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BACKGROUND: Cap-mounted-clips, especially Over-The-Scope-Clip (OTSC™), are recommended for recurrent nonvariceal upper gastrointestinal bleeding (NVUGIB). There has been recent interest in their use as an initial hemostatic modality. We performed a systematic review of randomized controlled trials (RCTs) assessing cap-mounted clips' efficacy as a primary hemostatic modality in NVUGIB. METHODS: A literature search of MEDLINE, EMBASE, and ISI Web of Science databases up to April 2024 identified RCTs comparing cap-mounted clips to standard endoscopic therapy (SET) as a primary hemostatic modality in NVUGIB. The primary endpoint was the composite outcome of further bleeding (persistent or recurrent) at 30 days. Secondary outcomes included persistent bleeding at index endoscopy and 30-day rebleeding, individually. Other pertinent outcomes were also recorded. A meta-analysis was performed to determine pooled risk ratios (RRs), comparing cap-mounted clip to SET. Out of 516 citations, five RCTs (n = 555), all assessing OTSC™, were included. RESULTS: The composite outcome of further bleeding was lower with cap-mounted clip versus SET (RR = 0.33 [95% confidence interval {CI}: 0.20-0.54]). There was no difference in persistent bleeding at initial endoscopy (RR = 0.30 [95% CI: 0.07-1.30]), but 30-day rebleeding was lower with cap-mounted clip (RR = 0.38 [95% CI: 0.21-0.70]). There were no differences in other outcomes. Grading of the evidence ranged from very low to moderate, mainly due to risk of bias and imprecision. CONCLUSIONS: Cap-mounted clips may be an efficacious primary hemostatic modality, associated with a lower further bleeding at 30 days compared to SET in NVUGIB. However, due to limitations in existing evidence, further research must better characterize an optimal subgroup of patients benefiting most from this approach before adopting its routine use.
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Annual prevalence estimates of peptic ulcer disease range between 0·12% and 1·5%. Peptic ulcer disease is usually attributable to Helicobacter pylori infection, intake of some medications (such as aspirin and non-steroidal anti-inflammatory medications), or being critically ill (stress-related), or it can be idiopathic. The clinical presentation is usually uncomplicated, with peptic ulcer disease management based on eradicating H pylori if present, the use of acid-suppressing medications-most often proton pump inhibitors (PPIs)-or addressing complications, such as with early endoscopy and high-dose PPIs for peptic ulcer bleeding. Special considerations apply to patients on antiplatelet and antithrombotic agents. H pylori treatment has evolved, with the choice of regimen dictated by local antibiotic resistance patterns. Indications for primary and secondary prophylaxis vary across societies; most suggest PPIs for patients at highest risk of developing a peptic ulcer, its complications, or its recurrence. Additional research areas include the use of potassium-competitive acid blockers and H pylori vaccination; the optimal approach for patients at risk of stress ulcer bleeding requires more robust determinations of optimal patient selection and treatment selection, if any. Appropriate continuation of PPI use outweighs most possible side-effects if given for approved indications, while de-prescribing should be trialled when a definitive indication is no longer present.
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Infecciones por Helicobacter , Úlcera Péptica , Inhibidores de la Bomba de Protones , Humanos , Antibacterianos/uso terapéutico , Antibacterianos/efectos adversos , Antiinflamatorios no Esteroideos/efectos adversos , Antiinflamatorios no Esteroideos/uso terapéutico , Infecciones por Helicobacter/tratamiento farmacológico , Infecciones por Helicobacter/complicaciones , Úlcera Péptica/prevención & control , Inhibidores de la Bomba de Protones/uso terapéutico , Inhibidores de la Bomba de Protones/efectos adversosRESUMEN
ABSTRACT: Eosinophilic esophagitis is an antigen-mediated chronic inflammatory disorder that has risen in incidence and prevalence over the past 2 decades. The clinical presentation is variable and consists of mainly esophageal symptoms such as dysphagia, heartburn, food impaction, and vomiting. Current management relies on dietary elimination, proton-pump inhibitors, and topical corticosteroids with different response rates and relapses after treatment discontinuation. With a better understanding of the underlying pathophysiology, many molecules emerged recently as targeted treatment including dupilumab (IL4/IL13 blocker), as the first FDA-approved biological treatment, which has changed the management paradigm.
