Prevalence of gastroesophageal reflux symptoms in a large unselected general population in Japan

AIM：To examine the prevalence of gastroesophageal reflux disease （GERD） symptoms in a large unselected general population in Japan.
METHODS： In Japan, mature adults are offered regular check-ups for the prevention of gastric cancer. A notice was sent by mail to all inhabitants aged 〉 40 years. A total of 160 983 Japanese （60 774 male, 100 209 female; mean age 61.9 years） who underwent a stomach check up were enrolled in this study. In addition, from these 160 983 subjects, we randomly selected a total of 82 894 （34 275 male, 48 619 female; mean age 62.4 years） to evaluate the prevalence of abdominal pain. The respective subjects were prospectively asked to complete questionnaires concerning the symptoms of heartburn, dysphagia, and abdominal pain for a 1 mo period.
RESULTS： The respective prevalences of the symptoms in males and females were： heartburn, 15.8% vs 20.7%; dysphagia, 5.4% vs 7.8%; and abdominal pain, 6.6% vs 9.6%. Among these symptoms, heartburn was significantly high compared with the other symptoms, and the prevalence of heartburn was significantly more frequent in females than in males in the 60-89-year agegroup. Dysphagia was also significantly more frequent in female patients.
CONCLUSION： The prevalence of typical GERD symptoms （heartburn） was high, at about 20% of the Japan population, and the frequency was especially high in females in the 60-89 year age group.     

Non-alcoholic fatty liver disease is associated with high prevalence of gastro-oesophageal reflux symptoms

Background

Gastro-oesophageal reflux symptoms are usually reported by patients with obesity and metabolic syndrome. Aim of this study was to assess the prevalence and clinical characteristics of gastro-oesophageal reflux symptoms in subjects with non-alcoholic fatty liver disease.

Methods

Cross-sectional, case–control study of 185 consecutive patients with non-alcoholic fatty liver disease and an age- and sex-matched control group of 112 healthy volunteers. Participants were interviewed with the aid of a previously validated questionnaire to assess lifestyle and reflux symptoms in the 3 months preceding enrolment. Odds ratios were determined before and after adjustment for body mass index, increased waist circumference, physical activity, metabolic syndrome and proton pump inhibitors and/or antiacid medication.

Results

The prevalence of heartburn and/or regurgitation and of at least one of gastro-oesophageal reflux symptoms was significantly higher in the non-alcoholic fatty liver disease group. Non-alcoholic fatty liver disease subjects were associated to higher prevalence of heartburn (adjusted odds ratios: 2.17, 95% confidence intervals: 1.16–4.04), regurgitation (adjusted odds ratios: 2.61, 95% confidence intervals: 1.24–5.48) and belching (adjusted odds ratios: 2.01, 95% confidence intervals: 1.12–3.59) and had higher prevalence of at least one GER symptom (adjusted odds ratios: 3.34, 95% confidence intervals: 1.76–6.36).

Conclusion

Non-alcoholic fatty liver disease is associated with a higher prevalence of gastro-oesophageal reflux symptoms.     

