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Reflux Symptoms (reflux + symptom)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Gastroenterology & Hepatology	57%
Gastroenterology	17%
Surgery & Surgical Specialties	15%
Pediatrics	3%
2 Other Subdomains	8%

Selected Abstracts

Improvement of Reflux Symptoms 3 Years After Cure of Helicobacter pylori Infection: A Case-Controlled Study in the Japanese Population

HELICOBACTER, Issue 4 2002
Hiroto Miwa
Abstract Background. Development of reflux esophagitis is one of the adverse effects that cause concern in relation to curative treatment of Helicobacter pylori infection. However, recent studies present a rather negative association between curative treatment and development of reflux esophagitis or reflux symptoms. Therefore, this issue has remained controversial. Accordingly, we investigated the long-term adverse effects of H. pylori eradication treatment in special reference to development of reflux symptoms. Patients and Methods. We conducted a case controlled study by mailing structured questionnaires on past (before curative treatment or 3 years previously) and current status. A case was an endoscopically confirmed peptic ulcer patient with confirmed cure of the infection after eradication treatment 3 years previously and a control was one who had not undergone the eradication treatment during the same period. We studied 241 pairs who matched for age, gender, and type of ulcer disease (GU, DU or GDU). Of these pairs, 81.3% were male and the mean age was 52.6 ± 9.6 year (range 23,76). Results. The rates of patients with improved reflux symptoms in the case and control groups were 65.4% and 30.4%, respectively, with the rate being significantly greater in the case group. On the contrary, the rates of those with worsened reflux symptoms were similar (5.1% and 7.6%). Regarding general events, the rate of patients with decreased frequency of hospital visits and of those who regularly used antiacid medications were significantly decreased in the case group. Furthermore, the case group experienced significantly fewer hospital admissions for various diseases in this 3-year period. However, a significantly greater number of case group patients than control subjects gained weight. Conclusion. Reflux symptoms as well as general well-being were significantly improved after cure of H. pylori infection. [source]

Medium-term outcome of fundoplication after lung transplantation

DISEASES OF THE ESOPHAGUS, Issue 8 2009
P. R. Burton
SUMMARY Gastroesophageal reflux disease (GERD) in lung transplant recipients has gained increasing attention as a factor in allograft failure. There are few data on the impact of fundoplication on survival or lung function, and less on its effect on symptoms or quality of life. Patients undergoing fundoplication following lung transplantation from 1999 to 2005 were included in the study. Patient satisfaction, changes in GERD symptoms, and the presence of known side effects were assessed. The effect on lung function, body mass index, and rate of progression to the bronchiolitis obliterans syndrome (BOS) were recorded. Twenty-one patients (13 males), in whom reflux was confirmed on objective criteria, were included, with a mean age of 43 years (range 20,68). Time between transplantation and fundoplication was 768 days (range 145,1524). The indication for fundoplication was suspected microaspiration in 13 and symptoms of GERD in 8. There was one perioperative death, at day 17. There were three other late deaths. Fundoplication did not appear to affect progression to BOS stage 1, although it may have slowed progression to stage 2 and 3. Forced expiratory volume-1% predicted was 72.9 (20.9), 6 months prior to fundoplication and 70.4 (26.8), six months post-fundoplication, P= 0.33. Body mass index decreased significantly in the 6 months following fundoplication (23 kg/m2 vs. 21 kg/m2, P= 0.05). Patients were satisfied with the outcome of the fundoplication (mean satisfaction score 8.8 out of 10). Prevalence of GERD symptoms decreased significantly following surgery (11 of 14 vs. 4 of 17, P= 0.002). Fundoplication does not reverse any decline in lung function when performed at a late stage post-lung transplantation in patients with objectively confirmed GERD. It may, however, slow progression to the more advanced stages of BOS. Reflux symptoms are well controlled and patients are highly satisfied. Whether performing fundoplication early post-lung transplant in selected patients can prevent BOS and improve long-term outcomes requires formal evaluation. [source]

Improvement of Reflux Symptoms 3 Years After Cure of Helicobacter pylori Infection: A Case-Controlled Study in the Japanese Population

