Manual Cervical Traction and Trunk Stabilization Cause Significant Changes in Upper and Lower Esophageal Sphincter: A Randomized Trial.

OBJECTIVES: Dysfunctions in the lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) levels can occur owing to poor muscle coordination, contraction, or relaxation. Such condition can possibly be addressed by functional rehabilitation. The aim of this study was to measure pressure changes in the UES and LES at rest and during routine rehabilitation techniques, that is, cervical manual traction and trunk stabilization maneuver. METHODS: This study was conducted in a University Hospital Gastrointestinal Endoscopy Center. Cervical manual traction and a trunk stabilization maneuver were performed in a convenient group of 54 adult patients with gastroesophageal reflux disease. High-resolution manometry was used to measure pressure changes in the LES and UES at rest and during manual cervical traction and trunk stabilization maneuver. RESULTS: Average initial resting UES pressure was 90.91 mmHg. A significant decrease was identified during both cervical traction (average UES pressure = 42.13 mmHg, P < .001) and trunk stabilization maneuver (average UES pressure = 62.74 mmHg, P = .002). The average initial resting LES pressure was 14.31 mmHg. A significant increase in LES pressure was identified both during cervical traction (average LES pressure = 21.39 mmHg, P < .001) and during the trunk stabilization maneuver, (average pressure = 24.09 mmHg, P < .001). CONCLUSION: Cervical traction and trunk stabilization maneuvers can be used to decrease pressure in the UES and increase LES pressure in patients with gastroesophageal reflux disease.

Seguimiento fisioterápico a lo largo de 14 meses a niño con síndrome de Sandifer / A 14-month physiotherapy follow up to a child with Sandifer syndrome

INTRODUCCIÓN: El síndrome de Sandifer fue descrito en 1964 por el neurólogo Paul Sandifer cuando detectó un trastorno del tracto gastrointestinal superior, que generaba enfermedad de reflujo gastroesofágico, especialmente en bebés y recién nacidos. Suele presentarse con esofagitis, anemia ferropénica y movimientos posturales paroxísticos relacionados con la ingesta, que remiten durante el sueño. Puede provocar en el niño un retraso psicomotor y, por lo tanto, la detección y la identificación precoz de los signos son fundamentales. Con respeto al tratamiento no farmacológico, la estimulación precoz resulta imprescindible en el proceso de aprendizaje y la consolidación de hitos psicomotrices. El tratamiento consiste en estimular al niño mediante el juego activo para la progresión psicomotora y trabajar las alteraciones perceptivas y sensoriales evitando el dolor. CASO CLÍNICO: Lactante de ocho meses con retraso psicomotor derivado a Atención Temprana desde el ámbito hospitalario. Presenta hiperextensión de cuello, hipotonía cervicoaxial, rechazo del decúbito prono, opistótonos en decúbito supino y regurgitaciones esporádicas. A nivel motriz no tiene ninguna vía de desplazamiento y tampoco mantiene la sedestación; en cuanto a la manipulación, aún no choca juguetes. A nivel comunicativo, el contacto es bueno, pero no señala objetos ni emite bisílabos. COMENTARIOS: Después de catorce meses de Atención Temprana (Fisioterapia), el niño sube y baja escaleras cogido de la barandilla con una mano y puede levantarse del suelo casi solo. Además, puede realizar encajes complejos, con dominancia de la mano derecha. A nivel cognitivo-comunicativo comprende los conceptos de permanencia y de acción-reacción, repite muchas palabras y emite de forma espontánea más de diez palabras. La colaboración familiar aplicando las pautas recomendadas ha sido una pieza clave en el tratamiento. Así, las pautas aplicadas en diversos entornos facilitaron la consecución de hitos motrices y el afianzamiento de etapas

INTRODUCTION: The Sandifer's Syndrome was described in 1964 by the neurologist Paul Sandifer when detected a disorder of the upper gastrointestinal tract that generated gastroesophageal reflux disease, especially in new-borns and children. It tends to present with esophagitis, iron deficiency anemia and paroxysmal postural movements. These symptoms are related with the ingestion and they use to remit during the sleep. This syndrome generates to the child a psychomotor delay and, therefore, the Early Care is essential to detect and to identify all the signs early; always focusing on the process of learning and consolidation of psychomotor achievements. Thus, the treatment consists of stimulating the child trough the active game to get the psychomotor progression, working on perceptual and sensory changes, and avoiding pain during the intervention. CASE REPORT: 8-month-old lactating child with psycmotor delay referred to Early Care from Hospital. The baby presents neck hyperextension, cervicoaxial hypotonia, rejection of the prone position, opisthotonus in supine position and sporadic regurgitations. The child can not move neither maintains the sedestation. Furthermore, he does not hit toys; he has good contact but does not point out objects and does not emit bisyllables. COMMENTS: After fourteen months of Early Care (Physiotherapy), the toddler can up and down the stairs grabbed to the railing with one hand and he gets up from the ground practically alone. He can make more complex lace with dominance of the right hand. The toddler understands concepts of permanence and of action-reaction; and he repeats many words and emits more than ten words spontaneously. The family collaboration by applying the recommended patterns has been a key piece in the treatment. The guidelines applied in various settings facilitated the achievement of motor skills and the consolidation of stages