腹腔镜抗反流手术对胃食管反流病主观症状的影响因素分析

目的分析腹腔镜胃底折叠术和食管裂孔疝修补术治疗胃食管反流病（GERD）主观症状改善的因素分析。 方法回顾分析2011年1月至2019年12月于上海长征医院甲乳疝外科接受腹腔镜下抗反流手术92例患者的临床资料。胃底折叠术包括Nissen患者54例和Toupet患者38例。随访108个月,所有患者均通过电话随访,内容包括反流症状（反酸、胃灼热）的改善,术后并发症、满意度等。并以反流和胃灼热症状的复发作为评判抗反流术后疗效的标准。通过χ²检验单因素分析和Logistic回归多因素分析,分析了性别、年龄（60岁为界）、质子泵抑制剂（PPI）使用时间（30和60个月为界）、PPI反应性（良好/不佳）、裂孔疝复发、手术方式（Nissen/Toupet）以及是否应用补片等因素对于GERD相关症状的影响。 结果所有手术均顺利完成,末次随访时共有11例出现反流复发和21例胃灼热复发,其中12例患者自觉食管炎症状（反流、胃灼热）无缓解,手术总满意率为81.52%。末次随访时共有16例存在不同程度的吞咽困难,Niseen组10例,Toupet组6例。反流复发的单因素分析结果表明性别、年龄、手术方式、术前PPI使用时间以及PPI反应性与反流复发无相关性（P>0.05）,裂孔疝复发和是否应用补片是术后反流复发的影响因素（P<0.05）,多因素分析提示裂孔疝复发是术后反流复发的独立影响因素。胃灼热复发的单因素分析结果表明性别、年龄、手术方式、术前PPI使用时间以及应用补片与胃灼热复发无相关性（P>0.05）,但PPI反应性和裂孔疝复发是术后胃灼热复发的影响因素（P<0.05）,多因素分析表明PPI反应性是术后胃灼热复发的独立影响因素。 结论腹腔镜抗反流手术（胃底折叠术和食管裂孔疝修补术）治疗GERD是安全有效的,对于术前PPI反应性较差的患者,手术指征应更加慎重。     

Long-term retention of endoscopically placed hydrogel prostheses at the lower esophageal sphincter in pigs

Background: Using flexible endoscopic methods, hydrogel prostheses can be safely placed, retained for long periods of time, and removed from the esophageal submucosa of pigs. This new technique may have future applications in the treatment of gastroesophageal reflux disease in selected situations. Methods: In a controlled, prospective trial, farm pigs (n = 28) or Sinclair mini-swine (n = 18) underwent sequential placements of 2–13 pliable, radio-opaque hydrogel prostheses into the submucosa of the esophagus during a single endoscopy session. A novel endoscope-overtube device was used. Followup endoscopy and/or fluoroscopy sessions were video-recorded at 6-week, 12-week, 6-month, and yearly intervals. The endoscopic removal of hydrogels was tested in vivo. Necropsy specimens were inspected for signs of chronic inflammation. Results: Overall, 98% of delivery attempts were successful (288/293). Only three hydrogels were lost after 6 weeks. Short-term animals (n = 36) retained 88% of hydrogels for periods up to 6 months. Intact hydrogels (n = 12) were easily removed from four animals at endoscopy. Long-term subjects had two or three hydrogels per animal, using either a beveled-needle device (six pigs) or a trocar design (four pigs). Trocar design: nine of nine prostheses retained at 3 years (100%). Needle design: nine of 10 prostheses retained at 3 years (90%). No significant adverse event occurred. Growth curves were similar between groups. All hydrogels remained pliable to gross inspection upon in vivo removal or necropsy. Pathology showed minimal fibrosis and no chronic inflammation. Conclusions: A novel endoscopic overtube device allows for the successful delivery of multiple hydrogel prostheses with acceptable safety and long term retention rates. These hydrogel prostheses can also be easily removed from the submucosal space of the esophagus.     

Impact of Nocturnal Heartburn on Quality of Life,Sleep, and Productivity: The SINERGE Study

The aim of the SINERGE study was to assess the impact of nocturnal heartburn on quality of life, sleep, and productivity. Ambulatory patients >/=18 years old and classified as defined cases of nocturnal heartburn (n=337), nonnocturnal heartburn (n=139), uncontrolled hypertension (n=198), and symptomatic depression (n=104) were included in this cross-sectional study. Information on age, gender, body mass index, and comorbidity was collected and the following validated questionnaires were applied: SF-12, Pittsburgh Sleep Quality Index, and Work Productivity and Activity Impairment questionnaire. The prevalence of primary care consultation for heartburn and nocturnal heartburn was 4.7% and 1.9%, respectively. Health-related quality of life, sleep, and productivity were significantly impaired in patients with frequent nocturnal heartburn symptoms as compared with those of the patients without nocturnal symptoms or patients with hypertension. Nocturnal heartburn poses a considerable burden for the sufferer because of the impact on quality of life, sleep, and daily activities.     