Reflux symptoms in wind instrument players

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2010
G. CAMMAROTA
Aliment Pharmacol Ther,31, 593,600 Summary Background, An occupation-related susceptibility of orchestral wind instrument players to gastro-oesophageal reflux was hypothesized. Aim, To compare reflux symptoms reported by wind instrument players with those reported by players of other instruments. Methods, A questionnaire was distributed to 1083 musicians (414 wind instrument players and 669 players of other instruments) from 21 Italian orchestras to obtain information on reflux symptoms in the year preceding the survey together with selected individual characteristics and lifestyle habits. Crude and adjusted prevalence rate ratios (PRR) were computed by a model including gender, age, body mass index, smoking status, alcohol consumption and other confounding factors. Results, Wind instrument players reported a higher prevalence of heartburn in the previous year than the other instrument players (adjusted PRR 1.23, CI 95% 1.04,1.46). Wind instrument players also reported higher, although not fully significant, prevalence of regurgitation (adjusted PRR 1.22, CI 95% 0.97,1.54). Flute and double-reed instrument players seem to carry a higher risk of reflux symptoms. Conclusions, Wind instrument players reported a prevalence of typical reflux symptoms higher than other instrument players. [source]

There are no reliable symptoms for erosive oesophagitis and Barrett's oesophagus: endoscopic diagnosis is still essential

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2002
B. Avidan
Aims: To evaluate the sensitivity and specificity of different symptoms in erosive reflux oesophagitis and Barrett's oesophagus. Methods: The presence of reflux symptoms was compared between a case population of 306 patients with endoscopically determined erosive reflux oesophagitis, 235 patients with biopsy-proven Barrett's oesophagus and a control population of 198 subjects without reflux disease. Results: Heartburn at any time and heartburn at night represented the only two symptoms to be simultaneously sensitive and specific. Symptoms that were induced by various foods, such as fat, tomato, chocolate, citrus or spices, tended to cluster in the same sub-group of patients. Similarly, heartburn induced by exercise, lying down or bending over tended to occur in the same sub-groups. The frequency of symptoms was influenced more by the presence of mucosal erosions than by the presence of Barrett's oesophagus. Reflux symptoms occurred more frequently in the presence rather than the absence of Barrett's oesophagus, and in long segment rather than short segment of Barrett's mucosa. Conclusions: Endoscopic inspection of the oesophageal mucosa remains the only certain method by which to reliably diagnose erosive reflux oesophagitis and Barrett's oesophagus. [source]

Reflux symptoms are associated with psychiatric disease

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 12 2001
B. Avidan
Methods: To evaluate the frequency of reflux symptoms in patients with a diagnosed psychiatric disorder and to assess potential risk factors for symptom occurrence. Methods: The presence of reflux symptoms was compared between a case population of 94 psychiatric patients and a control population of 198 non-psychiatric patients. Results: Heartburn, exercise-induced heartburn, cough and dysphagia were all reported significantly more frequently by subjects with psychiatric disorders than by control subjects. The presence of any psychiatric diagnosis exerted an increased risk for both heartburn (odds ratio, 2.71; 95% confidence interval, 1.01,7.30) and exercise-induced heartburn (3.34; 1.12,9.96). The type of psychiatric disorder, the type of psychotropic medication and the lifestyle did not influence the presence of reflux symptoms. Conclusions: Reflux symptoms occur more frequently in patients with than without a diagnosed psychiatric disorder. The reflux symptoms are not associated with any specific type of medication and may reflect a generally reduced threshold for or distorted perception of symptoms. [source]

Oesophageal and gastric bile exposure after gastroduodenal surgery with Henley's interposition or a Roux-en-Y loop

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2004
J.-Y. Mabrut
Background: The degree which the various reconstruction techniques prevent bile reflux after gastroduodenal surgery has been poorly studied. Methods: Bile exposure in the intestinal tract just proximal to the jejunal loop was measured with the Bilitec 2000® device for 24 h after gastroduodenal surgery in three groups of patients. Group 1 comprised 24 patients with a 60-cm Henley's loop after total gastrectomy. Group 2 included 31 patients with a 60-cm Roux-en- loop after total (22 patients) or subtotal (nine) gastrectomy. Group 3 contained 21 patients with a 60-cm Roux-en- loop anastomosed to the proximal duodenum as part of a duodenal switch operation for pathological transpyloric duodenogastric reflux. Bile exposure, measured as the percentage time with bile absorbance greater than 0·25, was classified as nil, within the range of a control population of healthy subjects, or pathological (above the 95th percentile for the control population). Reflux symptoms were scored and all patients had upper gastrointestinal endoscopy. Results: Bile was detected in the intestine proximal to the loop in none of 24 patients in group 1, eight of 31 in group 2 and 12 of 21 in group 3 (P < 0·001). The mean reflux symptom score increased with the degree of bile exposure, and the proportion of patients with oesophagitis or gastritis correlated well with the extent of bile exposure (P < 0·001). Conclusion: A long Henley's loop was more effective in preventing bile reflux than a long Roux-en- loop. Bilitec® data correlated well with the severity of reflux symptoms and the presence of mucosal lesions. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Health-related quality of life in patients with gastro-oesophageal reflux disease under routine care: 5-year follow-up results of the ProGERD study