Modified inspiratory muscle training (m-IMT) as promising treatment for gastro-oesophageal reflux disease (GERD) / Entrenamiento de músculos inspiratorios modificado como tratamiento prometedor de la enfermedad por reflujo gastroesofágico

BACKGROUND: Gastro-oesophageal reflux disease (GERD) is one of the most common diseases, but is still a challenge to cure. Different medical treatments are used, first of all Proton pump inhibitors (PPIs), however these are sometimes ineffective and long-term intake can lead to underestimated complications. Recently, some studies investigated the role of inspiratory muscle training (IMT) in the medical treatment of GERD. It seems that IMT is able to increase the pressure generated by the lower oesophageal sphincter (LES), reduce spontaneous releases of LES, acid exposure, use of PPIs, and improve symptoms and quality of life for GERD patients. OBJECTIVE: The aim of this study was to evaluate the effectiveness of IMT in association with myofunctional therapy exercises of swallowing set by Daniel Garliner (m-IMT) on the symptoms of patients with non-erosive gastro-oesophageal reflux disease (NERD). METHODS: Twenty-one adult patients with NERD were enrolled from May to December 2017 and performed m-IMT over a period of 4 weeks. Before and after treatment, all the patients completed the following questionnaires: GERD oesophageal symptomatology (GERDQ), extra-oesophageal GERD symptomatology (RSI), quality of life (GERD-Health Related Quality of Life Questionnaire (GERD-HRQL), and underwent laryngeal endoscopy. RESULTS: Nineteen patients completed m-IMT. GERDQ (from 8.36 ± 3.94 to 1.7 ± 3.41; p < .05), RSI (from to 21.68 ± 10.26 to 6.93 ± 8.37; p < .05) and GERDHRQL (from 25.68 ± 16.03 to 8.4 ± 11.06; p<.05) the questionnaire scores significantly reduced after treatment. In addition, the laryngeal endoscopy score greatly improved (from 14.24 ± 4.15 to 7.4 ± 1.77; p < .05). CONCLUSIONS: m-IMT is a low cost therapy without side effects. It could be useful in association with PPI or alone for selected GERD cases and for mild NERD forms, in association with diet. Further studies are required to prove the effects of m-IMT on GERD symptoms and decide the best treatment Schedule

INTRODUCCIÓN: La enfermedad por reflujo gastroesofágico (ERGE) es una de las enfermedades más comunes, pero sigue siendo un desafío para curar. Se utilizan diferentes tratamientos médicos, en primer lugar los inhibidores de la bomba de protones (IBP), sin embargo, en ocasiones son ineficaces y una ingesta a largo plazo puede llevar a complicaciones subestimadas. Recientemente, algunos estudios investigaron el papel del entrenamiento muscular inspiratorio (IMT) en el tratamiento médico de la ERGE. Parece que el IMT es capaz de aumentar la presión generada por el esfínter esofágico inferior (LES), reducir las liberaciones espontáneas del LES, la exposición al ácido, el uso de IBP, y mejorar los síntomas y la calidad de vida en pacientes con ERGE. OBJETIVO: El objetivo de este estudio es evaluar la efectividad de la IMT en asociación con los ejercicios de terapia miofuncional de tragar de Daniel Garliner (m-IMT) en los síntomas de los pacientes con ERGE no erosivo (NERGE). MÉTODOS: Veintiún pacientes adultos con ERGE se inscribieron de mayo a diciembre de 2017 y realizaron un período de 4 semanas de m-IMT. Antes y después del tratamiento todos los pacientes completaron los siguientes cuestionarios: sintomatología esofágica de ERGE, sintomatología de ERGE extraesofágica (RSI), calidad de vida (cuestionario de calidad de vida relacionada con la salud [ERGE-HRQL]) y endoscopia laríngea. RESULTADOS: Diecinueve pacientes completaron m-IMT. GERDQ (desde 8,36 ± 3,94 a 1,7 ± 3,41; p < 0,05), RSI (desde hasta 21,68 ± 10,26 hasta 6,93 ± 8,37; p < 0,05) y ERGE-HRQL (desde 25,68±16,03 hasta 8,4 ± 11,06; p < 0,05), las puntuaciones se redujeron significativamente después del tratamiento. Además, la puntuación de la endoscopia laríngea mejoró enormemente (de 14,24 ± 4,15 a 7,4 ± 1,77; p< 0,05). CONCLUSIONES: m-IMT es una terapia de bajo costo sin efectos secundarios. Podría ser útil en asociación con IBP o solo en casos seleccionados de ERGE y en formas NERGE leves, en asociación con la dieta. Se requieren estudios adicionales para probar los efectos de m-IMT en los síntomas de ERGE y establecer el mejor programa de tratamiento

