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1.
Mayo Clin Proc ; 96(3): 563-576, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33673910

RESUMO

OBJECTIVE: To explore the natural history of chronic unexplained gastrointestinal (GI) symptoms and to determine the longitudinal trends of prevalence during a 20-year period in a single US community. METHODS: Between January 1, 1990, and December 31, 2009, valid self-report questionnaires of GI symptoms were mailed to randomly selected cohorts of a community. The study used respondents who answered questions on 1 or more of 3 surveys (initial, 1990-1992; second, 2003-2004; and third, 2008-2009). The trends of prevalence of GI symptoms over time were analyzed in responders who completed 3 surveys, and the natural history or transition was evaluated. RESULTS: The overall prevalence of major symptom groupings including gastroesophageal reflux disease was consistent among residents in a community on 3 survey time points (1990-1992, 2003-2004, and 2008-2009). The transitions of GI symptoms were common in 228 patients who responded to all 3 surveys; only 29% had the same symptom category in 3 surveys; otherwise, symptoms changed over time, resolving, recurring, or transitioning to another disorder. Observed proportions of symptom transitions were significantly different from expected during 20 years (P<.001). Higher non-GI somatic symptom scores were significantly associated with both symptom transitions (odds ratio, 3.9; 95% CI, 1.38 to 10.77) and having sustained symptoms (odds ratio, 12.7; 95% CI, 4.62 to 34.90). CONCLUSION: The overall population prevalence of chronic unexplained GI symptoms is stable, but in individuals, transitions seem to be the rule. As these various GI syndromes appear to be so intimately interconnected, the common underlying pathogenesis may account for a major subgroup of chronic unexplained GI disorders.


Assuntos
Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Índice de Gravidade de Doença , Adulto , Constipação Intestinal/diagnóstico , Constipação Intestinal/epidemiologia , Diarreia/diagnóstico , Diarreia/epidemiologia , Feminino , Gastroenteropatias/diagnóstico , Gastroenteropatias/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários
2.
Georgian Med News ; (310): 48-54, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33658409

RESUMO

Aim of the study -to determine the indices of local immunity in patients who had combined dental pathology (caries) and gastroesophageal reflux disease. In total were exanimated 33 patients with dental caries in age from 18 to 25 years, including 21 men and 12 women. The main group consisted of 17 patients who had a combined dental pathology (caries) and gastroesophageal reflux disease. The comparison group consisted of 16 people who had dental caries without other systemic diseases.  All patients, who were included in the study was carried out the following researches: a study of the dental status, an immunological study for all patients with the determination of a quantitative assessment of the main populations and subpopulations of lymphocytes, determination of their functional activity, determination of level of serum immunoglobulins, determination of the concentration of circulating immune complexes of various molecular sizes, phagocytic activity of neutrophils and cytokine status in serum and oral fluid, as well as assessment of the course of gastroesophageal reflux disease with questionnaires. The results of the values of the resistance of hard tissues to the effects of cariogenic factors had a high positive correlation with the intensity of dental caries lesions. That confirms the presence of a relationship between manifestations of systemic diseases together with the development of dental caries, especially against the background of a decrease in caries resistance. In the presence of gastroesophageal reflux disease in patients dental caries detected spontaneous activation of lymphocyte proliferation by 25.8%, an increasing of the phagocytic activity of neutrophils, detected significantly higher indicators of the phagocytic number and phagocytic index, increased content of medium and small molecular circulating immune complexes with pathogenic properties. Detected significantly higher content of pro-inflammatory cytokines - tumor necrosis factor-α, an increased concentration of IgG as a result of antigenic stimulation, and also a significantly lower concentration of secretory IgA. It has been established that in patients with gastroesophageal reflux disease combined with dental caries observing changes in the immune system, which bear the features of subclinical immune inflammation. The study revealed a higher intensity of the carious process in patients with gastroesophageal reflux disease, which is associated with permanent acid damage of the oral mucosa. Furthermore, it was found violation in terms of concentration with increasing local immunity oral liquid proinflammatory factors and a reduced concentration of secretory IgA namely with concomitant pathologies of the gastroesophageal reflux disease.


Assuntos
Cárie Dentária , Refluxo Gastroesofágico , Adolescente , Adulto , Citocinas , Cárie Dentária/complicações , Cárie Dentária/epidemiologia , Suscetibilidade à Cárie Dentária , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/epidemiologia , Humanos , Masculino , Mucosa Bucal , Adulto Jovem
3.
BMC Pulm Med ; 21(1): 56, 2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33573635

RESUMO

BACKGROUND: The effects of comorbidities on chronic obstructive pulmonary disease (COPD) have been usually studied individually in the past. In this study, we aimed to investigate the comorbidities associated with mortality, the effect of multimorbidity on mortality and other factors associated with mortality among Korean COPD population. METHODS: The Korean National Health Insurance Service-National Sample Cohort version 2.0, collected between 2002 and 2015, was used. Among COPD patients [entire cohort (EC), N = 12,779], 44% of the participants underwent additional health examination, and they were analysed separately [health-screening cohort (HSC), N = 5624]. Fifteen comorbidities previously reported as risk factors for mortality were studied using Cox proportional hazards regression models. RESULTS: Total mortality rates were 38.6 per 1000 person-years (95% CI 37.32-40.01) and 27.4 per 1000 person-years (95% CI 25.68-29.22) in EC and HSC, respectively. The most common causes of death were disease progression, lung cancer, and pneumonia. Only some of the comorbidities had a direct impact on mortality. Multimorbidity, assessed by the number of comorbid diseases, was an independent risk factor of all-cause mortality in both cohorts and was a risk factor of respiratory mortality only in HSC. The Kaplan-Meier analysis showed significant differences in survival trajectories according to the number of comorbidities in all-cause mortality but not in respiratory mortality. Low BMI, old age and male sex were independent risk factors for both mortalities in both cohorts. CONCLUSIONS: The number of comorbidities might be an independent risk factor of COPD mortality. Multimorbidity contributes to all-cause mortality in COPD, but the effect of multimorbidity is less evident on respiratory mortality.