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009
M. NOCON
Summary Background, Gastro-oesophageal reflux disease (GERD) is a common disorder associated with substantial reductions in health-related quality of life (HRQL). Aim, To describe patterns of change in HRQL during 5 years of follow-up in a large population of GERD patients. Methods, In 2000, a total of 6215 GERD patients were enrolled in the Progression of GERD (ProGERD) study. During follow-up, patients received any medication considered necessary. HRQL was assessed yearly with the Short-Form 36 and the Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaires. Associations between patient characteristics and changes in HRQL were analysed using multiple logistic regression models. Results, After 5 years, data on HRQL were available for 4597 (74%) patients. Both generic and disease-specific HRQL improved after baseline and remained well above baseline levels in the following years. A clinically relevant decrease in QOLRAD scores was reported by 3,5% of patients. According to our multivariate analysis, a decrease in HRQL was associated with a higher reflux symptom load and the presence of night-time heartburn. Conclusions, Only a small minority of the ProGERD population reported a clinically relevant decrease in HRQL, which was associated most strongly with nocturnal heartburn. [source]

Symptoms in patients on long-term proton pump inhibitors: prevalence and predictors

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2009
A. S. RAGHUNATH
Summary Background, Symptom control in primary care patients on long-term proton pump inhibitor (PPI) treatment is poorly understood. Aim, To explore associations between symptom control and demographics, lifestyle, PPI use, diagnosis and Helicobacter pylori status. Methods, A cross-sectional survey (n = 726) using note reviews, questionnaires and carbon-13 urea breath testing. Determinants of symptom control [Leeds Dyspepsia Questionnaire (LDQ), Carlsson and Dent Reflux Questionnaire (CDRQ), health-related quality-of-life measures (EuroQoL: EQ-5D and EQ-VAS)] were explored using stepwise linear regression. Results, Moderate or severe dyspepsia symptoms occurred in 61% of subjects (LDQ) and reflux symptoms in 59% (CDRQ). Age, gender, smoking and body mass index had little or no influence upon symptom control or PPI use. Average symptom scores and PPI use were lower in patients with non-ulcer dyspepsia and gastro-protection than gastro-oesophageal reflux disease (GERD) and uninvestigated dyspepsia. H. pylori infection was associated with lower reflux symptom scores only in patients with GERD and uninvestigated dyspepsia. EQ-5D was not able to discriminate between diagnostic groups, although the EQ-VAS performed well. Conclusions, A majority of patients suffered ongoing moderate or severe symptoms. GERD and uninvestigated dyspepsia were associated with poorer long-term symptom control; H. pylori appeared to have a protective effect on reflux symptoms in these patients. [source]

Recurrence of intramucosal esophageal adenocarcinoma arising in a former esophagostomy site: a unique case report

DISEASES OF THE ESOPHAGUS, Issue 6 2009
J. M. Leers
SUMMARY., A 75-year-old male with a long history of gastroesophageal reflux symptoms developed adenocarcinoma proximally within a long segment of Barrett's esophagus. He was taken for esophagectomy and gastric pull-up, but intraoperatively, he was found to have a marginal blood supply in the gastric tube. A temporary left-sided esophagostomy was created with the gastric tube sutured to the left sternocleidomastoid muscle in the neck. Pathology showed an intramucosal adenocarcinoma, limited to the muscularis mucosa with surrounding high-grade dysplasia and intestinal metaplasia. The proximal esophageal margin showed no tumor cells, but there was low-grade dysplasia within Barrett's esophagus. He was reconstructed after several months, and 2 years after reconstruction, the patient noticed a nodule at the former esophagostomy site. Biopsy revealed an implant metastasis of esophageal adenocarcinoma. Here, we review the literature and discuss the possible etiology. [source]

Short-term symptom and quality-of-life comparison between laparoscopic Nissen and Toupet fundoplications

