ABSTRACT
ABSTRACT: The aim of this study was to assess the relationship of heartburn in pediatric patients with functional dyspepsia (FD) and irritable bowel syndrome (IBS) with gastrointestinal symptoms, sleep disturbances, and psychologic distress.The overlap in symptoms of FD, IBS, and gastroesophageal reflux disease (GERD) predicts greater symptom severity and decreased quality of life and presents opportunities for improved diagnostic classification and personalized therapeutics.A cross-sectional observational study of 260 pediatric patients with abdominal pain was conducted. Patients completed standardized questionnaires assessing clinical symptoms, sleep quality, and psychologic symptoms during routine clinical care. Questionnaire data were compared for patients reporting heartburn and not reporting heartburn using χ2 and t tests where appropriate.Gastrointestinal symptoms were significantly more prevalent among patients with a positive report of heartburn (vs a negative report of heartburn): pain with eating (83% vs 67%, Pâ=â.007), bloating (63% vs 44%, Pâ=â.005), acid regurgitation (47% vs 24%, Pâ≤â.001), and chest pain (45% vs 20%, Pâ≤â.001). Likewise, initiating and maintaining sleep (Pâ=â.007), arousal/nightmares (Pâ=â.046), sleep-wake transition (Pâ=â.001), hyperhidrosis during sleep (Pâ=â.016), and anxiety (Pâ=â.001) and depression (Pâ=â.0018) were also significantly increased in patients who reported heartburn versus patients who did not report heartburn.Patients with a positive report of heartburn, whether classified as having FD and/or IBS, had increased gastrointestinal symptoms, sleep disturbances, anxiety, and depression than patients with a negative report of heartburn. A better understanding of these associations may allow for personalized treatment for youth with abdominal pain and heartburn as a primary symptom.
Subject(s)
Anxiety/epidemiology , Depression/epidemiology , Dyspepsia/complications , Heartburn/etiology , Irritable Bowel Syndrome/complications , Sleep Wake Disorders/epidemiology , Adolescent , Anxiety/diagnosis , Anxiety/psychology , Biopsy , Child , Cross-Sectional Studies , Depression/diagnosis , Depression/psychology , Dyspepsia/diagnosis , Dyspepsia/pathology , Dyspepsia/psychology , Endoscopy, Digestive System , Esophageal Mucosa/diagnostic imaging , Esophageal Mucosa/pathology , Female , Gastric Mucosa/diagnostic imaging , Gastric Mucosa/pathology , Heartburn/psychology , Humans , Intestinal Mucosa/diagnostic imaging , Intestinal Mucosa/pathology , Irritable Bowel Syndrome/psychology , Male , Patient Health Questionnaire/statistics & numerical data , Quality of Life , Retrospective Studies , Risk Factors , Self Report/statistics & numerical data , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/psychologyABSTRACT
BACKGROUND: Psychological stress and anxiety, such those generated by forced quarantine, affect gastrointestinal symptoms course in patients with functional gastrointestinal disorders. Thus, our aim was to assess, in a cohort of patients regularly followed up in a devoted outpatient clinic of Southern Italy, the association between their gastrointestinal symptoms changes, stress, and anxiety reported during the Italian lockdown. METHODS: We recruited patients from the outpatient clinic of the University of Salerno, devoted to functional gastrointestinal disorders, selecting only patients for whom an evaluation was available in the last 6 months before the lockdown. Gastrointestinal symptoms were evaluated at each visit through standardized questionnaire and pooled in a database. On 45th days from the beginning of the lockdown, patients were re-assessed by phone with the same questionnaire. Anxiety and stress levels were assessed through a self-administered online questionnaire based on Generalized Anxiety Disorder 7 test and Perceived Stress Scale 10 test. KEY RESULTS: The intensity-frequency scores of several upper gastrointestinal symptoms improved (Wilcoxon test <0.05). Higher anxiety levels had a higher risk of worsening chest pain (OR 1.3 [1.1-1.7]), waterbrash (OR 1.3 [1.0-1.7]), epigastric burning (OR 1.3 [1.0-1.6]), and abdominal pain (OR 1.6 [1.0-2.3]). When compared to the interval preceding the outbreak, half of the patients declared their symptoms remained unchanged, 13.6% worsened, and 36.4% improved. CONCLUSIONS AND INFERENCES: During the COVID-19 quarantine, there was an improvement of the majority of upper gastrointestinal symptoms in our patients, and anxiety seems an important risk of worsening few of them.
