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Esophageal epithelial surface in patients with gastroesophageal reflux disease: An electron microscopic study  [cached]
Takane Azumi, Kyoichi Adachi, Kenji Furuta, Shuji Nakata, Shunji Ohara, Kenji Koshino, Masaharu Miki, Terumi Morita, Takashi Tanimura, Nobuo Ashizawa, Yoshikazu Kinoshita
World Journal of Gastroenterology , 2008,
Abstract: AIM: To investigate the intercellular spaces between the most superficially located esophageal epithelial cells in patients with gastroesophageal reflux disease (GERD).METHODS: Eighteen patients with erosive esophagitis, 10 patients with non-erosive reflux disease (NERD), and 18 normal asymptomatic volunteers were enrolled. Biopsy specimens were obtained from the lower esophageal mucosa without ulcer or erosion. Scanning electron microscopy was employed to investigate the tightness of the superficial cellular attachment.RESULTS: The intercellular space between the most superficially located epithelial cells in patients with erosive esophagitis or NERD was not different from that in asymptomatic healthy individuals.CONCLUSION: Widened luminal intercellular spaces of esophageal superficial epithelium are not responsible for the induction of reflux symptoms in patients with GERD.
The Evaluation of Gastroesophageal Reflux Disease with Esophageal pH Monitorization in Children  [cached]
Gülin Erdemir,Taner ?zgür,Yakup Can?tez,Bülent Kay?k
Güncel Pediatri , 2009,
Abstract: Introduction: Gastroesophageal reflux disease is named when gastroesophageal reflux becomes symptomatic, influences the life comfort, and results in morbidity. In this study, we aimed to evaluate the patients admitted with GER-associated symptoms with demographic characteristics, 24-hour esophageal pH monitorization results, and responses to different treatment protocols. Materials and Method: The data of patients who admitted to Uludag University Pediatrics Outpatient Clinic between January 2008 and September 2009 with GERD-associated symptoms and underwent esophageal pH monitorization was collected retrospectively. The associations between initial symptoms, 24-hour esophageal pH monitorization results, presence of accompanying disease, sociocultural conditions, and therapy responses were evaluated. Results: Ninety-two patients (37 female, 55 male) were included and mean age was 4.42±4.33 (1 mo-18 years). The frequency of cough, vomiting and abdominal pain at admission were 49.5%, 47.3% and 22% respectively. Esophageal pH monitorization diagnosed GERD in 21 patients (22.8%). The frequency of symptoms in GERD patients who diagnosed with esophageal pH monitorization was; cough (n:15, 33.4%), vomiting (n:11, 25.6%), and abdominal pain (n:5, 22.3%). Among all complaints, cough was found to be significantly associated with GERD (p=0.041). Accompanying neurological disease was present in 13.1% (n:12), immunodeficiency 13.1% (n:12) and bronchial reactivity 13.1% (n:12). Therapy success was achieved in 57.7% of patients. Therapy response were similar with different therapy protocols (proton pump inhibitor+prokinetic+sucralfate, proton pump inhibitor+prokinetic, H2 receptor blocker+sucralfate, proton pump inhibitor+sucralfate, H2 receptor blocker+ prokinetic, monotherapy with proton pump inhibitor or H2 receptor blocker) (p=0.068).Conclusion: GERD is a common childhood disease. Currently, diagnosis and treatment of GERD in children is still controversial. The results of our study revealed no association with therapy success and different treatment regimens, sociocultural status or accompanying disease. The complaint of cough was found to be significantly in association with GERD. (Journal of Current Pediatrics 2009; 7: 130-6)
Helicobacter pylori eradication improves acid reflux and esophageal motility in patients with Gastroesophageal Reflux Disease and antral gastritis  [cached]
T. Maris,A. Ilias,D. Kapetanos,A. Augerinos
Annals of Gastroenterology , 2009,
Abstract: Introduction: The relationship between Ηelicobacter pylori (Hp) gastritis, the most common infection worldwide and Gastroesophageal Reflux Disease (GERD), a major health problem in Western Countries, remains controversial. AIM: To investigate the association between Hp infection and GERD and the impact of Hp eradication on esophageal acid exposure and esophageal motility in Hp-positive patients with GERD. Methods: Twenty seven Hp-positive (group I) and 20 Hp-negative (group II) patients with GERD underwent endoscopy- biopsy, esophageal manometry and 24-hour pH-metry. All group I patients received eradication treatment and six months later they were re-evaluated with 24-hour pHmetry, esophageal manometry and endoscopy-biopsy. Results: There were no significant differences between the two groups regarding sex, age, grade of esophagitis, manometric and pH-metry findings. All Hp-positive patients had antrum predominant gastritis. In all group I patients’ eradication of Hp was successful. Gastritis and esophagitis were healed in all patients. The mean Lower Oesophageal Sphincter Pressure (LOSP) showed a significant increase of 11.7 mmHg before and 12.48 mmHg after eradication (p<0.04). A significant decrease in DeMeester score was observed (mean score 62.92 before versus 41.88 after eradication (p<0.01). Conclusions: 1. In patients with GERD the presence of Hp has no impact on manometric and pH-metry findings. 2 The eradication of Hp infection results in increase in LOSP with a consequent decrease in esophageal acid exposure.