DISEASES OF THE ESOPHAGUS, Issue 1 2009
R. Radajewski
SUMMARY Laparoscopic antireflux surgery is an established method of treatment of gastroesophageal reflux disease (GERD). This study evaluates the efficacy of Nissen versus Toupet fundoplication in alleviating the symptoms of GERD and compares the two techniques for the development of post-fundoplication symptoms and quality of life (QOL) at 12 months post-surgery. In this prospective consecutive cohort study, 94 patients presenting for laparoscopic antireflux surgery underwent either laparoscopic Nissen fundoplication (LN) (n = 51) from February 2002 to February 2004 or a laparoscopic Toupet fundoplication (LT) (n = 43) from March 2004 to March 2006, performed by a single surgeon (G. S. S.). Symptom assessment, a QOL scoring instrument, and dysphagia questionnaires were applied pre- and postoperatively. At 12 months post-surgery, patient satisfaction levels in both groups were high and similar (LT: 98%, LN: 90%; P = 0.21). The proportion of patients reporting improvement in their reflux symptoms was similar in both groups (LT: 95%, LN: 92%; P = 0.68), as were post-fundoplication symptoms (LT: 30%, LN: 37%; P = 0.52). Six patients in the Nissen group required dilatation for dysphagia compared with one in the Toupet group (LT: 2%, LN: 12%; P = 0.12). One patient in the Nissen group required conversion to Toupet for persistent dysphagia (P = 0.54). In this series, overall symptom improvement, QOL, and patient satisfaction were equivalent 12 months following laparoscopic Nissen or Toupet fundoplication. There was no difference in post-fundoplication symptoms between the two groups, although there was a trend toward a higher dilatation requirement and reoperation after Nissen fundoplication. [source]

Antireflux stents for palliation of malignant esophagocardial stenosis

DISEASES OF THE ESOPHAGUS, Issue 2 2007
K. Schoppmeyer
SUMMARY., Placement of self-expanding metal stents (SEMS) for palliation of malignant stenoses at the gastroesophageal junction is often associated with stent migration and reflux symptoms. SEMS with an antireflux mechanism have been developed to overcome the latter problem. The aim of this study was to evaluate the safety and efficacy of antireflux Z-stents. Patients with advanced squamous cell or adenocarcinoma of the distal esophagus or cardia suffering from dysphagia received an antireflux Z-stent. Technical success, complications of the procedure, clinical symptoms before and after stent placement, reinterventions and survival were recorded. Follow-up was accomplished by patient interviews and a standardized questionnaire for primary care physicians. Eighteen consecutive patients received an antireflux Z-stent. Seventeen of 18 stents were placed technically successful in a single endoscopic procedure. Mean dysphagia score improved from 2.2 to 0.6. Four patients (22%) had permanent reflux symptoms, an additional nine (50%) were taking proton pump inhibitors on a regular basis. In 10 patients, a re-intervention was necessary mainly due to dislocation of the stent. To ensure adequate nutrition three and two patients received a percutaneous gastrostomy and a jejunostomy, respectively. Median survival from stent insertion was 54 days (range, 3,201). Although placement of an antireflux Z-stent is technically feasible, its application is hampered by frequent stent migration and insufficient prevention of gastroesophageal reflux. Further technical improvements of stents or alternative methods like brachytherapy are required for satisfactory palliation of malignant gastroesophageal stenosis. [source]

Eosinophilic esophagitis: an update

DISEASES OF THE ESOPHAGUS, Issue 1 2007
D. D. Ferguson
SUMMARY., Eosinophilic esophagitis (EE) is a disease that is being recognized with increasing frequency. In children it is responsible for feeding disorders, vomiting, reflux symptoms and abdominal pain and in adults it causes dysphagia and esophageal food impactions. The diagnosis requires the histologic finding of > 20 eosinophils per high powered field in esophageal squamous mucosa. The most common treatment regimens in children and adults involve the ingestion of topical corticosteroids. Symptomatic relapse after one treatment course is common, and many patients require repeated courses of treatment. The long-term prognosis of EE is largely unknown. [source]

Utility of esophageal biopsy in the diagnosis of nonerosive reflux disease

DISEASES OF THE ESOPHAGUS, Issue 3 2003
R. I. Narayani
SUMMARY This study evaluated the accuracy of esophageal biopsy for the diagnosis of nonerosive reflux disease (NERD) in adults. Thirty-five patients with reflux symptoms and a normal endoscopy were prospectively evaluated using esophageal biopsies, 24-h ambulatory pH monitoring and symptomatic response 4 weeks after an increase in antireflux therapy. Biopsies were scored for the total number of typical histologic reflux features seen. Patients were considered to have NERD if both pH-metry was positive and step-up therapy was successful. Biopsies were then compared to this predefined gold standard. Biopsy was most sensitive (62%) but poorly specific (27%) when one or more histologic reflux features were seen. A threshold of three or more histologic features improved the specificity (91%) but reduced sensitivity (31%). Response to step-up therapy was associated with 100% sensitivity and 100% negative predictive value when compared to biopsy and pH-metry as an alternate combined gold standard. In conclusion, biopsy is insensitive in diagnosing NERD but reasonably specific if three or more typical histologic reflux features are present. [source]