Gastrointestinal manifestations on impaired quality of life in systemic sclerosis.

OBJECTIVE: To analyze the impact of gastrointestinal manifestations on quality of life in patients with systemic sclerosis (SSc) and to provide clinical evidence for their early treatment and health-related management. METHODS: Altogether 65 patients admitted to the Peking Union Medical College Hospital selected from a disease cohort and 127 matched controls were enrolled. A self-assessment questionnaire was completed by all participants. Each participant completed scleroderma gastrointestinal tract 1.0 (SSC-GIT 1.0) questionnaire (including reflux or indigestion, diarrhea, constipation, distention, emotional well-being, and social functioning). Autoimmune antibodies were tested in SSc patients. RESULTS: Among these SSc cases, gastrointestinal manifestations were seen in 84.6%. Reflux/indigestion and diarrhea were more common in SSc patients than in the control group (67.7% vs 27.8%; 27.7% vs 10.2%, P < 0.05). SSc patients had a significantly higher percentage of abnormal social functioning than the control group (33.8% vs 3.9%, P < 0.05). SSc patients with abnormal social functioning and abnormal emotional well-being had worse distention, diarrhea, and constipation statuses. Patients with reflux or indigestion and diarrhea had lower anti-Scl-70 level than those without (both P < 0.05). Patients with distention had higher levels of anti-RNP and anti-SSA than those without distention (both P < 0.05). Patients with diarrhea had higher levels of anti-RNP than those without diarrhea (P = 0.014). CONCLUSIONS: Gastrointestinal involvement is frequent in SSc, with reflux or indigestion as the most common symptom. The impaired quality of life in patients with SSc indicates that early and active management should be considered.

[The novel approaches to the rehabilitation of the patients presenting with gastroesophageal reflux disease and co-morbid pathology]. / Novye podkhody k reabilitatsii bol'nykh gastroézofageal'noi refliuksnoi bolezn'iu s komorbidnoi patologiei.

This paper was designed to discuss the problems of co-morbidity and approaches to the rehabilitation of the patients presenting with gastroesophageal reflux disease and a concomitant pathology and to analyze the issues concerning the possible vertebro-visceral correlations inherent in the diseases of the internal organs. AIM: To evaluate the vertebro-neurological status of the thoracic segment of the vertebral column in the patients suffering from gastroesophageal reflux disease and to further improve the methods for their treatment taking into consideration the concomitant pathology, if any. MATERIAL AND METHODS: A total of 290 patients at the age varying from 25 to 60 (mean 44,3±11,3) years with the non-erosive form of gastroesophageal reflux disease were examined in the phase of its exacerbation. They included 132 (45.5%) men and 158 (54.5%) women. The duration of the disease averaged 13.1±3.3 years and that of the exacerbation period 1.2±0.5 months. All the patients underwent the vertebro-neurological examination. The visual analog scale was used to obtain the subjective characteristics of the pain syndrome associated with thoracalgia The quality of life of the patients was estimated based on the Medical Outcomes Study Short Form-36 (scores of MOS SF-36). To evaluate the effectiveness of the proposed approach to the treatment of the gastroesophageal reflux disease, the 260 participants of the study were randomly allocated to two groups, the main and control ones. The latter group was comprised of 130 patients given the standard treatment including the use of histamine H2-receptor antagonists, proton pump inhibitors, stimulators of the motility of the gastrointestinal tract, alginates, and other drugs, as indicated. The former group consisted of the remaining 130 patients undergoing the standard course of pharmacopuncture to correct the functional disorders in the thoracic segment of the vertebral column. The medications of choice for the purpose were the anti-homotoxic agents, such as placental compositum, co-enzyme compositum, and ubichinon compositum (Biologische Heilmittel Heel GmbH, Germany). The statistical analysis was performed with the use of the non-parametric methods based on the Statistica application software package ('StatSoft Inc.', США). RESULTS: The present article reports the results of the study that demonstrate significant strong positive correlation between the clinical manifestations of gastroesophageal reflux disease (the frequency and severity of symptoms) and thoracalgia and provides a rationale for the assessment of the vertebro-neurological status of the thoracic spine in the patients exhibiting the clinical signs of gastroesophageal reflux disease. The study substantiated the inclusion of pharmacopuncture with placenta compositum, co-enzyme compositum, and ubichinon compositum anti-homotoxic medications in the complex rehabilitation programs for the patients presenting with the clinical signs of gastroesophageal reflux disease and the concomitant thoracalgia symptoms. To assess the effectiveness of the proposed method for the treatment of this condition, such diagnostic criteria as the vertebro-neurological symptoms, coefficient of the thoracalgia-associated pain syndrome, the frequency and intensity of the gastroesophageal reflux disease symptoms, and the quality of life parameters were used. CONCLUSION: The results of the present study provide strong evidence that pharmacopuncture helps to improve the quality of life of the patients, alleviate thoracalgia symptoms and clinical signs of gastroesophageal reflux disease, and reduce the intensity of the pain syndrome caused by thoracalgia.