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Esofagitis Eosinofílica , Inhibidores de la Bomba de Protones , Humanos , Esofagitis Eosinofílica/diagnóstico , Esofagitis Eosinofílica/terapia , Esofagitis Eosinofílica/epidemiología , Inhibidores de la Bomba de Protones/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Corticoesteroides/uso terapéuticoRESUMEN
ABSTRACT: Gastroesophageal reflux disease (GERD) is one of the most common problems encountered in outpatient general medicine and gastroenterology clinics. GERD may present with classic esophageal symptoms, extraesophageal symptoms, or mixed symptoms. The diagnosis and treatment of GERD are challenging due to the variety of symptoms and multifactorial pathophysiology. Since there is no consensus on the diagnosis and treatment of GERD in Saudi Arabia, the Saudi Gastroenterology Association established an expert group to formulate a consensus on the clinical care pathway for the diagnosis and treatment of GERD to update health-care providers in Saudi Arabia. The expert group reviewed the literature including recently published international guidelines, clinical trials, and expert opinion and conducted virtual and in-person meetings. A total of 22 statements on the definition, diagnosis, and treatment of GERD were formulated, and three algorithms for the clinical care of GERD were developed with a detailed description for each step. The expert group endorsed the new definition of GERD, the practical principles of interpretation of the diagnostic GERD evaluation, and the practical guidance for GERD treatment including medical, surgical, and endoscopic therapy. The expert group recommends further studies to investigate local data on the diagnosis and treatment of GERD.
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OBJECTIVE: Proton pump inhibitors (PPIs) are widely prescribed with proven efficacy in many indications, yet longstanding controversy about potential adverse events persists. We aimed to acquire knowledge about perceptions of outpatient PPI long-term prescribing (≥8 wk) among primary and specialty care trainees at 2 Canadian Universities. METHODS: Family medicine, internal medicine, and gastroenterology trainees completed a web-based survey that included 20 clinical scenarios assessing trainee knowledge about PPI efficacy. Contextual PPI prescribing decisions were also elicited, balancing possible PPI indications versus side effects. Management strategies were compared between junior and senior trainees, as well as across training programs. RESULTS: Over a 4-month period,163 trainees (age <26 y: 12%; age 26 to 45: 88%; 59% females) participated in the survey (family medicine: 51%, internal medicine: 44%, and gastroenterology: 5%); 83% were considered junior residents. Only 42% had received formal education on prescribing PPI long-term. Overall, 93% believed they would benefit from such teaching, with 98% stating they would follow related guidelines. No between-group differences were noted in knowledge of appropriate PPI indications nor possible side effects when comparing juniors to seniors, or among different specialties. Across different management scenarios, inappropriate PPI discontinuation was chosen by 14.3% to 67.2%, whereas inappropriate PPI continuation was reported in up to 57%. Trainee seniority and specialty did not differ in appropriate deprescribing rates. CONCLUSIONS: Training level and primary versus specialty care settings are associated with frequent inappropriate PPI prescribing and deprescribing. These findings highlight the need for and may inform future educational programs on PPI usage.
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This study was intended to evaluate the healing of skin injury by using decellularized urinary bladder submucosa scaffolds and tendon-derived hydrogel. Thirty-six adult local breeds of both sex rabbits, with an average weight of 2.0-2.5 kg, were divided randomly into three groups (12 animals for each group). All groups were subjected to an induced injury (2 cm) in diameter at the right side of the abdominal skin, the rabbits of the 1st group (A) were sutured without the application of any substance as a control group, the rabbits of the 2nd group (B) were sutured and treated with the application of decellularized urinary bladder submucosa scaffolds, and in the 3rd group (C), they were sutured and treated with the application of tendon-derived hydrogel. Postoperative care following had been done for all groups throughout the study period. Specimens from the injured skin were taken for the histopathological study on the postinjury day, 8th, 14th, 21st, and 24th. The study showed a clear effect of materials used in the treatment of wounds through a clear progression in the healing stages with a noticed superiority of the submucosa scaffold group.