Subject(s)
Anxiety/psychology , COVID-19 , Dyspepsia/physiopathology , Gastrointestinal Diseases/physiopathology , Heartburn/physiopathology , Irritable Bowel Syndrome/physiopathology , Stress, Psychological/psychology , Abdominal Pain/physiopathology , Abdominal Pain/psychology , Adult , Chest Pain/physiopathology , Chest Pain/psychology , Communicable Disease Control , Dyspepsia/psychology , Female , Gastrointestinal Diseases/psychology , Heartburn/psychology , Humans , Irritable Bowel Syndrome/psychology , Italy , Male , Middle Aged , Patient Health Questionnaire , Public Policy , SARS-CoV-2 , Surveys and QuestionnairesABSTRACT
BACKGROUND: Irritable bowel syndrome (IBS) and functional constipation (FC) are highly prevalent in the general population and have signiï¬cant symptom overlap, while the clinical associations and psychological links between IBS and FC remains poorly understood. We aimed to compare the clinical, metabolic and psychological factors between patients with FC patients and constipation predominated IBS. METHODS: We consecutively enrolled 360 patients from the outpatient clinics of Hualien Tzu Chi medical center. Constipation-predominant IBS (IBS-C) and FC were diagnosed based on Rome III criteria. All participants completed the Pittsburg Sleep Quality Index (PSQI) score, the State Trait Anxiety Inventory (STAI) score and the Taiwanese Depression Questionnaire (TDQ) score. RESULTS: Fifty-four patients had FC and twenty-three patients had IBS-C. Compared to asymptomatic controls, FC/IBS-C groups had female predominance (p < 0.001), FC as well as more GI discomforts and inferior psychosocial characteristics (p < 0.05). Compared to FC, IBS-C had higher severity scores of abdominal distention (4.52 ± 1.90 vs. 3.07 ± 1.88) and heartburn (2.17 ± 1.50 vs. 1.46 ± 1.14). However, FC was independently associated with poor sleep quality [adjusted OR: 1.19 (1.08-1.31), p < 0.001] and IBS-C with depression [adjusted OR: 1.07 (1.02-1.12), p = 0.005]. CONCLUSION: Patients with FC and IBS-C shared many similar GI complaints and psychosocial characteristics, however IBS-C had more severe bloating, heartburn and depression and FC had worse sleeping quality.
Subject(s)
Abdominal Pain/diagnosis , Constipation/diagnosis , Irritable Bowel Syndrome/diagnosis , Sleep Wake Disorders/diagnosis , Abdominal Pain/physiopathology , Abdominal Pain/psychology , Adult , Anxiety/diagnosis , Anxiety/psychology , Constipation/physiopathology , Constipation/psychology , Cross-Sectional Studies , Depression/diagnosis , Depression/psychology , Female , Heartburn/diagnosis , Heartburn/psychology , Humans , Irritable Bowel Syndrome/physiopathology , Irritable Bowel Syndrome/psychology , Male , Middle Aged , Risk Factors , Severity of Illness Index , Sleep Wake Disorders/psychology , Surveys and Questionnaires , TaiwanABSTRACT
Introduction: Gastroesophageal reflux disease (GERD) is a highly prevalent condition in the Western world. It is a frequent cause of medical appointments and has a high impact on quality of life (QOL). This study aimed to assess health-related quality of life (HQ-QOL) of patients with non-erosive gastroesophageal disease (NERD) and compare their scores with the scores of patients with GERD symptoms and non-pathological acid reflux (non-NERD). Methods: We studied 42 patients with GERD symptoms21 with positive pHmetry for acid reflux (NERD group) and 21 with negative pHmetry for acid reflux (non-NERD group). We enrolled patients matched by age and gender. Patient inclusion criteria were based on clinical and endoscopic findings and pHmetry. All other major diseases having an impact on QOL were excluded as well as patients in regular use of proton pump inhibitors, prokinetics, histamine-2 receptor antagonists and anti-depressants. All subjects were asked to fill in a validated translation of the SF-36 questionnaire. We described scores trough median and interquartile range (IQR) and assessed the significance of the comparisons through Mann-Whitney test and chi-square test or Student's t-test when appropriate. Results: We found no significant differences in the eight domains of SF-36 between the two groups. Conclusion: QOL of patients with GERD symptoms was equivalent, regardless of acid reflux at pHmetry (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Gastroesophageal Reflux/psychology , Quality of Life , Gastroesophageal Reflux/complications , Heartburn/complications , Heartburn/psychology , Severity of Illness Index , Signs and Symptoms, Digestive , Symptom AssessmentABSTRACT
