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1.
Curr Opin Gastroenterol ; 40(4): 285-290, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38662363

RESUMO

PURPOSE OF REVIEW: To review recent publications on the inability to belch syndrome. RECENT FINDINGS: Five recent retrospective case series indicate that the inability to belch syndrome usually starts in early childhood and is often accompanied by gurgling noises in the chest, pain in the chest or upper abdomen, bloating, and excessive flatulence. Currently, the vast majority of patients who have been identified with inability to belch have self-diagnosed the syndrome on the basis of information available on the internet. A favorable response to injection of botulinum toxin in the cricopharyngeus muscle is regarded as confirmation of the diagnosis. In a mechanistic study in eight patients, absence of reflexogenic relaxation of the upper esophageal sphincter upon rapid gaseous esophageal distension was confirmed to play a pivotal role in the pathogenesis of the syndrome. SUMMARY: The inability to belch syndrome, caused by failure of the upper esophageal sphincter to relax when the esophageal body is distended, clearly exists and may not be as rare as thought hitherto. However, overdiagnosis is also likely to occur because the diagnosis is usually made on the basis of symptoms only. The efficacy of botulinum toxin injection in the upper sphincter needs to be assessed in double-blind placebo-controlled studies.


Assuntos
Esfíncter Esofágico Superior , Humanos , Síndrome , Esfíncter Esofágico Superior/fisiopatologia , Eructação/terapia , Eructação/diagnóstico , Eructação/etiologia , Eructação/fisiopatologia , Toxinas Botulínicas/administração & dosagem , Toxinas Botulínicas/uso terapêutico , Transtornos da Motilidade Esofágica/diagnóstico , Transtornos da Motilidade Esofágica/fisiopatologia , Transtornos da Motilidade Esofágica/terapia , Fármacos Neuromusculares/uso terapêutico , Fármacos Neuromusculares/administração & dosagem
2.
Digestion ; 105(1): 18-25, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37844547

RESUMO

BACKGROUND: Belching disorders and rumination syndrome (RS) are disorders of gut-brain interaction (DGBIs) in Rome IV. Belching disorders are composed of excessive gastric belching (GB) and supragastric belching (SGB). Excessive GB is related to physiological phenomenon whereas excessive SGB and RS are behavioral disorders. SUMMARY: A recent large internet survey found that prevalence of belching disorders and RS were 1% and 2.8%, respectively. It has been recognized that not a few patients with two behavioral disorders, excessive SGB and RS, could be misdiagnosed as proton pump inhibitors (PPI)-refractory gastroesophageal reflux disease (GERD). In patients with reflux symptoms, distinguishing these conditions is essential because they need psychological treatment (i.e., cognitive behavioral therapy (CBT) rather than acid suppressants. Clinicians should take a medical history meticulously first to identify possible excessive SGB and/or RS. High-resolution impedance manometry and/or 24-h impedance-pH monitoring can offer an objective diagnosis of the disorders. Several therapeutic options are available for excessive SGB and RS. The first-line therapy should be CBT using diaphragmatic breathing that can stop the behaviors involving complex muscle contraction (e.g., abdominal straining) to generate SGB or rumination. Overlap with eating disorders and/or other DGBIs such as functional dyspepsia can make management of the behavioral disorders challenging since such coexisting conditions often require additional treatments. KEY MESSAGES: Excessive SGB and RS are not unusual conditions. It is important to raise awareness of the behavioral disorders for appropriate management.


Assuntos
Dispepsia , Refluxo Gastroesofágico , Síndrome da Ruminação , Humanos , Eructação/diagnóstico , Eructação/epidemiologia , Eructação/etiologia , Síndrome da Ruminação/complicações , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/terapia , Dispepsia/complicações , Estômago , Manometria
3.
J Clin Gastroenterol ; 56(1): 36-40, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34739403