Characteristics of Sleep Disturbances in Patients with Gastroesophageal Reflux Disease.

Objective Gastroesophageal reflux disease (GERD) is strongly associated with sleep disturbances; however, the detailed differences in the characteristics of sleep disturbances between GERD and non-GERD patients are unknown. The aim of the present study was to analyze the clinical characteristics as well as health-related quality of life in GERD and non-GERD patients with sleep disturbances. Methods Three hundred and fifty patients, including 124 patients with GERD and 226 patients without GERD, completed a self-administered questionnaire that evaluated clinical information. The Pittsburg Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS) and 8-item Short-Form Health Survey (SF-8) were also used. Sleep disturbance was considered to be present if the PSQI was >5.5. Results The prevalence of sleep disturbances was significantly higher in the GERD patients (66/124, 53.9%) than in the non-GERD patients (89/226, 39.3%). Depression and anxiety were significantly more common in the subjects with sleep disturbances than in those without sleep disturbances, although there were no differences between the GERD and non-GERD patients. Among the subjects with sleep disturbances, daytime sleepiness was more common in the GERD patients than in the non-GERD patients. The subjects with sleep disturbances had a poorer health-related quality of life. The physical components of quality of life were impaired, particularly in the GERD patients with sleep disturbances. Conclusion GERD patients with sleep disturbances commonly experience daytime sleepiness and an impaired health-related quality of life, especially in terms of physical components.

Gastro-oesophageal reflux disease and dental erosions in adults: influence of acidified food intake and impact on quality of life.

BACKGROUND AND AIM: Gastro-oesophageal reflux disease (GORD) and dental erosions (DE) have an established association. We assessed whether GORD is associated with DE controlling for acidified food intake and their relationships with quality of life (QOL). METHODS: In this cross-sectional study, 419 adult patients who sought dentistry consultation were considered eligible. Patients responded to questionnaires for GORD symptoms, acidified food ingestion and World Health Organization quality of life (WHOQOL Bref), followed by an oral examination, in which DE were characterized according to the Smith & Knight criteria. RESULTS: A total of 417 patients were included (43.8±13.7 years; 68.8% women). There were 143 patients with GORD (34.3%) and 274 controls without GORD. The prevalence of DE was higher in GORD patients compared with the controls (25.9 vs. 17.2%; P=0.041). GORD was associated with DE after adjusting for acidified food intake (P=0.035), with a prevalence ratio of 1.52 (0.95 confidence interval 1.03-2.22). The WHOQOL Bref score was significantly lower in the presence of GORD [median 17.2 (GORD-DE-) vs. 15.4 (GORD+DE+); P<0.01], irrespective of DE. CONCLUSION: In adults examined in a referential dentistry centre in South America, DE were prevalent and significantly associated with GORD. This association was independent of the intake of acidified food in our study. Impairment in QOL was observed in GORD patients irrespective of the presence of DE.

[Therapeutic mechanism of diaphragm training at different periods in patients with gastroesophageal reflux disease].

