[Gastro-oesophageal reflux disease-update 2021]. / Gastroösophageale Refluxkrankheit ­ Update 2021.

Gastro-oesophageal reflux disease (GORD), a highly prevalent disease, is defined by troublesome symptoms and/or oesophageal lesions caused by reflux of gastric content. A diagnostic gold standard does not exist. A reliable diagnosis may be difficult in individual cases. Patients' history, endoscopic findings and pH-impedance monitoring contribute to the evaluation of gastro-oesophageal reflux and its consequences. High-resolution manometry may add important information on the pathophysiology of the disease and may help to rule out motility disorders as the leading cause of the symptoms. Proton pump inhibitors (PPI) are the drugs of first choice. In patients with insufficient PPI response, optimization of PPI therapy and/or combination with drugs having another mechanism of action are the available options. If PPIs are not sufficiently effective, not tolerated, or not wished antireflux procedures may be offered in specialized centers taking pathophysiological data into account.

The study and comparative analysis of GerdQ and GSRS Questionnaires on gastroesophageal reflux disease diagnostics.

INTRODUCTION: Clinical questionnaires have some limitations compared to instrumental diagnosis of gastroesophageal reflux disease (GERD), but clinical diagnosis of GERD based on typical symptoms is pragmatic and well-established by societal guidelines. AIM: To study the diagnostic value and provide comparative analysis of GerdQ and GSRS questionnaires regarding the GERD diagnostics based on a comparison of the questionnaires with the results of intraluminal oesophageal impedance-pH monitoring in Ukraine. MATERIAL AND METHODS: Twenty-eight patients (11 men and 17 women with a mean age of 47 ±2.4 years and a mean body mass index of 25.6 ±1.1 kg) filled in the GerdQ and GSRS questionnaires and underwent 24-hour multichannel intraluminal oesophageal impedance-pH monitoring. RESULTS: The GerdQ questionnaire showed a significantly strong correlation between the total score of the questionnaire and the key indicators of 24-hour impedance-pH monitoring: AET (rs = 0.793), acid reflux episodes (rs = 0.796), and liquid reflux episodes (rs = 0.730). Correlation of reflux syndrome according to the GSRS questionnaire was established between the acid reflux episodes (rs = 0.530), the episodes of all fluid refluxes (rs = 0.598), and AET (rs = 0.560), but the strength of the correlation relationships is weaker. The GerdQ questionnaire showed a sensitivity of 78.6%, specificity of 92.9%, and accuracy (diagnostic efficiency) of 85.7%. CONCLUSIONS: The use of the GerdQ questionnaire for the diagnosis of GERD is optimal in everyday practice for deciding whether to prescribe "ex juvantibus" therapy or whether to use instrumental examination methods (upper endoscopy, oesophageal pH monitoring, oesophageal impedance-pH monitoring).

Detection of gastro-oesophageal reflux in the neonatal unit.

AIM: To determine whether a pH probe or multichannel intraluminal impedance (MII) more frequently detected gastro-oesophageal reflux and test the hypothesis that acid reflux was associated with lower baseline impedance. METHODS: A prospective study of infants in whom reflux was suspected and evaluated using combined pH and multichannel impedance. Studies were considered abnormal if the acid index was >10% or there were >79MII reflux events in 24 hours. The acid index was the percentage of total study time with a pH

In vivo evaluation of acid-induced changes in oesophageal mucosa integrity and sensitivity in non-erosive reflux disease.

OBJECTIVE: Patients with non-erosive reflux disease (NERD) have impaired oesophageal mucosal integrity (dilated intercellular spaces). Oesophageal mucosal integrity reflects the balance between repeated reflux damage and mucosal recovery. The relationship between mucosal integrity and acid sensitivity is unclear. Oesophageal impedance may be used for in vivo mucosal integrity measurement. We studied acid-induced changes in oesophageal mucosal integrity and acid perception in patients with heartburn. DESIGN: 50 patients with heartburn whithout oesophagitis underwent impedance monitoring before, during and after 10 min oesophageal perfusion with neutral (pH 6.5) and acid solutions (pH 1). Symptoms and impedance were recorded during perfusion. Impedance recovery was assessed for 2 h post-perfusion in ambulatory conditions followed by 24-h impedance-pH study. RESULTS: Reflux monitoring discriminated 20 NERD and 30 functional heartburn (FH) patients. Neutral perfusion caused impedance fall that recovered within 10 min. Acid perfusion caused impedance fall with slow recovery: 6.5 Ω/min (IQR 3.3-12.0 Ω/min). Patients with slow recovery (< 25th percentile) had lower baseline impedance (1273 Ω ± 208 Ω vs. 3220 Ω ± 275 Ω ±, p < 0.01) and more frequent acid sensitivity (10/12 vs. 4/12, p = 0.04) than those with fast (> 75th percentile) recovery. Patients with NERD had lower baseline impedance (1669 ± 182 Ω vs. 2384 ± 211 Ω, p = 0.02) and slower impedance recovery (6.0 ± 0.9 Ω/min vs. 10.7 ± 1.6 Ω/min, p = 0.03) than patients with FH. CONCLUSION: Impaired mucosal integrity might be the consequence of repeated reflux episodes with slow recovery. Mucosal integrity, recovery capacity and symptom perception are linked. Low basal impedance and slow recovery after acid challenge are associated with increased acid sensitivity.

Pharyngeal pH alone is not reliable for the detection of pharyngeal reflux events: A study with oesophageal and pharyngeal pH-impedance monitoring.

BACKGROUND: Pharyngeal pH probes and pH-impedance catheters have been developed for the diagnosis of laryngo-pharyngeal reflux. OBJECTIVE: To determine the reliability of pharyngeal pH alone for the detection of pharyngeal reflux events. METHODS: 24-h pH-impedance recordings performed in 45 healthy subjects with a bifurcated probe for detection of pharyngeal and oesophageal reflux events were reviewed. Pharyngeal pH drops to below 4 and 5 were analysed for the simultaneous occurrence of pharyngeal reflux, gastro-oesophageal reflux, and swallows, according to impedance patterns. RESULTS: Only 7.0% of pharyngeal pH drops to below 5 identified with impedance corresponded to pharyngeal reflux, while 92.6% were related to swallows and 10.2 and 13.3% were associated with proximal and distal gastro-oesophageal reflux events, respectively. Of pharyngeal pH drops to below 4, 13.2% were related to pharyngeal reflux, 87.5% were related to swallows, and 18.1 and 21.5% were associated with proximal and distal gastro-oesophageal reflux events, respectively. CONCLUSIONS: This study demonstrates that pharyngeal pH alone is not reliable for the detection of pharyngeal reflux and that adding distal oesophageal pH analysis is not helpful. The only reliable analysis should take into account impedance patterns demonstrating the presence of pharyngeal reflux event preceded by a distal and proximal reflux event within the oesophagus.