Assuntos
Neoplasias Pulmonares/mortalidade , Pneumonia/mortalidade , Doença Pulmonar Obstrutiva Crônica/mortalidade , Idoso , Asma/epidemiologia , Bronquiectasia/epidemiologia , Doenças Cardiovasculares/epidemiologia , Causas de Morte , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Neoplasias do Sistema Digestório/epidemiologia , Progressão da Doença , Dislipidemias/epidemiologia , Feminino , Refluxo Gastroesofágico/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Hepatopatias/epidemiologia , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Multimorbidade , Osteoporose/epidemiologia , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Insuficiência Renal Crônica/epidemiologia , República da Coreia/epidemiologia , Fatores de Risco , Neoplasias da Glândula Tireoide/epidemiologia
4.
BMC Pulm Med ; 21(1): 53, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33557802

RESUMO

BACKGROUND: Gastroesophageal reflux disease (GERD) has been reported to be significantly associated with chronic rhinosinusitis, but the strength of the association is still debated. AIMS: To evaluate the strength of the association between gastritis/GERD and non-allergic rhinitis (NAR)/allergic rhinitis (AR)/sinusitis. METHODS: We investigated 2887 subjects aged 20-84 years, who underwent a clinical visit in seven Italian centres (Ancona, Palermo, Pavia, Terni, Sassari, Torino, Verona) within the study on Gene Environment Interactions in Respiratory Diseases, a population-based multicase-control study between 2008 and 2014. Subjects were asked if they had doctor-diagnosed "gastritis or stomach ulcer (confirmed by gastroscopy)" or "gastroesophageal reflux disease, hiatal hernia or esophagitis". The association between NAR/AR/sinusitis and either gastritis or GERD was evaluated through relative risk ratios (RRR) by multinomial logistic regression. RESULTS: The prevalence of gastritis/GERD increased from subjects without nasal disturbances (22.8% = 323/1414) to subjects with AR (25.8% = 152/590) and further to subjects with NAR (36.7% = 69/188) or sinusitis (39.9% = 276/691). When adjusting for centre, sex, age, education level, BMI, smoking habits and alcohol intake, the combination of gastritis and GERD was associated with a four-fold increase in the risk of NAR (RRR = 3.80, 95% CI 2.56-5.62) and sinusitis (RRR = 3.70, 2.62-5.23) with respect to controls, and with a much smaller increase in the risk of AR (RRR = 1.79, 1.37-2.35).. CONCLUSION: The study confirmed the association between gastritis/GERD and nasal disturbances, which is stronger for NAR and sinusitis than for AR.


Assuntos
Gastrite/epidemiologia , Refluxo Gastroesofágico/epidemiologia , Rinite Alérgica/epidemiologia , Sinusite/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Rinite/epidemiologia , Adulto Jovem
5.
Medicine (Baltimore) ; 100(6): e24595, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578560

RESUMO

ABSTRACT: Gastroesophageal reflux (GER) in radiofrequency catheter ablation (RFCA) occurs due to vagal plexus damage during pulmonary vein isolation. We hypothesized that the frequency of GER in the oropharynx will be less compared to other areas (low-esophagus, mid-esophagus). We confirmed the frequency of GER before and after RFCA in 3 areas.We studied 30 patients who were scheduled for RFCA under general anesthesia. Anesthesia was performed using supraglottic devices (SGD) with a suction port. Two esophageal temperature probes capable of suction and measuring temperature were inserted through the suction port. The pH of the 3 areas was measured before and after the RFCA at 3 areas (mid-esophagus, low-esophagus, and oropharynx).GER was observed in 13 of 30 patients (43%). In one patient, it was observed in the oropharynx, in 4 patients it was observed in the mid-esophagus, and in 13 patients, it was observed in the low-esophagus. For patients with GER at the oropharynx and mid-esophagus, it was also observed at the low-esophagus. The difference in the pH before and after the RFCA was not significant at the oropharynx and mid-esophagus (P = .726 and P = .424, respectively), but it was significantly different at the low-esophagus (P < .001). The total ablation time was longer in the GER group compared to the non-GER group (P = .021).GER after RFCA occurred in 43% of patients, only 1 patient in the oropharynx. And aspiration pneumonia after SGD extubation did not occur. Therefore, the use of SGDs in RFCA does not completely eliminate the possibility of aspiration, so care should be taken.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Refluxo Gastroesofágico/etiologia , Idoso , Anestesia Geral , Monitoramento do pH Esofágico , Feminino , Refluxo Gastroesofágico/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , República da Coreia/epidemiologia
6.
Ter Arkh ; 92(8): 12-17, 2020 Sep 03.
Artigo em Russo | MEDLINE | ID: mdl-33346456