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Background: Tetrazole-based derivatives and their electronic structures have displayed interesting antimicrobial activity. Methods: The tetrazole-based hybrids linked with thiazole, thiophene and thiadiazole ring systems have been synthesized through various chemical reactions. The computational method DFT/B3LYP has been utilized to calculate their electronic properties. The antimicrobial effectiveness was investigated against representative bacterial and fungal strains. Additionally, the synthesized derivatives binding interaction was stimulated by docking program against PDB ID: 4URO as a model of the ATP binding domain of S. aureus DNA Gyrase subunit B. Results: The structures of the synthesized tetrazole-based derivatives were confirmed by IR, NMR, and Mass spectroscopic data. The DFT/B3LYP method showed that the thiadiazole derivatives 9a-c had lower ΔEH-L than the thiophenes 7a-c and thiazoles 5a-c. The hybrids 5b, 5c, and 7b exhibited proper antibacterial activity against Gram's +ve bacterial strains (S. aureus and S. pneumonia), while 9a displayed potent activity towards Gram's -ve bacterial strains (S. typhimurium and E. coli). Meanwhile, derivatives 5a-b, 7a, 7c, and 9c showed good effectiveness towards fungal strain (C. albicans). Conclusion: The study provides valuable tetrazole core-linked heterocyclic rings and opens the door to further research on their electrical characteristics and applications. Tetrazoles and thiazoles have antibacterial properties in pharmacological frameworks, making these hybrids potential lead molecules for drug development. The conclusion summarizes the data and suggests that the synthesized chemicals' interaction with a particular protein domain suggests focused biological activity.
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BACKGROUND: Lower gastrointestinal bleeding (LGIB) is a common emergency with substantial associated morbidity and mortality. Elective colonoscopy plays an essential role in management, with an even more important role for radiology in the acute setting. Recent advances in the management of patients with LGIB warrant review as the management has recently evolved. AIMS: To provide a comprehensive and updated overview of advances in the approach to patients with LGIB METHODS: We performed a comprehensive literature search to examine the current data for this narrative review supplemented by expert opinion. RESULTS: The incidence of LGIB is increasing worldwide, partly related to an ageing population and the increasing use of antithrombotics. Diverticulosis continues to be the most common aetiology of LGIB. Pre-endoscopic risk stratification tools, especially the Oakland score, can aid appropriate patient triage. Adequate resuscitation continues to form the basis of management, while appropriate management of antithrombotics is crucial to balance the risk of worsening bleeding against increased cardiovascular risk. Radiological imaging plays an essential role in the diagnosis and treatment of acute LGIB, especially among unstable patients. Colonoscopy remains the gold-standard test for the elective management of stable patients. CONCLUSIONS: The management of LGIB has evolved significantly in recent years, with a shift towards radiological interventions for unstable patients while reserving elective colonoscopy for stable patients. A multidisciplinary approach is essential to optimise the outcomes of patients with LGIB.
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Fibrinolíticos , Hemorragia Gastrointestinal , Humanos , Fibrinolíticos/efectos adversos , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Colonoscopía/métodos , Enfermedad AgudaRESUMEN
ABSTRACT: The management of inflammatory bowel disease (IBD) in pregnant women is challenging and must be addressed on a patient-by-patient basis. Optimal patient management requires a multidisciplinary team and clear evidence-based recommendations that cater to this subset of patients. In this article, we provide concise guidelines and clinical care pathway for the management of IBD in pregnant women. Our recommendations were developed by a multidisciplinary working group that includes experts from the Saudi Ministry of Health in collaboration with the Saudi Gastroenterology Association and the Saudi Society of Clinical Pharmacology. All recommendations are based on up-to-date information following an extensive literature review. A total of 23 evidence-based expert opinion recommendations for the management of IBD in pregnant women are herein provided.
