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1.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(10): 1507-1512, 2020 Oct 30.
Artigo em Chinês | MEDLINE | ID: mdl-33118504

RESUMO

OBJECTIVE: To analyze the differences in reflux patterns in 24-hour esophageal pH-impedance monitoring in patients with non-erosive reflux disease (NERD), reflux hypersensitivity (RH) and functional heartburn (FH) and explore the possible mechanism of symptoms in patients with heartburn and negative endoscopic findings. METHODS: Seventy-nine patients with heartburn as the main symptoms but negative endoscopic findings, including 35 with NERD, 16 with RH and 28 with FH, were enrolled in this study.All the patients underwent 24-h esophageal pH-impedance monitoring and esophagogastroscopy, and the results were compared among the 3 groups. RESULTS: Acid reflux episode was significantly increased and weakly alkaline reflux episode was significantly decreased in NERD group in comparison with RH group and FH group (P < 0.05).The patients in NERD group showed significantly increased total reflux episode, mixed reflux episode, proximal acid reflux episode, proximal weak acid reflux episode, total proximal reflux episode, percentage of proximal acid reflux, percentage of proximal weak acid reflux, and percentage of total proximal reflux as compared with the other two groups (all P < 0.05).Bolus clear time was significantly prolonged in NERD group compared with that in the other two groups (P < 0.05).Analysis of the reflux acidity showed that the percentages of different reflux episodes differed significantly among the 3 groups (P < 0.05);acid reflux was the main reflux in NERD, while weak acid reflux was the main reflux in RH and FH groups, which had also significantly increased weakly alkaline reflux episodes compared with NERD group. CONCLUSIONS: Patients with NERD, RH and FH had different reflux patterns.Acid reflux is predominant in the NERD, while weakly alkaline reflux is significantly increased RH and FH.In patients with normal esophageal acid exposure but without symptoms or without recorded symptoms during esophageal pH-impedance monitoring, analysis of the total reflux episode, mixed reflux episode, proximal acid reflux episode and percentage can help in the differential diagnosis between RH and FH.


Assuntos
Refluxo Gastroesofágico , Azia , Impedância Elétrica , Monitoramento do pH Esofágico , Refluxo Gastroesofágico/diagnóstico , Azia/etiologia , Humanos , Concentração de Íons de Hidrogênio
2.
J Assoc Physicians India ; 68(10): 69-80, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32978931

RESUMO

Gastroesophageal reflux disease (GERD) is a common problem in the community. The Indian Society of Gastroenterology and Association of Physicians of India have developed this evidence-based practice guideline for management of GERD in adults. A modified Delphi process was used to develop this consensus containing 43 statements, which were generated by electronic voting iteration as well as face-to-face meeting, and review of the supporting literature primarily from India. These statements include 4 on epidemiology, 9 on clinical presentation, 11 on investigations, 18 on treatment (including medical, endoscopic, and surgical modalities), and one on complications of GERD. The statement was regarded as accepted when the proportion of those who voted either to accept completely or with minor reservation was 80% or higher. The prevalence of GERD in large population-based studies in India is approximately 10% and is probably increasing due to lifestyle changes and increase in obesity. The diagnosis of GERD in the community should be mainly based on presence of classical symptoms like heartburn and sour regurgitation, and empiric treatment with a proton pump inhibitor (PPI) or H2 receptor antagonist should be given. All PPIs in equipotent doses are similar in their efficacy in the management of symptoms. Patients in whom symptoms do not respond adequately to PPI are regarded as having PPIrefractory GERD. Invasive investigations should be limited to patients with alarm symptoms and those with refractory GERD.


Assuntos
Gastroenterologia , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/terapia , Adulto , Consenso , Humanos , Índia/epidemiologia , Inibidores da Bomba de Prótons/uso terapêutico
3.
Zhonghua Wai Ke Za Zhi ; 58(9): 668-671, 2020 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-32878411

RESUMO

The advent of high-resolution esophageal manometry in this century produced manometric types of esophageal achalasia, which was very important for the selection of treatment methods and the assessment of prognosis. The application of 24-hour esophageal pH monitoring combined with impedance played a decisive role in determination of gastroesophageal reflux and refluxant. Advanced technologies such as laparoscopic Heller myotomy and per-oral endoscopic myotomy were used for surgical treatment of achalasia, laparoscopic anti-reflux procedures and magnetic sphincter augmentation were applied to the treatment of gastroesophageal reflux diseases (GERD). These advanced procedures implied that the treatment of primary esophageal motility disorders (PEMD) and GERD came into the minimally invasive era. However, the diagnosis and treatment of PEMD and GERD are not popular enough in our country, the studies and high-level clinical evidences are insufficient on uncommon PEMD and complex GERD, which are the further directions of efforts.