RESUMO

Gastroesophageal reflux disease (GERD) is a common chronic disease of the upper gastrointestinal tract with long course of the disease and followed by different symptoms significantly reducing quality of life (QoL) in pts. Assessment of QoL in pts with GERD may be of value for comprehensive evaluation of treatment effect as well as for monitoring of pts during treatment course in a real clinical practice. AIM: Development of the Russian version of GERD-HRQL questionnaire to assess symptomatic outcomes of GERD in research and real clinical practice. MATERIALS AND METHODS: GERD-HRQL questionnaire (V. Velanovich, USA) consists of 11 items: 10 items for assessment of the most frequent symptoms/problems related with QoL in pts with GERD and 1 item for assessment of patient-reported global satisfaction with health condition. RESULTS: In accordance with international guidelines, the new language version of the tool may be used in research and clinical practice after cross cultural adaptation, linguistic validation and psychometric testing. This paper presents the results of cross-cultural adaptation and linguistic validation of the Russian version of GERD-HRQL. The following steps of linguistic and cultural adaptation of GERD-HRQL for Russia were conducted after the permission from the author of GERD-HRQL was obtained: forward translation with creation of two forward translations of GERD-HRQL in Russian, reconciliation and expert evaluation of translations of GERD-HRQL in Russian and creation of the preliminary version of GERD-HRQL in Russian, back translation, harmonization, creation of the first test-version of GERD-HRQL in Russian, cognitive debriefing and decentering, creation of the second test-version of GERD-HRQL in Russian, final expert evaluation and development of the final test-version of GERD-HRQL in Russian. Satisfactory face validity of the Russian test-version of GERD-HRQL was shown: face validity indices were 0.98, 0.95, 0.92, and 0.97. CONCLUSION: As the result of translation, cross cultural adaptation and linguistic validation, the Russian version of GERD-HRQL for the use in pts with GERD in Russia was developed. The Russian version of GERD-HRQL may be used in research studies and clinical practice after testing its psychometric properties.


Assuntos
Refluxo Gastroesofágico , Qualidade de Vida , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Humanos , Idioma , Reprodutibilidade dos Testes , Federação Russa/epidemiologia , Inquéritos e Questionários
7.
Ter Arkh ; 92(8): 66-72, 2020 Sep 03.
Artigo em Russo | MEDLINE | ID: mdl-33346464

RESUMO

AIM: To evaluate nutritional patterns in patients with gastroesophageal reflux disease (GERD) compared to the control group without GERD. MATERIALS AND METHODS: The data of complex examination of patients referred to perform esophageal pH-impedance recording and who gave written informed consent to participate in the study served as a source data. All the participants underwent complex examination, including clinical data (presence of heartburn and acid regurgitation), symptom evaluation (GERD-Q questionnaire), esophagogastroscopy, esophageal pH-impedance recordings and food frequency questionnaire. Diagnosis of GERD was based on GERD-Q score 8, acid exposure time 6%, number of gastroesophageal refluxes 80/day by 24-hrs esophageal pH-impedance recordings. Nutritional patterns were assessed with the use of healthy eating pyramid principles. RESULTS: Overall 165 patients were enrolled and the data of 150 of them (34 with confirmed GERD and 116 of the control group) were available for the final analysis. The patients of the both groups consumed lower compared to the recommended amounts of dairy and higher amounts of meat. Those with GERD consumed larger amounts of fruits (0.910.68 compared to the values of healthy eating pyramid vs 0.520.57 in the control group, p=0.001), and fats (0.690.55 vs 0.490.55, p=0.001). Compared to the controls, patients with GERD consumed lower amounts of vegetables (0.860.46 of the healthy eating pyramid vs 0.940.63 in the control group, р=0.004) and sugars confectionaries (0.380.39 vs 1.930.98, p=0.0001). CONCLUSION: Nutritional patterns of patients with gastroesophageal reflux disease significantly differ compared to the control group. The obtained data may be used for diet modification in patients with arterial hypertension.


Assuntos
Refluxo Gastroesofágico , Monitoramento do pH Esofágico , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/etiologia , Azia , Humanos , Manometria , Federação Russa/epidemiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-33166098

