Hospital discharges resulting from esophagitis among medicare beneficiaries

Despite the frequent occurrence of gastroesophageal reflux disease, until now only very few studies have dealt with the epidemiology of this common disorder. The Health Care Fionancing Administration compiles annually 10 million records of all hospital discharges among Medicare beneficiaries distributed throughout the United States. The purpose of the present study was to take advantage of this large data set and analyze the demographic characteristics of patients discharged with esophagitis, esophageal ulcer, or esophageal stricture. The hospital discharge rates of all three diagnoses showed an age-related rise, the rise being most pronounced for esophageal stricture and, less significant, esophageal ulcer. The marked age dependency of esophageal stricture and ulcer may reflect the time necessary for complications to develop. While simple esophagitis affected women more frequently than men, significantly more men contracted its severe forms involving ulcers and strictures. All forms were more common in whites than blacks, and living in the southern parts of the United States was associated with an increased risk for esophagitis and strictures. The data suggest that besides varying exposure to environmental risk factors, differences in the pathophysiology among demographically stratified groups contribute to the occurrence of esophagitis.     

Drug effects on esophageal smooth muscle

To assess which manometric parameters should be evaluated to discriminate health and esophageal motility disorders, we established normal values for lower esophageal sphincter pressure (LESP), LES residual pressure, percentage and duration of LES relaxation, contraction amplitude in the esophageal body, duration of the contractile waves, mode of wave propagation, and shape of contraction amplitudes as well as upper esophageal sphincter pressure (UESP) in 40 healthy volunteers. The values obtained were compared to values in 25 patients with achalasia, 48 patients with nonspecific motility disorders, and 28 patients with reflux esophagitis. Although significant differences of mean values could be found between health and diseased states of esophageal motility, it was impossible to establish clear cutoff points in individuals due to a large overlap of manometric parameters in healthy volunteers and patients. Further prospective studies are necessary to determine sensitivity, specificity, and predictive values of cutoff lines of manometric data. In addition to the inability to define esophageal motility disorders on the basis of motility parameters alone, there is a lack of correlation between the severity of esophageal symptoms and manometric findings. For example, in diffuse esophageal spasm and related disorders, amplitude, duration, configuration, and propagation of esophageal body contractions are not closely related to the severity of symptoms. In reflux esophagitis, mean LESP does not reflect the extent of symptoms or mucosal damage. Only in achalasia, do LESP and resting pressure of the esophageal body seem to be correlated to dysphagia. It is concluded that drug effects on esophageal motility should be evaluated not primarily by manometric data but by clinical effects.     

Effectiveness of acid suppression in preventing gastroesophageal reflux disease (GERD) after successful treatment of Helicobacter pylori infection

There is evidence that Helicobacter pylori eradication might predispose to gastroesophageal reflux disease (GERD). The aim of this prospective study was to examine the effectiveness of antisecretory treatment, after successful H. pylori eradication, in preventing GERD, since no data exist so far. Eighty initially H. pylori(+) patients, without GERD at the time of H. pylori eradication [50 peptic ulcer (PU) and 30 nonulcer (NU), 55 men, 25 women, median age 38 years, range 19–57], after successful H. pylori eradication were randomized to recieve either omeprazole 20 mg daily (group A) or no treatment (group B) for one year. All patients underwent upper gastrointestinal endoscopy at 0, 6, and 12 months or when GERD symptoms occurred. There were 40 patients in each group, and there were no statistically significant differences between the two groups in terms of sex, age, body weight, ulcer/no ulcer ratio, and other demographic data. Seven patients from group A and five patients from group B were lost to follow-up, and therefore there were 33 and 35 patients in groups A and B, respectively, who completed the study. One of 33 patients in group A (3%) and 10/35 (28.5%) in group B developed GERD symptoms during follow-up (P = 0.0022). The respective values for esophagitis were 0/33(0%) and 6/35(17.1%) (P = 0.0083). In conclusion, antisecretory treatment in H. pylori(+) patients, after successful eradication, is effective in preventing GERD.     

幽门螺杆菌感染与反流性食管炎的关系

目的探讨幽门螺杆菌（Hp）感染与反流性食管炎（RE）的关系。方法对在本院消化科就诊的患者行内镜下快速尿素酶测定却感染，观察比较却阴性组、却阳性组RE的发病率。对却阳性组中经胃镜及病理切片证实为消化性溃疡的患者，进行却根除治疗，3个月后复查胃镜比较抗却治疗前后RE发病率的变化。结果却阳性组RE发病率为5．28％，却阴性组RE发病率为7．59％，二者差异有统计学意义（P〈0．05）。抗却治疗前后RE发病率分别为10．7％、35．7％，二者差异有统计学意义（P〈0．05）。结论①却不是RE的病因；②抗坳治疗会导致RE发病率的升高。     

Reflux oesophagitis in Italy (Diomede project)

AIMS: A multicentric observational study was performed to update the available information on reflux oesophagitis in Italy. METHODS: In phase I, the number and severity of reflux oesophagitis diagnosed in 1 year (2003) were reported together with the associated endoscopic findings. In phase II, oesophagitis patients consecutively referred in a 3-month period were analysed. A multivariate analysis was used to identify the risk factors for severe oesophagitis. RESULTS: 253,992 upper endoscopies were collected. The overall prevalence of oesophagitis was 14.8% and the endoscopic findings associated with oesophagitis were hiatus hernia (46.3%), duodenal ulcer (10.7%), gastric ulcer (3.6%) and Barrett's oesophagus (2.9%). In phase II, 1542 reflux oesophagitis patients were analysed (60.3% males; mean age 50.7 +/-16.6 years). Only 53.4% of patients reported heartburn and/or regurgitation as main complaint. Severe symptoms, age > 50 years, hiatus hernia and male gender were identified as independent predictors of severe oesophagitis. CONCLUSIONS: Oesophagitis is the most frequent among the peptic diseases of the upper gastro-intestinal tract. Only half of the oesophagitis patients reported typical reflux symptoms as dominant. Advanced age, male gender, severe symptoms and hiatus hernia were independent risk factors for severe disease.     

施维舒联合雷贝拉唑钠治疗反流性食管炎的疗效观察

目的：观察施维舒联合雷贝拉唑钠治疗反流性食管炎的临床疗效。方法：选取本院收治的92例反流性食管炎患者,按照随机数字表法将其分为观察组和对照组各46例。两组均口服雷贝拉唑钠和吗丁啉,其中观察组加用施维舒,对照组加用硫糖铝。疗程均为8周。观察比较两组患者的临床有效率、内镜下愈合率和不良反应以及1年后的随访结果。结果：两组治疗后临床积分均明显低于治疗前,且观察组治疗后各时间段临床积分均明显低于对照组,观察组临床症状缓解时间为（9.21±2.94）d,明显短于对照组的（14.34±5.64）d,且总有效率为94.89%,明显高于对照组的79.91%;观察组内镜下食管炎疗效总有效率为95.65%,明显高于对照组的73.91%,而观察组1年复发率为6.52%,明显低于对照组的23.91%,比较差异均有统计学意义（P〈0.05）;两组患者有头痛、恶心反应各1例,无严重不良反应发生。结论：施维舒联合雷贝拉唑钠治疗反流性食管炎有更好的近期疗效和较低的复发率,值得临床推广应用。