Impact of prolonged 48-h wireless capsule esophageal pH monitoring on diagnosis of gastroesophageal reflux disease and evaluation of the relationship between symptoms and reflux episodes
Domingues, Gerson Ricardo de Souza;Moraes-Filho, Joaquim Prado P.;Domingues, Aline Gon?alves Leite;
Arquivos de Gastroenterologia , 2011, DOI: 10.1590/S0004-28032011000100006
Abstract: context: gastroesophageal reflux disease is one of the most common digestive diseases and an important cause of distress to patients. diagnosis of this condition can require ambulatory ph monitoring. objectives: to determine the diagnostic yield of a wireless ambulatory ph monitoring system of 48-hours, recording to diagnose daily variability of abnormal esophageal acid exposure and its symptom association. methods: a total of 100 consecutive patients with persistent reflux symptoms underwent wireless ph capsule placement from 2004 to 2009. the wireless ph capsule was deployed 5 cm proximal to the squamocolumnar junction after lower esophageal sphincter was manometrically determined. the ph recordings over 48-h were obtained after uploading data to a computer from the receiver that recorded ph signals from the wireless ph capsule. the following parameters were analyzed: (1) percentual time of distal esophageal acid exposure; (2) symptom association probability related to acid reflux. the results between the first and the second day were compared, and the diagnostic yield reached when the second day monitoring was included. results: successful ph data over 48-h was obtained in 95% of patients. nearly one quarter of patients experienced symptoms ranging from a foreign body sensation to chest pain. forty-eight hours ph data analysis was statistically significant when compared to isolated analysis of day 1 and day 2. study on day 2 identified seven patients (30.4%) that would be missed if only day 1 was analyzed. three patients (18.7%) out of 16 patients with normal esophageal acid exposure on both days, showed positive symptom association probability, which generated an increase in diagnostic yield of 43.4%. conclusion: esophageal ph monitoring with wireless capsule is safe, well tolerated, does not require sedation. the extended 48-h period of study poses an increased yield to diagnose gastroesophageal reflux disease patients.
Neuro-regulation of lower esophageal sphincter function as treatment for gastroesophageal reflux disease  [cached]
Anupender Singh Sidhu, George Triadafilopoulos
World Journal of Gastroenterology , 2008,
Abstract: The junction between the esophagus and the stomach is a specialized region, composed of lower esophageal sphincter (LES) and its adjacent anatomical structures, the gastric sling and crural diaphragm. Together these structures work in a coordinated manner to allow ingested food into the stomach while preventing reflux of gastric contents across the esophago-gastric junction (EGJ) into the esophagus. The same zone also permits retrograde passage of air and gastric contents into esophagus during belching and vomiting. The precise coordination required to execute such a complicated task is achieved by a finely-regulated high-pressure zone. This zone keeps the junction between esophagus and stomach continuously closed, but is still able to relax briefly via input from inhibitory neurons that are responsible for its innervation. Alterations of the structure and function of the EGJ and the LES may predispose to gastroesophageal reflux disease (GERD).