Acid reflux episodes that extend to the proximal esophagus are more likely to be perceived. This suggests that the proximal esophagus is more sensitive to acid than the distal esophagus, which could be caused by impaired mucosal integrity in the proximal esophagus. Our aim was to explore sensitivity to acid and mucosal integrity in different segments of the esophagus. We used a prospective observational study, including 12 patients with gastroesophageal reflux disease (GERD). After stopping acid secretion-inhibiting medication, two procedures were performed: an acid perfusion test and an upper endoscopy with electrical tissue impedance spectroscopy and esophageal biopsies. Proximal and distal sensitivity to acid and tissue impedance were measured in vivo, and mucosal permeability and epithelial intercellular spaces at different esophageal levels were measured in vitro. Mean lag time to heartburn perception was much shorter after proximal acid perfusion (0.8 min) than after distal acid perfusion (3.9 min) (P = 0.02). Median in vivo tissue impedance was significantly lower in the distal esophagus (4,563 Ω·m) compared with the proximal esophagus (8,170 Ω·m) (P = 0.002). Transepithelial permeability, as measured by the median fluorescein flux was significantly higher in the distal (2,051 nmol·cm(-2)·h(-1)) than in the proximal segment (368 nmol·cm(-2)·h(-1)) (P = 0.033). Intercellular space ratio and maximum heartburn intensity were not significantly different between the proximal and distal esophagus. In GERD patients off acid secretion-inhibiting medication, acid exposure in the proximal segment of the esophagus provokes symptoms earlier than acid exposure in the distal esophagus, whereas mucosal integrity is impaired more in the distal esophagus. These findings indicate that the enhanced sensitivity to proximal reflux episodes is not explained by increased mucosal permeability.
Subject(s)
Esophageal Mucosa/metabolism , Gastric Acid/metabolism , Gastroesophageal Reflux/diagnosis , Heartburn/diagnosis , Hydrochloric Acid/administration & dosage , Pain Perception , Adult , Aged , Biopsy , Electric Impedance , Esophageal Mucosa/injuries , Esophageal Mucosa/ultrastructure , Esophagoscopy , Female , Gastroesophageal Reflux/metabolism , Gastroesophageal Reflux/physiopathology , Gastroesophageal Reflux/psychology , Heartburn/metabolism , Heartburn/physiopathology , Heartburn/psychology , Humans , Male , Middle Aged , Pain Measurement , Permeability , Predictive Value of Tests , Prospective Studies , Time FactorsABSTRACT
BACKGROUND: Patients with functional heartburn (FH) experience troublesome heartburn that is not related to gastroesophageal reflux. The etiology of the heartburn sensation in FH patients is unknown. In patients with reflux disease, esophageal hypersensitivity seems associated with impaired mucosal integrity. We aimed to determine esophageal sensitivity and mucosal integrity in FH and non-erosive reflux disease (NERD) patients. METHODS: In this prospective experimental study, we performed an acid perfusion test and upper endoscopy with biopsies in 12 patients with NERD and nine patients with FH. Mucosal integrity was measured during endoscopy using electrical tissue impedance spectroscopy and biopsy specimens were analyzed in Ussing chambers for transepithelial electrical resistance and transepithelial permeability. KEY RESULTS: Lag time to heartburn perception was significantly longer in FH patients (median 12 min) than in NERD patients (median 3 min). Once perceived, intensity of heartburn was scored equal with median visual analog scale 6.5 and 7.1 respectively. Esophageal mucosal integrity was also comparable between FH and NERD patients, both in vivo extracellular impedance and ex vivo transepithelial resistance and permeability were similar. CONCLUSIONS & INFERENCES: Patients with FH did not show acid hypersensitivity as seen in patients with NERD. However, once perceived, intensity of heartburn is similar. Esophageal mucosal integrity is similar between NERD and FH patients, and is therefore unlikely to be the underlying cause of the observed difference in esophageal acid perception.