Rare case of inflammatory fibrous polyp of the esophagus

DISEASES OF THE ESOPHAGUS, Issue 4 2002
B. Solito
SUMMARY. Esophageal inflammatory fibrous polyps are extremely rare benign neoplasms. The manuscript illustrates a case of a man complaining of pyrosis and gastroesophageal reflux symptoms. Diagnostic work-up showed an expansive lesion of the distal esophagus simulating malignancy but with negative, repeated, multiple biopsies. The considerable size of the lesion, and the suspicion of a malignant tumor because of the presence of ulceration, indicated esophagectomy with extensive lymphadenectomy and intrathoracic esophagogastroplasty. The diagnosis of inflammatory polyp of the esophagus was achieved postoperatively. The Discussion deals with a review of the literature and considers the performed operation a good choice considering the hypothesis of a malign neoplastic evolution of this lesion. [source]

Helicobacter pylori Infection and Gastroesophageal Reflux in a Population-Based Study (The HUNT Study)

HELICOBACTER, Issue 1 2007
Helena Nordenstedt
Abstract Background and Aim:, It has been suggested that Helicobacter pylori infection may prevent gastroesophageal reflux, possibly through gastric atrophy. Since, however, previous results are contradictory and no population-based studies are available, the relationship between H. pylori and reflux remains uncertain. The aim of this study was to investigate this relationship in a population-based, nested, case-control study. Methods:, From a cohort of 65,363 individuals, representing 71.2% of the adult population in the Norwegian county of Nord-Trondelag, we randomly selected 472 persons with recurrent reflux symptoms (cases) and 472 without such symptoms (controls). Occurrence of H. pylori and its virulence factor cagA was determined serologically, using an immunoblot assay. Gastric atrophy was assessed through serum levels of pepsinogen I. Odds ratios (OR) with 95% confidence intervals (CI), adjusted for potential confounding factors, represented relative risks. Results:,H. pylori infection was not associated with a decreased risk of reflux symptoms (OR 1.1, 95% CI 0.8,1.6), irrespective of positive cagA status (OR 1.1, 95% CI 0.8,1.5). Gastric atrophy reduced the risk of reflux symptoms (OR 0.2, 95% CI 0.0,0.6). Infection with H. pylori entailed a ninefold increase in the risk of gastric atrophy compared to non-infection (OR 8.9, 95% CI 2.0,39.9). Conclusions:,H. pylori infection, irrespective of cagA status, did not affect the occurrence of reflux symptoms in this population-based setting. Infected individuals are at increased risk of gastric atrophy, which in turn reduces reflux symptoms, but due to the low frequency of gastric atrophy among infected individuals overall, there was no association with reflux symptoms on a population level. [source]

Improvement of Reflux Symptoms 3 Years After Cure of Helicobacter pylori Infection: A Case-Controlled Study in the Japanese Population

Changing trends in gastrointestinal disease in the Asia,Pacific region

JOURNAL OF DIGESTIVE DISEASES, Issue 4 2007
KL GOH
The new millennium has seen distinct changes in the pattern of gastrointestinal disease in the Asia,Pacific region. These changes are important as more than half of the world's population come from the region and therefore impact significantly on the global disease burden. The highest incidence of gastric cancer (GCA) has been reported from Asia and GCA remains a very important cancer. However time-trend studies have shown a decrease in GCA incidence in several countries in Asia. A rise in cardio-esophageal cancers as seen in the West has not been reported. On the other hand, colorectal cancer has been steadily increasing in Asia with age-standardized incidence rates of some countries approaching that of the West. The pattern of acid-related diseases has also changed. Gastroesophageal reflux disease is a fast emerging disease with an increasing prevalence of reflux esophagitis and reflux symptoms. The prevalence of peptic ulcer disease has at the same time declined in step with a decrease in H. pylori infection. Many of the changes taking place mirror the Western experience of several decades ago. Astute observation of the epidemiology of emerging diseases combined with good scientific work will allow a clearer understanding of the key processes underlying these changes. With rapid modernization, lifestyle changes have been blamed for an increase in several diseases including gastroesophageal reflux disease, nonalcoholic fatty liver disease and colorectal cancer. A worrying trend has been the increase in obesity among Asians, which has been associated with an increase in metabolic diseases and various gastrointestinal cancers. Conversely, an improvement in living conditions has been closely linked to the decrease in GCA and H. pylori prevalence. [source]

Randomised comparison of the FerX Ella antireflux stent and the ultraflex stent: Proton pump inhibitor combination for prevention of post-stent reflux in patients with esophageal carcinoma involving the esophago-gastric junction

