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Mean nocturnal baseline impedance in gastro-esophageal reflux disease diagnosis:Should we strictly follow the Lyon 2 Consensus?

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World Journal of gastroenterology 2024年第26期30卷 3253-3256页

作者： Theodoros A Voulgaris Georgios P Karamanolis Department of gastroenterology School of MedicineNational and Kapodistrian University of AthensAthens 11527Greece

Clinical practice guidelines drive clinical practice and clinicians rely to them when trying to answer their most common *** of the most important position papers in the field of gastro-esophageal reflux disease(GERD)is the one produced by the Lyon *** an updated second version has been *** nocturnal baseline impedance(MNBI)was proposed by the first Consensus to act as supportive evidence for GERD *** a cut-off of 2292 Ohms was proposed,a value revised in the second *** updated Consensus recommended that an MNBI2500 Ohms can be used to refute *** proposed cut-offs move in the correct direction by diminishing the original cut-off,nevertheless they arise from a study of normal subjects where cut-offs were provided by measuring the mean value±2SD and not in symptomatic ***,data exist that even symptomatic patients with inconclusive disease or reflux hypersensitivity(RH)show lower MNBI values in comparison to normal subjects or patients with functional heartburn(FH).Moreover,according to the data,MNBI,even among symptomatic patients,is affected by age and body mass ***,various studies have proposed different cut-offs by using receiver operating characteristic curve analysis even lower than the one ***,no information is given for patients submitted to on-proton pump inhibitors pH-impedance studies even if new and extremely important data now ***,even if MNBI is an extremely important tool when trying to approach patients with reflux symptoms and could distinguish conclusive GERD from RH or FH,its values should be interpreted with caution.

关键词： Mean nocturnal baseline impedance gastro-esophageal reflux disease Lyon 2 Consensus pH-impedance Diagnosis

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Clinical usefulness of adherence to gastro-esophageal reflux disease guideline by Spanish gastroenterologists

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World Journal of gastroenterology 2012年第35期18卷 4885-4891页

作者： Fermín Mearin Julio Ponce Marta Ponce Agustín Balboa Miguel A González Javier Zapardiel Service of gastroenterology Centro Medico Teknon Digestive disease Unit Hospital Quiron Centro de Investigacion Biomedica en Red:Enfermedades Hepaticasy Digestivas Service of gastroenterology Hospital Universitario La Fe Biostatistics Innovex-Grupo Quintiles Espana Medical Department AstraZeneca Farmaceutica

AIM:To investigate usefulness of adherence to gastroesophageal reflux disease(GERD) guideline established by the Spanish Association of ***:Prospective,observational and multicentre study of 301 patients with typical symptoms of GERD who should be managed in accordance with guidelines and were attended by gastroenterologists in daily ***(aged > 18 years) were eligible for inclusion if they had typical symptoms of GERD(heartburn and/or acid regurgitation) as the major complaint in the presence or absence of accompanying atypical symptoms,such as dyspeptic symptoms and/or supraesophageal *** and therapeutic decisions should be made based on specific recommendations of the Spanish clinical practice guideline for GERD which is a widely disseminated and well known instrument among Spanish in digestive disease ***:Endoscopy was indicated in 123(41%) patients:50 with alarm symptoms,32 with age > 50 years without alarm ***-two patients(58.5%) had esophagitis(grade A,23,grade B,28,grade C,18,grade D,3).In the presence of alarm symptoms,endoscopy was indicated consistently with recommendations in 98% of ***,in the absence of alarm symptoms,endoscopy was indicated in 33% of patients > 50 years(not recommended by the guideline).Adherence for proton pump inhibitors(PPIs) therapy was 80%,but doses prescribed were lower(half) in 5% of cases and higher(double) in 15%.Adherence regarding duration of PPI therapy was 69%;duration was shorter than recommended in 1%(4 wk in esophagitis grades C-D) or longer in 30%(8 wk in esophagitis grades A-B or in patients without endoscopy).Treatment response was higher when PPI doses were consistent with guidelines,although differences were not significant(95% vs 85%).CONCLUSION:GERD guideline compliance was quite good although endoscopy was over indicated in patients > 50 years without alarm symptoms;PPIs were prescribed at higher doses and longer duration.