Subject(s)
Esophageal Mucosa/metabolism , Esophageal pH Monitoring/methods , Esophagus/metabolism , Gastric Acid/metabolism , Heartburn/diagnosis , Heartburn/metabolism , Adult , Female , Heartburn/psychology , Humans , Male , Manometry/methods , Middle Aged , Perception/physiology , Prospective StudiesABSTRACT
OBJECTIVE: The aim of this study was to investigate the predictor variables that could influence overlap syndrome in functional gastrointestinal disorders (FGID) among firefighters in Korea. METHODS: Data collected from 1217 firefighters in Korea were reviewed. FGID were diagnosed according to the Rome III diagnostic criteria. Psychological factors were measured by self-reported questionnaires. The scores for depression, anxiety, quality of life (QOL) and occupational job stress were analyzed. The correlation between psychological factors and QOL was analyzed and a stepwise multiple regression analysis was performed. RESULTS: FGID were observed in 461 (37.9%) participants. In those with FGID, functional heartburn (FH) was most common (32.2%), followed by functional dyspepsia (12.2%). Patients with overlap syndrome had the highest depression, anxiety and occupational stress score than those having non-overlap syndrome and healthy controls, respectively (depression: F = 142.29, η(2) = 0.190; anxiety: F = 88.33, η(2) = 0.127; occupational stress: F = 43.68, η(2) = 0.067; all P < 0.001). Healthy controls had the highest QOL score (F = 73.39, P < 0.001, η(2) = 0.108). Pychological factors were significantly correlated with QOL in the overlap syndrome of FGID. After the stepwise selection, the final model explained 45.6% of predictable variance and contained four significant variables: depression, self-esteem, occupational stress and anxiety. CONCLUSIONS: Psychological factors are associated with the overlap syndrome of FGID. Acknowledging this common comorbidity may facilitate the recognition and treatment of patients with FGID.
Subject(s)
Firefighters/psychology , Gastrointestinal Diseases/psychology , Occupational Diseases/psychology , Quality of Life , Stress, Psychological/psychology , Adult , Anxiety/diagnosis , Comorbidity , Cross-Sectional Studies , Depression/diagnosis , Female , Gastrointestinal Diseases/diagnosis , Heartburn/diagnosis , Heartburn/psychology , Humans , Male , Mass Casualty Incidents/psychology , Middle Aged , Occupational Diseases/diagnosis , Regression Analysis , Republic of Korea , Self Report , Stress, Psychological/diagnosis , Surveys and Questionnaires , Young AdultABSTRACT
Functional heartburn (FH) is a benign but burdensome condition characterized by painful, burning epigastric sensations in the absence of acid reflux or symptom-reflux correlation. Esophageal hypersensitivity and its psychological counterpart, esophageal hypervigilance (EHv) drive symptom experience. Hypnotherapy (HYP) is an established and preferred intervention for refractory symptoms in functional gastrointestinal disorders (FGIDs) and could be applied to FH. The objective of this study was to determine the feasibility, acceptability, and clinical utility of 7 weekly sessions of esophageal-directed HYP (EHYP) on heartburn symptoms, quality of life, and EHv. Similar to other work in FGIDs and regardless of hypnotizability, there were consistent and significant changes in heartburn symptoms, visceral anxiety, and quality of life and a trend for improvement in catastrophizing. We would recommend EHYP in FH patients who are either non-responsive to medications or who would prefer a lifestyle intervention.
Subject(s)
Heartburn/therapy , Hypnosis/methods , Adult , Anxiety , Catastrophization , Esophagus/physiopathology , Feasibility Studies , Female , Heartburn/psychology , Humans , Male , Middle Aged , Pilot Projects , Quality of Life , Self Report , Surveys and Questionnaires , Treatment OutcomeABSTRACT
Multichannel impedance pH monitoring has shown that weakly acidic refluxes are able to generate heartburn. However, data on the role of different pH values, ranging between 4 and 7, in the generation of them are lacking. The aim of this study was to evaluate whether different pH values of weakly acidic refluxes play a differential role in provoking reflux symptoms in endoscopy-negative patients with physiological esophageal acid exposure time and positive symptom index and symptom association probability for weakly acidic refluxes. One hundred and forty-three consecutive patients with gastroesophageal reflux disease, nonresponders to proton pump inhibitors (PPIs), were allowed a washout from PPIs before undergoing: upper endoscopy, esophageal manometry, and multichannel impedance pH monitoring. In patients with both symptom index and symptom association probability positive for weakly acidic reflux, each weakly acidic reflux was evaluated considering exact pH value, extension, physical characteristics, and correlation with heartburn. Forty-five patients with normal acid exposure time and positive symptom association probability for weakly acidic reflux were identified. The number of refluxes not heartburn related was higher than those heartburn related. In all distal and proximal liquid refluxes, as well as in distal mixed refluxes, the mean pH value of reflux events associated with heartburn was significantly lower than that not associated. This condition was not confirmed for proximal mixed refluxes. Overall, a low pH of weakly acidic reflux represents a determinant factor in provoking heartburn. This observation contributes to better understand the pathophysiology of symptoms generated by weakly acidic refluxes, paving the way toward the search for different therapeutic approaches to this peculiar condition of esophageal hypersensitivity.