Assuntos
Transtornos da Motilidade Esofágica/diagnóstico , Transtornos da Motilidade Esofágica/cirurgia , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/cirurgia , Monitoramento do pH Esofágico , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/cirurgia , Humanos , Manometria , Resultado do Tratamento
4.
Am J Gastroenterol ; 115(9): 1412-1428, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32769426

RESUMO

Esophageal symptoms are common and may indicate the presence of gastroesophageal reflux disease (GERD), structural processes, motor dysfunction, behavioral conditions, or functional disorders. Esophageal physiologic tests are often performed when initial endoscopic evaluation is unrevealing, especially when symptoms persist despite empiric management. Commonly used esophageal physiologic tests include esophageal manometry, ambulatory reflux monitoring, and barium esophagram. Functional lumen imaging probe (FLIP) has recently been approved for the evaluation of esophageal pressure and dimensions using volumetric distension of a catheter-mounted balloon and as an adjunctive test for the evaluation of symptoms suggestive of motor dysfunction. Targeted utilization of esophageal physiologic tests can lead to definitive diagnosis of esophageal disorders but can also help rule out organic disorders while making a diagnosis of functional esophageal disorders. Esophageal physiologic tests can evaluate obstructive symptoms (dysphagia and regurgitation), typical and atypical GERD symptoms, and behavioral symptoms (belching and rumination). Certain parameters from esophageal physiologic tests can help guide the management of GERD and predict outcomes. In this ACG clinical guideline, we used the Grading of Recommendations Assessment, Development and Evaluation process to describe performance characteristics and clinical value of esophageal physiologic tests and provide recommendations for their utilization in routine clinical practice.


Assuntos
Transtornos de Deglutição/diagnóstico , Esôfago/fisiopatologia , Refluxo Gastroesofágico/diagnóstico , Transtornos de Deglutição/fisiopatologia , Monitoramento do pH Esofágico/métodos , Esofagoscopia/métodos , Refluxo Gastroesofágico/fisiopatologia , Humanos , Manometria/métodos
5.
Am Surg ; 86(5): 422-428, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32684031

RESUMO

BACKGROUND: Patients with symptoms of gastroesophageal reflux disease (GERD) are often given a trial of proton pump inhibitors (PPIs). When they respond, patients usually continue PPI therapy. If this empiric treatment fails, esophagogastroduodenoscopy (EGD) is recommended. When EGD findings are equivocal, pH study is warranted. We hypothesize that this algorithm results in prolonged PPI therapy, repetition of EGDs and patient dissatisfaction. This study evaluates the impact of placing a pH probe at the time of the initial EGD. METHODS: IRB approval was obtained for retrospective chart review of patients who presented with GERD symptoms between August 2015 and March 2019. Patients were included if they underwent EGD with placement of wireless pH probe. RESULTS: A total of 379 patients (260 females, 119 males) with average age was 56.7±14.2 years. There were 253/379 (66.7%) patients who had previous EGDs (1-10). Health Satisfaction Survey was completed by 357/379 (94.2%) patients and 250/357 (70%) reported dissatisfaction with GERD control. PPI use was noted in 299/379 (78.8%) patients with average duration of 10.9±9.1 years. Testing off antisecretory medication was performed in 360/379 (94.9%). The average time interval between the clinic visit and performing EGD and pH study was 22±25 days. CONCLUSION: The current GERD algorithm results in prolonged PPI therapy, repeated endoscopies and patient dissatisfaction. Placing a pH probe at the time of initial endoscopy is safe and expedient in a rural setting. Positive pH studies avoid repeating EGDs and negative pH studies warrant a search for potential alternative diagnosis.


