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Comparison of multichannel intraluminal impedance-pH monitoring and reflux scintigraphy in pediatric patients with suspected gastroesophageal reflux

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World Journal of Gastroenterology 2016年第43期22卷 9595-9603页

作者： Nuray Uslu Kizilkan Murat Fani Bozkurt Inci Nur Saltik Temizel Hülya Demir Aysel Yüce Biray Caner Hasan Ozen Division of Pediatric Gastroenterology Koc University Hospital Topkapi Istanbul 34010 Turkey Hacettepe University Faculty of Medicine Department of Nuclear Medicine Ankara 06100 Turkey Division of Gastroenterology Hepatology and Nutrition Unit Department of Pediatrics Hacettepe University Faculty of MedicineAnkara 06100 Turkey

AIM To evaluate the agreement of multichannel intraluminal impedance-p H monitoring(MII-p HM) and gastroesophageal reflux scintigraphy(GES) for the diagnosis of gastroesophageal reflux disease. METHODS Seventy-five consecutive patients with suspectedgastroesophageal reflux disease(GERD) underwent 24-h combined MII-p HM recording and one hour radionuclide scintigraphy during the course of the MIIpH M study. Catheters with 6 impedance channels and 1 p H sensor were placed transnasally. Impedance and p H data analysis were performed automatically and manually. For impedance monitoring, reflux was defined as a retrograde 50% drop in impedance, starting distally and propagating retrogradely to at least the next two more proximal measuring channels. Reflux index(RI, percentage of the entire record that esophageal p H is gastroesophageal reflux was defined as at least one reflux episode in the esophagus. After scintigraphic evaluation, impedance-pH recordings and scintigraphic images were evaluated together and agreement between tests were evaluated with Cohen's kappa.RESULTS Sufficient data was obtained from 60(80%) patients(34 male, 56.7%) with a mean age of 8.7 ± 3.7 years(range: 2.5-17.3 years; median: 8.5 years). Chronic cough, nausea, regurgitation and vomiting were the most frequent symptoms. The mean time for recording of MII-pH M was 22.8 ± 2.4 h(range: 16-30 h; median: 22.7 h). At least one test was positive in 57(95%) patients. According to diagnostic criteria, GERD was diagnosed in 34(57.7%), 44(73.3%), 47(78.3%) and 51(85%) patients by means of p HM, MII, GES and MII-p HM, respectively. The observed percentage agreements/κ values for GES and p HM, GES and MII, GES and MII-p HM, and MII and p HM are 48.3%/-0.118; 61.7%/-0.042; 73.3%/0.116 and 60%/0.147, respectively. There was no or slight agreem

关键词： gastroesophageal 倒流疾病孩子多信道的 intraluminal 阻抗监视的食道的 pH Scintigraphy

Full-thickness myotomy is associated with higher rate of postoperative gastroesophageal reflux disease

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World Journal of Gastroenterology 2016年第42期22卷 9419-9426页

作者： Xue-Hong Wang Yu-Yong Tan Hong-Yi Zhu Chen-Jie Li De-Liang Liu Department of Gastroenterology the Second Xiangya Hospital of Central South University

AIM To compare long-term occurrence of gastroesophageal reflux disease(GERD) between two different types of peroral endoscopic myotomy(POEM) for achalasia.METHODS We included all patients with achalasia who underwent POEM at our hospital from August 2011 to October 2012 and had complete GERD evaluation with ≥ 3 years of follow-up. They were divided into circular or full-thickness myotomy groups according to the depth of myotomy. Demographics, Eckardt score, manometry results, 24-h pH monitoring, and GERD symptoms were recorded and compared between the two groups.RESULTS We studied 56 patients(32 circular myotomy and 24 fullthickness myotomy) with complete GERD evaluation. There was no significant difference between the two groups in terms of treatment success(defined as Eckardt score ≤ 3), postoperative Eckardt score, mean basal lower esophageal sphincter pressure, and 4-s integrated relaxation pressure(4s IRP). Postoperative abnormal esophageal acid exposure was found in 25 patients(44.6%). A total of 13 patients(23.2%) had GERD symptoms and 12 had esophagitis(21.4%). Clinically relevant GERD(abnormal esophageal acid exposure associated with GERD symptoms and/or esophagitis) was diagnosed in 13 patients(23.2%).Multivariate analysis revealed that full-thickness myotomy and low level of postoperative 4s IRP were predictive factors for clinically relevant GERD.CONCLUSION Efficacy and manometry are comparable between achalasia patients treated with circular or full-thickness myotomy. But patients with full-thickness myotomy and low postoperative 4sI RP have more GERD.

