Studies on the Relationship between Esophageal Acid Exposure,Mucosal Lesions and Heartburn Using an Acid Exposure Sensor

Background: In vitro studies of a recently developed acid exposure sensor show that the sensor response (SR) to acid < pH 4 is linearly determined by the duration and degree of acidity. The aim was to determine whether SR correlates with the severity of acid-induced esophageal mucosal lesions and acid-induced heartburn. Methods: HCl pH 1.5 or saline was infused into the feline esophagus for 5-20 min. Simultaneously, sensor measurements were performed below the infusion port. The histological damage was scored by an independent pathologist. In 15 normal subjects, HCl pH 1 was infused into the esophagus and the severity of the heartburn (0-5) was scored at 5-min intervals. In 10 subjects who experienced heartburn during acid perfusion, initial perfusion with HCl was repeated during heartburn induction time minus 5 min, followed by perfusion with the subject's own gastric juice, titrated to pH 2; heartburn severity was again scored at 5-min intervals. Acid exposure sensors positioned below the infusion port were removed at heartburn scores 1, 2 and 3. Results: A good correlation was found between SR and the histological score for mucosal damage in the cat esophagus ( r = 0.64, P < 0.005). There was a good relation between heartburn severity score and acid exposure time ( r = 0.84, P < 0.001), and a significant but weaker relation between heartburn severity and SR. Conclusion: In cats, there is a good relation between the severity of acid-induced esophageal mucosal lesions and SR. In men, there is a significant correlation between the severity of acid-induced heartburn and the simultaneously measured SR. Therefore, SR measurement has the potential of yielding clinically relevant information in the investigation of GERD.     

A Comparison Between Sodium Alginate and Magaldrate Anhydrous in the Treatment of Patients with Gastroesophageal Reflux Symptoms

The aims of the present study were to compare effects of sodium alginate and the antacid magaldrate anhydrous in adults with gastroesophageal reflux (GOR) symptoms.Patients with heartburn and/or acid regurgitation for at least 3 days in the week before the study started (n=203) were randomized to receive a single dose of sodium alginate or magaldrate anhydrous at the onset of symptoms during a 3-day run-in period. Patients with symptoms during the run-in (n=191) were rerandomized to receive a 14-day treatment with either drug given as four daily doses. A speed of action ≤30 min was significantly more frequent among patients in the alginate group (49.4% vs. 40.4%; P=0.0074). A trend toward a more prolonged duration of action (median: 16.5 vs. 12.7 hr) and a greater sum of the symptom intensity difference (median: 40.0 vs. 31.0) was observed in the sodium alginate group. Total disappearance of symptoms was reported in 81.6% and 73.9% of patients in the sodium alginate group and magaldrate group, respectively. We conclude that sodium alginate was faster than magaldrate in relieving GRO symptoms and showed a tendency toward a more prolonged duration of action and a higher level of efficacy.     

Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease

AIM To investigate the effect of dietary fiber on symptoms and esophageal function testing parameters in nonerosive gastroesophageal reflux disease(GERD)(NERD) patients.METHODS Thirty-six NERD patients with low( 20 g/d) dietary fiber intake were enrolled in the study. They were examined with the use of symptom questionnaire(GERD-Q), highresolution esophageal manometry, 24-h esophageal p Himpedance examinations, and food frequency questionnaire before and after 10 d of usual diet supplemented by psyllium 5.0 g TID. Complete data of 30 patients were available to the final analysis. The obtained results were analyzed with the use of non-parametric statistics(Wilcoxon matched pairs test). RESULTS The number of patients experiencing heartburn was less(93.3% at baseline vs 40% at the end of the study, P 0.001) and the GERD-Q score decreased(mean ± SD: 10.9 ± 1.7 vs 6.0 ± 2.3, P 0.001) after the treatment period. Minimal resting lower esophageal sphincter(LES) pressure increased from 5.41 ± 10.1 to 11.3 ± 9.4 mm Hg(P = 0.023), but no change in residual LES pressure and mean resting pressure was found. Total number of gastroesophageal refluxes(GER) decreased from 67.9 ± 17.7 to 42.4 ± 13.5(P 0.001) predominantly by acid and weak acid types of GERs. No significant change in mean esophageal p H and % of time p H 4 was registered. Maximal reflux time decreased from 10.6 ± 12.0 min to 5.3 ± 3.7 min(P 0.05). CONCLUSION Fiber-enriched diet led to a significant increase of minimal lower esophageal sphincter resting pressure, a decrease of number of gastroesophageal refluxes, and a decrease of heartburn frequency per week in NERD.     

