The association between gastroesophageal reflux disease and obesity

Nearly all epidemiologic studies have found an association between increasing body mass index (BMI) and symptoms of gastroesophageal reflux disease (GERD). Changes in gastroesophageal anatomy and physiology caused by obesity may explain the association. These include an increased prevalence of esophageal motor disorders, diminished lower esophageal sphincter (LES) pressure, the development of a hiatal hernia, and increased intragastric pressure. Central adiposity may be the most important risk for the development of reflux and related complications such as Barrett's esophagus and esophageal adenocarcinoma. Weight loss, through caloric restriction and behavioral modification, has been studied infrequently as a means of improving reflux. Bariatric surgery and its effects on a number of obesity-related disorders have been studied more extensively. Roux-en-Y gastric bypass (RYGB) has been consistently associated with improvement in the symptoms and findings of GERD. The mechanism of action through which this surgery is successful at improving GERD may be independent of weight loss and needs further examination. Current evidence suggests that laparoscopic adjusted gastric banding should be avoided in these patients as the impact on gastroesophageal reflux disease appears unfavorable.     

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...     

原发性胆汁反流性胃炎与胃食管反流病的关系

目的:探讨原发性胆汁反流性胃炎(primary bile reflux gastritis,PBRG)与胃食管反流病(gastroesophageal reflux disease,GERD)之间的相关性.方法:选取我院确诊为PBRG的患者1060例为观察组,无痛胃镜下未查见有PBRG的体检者1060例为对照组,比较两组GERD的发生率;依据内镜下PBRG的诊断标准,将260例PBRG伴有GERD的患者分为轻度、中度及重度3组,对比各组食管黏膜损伤的程度以及GERD症状积分的分布.结果:PBRG组GERD的发生率高于对照组(24.5%vs9.8%,P<0.05).食管黏膜损伤程度加深的发生率随着PBRG程度的加重而增加.PBRG的程度与GERD症状分级无相关性.结论:PBRG与反流性食管炎(refluxe sophagitis,RE)形成存在正性相关,PBRG并非是引起GERD症状的主要原因.     

Strong association between gallstones and cardiovascular disease

BACKGROUND AND AIM: Obesity is closely associated with the increased morbidity and mortality of many common diseases in the Western world, including coronary heart disease (CHD) and gallstone diseases (GD). We have investigated the association between GD and CHD in a cross-sectional study. METHODS AND RESULTS: Subjects who had gallstones visible by ultrasound were considered as cases and subjects negative for gallstones were classified as controls. Positive CHD was defined when the stress test was positive. Body mass index (BMI), waist circumference, blood pressure, serum lipid concentrations, and insulin resistance were measured. The association was estimated by odds ratios using logistic regression models adjusted for confounders. Four hundred and seventy-three subjects (292 males and 181 females) were included, comprising 354 controls and 119 cases. Subjects with GD had higher prevalence of CHD (15.96%) than controls (4.52%) (p < 0.0001). In univariate unconditional logistic regression analysis CHD, BMI >/= 30 kg/m(2), waist circumference, high blood pressure, and HOMA-IR > 2.5 were the most important risk factors for GD. In multivariate analysis (adjusted for age and gender, and BMI) the risk for GD in subjects with CHD was higher (OR 2.84, 95% CI: 1.33-6.07, p < 0.007). CONCLUSIONS: Subjects with CHD have an increased risk to have GD, both diseases are strongly associated and the main characteristics of these subjects are those frequently involved as part of the metabolic syndrome.     

Evidence for the 'paradox' association between hypertensive lower esophageal sphincter and gastroesophageal reflux disease

There are several studies suggesting the paradoxical simultaneous presence of hypertensive lower oesophageal sphincter and gastroesophageal reflux disease. We present a case of a 22-year-old male patient who was examined in our outpatient clinic with oesophageal food bolus impaction during a meal, severe chest pain and drooling. Manometry revealed a hypertensive lower esophageal sphincter pressure (resting pressure 35 mmHg) and pHmetry revealed a DeMeester score > 14.72 (43.27). Six months after therapy with lansoprazole, manometry revealed a normal lower oesophageal sphincter (resting pressure 14 mmHg) and the DeMeester score was < 14.72 (5.89). The patient is now asymptomatic. This report is the only published case which exhibits the normalization of lower oesophageal pressure 6 months after gastroesophageal reflux disease management with lansoprazole, thus proving and establishing the above 'paradox'.     