Assuntos
Algoritmos , Monitoramento do pH Esofágico , Refluxo Gastroesofágico/diagnóstico , Gastroscopia , Adulto , Idoso , Monitoramento do pH Esofágico/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tecnologia sem Fio
6.
PLoS One ; 15(7): e0235069, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628682

RESUMO

BACKGROUND: Pneumonia is the leading cause of death among children and young people (CYP) with severe cerebral palsy (CP). Only a few studies used nomogram for assessing risk factors and the probability of pneumonia. Therefore, we aimed to identify risk factors and devise a nomogram for identifying the probability of severe pneumonia in CYP with severe CP. METHODS: This retrospective nationwide population-based cohort study examined CYP with newly diagnosed severe CP before 18 years old between January 1st, 1997 and December 31st, 2013 and followed them up through December 31st, 2013. The primary endpoint was defined as the occurrence of severe pneumonia with ≥ 5 days of hospitalization. Logistic regression analysis was used for determining demographic factors and comorbidities associated with severe pneumonia. These factors were assigned integer points to create a scoring system to identify children at high risk for severe pneumonia. RESULTS: Among 6,356 CYP with newly diagnosed severe CP, 2,135 (33.59%) had severe pneumonia. Multivariable logistic regression analysis revealed that seven independent predictive factors, namely age <3 years, male sex, and comorbidities of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications. A nomogram was devised by employing these seven significant predictive factors. The prediction model presented favorable discrimination performance. CONCLUSIONS: The nomogram revealed that age, male sex, history of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications were potential risk factors for severe pneumonia among CYP with severe CP.


Assuntos
Paralisia Cerebral/diagnóstico , Paralisia Cerebral/epidemiologia , Nomogramas , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/epidemiologia , Doença Aguda , Adolescente , Fatores Etários , Asma/diagnóstico , Asma/fisiopatologia , Paralisia Cerebral/complicações , Paralisia Cerebral/mortalidade , Criança , Pré-Escolar , Feminino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/fisiopatologia , Humanos , Modelos Logísticos , Masculino , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/mortalidade , Lesão por Pressão/diagnóstico , Lesão por Pressão/fisiopatologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Convulsões/diagnóstico , Convulsões/fisiopatologia , Fatores Sexuais , Análise de Sobrevida , Taiwan/epidemiologia
7.
Medicine (Baltimore) ; 99(29): e20471, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702810

RESUMO

Traditional Chinese medicine tongue diagnosis can mirror the status of the internal organ, but evidence is lacking regarding the accuracy of tongue diagnosis to gastroesophageal reflux disease (GERD). This study was to investigate the association between GERD and tongue manifestation, and whether tongue imaging could be initial diagnosis of GERD noninvasively.We conducted a cross-sectional, case-controlled observational study at Kaohsiung Chang Gung Memorial Hospital in Taiwan from January 2016 to September 2017. Participants aged over 20 years old with GERD were enrolled and control group without GERD were matched by sex. Tongue imaging were acquired with automatic tongue diagnosis system, then followed by endoscope examination. Nine tongue features were extracted, and a receiver operating characteristic (ROC) curve, analysis of variance, and logistic regression were used.Each group enrolled 67 participants. We found that the saliva amount (P = .009) and thickness of the tongue's fur (P = .036), especially that in the spleen-stomach area (%) (P = .029), were significantly greater in patients with GERD than in those without. The areas under the ROC curve of the amount of saliva and tongue fur in the spleen-stomach area (%) were 0.606 ±â€Š0.049 and 0.615 ±â€Š0.050, respectively. Additionally, as the value of the amount of saliva and tongue fur in the spleen-stomach area (%) increased, the risk of GERD rose by 3.621 and 1.019 times, respectively. The tongue fur in the spleen-stomach area (%) related to severity of GERD from grade 0 to greater than grade B were 51.67 ±â€Š18.72, 58.10 ±â€Š24.60, and 67.29 ±â€Š24.84, respectively.The amount of saliva and tongue fur in the spleen-stomach area (%) might predict the risk and severity of GERD and might be noninvasive indicators of GERD. Further large-scale, multi-center, randomized investigations are needed to confirm the results.Trial registration: NCT03258216, registered August 23, 2017.