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 5 2008
Tarun Sabharwal
Abstract Background and Aim:, Metal stents placed across the gastroesophageal junction in patients with malignant dysphagia frequently present with reflux symptoms. We compared an antireflux stent with a standard open stent used in combination with proton pump inhibitor medication. Methods:, Forty-nine patients with dysphagia due to inoperable carcinoma in the lower third of the esophagus were randomly selected to receive either a antireflux valve stent (FerX-Ella) (n = 22) or a covered standard open stent (Ultraflex), which was combined with proton pump inhibitors such as omeprazole (n = 26). The technical success, the presence of reflux, and complications were recorded. Results:, Reflux was seen in 3/22 patients (13.6%) in the FerX-Ella group and in 2/26 patients (7.7%) in the Ultraflex and proton pump inhibitor combination group (P -value not significant). In both groups, a significant improvement in the dysphagia score was seen and no statistically significant difference was detected between the two groups (P = 0.84). The FerX-Ella stents migrated more frequently (32%) than the Ultraflex stents (23%). This also necessitated surgical intervention more frequently in the FerX-Ella group (2/22, 9.1%) compared to the Ultraflex group (1/26, 3.8%). Conclusion:, The antireflux stent had no demonstrable advantages compared to the combination of standard open stent and proton pump inhibitor medication. [source]

Association of body mass index with heartburn, regurgitation and esophagitis: Results of the Progression of Gastroesophageal Reflux Disease study

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 11 2007
Marc Nocon
Abstract Background:, Overweight and obesity are believed to be risk factors for gastroesophageal reflux disease (GERD). The aim of the present study was to analyze the impact of body mass index (BMI) on the severity and frequency of reflux symptoms and esophagitis in a large cohort of reflux patients. Methods:, As part of the Progression of Gastroesophageal Reflux Disease (ProGERD) study, 6215 patients with clinically assessed GERD were included in the present investigation (53% male, 52 ± 14 years; 47% female, 56 ± 14 years). Heartburn and regurgitation symptoms were assessed using the validated Reflux Disease Questionnaire. Endoscopies were performed and patients were subsequently classified as having non-erosive or erosive disease. To examine the association between BMI, GERD symptoms, and esophagitis, odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using logistic regression models. Results:, In patients with GERD, higher BMI was associated with more frequent and more severe heartburn and regurgitation, as well as with esophagitis. The effects were more pronounced for regurgitation than for heartburn. The strongest association was between obesity and severity of regurgitation symptoms (women: OR 2.11, 95%CI 1.60,2.77; men: OR 2.15, 95%CI 1.59,2.90). Obese women, but not men, had an increased risk of severe esophagitis compared to women with normal weight (OR 2.51, 95%CI 1.53,4.12). Conclusions:, In patients with GERD, higher BMI was associated with more severe and more frequent reflux symptoms and esophagitis. [source]

Effect of cisapride on gastric emptying in premature infants with feed intolerance

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2001
CP Barnett
Objective: To assess the effect of cisapride on gastric emptying and gastro-oesophageal reflux (GOR) symptoms in preterm infants with feed intolerance. Methods: Sixteen preterm infants (gestational age 24,35 weeks) with feed intolerance were enrolled in the study. Infants were randomized to receive 7 days of cisapride 0.2 mg/kg four times a day, immediately followed by 7 days of placebo or vice versa. Gastric emptying was measured using the [13C]-octanoic acid breath test prior to study entry and repeated on day 5, 6 or 7 after randomization and 5, 6 or 7 days after crossover. The symptoms of GOR were monitored during the study period using a standardized reflux chart. Weight was recorded daily. Results: There was no change in gastric emptying in infants prescribed cisapride (gastric half-emptying time (t1/2) 31.9 ± 4.7 vs 34.2 ± 3.9 min for placebo vs cisapride, respectively; P = 0.65). Infants on cisapride had slower growth and there was no change in reflux symptoms. Conclusions: The use of cisapride in preterm infants with feed intolerance cannot be recommended. [source]

Systematic review: persistent reflux symptoms on proton pump inhibitor therapy in primary care and community studies

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2010
H. El-Serag
Summary Background, Persistent gastro-oesophageal reflux disease (GERD) symptoms can occur despite proton pump inhibitor (PPI) therapy. Aim, To assess the prevalence and potential determinants of persistent GERD symptoms in primary care and community-based studies. Methods, Studies were identified by systematic PubMed and Embase searches; pooled prevalence data are shown as sample-size weighted means and 95% confidence intervals. Results, Nineteen studies in individuals with GERD taking a PPI were included. In interventional, nonrandomized primary care trials, the prevalence of persistent troublesome heartburn and regurgitation was 17% (6,28%) and 28% (26,30%) respectively; in randomized trials, it was 32% (25,39%) and 28% (26,30%), respectively. In observational primary care and community-based studies, 45% (30,60%) of participants reported persistent GERD symptoms. Overall, persistent GERD symptoms despite PPI treatment were more likely in studies with a higher proportion of female participants [>60% vs. <50%, risk ratio (RR): 3.66; P < 0.001], but less likely in studies from Europe than in those from the USA (RR: 0.71; P < 0.001), and were associated with decreased psychological and physical well-being. Conclusions, Persistent GERD symptoms despite PPI treatment are common in the primary care and community setting. Alternative approaches to management are required. [source]