RESUMO

Objective: To report the clinical characteristics and transmission rate of coronavirus disease 2019 (COVID-19) in a community inpatient long-term care psychiatric rehabilitation facility designed for persons with serious mental illness to provide insight into transmission and symptom patterns and emerging testing protocols, as well as medical complications and prognosis. Methods: This study examined a cohort of 54 residents of a long-term care psychiatric rehabilitation program from March to April 2020. Baseline demographics, clinical diagnoses, and vital signs were examined to look for statistical differences between positive versus negative severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) groups. During the early phase of the pandemic, the facility closely followed the local shelter-in-place order (starting March 19, 2020) and symptom-based testing. Results: Of the residents, the primary psychiatric diagnoses were schizoaffective disorder: 28 (51.9%), schizophrenia: 21 (38.9%), bipolar I disorder: 3 (5.5%), and unspecified psychotic disorder: 2 (3.7%). Forty (74%) of 54 residents tested positive for SARS-COV-2, with a doubling time of 3.9 days. There were no statistical differences between the positive SARS-COV-2 versus negative groups for age or race/ethnicity. Psychiatric and medical conditions were not significantly associated with contracting SARS-COV-2, with the exception of obesity (n = 17 [43%] positive vs n = 12 [86%] negative, P = .01). Medical monitoring of vital signs and symptoms did not lead to earlier detection. All of the residents completely recovered, with the last resident no longer showing any symptoms 24 days from the index case. Conclusion: Research is needed to determine optimal strategies for long-term care mental health settings that incorporate frequent testing and personal protective equipment use to prevent rapid transmission of SARS-COV-2.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Transtornos Psicóticos/reabilitação , Centros de Reabilitação , Esquizofrenia/reabilitação , Adulto , Afro-Americanos , Americanos Asiáticos , Betacoronavirus , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/reabilitação , California/epidemiologia , Técnicas de Laboratório Clínico , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/transmissão , Diabetes Mellitus/epidemiologia , Grupo com Ancestrais do Continente Europeu , Refluxo Gastroesofágico/epidemiologia , Hispano-Americanos , Humanos , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Hipotireoidismo/epidemiologia , Controle de Infecções , Assistência de Longa Duração , Programas de Rastreamento , Pessoa de Meia-Idade , Obesidade/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/transmissão , Reabilitação Psiquiátrica , Psicoterapia de Grupo , Transtornos Psicóticos/epidemiologia , Recreação , Reabilitação Vocacional , Esquizofrenia/epidemiologia , Fumar/epidemiologia , Visitas a Pacientes
9.
Stomatologiia (Mosk) ; 99(5): 25-31, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33034173

RESUMO

The number of men and women with gastroesophageal reflux disease (GERB) is increasing each year; besides, the disease seeks rejuvenation. Because the oral cavity is the initial digestive system, gastrointestinal tract diseases (GT) and associated changes in the oral cavity are closely related. THE AIM OF THE STUDY: Was to assess the dental status of patients with gastroesophageal reflux disease depending on the use of proton pump inhibitors based on the comprehensive clinical and laboratory study. The study involved 100 people aged between 35-65 years, which were divided into 3 groups (30 people - I control group, 35 - II patients with GERD who did not take proton pump inhibitors and 35 - III patients with GERD who take proton pump inhibitors). To detect patients with a predisposition to GERB, all participants in the study answered the «GRDQ¼ questionnaire. The patient was referred to a gastroenterologist for consultation, if the final score was more than 8 points. To identify the dental status of the patients, the DMFT (Decayed/Missing/Filled Teeth) index and the periodontal PI index were determined, the pH of the saliva was measured, and also the PCR (polymerase chain reaction) method was used. According to the results of the study, the final score of the GRDQ questionnaire in group II was significantly higher than that of group I and group III. The study revealed a high level of caries intensity, deterioration of periodontal and hygienic status, high prevalence of periodontal pathogens: Porphyromonas gingivalis, Prevotella intermedia and Actinobaccilus actinomecetemcomitans in patients of group II, compared with patients of group III and the control group. As a result of the study of the pH of mixed saliva, an acid shift was observed in group II. Dental status in patients with gastroesophageal reflux disease worsens.


Assuntos
Refluxo Gastroesofágico , Inibidores da Bomba de Prótons , Adulto , Idoso , Feminino , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Índice Periodontal , Saliva
10.
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
11.
Medicine (Baltimore) ; 99(30): e21318, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791724

RESUMO

BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases in the world and is showing increasing prevalence in some countries. The disease has a chronic course that leads to a significant decline in the quality of life of patients and is associated with a high economic burden worldwide. And complementary and alternative medicine is used to treat the disease. Over the past few decades, a number of randomized controlled trials and systematic evaluations have been conducted to evaluate the effectiveness and safety of different types of complementary and alternative medicine methods, so there is an urgent need to summarize and further evaluate these studies. METHODS: We will search the following sources without restrictions for date, language, or publication status: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) Cochrane Library, and EMBASE, China National Knowledge Infrastructure, Chinese Bio-medicine Database, VIP Chinese Periodical Database, Wan Fang Database. We will apply a combination of Medical Subject Heading and free-text terms incorporating database-specific controlled vocabularies and text words to implement search strategies. We will also search the ongoing trials registered in the World Health Organization's International Clinical Trials Registry Platform. Besides, the previous relevant reviews conducted on complementary and alternative therapies for GERD and reference lists of included studies will also be searched. RESULTS: This study will provide a reliable basis for the treatment of GERD with complementary and alternative therapies. CONCLUSIONS: The findings will be an available reference to evaluate the efficacy and safety of complementary and alternative therapies on GERD and may provide decision-making reference on which method to choose for clinicians. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42020169332.


