Early effects of irradiation on laryngeal mucosa in a gastroesophageal reflux model: an experimental study.

OBJECTIVE: The aim of this study was to evaluate the early histopathological changes of gastroesophageal reflux and irradiation on laryngeal mucosa in rats. STUDY DESIGN: Animal study. SETTING: Experimental animal laboratory, tertiary referral center. SUBJECT AND METHOD: Twenty-four adult female Wistar Albino rats were grouped as: control (n = 6), reflux and irradiation (n = 10), and irradiation (n = 8). Rats were operated to create a reflux model 30 days before irradiation. Ionizing radiation was administered in a single fraction of a 20 Gy to the larynx. Laryngeal tissue samples were taken at the 4th day of irradiation and all specimens underwent histopathological examination. RESULTS: Edema and vascular dilation in lamina propria were higher in the reflux and irradiation, and irradiation groups than control group. Inflammation was higher in the reflux and irradiation group than the control group. Inflammation in squamous epithelium was higher in the reflux and irradiation and irradiation groups compared to the control group. Inflammation in the squamous epithelium of the irradiation group was higher than the reflux and irradiation group. In the respiratory tract epithelium, inflammation was higher in the reflux and irradiation group; additionally, a significant loss of cilia was present in the reflux and irradiation and irradiation groups while pseudostratification was higher in the reflux and irradiation group. CONCLUSION: Ionizing radiation-induced inflammation may increase on previously inflammated area due to gastroesophageal reflux. Therefore, it may be helpful to investigate and treat the reflux in laryngeal cancer patients that will receive ionizing radiation.

Budget Impact Analysis to Estimate the Cost Dynamics of Treating Refractory Gastroesophageal Reflux Disease With Radiofrequency Energy: a Payer Perspective.

PURPOSE: A minimally invasive endoscopic treatment that utilizes radio-frequency energy (RFE) has received increased attention as an appropriate middle-ground approach in the treatment of refractory gastroesophageal reflux disease (GERD) and as an alternative to complicated and invasive surgical procedures. The objective of this study was to develop a longitudinal budget impact analysis from the payer perspective to estimate the direct medical costs of treatment for the refractory GERD patient population and to estimate the budgetary impact of further extending the RFE treatment option to other target populations. DESIGN AND METHODOLOGY: A retrospective analysis of claims designed to assess the longitudinal costs and budget impact on payer expenditures associated with managing and treating GERD surgically (Nissen fundoplication [NF]), endoscopically (RFE), or medically was performed. Both Medicare and commercially insured claims databases were interrogated for such population-level analyses. RESULTS: At current adoption rates (less than 1% of procedures), RFE demonstrated overall cost savings ranging from 7.3% to 50.5% in the 12-month time period following the index procedure (inclusive of procedure costs) when compared to medical management and fundoplication across the commercial and Medicare patient populations. Increasing the total number of RFE procedures to 2% of total cases performed generated per-member, per-month (PMPM) savings of $0.28 in the Medicare population and $0.37 in the commercially insured population. Further increases yielded higher PMPM savings. CONCLUSION: Adding to the clinical importance of RFE in filling the gap between medical and surgical management, this economic analysis demonstrates to payers that the adoption of RFE can create notable savings to their plans when compared to surgery or medical management.

[The effect of low-level laser therapy on gastric mucosa microcirculation in patients with gastroesophageal reflux disease].

OBJECTIVE: To study the influence of laser radiation on the parameters of microcirculation in patients with gastroesophageal reflux disease (GERD). MATERIALS AND METHODS: The examined 112 patients with GERD aged 19 to 79 years. 78 patients were given a ten-day course of intravenous laser therapy, which was conducted with the help of the apparatus of laser therapy "matrix-vlok" (produced by "the matrix", Russia) with wavelength 0,405 microns, the radiation power at the output of the main fiber 1-1,5 mW, continuous mode radiation. The studied parameters were determined before and after treatment. RESULTS: The obtained data testify to the improvement of microcirculation in patients with GERD under the influence of laser therapy.

[Dynamics of autonomic regulation and daily pH-metry in patients with gastroesophageal reflux disease under the influence of low-intensity laser irradiation of blood].

102 patients with GERD were examined: 70 female (68%) and 32 men (32%). Age of respondents ranged from 20 to 65 years (average of 45.8 ±8,2). All patients were randomly divided into 2 groups. In the first (control) group (30 people) traditional drug treatment were used according to the standard therapy of GERD (proton pump inhibitors, antacids, prokinetics), patients in the second (main) group (70 people) along with drug therapy has received a course of intravenous laser therapy according to the methods ILIB-405. For intravenous laser treatment Russian apparatus "Matrix-ILIB" ("Matrix", Russia) was used with wavelength 0,405 µm, output power at the end of the main optical path of 1-1.5 mW. Laser blood irradiation was carried out for 15 minutes in the CW mode, the course of treatment was 10 daily treatments with a break on Saturday and Sunday. Conclusions: 1. Intravenous laser irradiation of blood in the complex therapy of patients with gastroesophageal reflux disease improved significantly of HRV due to the alignment of parasympathetic regulation circuit and reducing the activity of sympathetic autonomic regulation, 2. the inclusion of intravenous laser irradiation of blood in the complex therapy of patients with GERD was accompanied by reliable normalization of the indicators of the daily pH-metry of the esophagus in patients with GERD.

[The influence of intravenous laser therapy on prostaglandin E2 and F2-alpha dynamics and the state of microcirculation in the patients presenting with gastroesophageal reflux disease].