RESUMO

PURPOSE: Belching is a common condition that frequently overlaps with other functional gastrointestinal disorders. While not associated with any increase in mortality, it is associated with impaired health-related quality of life. Management is challenging, as there are no pharmacologic therapies specifically targeted towards this disorder. This review covers pathogenesis, prevalence, and treatments for this condition, with specific emphasis on the evolving role of behavioral treatments in management. KEY FINDINGS: The diagnosis of gastric and supragastric belching can usually be made clinically, without the need for invasive testing. If necessary, multichannel intraluminal impedance and pH testing can provide a more definitive diagnosis and can also be used to estimate the frequency of gastric and supragastric belching episodes, which each have a distinct appearance on impedance tracing. Belching disorders are commonly associated with gastroesophageal reflux disease and functional disorders of the gastrointestinal tract. Supragastric belching is also associated with behavioral disorders like anxiety and obsessive-compulsive disorder. Speech therapy, cognitive-behavioral therapy, and diaphragmatic breathing are all interventions that have recently shown promise in the management of this challenging disorder.


Assuntos
Eructação , Refluxo Gastroesofágico , Impedância Elétrica , Eructação/diagnóstico , Eructação/epidemiologia , Eructação/etiologia , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/terapia , Humanos , Qualidade de Vida , Estômago
4.
J Pediatr Gastroenterol Nutr ; 70(1): e7-e11, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31880681

RESUMO

A few studies have shown that esophageal air events (EAEs), such as air-swallows, may be associated with symptoms that have historically been associated with gastroesophageal reflux disease (GERD). To objectively test a hypothesis that all EAE types (air-swallows, supragastric belches and gastric belches) can be associated with GERD-like symptoms, we removed the impedance "tags" from the GER episodes (placed during autoscan) and instead tagged either air-swallows, supragastric belches or gastric belches in each of 3 copies of the 24-hour impedance tracing for 2 infant patients who presented with symptoms suggestive of GER as an etiology. Impedance system software (MMS) analyses revealed that, in both infants, all EAE types were significantly associated (SAP >95%) with 1 or more of the GERD-like symptom types (cough, pain/crying, back-arching, and gagging). These data underscore the importance of considering other diagnoses when developing management strategies for treating GERD-like symptoms in infants.


Assuntos
Aerofagia/diagnóstico , Impedância Elétrica , Eructação/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Diagnóstico Diferencial , Monitoramento do pH Esofágico , Esôfago/fisiopatologia , Feminino , Humanos , Lactente , Masculino
5.
Am J Gastroenterol ; 111(9): 1245-56, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27325223

RESUMO

The development of intraluminal esophageal impedance monitoring has improved our ability to detect and measure gastroesophageal reflux without dependence on acid content. This ability to detect previously unrecognized weak or nonacid reflux episodes has had important clinical implications in the diagnosis and management of gastroesophageal reflux disease (GERD). In addition, with the ability to assess bolus transit within the esophageal lumen, impedance monitoring has enhanced the recognition and characterization of esophageal motility disorders in patients with nonobstructive dysphagia. The assessment of the intraluminal movement of gas and liquid has also been proven to be of diagnostic value in conditions such as rumination syndrome and excessive belching. Further, alternative applications of impedance monitoring, such as the measurement of mucosal impedance, have provided novel insights into assessing esophageal mucosal integrity changes as a consequence of inflammatory change. Future applications for esophageal impedance monitoring also hold promise in esophageal conditions other than GERD. However, despite all of the clinical benefits afforded by esophageal impedance monitoring, important clinical and technical shortcomings limit its diagnostic value and must be considered when interpreting study results. Overinterpretation of studies or application of impedance monitoring in patients can have deleterious clinical implications. This review will highlight the clinical benefits and limitations of esophageal impedance monitoring and provide clinical pearls and pitfalls associated with this technology.


Assuntos
Impedância Elétrica , Transtornos da Motilidade Esofágica/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Eructação/diagnóstico , Eructação/fisiopatologia , Transtornos da Motilidade Esofágica/fisiopatologia , Esôfago/fisiopatologia , Refluxo Gastroesofágico/fisiopatologia , Humanos
6.
Dis Esophagus ; 29(6): 688-9, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23590344

RESUMO

We present a patient that developed severe belching during pregnancy. Esophageal pH-impedance monitoring revealed frequent supragastric belching, but not gastroesophageal reflux disease (GERD). Thus, severe belching during pregnancy can be due to a behavioral disorder in the absence of GERD. Belching complaints during pregnancy should therefore not always be treated as GERD.