Belching during gastroscopy and its association with gastroesophageal reflux disease

Belching may result from transient lower esophageal sphincter relaxation; therefore, it has been proposed that belching may be a manifestation of gastroesophageal reflux disease (GERD). This study was conducted to investigate the frequency of belching during esophagogastroduodenoscopy (EGD) and its association with GERD. A retrospective review was performed on prospectively collected clinical and endoscopic data from 404 subjects who underwent EGD without sedation from December 2012 to May 2013 in a training hospital in Korea. All detectable belching events during endoscopy were counted. Frequency and severity of belching events were compared between the group with and without GERD using an ordinal logistic regression model. There were 145 GERD patients (26 erosive reflux disease and 119 nonerosive reflux disease [NERD]). In the multivariable analysis, GERD was significantly associated with a higher frequency of belching events (odds ratio = 6.59, P < 0.001). Central obesity, female, and younger age were also risk factors for frequent belching during EGD. Subgroup analyses were performed in subjects without erosive reflux disease (n = 378) and NERD (n = 293). NERD was also a predictive factor for frequent belching during EGD (odds ratio = 6.61, P < 0.001), and the frequency of belching was significantly correlated with GERD severity according to the Los Angeles classification (P < 0.05). Frequent belching during EGD was associated with GERD, including NERD. Future research should focus on its adjuvant role in the diagnosis of GERD/NERD and the necessity for applying differentiated endoscopy strategies for GERD patients, leading to less discomfort during EGD in patients at risk for intolerability.     

The relationship between gastroesophageal reflux disease and sleep

Recent studies demonstrate a bidirectional relationship between gastroesophageal reflux disease (GERD) and sleep in which nighttime reflux leads to sleep deprivation and sleep deprivation can exacerbate GERD by enhancing perception of intraesophageal stimuli. Current treatment primarily focuses on reducing nighttime reflux, thus improving sleep quality. Future studies are needed to further explore the relationship between GERD and sleep and the potential of novel therapeutic options to interrupt the vicious cycle between them.     

产后不同程度的抑郁症状与胃食管反流病的相关性

目的探讨产后不同程度的抑郁症状与胃食管反流病的相关性。 方法自2018年8月至2019年3月在新疆维吾尔自治区人民医院妇产科门诊行产前检查,经住院分娩的初产妇82例设定为研究组。要求所有孕产妇均于产后2~8周进行焦虑自评量表（SAS）、抑郁自评量表（SDS）、爱丁堡产后抑郁自测量表（EPDS）以及GERD量表来调查分析产妇抑郁患病率及GERD相关症状的发生频率和严重程度。 结果孕期至产后2~8周的随访调查发现,孕期SDS和SAS问卷调查中出现的轻中重度抑郁焦虑者中,产后抑郁［EPDS（+）］患病率有所增加,这说明孕期有抑郁、焦虑等不良情绪的产妇产后抑郁症发病率相对较高。经SDS评分显示的EPDS（+）总例数21例产妇和EPDS（-）总例数61例产妇进行GERD症状评分分析,发现EPDS（+）组产妇GERD相关症状（反酸、烧心、胸骨后疼及睡眠障碍）的患病率均显著高于EPDS（-）组（P＜0.01）;产后抑郁（EPDS）评分相关性分析发现,反酸、烧心、胸骨后疼及睡眠障碍等GERD相关症状的发生频率与抑郁的严重程度呈正相关（P＜0.01）。 结论产后抑郁症患者GERD患病率较高,且随着抑郁严重程度其患病率逐渐增高。     

胃食管反流病与颈椎病相关性研究

目的探讨颈椎病患者是否为胃食管反流病(gastroesophageal reflux disease,GERD)的高发人群。方法 321例经临床及磁共振诊断为颈椎病的患者作为颈椎病组,同期选取249名健康体检者作为对照组,进行RDQ评分问卷调查,比较颈椎病组及对照组的RDQ评分及GERD发生率差异是否有统计学意义,颈痛程度与RDQ评分是否相关,并对可能危险因素及颈椎病分型情况进行统计学分析。结果颈椎病组RDQ评分明显高于对照组(P0.05);以RDQ评分≥12分作为GERD评判标准,颈椎病组GERD 43例(13.4%),对照组GERD 17例(6.8%),颈椎病组GERD发生率明显高于对照组(P0.05);不同颈痛程度组间RDQ评分差异有统计学意义(P0.05);各型颈椎病中,交感神经型发生GERD的风险明显高于其他各型(P0.05);颈椎病合并GERD的危险因素主要为女性、非甾体抗炎药和精神心理因素。结论颈椎病患者发生GERD的风险较高,且以交感神经型最为显著。女性、药物和精神心理因素是颈椎病合并GERD的主要危险因素。     