Assuntos
Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/patologia , Doenças da Língua/diagnóstico por imagem , Doenças da Língua/patologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Endoscopia/métodos , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Masculino , Medicina Tradicional Chinesa/métodos , Pessoa de Meia-Idade , Saliva/fisiologia , Índice de Gravidade de Doença , Taiwan/epidemiologia , Língua , Doenças da Língua/etiologia
8.
Ann Otol Rhinol Laryngol ; 129(12): 1195-1209, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32527140

RESUMO

OBJECTIVES: To explore long-term patient reported outcome (PRO) measures of pediatric paradoxical vocal cord motion (PVCM) including ease of diagnosis, management, symptom duration and effect on quality of life. METHODS: All children >8 years of age diagnosed with PVCM at a tertiary pediatric hospital between 2006 and 2017 were invited to complete a survey addressing study objectives. RESULTS: 21/47 eligible participants could be contacted and 18/21 (86%) participated. 78% were female with a mean age at diagnosis of 11.6 and 15.0 years at survey completion. Common PVCM symptoms reported were dyspnea (89%), globus sensation (56%), and stridor (50%). The median time to diagnosis was 3 months (IQR 2-5 months). Nearly all reported being misdiagnosed with another condition, usually asthma, until being correctly diagnosed usually by an otolaryngologist. Participants reported undergoing 3.7 diagnostic studies (range 0-8); pulmonary function testing was most common. Of numerous treatments acknowledged, breathing exercises were common (89%) but only reported helpful by 56%. Use of biofeedback was recalled in 1/3 of subjects but reported helpful in only 14% of them. Anti-reflux, allergy, anticholinergics, inhalers and steroids were each used in >50%, but rarely reported effective. PVCM was reportedly a significant stressor when initially diagnosed but despite 2/3 of participants still reporting ongoing PVCM symptoms, the perceived stress significantly decreased over time (Z = 3.26, P = 0.001). CONCLUSIONS: This first PVCM PRO study endorses that diagnosis is often delayed and prescribed treatments often viewed as ineffective. While biofeedback and breathing exercises may be critical for short-term control of PVCM episodes, lifestyle changes and stress reduction are likely necessary for long-term management. Increased awareness and improvements in management are needed for this condition.


Assuntos
Biorretroalimentação Psicológica , Exercícios Respiratórios , Dispneia/fisiopatologia , Sensação de Globus/fisiopatologia , Sons Respiratórios/fisiopatologia , Estresse Psicológico/psicologia , Disfunção da Prega Vocal/terapia , Adolescente , Asma/diagnóstico , Criança , Erros de Diagnóstico , Feminino , Refluxo Gastroesofágico/diagnóstico , Humanos , Masculino , Medidas de Resultados Relatados pelo Paciente , Terapia de Relaxamento , Hipersensibilidade Respiratória/diagnóstico , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/fisiopatologia , Disfunção da Prega Vocal/psicologia
9.
Rev. cuba. estomatol ; 57(2): e1775, abr.-jun. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126498

RESUMO

RESUMEN Introducción: La enfermedad por reflujo gastroesofágico es un trastorno funcional, multifactorial, del tracto gastrointestinal superior. Las alteraciones bucales han sido consideradas como parte de sus manifestaciones extraesofágicas. Objetivo: Determinar las alteraciones bucales encontradas en pacientes con enfermedad por reflujo gastroesofágico. Métodos: Se realizó un estudio observacional descriptivo en 37 pacientes con diagnóstico de enfermedad por reflujo gastroesofágico. Las variables analizadas fueron: edad, sexo, presencia de alteración, signos y síntomas, y localización. Se confeccionó base de datos con registros, se calcularon las frecuencias absolutas y porcentajes. Resultados: El 48,6 por ciento de los pacientes presentó alguna alteración bucal, como sensación de ardor o urente (40,5 por ciento) y eritema (35,1 por ciento). Entre las regiones afectadas se encontraron paladar blando/úvula (72,2 por ciento) y lengua (61,1 por ciento). Conclusiones: Casi la mitad de los pacientes afectados por reflujo gastroesofágico presentó alguna manifestación bucal. Las más frecuentemente encontradas fueron: la sensación de ardor o urente, eritema, sensación de boca seca y ulceraciones. Las localizaciones más frecuentes fueron paladar blando/úvula y lengua(AU)