The objective of the present work was to study the influence of low-frequency laser radiation on the levels of prostaglandins E2 and F2-alpha and characteristics of microcirculation in the patients suffering from gastroesophageal reflux disease (GERD). A total of 112 patients at the age from 19 to 79 years presenting with GERD were examined. 78 of them were given the complete 10-day course of intravenous laser therapy based on a Matriks-VLOK ("Matriks", Russia) therapeutic laser set emitting in the continuous mode at a wavelength of 0.405 mcm with the radiation power 1-11.5 mW at the output of the main lightguide. The characteristics of interest were determined before and after the treatment. It was shown that laser irradiation resulted in the elevation of pro-inflammatory prostaglandin levels and the improvement of parameters of microcirculation.

[Impact of laser therapy on PGE2 level, 24-hour pH-metry changes, and quality of life in patients with gastroesophageal reflux disease].

AIM: To study the impact of low-intensity laser irradiation on 24-hour pH-metry parameters and prostaglandin E2 (PGE2) levels in patients with gastroesophageal reflux disease (GERD). SUBJECTS AND METHODS: One hundred and twelve patients aged 19 to 79 years with GERD were examined. Seventy-eight patients received a 10-day course of continuous intravenous laser therapy using a Matrix VLOK laser therapy apparatus (Matrix, Russia) with a wavelength of 0.405 pm, radiation power at the exit of a main light guide 1-1.5 mW, pulse rate 80 Hz. The indicators under study were determined before and after treatment. RESULTS: After treatment, the intravenous laser therapy group showed a significant increase in PGE2 (1376 +/- 93 pg/ml) to the levels typical of those in healthy individuals and a significant decrease in all esophageal pH-metry parameters; the DeMeester score achieved normal values, and all quality of life (QL) indicators, except for physical function index, significantly improved (10.2 +/- 5.7; p < 0.05). CONCLUSION: The findings are suggestive of elevated PGE2 levels and improved QL during laser therapy.

[Gastroesophageal reflux: alternatives to medical treatment]. / Reflux gastro-oesophagien: alternatives au traitement médical.

The vast majority of patients having gastroesophageal reflux disease (GERD) are well-controlled by medical therapy. Surgical treatment is indicated for patients who do not want to take life-long medication, those having persisting symptoms despite PPI therapy or those having atypical symptoms associated with GERD. Although very effective, surgical treatment is loosing part of its efficacy after 10 years and may be associated with chronic or acute complications. This is probably one of the reasons why only a small minority of patients having GERD will ask for surgical therapy. Many endoscopic techniques for treating GERD have been the topic of great enthusiasm over the last 10 years. Most of them, however, have been abandoned either because of severe adverse events, lack of efficacy or non adoption by physicians for routine clinical use. Only few of them have survived and are still used or in development. They include radiofrequency application at the lower esophagus, which is probably indicated in subgroup of patients having symptomatic GERD in the absence of esophagitis and techniques of endoscopic suture which aims to recreate a gastroesophageal valve by endoscopic route. Up to now, most of the published studies dealing with endoscopic treatment of GERD have been focused on patients having typical GERD symptoms who are also those having the highest benefit from PPI therapy. Interestingly, the group which could really benefit from this kind of treatment, namely those patients having persisting symptoms under PPI therapy or those having atypical GERD symptoms have been the topic of much less investigations.

Radiofrequency energy delivery to the lower esophageal sphincter (Stretta procedure) in patients with recurrent reflux after antireflux surgery: can surgery be avoided?

BACKGROUND: Recurrent reflux following antireflux surgery (ARS) can be difficult to manage, especially in patients who also fail medical management. In these patients, redo ARS remains the only treatment option. Endoscopic radiofrequency energy delivery to the lower esophageal sphincter (the Stretta procedure; Stretta, Curon, Sunnyvale, CA) has been shown to significantly decreased symptom scores and improve quality of life in patients with gastroesophageal reflux disease (GERD). The aim of this study was to evaluate the use of the Stretta procedure in treating patients with recurrent reflux after fundoplication. METHODS: Between March 2002 and December 2003, eight patients with recurrent reflux following ARS underwent the Stretta procedure. All patients were asked to complete an institutional symptom survey pre-Stretta and at 1, 6, and 12 months after the procedure. Patients rated 7 reflux-related symptoms (heartburn, dysphagia, regurgitation, cough, voice changes/hoarseness, asthma, chest pain) on a 0 (none) to 3 (severe) scale. Data were analyzed using a Wilcoxon matched pairs signed rank test where appropriate. RESULTS: Complete data were obtained for seven of the eight patients, with a median follow-up of 253 days (range, 67-378 days). One patient was lost to follow-up and not included in our analysis. Symptom scores decreased significantly, with six patients noting both improved typical and atypical symptoms. Overall, six patients (85%) were satisfied with their results. CONCLUSIONS: Based on this small series, the Stretta procedure significantly reduces subjective symptoms of GERD. The Stretta procedure may serve an important role as an additional management strategy to help manage recurrent GERD after ARS.

Evaluación de métodos para el estudio del reflujo gastroesófagico / Evaluation of the methods for the study of gastroesophageal reflux

Veinticinco pacientes adultos y quince niños con sospecha clínica de esofagitis por reflujo, fueron evaluados mediante radiología, endoscopía con biopsia y centellografía con cámara gamma computada. En los niños, la radiología demostró ser un método muy sensible no así en los adultos. La fibroendoscopía resultó útil para valorar el daño de la mucosa. El diagnóstico histopatológico de esofagitis fue hecho sobre 88% de los adultos y sobre todos los niños con esofagitis endoscópicamente diagnosticada. La centellografía permitió detección directa y cuantificación de los episodios de reflujo, con una positividad de 100% en adultos, con maniobra de Valsalva y 90% en niños, siendo un método más fisiológico, incruento y que produce menor irradiación que la radiología. Estas razones favorecen los controles postratamiento de los pacientes