胃食管反流病与心房颤动

心房颤动（房颤）是临床上最常见的持续性心律失常,可导致患者死亡率升高。胃食管反流是消化科的常见病症,是胃内容物反流入食管引起的不适症状和／或并发症。有研究报道胃食管反流可能会引起房颤。炎症、迷走神经刺激和慢性心房缺血可能是其中的重要机制,炎症反应和自主神经功能异常参与房颤和胃食管反流病的发生发展。本文结合国内外文献对房颤与胃食管反流间的关系及其可能机制进行综述。     

Prevalence of gastroesophageal reflux disease and gastroesophageal reflux disease symptoms in Japan

BACKGROUND AND AIM: Epidemiological studies have shown that 10-48% of people in developed countries have gastroesophageal reflux disease (GERD) symptoms such as heartburn and acid regurgitation. The present study aimed to examine the prevalence of GERD symptoms and GERD in Japanese subjects. METHODS: A cross-sectional study of Japanese subjects who visited a clinic for a routine health check up was carried out. Subjects were asked to fill out a self-report questionnaire. GERD was defined as the presence of heartburn and/or acid regurgitation at least twice per week. RESULTS: Of the 6035 eligible subjects, 2662 (44.1%) reported having had heartburn and/or acid regurgitation during the past year: 124 (2.1%) daily, 275 (4.6%) twice per week, 773 (12.8%) twice per month and 1490 (24.7%) less than twice per month. Three hundred and ninety-nine (6.6%) subjects were diagnosed as having GERD and there was no relationship between the prevalence of GERD and either sex or age. The prevalence of bothersome GERD symptoms was significantly higher in subjects with GERD than in those without GERD. CONCLUSION: Approximately 6.6% of Japanese have GERD and most persons with GERD described heartburn or acid regurgitation as bothersome.     

胃食管反流病中医分型与酸反流的关系

目的研究胃食管反流病(gastroesophageal reflux disease,GERD)的中医的辨证分型与酸反流各项指标的关系,为本病辨证分型寻求特征性的客观指标.方法通过对97例经24 h食管pH值动态监测和内镜检查确诊为GERD的患者的临床观察,以临床四诊资料为基础,在中医理论指导下,对其进行病位、病性、病因、病机的辨证分析,从而筛选出本病的主要证型.在此基础上,选用24 h食管pH值动态监测的多项酸反流指标,运用多种统计学分析方法,研究各主要证型与食管酸反流多项指标之间的关系.结果 GERD 97例的辨证分型筛选出的主要证型有肝胃郁热、肝胃不和、脾胃虚弱、胃热气逆、痰气郁阻5型.总反流次数在肝胃郁热型中显著高于肝胃不和、脾胃虚弱、痰气郁阻型,在胃热气逆型中显著高于脾胃虚弱、痰气郁阻型(P＜0.05);总pH＜4时间百分率和反流总分在肝胃郁热、肝胃不和、胃热气逆型中显著高于脾胃虚弱型(P＜0.05).酸反流的症状指数≥50%病例数的百分率在肝胃不和、肝胃郁热、胃热气逆型中极显著高于其余各证型(P＜0.01).酸反流体位分型为混合型的病例数的百分率在脾胃不和、痰气郁阻型中显著高于其余各证型(P＜0.05).结论 GERD的中医辨证分型与某些食管酸暴露参数之间存在明显关系.     

Prevalence of gastroesophageal reflux disease and gastroesophageal reflux disease symptoms in Japan

Background and Aim:  Epidemiological studies have shown that 10–48% of people in developed countries have gastroesophageal reflux disease (GERD) symptoms such as heartburn and acid regurgitation. The present study aimed to examine the prevalence of GERD symptoms and GERD in Japanese subjects.
Methods:  A cross-sectional study of Japanese subjects who visited a clinic for a routine health check up was carried out. Subjects were asked to fill out a self-report questionnaire. GERD was defined as the presence of heartburn and/or acid regurgitation at least twice per week.
Results:  Of the 6035 eligible subjects, 2662 (44.1%) reported having had heartburn and/or acid regurgitation during the past year: 124 (2.1%) daily, 275 (4.6%) twice per week, 773 (12.8%) twice per month and 1490 (24.7%) less than twice per month. Three hundred and ninety-nine (6.6%) subjects were diagnosed as having GERD and there was no relationship between the prevalence of GERD and either sex or age. The prevalence of bothersome GERD symptoms was significantly higher in subjects with GERD than in those without GERD.
Conclusion:  Approximately 6.6% of Japanese have GERD and most persons with GERD described heartburn or acid regurgitation as bothersome.     