ABSTRACT Introduction: Gastroesophageal reflux disease is a functional multifactorial disorder of the upper gastrointestinal tract. Oral alterations are considered to be extraesophageal manifestations of this disease. Objective: Determine the oral alterations found in patients with gastroesophageal reflux disease. Methods: An observational descriptive study was conducted of 37 patients diagnosed with gastroesophageal reflux disease. The variables analyzed were age, sex, presence of alteration, signs and symptoms, and location. A database was developed with the information recorded, and absolute frequencies and percentages were estimated. Results: Of the patients studied, 48.6 percent had some sort of oral alteration, such as a burning sensation (40.5 percent) and erythema (35.1 percent). The regions affected included the soft palate / uvula (72.2 percent) and the tongue (61.1 percent). Conclusions: Almost half of the patients affected by gastroesophageal reflux had some sort of oral manifestation, the most common of which were a burning sensation, erythema, a dry mouth sensation and ulcerations. The most common locations were the soft palate / uvula and the tongue(AU)


Assuntos
Humanos , Manifestações Bucais , Refluxo Gastroesofágico/diagnóstico , Epidemiologia Descritiva , Estudos Observacionais como Assunto
10.
Khirurgiia (Mosk) ; (6): 38-43, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573530

RESUMO

OBJECTIVE: To find out significance of the main locking mechanisms of lower esophageal sphincter in the relapse of GERD in patients with axial hiatal hernia after previous antireflux laparoscopic surgery. MATERIAL AND METHODS: There were 103 patients with GERD and axial hiatal hernia who underwent original circular laparoscopic esophagofundoplication with correction of hiatal opening dimensions by crural and hiatal repair. Depending on generalized DeMeester index (within the normal range or its excess), all patients were divided into two groups - without relapse (group 1, n=88) and with recurrent GERD (group 2, n=15). Both groups were comparable by the main characteristics and postoperative follow-up period (mean - 6 years). Antireflux function was investigated by X-ray examination and endoscopy, manometry of the esophageal-gastric passage, intra-esophageal 24-hour pH-monitoring. Processing and graphical presentation of data was carried out using Statistica v.10.0 Rus software (StatSoft, USA) and Microsoft Office Excel 2013 (USA). RESULTS: Abnormal gastroesophageal reflux was detected in 14.56±3.48% of patients after laparoscopic anti-reflux surgery. Recurrent hiatal hernia occurred in 20±10.33% of these patients, malfunction of lower esophageal sphincter - in 80±10.33%. Failure of cardia was caused by shortening of its length by 30.43% and decrease of tone by 6.78% with significantly (61.09%) increased tone of the stomach. Failure of cardia was manifested by increase of generalized DeMeester index in the lower third of the esophagus by 3.2 times, acidic gastroesophageal refluxes, reflux index and index reflux values. Preserved esophageal motility combined with shortening of time of esophageal clearance in patient's lying position was associated with reduced incidence of reflux-esophagitis by 77.26% even in case of recurrent GERD. CONCLUSION: Abnormal reflux after antireflux laparoscopic surgery due to GERD with axial hiatal hernia is caused by recurrent hiatal hernia in every fifth patient while the main reason is failure of LES cuff with increased intragastric pressure.


Assuntos
Esfíncter Esofágico Inferior/fisiopatologia , Fundoplicatura/efeitos adversos , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/cirurgia , Esfíncter Esofágico Inferior/cirurgia , Fundoplicatura/métodos , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/fisiopatologia , Hérnia Hiatal/diagnóstico , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Laparoscopia , Recidiva
12.
Indian J Gastroenterol ; 39(2): 165-170, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32388711