Patient response to marketing minimally invasive surgery for heartburn

Background: Over 40% of Americans suffer from ``heartburn' at least once a month. This and other manifestations of gastroesophageal reflux (GERD) are often treated with neglect by both patients and their primary care physicians. Diagnostic evaluation is all too often sought only in late stages of the disease. We studied the response to a media campaign promoting minimally invasive surgery as a cure for longstanding heartburn. Methods: The information was publicized on 14 TV and six radio stations over 4 weeks. Patients were referred to an 800-number and data on the following topics were obtained using a standardized questionnaire: demographics, reflux symptoms, previous specialist referral, diagnostic evaluation and treatment, insurance information, and reasons for and expectations in calling. All questionnaires were screened for likelihood of GERD (high, medium, low). A return call was placed to triage patients (surgical or medical appointment, information only, no contact). Results: We received calls from 1,389 potential patients. Based on symptoms, medical therapy, and previous evaluation, 891 (64%) were judged to likely have GERD and assigned high-priority status. Of the patients providing insurance information, 32% were enrolled in an HMO; 29% commercial; 16% Medicare; 14% employer based; and 9% had no insurance. Six hundred ninety-eight high-priority patients were contacted. Of these, 402 (58%) wanted information only; 228 (33%) desired surgical and 68 (%) medical appointments. Two hundred fifteen patients (16% of callers) were seen by a surgical or medical consultant. One hundred thirty-five underwent diagnostic studies, of which 77 (57%) had pathologic esophageal acid exposure. Eighty-three patients have undergone surgery to date—60 laparoscopic and 14 open antireflux procedures; nine had other surgical procedures. Conclusions: Surprisingly, 64% of patients responding to a marketing campaign for heartburn have typical symptoms of GERD, have consulted one or more physicians and/or received medical treatment. More than half the patients tested (77/135) were found to have a positive 24-h pH study, and 78% (60/77) of these elected antireflux surgery to control their reflux symptoms. Received: 3 April 1997/Accepted: 10 June 1997     

Upper Gastrointestinal Symptoms and Associated Disorders in Morbidly Obese Patients: A Prospective Study

Objective To prospectively evaluate the frequency of upper gastrointestinal symptoms and associated disorders in morbidly obese patients with endoscopy and histology prior to their gastric bypass surgery in comparison with age- and sex-matched nonobese control subjects. Methods All patients who were scheduled to undergo laparoscopic gastric bypass for treatment of morbid obesity (body mass index, BMI > 40 kg/m²) during a 1-year period (n = 101) were included in the study. Age- and sex-matched nonobese patients who were seen in the medical clinics during the study period were enrolled as control subjects. The demographic data, total body weight, body mass index, and gastrointestinal symptoms were recorded, and the results of upper endoscopy and histology were tabulated. Endoscopic documentation of hiatal hernia, esophagitis, gastritis, gastric polyps, and peptic ulcer disease was also noted along with the histologic findings of the mucosal biopsies from the upper gastrointestinal tract. Results The prevalence of heartburn as a symptom was significantly higher (P < 0.05) in the morbidly obese patients (32.6%) compared with in the control group (18.8%). Endoscopically, the prevalence of hiatal hernia was also significantly higher (P < 0.05) in the morbidly obese group (38.6%) compared with in the control group (13.8%). Similarly the frequency of endoscopically and histologically identified gastritis was significantly higher (P < 0.01) in the morbidly obese patient group. However, the frequency of histologically identified Helicobacter pylori was not statistically different in the two groups. Conclusion These observations suggest a significant increase in the frequency of heartburn, hiatal hernia, and histologically identified gastritis in morbidly obese patients.