关键词： Achalasia gastroesophageal 倒流疾病 Peroral 内视镜的肌切开术圆形的肌切开术完整厚度的肌切开术

Esophagogastric junction distensibility assessed using the functional lumen imaging probe

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World Journal of Gastroenterology 2017年第7期23卷 1289-1297页

作者： Joan W Chen Joel H Rubenstein Department of Gastro-enterology and Hepatology University of Michigan Health SystemsAnn ArborMI 48109United States

AIM To assess reference values in the literature for esophageal distensibility and cross-sectional area in healthy and diseased subjects measured by the functional lumen imaging probe(FLIP). METHODS Systematic search and review of articles in Medline and Embase pertaining to the use of FLIP in the esophagus was conducted in accordance with the PRISMA guidelines. Cross-sectional area and distensibility at the esophagogastric junction(EGJ) were abstracted for normal subjects, achalasia, and gastroesophageal reflux disease(GERD) patients, stratified by balloon length and volume of inflation.RESULTS Six achalasia studies(n = 154), 3 GERD(n = 52), and 5 studies including healthy controls(n = 98) were included in the systematic review. Normative data varied widely amongst studies of healthy volunteers. In contrast, studies in achalasia patients uniformly demonstrated low point estimates in distensibility ≤ 1.6 mm2/mmH g prior to treatment that increased to ≥ 3.4 mm2/mmH g following treatment at 40 mL bag volume. In GERD patients, distensibility fell to the range of untreated achalasia(≤ 2.85 mm2/mm Hg) following fundoplication.CONCLUSION FLIP may be a useful tool in assessment of treatment efficacy in achalasia. The drastic drop in EGJ distensibility after fundoplication suggests that FLIP measurements need to be interpreted in the context of esophageal body motility and highlights the importance of pre-operative screening for dysmotility. Future studies using standardized FLIP protocol and balloon size are needed.

关键词：阻抗测面积池 gastroesophageal 倒流疾病食道的膨胀性 Achalasia

Development and validation of a simple and multifaceted instrument,GERD-TEST,for the clinical evaluation of gastroesophageal reflux and dyspeptic symptoms

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World Journal of Gastroenterology 2017年第28期23卷 5216-5228页

作者： Koji Nakada Nobuyuki Matsuhashi Katsuhiko Iwakiri Atsushi Oshio Takashi Joh Kazuhide Higuchi Ken Haruma Department of Laboratory Medicine Daisan Hospital Jikei University School of Medicine Department of Gastroenterology NTT Medical Center Tokyo Department of Gastroenterology Nippon Medical School Graduate School of Medicine Faculty of Letters Arts and SciencesWaseda University Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Sciences Second Department of Internal Medicine Osaka Medical College Department of General Internal Medicine 2 Kawasaki Medical School Kawasaki Hospital

AIM To evaluate the psychometric properties of a newly developed questionnaire,known as the gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test(GERD-TEST),in patients with GERD.METHODS Japanese patients with predominant GERD symptoms recruited according to the Montreal definition were treated for 4 wk using a standard dose of proton pump inhibitor(PPI). The GERD-TEST and the Medical Outcome Study Short Form-8 Health Survey(SF-8) were administered at baseline and after 4 wk of treatment. The GERD-TEST contains three domains: the severity of GERD and functional dyspepsia(FD) symptoms(5 items),the level of dissatisfaction with daily life(DS)(4 items),and the therapeutic efficacy as assessed by the patients and medication compliance(4 items).RESULTS A total of 290 patients were eligible at baseline; 198 of these patients completed 4 wk of PPI therapy. The internal consistency reliability as evaluated using the Cronbach's α values for the GERD,FD and DS subscales ranged from 0.75 to 0.82. The scores for the GERD,FD and DS items/subscales were significantly correlated with the physical and mental component summary scores of the SF-8. After 4 wk of PPI treatment,the scores for the GERD items/subscales were greatly reduced,ranging in value from 1.51 to 1.87 and with a large effect size(P < 0.0001,Cohen's d; 1.29-1.63). Statistically significant differences in the changes in the scores for the GERD items/subscales were observed between treatment responders and non-responders(P < 0.0001).CONCLUSION The GERD-TEST has a good reliability,a good convergent and concurrent validity,and is responsive to the effects of treatment. The GERD-TEST is a simple,easy to understand,and multifaceted PRO instrument applicable to both clinical trials and the primary care of GERD patients.

