Hiatus hernia in healthy volunteers is associated with intrasphincteric reflux and cardiac mucosal lengthening without traditional reflux
Background and aims Hiatus hernia (HH) is a key mediator of gastro-oesophageal reflux disease but little is known about its significance in the general population. We studied the structure and function of the gastro-oesophageal junction in healthy volunteers with and without HH. Methods We compared 15 volunteers with HH, detected by endoscopy or MRI scan, but without gastro-oesophageal reflux disease with 15 controls matched for age, gender and body weight. Jumbo biopsies were taken across the squamocolumnar junction (SCJ). High-resolution pH metry (12 sensors) and manometry (36 sensors) were performed upright and supine, before and after a meal. The SCJ was marked with an endoscopically placed clip and visualised fluoroscopically. Results Cardiac mucosa was longer in volunteers with HH (3.5 vs 2.5 mm, p=0.01). There was no excessive acid reflux 5 cm above the upper border of the lower oesophageal sphincter (LOS) in either group but those with HH had short segment reflux 11 mm above the pH transition point after the meal when supine (pH
Conclusions: Children with rumination syndrome have a distinct pattern of impedance-pH monitoring and can be distinguished amongst children presenting with refractory GERD. Applying a simple scoring system during impedance-pH analysis could lead to early diagnosis of children with rumination syndrome.
Journal of Perinatology, Published online: 21 February 2020; doi:10.1038/s41372-020-0630-4Prolonging gavage feeds for reduction of gastroesophageal reflux in infants
AbstractBackgroundGastro-esophageal reflux disease (GERD) can present with typical or atypical or laryngo-pharyngeal reflux (LPR) symptoms. Pulmonary aspiration of gastric refluxate is one of the most serious variants of reflux disease as its complications are difficult to diagnose and treat. The aim of this study was to establish predictors of pulmonary aspiration and LPR symptoms.MethodsRecords of 361 consecutive patient from a prospectively populated database were analyzed. Patients were categorized by symptom profile as predominantly LPR or GERD (98 GER and 263 LPR). Presenting symptom profile, pH studies, esophageal m...
CONCLUSION: Based on the results of studies of low-to-moderate quality, antireflux surgery improved QoL and reduced oesophageal acid exposure in NN and NI children in the short and medium term. Although antireflux surgery is a common elective operation, the lack of rigorous preoperative and postoperative evaluation(s) in the majority of patient-reported studies is striking. PMID: 32083325 [PubMed - as supplied by publisher]
Refractory gastroesophageal reflux disease (GERD) reduces quality of life and creates significant financial burden on the healthcare system. Approximately 30% of patients with GERD who receive label-dose proton pump inhibitors (PPIs) still have symptoms. We performed a trial to evaluate the efficacy and safety of IW-3718, a bile acid sequestrant, as an adjunct to PPI therapy.
The main side effect of long-term laparoscopic sleeve gastrectomy (LSG) is the onset of severe gastroesophageal reflux disease (GERD).
ConclusionOur systematic review and meta-analysis showed consistent association between abnormal GEFV indicated by Hill ’s classification III/IV and symptomatic GERD and erosive esophagitis. Our recommendation is to include Hill’s classification in routine endoscopy reports and workup for GERD.
AbstractPurpose of reviewTo examine recent key developments in the pathophysiology, diagnosis, and treatment of gastroesophageal reflux disease (GERD).Recent findingsNewer research has suggested cytokine-mediated inflammation may play a role in the physiology of GERD, implying that the underlying mechanism may not be entirely related to chemical damage due to acid. Aided by novel technologies, diagnostic testing is also moving toward elucidating individual mechanisms and better defining specific GERD phenotypes with the goal of providing directed therapy. This is especially important in current times given the increase in ...
AT Abstract Esophageal injury from acid exposure related to gastroesophageal reflux disease is a common problem and a risk factor for development of Barrett's esophagus and esophageal adenocarcinoma. Our previous work highlights the benefits of using porcine esophagus to study human esophageal disease because of the similarities between porcine and human esophagus. In particular, esophageal submucosal glands (ESMGs) are present in human esophagus and proximal porcine esophagus, but not in rodent esophagus. Although CFTR is expressed in the ducts of ESMGs, very little is known about CFTR and alternate anion channe...
Every once in a while, a field that has felt static for decades begins to move. Gastroesophageal reflux disease (GERD) is in one of those times. GERD is a big modern problem with estimates of significant GERD in some 30 million in the United States. For a long while, treatment has boiled down to 2 options: the pill (proton pump inhibitors, PPIs) or the knife (laparoscopic fundoplication). There is no doubt that these treatments benefit a majority of patients suffering from GERD but have also left many dissatisfied.