Assuntos
Terapias Complementares/efeitos adversos , Refluxo Gastroesofágico/terapia , Metanálise em Rede , Adulto , Idoso , Tomada de Decisão Clínica , Terapias Complementares/métodos , Efeitos Psicossociais da Doença , Bases de Dados Factuais , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/psicologia , Humanos , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Resultado do Tratamento
12.
Am J Gastroenterol ; 115(5): 697-705, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32356952

RESUMO

INTRODUCTION: Night-time gastroesophageal reflux (nGER) symptoms are commonly associated with interrupted sleep. Most studies attempting to understand the relationship between sleep, arousal, and nGER events have been performed so using accelerometry; however, this technology is limited in its ability to precisely determine the temporal association between sleep and reflux events. We aimed to examine the temporal relationships between nGER events and arousal/awakening from sleep using high resolution, in-laboratory polysomnography (PSG). METHODS: Individuals between 18 and 70 years who had undergone a gastroscopy within 12 months underwent simultaneous 24-hour pH/impedance monitoring and in-laboratory PSG. The temporal relationship between each nGER event and sleep/arousals/awakenings was determined for each participant. Analyses were limited to the sleep period (between "lights out" and time of final waking). RESULTS: Analyses were conducted on the data from 25 individuals, 64% of whom had nGER episodes (5 ± 5 events per person, range 1-18) and 64% of whom had obstructive sleep apnea (OSA, mean apnea-hypopnea index 20 ± 11 events/hr, range 6-44). There were no differences in PSG-determined sleep duration, sleep efficiency, sleep architecture, arousals/awakenings, or sleep apnea severity between those with nGER and those without. Most nGER events (82%) occurred during a PSG epoch that had been classified as wake. Arousals/awakenings preceded almost all events (73/76), whereas fewer had an arousal/awakening after the event (15/76). DISCUSSION: As opposed to what is typically assumed, nGER does not seem to cause arousal from sleep, but rather arousal from sleep predisposes to nGER.


Assuntos
Nível de Alerta/fisiologia , Refluxo Gastroesofágico/fisiopatologia , Sono/fisiologia , Adolescente , Adulto , Idoso , Austrália/epidemiologia , Monitoramento do pH Esofágico/métodos , Feminino , Seguimentos , Refluxo Gastroesofágico/epidemiologia , Refluxo Gastroesofágico/metabolismo , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Polissonografia , Fatores de Tempo , Adulto Jovem
13.
Sci Rep ; 10(1): 5814, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32242117

RESUMO

Although gastro-oesophageal reflux disease (GORD) is a common medical complaint, there is currently no consensus on the global prevalence of GORD. The aim of this study was to conduct a systematic review and meta-analysis on GORD prevalence and risk factors at a global level. MEDLINE, EMBASE, CINAHL, Scopus, Cochrane library, and Google Scholar were systematically searched, without language restrictions, for studies on the prevalence and risk factors of GORD. Data were pooled using a random effects model (95% confidence interval), and the odds ratio and relative risk for each risk factor were calculated. Out of 34,355 search results, 96 records reporting the results from 102 studies fulfilled the inclusion criteria, representing 37 countries and all regions of the UN geoscheme. The global pooled prevalence of GORD was 13.98% and varied greatly according to region (12.88% in Latin America and the Caribbean to 19.55% in North America) and country (4.16% in China to 22.40% in Turkey). Using the United Nations 2017 Revision of World Population Prospects, the estimated number of individuals suffering from GORD globally is 1.03 billion. Multiple risk factors associated with a significant increase in the risk of GORD were also identified. This systematic review and meta-analysis revealed that although a substantial proportion (13.98%) of the global population suffers from GORD, there are significant variations between regions and countries. Risk factors for GORD were also identified which may allow clinicians to recognise individuals most at risk.


Assuntos
Refluxo Gastroesofágico/epidemiologia , Região do Caribe/epidemiologia , China/epidemiologia , Saúde Global , Humanos , América do Norte/epidemiologia , Prevalência , Fatores de Risco , Turquia/epidemiologia
14.
J Korean Med Sci ; 35(14): e105, 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32281316

RESUMO

BACKGROUND: Periodontitis is reported to be associated with preterm birth (spontaneous preterm labor and birth). Gastroesophageal reflux disease (GERD) is common during pregnancy and is expected to be related to periodontitis. However, little research has been done on the association among preterm birth, GERD and periodontitis. This study uses popular machine learning methods for analyzing preterm birth, GERD and periodontitis. METHODS: Data came from Anam Hospital in Seoul, Korea, with 731 obstetric patients during January 5, 1995 - August 28, 2018. Six machine learning methods were applied and compared for the prediction of preterm birth. Variable importance, the effect of a variable on model performance, was used for identifying major determinants of preterm birth. RESULTS: In terms of accuracy, the random forest (0.8681) was similar with logistic regression (0.8736). Based on variable importance from the random forest, major determinants of preterm birth are delivery and pregestational body mass indexes (BMI) (0.1426 and 0.1215), age (0.1211), parity (0.0868), predelivery systolic and diastolic blood pressure (0.0809 and 0.0763), twin (0.0476), education (0.0332) as well as infant sex (0.0331), prior preterm birth (0.0290), progesterone medication history (0.0279), upper gastrointestinal tract symptom (0.0274), GERD (0.0242), Helicobacter pylori (0.0151), region (0.0139), calcium-channel-blocker medication history (0.0135) and gestational diabetes mellitus (0.0130). Periodontitis ranked 22nd (0.0084). CONCLUSION: GERD is more important than periodontitis for predicting and preventing preterm birth. For preventing preterm birth, preventive measures for hypertension, GERD and diabetes mellitus would be needed alongside the promotion of effective BMI management and appropriate progesterone and calcium-channel-blocker medications.