OBJECTIVE: To explore the effects of postprandial diaphragm training (DT) on esophageal acid exposure, esophageal motility and proximal gastric volume at different postprandial periods in patients with gastroesophageal reflux disease (GERD). METHODS: Thirty GERD patients and 9 healthy subjects (HS) with matched demographic characteristics were enrolled from June 2005 to June 2006 at Peking Union Medical College Hospital. Esophageal manometry with a Dent sleeve catheter and simultaneous esophageal pH monitoring were recorded in a 30-min fasting period and a 120-min postprandial period. The GERD patients were divided into 3 groups: 9 patients received diaphragm training at 1(st) hour after meal (group DT1 h) and another 10 at 2(nd) hour after meal (group DT2 h) whereas no diaphragm training after meal in 11 (group NDT). Ultrasonic imaging of proximal gastric volume was undertaken at 0, 30, 60, 90 and 120 min after meal. RESULTS: (1) The percentage time with pH<4 in group DT1 h was lower than that in group NDT in the 120-min postprandial period (0.2% (0-4.1%), 6.6% (2.2%-18.2%), P < 0.05) and no significant difference of esophageal acid exposure was observed between groups DT2 h and NDT (3.7% (0.1%-17.8%), 6.6% (2.2%-18.2%), P > 0.05) . (2) Esophagogastric junction (EGJ) and crural diaphragm pressures at the 1(st) hour after meal in group DT1 h were both significantly higher than those in group NDT during diaphragm training ((44.4 ± 8.1) vs(16.2 ± 4.5) mm Hg, (38.2 ± 4.2) vs (9.8 ± 4.5) mm Hg, 1 mm Hg = 0.133 kPa, both P < 0.05). EGJ and crural diaphragm pressures at the 2(nd) hour after meal in group DT2 h were significantly higher than those in group N-DT during diaphragm training ((53.2 ± 7.5) vs (14.0 ± 3.7) mm Hg, (48.2 ± 6.3) vs (8.9 ± 2.7) mm Hg, both P < 0.05). There was no change of lower esophageal sphincter pressure (all P > 0.05). (3) After test meal, the groups DT1 h, DT2 h and N-DT had similar proximal stomach volume (all P > 0.05). CONCLUSIONS: Diaphragm training at the 1(st) hour after meal might reduce the 120-min postprandial esophageal acid exposure in GERD patients. The reduction in esophageal acid exposure may result from enhanced antireflux barrier of EGJ function. Therefore postprandial diaphragm training provides a new approach to conservative treatment of GERD.

[The experience with the application of non-medicamental methods for the treatment of the patients presenting with gastroesophageal reflux disease].

The present study was designed to estimate the effectiveness of structural resonance electromagnetic therapy, acupuncture, and DMW therapy applied for the treatment of the patients presenting with gastroesophageal reflux disease. It was shown that acupuncture produced beneficial effect on the functional state of oesophagus and neurohumoral regulation of the lower oesophageal sphincter; moreover, it suppressed the acid-producing activity of the stomach. Structural resonance electromagnetic therapy, acupuncture, and DMW therapy decreased the level of vasoactive intestinal peptide in blood sera of the patients with this condition. These findings give reason to recommend acupuncture using corporal points (in the form of monotherapy in combination with a diet) to the patients presenting with gastroesophageal reflux disease and grade 0 and 1 oesophagitis (Savary-Miller classification). Structural resonance electromagnetic therapy (both alone and in combination with iodine-bromine baths) may be used to treat patients with gastroesophageal reflux disease and grade 0 oesophagitis. Such patients may be just as well managed using DMW therapy in combination with iodine-bromine baths. Patients presenting with grade 1 oesophagitisshoud be treated with the use of the above physical factors in combination with medicamental therapy.

Transferable skills in the field of speech language pathology.

PURPOSE: To highlight new knowledge and technologies that support the transfer of skills generally acquired by speech language pathologists (SLPs) in academic training programs and clinical practice to involvement in the evaluation and management of individuals with disorders such as paradoxical vocal fold movement (PVFM), chronic cough, manifestations of extra-esophageal reflux (EER), esophageal dysphagia and rumination disorder. RECENT FINDINGS: A range of studies published in the previous year provide data to support SLP involvement in the management of some disorders, including PVFM, chronic cough, and some manifestations of EER, both as providers and as clinical resources for other health professionals. However, little research is available that describes the role of SLPs in management of esophageal dysphagia or rumination disorder. SUMMARY: Recent research supports the expanded role of the SLP in the interdisciplinary management of PVFM, chronic cough, manifestations of EER, esophageal dysphagia, and rumination. SLP and other health professionals involved in the care of these patients must find a balance between the practical challenges of treating individuals with increasingly complex medical issues and staying abreast of the latest developments in the diagnosis and treatment of these disorders.