The Benefits of Combination Therapy with Esomeprazole and Rebamipide in Symptom Improvement in Reflux Esophagitis: An International Multicenter Study

Background/AimsTo investigate the effects of esomeprazole and rebamipide combination therapy on symptomatic improvement in patients with reflux esophagitis.MethodsA total of 501 patients with reflux esophagitis were randomized into one of the following two treatment regimens: 40 mg esomeprazole plus 300 mg rebamipide daily (combination therapy group) or 40 mg esomeprazole daily (monotherapy group). We used a symptom questionnaire that evaluated heartburn, acid regurgitation, and four upper gastrointestinal symptoms. The primary efficacy end point was the mean decrease in the total symptom score.ResultsThe mean decreases in the total symptom score at 4 weeks were estimated to be −18.1±13.8 in the combination therapy group and −15.1±11.9 in the monotherapy group (p=0.011). Changes in reflux symptoms from baseline after 4 weeks of treatment were −8.4±6.6 in the combination therapy group and −6.8±5.9 in the monotherapy group (p=0.009).ConclusionsOver a 4-week treatment course, esomeprazole and rebamipide combination therapy was more effective in decreasing the symptoms of reflux esophagitis than esomeprazole monotherapy.     

Reflux symptoms in professional opera soloists

BackgroundProfessions distinguished by repeated vocal stress carry a high risk of developing gastroesophageal reflux symptoms (GERS) which may affect vocal performance.AimsTo investigate the prevalence of self-reported GERS in professional opera soloists.MethodsA validated questionnaire regarding self-reported GERS (heartburn, regurgitation, chest pain, dysphagia, hoarseness, and cough) and lifestyle habits was administered to 116 professional opera soloists (mean age 34.1 ± 7.3 years, F:M ratio 1:1.1). Age and sex-matched opera choristers and control subjects were used as control. Prevalence rate ratios (PRRs) adjusted for confounding factors were evaluated.ResultsAmong GERS, belching (33.6%), heartburn (19.8%), and dysphagia (15.5%) were the most commonly reported by soloists. In particular, a higher risk of heartburn (PRR 2.61, 95% CI 1.45–4.69) and dysphagia (PRR 2.58, 95% CI 1.31–5.10) was reported in soloists as compared to choristers. The prevalence of obesity and late dinner was higher in both choristers and soloists in comparison to the population sample (p < 0.001). GERS was more common among soloists who received pharmacologic treatment and their prevalence was unrelated to the years of singing activity.ConclusionsProfessional opera soloists, regardless of the length of their career, are predisposed to developing GERS. Physicians should encourage patients to correct preventable risk factors. A prolonged pharmacological treatment might be needed.     

Esophageal manometry in systemic sclerosis: screening procedure or confined to symptomatic patients?

The predictive value of esophagus-related symptoms for the diagnosis of esophageal dysmotility induced by systemic sclerosis (SSc) was prospectively evaluated in 50 consecutive patients with SSc. Patients were classified as symptomatic when either dysphagia or repeated episodes of heartburn were present. All patients underwent esophageal manometry; SSc-induced esophageal dysfunction was diagnosed when there was aperistalsis or marked hypocontractility of the distal two-thirds of the esophageal body. Twenty-nine patients (58%) had a history of esophagus-related symptoms, while 21 patients (42%) were asymptomatic. Compared to esophageal manometry, esophagus-related symptoms had a sensitivity of 64%, a specificity of 52%, a negative predictive value of 50% and a positive predictive value of 62% for the diagnosis of SSc-induced esophageal dysfunction. In conclusion, the association of esophagus-related symptoms and esophageal motility pattern is poor. As clinical management strategies depend on proof of esophageal dysfunction, screening examinations are mandatory in all patients with SSc. Received: 30 January 1997 / Accepted: 21 April 1997     