Subject(s)
Esophageal pH Monitoring/methods , Gastroesophageal Reflux , Heartburn , Hydrogen-Ion Concentration , Pain Perception/physiology , Adult , Esophagus/physiopathology , Female , Gastric Acidity Determination , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/physiopathology , Heartburn/diagnosis , Heartburn/etiology , Heartburn/physiopathology , Heartburn/psychology , Humans , Male , Manometry/methods , Middle Aged , Proton Pump Inhibitors/therapeutic use , Statistics as Topic , Symptom AssessmentABSTRACT
BACKGROUND: Heartburn and regurgitation frequently occur in the third trimester of pregnancy, but their impact on quality of life has not been thoroughly investigated. OBJECTIVE: To measure health-related quality of life of third-trimester pregnant women with heartburn and regurgitation. Methods Data on obstetric history, heartburn and regurgitation frequency and intensity, history of heartburn and regurgitation and health-related quality of life were collected of 82 third-trimester pregnant women. RESULTS: Sixty-two (76%) women had heartburn, and 58 (71%), regurgitation; 20 were asymptomatic. Mean gestational age was 33.8±3.7 weeks; 35 (43%) women had a family history of heartburn and/or regurgitation, and 57 (70%) were asymptomatic before pregnancy. The following quality of life concepts were significantly reduced: physical problems and social functioning for heartburn; physical problems and emotional functioning for regurgitation. There was agreement between heartburn in present and previous pregnancies. CONCLUSION: Heartburn and/or regurgitation affected health-related quality of life of third trimester pregnant women.
Subject(s)
Gastroesophageal Reflux/psychology , Heartburn/psychology , Pregnancy Complications/psychology , Pregnancy Trimester, Third/psychology , Quality of Life/psychology , Adult , Case-Control Studies , Cross-Sectional Studies , Female , Humans , Pregnancy , Severity of Illness IndexABSTRACT
Background Heartburn and regurgitation frequently occur in the third trimester of pregnancy, but their impact on quality of life has not been thoroughly investigated. Objective To measure health-related quality of life of third-trimester pregnant women with heartburn and regurgitation. Methods Data on obstetric history, heartburn and regurgitation frequency and intensity, history of heartburn and regurgitation and health-related quality of life were collected of 82 third-trimester pregnant women. Results Sixty-two (76%) women had heartburn, and 58 (71%), regurgitation; 20 were asymptomatic. Mean gestational age was 33.8±3.7 weeks; 35 (43%) women had a family history of heartburn and/or regurgitation, and 57 (70%) were asymptomatic before pregnancy. The following quality of life concepts were significantly reduced: physical problems and social functioning for heartburn; physical problems and emotional functioning for regurgitation. There was agreement between heartburn in present and previous pregnancies. Conclusion Heartburn and/or regurgitation affected health-related quality of life of third trimester pregnant women .
Contexto A pirose e a regurgitação ocorrem com frequência no terceiro trimestre de gestação, mas o seu impacto na qualidade de vida não foi completamente investigado. Objetivo Avaliar a qualidade da vida de gestantes do terceiro trimestre com pirose e regurgitação. Métodos Os dados sobre a história obstétrica, frequência, intensidade e história de pirose e regurgitação, bem como a qualidade de vida foram coletados de 82 mulheres do terceiro trimestre de gestação. Resultados Sessenta e duas (76%) mulheres tinham pirose e, 58 (71%), regurgitação; 20 eram assintomáticas. A idade gestacional média foi de 33,8 ± 3,7 semanas; 35 (43%) mulheres tinham história familiar de pirose e/ou regurgitação e 57 (70%) eram assintomáticos antes da gestação. Os seguintes domínios de qualidade de vida estavam significativamente reduzidos: limitação física e aspectos sociais pela pirose; limitação física e aspectos emocionais pela regurgitação. Houve concordância entre pirose nas gestações atuais e prévias. Conclusão A pirose e/ou regurgitação afetam a qualidade de vida de gestantes de terceiro trimestre. .