Assuntos
Eructação/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Complicações na Gravidez/diagnóstico , Adulto , Diagnóstico Diferencial , Impedância Elétrica , Monitoramento do pH Esofágico , Feminino , Humanos , Gravidez
7.
Dis Esophagus ; 29(4): 342-9, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-25708811

RESUMO

Belching may result from transient lower esophageal sphincter relaxation; therefore, it has been proposed that belching may be a manifestation of gastroesophageal reflux disease (GERD). This study was conducted to investigate the frequency of belching during esophagogastroduodenoscopy (EGD) and its association with GERD. A retrospective review was performed on prospectively collected clinical and endoscopic data from 404 subjects who underwent EGD without sedation from December 2012 to May 2013 in a training hospital in Korea. All detectable belching events during endoscopy were counted. Frequency and severity of belching events were compared between the group with and without GERD using an ordinal logistic regression model. There were 145 GERD patients (26 erosive reflux disease and 119 nonerosive reflux disease [NERD]). In the multivariable analysis, GERD was significantly associated with a higher frequency of belching events (odds ratio = 6.59, P < 0.001). Central obesity, female, and younger age were also risk factors for frequent belching during EGD. Subgroup analyses were performed in subjects without erosive reflux disease (n = 378) and NERD (n = 293). NERD was also a predictive factor for frequent belching during EGD (odds ratio = 6.61, P < 0.001), and the frequency of belching was significantly correlated with GERD severity according to the Los Angeles classification (P < 0.05). Frequent belching during EGD was associated with GERD, including NERD. Future research should focus on its adjuvant role in the diagnosis of GERD/NERD and the necessity for applying differentiated endoscopy strategies for GERD patients, leading to less discomfort during EGD in patients at risk for intolerability.


Assuntos
Endoscopia do Sistema Digestório , Eructação , Esfíncter Esofágico Inferior , Refluxo Gastroesofágico/fisiopatologia , Adulto , Fatores Etários , Endoscopia do Sistema Digestório/efeitos adversos , Endoscopia do Sistema Digestório/métodos , Eructação/diagnóstico , Eructação/etiologia , Eructação/fisiopatologia , Esfíncter Esofágico Inferior/diagnóstico por imagem , Esfíncter Esofágico Inferior/fisiopatologia , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Fatores de Risco , Fatores Sexuais , Estatística como Assunto
8.
Am J Gastroenterol ; 109(8): 1196-203); (Quiz) 1204, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25001253

RESUMO

Excessive belching is a commonly observed complaint in clinical practice that can occur not only as an isolated symptom but also as a concomitant symptom in patients with gastroesophageal reflux disease (GERD) or functional dyspepsia. Impedance monitoring has revealed that there are two mechanisms through which belching can occur: the gastric belch and the supragastric belch. The gastric belch is the result of a vagally mediated reflex leading to relaxation of the lower esophageal sphincter and venting of gastric air. The supragastric belch is a behavioral peculiarity. During this type of belch, pharyngeal air is sucked or injected into the esophagus, after which it is immediately expulsed before it has reached the stomach. Patients who belch excessively invariably exhibit an increased incidence of supragastric, not of gastric belches. Moreover, supragastric belches can elicit regurgitation episodes in patients with the rumination syndrome and sometimes appear to induce reflux episodes as well. Behavioral therapy has been proven to decrease belching complaints in patients with isolated excessive belching, but its effect is unknown in frequently belching patients with GERD, functional dyspepsia or rumination.


Assuntos
Eructação , Dispepsia/complicações , Dispepsia/fisiopatologia , Eructação/diagnóstico , Eructação/etiologia , Eructação/fisiopatologia , Eructação/terapia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/fisiopatologia , Humanos
9.
Curr Opin Otolaryngol Head Neck Surg ; 31(6): 343-349, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-37678344

RESUMO

PURPOSE OF REVIEW: This review article aims to discuss the clinical presentation and diagnosis of rumination syndrome and supragastric belching, as well as treatment options for both diseases. RECENT FINDINGS: Functional gastrointestinal disorders such as rumination syndrome and supragastric belching may be effectively treated using biofeedback. SUMMARY: A comprehensive approach that includes potential pharmacologic treatments, cognitive behavioral therapy and biofeedback should also be considered for optimal management of supragastric belching and rumination.


