A single-center retrospective study on epidemiological and Traditional Chinese Medicine syndrome characteristics of 21010 patients with reflux/heartburn symptoms.

OBJECTIVE: To provide a basis for the clinical identification of true and false reflux, integrated traditional Chinese and Western medicine, and psychosomatic treatment, we conducted a retrospective study of the etiology and epidemiological and Traditional Chinese Medicine (TCM) syndrome characteristics of patients with reflux/heartburn symptoms. METHODS: The 210 10 patients with reflux/heartburn treated at Tianjin Nankai Hospital from January 1, 2016, to December 31, 2019, were divided into four groups according to their pathogenesis. Sex, age, course of disease, incidence rate, gastroscopy, 24-h pH-impedance, esophageal manometry, Hamilton Anxiety Scale (HAMA) / Hamilton Depression Scale (HAMD) score, 8-week proton pump inhibitor (PPI) treatment effect, and TCM syndrome characteristics were statistically analyzed. RESULTS: A total of 21010 patients (8864 men and 12146 women), with reflux/heartburn symptoms were screened, including 6284 (29.9%) patients with reflux esophagitis (RE), 10427 (49.6%) patients with non-erosive reflux esophagitis (NERD), 2430 (11.6%) patients with reflux hypersensitivity (RH), and 1870 (8.9%) patients with functional heartburn (FH). The incidence of the disease was higher in women than in men (0.0001). The ranking of the incidence of anxiety and depression in these four groups was FH>RH>NERD>RE ( 0.0001). There were more women than men in the groups with anxiety and more men than women in the groups with depression ( 0.0001), and there was no significant difference in the distribution of anxiety and depression between men and women ( 0.5689). There were significant differences in TCM syndrome characteristics between NERD, RE, and functional esophageal diseases ( 0.01). The highest proportion of functional esophageal disease TCM symptoms was stagnation and phlegm obstruction syndrome (36.16%), and there was no significant difference between RH and FH. The effective rates of PPI treatment at 8 weeks in patients in the RE, NERD, RH, and FH groups were 89%, 72%, 54%, and 0%, respectively. RE was classified into grades A, B, C, and D according to the Los Angeles grading system. The ranking of the incidence of these four grades was A>B>C>D ( 0.0001). The effective rates of PPI treatment at 8 weeks were 91%, 81%, 69%, and 63% in patients with grade A, B, C, and D RE, respectively ( 0.0001). The highest proportion of TCM syndrome types of NERD and RE was the stagnated heat syndrome in the liver and stomach syndrome, 38.99% and 33.90%, respectively. CONCLUSION: Reflux/heartburn symptoms are relatively common in middle-aged women, and NERD is the most common etiology, followed by RE, RH, and FH. The most common TCM syndrome characteristics in NERD and RE were stagnated heat syndrome in the liver and stomach syndrome, and stagnation and phlegm obstruction syndrome in functional esophageal diseases. Most patients with reflux/heartburn symptoms also experienced anxiety and depression.

A comparative study of the common complaints and secondary complications in patients of osteoarthritis on allopathic, homeopathic and herbal system of medicines.

Osteoarthritis is the most common form of arthritis worldwide and progression of arthritis may lead to secondary complications. Osteoarthritis is the degradation of joint tissues from the effects of injury, grinding sensation and inflammation. There are three main systems of medicine including allopathic, homeopathic and herbal system for the treatment of osteoarthritis. Plants are the basis for traditional medicine which is still widely practiced today. The objective of the present study is to find out the complaints and secondary complications in patients of osteoarthritis on allopathic, homeopathic and herbal system of medicine. This study was conducted in Karachi from January 2019 to January 2020. Allopathic, Homeopathic and Herbal practitioners were consulted in the study (n=600, with= 200 in each study group). Data was analyzed by SPSS 22 version. Finding of the study suggest that after the treatment with allopathic medicines orthopaedician, family physician or rheumatologist / internal medicine specialist, there was no significant difference in complaints (Chi-square =0.598, p=0.742). Moreover, there was no significant difference in complications (Chi-square = 0.039, p=0.981). While treatment with homeopathic medicines either by orthologist or family physician significant difference in complaints were observed (Chi-square =4.86, p=0.027). The patient visiting family physicians have higher number of complications than orthologists. While treatment with herbal medicines either by orthologists or family physician there was significant difference in complaints. (Chi-square =5.404, p=0.020). The study reveals that there is no significant difference of complaints and complications in allopathic systems of medicine when treating osteoarthritis, while it is significant for homeopathic and herbal medicine.

