaires were compiled. After calculating the sensitivity, specificity and accuracy in relation to the diagnosis of GERD and other conditions, it was found that questionnaire B (selection of persons answering 'yes' to at least one of questions 1-5 and exclusion of persons answering 'yes' to at least three of questions 7-10) had a high sensitivity, high specificity and low false positive rate. CONCLUSION: A novel questionnaire was developed. It was designed to detect the symptoms of GERD while simultaneously excluding non-GERD patients. This simplified nine-item simplified questionnaire had a sensitivity of 79.8%, a specificity of 53.6% and an accuracy of 63.4%.     

Definition and diagnosis of gastroesophageal reflux disease

Abstract   With widespread treatment of Helicobacter pylori infection, and that peptic ulcer diseases are no longer considered a chronic illness and are declining in most parts of the world, gastroesophageal reflux disease (GERD) predominates the upper gastrointestinal disease spectrum. GERD is a well-defined condition. More innovative research in GERD in recent years led us to new conceptual frameworks on pathogenesis and novel diagnostic tests. The proton pump inhibitor test has evolved to become the diagnostic test of choice for the investigation of patients with the disease spectrum of GERD. Multi-channel intraluminal impedance with pH sensor allows the detection of pH episodes irrespective of their pH values (acid and nonacid reflux). It is useful to measure gastroesophageal reflux in the postprandial period, and in patients with persistent symptoms while on therapy and those with atypical symptoms.     

Symptoms associated with gastroesophageal reflux disease: development of a questionnaire for use in clinical trials

Many persons who suffer from GERD report additional symptoms, e.g., chest pain, dyspepsia, dysphagia, that are often not measured in clinical trials even though they may be distressing to the GERD sufferer. The primary goal of this study was to develop and assess the psychometric characteristics of a new GERD symptom scale measuring frequency, severity, and distress. The GERD Symptom Assessment Scale (GSAS) was administered to a sample of 169 GERD sufferers at baseline and two weeks. Internal consistency, construct validity, and test–retest reliability were assessed. Responsiveness was evaluated using clinical trial data assessing drug efficacy. Results: Internal consistency was >0.80 for the symptom severity and distress scales. All three scales showed stability over two weeks (ICC >0.70). Both validity hypotheses were supported. Comparison of effect sizes showed the GSAS is sensitive to changes in severity of symptoms. In conclusion, the GSAS is a reliable, valid, and responsive measure of GERD symptoms.     

慢性结石性胆囊炎与胃食管反流病的系的研究

目的探讨胃食管反流病与结石性胆囊炎的关系。 方法前瞻性研究2017年9月至2019年9月在新疆民心医院通过胃食管反流病调查问卷（GerdQ）或体检胃镜检查被诊断为胃食管反流病（GERD）的488例患者的临床资料（GERD组）,同时通过同样的方法诊断选取为非GERD的590例患者的临床资料（非GERD组）,2组均分别进行腹部彩超、腹部CT检查或将同期腹部彩超结果作为参看,诊断是否伴有胆囊结石,并对其结果进行统计学分析。 结果2组腹部彩超或腹部CT结果示胆囊结石发病率比较,差异无统计学意义（P＞0.05）。 结论胃食管反流病与慢性结石性胆囊炎之间的无明显关系,GERD的严重程度也没有受到胆结石的影响。     

Antimicrobial peptide LL-37 circulating levels in chronic obstructive pulmonary disease patients with high risk of frequent exacerbations

Background

Exacerbations of chronic obstructive pulmonary disease (COPD) increase the decline in lung function, deterioration in health status and risk of death. The assessment of exacerbation risk is important in the grading of COPD. The most common cause of COPD exacerbation is respiratory tract infection. The only known human cathelicidin antimicrobial peptide, LL-37, play an important role in innate defense against infection. Its gene expression is regulated by the bioactive form of vitamin D. The objective of the present study was to explore the relationship between LL-37 plasma levels, vitamin D status and exacerbation risk in patients with COPD.

Methods

COPD patients and normal subjects were recruited from Beijing Hospital for this study. COPD patients were divided into low risk group and high risk group according to the criteria of GOLD strategy. The plasma concentrations of LL-37 were measured by ELISA technique to explore the difference in LL-37 levels between groups. The plasma levels of 25-hydroxy vitamin D [25(OH)D] were analyzed using electrochemiluminescence immunoassay (ECLIA).

Results

A total of 84 COPD patients and 51 normal subjects (control group) were recruited. COPD patients were divided into low risk group (37 cases) and high risk group (47 cases), depending on forced expiratory volume in one second (FEV₁)%pred and exacerbation frequency in the previous year. The plasma concentrations of LL-37 in control group, low risk group and high risk group were 20.7±5.8, 19.5±4.1 and 17.9±3.9 µg/L respectively. The plasma concentration of LL-37 was significantly lower in high risk group than in control group (P=0.006). But there was no significant difference between low risk group and high risk group (P=0.152). The plasma concentrations of 25(OH)D in control group, low risk group and high risk group were 18.1±9.4, 13.1±6.9 and 9.3±5.8 ng/mL respectively. The plasma concentration of 25(OH)D was significantly higher in control group than in low risk group (P=0.004) or high risk group (P<0.001). The plasma concentration of 25(OH)D was significantly lower in high risk group than in low risk group (P=0.031). Hospitalization frequency for COPD exacerbations was negative correlated with plasma levels of LL-37 (r=−0.290, P=0.048) and 25(OH)D (r=−0.341, P=0.020) in high risk group. There was not significant correlation between LL-37 and 25(OH)D in COPD patients (r=0.115, P=0.303).

Conclusions

The plasma levels of LL-37 and 25(OH)D were lower in COPD patients with high risk of frequent exacerbations than normal subjects. Low plasma levels of LL-37 and 25(OH)D might be predictors of exacerbation risk in COPD patients.     

Tolerance to H2 receptor antagonist correlates well with the decline in efficacy against gastroesophageal reflux in patients with gastroesophageal reflux disease

BACKGROUND AND AIM: The attenuated antisecretory activity of H2 receptor antagonists (H2RA) during continuous administration is known as the tolerance phenomenon. The authors recently clarified that presence or absence of Helicobacter pylori infection influences the occurrence of the tolerance phenomenon. The aim of this study was to clarify whether tolerance to H2RA is correlated with attenuation of the inhibitory effect against gastroesophageal acid reflux in patients with gastroesophageal reflux disease (GERD). METHODS: Ten male patients with GERD symptoms and abnormal gastroesophageal reflux were investigated by pH monitoring on days 1 and 15 of continuous oral famotidine administration at 20 mg twice daily, and H. pylori infection was examined using the urea breath test. RESULTS: Intragastric and intraesophageal acidity were significantly decreased on the first day of famotidine administration, but then increased during the 15-day administration period in seven patients who were negative for H. pylori. In contrast, the efficacy of famotidine against gastric acid secretion and gastroesophageal acid reflux was not attenuated in three H. pylori-positive patients. The changes in GERD symptoms were correlated with the change in the degree of gastroesophageal reflux. CONCLUSION: The presence or absence of tolerance to H2RA during 15-day administration is correlated with the efficacy for inhibition of gastroesophageal acid reflux.