Assuntos
Refluxo Gastroesofágico , Síndrome da Ruminação , Humanos , Eructação/diagnóstico , Eructação/terapia , Refluxo Gastroesofágico/diagnóstico
10.
Neurogastroenterol Motil ; 35(4): e14520, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36537295

RESUMO

BACKGROUND: Supragastric belching (SGB) is a phenomenon where air is rapidly sucked from the pharynx into the esophagus and immediately expelled through abdominal straining. It is considered a behavior disorder and is increasingly recognized not only in patients with excessive belching, but also in those with reflux-like symptoms. Increased prevalence of esophageal hypomotility and increased acid exposure were previously reported in small cohorts of SGB patients. We aimed to clarify the impact of SGB on motility, reflux, and acid exposure in a large cohort of SGB patients. METHODS: In a single-center database study, we searched for patients with pathological SGB. MII-pH and Manometry tracings were manually re-evaluated in all patients. Demographic, clinical, motility, reflux, and SGB-related data were gathered. KEY RESULTS: Three hundred and forty-eight patients were included. Heartburn, belching, and regurgitation were the most common symptoms. Ineffective esophageal motility (IEM) was found in 27% of patients. SGB related to 47% of all reflux and to 53.6% of acid reflux events, and accounted for 27.3% of acid exposure time (AET). In those with severe SGB, 62% of acid reflux events and 46% of AET were SGB-related. CONCLUSIONS & INFERENCES: Supragastric belching is common, associated with higher incidence of IEM and is responsible for almost a third of esophageal acid burden. The impact of SGB is proportional to its severity. Diagnosis of SGB should be sought in patients with excessive belching and in patients with refractory reflux symptoms. Recognizing SGB and treating patients with behavioral therapy may alleviate acid exposure and improve quality of life.


Assuntos
Esofagite Péptica , Refluxo Gastroesofágico , Humanos , Eructação/diagnóstico , Qualidade de Vida , Refluxo Gastroesofágico/complicações , Azia/complicações , Manometria/efeitos adversos , Monitoramento do pH Esofágico/efeitos adversos
11.
Clin Gastroenterol Hepatol ; 10(4): 379-84, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22079512

RESUMO

BACKGROUND & AIMS: In patients with clinically suspected rumination, esophageal impedance manometry differentiates episodes of rumination (involuntary straining with intragastric pressure increases) from aerophagia/supragastric belching. Treatment options are limited and focused on behavioral therapy. Baclofen, an agonist of the γ-aminobutyric acid B receptor, increases lower esophageal sphincter pressure and decreases swallowing rate. We investigated its effects in these patients. METHODS: High-resolution manometry-impedance recordings were taken from 12 patients (8 women; mean age, 45 years; range, 18-89 years) with clinically suspected rumination or supragastric belching before and during treatment with baclofen (10 mg, 3 times daily). After 30 minutes of recordings, patients received a 1000-kcal solid meal; recordings were then continued for 1 hour. Patients were asked to register symptoms with an event marker. The number of symptoms registered and number and type of flow events were compared before and during treatment. RESULTS: An average of 20 symptom markers (range, 14-34) were recorded at baseline (10 [range, 4-25] for belching and 9 [range, 0-11] for regurgitation). This was significantly reduced to 6 (range, 2-22) (3 [range, 1-15] for belching and 1 [range, 0-13] for regurgitation) during baclofen treatment (P = .01). The number of flow events (473 at baseline [42 reflux, 192 rumination, 188 supragastric belching, and 42 aerophagia]) was significantly reduced to 282 (32 reflux, 99 rumination, 123 supragastric belching, and 13 aerophagia) during baclofen therapy (P = .02). The reduction in flow events correlated with the increase in lower esophageal sphincter pressure (r = -0.62; P = .03) and reduction in swallowing frequency (r = 0.64; P = .02). CONCLUSIONS: Baclofen is an effective treatment for patients with rumination or supragastric belching/aerophagia.