Acute Effects of Red Chili, a Natural Capsaicin Receptor Agonist, on Gastric Accommodation and Upper Gastrointestinal Symptoms in Healthy Volunteers and Gastroesophageal Reflux Disease Patients.

The effects of chili on gastric accommodation (GA) in gastroesophageal reflux disease (GERD) patients have not been explored. METHODS: In total, 15 healthy volunteers (HV) and 15 pH-positive non-erosive GERD (NERD) patients underwent single-photon emission computed tomography after ingesting 2 g of chili or placebo in capsules in a randomized double-blind crossover fashion with a one-week washout period. GA was the maximal postprandial gastric volume (GV) after 250 mL of Ensure® minus the fasting GV. Upper gastrointestinal symptoms were evaluated by using a visual analog scale. RESULTS: NERD patients but not HV had significantly greater GA after chili compared to a placebo (451 ± 89 vs. 375 ± 81 mL, p < 0.05). After chili, the postprandial GVs at 10, 20, and 30 min in NERD patients were significantly greater than HV (10 min, 600 ± 73 vs. 526 ± 70 mL; 20 min, 576 ± 81 vs. 492 ± 78 mL; 30 min, 532 ± 81 vs. 466 ± 86 mL, all p < 0.05). In NERD, chili was associated with significantly less satiety, more severe abdominal burning (p < 0.05), and a trend of more severe heartburn (p = 0.06) compared to the placebo. In HV, postprandial symptoms after chili and placebo ingestion were similar (p > 0.05). CONCLUSIONS: Chili enhanced GA in NERD patients but not in HV. This suggests that the modulation of GA in NERD is abnormal and likely involves transient receptor potential vanilloid 1 (TRPV1) sensitive pathways.

The "Aachen sings" study ("Aachen choir engagement study into GERD symptoms"): moderate singing and breathing exercises in a choir reduce reflux symptoms - a cohort study in non-specialist choristers.

BACKGROUND: The influence of singing activities and breathing exercises on the presence of gastroesophageal reflux disease (GERD) symptoms is not clear. While an Austrian study found symptom reduction, an Italian study showed more symptoms in professional opera choristers. These contradictory results may be due to differential intensity of the singing exercises. We therefore developed a questionnaire to investigate the presence of GERD typical symptoms and defined GERD in nonprofessional choristers with moderate singing activity and breathing exercises and compared the results to those from related non-singing control persons. METHODS: 434 actively engaged lay-choir persons and 310 non-singing friends or relatives answered questions in a questionnaire regarding basic data, singing habits, GERD symptoms, and past or present diagnostic events and medications. RESULTS: Non-singing control persons experienced more frequently heartburn (1.1 ±â€Š4.1 vs. 0.5 ±â€Š1.2 episodes/week, p = 0.001) and acid regurgitation (0.9 ±â€Š4.1 vs. 0.5 ±â€Š1.3 episodes/week, p < 0.001) and had more often already received the diagnosis of GERD (16.8 % vs. 10.4 %, p = 0.011). From the persons without known GERD, members of the control cohort more often fulfilled the simplified diagnostic criteria of GERD (14.3 % vs. 5.1 %, p < 0.001). A multivariate analysis identified non-singing, high body mass index, and smoking as significant risk factors for the presence of GERD symptoms. CONCLUSION: The frequency of reflux symptoms and GERD is probably still increasing. Moderate singing activities and breathing exercises seem to be helpful in avoiding reflux symptoms such as heartburn and acid regurgitation.