关键词：治疗学的功效和满足测试的 gastroesophageal 倒流和消化不良报导病人的结果 gastroesophageal 倒流疾病有效性可靠性

Oropharyngeal acid reflux and motility abnormalities of the proximal esophagus

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World Journal of Gastroenterology 2016年第40期22卷 8991-8998页

作者： Sandro Passaretti Giorgia Mazzoleni Cristian Vailati Pier Alberto Testoni Gastroenterology and Gastrointestinal Endoscopy Division IRCCS San Raffaele Scientific Institute Vita-Salute San Raffaele University

AIM To investigate the relationship between pathological oropharyngeal(OP) acid exposure and esophageal motility in patients with extra-esophageal syndromes.METHODS In this prospective study we enrolled consecutive outpatients with extra-esophageal symptoms suspected to be related to gastroesophageal reflux disease(GERD). We enrolled only patients with a reflux symptom index(RSI) score-higher than 13 and with previous lung, allergy and ear, nose and throat evaluations excluding other specific diagnoses. All patients underwent 24-h OP pH-metry with the Dx probe and esophageal highresolution manometry(HRM). Patients were divided into two groups on the basis of a normal or pathological p H-metric finding(Ryan Score) and all manometric characteristics of the two groups were compared.RESULTS We examined 135 patients with chronic extra-esophageal syndromes. Fifty-one were considered eligible for the study. Of these, 42 decided to participate in the protocol. Patients were divided into two groups on the basis of normal or pathological OP acid exposure. All the HRM parameters were compared for the two groups. Significant differences were found in the median upper esophageal sphincter resting pressure(median 71 mmH g vs 126 mmH g, P = 0.004) and the median proximal contractile integral(median 215.5 cm·mmH g·s vs 313.5 cm·mmH g·s, P = 0.039), both being lower in the group with pathological OP acid exposure, and the number of contractions with small or large breaks, which were more frequent in the same group. This group also had a larger number of peristaltic contractions with breaks in the 20 mm Hg isobaric contour(38.7% vs 15.38%, P < 0.0001).CONCLUSION In patients with suspected GERD-related extraesophageal syndromes pathological OP acid exposure was associated with weaker proximal esophageal motility.

关键词：食管活动性 Oropharyngeal 倒流 gastroesophageal 倒流疾病高分辨率 manometry pH-metry

Influence of capsaicin infusion on secondary peristalsis in patients with gastroesophageal reflux disease

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World Journal of Gastroenterology 2016年第45期22卷 10045-10052页

作者： Chih-Hsun Yi Wei-Yi Lei Jui-Sheng Hung Tso-Tsai Liu Chien-Lin Chen Fabio Pace Department of Medicine Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation and Tzu Chi University Division of Gastroenterology Department of Clinical Sciences L. Sacco University Hospital

AIM To determine whether capsaicin infusion could influence heartburn perception and secondary peristalsis in patients with gastroesophageal reflux disease(GERD). METHODS Secondary peristalsis was performed with slow and rapid mid-esophageal injections of air in 10 patients with GERD. In a first protocol, saline and capsaicincontaining red pepper sauce infusions were randomly performed, whereas 2 consecutive sessions of capsaicin-containing red pepper sauce infusions were performed in a second protocol. Tested solutions including 5 m L of red pepper sauce diluted with 15 m L of saline and 20 m L of 0.9% saline were infused into the mid-esophagus via the manometric catheter at a rate of 10 mL /min with a randomized and doubleblind fashion. During each study protocol, perception of heartburn, threshold volumes and peristaltic parameters for secondary peristalsis were analyzed and compared between different stimuli.RESULTS Infusion of capsaicin significantly increased heartburn perception in patients with GERD(P gastroesophageal reflux disease, but repetitive capsaicin infusion reverses these effects.

关键词： Capsaicin 食道的活动性第二等的蠕动食道的 manometry gastroesophageal 倒流疾病

Esophagitis and its causes:Who is “guilty” when acid is found “not guilty”?