Sonographic measurement of abdominal esophageal length as a diagnostic tool in gastroesophageal reflux disease in infants  [cached]
Dehdashti Hamid,Dehdashtian Masoud,Rahim Fakher,Payvasteh Mehrdad
Saudi Journal of Gastroenterology , 2011,
Abstract: Background/Aim: This study was conducted to provide sonographic measurements of the abdominal esophagus length in neonates and infants with and without gastroesophageal reflux disease (GERD) and to investigate its diagnostic value. GERD severity was also evaluated and correlated with esophageal length. It is a prospective case-control study. Materials and Methods: This prospective case-control study comprised 235 neonates and infants (120 without reflux and 115 with reflux). There were 40 children without reflux in each of three age categories: less than 1 month, 1-6 months, and 6-12 months. Of the children with reflux, 40 were less than 1 month old; 37, 1-6 months; and 38, 6-12 months. The abdominal esophagus was measured from its entrance into the diaphragm to the base of gastric folds in fed infants. GERD was sonographically diagnosed and confirmed by a barium meal. The number of refluxes during a 10-min period were recorded. Results: Neonates and infants with reflux had a significantly shorter abdominal esophagus than subjects without reflux: the mean difference in neonates, 4.65 mm; 1-6 months, 4.57 mm; 6-12 months, 3.61 mm. Conclusions: Children with severe reflux had a shorter esophagus compared with those with mild and moderate reflux only in the neonate group. Therefore, thinking of GERD and carefully looking for its symptoms is necessary to avoid unnecessary utilization of healthcare resources in children with severe reflux.
Esophageal cell proliferation in gastroesophageal reflux disease: Clinical-morphological data before and after pantoprazole  [cached]
Carlo Calabrese, Davide Treré, Giuseppina Liguori, Veronica Gabusi, Manuela Vici, Giovanna Cenacchi, Massimo Derenzini, Giulio Di Febo
World Journal of Gastroenterology , 2009,
Abstract: AIM: To evaluate esophageal mucosal defense mechanisms at an epithelial level to establish if pantoprazole treatment can induce ultrastructural healing and improvement in the proliferation activity of the esophageal epithelium in gastroesophageal reflux disease (GERD).METHODS: This was a single-blinded study for pH-monitoring, and histological, ultrastructural and MIB1 immunostaining evaluation. Fifty eight patients with GERD were enrolled and underwent 24 h pH-monitoring and endoscopy. Patients were treated for 12 and 24 mo with pantoprazole. Esophageal specimens were taken for histological and ultrastructural evaluation, before and after the treatment.RESULTS: With transmission electron microscopy, all patients with GERD showed ultrastructural signs of damage with dilation of intercellular spaces (DIS). After 3 mo of therapy the mean DIS values showed a significant reduction and the mean MIB1-LI values of GERD showed an increase in cell proliferation. A further 3 mo of therapy significantly increased cell proliferation only in the erosive esophagitis (ERD) group.CONCLUSION: Three months of pantoprazole therapy induced ultrastructural healing of mucosal damage in 89% and 93% of ERD and non-erosion patients, respectively. Moreover, long-term pantoprazole treatment may be helpful in increasing the capability for esophageal cell proliferation in GERD, particularly in ERD patients.
Primary and secondary esophageal contractions in patients with gastroesophageal reflux disease
Aben-Athar, C.G.;Dantas, R.O.;
Brazilian Journal of Medical and Biological Research , 2006, DOI: 10.1590/S0100-879X2006000800005
Abstract: we studied the primary and secondary esophageal peristalsis in 36 patients with heartburn and acid regurgitation and in 14 asymptomatic volunteers. primary peristalsis was elicited by ten swallows of a 5-ml bolus of water and secondary peristalsis was elicited by intra-esophageal infusion of 5, 10, and 15 ml water, 0.1 n hydrochloric acid and air. esophageal contractions were measured by an 8-lumen manometric catheter assembly incorporating a 6-cm sleeve device. contractions were registered at 3, 9, and 15 cm from the upper margin of the sleeve and the infusion was done through a side hole located at 12 cm. twenty patients had normal endoscopic esophageal examination, 10 with normal (group i) and 10 with abnormal ph-metric examination (group ii), and 16 had esophagitis (group iii). the amplitude of contractions after swallows was lower (97.8 ± 10.0 mmhg) in the distal esophagus of group iii patients than in controls (142.3 ± 14.0 mmhg). patients of group iii had fewer secondary contractions (water: 25% of infusion) than patients of the other groups and controls (67% of infusion). patients of group iii also had a lower amplitude of secondary peristalsis in the distal esophagus (water: 70.1 ± 9.6 mmhg) than controls (129.2 ± 18.2 mmhg). we conclude that patients with esophagitis have an impairment of primary and secondary peristalsis in the distal esophagus.