Subject(s)
Adult , Female , Humans , Pregnancy , Gastroesophageal Reflux/psychology , Heartburn/psychology , Pregnancy Complications/psychology , Pregnancy Trimester, Third/psychology , Quality of Life/psychology , Case-Control Studies , Cross-Sectional Studies , Severity of Illness IndexABSTRACT
OBJECTIVES: Anxiety and depression occur frequently in patients with functional gastrointestinal disorders (FGIDs), but their precise prevalence is unknown. We addressed this issue in a large cohort of adult patients and determined the underlying factors. METHODS: In total, 4,217 new outpatients attending 2 hospitals in Hamilton, Ontario, Canada completed questionnaires evaluating FGIDs and anxiety and depression (Hospital Anxiety and Depression scale). Chart review was performed in a random sample of 2,400 patients. RESULTS: Seventy-six percent of patients fulfilled Rome III criteria for FGIDs, but only 57% were diagnosed with FGIDs after excluding organic diseases, and the latter group was considered for the analysis. Compared with patients not meeting the criteria, prevalence of anxiety (odds ratio (OR) 2.66, 95% confidence interval (CI): 1.62-4.37) or depression (OR 2.04, 95% CI: 1.03-4.02) was increased in patients with FGIDs. The risk was comparable to patients with organic disease (anxiety: OR 2.12, 95% CI: 1.24-3.61; depression: OR 2.48, 95% CI: 1.21-5.09). The lowest prevalence was observed in asymptomatic patients (OR 1.37; 95% CI 0.58-3.23 and 0.51; 95% CI 0.10-2.48; for both conditions, respectively). The prevalence of anxiety and depression increased in a stepwise manner with the number of co-existing FGIDs and frequency and/or severity of gastrointestinal (GI) symptoms. Psychiatric comorbidity was more common in females with FGIDs compared with males (anxiety OR 1.73; 95% CI 1.35-2.28; depression OR 1.52; 95% CI 1.04-2.21). Anxiety and depression were formally diagnosed by the consulting physician in only 22% and 9% of patients, respectively. CONCLUSIONS: Psychiatric comorbidity is common in patients referred to a secondary care center but is often unrecognized. The prevalence of both anxiety and depression is influenced by gender, presence of organic diseases, and FGIDs, and it increases with the number of coexistent FGIDs and frequency and severity of GI symptoms.
Subject(s)
Anxiety/epidemiology , Anxiety/etiology , Depression/epidemiology , Depression/etiology , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/psychology , Adolescent , Adult , Aged , Comorbidity , Cross-Sectional Studies , Dyspepsia/psychology , Female , Gastrointestinal Diseases/epidemiology , Heartburn/psychology , Humans , Irritable Bowel Syndrome/psychology , Male , Medical Records , Middle Aged , Odds Ratio , Ontario/epidemiology , Prevalence , Retrospective Studies , Risk , Severity of Illness Index , Sex Distribution , Surveys and Questionnaires , Young AdultABSTRACT
AIM: To investigate the impact of heartburn and regurgitation on the quality of life among patients with gastroesophageal reflux disease (GERD). METHODS: Data from patients with GERD, who were diagnosed according to the Montreal definition, were collected between January 2009 and July 2010. The enrolled patients were assigned to a heartburn or a regurgitation group, and further assigned to an erosive esophagitis (EE) or a non-erosive reflux disease (NERD) subgroup, depending on the predominant symptoms and endoscopic findings, respectively. The general demographic data, the scores of the modified Chinese version of the GERDQ and the Short-form 36 (SF-36) questionnaire scores of these groups of patients were compared. RESULTS: About 108 patients were classified in the heartburn group and 124 in the regurgitation group. The basic characteristics of the two groups were similar, except for male predominance in the regurgitation group. Patients in the heartburn group had more sleep interruptions (22.3% daily vs 4.8% daily, P = 0.021), more eating or drinking problems (27.8% daily vs 9.7% daily, P = 0.008), more work interferences (11.2% daily vs none, P = 0.011), and lower SF-36 scores (57.68 vs 64.69, P = 0.042), than patients in the regurgitation group did. Individuals with NERD in the regurgitation group had more impaired daily activities than those with EE did. CONCLUSION: GERD patients with heartburn or regurgitation predominant had similar demographics, but those with heartburn predominant had more severely impaired daily activities and lower general health scores. The NERD cases had more severely impaired daily activity and lower scores than the EE ones did.