Gastrointestinal symptom improvement from fiber, STW 5, peppermint oil, and probiotics use-Results from an online survey.

OBJECTIVES: Several common supplements are used by a significant number of patients affected by gastrointestinal (GI) disorders to improve symptoms and quality of life. We investigated the impact of GI symptom improvement with the use of fiber, STW 5, probiotics, and peppermint oil in relation to overall GI pain and quality of life via an online survey. DESIGN: We used a cross-sectional, descriptive, correlation design. A Qualtrics online survey was utilized to collect data from January to June 2013 through various websites. Areas evaluated included participant demographics, use of supplements, and gastrointestinal symptom severity. RESULTS: The rate of supplement use among patients with GI disorders was high (90% in past year) and consultation with healthcare providers was reported by 80%. Participants who completed the survey (n = 68) reported a strong correlation between GI symptom severity and overall quality of life (r2 = 0.8682, p < 0.001). The use of fiber improved GI symptom severity while both STW 5 and probiotics were linked to specific improvements. CONCLUSIONS: Persons with chronic GI disorders often choose the complementary use of common supplements to mitigate GI symptoms and consult with their healthcare providers frequently. The use of STW 5 and probiotics specifically is linked to overall reduction in GI symptoms and improvement of quality of life.

Complementary and alternative medicine used by persons with functional gastrointestinal disorders to alleviate symptom distress.

AIM: The aim of this study was to describe the complementary and alternative medicine methods most commonly used to alleviate symptom distress in persons with functional gastrointestinal disorders. BACKGROUND: People with functional gastrointestinal disorders face many challenges in their everyday lives, and each individual has his/her own way of dealing with this illness. The experience of illness often leads persons with functional gastrointestinal disorders to complementary and alternative medicine as a viable healthcare choice. DESIGN: Quantitative and describing design. METHOD: A study-specific complementary and alternative medicine questionnaire was used, including questions about complementary and alternative medicine methods used and the perceived effects of each method. Efficacy assessments for each method were preventive effect, partial symptom relief, total symptom relief or no effect. RESULTS: A total of 137 persons with functional gastrointestinal disorders answered the questionnaire, 62% (n = 85) women and 38% (n = 52) men. A total of 28 different complementary and alternative medicine methods were identified and grouped into four categories: nutritional, drug/biological, psychological activity and physical activity. All persons had tried at least one method, and most methods provided partial symptom relief. CONCLUSION: Persons with functional gastrointestinal disorders commonly use complementary and alternative medicine methods to alleviate symptoms. Nurses have a unique opportunity to expand their roles in this group of patients. RELEVANCE TO CLINICAL PRACTICE: Increased knowledge of complementary and alternative medicine practices would enable a more comprehensive patient assessment and a better plan for meaningful interventions that meet the needs of individual patients.

Relationship between gastro-oesophageal reflux and airway diseases: the airway reflux paradigm.

Our understanding of the relationship between gastro-oesophageal reflux and respiratory disease has recently undergone important changes. The previous paradigm of airway reflux as synonymous with the classic gastro-oesophageal reflux disease (GORD) causing heartburn has been overturned. Numerous epidemiological studies have shown a highly significant association of the acid, liquid, and gaseous reflux of GORD with conditions such as laryngeal diseases, chronic rhinosinusitis, treatment resistant asthma, COPD and even idiopathic pulmonary fibrosis. However, it has become clear from studies on cough hypersensitivity syndrome that much reflux of importance in the airways has been missed, since it is either non- or weakly acid and gaseous in composition. The evidence for such a relationship relies on the clinical history pointing to symptom associations with known precipitants of reflux. The tools for the diagnosis of extra-oesophageal reflux, in contrast to the oesophageal reflux of GORD, lack sensitivity and reproducibility. Unfortunately, methodology for detecting such reflux is only just becoming available and much additional work is required to properly delineate its role.

[The relationship between the popular beverages in Korea and reported postprandial heartburn].