RESUMO

BACKGROUND: A proportion of patients with gastroesophageal reflux disease (GERD) do not respond to proton pump inhibitor (PPI) therapy. AIM OF THE STUDY: To determine the findings on high-resolution esophageal manometry (HREM) and 24-h pH recording in patients with typical GERD symptoms, refractory to PPI treatment. METHODS: Retrospective analysis of prospectively maintained database of patients referred for HREM and 24-h pH recording was done. We selected patients who were referred for evaluation of refractory GERD symptoms despite > 8 weeks of at least once-daily PPI treatment. Details noted were demographic profile, upper gastrointestinal endoscopy report, HREM findings and 24-h pH findings. RESULTS: Ninety-six patients had symptoms of GERD that were refractory to PPI therapy. Seven patients (7.1%) were diagnosed having diseases mimicking GERD: eosinophilic esophagitis (n=2), supragastric belching (n=4) and rumination (n=1). After excluding these patients and those with insufficient data, the final study cohort included 82 cases. Fifty patients (61%) had normal motility. Major motility disorders were detected in 8 (9.75%) patients: achalasia cardia (6) and distal esophageal spasm (2). Ineffective esophageal motility was noted in 24 patients. A total of 74 patients underwent 24-h pH testing. Significant acid reflux with good symptom correlation was noted in 56 patients. Eighteen patients did not have significant acid reflux (Johnson-DeMeester score < 14.7): hypersensitive esophagus (12) and functional heartburn (6). CONCLUSION: Fifty-six patients (68.3%) had definite diagnosis of GERD and 31.7% (26) had non-GERD conditions like motility disorders, functional heartburn and hypersensitive esophagus.


Assuntos
Determinação da Acidez Gástrica , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/tratamento farmacológico , Manometria/métodos , Monitorização Fisiológica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico , Estudos Retrospectivos , Falha de Tratamento , Adulto Jovem
13.
Ann Thorac Surg ; 110(4): 1160-1166, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32454018

RESUMO

BACKGROUND: Patient-reported reflux is among the most common symptoms after esophagectomy. This study aimed to determine predictors of patient-reported reflux and to ascertain whether a preserved pylorus would protect patients from symptomatic reflux. METHODS: A prospective clinical study recorded patient-reported reflux after esophagectomy from August 2015 to July 2018. Eligible patients were at least 6 months from creation of a traditional posterior mediastinal gastric conduit, had completed at least 1 reflux questionnaire, and had the pylorus treated either temporarily (≥100 IU Botox [onabotulinumtoxinA]) or permanently (pyloromyotomy or pyloroplasty). RESULTS: Of the 110 patients meeting inclusion criteria, the median age was 65 years, and 88 of the 110 (80%) were male. Botox was used in 15 (14%) patients, pyloromyotomy in 88 (80%), and pyloroplasty in 7 (6%). A thoracic anastomosis was performed in 78 (71%) patients, and a cervical anastomosis was performed in 32 (29%). Esophagectomy was performed for malignant disease in 105 of 110 (95%), and 78 of 110 (71%) patients were treated with perioperative chemoradiation. Multivariable linear regression analysis revealed that patient-reported reflux was significantly worse in patients with shorter gastric conduit lengths (P = .02) and in patients who did not undergo perioperative chemoradiation (P = .01). No significant difference was found between patients treated with pyloric drainage and those treated with Botox. CONCLUSIONS: The absence of perioperative chemoradiation therapy and a shorter gastric conduit were predictors of patient-reported reflux after esophagectomy. Although few patients had Botox, preservation of the pylorus did not appear to affect patient-reported reflux. Further objective studies are needed to confirm these findings.


Assuntos
Esofagectomia/efeitos adversos , Refluxo Gastroesofágico/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Piloro/cirurgia , Idoso , Feminino , Seguimentos , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
14.
Internist (Berl) ; 61(7): 741-745, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32430688

RESUMO

Adenocarcinoma of the esophagus is the oncologic entity with the most progressive incidence in western countries over the last 30 years. This is caused by, among other factors, a growing rate of obesity and the associated gastroesophageal reflux disease. Typical sites of metastasis include the liver, lymph nodes and peritoneum. Adrenal glands and thoraco-abdominal skeleton can also be affected. Cerebral metastasis is infrequent and there are only a handful cases described in the literature. The case presented here relates to a 61-year-old woman with osteolytic metastasis that was infiltrating the orbital cavity and was initially diagnosed as a dacryoadenitis.