Subject(s)
Esophagitis, Peptic/etiology , Gastroesophageal Reflux/complications , Heartburn/etiology , Quality of Life , Activities of Daily Living , Adult , Cost of Illness , Endoscopy, Gastrointestinal , Esophagitis, Peptic/diagnosis , Esophagitis, Peptic/psychology , Female , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/psychology , Health Status , Heartburn/diagnosis , Heartburn/psychology , Humans , Male , Middle Aged , Prospective Studies , Surveys and QuestionnairesABSTRACT
BACKGROUND: The transient receptor potential vanilloid 1 has been implicated as a target mediator for heartburn perception and modulation of esophageal secondary peristalsis. Our aim was to determine the effect of repeated esophageal infusion of capsaicin-contained red pepper sauce on heartburn perception and secondary peristalsis in healthy adults. METHODS: Secondary peristalsis was performed with mid-esophageal injections of air in 15 healthy adults. Two separate protocols including esophageal infusion with saline and capsaicin-contained red pepper sauce and 2 consecutive sessions of capsaicin-contained red pepper sauce were randomly performed. KEY RESULTS: After repeated infusion of capsaicin-contained red pepper sauce, the threshold volume to activate secondary peristalsis was significantly increased during slow (p < 0.001) and rapid air injections (p = 0.004). Acute infusion of capsaicin-contained red pepper sauce enhanced heartburn perception (p < 0.001), but the intensity of heartburn perception was significantly reduced after repeated capsaicin-contained red pepper sauce infusion (p = 0.007). Acute infusion of capsaicin-contained red pepper sauce significantly increased pressure wave amplitudes of distal esophagus during slow (p = 0.003) and rapid air injections (p = 0.01), but repeated infusion of capsaicin-contained red pepper sauce significantly decreased pressure wave amplitude of distal esophagus during slow (p = 0.0005) and rapid air injections (p = 0.003). CONCLUSIONS & INFERENCES: Repeated esophageal infusion of capsaicin appears to attenuate heartburn perception and inhibit distension-induced secondary peristalsis in healthy adults. These results suggest capsaicin-sensitive afferents in modulating sensorimotor function of secondary peristalsis in human esophagus.
Subject(s)
Capsaicin/pharmacology , Esophagus/drug effects , Esophagus/physiology , Heartburn/physiopathology , Heartburn/psychology , Peristalsis/drug effects , Adult , Capsaicin/administration & dosage , Female , Humans , Male , Manometry , Young AdultABSTRACT
BACKGROUND: Non-erosive reflux disease (NERD) patients generally present with heartburn as the main symptom. Antidepressants might help to relieve heartburn by acting on the esophagus-brain axis. We aimed to assess the effect of nortriptyline on behavioral and brain responses to painful esophageal acid infusion in NERD patients evaluated with functional magnetic resonance imaging (fMRI). METHODS: In a randomized double-blind crossover design, 20 NERD patients off proton pump inhibitors (36.1 ± 9.3 years, 75% women) were assigned to 21 days of nortriptyline and placebo, in counterbalanced order, with a 21 days washout period in between both treatment periods. Changes in acid-induced brain response on fMRI and heartburn perception were assessed and at the end of each treatment. KEY RESULTS: Nortriptyline significantly reduced the acid-induced brain response in prefrontal cortex (median [IQR]: -1.9 [-4.5 to -0.1] vs -0.3 [-2.5 to 2.3]; p = 0.050), caudate (-3.0 [-5.1 to -0.01] vs 0.48 [-1.9 to 3.1]; p = 0.029), insula (-2.4 [-4.8 to -0.6] vs -0.2 [-1.5 to 1.5]; p = 0.029), cingulate (-4.2 [-8.8 to -0.1] vs -0.6 [-1.8 to 3.0]; p = 0.017), and hippocampus (-2.7 [-6.0 to 0.5] vs -0.04 [-2.3 to 1.9]; p = 0.006) in comparison with placebo. However, there was no significant difference between nortriptyline and placebo in clinical outcomes and side effects. CONCLUSIONS & INFERENCES: Nortriptyline decreased the brain response to esophageal acid infusion more markedly than placebo, but without clinical significance.
Subject(s)
Antidepressive Agents, Tricyclic/therapeutic use , Brain/drug effects , Gastroesophageal Reflux/drug therapy , Heartburn/drug therapy , Nortriptyline/therapeutic use , Pain Perception/drug effects , Adult , Brain/physiology , Brain Mapping , Cross-Over Studies , Double-Blind Method , Esophagus/drug effects , Female , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/physiopathology , Heartburn/etiology , Heartburn/physiopathology , Heartburn/psychology , Humans , Hydrochloric Acid/pharmacology , Magnetic Resonance Imaging , Male , Pain Perception/physiologyABSTRACT
BACKGROUND: Evidence suggests that some physicians harbor negative attitudes towards patients with substance use disorders (SUDs). The study sought to (1) measure internal medicine residents' attitudes towards patients with SUDs and other conditions; (2) determine whether demographic factors influence regard for patients with SUDs; and (3) assess the efficacy of a 10-hour addiction medicine course for improving attitudes among a subset of residents. METHODS: A prospective cohort study of 128 internal medicine residents at an academic medical center in New York City. Scores from the validated Medical Condition Regard Scale (MCRS) were used to assess attitude towards patients with alcoholism, dependence on narcotic pain medication, heartburn, and pneumonia. Demographic variables included gender, postgraduate training year, and prior addiction education. RESULTS: Mean baseline MCRS scores were lower (less regard) for patients with alcoholism (41.4) and dependence on narcotic pain medication (35.3) than for patients with pneumonia (54.5) and heartburn (48.9) (P < .0001). Scores did not differ based upon gender, prior hours of addiction education, or year of training. After the course, MCRS scores marginally increased for patients with alcoholism (mean increased by 0.16, P = .04 [95% confidence interval, CI: 0.004-0.324]) and dependence on narcotic pain medication (mean increased by 0.09, P = .10 [95% CI: 0.02-0.22]). CONCLUSIONS: Internal medicine residents demonstrate less regard for patients with SUDs. Participation in a course in addiction medicine was associated with modest attitude improvement; however, other efforts may be necessary to ensure that patients with potentially stigmatized conditions receive optimal care.
