Impairment of chemical clearance is relevant to the pathogenesis of refractory reflux oesophagitis

BackgroundThe pathophysiological mechanisms underlying proton pump inhibitor-refractory reflux oesophagitis has been scarcely studied.AimsTo assess impedance-pH parameters relevant to the pathogenesis of refractory reflux oesophagitis.MethodsCases referred for heartburn/regurgitation refractory to high-dosage proton pump inhibitors between January 2008 and December 2012 were reviewed and subdivided into refractory oesophagitis (29 patients, 72% males, median age 50 years), healed oesophagitis (18 patients, 67% males, median age 54 years), and non-erosive reflux disease (49 patients, 53% males, median age 42 years). On-therapy impedance-pH tracings were blindly re-analysed by one observer to assess gastric and oesophageal acid exposure time and chemical clearance as expressed by the post-reflux swallow-induced peristaltic wave index.ResultsThe median gastric and oesophageal acid exposure time did not differ among the three groups (35%, 34%, 41% and 1.2%, 0.7%, 0.8%, respectively; P > 0.05 for all comparisons). A normal oesophageal acid exposure time was found in two thirds of patients with refractory oesophagitis. The post-reflux swallow-induced peristaltic wave index was significantly lower in refractory oesophagitis (16%) than in healed oesophagitis (30%) and non-erosive reflux disease (29%) (P = 0.003).ConclusionsRefractory reflux oesophagitis is characterized by impairment of chemical clearance. Adequate acid suppression is found in the majority of patients who would likely not benefit from further proton pump inhibitor dose escalation.     

Hypomagnesemia in the intensive care unit: Choosing your gastrointestinal prophylaxis,a case report and review of the literature

We report a case of symptomatic hypomagnesaemia in medical intensive care unit that is strongly related to proton pump inhibitors (PPIs) and provide literature review. A 65-year-old male with severe gastroesophageal reflux on omeprazole 20 mg orally twice a day, who presented to the hospital with abdominal pain, nausea, diarrhea, and new onset seizures. On admission, his serum magnesium level was undetectable. Electrocardiogram showed a new right bundle branch block with a prolonged QT interval. The hypomagnesemia was corrected with aggressive magnesium supplementation and hypomagnesemia resolved only after the PPI was stopped. Neurologic and cardiac abnormalities were corrected. This is a life-threatening case of an undetectable magnesium level strongly associated with PPI use. In critically, ill patients with refractory hypomagnesemia, we advocate considering changing gastrointestinal prophylaxis from a PPI to a histamine-receptor blocker.     

2015—2017年天津市津南区咸水沽医院消化性溃疡和胃食管反流病药物使用情况分析

目的 了解天津市津南区咸水沽医院消化性溃疡和胃食管反流病药物的使用情况和变化趋势,为促使临床合理用药提供依据。方法 对2015—2017年天津市津南区咸水沽医院消化性溃疡和胃食管反流病药物的使用数量、销售金额、用药频度（DDDs）和日均用药费用（DDC）等进行统计和分析。结果 2015—2017年消化性溃疡和胃食管反流病药物的销售总金额基本呈现先上升后下降趋势,浮动不明显。在2016年其构成比达到了3.62%。胃酸分泌抑制剂的销售总金额始终居首位,胃肠动力药的销售总金额居第2位。2015—2017年,雷贝拉唑钠肠溶胶囊的排名始终排名浮动在前两位,2017年跃居首位。米索前列醇片的DDDs始终保持在第1位,兰索拉唑肠溶片和盐酸苯海拉明注射液的DDDs排名稳定。除了注射用艾司奥美拉唑钠,2015—2016年的注射用兰索拉唑,2015年的盐酸阿扎司琼氯化钠注射液,其他所有消化性溃疡和胃食管反流病药物的DDC都在100以下。结论 天津市津南区咸水沽医院消化性溃疡和胃食管反流病药物应用基本合理,但仍存在一些不足,还需进一步加强消化性溃疡和胃食管反流病药物管理。     

Dental erosion and salivary flow rate in cerebral palsy individuals with gastroesophageal reflux

J Oral Pathol Med (2012) 41 : 367–371 Background: A high prevalence of gastroesophageal reflux (GERD) has been observed in individuals with cerebral palsy (CP). One of the main risks for dental erosion is GERD. This study aimed to evaluate the presence of GERD, variables related to dental erosion and associated with GERD (diet consumption, gastrointestinal symptoms, bruxism), and salivary flow rate, in a group of 46 non‐institutionalized CP individuals aged from 3 to 13 years. Methods: Twenty CP individuals with gastroesophageal reflux (GERDG) and 26 without gastroesophageal reflux (CG) were examined according to dental erosion criteria, drinking habits, presence of bruxism, and salivary flow rate. A face‐to‐face detailed questionnaire with the consumption and frequency of acid drinks, gastrointestinal symptoms (regurgitation and heart burn), and the presence of bruxism were answered by the caregivers of both groups. Unstimulated whole saliva was collected under slight suction, and salivary flow rate (ml/min) was calculated. Results: The GERDG presented higher percentages of younger quadriplegics individuals compared to CG. The presence of regurgitation, heart burn, and tooth erosion (Grade 1) was significantly more prevalent in GERDG. It was observed difference in the salivary flow rate between the studied groups. On logistic multivariate regression analysis, the unique variable independently associated with the presence of GERD was dental erosion (P = 0.012, OR 86.64). Conclusion: The presence of GERD contributes significantly to dental erosion in the most compromised individuals with quadriplegics cerebral palsy individuals, increasing the risk of oral disease in this population.     

Pepsin levels and oxidative stress markers in exhaled breath condensate of patients with gastroesophageal reflux disease

Aim

To evaluate the pepsin and oxidative stress markers in exhaled breath condensate (EBC) in patients with gastroesophageal reflux disease (GERD).

Patients and Method

Patients with a presumptive diagnosis of GERD with recurrent respiratory and gastrointestinal problems aged between 2 and 14 years were included in the study. All patients underwent pH monitoring. Patients with a reflux index (RI) ≥ 4 were assessed as the reflux group, and those with an RO < 4 were assessed as the non-reflux group. Pepsin levels and oxidative stress markers [NO metabolites (NOX) and total sulphydrile (TSH) levels] were measured in the EBC.

Results

There were 24 patients in the reflux group [RI 17.6 (6.6–46.4)] [median, interquartile range] and 23 in the non-reflux group [RI 0.8 (0.5–1.9) (p < 0.001). Pepsin levels in the EBC were below the level of detection. The median levels of NOx in the EBC of children with reflux [13.7 μmol/L (7.3–24.5)] were lower in than non-reflux group [21.0 μmol/L (14.0–25.2)] (p = 0.034). There was a negative correlation between reflux index and NOX levels in EBC (rs: − 0.331, p = 0.023). In contrast, there was no difference in TSH levels between the reflux and non-reflux groups [37.4 μmol/L (30.2–44.6) vs 40.1 μmol/L (37.4–44.9), respectively, (p > 0.05)].

Conclusion

Decreased levels of NOX in patients with GER disease suggest increased oxidative stress in airways of these patients.     

非糜烂性反流病与功能性烧心

罗马Ⅲ标准提出了非糜烂性反流病(NERD)和功能性烧心(FH)的诊断标准,实际上,临床上有时很难区分NERD和FH。NERD和FH是两种发病机制及临床特点不同的异质性疾病,本综述结合目前研究进展,从食管内脏敏感性、食管动力、精神心理因素、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。