Valoración de la calidad de vida en los pacientes intervenidos por refl ujo gastroesofágico en la edad pediátrica / Evaluation of quality of life in patients operated on for gastroesophageal reflux in the pediatric age

Objetivo. Valorar la calidad de vida y sintomatología de los pacientes intervenidos por RGE mediante laparoscopia en nuestro centro, antes y después de la cirugía. Material y métodos. Recogemos los datos de los pacientes intervenidos laparoscópicamente por reflujo gastroesofágico (RGE) en nuestro centro, pre y postcirugía, agrupados en 3 ítems: estudio nutricional, pruebas diagnósticas, encuesta realizada a las familias de los pacientes sobre sintomatología (diferenciando en síntomas preferentemente digestivos o respiratorios) y calidad de vida; además, determinamos la edad y sexo de los pacientes, antecedentes personales y la técnica quirúrgica utilizada. Resultados. Hemos intervenido a 30 pacientes por RGE, 22 varones y 8 mujeres, de 11 meses a 14 años (mediana 5 años) de los cuales 12 (40%) presentaban algún grado de encefalopatía. La técnica quirúrgica más utilizada es la de Nissen (73% de los casos). La mayoría de los pacientes presentaban alteración importante en sus actividades diarias previamente a la cirugía. La sintomatología más frecuente fue la digestiva (70% casos) y, aunque todos presentaron mejoría, las familias de los niños con clínica predominantemente respiratoria referían mayor satisfacción tras la corrección quirúrgica. Todos mejoraron en su curva de crecimiento. Conclusiones. Los pacientes intervenidos por RGE tienen una mejora importante en su calidad de vida, no solo por la reducción de su sintomatología, sino también por la recuperación nutricional. Los pacientes con sintomatología respiratoria presentan una mayor satisfacción con el tratamiento quirúrgico que aquellos que presentan clínica principalmente digestiva (AU)

Aim. To assess the quality of life and symptoms of GER patients who underwent laparoscopy in our hospital before and after surgery. Material and methods. We collect data from patients operated laparoscopically for gastroesophageal reflux disease (GER) in our center before and after surgery in 3 items: nutritional studies, diagnostic methods, interviews with the families of patients about symptoms (preferably differing in digestive or respiratory symptoms) and quality of life; also, determined the age, gender, personal history and surgical technique of patients. Results. 30 patients have been operated for GER, 22 men and 8 women, 11 months to 14 years (median age 5 years) of whom 12 (40%) had some degree of encephalopathy The most common surgical technique used is Nissen (73% cases). Most patients had significant alterations in their daily activities before surgery. The most common symptom was gastrointestinal (70% cases), although all showed improvement, families of children with respiratory symptoms related predominantly greater reduction in the clinic after surgical correction. All improved in its growth curve. Conclusions. Surgery for GER patients have a signifi cant improvement in their quality of life, not only by the reduction of their symptoms but also in enhancing from the nutritional status. Patients with respiratory symptoms have a higher satisfaction with surgical treatment than those with gastrointestinal clinica (AU)

Management of gastroesophageal reflux disease in primary care settings in Spain: SYMPATHY I study.

OBJECTIVE: Our study was designed to assess the symptom loads, treatment strategies, and impact on daily life of patients with gastroesophageal reflux disease (GERD) symptoms who consulted primary care (PC) health care providers in Spain. METHODS: This was a multicenter, observational, cross-sectional study in a sample of 5735 consecutive patients visiting PC clinics with GERD symptoms. Participating primary care physicians (PCPs) collected clinical data by using a questionnaire, and completed a survey on their perceptions of diagnostic and therapeutic approaches to GERD. Patients self-completed the GERD Impact Scale during the study visit. RESULTS: In the week before visiting the PC clinic, typical GERD symptoms were present in a majority of patients (89.6% heartburn and 81.6% regurgitation), but extraesophageal symptoms were also frequent (55.6% reflux-related sleep disturbances, 45.7% noncardiac chest pain, 30.8% chronic cough, and 24.7% hoarseness), these being more prevalent in the patients diagnosed earlier. Although primary care physicians considered that 55.9% of the patients could be diagnosed on the basis of symptoms without further investigation, in their practice only one-third of new diagnoses of GERD and 71.1% of those already diagnosed were symptom-managed. Upon arrival at the clinic, patients with GERD symptoms were taking the following medications: 28.1% (47.8% in the case of those already diagnosed) proton pump inhibitors (PPIs), 16.6% antacids, 6.1% H2 antagonists, and 4.5% prokinetics. Most patients (90.2%) were treated with PPIs after the study visit. The evaluation of agreement between physicians and patients on the severity of GERD resulted in a kappa index of 0.19. CONCLUSION: There is a high occurrence of typical and extraesophageal symptoms in patients in Spain complaining of GERD symptoms in PC settings. Two-thirds of new GERD patients were referred for further investigation. PPIs were the treatment prescribed in almost all cases. The degree of agreement between physicians and patients about the severity of the symptoms was limited.