咽喉反流病与胃食管反流病关系的研究进展

咽喉反流病与胃食管反流病是耳鼻喉及消化系统的常见疾病,因为患病率的不断增高,二者的诊断与治疗不断受到重视。但因其二者的发病机制仍不完全明确,目前的诊疗仍存在争议。本文结合国内外有关咽喉反流病与胃食管反流病的文献,通过二者发病机制、诊疗现状的特点,阐述其关系,以为后续的研究和临床实践提供参考。     

Temporal correlation between chronic cough and gastroesophageal reflux disease

Reflux disease (GERD) and chronic cough often coexist, but a temporal correlation using the symptom association probability has not been reported. Our aim was to determine if a temporal correlation exists between cough and GERD. Sixty-one patients with chronic cough had esophageal pH monitoring with sensors 5 and 20 cm above the LES. The symptom (SI) and symptom sensitivity (SSI) indices and the symptom association probability (SAP) were used to test cough–reflux association. Pathological reflux was defined as the percentage of time pH <4 exceeded 4.2%. A significant temporal association between cough and distal reflux was made in 35% of patients by SAP compared with only 14.8% by SI and SSI alone (P < 0.002). Patients with pathologic reflux had a greater likelihood of a temporal symptom correlation (57.1%) when not on acid-blocking medications. In conclusion, a temporal association between cough and distal reflux exists in one third of patients, especially those with pathological reflux. The SAP is a more sensitive measure of temporal association than SI or SSI.     

胃食管反流病与幽门螺杆菌感染

幽门螺杆菌(Helicobacterpylori,Hp)是公认的慢性胃炎与消化性溃疡病的重要致病因子之一。近年来在溃疡病的治疗中,除研制出许多强力制酸药外,还着力寻求根治Hp的治疗方案。实践证明,抑酸剂加上敏感的抗菌素,明显提高了溃疡病的治疗效果,不仅可以促进溃疡的愈合,而且明显减少溃疡病的复发率。然而有趣的是,人们发现,随着Hp     

无效食管运动与胃食管反流病关系的探讨

目的 探讨无效食管运动(IEM)与胃食管反流病(GERD)的关系.方法 对90例GERD全部进行胃镜检查并做食管压力测定和24h食管动态pH监测,其中反流性食管炎(RE)组62例,非糜烂性反流病(NERD)组28例.研究IEM与食管酸暴露及RE的关系.结果 RE组中确诊IEM 30例(48.4％)明显高于NERD组6例(21.4％)(P＜0.05).36例IEM患者33例(91.7％)食管酸暴露阳性,高于食管动力正常患者( 28/49,57.2％)(P＜0.01);远端食管pH ＜4总反流时间、卧位反流时间百分比、＞5 min长反流周期数、最长反流时间、DeMeester评分IEM者明显高于食管动力正常者(P＜0.01),反流周期数前者明显高于后者(P＜0.05).结论 IEM在GERD中较常见,其食管动力障碍中绝大多数为IEM,IEM与食管远端酸暴露及RE密切相关.     

Potential relationship between gastroesophageal reflux disease and atrial arrhythmias

A potential reduction in symptoms related to atrial fibrillation after treatment of gastroesophageal reflux disease symptoms with proton pump inhibitor therapy has been previously described. However, illustration of this relationship by combined 24-hour pH and ambulatory Holter monitoring has not been performed. We report 3 patients with symptoms of both palpitations and reflux who underwent simultaneous Holter and 24-hour ambulatory pH monitoring off of antireflux therapy. All of the patients reported a reduction in arrhythmia symptoms on proton pump inhibitor therapy. The findings from this preliminary series suggest a potential relationship between gastroesophageal reflux disease and atrial arrhythmias that might improve with antireflux therapy. Patients with documentation of both atrial arrhythmias and reflux should have a trial of aggressive acid suppressive therapy To further confirm this relationship, larger prospective studies are needed to assess whether maximal acid suppression improves arrhythmias.