NERD患者症状与食管鳞状上皮细胞间隙关系的研究

背景:通过光学显微镜可发现非糜烂性反流病(NERD)患者存在食管鳞状上皮细胞间隙增宽(DIS),但关于不同症状与DIS的研究少见。目的:研究NERD患者症状与食管鳞状上皮细胞间隙之间的关系。方法:选取40例通过内镜检查和质子泵抑制剂试验诊断为NERD的患者,按照症状分为反流组、烧心组和胸痛组,同时选取10名健康志愿者作为对照。行胃镜检查和HE染色,测量光镜下平均细胞间隙(LMIS)。NERD患者同时行症状评分,并分析与LMIS的关系。结果:NERD组LMIS明显高于健康对照组[(1.38±0.43)μm对(0.45±0.07)μm;t=4.47,P=0.00]。反流组、烧心组和胸痛组之间LMIS差异有统计学意义(F=177.89,P<0.01),烧心组、胸痛组又明显高于反流组[(1.46±0.73)μm、(1.45±0.49)μm对(1.34±0.41)μm;P=0.00,P=0.00]。反流组、烧心组和胸痛组LMIS与症状评分之间均呈正相关(r=0.925,P<0.01;r=0.919,P<0.01;r=0.922,P<0.01)。结论:DIS是NERD对食管上皮组织损伤的一种微观变化,与NERD症状发生相关,烧心和胸痛患者DIS变化更为明显。     

Impact of body mass index and gender on quality of life in patients with gastroesophageal reflux disease

AIM: To investigate the symptom presentation and quality of life in obese Chinese patients with gastroesophageal reflux disease (GERD).METHODS: Data from patients diagnosed with GERD according to the Montreal definition, were collected between January 2009 to March 2010. The enrolled patients were assigned to the normal [body mass index (BMI) < 25 kg/m²], overweight (25-30 kg/m²), and obese (BMI > 30 kg/m²) groups. General demographic data, endoscopic findings, and quality of life of the three groups of patients were analyzed and compared.RESULTS: Among the 173 enrolled patients, 102, 56 and 15 patients were classified in the normal, overweight, and obese, respectively. There was significantly more erosive esophagitis (73.3% vs 64.3% vs 39.2%, P = 0.002), hiatal hernia (60% vs 33.9% vs 16.7%, P = 0.001), and males (73.3% vs 73.2% vs 32.4%, P = 0.001) in the obese cases. The severity and frequency of heartburn, not acid regurgitation, was positively correlated with BMI, with a significant association in men, but not in women. Obese patients were prone to have low quality of life scores, with obese women having the lowest scores for mental health.CONCLUSION: In patients with GERD, obese men had the most severe endoscopic and clinical presentation. Obese women had the poorest mental health.     

精神心理因素与功能性食管病

功能性食管病的发病机制是多方面的，近年精神心理因素与功能性食管病的关系越来越受到广泛关注。多项研究显示功能性食管病患者常合并精神心理异常。精神心理因素可通过脑．肠轴机制影响食管动力和感觉功能，在功能性食管病患者的症状发生机制中起重要作用；同时心理异常影响患者的就医行为和预后。因此，在功能性食管病患者的治疗中，针对精神心理异常进行心理干预治疗显得尤为重要。     

Gastroesophageal Reflux Disease: Clinical Features*

Gastroesophageal reflux disease (GERD) is a chronic disease affecting up to 40% of people in the Western world. Risk factors associated with GERD include age and lifestyle habits, although the clinically relevant contribution of many of these factors is unclear. In GERD, refluxed gastric acid damages the oesophageal mucosa, generally when the pH falls below 4. GERD patients present a variety of symptoms, most commonly heartburn and regurgitation. Oesophageal complications associated with GERD include erosions, ulcers, peptic strictures, and Barrett’s oesophagus which is implicated in the development of oesophageal adenocarcinoma. Diagnosis of GERD is problematic due to the range of symptoms which may be presented to the physician and symptom severity is frequently unrelated to disease severity. While endoscopic monitoring may be used to assess the presence and severity of GERD, a lack of visible damage does not necessarily indicate an absence of GERD. Techniques used to diagnose GERD include addition of an acid solution into the oesophagus in order to replicate symptoms (Bernstein test) or 24-hour intra-oesophageal pH monitoring. Proton pump inhibitors are effective in the treatment of GERD, acting to reduce the acidity of the gastric juice and hence reduce oesophageal damage and symptoms associated with GERD. Symptoms most indicative of GERD are those associated with erosive oesophagitis, including heartburn and acid regurgitation. Less common GERD-associated symptoms include chest pain, a range of ear, nose and throat conditions, and asthma. In contrast to perceptions of the disease as ‘merely’ heartburn, the impact on patients’ quality of life can be profound. Increasing awareness of GERD by health care professionals has led to improved diagnosis and a greater appreciation of the need for maintenance therapy. This Commentary is accompanied by a Review article on pp. 432–435.