Impact of gastroesophageal reflux disease on the quality of life of Spanish patients: the relevance of the biometric factors and the severity of symptoms.

BACKGROUND: Gastroesophageal reflux disease (GERD) has a negative impact on health-related quality of life (HRQoL). AIM: (i) To evaluate HRQoL in the general Spanish population with GERD. (ii) To analyze the influence of biometric factors and symptoms profile on HRQoL. MATERIALS AND METHODS: A multicenter and population-based evaluation was performed. Surveys were sent out to the general population and 335 responders (16%) fulfilled symptomatic criteria of GERD. They filled out two HRQoL questionnaires [Short Form-36 (SF-36) and Quality of Life in Reflux and Dyspepsia]. Biometric factors and symptoms profile were collected. The SF-36 physical and mental component summary scores were calculated. RESULTS: Two hundred and fifty-two individuals (75.2%) participated. SF-36 and Quality of Life in Reflux and Dyspepsia (QoLRAD) punctuations were lower compared with the general population. Female sex, severity of symptoms, and nocturnal symptoms were associated with a greater deterioration of HRQoL. Obese participants had a negative impact on the physical component summary score, but mental component summary score was better than in participants with normal weight. Adjusted by age, punctuations of smokers, exsmokers, and nonsmokers were similar. No differences in HRQoL with regard to alcohol consumption were observed. CONCLUSION: In participants who fulfill symptomatic criteria of GERD, the HRQoL is very deteriorated. The factors that worsen the QoL are being female, increase in BMI, and nocturnal symptoms.

Application of generalizability theory confirmed lower reliability of the standard gamble than the feeling thermometer.

OBJECTIVES: Recent studies suggest that rating clinical marker states (CMS) does not improve the measurement properties of the standard gamble (SG) and only slightly improves those of the feeling thermometer (FT). The poor intrarater (test-retest) reliability of CMS may explain their meager performance. Further, lack of interrater reliability may compromise the use of CMS in interpreting health state ratings. The aim of this study was to assess the reliability of CMS ratings for the SG and the FT. STUDY DESIGN AND SETTING: Two similar studies in patients with chronic obstructive pulmonary disease (COPD, n=91) and in patients with gastroesophageal reflux disease (GERD, n=112) provided data for this analysis. Patients rated three different CMS (mild, moderate, and severe disease) twice several weeks apart. We used generalizability theory to calculate reliability coefficients. RESULTS: Test-retest reliability for CMS ratings was higher for the FT compared to the SG (COPD: 0.86 vs. 0.67; GERD: 0.86 vs. 0.67). Interrater reliability was much higher for the FT compared to the SG (COPD: 0.78 vs. 0.46; GERD: 0.71 vs. 0.26). CONCLUSIONS: These results suggest that the markedly poorer reliability of CMS for the SG than the FT is driven largely by poor interrater reliability.

Patient education in gastro-oesophageal reflux disease: a randomized controlled trial.

OBJECTIVES: Gastro-oesophageal reflux disease (GORD) is chronic, affects 8-20% of the population, impairs quality of life (QoL) and generates substantial health-related costs. Patient education is intended to improve patients' disease-related competency, potentially enabling them to deal more efficiently with their disease, eventually improving QoL and reducing healthcare cost. This study aimed to investigate the effects of a group-based education programme for patients with mild GORD. METHODS: Patients with GORD were randomly allocated to education (n=102) or control (n=109). The education programme was designed as a structured dialogue conveying medical information about the pathophysiology and prognosis, pharmacological and nonpharmacological treatment of GORD, patients' rights and use of healthcare. Outcomes were measured using general QoL [General Health Questionnaire-30 (GHQ-30)], disease-specific QoL [Digestive Symptoms and Impact Questionnaire (DSIQ)], global QoL and healthcare use at 2 and 12 months after the educational programme. RESULTS: No statistically significant differences were found in GHQ-30, DSIQ or global QoL at 2 or 12 months' follow-up between the GORD-education group and controls. In the GORD-education group, patients who had completed primary school education only showed improved QoL at 12 months on both GHQ and DSIQ, whereas patients who had completed advanced schooling showed no change. No difference was found between the groups in their use of healthcare. CONCLUSION: A group-based education programme for patients with mild GORD showed no effect on QoL or use of healthcare. Subgroup analyses showed improved QoL only in patients with primary school education, who had been allocated to GORD education.