Assuntos
Baclofeno/administração & dosagem , Eructação/tratamento farmacológico , Transtornos de Alimentação na Infância/tratamento farmacológico , Agonistas dos Receptores de GABA-B/administração & dosagem , Período Pós-Prandial/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Eructação/diagnóstico , Transtornos de Alimentação na Infância/diagnóstico , Feminino , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Adulto Jovem
13.
Zhonghua Yi Xue Za Zhi ; 92(32): 2252-5, 2012 Aug 28.
Artigo em Zh | MEDLINE | ID: mdl-23158483

RESUMO

OBJECTIVE: To explore the symptomatic features and psychosocial factors in patients with belching disorders. METHODS: At Peking Union Medical College Hospital Outpatient Clinic from September 2010 to January 2011, 21 consecutive patients with repetitive belching were profiled by symptom questionnaires, including general demographics, spectrum of symptoms, disease course, predisposing factors, previous treatment, psychosocial factors, mental status and personality traits, etc. Pearson's correlation analysis and exact probability were used. RESULTS: Among them, 20 patients fulfilled the Rome III criteria of belching disorders. There were 5 males and 15 females with an age range of (49 ± 10) years. Among them, the belching patterns were daily (n = 18), meal-related (n = 16), spontaneous (n = 15), controllable (n = 16) and symptomatic overlapping (n = 17). The most common symptoms were functional dyspepsia (FD) (n = 13) and gastroesophageal reflux disease (GERD) (n = 11). Sixteen patients experienced mental stimulation/negative events and 13 patients were related to family tension, work stress and overwork. There were 12 patients with anxiety and/or depression and 8 with neurotic personality. The number of overlapping symptoms was related to anxiety states (r = 0.47, t = 2.14, P < 0.05). But the severity of belching was unrelated to with or without depression and anxiety state (P = 0.096). CONCLUSIONS: There are a variety of clinical manifestations in patients with belching disorders. Belching disorders is often related to emotional change and environmental stress and accompanied by abnormal mental and personality characteristics. Belching may be an abnormal behavior reaction to gastrointestinal discomfort symptoms. The psychological and social factors probably play an important role in the pathogenesis of belching disorders.


Assuntos
Eructação/diagnóstico , Eructação/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicologia Social , Inquéritos e Questionários
14.
Saudi J Gastroenterol ; 28(3): 168-174, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35562166

RESUMO

Belching is defined as an audible escape of air from the esophagus or the stomach into the pharynx. It becomes pathologic if it is excessive and becomes bothersome. According to Rome IV diagnostic criteria, there is a belching disorder when one experiences bothersome belching (severe enough to impact on usual activities) more than 3 days a week. Esophageal impedance can differentiate between gastric and supragastric belching. The aim of this review was to provide data on pathogenesis and diagnosis of supragastric belching and study its relationship with gastroesophageal reflux disease and psychological factors. Treatment options for supragastric belching are also presented.


Assuntos
Eructação , Refluxo Gastroesofágico , Impedância Elétrica , Eructação/diagnóstico , Eructação/etiologia , Eructação/terapia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/terapia , Humanos , Manometria , Estômago
15.
Scand J Gastroenterol ; 46(11): 1310-5, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21815865

RESUMO

BACKGROUND: Rumination syndrome is a disorder of unknown etiology characterized by regurgitation of recently ingested food. We aimed to improve the diagnosis of rumination syndrome by classification of separate rumination symptoms using (1) an ambulatory manometry/impedance (AMIM) measurement and (2) a single-catheter high-resolution manometry/impedance (HRIM) measurement. METHODS: A total of 96 symptoms during AMIM and 37 symptoms during HRIM were analyzed in five patients with clinically diagnosed rumination syndrome. KEY RESULTS: AMIM identified rumination events in 85 out of 96 reported symptoms (symptom index (SI): 89%). Of these events, 63% were non-acidic and would have been missed by pH-metry. HRIM identified 32 out of 37 reported symptoms (SI: 86%). Upper esophageal sphincter (UES) relaxation was observed during all rumination events identified by HRIM and could be an additional criterion in the definition of rumination events. CONCLUSIONS: Impedance measurement and high-resolution manometry contribute to a more detailed description of rumination events. Rumination events defined as gastric strain, common cavity phenomenon, retrograde esophageal fluid flow, and UES relaxation show a high SI when measured with AMIM or single-catheter HRIM.