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Background: In cases of atopy, IgE antibodies are formed in reaction to certain environmental factors like house dust mites, pollen, or even food allergens. Some studies have shown an association between atopic diseases and keratoconus. This study aims to determine the prevalence of atopy and its associated factors among keratoconus patients. Materials and Methods: A cross-sectional study was conducted among the Jazan population attending ophthalmology clinics regardless of their sex. Data collection started in August 2020 and finished in mid-June 2021. The sample was selected using the convenience sampling technique, and the total sample size was 83 participants. Data were collected via a questionnaire-based interview that contained 46 questions in the Arabic language. The data collected were analyzed using SPSS software. Results: Family history is the leading predisposing factor for keratoconus (P < 0.001). Also, eye rubbing was a significant (P < 0.015) trigger for keratoconus. However, other factors, including demographic factors such as gender and atopic conditions, did not have any significant association. Conclusion: A combination of genetic and environmental factors is the leading cause of the development of keratoconus; however, family history is the most influential factor, followed by eye rubbing.
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The authors would like to make the following correction to the published paper [...].
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OBJECTIVE: The main objective of performing this study was the mutational analysis of Forkhead box family member (FoxP3) and Interleukin-22 (IL-22) genes and their associations with systemic lupus erythematosus (SLE). MATERIALS AND METHODS: A total of sixty blood samples were collected from SLE patients from different hospitals in Lahore. Proforma was based on American College of Rheumatology (ACR) criteria. The total time for this research was one year (2018-2019). DNA was extracted, and FoxP3 and IL-22 genes were polymerized through PCR and further sequenced through the Sanger Sequencing method. Chromas version 2.6.6 was used for the similarity index of sequences. NG_060763 and NG_007392.1 were used as Reference Sequences of IL-22 and FoxP3 genes, respectively. RESULTS: Three already identified Single Nucleotide Polymorphisms (SNPs) in the IL-22 gene i.e., rs2227491, rs2227485, and rs2227513, were confirmed in the sequencing results of SLE patients. Results showed that there were nine novel mutations (27.27%) in the case of the IL-22 gene in the studied genotyped samples. These SNPs had remarkably increased allele T frequency in rs2227485 and allele C frequency in rs2227491 and rs2227513. On the other hand, in the case of FoxP3 gene exon 2, there was an addition of T at position 10 in the intronic portion, thus not involved in the progression of the disease. CONCLUSIONS: The importance of cytokine-mediated signaling pathways, such as the IL-22 gene, is thus established. Novel variants in the IL-22 gene likely contributed significantly to the development of this autoimmune disorder. The current study found that the dysregulation of the inflammatory markers in SLE is not related to the FoxP3 gene, even though FoxP3 is implicated in the tolerance process.
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Lupus Eritematoso Sistémico , Polimorfismo de Nucleótido Simple , Humanos , Intrones , Frecuencia de los Genes , Mutación , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/genética , Exones , Factores de Transcripción Forkhead/genética , Predisposición Genética a la Enfermedad , Estudios de Casos y Controles , Interleucina-22RESUMEN
Background: Metabolic syndrome (MetS) is a collection of cardiovascular risk factors induced by insulin resistance and an inflammatory state that increases the likelihood of developing type 2 diabetes and a variety of cardiovascular disorders. Objective: The study aims to determine the distribution of MetS by diagnostic criteria and family history among adults in Al- Basra province, southern Iraq. Methods: A cross-sectional study was conducted at the Al- Fiaha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC) from October 2nd, 2022, to May 1st, 2023. Following ethical approval, data was obtained using a pre-tested questionnaire. All patient information was obtained from direct interviews as well as FDEMC's digital records, which controlled patient data via a Microsoft Access program and an internal network. Results: This study included 476 people, aged 19 to 89. The sample had an equal number of males and females (238). MetS was identified in 247 people in the entire sample using the International Diabetes Federation criteria. The proportion of participants with a family history was as follows: obesity (30.0%), hypertension (44.1%), diabetes mellitus (46.6%), and cardiovascular disease (9.3%). The diagnostic criteria for MetS were as follows: high wc (94.3%), elevated glucose (69.6%), reduced highdensity lipoprotein (HDL) (80.2%), elevated TG (40.5%), and hypertension (71.7%). Controlled on glycemic status (21.1%), hypertension (61.9%), and lipids (44.1%). Conclusion: Large wc, reduced HDL, and family histories of obesity, hypertension, diabetes mellitus, or cardiovascular disease are the most important risk factors for MetS. Participants with MetS have difficulties controlling their blood sugar, but they regulate the other MetS components.