Assuntos
Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Neoplasias Esofágicas/secundário , Refluxo Gastroesofágico/complicações , Neoplasias Orbitárias/diagnóstico , Neoplasias Orbitárias/secundário , Pseudotumor Orbitário/diagnóstico , Dacriocistite , Edema/etiologia , Feminino , Refluxo Gastroesofágico/diagnóstico , Humanos , Pessoa de Meia-Idade
15.
Pediatr Pulmonol ; 55(6): 1495-1502, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32289209

RESUMO

BACKGROUND: To date there are limited data in the literature to guide the initial evaluation for etiologies of apnea in full-term infants born at greater than or equal to 37 weeks conceptional age (apnea of infancy [AOI]). Pediatricians and pediatric pulmonologists are left to pursue a broad, rather than targeted and a stepwise approach to begin diagnostic evaluation. METHODS: We performed a retrospective chart review of 101 symptomatic full-term infants (age under 12 months) diagnosed with apnea with an inpatient multichannel pneumogram (six channels) or a fully attended overnight pediatric polysomnogram in our outpatient sleep center accredited by American Academy of Sleep Medicine (AASM), scored using the standards set forth by the AASM. The infant was diagnosed as having AOI if the apnea hypopnea index (AHI) was greater than 1 (AHI is defined as the number of apnea and hypopnea events per hour of sleep). The final diagnosis/etiology was determined based on physician clinical assessment and work up. We then determined the frequency for each diagnosis. RESULTS: We found that the three most common etiologies were gastroesophageal reflux disease (GERD) (48/101), upper airway abnormalities/obstruction (37/101), and neurological diseases (19/101). There were significant numbers of infants with multiple etiologies for AOI. CONCLUSION: Based on the frequencies obtained, pediatric practitioners caring for full-term infants with apnea of unknown etiology are advised to begin with evaluation of more likely causes such as GERD and upper airway abnormalities/obstruction before evaluating for less common causes.


Assuntos
Refluxo Gastroesofágico/complicações , Doenças do Sistema Nervoso/complicações , Anormalidades do Sistema Respiratório/complicações , Síndromes da Apneia do Sono/etiologia , Feminino , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/fisiopatologia , Polissonografia , Anormalidades do Sistema Respiratório/diagnóstico , Anormalidades do Sistema Respiratório/fisiopatologia , Estudos Retrospectivos , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/fisiopatologia
16.
Laryngorhinootologie ; 99(4): 214-223, 2020 04.
Artigo em Alemão | MEDLINE | ID: mdl-32314335

RESUMO

Though showing an increasing incidence over the past 20 years, esophageal adenocarcinoma (EAC) remains a rather uncommon cancer (i. e., compared to colorectal and gastric cancer). Once detected, the prognosis of this cancer entity is still very poor. Hence, in spite of some unfavorable prerequisites to systematic screening, the development of a screening concept for Barrett's esophagus (BE) and EAC seems worthwhile. Nowadays, screening for BE and EAC is based on conventional endoscopy, mostly conducted individually in patients with reflux complaints (gastroesophageal reflux disease-GERD). Biopsies are taken obligatorily and are the centerpiece of diagnosis and scheduling of surveillance. So far, endoscopy is the diagnostic gold standard, but it is expensive and obviously lacks effectiveness - 8 of 10 cases of EAC are not detected in endoscopic screening (and surveillance) but by an opportunistic first-time endoscopy. Therefore, new methods for BE/EAC screening are strongly desirable. Research must be concentrated to favor procedures applicable for a screening of the population in a primary care setting. For that, the first step needs to consist of identifying a subgroup of people "at risk", which in a second step can be risk assessed and followed up by endoscopy and biopsy. From all screening variants, which have been actually tested in clinical application and experimental research, biomarker-based techniques seem to be most promising. Among those-under the aspect of costs and practicability-the Cytosponge, in addition with a panel of biomarkers, seemed to be promising in clinical trials.