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World Journal of Gastroenterology 2017年第17期23卷 3011-3016页

作者： laurino grossi antonio francesco ciccaglione leonardo marzio g.d’annunzio university of chieti-pescara school of gastroenterology digestive sciences c/o ospedale spirito santo

Esophagitis is mainly a consequence of gastroesophageal reflux disease, one of the most common diseases affecting the upper digestive tract. However the esophageal mucosa can also be targeted by some infectious, systemic or chemical conditions. Eosinophilic esophagitis(Eo E) is an immune-mediated inflammatory disease, characterized by eosinophilic infiltration in the mucosa. Esophageal localization of Crohn's disease is not very common, but it should always be considered in patients with inflammatory bowel disease complaining of upper digestive tract symptoms. There are also forms of infectious esophagitis(e.g., Herpes simplex virus or Candida albicans) occurring in patients with a compromised immune system, either because of specific diseases or immunosuppressive therapies. Another kind of damage to esophageal mucosa is due to drug use(including oncologic chemotherapeutic regimens and radiotherapy) or caustic ingestion, usually of alkaline liquids, with colliquative necrosis and destruction of mucosa within a few seconds. Dysphagia is a predominant symptom in Eo E, while infectious, drug-induced and caustic damages usually cause chest pain and odynophagia. Endoscopy can be useful for diagnosing esophagitis, although no specific pattern can be identified. In conclusion when a patient refers upper gastrointestinal tract symptoms and the diagnosis of gastro-esophageal reflux disease is not convincing we should always carefully investigate the patient's clinical history to consider possibilities other than the gastric refluxate.

关键词：食道炎 gastroesophageal 倒流疾病嗜曙红的食道炎 Crohns 疾病疱疹单一的病毒 Manometry Candida 苛性咽下困难胸疼痛

Lymphocytic esophagitis: Still an enigma a decade later

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World Journal of Gastroenterology 2017年第6期23卷 949-956页

作者： Carol Rouphael Ilyssa O Gordon Prashanthi N Thota Department of General Internal Medicine Cleveland Clinic Foundation Department of Pathology Cleveland Clinic Foundation Department of Gastroenterology and Hepatology Digestive Disease and Surgery InstituteCleveland Clinic Foundation

Lymphocytic esophagitis (LE) is a clinicopathologic entity first described by Rubio et al in 2006. It is defined as peripapillary intraepithelial lymphocytosis with spongiosis and few or no granulocytes on esophageal biopsy. This definition is not widely accepted and the number of lymphocytes needed to make the diagnosis varied in different studies. Multiple studies have described potential clinical associations and risk factors for LE, such as old age, female gender and smoking history. This entity was reported in inflammatory bowel disease in the pediatric population but not in adults. Other associations include gastroesophageal reflux disease and primary esophageal motility disorders. The most common symptom is dysphagia, with a normal appearing esophagus on endoscopy, though esophageal rings, webs, nodularities, furrows and strictures have been described. Multiple treatment modalities have been used such as proton pump inhibitors and topical steroids. Esophageal dilation seems to be therapeutic when dysphagia is present along with esophageal narrowing secondary to webs, rings or strictures. The natural history of the disease remains unclear and needs to be better delineated. Overall, lymphocytic esophagitis seems to have a chronic and benign course, except for two cases of esophageal perforation in the literature, thought to be secondary to this entity.

关键词：淋巴球的食道炎 intraepithelial 淋巴细胞 spongiosis gastroesophageal 倒流疾病 CD4 T 房间咽下困难煽动性的肠疾病食道的戒指质子泵禁止者食道的膨胀

Persistent severe hypomagnesemia caused by proton pump inhibitor resolved after laparoscopic fundoplication

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World Journal of Gastroenterology 2017年第37期23卷 6907-6910页

作者： Synne Semb Frederik Helgstrand Flemming Hjorne Peter Bytzer Department of Gastroenterology Zealand University Hospital Department of Surgery Zealand University Hospital Department of Clinical Medicine University of Copenhagen

Magnesium deficiency can cause a variety of symptoms, including potentially life-threatening complications such as seizures, cardiac arrhythmias and secondary electrolyte disturbances. Hypomagnesemia can be a serious adverse effect to proton pump inhibitor(PPI) therapy, which is worrying due to the widespread use of PPIs. Current evidence suggest that the mechanism of PPI induced hypomagnesemia is impaired intestinal magnesium absorption. In this report, we present the case of a long-term PPI user with persistent hypomagnesemia with severe symptoms at presentation. He was unable to stop PPI treatment because of severe reflux symptoms, and was dependent on weekly intravenous magnesium infusions, until his magnesium levels finally normalized without the need for supplementation after a successful laparoscopic fundoplication.

关键词： Hypomagnesemia 质子泵禁止者 gastroesophageal 倒流疾病药不利效果 Laparoscopic fundoplication