Effect of baseline symptom severity on patient-reported outcomes in gastroesophageal reflux disease.

OBJECTIVE: Patient-reported outcome instruments are becoming increasingly important tools in clinical trials. We aimed to investigate the effect of baseline symptom severity on: (i) a global rating of change using the Overall Treatment Effect questionnaire; (ii) the change from baseline for some commonly used questionnaires, namely the Gastrointestinal Symptom Rating Scale and the Quality of Life in Reflux and Dyspepsia questionnaire; and (iii) treatment differences assessed by Gastrointestinal Symptom Rating Scale in patients with symptoms of gastroesophageal reflux disease. METHODS: We used pooled data from two 4-week studies of patients with gastroesophageal reflux disease (but without endoscopically verified esophagitis) randomized either to esomeprazole (20 or 40 mg) or to omeprazole 20 mg. We also used data from a study of omeprazole (10 or 20 mg) or ranitidine 300 mg in gastroesophageal reflux disease patients with or without esophagitis. The analysis is based on descriptive statistics. RESULTS: Little impact of baseline symptoms/problems exists on the global rating of change (Overall Treatment Effect questionnaire). For example, the percentage of patients experiencing a large improvement with acid-suppressive therapy according to Overall Treatment Effect ranged from 63.2% for those with mild reflux at baseline to 70.3% for those with severe reflux. Change from baseline in the Gastrointestinal Symptom Rating Scale reflux dimension and quality of life in reflux and dyspepsia sleep disturbance and food/drink problems dimensions were associated with baseline symptoms/problems, with the largest change seen for patients with severe symptoms/problems at baseline. Baseline symptom severity was also associated with a clear effect on treatment differences, which tended to be larger for patients with severe symptoms than for patients with mild baseline symptoms. CONCLUSIONS: In patients with gastroesophageal reflux disease, baseline symptom/problem severity had little association with the global rating of change, whereas a clear association with change in symptoms/problems and on treatment differences was apparent. The magnitude of change increased with increasing baseline severity of symptoms/problems.

Using quality-of-life instruments to measure outcome after laparoscopic fundoplication.

AIM: This article describe the symptomatic outcome of antireflux surgery in 56 consecutive patients in a single-centre, single-surgeon study--measured by previously validated, generic, and disease-specific quality-of-life instruments. METHODS: In this retrospective study, data was collected from the case records of patients and postal questionnaires. The quality-of-life instruments used were the global quality of life (GQOL) scale; gastroesophageal reflux disease health related quality of life (GERD-HRQL) scale; and the gastrointestinal symptom rating score (GSRS), self-administered version. Paired student t test and Wilcoxon signed rank test were used to analyse the data. RESULTS: The response rate to our postal questionnaire was 100%. The male:female ratio was 1:1.4 and the age range was from 19 to 71 years. The operative technique was either a 'total 360 degree wrap' (47 patients) or a partial posterior fundoplication (270 degree wrap) based on the DeMeester technique. The median follow-up time was 36 months. The mean hospital stay post procedure was 2.3 days. Our results showed good satisfaction rates (80%) and recommendation rates (93%). Best results were achieved in the subgroup of older (over 50 years of age) males. The side-effect profile was comparable to that reported in literature.

Review article: quality-of-life issues in gastro-oesophageal reflux disease.

The purpose of this review is to explore issues relating to quality of life in gastro-oesophageal reflux disease, examining the range of generic and disease-specific instruments available, their applicability and limitations and to overview the effect of gastro-oesophageal reflux disease on quality of life. Whereas instruments have been developed to assist researchers, there is a paucity of reliable instruments for pragmatic use in the clinical setting. The situation is complicated because there is not necessarily a direct correlation between endoscopic findings and symptom severity and non-erosive reflux disease is now recognized as an important manifestation of gastro-oesophageal reflux disease. However, quality-of-life instruments are useful in evaluating the impact of therapies and interventions, although these are limited, particularly in surgical interventions. Impaired quality of life now forms part of a definition of gastro-oesophageal reflux disease, the impact of which goes beyond the symptoms alone. While the symptoms themselves have a negative effect on sufferers' lives, there are secondary effects caused by impaired physical, emotional and social functioning on productivity. Non-gastrointestinal problems caused by gastro-oesophageal reflux disease also impair quality of life. There is an ongoing need to develop instruments which truly measure the impact of gastro-oesophageal reflux disease and which are readily interpretable to the individual patient and clinician.