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OBJECTIVE: Myopia is becoming more common, a significant public health issue everywhere, including in China. There needs to be a comprehensive analysis of the evidence about the extent of myopia in Chinese schoolchildren, despite earlier studies showing a growing frequency in China. Therefore, the frequency of myopia in Chinese schoolchildren is examined in this study with supporting data and a meta-analysis. MATERIALS AND METHODS: The 2022 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used for this research. From January 1, 2015, to December 31, 2022, five computerized bibliographic databases, including PUBMED, Scopus, Web of Science, ProQuest, and China Index Medicus, were reviewed and aimed at investigating myopia's prevalence in China. The studies' methodological quality was evaluated. Myopia is defined as a refractive error. Data were collected according to gender, age, and refraction method. The prevalence was calculated through a meta-analysis. RESULTS: Data from 11 quality-assessed studies, with a total of 1,013,206 adolescents, were included. Hanting District children had an overall myopia prevalence of 45.47%, but Changyi children had a myopia prevalence of 82.37%. In general, 48.56, 47.30, and 31.62% of elementary, middle, and higher school pupils had mild myopia, compared to 1.12, 8.89, and 20.12% who had high myopia. Children aged 7-9 years old experienced the largest overall increase in the prevalence of myopia. For girls and boys, the prevalence of higher myopia was 7.59% and 6.43% (p<0.001). Yet, the spherical equivalent (SE) dropped as students' ages and grades rose. Myopia prevalence rises as students age and grade. CONCLUSIONS: The recent findings revealed that myopia predominated among schoolchildren in Weifang. It steadily grew through age, in addition to it being more common in Changyi neighborhoods. Females had a greater frequency of myopia than males.
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Miopía , Masculino , Niño , Femenino , Adolescente , Humanos , Prevalencia , Miopía/epidemiología , Refracción Ocular , China/epidemiología , Instituciones AcadémicasRESUMEN
OBJECTIVE: The aim of the present study is to determine the in vivo and in silico anti-inflammatory effect of Azadirachta indica (A. indica) in carrageenan-induced rats and its blood biomarkers. A. indica (Neem) is a widely used medicinal plant across the world, especially in Pakistan. Neem leaves have been traditionally used for the synthesis of drugs and treatment of a wide variety of diseases. MATERIALS AND METHODS: In this study, sixty albino rats (160-200 g) were divided into 4 groups: control (group I), standard (group II), ethanolic and aqueous (group III and IV) at doses of 50, 100, 200 and 400 mg/kg. RESULTS: Ethanolic and aqueous extracts showed maximum inhibition in paw size at the 5th hour (400 mg/kg). Similarly, biomarkers measured, including Interleukin-6 and C-reactive protein, exhibited significant anti-inflammatory activity at the highest dose of 400 mg/kg in both experimental groups but were more distinct in the group treated with ethanolic extracts. Correlation between C-reactive protein (CRP) and inter-leukin-6 (IL-6) showed positive correlation in group III, while negative in group IV. Similarly, positive and negative correlations were observed between CRP biomarkers and paw size in group III and IV, and the same results were also shown in the case of IL-6 and paw size. In molecular docking, the binding energy value of protein CRP and IL-1ß with the identified ligands quercetin and nimbosterol showed (-8.2 kcal/mol and -7.7 kcal/mol) the best binding affinity as compared to standard drug diclofenac with -7.0 kcal/mol binding energy respectively. CONCLUSIONS: In conclusion, in silico and in vivo analysis revealed that the extracts of A. indica leaves can be used as an effective drug to manage inflammation.