Assuntos
Impedância Elétrica , Eructação/diagnóstico , Refluxo Laringofaríngeo/diagnóstico , Manometria , Adolescente , Adulto , Eructação/fisiopatologia , Esfíncter Esofágico Superior/fisiopatologia , Monitoramento do pH Esofágico , Feminino , Humanos , Refluxo Laringofaríngeo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial , Período Pós-Prandial , Síndrome , Adulto Jovem
16.
Neurogastroenterol Motil ; 33(4): e14075, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33368919

RESUMO

Up to 40% of patients with symptoms suspicious of gastroesophageal reflux disease (GERD) do not respond completely to proton pump inhibitor (PPI) therapy. The term "refractory GERD" has been used loosely in the literature. A distinction should be made between refractory symptoms (ie, symptoms may or may not be GERD-related), refractory GERD symptoms (ie, persisting symptoms in patients with proven GERD, regardless of relationship to ongoing reflux), and refractory GERD (ie, objective evidence of GERD despite adequate medical management). The present ESNM/ANMS consensus paper proposes use the term "refractory GERD symptoms" only in patients with persisting symptoms and previously proven GERD by either endoscopy or esophageal pH monitoring. Even in this context, symptoms may or may not be reflux related. Objective evaluation, including endoscopy and esophageal physiologic testing, is requisite to provide insights into mechanisms of symptom generation and evidence of true refractory GERD. Some patients may have true ongoing refractory acid or weakly acidic reflux despite PPIs, while others have no evidence of ongoing reflux, and yet others have functional esophageal disorders (overlapping with proven GERD confirmed off therapy). In this context, attention should also be paid to supragastric belching and rumination syndrome, which may be important contributors to refractory symptoms.


Assuntos
Consenso , Gerenciamento Clínico , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/terapia , Comportamento de Redução do Risco , Eructação/diagnóstico , Eructação/fisiopatologia , Eructação/terapia , Monitoramento do pH Esofágico/métodos , Monitoramento do pH Esofágico/normas , Refluxo Gastroesofágico/fisiopatologia , Humanos , Manometria/métodos , Manometria/normas , Inibidores da Bomba de Prótons/uso terapêutico
17.
Neurogastroenterol Motil ; 33(10): e14106, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33687131

RESUMO

BACKGROUND: Supragastric belching (SGB) and rumination are behavioral disorders associated with proton pump inhibitor (PPI) non-response and can be diagnosed using multichannel intraluminal impedance-pH (MII-pH) and post-prandial high-resolution impedance manometry (PPHRIM). This pilot study compared diagnostic yield and inter-rater agreement for SGB and rumination using MII-pH and PPHRIM. METHODS: Three esophageal physiologists performed blinded interpretations of MII-pH and PPHRIM in 22 PPI non-responders. Raters selected from 4 diagnostic impressions (normal, GERD, behavioral disorders, GERD+behavioral disorders) without clinical context. Primary outcomes were diagnostic impressions compared against clinical gold standard impression, between raters, and between test modalities. Following a 28-month wash-out period, raters re-interpreted MII-pH with clinical context and under consensus definition of diagnostic criteria. KEY RESULTS: Compared to gold standard, rater accuracy for presence of behavioral disorders ranged from 45 to 77% on MII-pH and 45-59% on PPHRIM. On MII-pH, inter-rater agreement was fair for diagnosis (ĸ0.32, p < 0.01) and suboptimal for presence of behavioral disorders (ĸ0.13, p = 0.14). On PPHRIM, inter-rater agreement was suboptimal for both diagnosis (ĸ0.03, p = 0.34) and presence of a behavioral disorder (ĸ-0.22, p = 0.96). Inter-rater agreement improved in post hoc MII-pH interpretations. Rumination was more frequently identified on PPHRIM (23, 35%) compared to MII-pH (7, 11%). CONCLUSIONS AND INFERENCES: Diagnostic accuracy and inter-rater agreement are higher for MII-pH than PPHRIM, and behavioral disorders are more frequently identified on PPHRIM. Identifying behavioral disorders on MII-pH and PPHRIM has implications for clinical evaluation of PPI non-response; clinical context is essential for accurate study interpretation. Further work is needed to standardize definitions and interpretations.