Association of Esophageal Inflammation, Obesity and Gastroesophageal Reflux Disease: From FDG PET/CT Perspective  [PDF]
Yen-Wen Wu, Ping-Huei Tseng, Yi-Chia Lee, Shan-Ying Wang, Han-Mo Chiu, Chia-Hung Tu, Hsiu-Po Wang, Jaw-Town Lin, Ming-Shiang Wu, Wei-Shiung Yang
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0092001
Abstract: Objective Gastroesophageal reflux disease (GERD) is associated with bothersome symptoms and neoplastic progression into Barrett's esophagus and esophageal adenocarcinoma. We aim to determine the correlation between GERD, esophageal inflammation and obesity with 18F-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). Methods We studied 458 subjects who underwent a comprehensive health check-up, which included an upper gastrointestinal endoscopy, FDG PET/CT and complete anthropometric measures. GERD symptoms were evaluated with Reflux Disease Questionnaire. Endoscopically erosive esophagitis was scored using the Los Angeles classification system. Inflammatory activity, represented by standardized uptake values (SUVmax) of FDG at pre-determined locations of esophagus, stomach and duodenum, were compared. Association between erosive esophagitis, FDG activity and anthropometric evaluation, including body mass index (BMI), waist circumference, visceral and subcutaneous adipose tissue volumes were analyzed. Results Subjects with erosive esophagitis (n = 178, 38.9%) had significantly higher SUVmax at middle esophagus (2.69±0.74 vs. 2.41±0.57, P<.001) and esophagogastric junction (3.10±0.89 vs. 2.38±0.57, P<.001), marginally higher at upper esophageal sphincter (2.29±0.42 vs. 2.21±0.48, P = .062), but not in stomach or duodenum. The severity of erosive esophagitis correlated with SUVmax and subjects with Barrett's esophagus had the highest SUVmax at middle esophagus and esophagogastric junction. Heartburn positively correlated with higher SUVmax at middle oesophagus (r = .262, P = .003). Using multivariate regression analyses, age (P = .027), total cholesterol level (P = .003), alcohol drinking (P = .03), subcutaneous adipose tissue (P<.001), BMI (P<.001) and waist circumference (P<.001) were independently associated with higher SUVmax at respective esophageal locations. Conclusions Esophageal inflammation demonstrated by FDG PET/CT correlates with endoscopic findings and symptomatology of GERD. Obesity markers, both visceral and general, are independent determinants of esophageal inflammation.
Epidemiologic aspects in esophageal pathology focusing on gastroesophageal reflux disease and Barrett’s esophagus  [PDF]
George S?raci,?tefan Cristian Vesa,Oliviu Pascu
Human & Veterinary Medicine , 2011,
Abstract: Objective: To determine the main epidemiologic characteristics of esophageal pathology,insisting on gastroesophageal reflux disease (GERD), Barrett’s esophagus (BE) and to evaluate therelationship between these conditions and some widely spread risk factors. Material and methods: Datawere collected from clinical file records archive, endoscopy reports and histopatologic reports and slidesfor 8225 patients (01.01.2005-31.07.2007) who presented esophageal changes during upper digestiveendoscopy. We used Kolmogorov-Smirnov test to assess the normality of variables distribution and thenwe used parametric or non-parametric tests along with multivariate analysis. Results: BE is associatedwith male sex (r=0.039; p<0.001), esophagitis (p=0.001), gastric surgery (r=0.027; p=0.015). BE isnegatively associated with esophageal varices (r=-0.1; p<0.01) and Helicobacter pylori (Hp) infection(r=0.024; p=0.02). Age is not an important factor (OR=0.99; p=0.03). Presence of sliding hiatal hernia(SHH) is influenced by body mass index (r=0.533; p<0.001) and female sex (p=0.001). SHH sizeinfluences the severity of esophagitis (r=0.04; p<0.01). The most frequent type of metaplasia is theincomplete intestinal one and the most frequent form of esophageal cancer is adenocarcinoma.Conclusion: BE is associated positively with GERD, esophagitis, male sex and negatively with Hp andesophageal varices. SHH influences severity of esophagitis and is more frequent in female patients.Adenocarcinoma is more frequent that squamous esophageal cancer.

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