Assuntos
Refluxo Gastroesofágico , Periodontite , Nascimento Prematuro , Diabetes Gestacional , Feminino , Refluxo Gastroesofágico/epidemiologia , Idade Gestacional , Humanos , Hipertensão Induzida pela Gravidez , Masculino , Periodontite/epidemiologia , Gravidez
15.
Lancet Gastroenterol Hepatol ; 5(6): 582-597, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32246941

RESUMO

BACKGROUND: Oesophageal cancer is a common and often fatal cancer that has two main histological subtypes: oesophageal squamous cell carcinoma and oesophageal adenocarcinoma. Updated statistics on the incidence and mortality of oesophageal cancer, and on the disability-adjusted life-years (DALYs) caused by the disease, can assist policy makers in allocating resources for prevention, treatment, and care of oesophageal cancer. We report the latest estimates of these statistics for 195 countries and territories between 1990 and 2017, by age, sex, and Socio-demographic Index (SDI), using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD). METHODS: We used data from vital registration systems, vital registration-samples, verbal autopsy records, and cancer registries, combined with relevant modelling, to estimate the mortality, incidence, and burden of oesophageal cancer from 1990 to 2017. Mortality-to-incidence ratios (MIRs) were estimated and fed into a Cause of Death Ensemble model (CODEm) including risk factors. MIRs were used for mortality and non-fatal modelling. Estimates of DALYs attributable to the main risk factors of oesophageal cancer available in GBD were also calculated. The proportion of oesophageal squamous cell carcinoma to all oesophageal cancers was extracted by use of publicly available data, and its variation was examined against SDI, the Healthcare Access and Quality (HAQ) Index, and available risk factors in GBD that are specific for oesophageal squamous cell carcinoma (eg, unimproved water source and indoor air pollution) and for oesophageal adenocarcinoma (gastro-oesophageal reflux disease). FINDINGS: There were 473 000 (95% uncertainty interval [95% UI] 459 000-485 000) new cases of oesophageal cancer and 436 000 (425 000-448 000) deaths due to oesophageal cancer in 2017. Age-standardised incidence was 5·9 (5·7-6·1) per 100 000 population and age-standardised mortality was 5·5 (5·3-5·6) per 100 000. Oesophageal cancer caused 9·78 million (9·53-10·03) DALYs, with an age-standardised rate of 120 (117-123) per 100 000 population. Between 1990 and 2017, age-standardised incidence decreased by 22·0% (18·6-25·2), mortality decreased by 29·0% (25·8-32·0), and DALYs decreased by 33·4% (30·4-36·1) globally. However, as a result of population growth and ageing, the total number of new cases increased by 52·3% (45·9-58·9), from 310 000 (300 000-322 000) to 473 000 (459 000-485 000); the number of deaths increased by 40·0% (34·1-46·3), from 311 000 (301 000-323 000) to 436 000 (425 000-448 000); and total DALYs increased by 27·4% (22·1-33·1), from 7·68 million (7·42-7·97) to 9·78 million (9·53-10·03). At the national level, China had the highest number of incident cases (235 000 [223 000-246 000]), deaths (213 000 [203 000-223 000]), and DALYs (4·46 million [4·25-4·69]) in 2017. The highest national-level age-standardised incidence rates in 2017 were observed in Malawi (23·0 [19·4-26·5] per 100 000 population) and Mongolia (18·5 [16·4-20·8] per 100 000). In 2017, age-standardised incidence was 2·7 times higher, mortality 2·9 times higher, and DALYs 3·0 times higher in males than in females. In 2017, a substantial proportion of oesophageal cancer DALYs were attributable to known risk factors: tobacco smoking (39·0% [35·5-42·2]), alcohol consumption (33·8% [27·3-39·9]), high BMI (19·5% [6·3-36·0]), a diet low in fruits (19·1% [4·2-34·6]), and use of chewing tobacco (7·5% [5·2-9·6]). Countries with a low SDI and HAQ Index and high levels of indoor air pollution had a higher proportion of oesophageal squamous cell carcinoma to all oesophageal cancer cases than did countries with a high SDI and HAQ Index and with low levels of indoor air pollution. INTERPRETATION: Despite reductions in age-standardised incidence and mortality rates, oesophageal cancer remains a major cause of cancer mortality and burden across the world. Oesophageal cancer is a highly fatal disease, requiring increased primary prevention efforts and, possibly, screening in some high-risk areas. Substantial variation exists in age-standardised incidence rates across regions and countries, for reasons that are unclear. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Adenocarcinoma/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Neoplasias Esofágicas/epidemiologia , Carga Global da Doença , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Poluição do Ar em Ambientes Fechados/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/epidemiologia , Dieta , Feminino , Refluxo Gastroesofágico/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Uso de Tabaco/epidemiologia , Adulto Jovem
16.
Respir Med ; 166: 105946, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32250874

RESUMO

AIM: To assess the pattern of use of oral corticosteroids (OC) in primary care patients with severe asthma. METHODS: Data derived from the Health Search Database (HSD) gathering information on 700 Italian general practitioners. A cohort of severe asthma patients was identified between 2013 and 2017 and followed-up for one year. The association between candidate predictors and the incident escalation to OC was tested through a multivariate Cox regression model. RESULTS: Among patients with asthma (N = 55,075), 284 were diagnosed with severe asthma. Among them, the proportion of OC users decreased from 82.2% in 2013 to 75.3% in 2017. For what concerns the determinants of OC prescriptions, among 284 patients being defined at baseline (2013-2016) as those suffering from severe asthma, 216 (76.1%) were first-ever prescribed with OC at least once during one year of follow-up. The presence of gastroesophageal reflux disease (HR 1.37; 95% CI 1.02-1.85), osteoarthritis (HR 1.54; 95% CI 1.12-2.12) and moderate asthma exacerbations (HR 1.72; 95% CI 1-02-2.93) was significantly associated with the outcome. CONCLUSIONS: The optimization of asthma treatment and the management of comorbidities may be potential leverages to reduce the inappropriate use of OC in patients with severe asthma.