Subject(s)
Attitude of Health Personnel , Internal Medicine/education , Internship and Residency , Stereotyping , Substance-Related Disorders/psychology , Curriculum , Education, Medical, Graduate , Female , Heartburn/psychology , Humans , Male , Pneumonia/psychology , Prospective StudiesABSTRACT
BACKGROUND: In gastro-oesophageal reflux disease (GERD), heartburn responds well to acid suppression, but regurgitation is a common cause of incomplete treatment response. AIM: To assess the prevalence and burden of persistent, frequent regurgitation in primary care patients with GERD treated with acid suppression. METHODS: We analysed observational data from 134 sites across six European countries in patients diagnosed with GERD. Within 3 months of the index visit, symptoms were assessed using the Reflux Disease Questionnaire, and their impact on sleep and work productivity with the Quality of Life in Reflux and Dyspepsia questionnaire and the Work Productivity and Activity Impairment Questionnaire, respectively. Patients provided information on concomitant over-the-counter (OTC) GERD medication use. RESULTS: Persistent, frequent (3-7 days/week) regurgitation was reported by 13.2% (153/1156) of GERD patients with no heartburn on acid suppression; the prevalence was very similar for patients with up to 2 days/week of ongoing mild heartburn. Among patients without heartburn, sleep disturbance of any type was reported by 50.7-60.1% with persistent, frequent regurgitation, compared with 38.1-51.1% and 14.4-19.2% of those with less frequent or no regurgitation respectively. Persistent, frequent regurgitation was associated with increased use of OTC medication and more hours of work missed, whether mild, infrequent heartburn was present or not. CONCLUSIONS: Frequent regurgitation, which persisted in 12-13% of patients with no or infrequent, mild heartburn on acid suppression, negatively affected sleep and work productivity, and increased use of OTC medication. Persistent, frequent regurgitation is problematic for primary care patients with GERD.
Subject(s)
Gastroesophageal Reflux/drug therapy , Gastrointestinal Agents/therapeutic use , Heartburn/drug therapy , Laryngopharyngeal Reflux/psychology , Quality of Life/psychology , Adult , Aged , Cross-Sectional Studies , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/psychology , Health Status , Heartburn/etiology , Heartburn/psychology , Humans , Hydrogen-Ion Concentration , Laryngopharyngeal Reflux/etiology , Middle Aged , Primary Health Care , Severity of Illness Index , Sleep Wake Disorders/etiology , Surveys and QuestionnairesABSTRACT
Prevalence data for heartburn in the urban Black American community is lacking. In order to estimate prevalence for this community, we analyzed data from an ongoing cohort study in progress at our hospital. Comprehensive interviews allowed for exploration of factors associated with heartburn. Complex, stratified sampling design was the method used. Survey invitations are hand-delivered to random blocks in a single zip code tabulation area. One member per eligible household is invited to complete a computer-based survey. Heartburn was defined as ≥ 3 days/week of symptoms as defined by the Montreal Definition and Classification of gastroesophageal reflux disease. Scaling and weighting factors were utilized to estimate population level prevalence. Multivariate logistic regression was used to identify independent predictor variables for heartburn. Enrolled 379 participants corresponding to a weighted sample size of 22,409 (20,888-23,930) citizens. Demographic characteristics of the sample closely matched those of the entire targeted population. Overall, the weighted prevalence of heartburn ≥ 3 times per week was 17.6% (16.4-18.8%). Variables independently associated with heartburn were body mass index, daily caloric and fat intake, diabetes mellitus (odds ratio = 2.95; 2.59-3.36), cigarette smoking, and alcohol consumption (odds ratio = 2.55; 2.25-2.89). Factors inversely associated included illicit drug use and increased physical activity. Waist : hip ratio showed no relationship. The prevalence of heartburn ≥ 3 times per week is high in the Black American community. Adverse lifestyle behaviors showed particularly important associations. Our study needs to be replicated in other communities with similar demographics.