Measurement of abdominal symptoms by validated questionnaire: a 3-month recall timeframe as recommended by Rome III is not superior to a 1-year recall timeframe

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2010
E. REY
Aliment Pharmacol Ther,31, 1237,1247 Summary Background, Rome III incorporates changes in the definition of functional gastrointestinal disorder that involve a 3-month recall time for symptoms, rather than 1-year. Aim, To validate a new version of the Talley-Bowel Disease Questionnaire (Talley-BDQ) and assess the impact of recall time period on the prevalence of symptoms. Methods, A sample of community residents were randomly mailed a survey using 1-year (n = 396) or 3-month recall period (n = 374). We evaluated the reliability and the concurrent validity of the two versions of the questionnaire. The proportions of subjects reporting symptoms in the two versions were compared. Results, The median (IQR) kappa on symptom-related questions was 0.70 (0.57,0.76) from the 1-year version and 0.66 (0.56,0.77) from the 3-month version. A median kappa of 0.39 (0.19,0.70) and 0.58 (0.39,0.73) was observed for concurrent validation of the 1-year and 3-month versions respectively. Except for gastro-oesophageal reflux symptoms, no differences were observed on the prevalence of clinically relevant symptoms. Conclusion, The revised Talley-BDQ is reliable, with excellent reproducibility and validity. There were few differences in reported symptom rates between the 3-month and 1-year recall time versions of the questionnaire. A 1-year recall time may more efficiently capture infrequent or subtle symptoms. [source]

Depression and treatment with antidepressants are associated with the development of gastro-oesophageal reflux disease

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2010
E. MARTÍN-MERINO
Aliment Pharmacol Ther,31, 1132,1140 Summary Background, The roles of depression and antidepressants in triggering reflux symptoms remain unclear. Aim, To compare the incidence of gastro-oesophageal reflux disease (GERD) in individuals with and without a depression diagnosis and to evaluate risk factors for a GERD diagnosis. The relationship between antidepressant treatment and GERD was also assessed. Methods, The Health Improvement Network UK primary care database was used to identify patients with incident depression and an age- and sex-matched control cohort with no depression diagnosis. Incident GERD diagnoses were identified during a mean follow-up of 3.3 years. Furthermore, we performed nested case-control analyses where odds ratios (OR) with 95% confidence intervals (CI) were estimated by unconditional logistic regression in multivariable models. Results, The incidence of GERD was 14.2 per 1000 person-years in the depression cohort and 8.3 per 1000 person-years in the control cohort. The hazard ratio of GERD in patients with depression compared with controls was 1.72 (95% CI: 1.60,1.85). Among patients with depression, tricyclic antidepressant use was associated with an increased risk of GERD (OR: 1.71; 95% CI: 1.34,2.20), while selective serotonin reuptake inhibitors were not associated with GERD. Conclusions, A depression diagnosis is associated with an increased risk of a subsequent GERD diagnosis, particularly in individuals using tricyclic antidepressants. [source]

Reflux symptoms in wind instrument players

Clinical trial: long-term use of proton pump inhibitors in primary care patients , a cross sectional analysis of 901 patients

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009
C. REIMER
Summary Background, The use of proton pump inhibitors (PPIs) is extensive. While the incidence of new treatments remains stable, the prevalence of long-term treatment is rising. Studies have shown that up to 70% of patients on chronic acid suppression lack a verified indication for treatment. Aims, To investigate primary care patient characteristics associated with long-term use of PPIs. Methods, A cross-sectional analysis of 42 634 patients registered with 22 general practitioners was performed. Patients with prescriptions of ,120 tablets/year were defined as long-term users. A survey of a subgroup of patients without verified indication was performed. Results, In all, 901 (2.1%) patients were long-term treated. Verified indications for treatment were identified for 247/901 (27%). An upper GI endoscopy had been performed in 418 patients (46%). Of the 194/654 without verified indication who participated in the survey, 71% reported heartburn/acid regurgitation as the reason for therapy. On-demand therapy was reported by 43/194 (22%) and previous attempts to withdraw by 119/194 (61%). Conclusions, The prevalence of PPI long-term treatment among primary care patients is 2.1%. The main reason for treatment is reflux symptoms or verified GERD. Rationalization of use of PPIs is possible as daily treatment without attempts to discontinue is frequently observed. [source]