关键词： gastro-esophageal reflux disease Clinicalpractice guidelines Adherence to guidelines Treatmentof gastro-esophageal reflux disease

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Comparative clinical trial of S-pantoprazole versus racemic pantoprazole in the treatment of gastro-esophageal reflux disease

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World Journal of gastroenterology 2006年第37期12卷 6017-6020页

作者： Vikas G Pai Nitin V Pai Hemant P Thacker Jaisingh K Shinde Vijay P Mandora Subhash S Erram Pai Clinic Pune India Thacker’s Clinic Sukh Sagar 4th Floor NS Patkar Marg Mumbai India Surya Hospital Pune India Inlaks & Budhrani Hospital Pune India Sharada Clinic Karad India

AIM: To compare the effi cacy and tolerability of S-pan- toprazole (20 mg once a day) versus racemic Panto- prazole (40 mg once a day) in the treatment of gastro- esophageal reflux disease (GERD). METHODS: This multi-centre, randomized, double-blind clinical trial consisted of 369 patients of either sex suf- fering from GERD. Patients were randomly assigned to receive either one tablet (20 mg) of S-pantoprazole once a day (test group) or 40 mg racemic pantoprazole once a day (reference group) for 28 d. Patients were evaluated for reduction in baseline on d 0, GERD symptom score on d 14 and 28, occurrence of any adverse effect during the course of therapy. gastrointestinal (GI) endoscopy was performed in 54 patients enrolled at one of the study centers at baseline and on d 28. RESULTS: Signifi cant reduction in the scores (mean and median) for heart burn (P < 0.0001), acid regurgitation (P < 0.0001), bloating (P < 0.0001), nausea (P < 0.0001) and dysphagia (P < 0.001) was achieved in both groups on d 14 with further reduction on continuing the therapy till 28 d. There was a statistically signifi cant difference in the proportion of patients showing improvement in acid regurgitation and bloating on d 14 and 28 (P = 0.004 for acid regurgitation; P = 0.03 for bloating) and heart burn on d 28 (P = 0.01) between the two groups, with a higher proportion in the test group than in the refer- ence group. Absolute risk reductions for heartburn/acid regurgitation/bloating were approximately 15% on d 14 and 10% on d 28. The relative risk reductions were 26%-33% on d 14 and 15% on d 28. GI endoscopy showed no signifi cant difference in healing of esophagitis (P = 1) and gastric erosions (P = 0.27) between the two groups. None of the patients in either group reported any adverse effect during the course of ***: In GERD, S-pantoprazole (20 mg) is more effective than racemic pantoprazole (40 mg) in improving symptoms of heartburn, acid regurgitation, bloating and equa

关键词： gastro-esophageal reflux disease Pantoprazole Efficacy Tolerability

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Outcome of nonerosive gastro-esophageal reflux disease patients with pathological acid exposure

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World Journal of gastroenterology 2009年第45期15卷 5700-5705页

作者： Fabio Pace Stefano Pallotta Gianpiero Manes Annalisa de Leone Patrizia Zentilin Luigi Russo Vincenzo Savarino Matteo Neri Enzo Grossi Rosario Cuomo Division of gastroenterology Department of Clinical Sciences "L. Sacco" University HospitalVia G. B. Grassi 74-20157 MilanoItaly gastroenterology Unit D.I.M.I University of GenovaViale Benedetto XV 6 16132 Genova Italy gastroenterology Unit Dip. Med. Clin e Sper. AOU Federico ⅡVia S. Pansini 5 80131 Napoli Italy Department of Medicine and Aging Sciences and Ce.S.I "G. D'Annunzio" University & FoundationVia dei Vestini 31 66013 Chieti Italy Department of Medical Bracco Imaging SpAVia XXV Aprile 4 20097 San Donato Milanese Milano Italy

AIM： To assess the management and outcome of nonerosive gastro-esophageal reflux disease （NERD） patients who were identified retrospectively, after a 5-year follow-up. METHODS： We included patients with gastro-esophageal reflux disease （GERD） symptoms who had a negative endoscopy result and pathological 24-h esophageal pH-monitoring while off therapy. We interviewed them after an average period of 5 years （range 3.5-7 years） by means of a structured questionnaire to assess presence of GERD symptoms, related therapy, updated endoscopic data and other features. We assessed predictors of esophagitis development by means of univariate and multivariate statistical analysis. RESULTS： 260 patients （137 women） were included. Predominant GERD symptoms were heartburn and regurgitation in 103/260 （40%）. 70% received a maintenance treatment, which was proton pump inhibitor （PPI） in 55% of cases. An average number of 1.5 symptomatic relapses per patient/year of follow-up were observed. A progression to erosive gastro-esophageal reflux disease （ERD） was found in 58/193 （30.0%） of patients undergoing repeat endoscopy; 72% of these were Los Angeles grade A-B. CONCLUSION： This study to ERD occurs in about 5% shows that progression of NERD cases per year, despite therapy. Only two factors consistently and independently influence progression： smoking and absence of PPI therapy.