BACKGROUND/AIMS: The aim of this study was to investigate the frequency of heartburn produced by beverages available in Korea and to clarify the mechanism causing heartburn. METHODS: We measured pH, titratable acidity, and osmolality of 35 beverages in vitro and correlated them with the severity of heartburn reported by questionnaire in 382 patients from November 2004 to June 2005. RESULTS: Coffee (1.15) and soju (1.12) showed the highest heartburn score, while oolong tea (0.17) and carrot juice (0.18) showed the lowest heartburn score among all beverages. Titratable acidity of citrus juices correlated with heartburn (r=0.78; p=0.023). Soft drinks had the lowest pH, which was unrelated with heartburn scores (r=-0.54; p=0.460). Increasing pH among alcoholic beverages was correlated with heartburn scores (r=0.84; p=0.037), and osmolality was inversely associated with heartburn scores (r=-0.86; p=0.028). The heartburn score of decaffeinated coffee was significantly lower than that of regular coffee (p<0.001). Regular milk caused more heartburn than low-fat milk (p=0.008). CONCLUSIONS: Our findings provide dietary information that helps to select appropriate beverages to the patients with heartburn.

The Relationship between the Popular Beverages in Korea and Reported Postprandial Heartburn / 대한소화기학회지

BACKGROUND/AIMS: The aim of this study was to investigate the frequency of heartburn produced by beverages available in Korea and to clarify the mechanism causing heartburn. METHODS: We measured pH, titratable acidity, and osmolality of 35 beverages in vitro and correlated them with the severity of heartburn reported by questionnaire in 382 patients from November 2004 to June 2005. RESULTS: Coffee (1.15) and soju (1.12) showed the highest heartburn score, while oolong tea (0.17) and carrot juice (0.18) showed the lowest heartburn score among all beverages. Titratable acidity of citrus juices correlated with heartburn (r=0.78; p=0.023). Soft drinks had the lowest pH, which was unrelated with heartburn scores (r=-0.54; p=0.460). Increasing pH among alcoholic beverages was correlated with heartburn scores (r=0.84; p=0.037), and osmolality was inversely associated with heartburn scores (r=-0.86; p=0.028). The heartburn score of decaffeinated coffee was significantly lower than that of regular coffee (p<0.001). Regular milk caused more heartburn than low-fat milk (p=0.008). CONCLUSIONS: Our findings provide dietary information that helps to select appropriate beverages to the patients with heartburn.

Indigestion and heartburn: a descriptive study of prevalence in persons seeking care from chiropractors.

OBJECTIVE: To determine the prevalence of indigestion and mid-back pain in persons seeking chiropractic care. DESIGN: A cross-sectional survey using a self-report questionnaire. SETTING: Three primary care private chiropractic practices in metropolitan Perth, Australia. SUBJECTS: Persons seeking chiropractic care during a 1-month period. INTERVENTION: None. OUTCOME MEASURES: Six-month prevalence of indigestion and mid-back pain, rate of association between indigestion and mid-back pain, and distribution of thoracic dysfunction and manipulation. Proportion who report relief from manipulation. OBSERVATIONS: Of 1567 persons who consulted 8 chiropractors on 2974 occasions during November 1994, 1494 responses were obtained. There were 119 first-time consultations. The mean age of respondents was 41 yr (range 10-94); 57% were women. Fifty-seven percent reported indigestion infrequently or more and 71% reported mid-back pain during the previous 6 months. Forty-six percent experienced both symptoms during this time. Of these, 36% reported the symptoms together at some time. Twenty-two percent of those with indigestion reported some relief after chiropractic care. Compared with those reporting no relief, mid-back pain was more common among those reporting indigestion. The level at which the manipulation was given was unrelated to relief. No major differences were noted between the three clinics in patient demographics or the main outcome measures. CONCLUSIONS: Indigestion and mid-back pain are commonly experienced in this population. A person with indigestion is more likely to report mid-back pain. Relief of indigestion by manipulation is more common among those who report mid-back pain. Further research is needed to understand differences between subgroups and differences compared with other studies.