Clinical trial: factors associated with resolution of heartburn in patients with reflux oesophagitis , results from the EXPO study

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2009
J. LABENZ
Summary Background, The ability to predict symptom response to reflux oesophagitis-healing therapy may optimize treatment decisions. Aim, To identify factors associated with heartburn resolution in patients receiving acid-suppressive therapy for reflux oesophagitis. Methods, In this multicentre, randomized, double-blind trial (EXPO; AstraZeneca study code: SH-NEG-0008), patients with endoscopically confirmed reflux oesophagitis and reflux symptoms received once-daily proton pump inhibitor therapy [esomeprazole 40 mg (n = 1562) or pantoprazole 40 mg (n = 1589)] for ,4 weeks. Factors associated with heartburn resolution after 4 weeks were identified by multiple logistic regression analysis. Results, Esomeprazole therapy, positive Helicobacter pylori status and greater age were associated with an increased likelihood of heartburn resolution [odds ratio (95% confidence interval): 1.31 (1.12, 1.54), 1.44 (1.19, 1.74) and 1.013 (1.007, 1.019) per year, respectively; all P < 0.001]. Men and patients with no acid regurgitation or epigastric pain pre-treatment were also more likely to achieve heartburn resolution (all P < 0.05). Conclusions, The use of esomeprazole rather than pantoprazole increases the probability of achieving resolution of heartburn during reflux oesophagitis-healing therapy. Other factors, including H. pylori status, age, gender and symptom profile may be helpful in determining the likelihood of heartburn resolution in such patients. [source]

Patient acceptance and clinical impact of Bravo monitoring in patients with previous failed catheter-based studies

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009
R. SWEIS
Summary Background, Standard pH monitoring is performed over 24 h with a naso-oesophageal catheter (C-pH). Limitations include naso-pharyngeal discomfort, nausea and social embarrassment resulting in reduced reflux-provoking activities. Recently a catheter-free pH-monitoring technique has become available. The tolerability and diagnostic yield of this system in patients who failed standard monitoring remain unknown. Aim, To examine the tolerability and diagnostic outcome of catheter-free pH-monitoring technique in patients who failed standard monitoring. Methods, Patients referred for C-pH and catheter-free pH monitoring completed a tolerability questionnaire. Acid exposure in the distal oesophagus and symptom index (SI) were reviewed. Results, Over 4 years, 883/1751 (50%) of patients with typical reflux symptoms referred for C-pH were diagnosed with gastro-oesophageal reflux disease (GERD) based on a pathological percentage time acid exposure (%time pH <4);134 (8%) patients failed C-pH and, of these, 129 successfully completed 2-day catheter-free pH monitoring. Ninety-eight (76%) of these patients had a pathological percentage pH <4 on either day compared with 49/102 (49%) of contemporaneous C-pH patients (P < 0.01). There was no difference in SI for heartburn (35% vs. 42%; P = 0.49). The questionnaire demonstrated a preference for catheter-free pH monitoring (96%) with less restriction in activities of daily living, naso-pharyngeal discomfort, dysphagia and chest pain. Conclusions Tolerance and satisfaction with catheter-free pH monitoring are high in patients who had previously failed C-pH; catheter-free pH monitoring assists the definitive diagnosis of GERD in this group. [source]

Symptoms in patients on long-term proton pump inhibitors: prevalence and predictors

Improved diagnosis of gastro-oesophageal reflux in patients with unexplained chronic cough

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2007
K. BLONDEAU
Summary Background Symptoms, oesophageal pHmetry and proton pump inhibitor treatment are used for diagnosing gastro-oesophageal reflux-related cough. Weakly acidic reflux is now increasingly associated with reflux symptoms such as regurgitation or chest pain. Aim To study the association between weakly acidic reflux and cough in a selected, large group of patients with unexplained chronic cough. Methods A total of 100 patients with chronic cough (77 ,off' and 23 ,on' a proton pump inhibitor) were studied using impedance-pHmetry for reflux detection and manometry for objective cough monitoring. Symptom Association Probability (SAP) Analysis characterized the reflux,cough association. Results Acid reflux could be a potential mechanism for cough in 45 patients (with either heartburn, high acid exposure or +SAP for acid reflux). Weakly acidic reflux could be a potential mechanism for cough in 24 patients (with either increased oesophageal volume exposure, increased number of weakly acidic reflux or +SAP for weakly acidic reflux). Reflux could not be identified as a potential mechanism for cough in 31 patients. Conclusion A positive association between cough and weakly acidic reflux was found in a significant subgroup of patients with unexplained chronic cough. Impedance-pH-manometry identified patients in whom cough can be related to reflux that would have been disregarded using the standard diagnostic criteria for acid reflux. [source]