Assuntos
Esôfago de Barrett/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Endoscopia , Esofagoscopia , Humanos , Programas de Rastreamento , Prognóstico
17.
Gastrointest Endosc Clin N Am ; 30(2): 227-238, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32146943

RESUMO

Patients with gastroesophageal reflux disease (GERD) present with heterogeneous symptoms, response to treatment, and physiologic profiles, requiring distinct and personalized management. This article provides a stepwise framework to phenotype GERD beginning with (1) characterization of symptom profile and response to acid suppression; (2) endoscopic evaluation of mucosal and anatomic integrity; (3) ambulatory reflux monitoring to characterize reflux burden and sensitivity; and (4) esophageal physiologic testing to assess gastroesophageal reflux mechanism and effectors of reflux clearance, and evaluate for alternate causes.


Assuntos
Gerenciamento Clínico , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/terapia , Medicina de Precisão/métodos , Idoso , Monitoramento do pH Esofágico/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Inibidores da Bomba de Prótons/uso terapêutico
18.
Gastrointest Endosc Clin N Am ; 30(2): 343-359, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32146950

RESUMO

This report discusses the potential mechanisms that might underlie refractory GERD and functional heartburn, and how to distinguish among those mechanisms using a systematic evaluation that includes careful medical history, endoscopy with esophageal biopsy, esophageal manometry, and esophageal multichannel intraluminal impedance-pH monitoring. The report provides an approach to patient management that depends on the underlying mechanism identified by this systematic evaluation.


Assuntos
Doenças do Esôfago/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Azia/diagnóstico , Biópsia , Técnicas de Apoio para a Decisão , Diagnóstico Diferencial , Impedância Elétrica , Doenças do Esôfago/complicações , Monitoramento do pH Esofágico , Esofagoscopia , Esôfago/fisiopatologia , Esôfago/cirurgia , Feminino , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/terapia , Azia/etiologia , Azia/terapia , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/uso terapêutico
19.
Gastrointest Endosc Clin N Am ; 30(2): 361-376, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32146951

RESUMO

Laryngopharyngeal reflux and atypical manifestations of gastroesophageal reflux disease have a high economic and social burden in the United States. There is increasing research supporting the reflex theory and hypersensitivity syndrome underlying this disease pathophysiology. Novel diagnostic biomarkers have gained more traction in the search for a more reliable diagnostic tool, but further research is needed. Current standard-of-care treatment relies on proton pump inhibitor therapy. Antireflux surgery is usually not recommended. Neuromodulators and treatments targeting specific neuronal receptors are discussed. A diagnostic algorithm is proposed for the evaluation of laryngeal symptoms suspected to be related to extraesophageal reflux disease.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Refluxo Gastroesofágico/diagnóstico , Refluxo Laringofaríngeo/diagnóstico , Algoritmos , Diagnóstico Diferencial , Refluxo Gastroesofágico/tratamento farmacológico , Humanos , Refluxo Laringofaríngeo/tratamento farmacológico , Laringe/fisiopatologia , Neurotransmissores/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico
20.
Georgian Med News ; (298): 88-93, 2020 Jan.
Artigo em Russo | MEDLINE | ID: mdl-32141857

RESUMO

The article is devoted to the study of the diagnostic effectiveness of using magnifying chromoendoscopy when examining the oral cavity in patients with a gastroenterological profile with extra-esophageal manifestations of reflux disease. Pathologies of the oral cavity are often one of the additional symptoms, according to the Montreal Consensus and classification of gastroesophageal reflux disease (GERD). Barrett's esophagus is a serious complication of GERD, in which a cylindrical epithelium with intestinal metaplasia is found in the epithelial lining of the mucous membrane of the esophagus, which is a marker of this disease often in combination with dysplasia instead of squamous stratified non-keratinized epithelium. The relevance is due to the fact that this disease is considered as a precancerous condition and is associated with an increased risk of developing adenocarcinoma of the lower third of the esophagus. In this regard, timely diagnosis of Barrett's esophagus and monitoring of these patients will improve the prognosis of the disease and reduce the frequency of deaths.


Assuntos
Esôfago de Barrett/diagnóstico , Esofagite Péptica/diagnóstico , Esofagoscopia/métodos , Refluxo Gastroesofágico/diagnóstico , Boca/diagnóstico por imagem , Esôfago de Barrett/patologia , Esofagite Péptica/patologia , Refluxo Gastroesofágico/patologia , Humanos , Valor Preditivo dos Testes , Ampliação Radiográfica
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