Assuntos
Corticosteroides/administração & dosagem , Asma/tratamento farmacológico , Bases de Dados Factuais , Atenção Primária à Saúde , Administração Oral , Asma/epidemiologia , Estudos de Coortes , Comorbidade , Interpretação Estatística de Dados , Progressão da Doença , Feminino , Seguimentos , Refluxo Gastroesofágico/epidemiologia , Humanos , Masculino , Osteoartrite/epidemiologia , Índice de Gravidade de Doença , Resultado do Tratamento
17.
Am J Otolaryngol ; 41(3): 102441, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32144021

RESUMO

PURPOSE: To use the synchronous esophageal and oropharyngeal Dx-pH monitoring analysis to investigate the relationship between LPRD and GERD. MATERIALS AND METHODS: Synchronous esophageal and oropharyngeal Dx-pH monitoring, electronic gastroscopy, reflux symptom index (RSI) and gastroesophageal reflux questionnaire (Gerd-Q) were collected from 514 consecutive patients and comparative analysis was done. RESULTS: A total of 85 patients had positive Ryan score and 251 cases had positive DeMeester or acid exposure time percent (AET) ≥4.2%. Moreover, 61.2% (52/85) of all LPRD cases were pure LPRD without GERD. There was no statistical difference in the acid exposure to oropharynx between pure LPRD group and LPRD+GERD group (U test, P > 0.05). Furthermore, there were no statistical differences in the other esophageal reflux data between pure GERD without LPRD group and LPRD+GERD group (U test, P > 0.05) apart from the number of episodes, which was higher in the pure GERD group than in LPRD+GERD group (U test, P = 0.027). Additionally, 149 patients were diagnosed with reflux esophagitis by electronic gastroscopy. No significant difference in the acid exposure to oropharynx was seen between different grades of reflux esophagitis (U test, P > 0.05). Among the LPRD patients, 32 cases (37.6%) were negative for Gerd-Q, Dx-pH esophageal probe and gastroscopy. CONCLUSION: The results of synchronous esophageal and oropharyngeal Dx-pH monitoring demonstrated that LPRD and GERD could co-exist as separate medical conditions. Our data suggest that some LPRD are not accompanied by GERD, and that LPRD is not secondary to severe GERD.


Assuntos
Monitoramento do pH Esofágico/métodos , Refluxo Gastroesofágico/diagnóstico , Refluxo Laringofaríngeo/diagnóstico , Adulto , Comorbidade , Feminino , Refluxo Gastroesofágico/epidemiologia , Gastroscopia , Humanos , Refluxo Laringofaríngeo/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
18.
Lancet Gastroenterol Hepatol ; 5(6): 561-581, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32178772

RESUMO

BACKGROUND: Gastro-oesophageal reflux disease is a common chronic ailment that causes uncomfortable symptoms and increases the risk of oesophageal adenocarcinoma. We aimed to report the burden of gastro-oesophageal reflux disease in 195 countries and territories between 1990 and 2017, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. METHODS: We did a systematic review to identify measurements of the prevalence of gastro-oesophageal reflux disease in geographically defined populations worldwide between 1990 and 2017. These estimates were analysed with DisMod-MR, a Bayesian mixed-effects meta-regression tool that incorporates predictive covariates and adjustments for differences in study design in a geographical cascade of models. Fitted values for broader geographical units inform prior distributions for finer geographical units. Prevalence was estimated for 195 countries and territories. Reports of the frequency and severity of symptoms among individuals with gastro-oesophageal reflux disease were used to estimate the prevalence of cases with no, mild to moderate, or severe to very severe symptoms at a given time; these estimates were multiplied by disability weights to estimate years lived with disability (YLD). FINDINGS: Data to estimate gastro-oesophageal reflux disease burden were scant, totalling 144 location-years (unique measurements from a year and location, regardless of whether a study reported them alongside measurements for other locations or years) of prevalence data. These came from six (86%) of seven GBD super-regions, 11 (52%) of 21 GBD regions, and 39 (20%) of 195 countries and territories. Mean estimates of age-standardised prevalence for all locations in 2017 ranged from 4408 cases per 100 000 population to 14 035 cases per 100 000 population. Age-standardised prevalence was highest (>11 000 cases per 100 000 population) in the USA, Italy, Greece, New Zealand, and several countries in Latin America and the Caribbean, north Africa and the Middle East, and eastern Europe; it was lowest (<7000 cases per 100 000 population) in the high-income Asia Pacific, east Asia, Iceland, France, Denmark, and Switzerland. Global prevalence peaked at ages 75-79 years, at 18 820 (95% uncertainty interval [95% UI] 13 770-24 000) cases per 100 000 population. Global age-standardised prevalence was stable between 1990 and 2017 (8791 [95% UI 7772-9834] cases per 100 000 population in 1990 and 8819 [7781-9863] cases per 100 000 population in 2017, percentage change 0·3% [-0·3 to 0·9]), but all-age prevalence increased by 18·1% (15·6-20·4) between 1990 and 2017, from 7859 (6905-8851) cases per 100  000 population in 1990 to 9283 (8189-10 400) cases per 100  000 population in 2017. YLDs increased by 67·1% (95% UI 63·5-70·3) between 1990 and 2017, from 3·60 million (1·93-6·12) in 1990 to 6·01 million (3·22-10·19) in 2017. INTERPRETATION: Gastro-oesophageal reflux disease is common worldwide, although less so in much of eastern Asia. The stability of our global age-standardised prevalence estimates over time suggests that the epidemiology of the disease has not changed, but the estimates of all-age prevalence and YLDs, which increased between 1990 and 2017, suggest that the burden of gastro-oesophageal reflux disease is nonetheless increasing as a result of ageing and population growth. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Refluxo Gastroesofágico/epidemiologia , Carga Global da Doença , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Anos de Vida Ajustados por Qualidade de Vida , Adulto Jovem
19.
J Bras Pneumol ; 46(3): e20180341, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32187258