Assuntos
Eructação , Refluxo Gastroesofágico , Impedância Elétrica , Eructação/diagnóstico , Monitoramento do pH Esofágico , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Humanos , Concentração de Íons de Hidrogênio , Manometria , Projetos Piloto , Inibidores da Bomba de Prótons/farmacologia , Reprodutibilidade dos Testes
19.
Aliment Pharmacol Ther ; 48(10): 1074-1081, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30294924

RESUMO

BACKGROUND: The real size of the gastro-oesophageal reflux disease (GERD) population not responding to proton pump inhibitor (PPI) therapy has still not been fully elucidated. Causes of PPI refractoriness include incorrect diagnosis and lack of adherence to therapy, in terms of incorrect dosage and timing. AIMS: To evaluate the prevalence of refractoriness to optimal PPI therapy and the contribution of non-erosive reflux disease (NERD), reflux hypersensitivity, and functional heartburn, to PPI refractoriness. The association of functional GI symptoms in non-responders was evaluated. METHODS: Frequency and severity of GERD symptoms (heartburn, regurgitation, chest pain), dysphagia, belching, epigastric pain, postprandial distress, irritable bowel syndrome (IBS), globus, and ear nose and throat (ENT) symptoms were evaluated in patients previously classified as non-responders. Patients with at least one of the oesophageal symptoms with a frequency ≥3 /week were treated with esomeprazole 40 mg once daily for 8 weeks and then re-evaluated. Non-responders (patients with oesophageal symptoms ≥3 times per week) underwent 24 hour multichannel intraluminal impedance-pH monitoring. RESULTS: Of 573 consecutive patients, 92 with oesophageal symptoms and classified as PPI-refractory underwent the esomeprazole trial; 60 did not respond. IBS, epigastric pain, and post-prandial distress episodes were associated with a poor response on multivariate analysis. NERD, reflux hypersensitivity, and functional heartburn patients constituted 32%, 42%, and 26%, respectively of the PPI-refractory group. CONCLUSIONS: True refractoriness in patients with GERD symptoms attending a secondary care setting is lower than previously reported. Following a careful history and optimal PPI dosing, the rate of refractoriness was 20%. True NERD constitutes only a third of the PPI-refractory group.


Assuntos
Resistência a Medicamentos/efeitos dos fármacos , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/tratamento farmacológico , Inibidores da Bomba de Prótons/uso terapêutico , Adulto , Idoso , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/tratamento farmacológico , Transtornos de Deglutição/epidemiologia , Resistência a Medicamentos/fisiologia , Eructação/diagnóstico , Eructação/tratamento farmacológico , Eructação/epidemiologia , Esomeprazol/farmacologia , Esomeprazol/uso terapêutico , Esofagite Péptica/diagnóstico , Esofagite Péptica/tratamento farmacológico , Esofagite Péptica/epidemiologia , Feminino , Refluxo Gastroesofágico/epidemiologia , Azia/diagnóstico , Azia/tratamento farmacológico , Azia/epidemiologia , Humanos , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/tratamento farmacológico , Síndrome do Intestino Irritável/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Inibidores da Bomba de Prótons/farmacologia
20.
Korean J Gastroenterol ; 70(6): 273-277, 2017 12 25.
Artigo em Coreano | MEDLINE | ID: mdl-29277088

RESUMO

Supragastric belching is the most important factor in the etiology of excessive belching complaints. Supragastric belching is a belching disorder with a behavioral origin. The standard diagnosis is made by monitoring the esophageal impedance. Supragastric belching has been shown to be associated with globus, as well as reflux symptoms in proton pump inhibitor non-responders in gastroesophageal reflux disease; however, the pathophysiology of supragastric belching in patients with gastroesophageal reflux disease or functional dyspepsia has not been clarified. Patient education with behavioral therapy is the treatment of choice in isolated supragastric belching. On the other hand, the best management of supragastric belching associated with globus, gastroesophageal reflux disease, and dyspepsia remains to be studied.


Assuntos
Eructação/diagnóstico , Animais , Comportamento , Impedância Elétrica , Eructação/complicações , Eructação/patologia , Eructação/terapia , Esôfago/fisiologia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Humanos , Ruminação Digestiva
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