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Azadirachta , Extractos Vegetales , Ratas , Animales , Extractos Vegetales/uso terapéutico , Interleucina-6 , Proteína C-Reactiva , Azadirachta/química , Simulación del Acoplamiento Molecular , Edema/inducido químicamente , Edema/tratamiento farmacológico , Antiinflamatorios/farmacología , Antiinflamatorios/uso terapéutico , Biomarcadores , Hojas de la PlantaRESUMEN
INTRODUCTION: Uncomplicated urinary tract infection (uUTI) is one of the most prevalent bacterial infections in clinical practice. Empirical treatment is used commonly; thus, knowledge of the local antimicrobial susceptibility pattern is crucial to avoid the growing antibiotic resistance. PURPOSE: The aim of this study is to evaluate the effectiveness of the empirical treatment of uUTI and determine the susceptibility pattern for common uUTI causative microorganisms at outpatient clinics in hospitals in the Jazan region. METHOD: This is a prospective observational study of 120 patients with uncomplicated urinary tract infections attending internal medicine outpatient clinics in Al-Hayat Jazan hospital, Saudi Arabia, from September 2021 to January 2023. RESULTS: In total, 120 patients were included in the study. The mean age of the participants was 48.53 ± 9.29. Risk factors for UTI were found in 57.5%, and type 2 diabetes mellitus (DM) was the major risk factor (27.5%). The most common causative microorganism was Escherichia coli (E. coli) (87.5%), followed by Klebsiella pneumoniae (5%), Staphylococcus aureus, Enterobacter spp., and Enterococcus spp. (2.5%). Nitrofurantoin was the most effective antimicrobial agent (sensitivity rate of 91.7%) against all microorganisms, followed by Ciprofloxacin (75%). CONCLUSIONS: This study concluded that nitrofurantoin and Ciprofloxacin are suitable empirical treatments for uncomplicated urinary tract infection in the Jazan region, and increased resistance against trimethoprim/sulphamethoxazole (TMPSMX) and cefaclor was observed; thus, empirical therapy with these agents should be reconsidered in local guidelines. Wide surveillance research is necessary to monitor effective empirical therapies and to evaluate the regional antimicrobial susceptibility pattern.
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Percutaneous image-guided minimally invasive thermal ablation and vertebral augmentation are robust techniques, part of the available armamentarium used by radiologists for the management of patients with spinal metastases. Such interventions have been established to be safe and effective in treatment of selected patients with vertebral metastases. Special attention to procedure techniques including choice of ablation modality, vertebral augmentation technique, and thermal protection is essential for improved patient outcomes.
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Neoplasias de la Columna Vertebral , Humanos , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/cirugía , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/cirugía , Resultado del TratamientoRESUMEN
Vertebral compression fractures (VCFs) can have a variety of etiologies, including trauma, osteoporosis, or neoplastic infiltration. Osteoporosis related fractures are the most common cause of VCFs and have a high prevalence among all postmenopausal women with increasing incidence in similarly aged men. Trauma is the most common etiology in those >50 years of age. However, many cancers, such as breast, prostate, thyroid, and lung, have a propensity to metastasize to bone, which can lead to malignant VCFs. Indeed, the spine is third most common site of metastases after lung and liver. In addition, primary tumors of bone and lymphoproliferative diseases such as lymphoma and multiple myeloma can be the cause of malignant VCFs. Although patient clinical history could help raising suspicion for a particular disorder, the characterization of VCFs is usually referred to diagnostic imaging. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Fracturas por Compresión , Osteoporosis , Fracturas de la Columna Vertebral , Masculino , Humanos , Femenino , Estados Unidos , Anciano , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/terapia , Fracturas por Compresión/diagnóstico por imagen , Fracturas por Compresión/terapia , Huesos , Sociedades MédicasRESUMEN
OBJECTIVES: To determine the prevalence of hiatal hernia (HH) and its association with age, gender, and body mass index (BMI). METHODS: We retrospectively included patients who underwent esophagogastroduodenoscopy (EGD) at an academic tertiary care hospital. Data were collected on the presence of HH as well as patient demographics including age, gender, and BMI. Univariate and multivariate analysis were done to determine risk factors for HH. RESULTS: A total of 2805 patients were included in this study. The mean age was 48.6 (±18.6) years and males constituted 28.8% of the study population. The mean BMI was 29.7 (±8.6) kg/m². The prevalence of HH was 29.8% among all patients and 48.6% among those who underwent EGD for gastroesophageal reflux disease-related indications. There was no significant association between HH and female gender (OR 1.04, 95%CI: 0.88 -1.26, p=0.53), older age (OR 0.77, 95%CI: 0.72 - 1.06, p=0.19) or BMI (OR 1.07, 95%CI: 0.9 - 1.2, p=0.39). CONCLUSION: The prevalence of HH was 28.9% based on this large endoscopy-based population. We found no association between HH and gender, age, or BMI.