RESUMO

Objective To describe the clinical features and to identify factors associated with significant severe asthma in samples of patients followed in a reference center in Salvador. Methods A cross-sectional study of 473 adults, regularly followed in the "Asthma Control Program" in Bahia (Programa de Controle da Asma e da Rinite Alérgica na Bahia (ProAR)), reassessed systematically between 2013 and 2015. The patients were admitted for meeting previous criteria of severe asthma and were reclassified according to the most current definition proposed by a joint document of the "European Respiratory Society/American Thoracic Society" (ERS/ATS) (ERS/ATS 2014). Results Only 88/473 (18%) were reclassified as having severe asthma by ERS/ATS criteria (SA-ERS/ATS). Among these patients, 87% were women, 48% obese, with a median Body Mass Index (BMI) of 29 kg·m2 (IQ 26-34), furthermore, 99% had symptoms of chronic rhinitis and 83% had symptoms of Gastroesophageal Reflux Disease (GERD). None of the 88 patients claimed to be current smokers. The most frequently corticosteroids were beclomethasone dipropionate (BDP) (88%) and budesonide (BUD) (69%). The majority of the evaluations reported adequate adherence (77%), however, the minority (0,6%) detected serious errors in inhalation techniques. The median Forced Expiratory Volume (FEV1) associated with post-bronchodilator test (post-BD) was 67% predicted (IQ 55-80). The median number of eosinophils in the peripheral blood was lower in patients with SA-ERS/ATS (258 cells/mm3 (IQ 116-321) than in the other patients studied [258 cells/mm3 (IQ 154-403)]. Gastroesophageal reflux symptoms were associated with a higher severity [OR = 2.2 95% CI (1.2-4.2)]. Conclusion In this group of patients, symptoms of GERD were associated with SA-ERS/ATS and eosinophil count > 260 cells/mm3 were associated 42% with less chance SA-ERS/ATS.


Assuntos
Asma/diagnóstico , Adulto , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Asma/epidemiologia , Beclometasona/uso terapêutico , Brasil/epidemiologia , Broncodilatadores/uso terapêutico , Budesonida/uso terapêutico , Estudos Transversais , Feminino , Volume Expiratório Forçado , Refluxo Gastroesofágico/epidemiologia , Humanos , Masculino , Obesidade/epidemiologia , Rinite/epidemiologia
20.
J Nepal Health Res Counc ; 17(4): 479-484, 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-32001852

RESUMO

BACKGROUND: Gastritis is one of the common diseases, which is frequently caused by Helicobacter pylori. Triple therapy has resulted significant decrease in morbidity and complications. Newer proton pump inhibitor drug rabeprazole has been introduced in the market. The aim of this study is to compare its efficacy with omeprazole in triple therapy regimen. METHODS: A total of 100 patients who were positive for Helicobacter pylori and gave consent in participating in the study were included. Fifty patients were prescribed omeprazole-based triple therapy and other 50 were prescribed with rabeprazole-based triple therapy. After 2 weeks of triple therapy and 4 weeks of proton pump inhibitor treatment, Helicobacter pylori antigen was tested in faecal material. RESULTS: Out of 100 patients, there was significant correlation between epigastric pain, nausea and water brash with p value, 0.001. Similarly P-value was < 0.001 among hiatus hernia and reflux whereas p value was < 0.05 between bile reflux, hiatus hernia and reflux. In follow up study, after triple therapy, Helicobacter pylori antigen tests were negative in 94% of the study population, who were prescribed rabeprazole which was similar who were prescribed omeprazole (92%). CONCLUSIONS: Rabeprazole (20 mg) has proved similar Helicobacter pylori eradication rates compared with omeprazole (40 mg) when co-administered with of antibiotics (amoxicillin and clarithromycin) for two weeks.


Assuntos
Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/epidemiologia , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/epidemiologia , Inibidores da Bomba de Prótons/uso terapêutico , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Criança , Estudos Transversais , Quimioterapia Combinada , Fezes/citologia , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Omeprazol/uso terapêutico , Inibidores da Bomba de Prótons/administração & dosagem , Inibidores da Bomba de Prótons/efeitos adversos , Rabeprazol/uso terapêutico , Adulto Jovem
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