关键词： Esophagus Nonerosive gastro-esophageal reflux disease gastro-esophageal reflux disease Epidemiology Acidity

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Management of gastro-esophageal reflux disease:Practice-oriented answers to clinical questions

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World Journal of gastroenterology 2023年第5期29卷 773-779页

作者： Leonardo Frazzoni Lorenzo Fuccio Rocco Maurizio Zagari Department of Digestive diseases IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S OrsolaBologna 40138Italy Department of Medical and Surgical Sciences University of BolognaBologna 40138Italy

gastro-esophageal reflux disease(GERD)is a condition which is frequently faced by primary care physicians and *** management of GERD is crucial to maximise both patient care and resource *** fact,the management of patients with GERD is complex and poses several questions to the clinician who faces them in clinical *** instance,many aspects should be considered,including the appropriateness of indication to endoscopy,the quality of the endoscopic examination,the use and interpretation of ambulatory reflux testing,and the choice and management of anti-reflux treatments,i.e.,protonpump inhibitors and *** of the present review was to provide a comprehensive update on the clinical management of patients with GERD,through a literature review on the diagnosis and management of patients with GER *** details,we provide practice-oriented concise answers to clinical questions,with the aim of optimising patient management and healthcare resource use.

关键词： gastro-esophageal reflux disease Diagnosis Management Proton-pump inhibitor

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Test-based exclusion diets in gastro-esophageal reflux disease patients:A randomized controlled pilot trial

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World Journal of gastroenterology 2014年第45期20卷 17190-17195页

作者： Michele Caselli Giovanni Zuliani Francesca Cassol Nadia Fusetti Elena Zeni Natalina Lo Cascio Cecilia Soavi Sergio Gullini Department of Medical Sciences Internal Medicine Institute University of Ferrara Department of gastroenterology School of Gastroenterology University of Ferrara Center Study Association on Food Intolerance and Nutrition of Ferrara

AIM: To investigate the clinical response of gastro-esophageal reflux disease (GERD) symptoms to exclusion diets based on food intolerance tests.

关键词： gastro-esophageal reflux disease Food intolerance Leukocytotoxic test Exclusion diet Treatment

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Perioperative and late outcomes of laparoscopic fundoplication for neurologically impaired children with gastro-esophageal reflux disease

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Chinese Medical Journal 2012年第21期125卷 3905-3908页

作者： WONG Kenneth KY LIU Xue-lai Department of Surgery LKS Faculty of Medicine The Universityof Hong Kong Hong Kong SAR China

Background Persistent gastro-esophageal reflux （GER） due to various pathological factors often results in overt clinical symptoms and signs, which is termed as gastro-esophageal reflux disease （GERD）. Affected children usually present with failure to thrive, recurrent pneumonia or apnea. Many neurologically impaired children have symptoms related to GERD. Although laparoscopic fundoplication has been established to be an effective treatment modality for children with GERD, data on its role and long-term efficacy for neurologically impaired patients remain sparse. The aim of this study was to review the results of such patients who underwent laparoscopic fundoplication.

关键词： laparoscopic fundoplication gastro-esophageal reflux disease neurological impaired patients outcomes

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Navigating reflux disease after achalasia treatments:Balancing risks and benefits

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World Journal of gastroenterology 2024年第21期30卷 2740-2743页

作者： Ewen A Griffiths Enoch Wong Department of Upper gastrointestinal Surgery University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWWest MidlandsUnited Kingdom Department of Immunology and Immunotherapy University of BirminghamBirmingham B152TTWest MidlandsUnited Kingdom

The peroral endoscopic myotomy(POEM)procedure has revolutionized the management of achalasia in many centres around the world as it offers patients a minimally invasive endoscopic solution to their dysphagia caused by *** its success in alleviating dysphagia,concerns regarding postoperative gastroesophageal reflux disease have emerged as a pertinent issue which are not fully *** this study,Nabi et al have comprehensively reviewed the topic of the prediction,prevention and management of gastroesophageal reflux after *** is a purely endoscopic procedure which is usually performed without any anti-reflux *** patients may be better served by a laparoscopic Heller’s myotomy and fundoplication and it is important that gastroenterologists and surgeons provide comprehensive risks and benefits of each achalasia treatment option so that patients can decide what treatment is best for *** article by Nabi et al provides a comprehensive review of the current status of this issue to allow these discussions to occur.

关键词： Achalasia gastro-esophageal reflux disease Laparoscopic heller’s myotomy Peroral endoscopic myotomy Fundoplication

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Overlapping approach Proton Pump Inhibitors/Nux vomica-Heel as new intervention for gastro-esophageal reflux management:Delphi consensus study

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World Journal of gastroenterology 2024年第18期30卷 2467-2478页

作者： Edda Battaglia Luciano Bertolusso Marco Del Prete Marco Monzani Marco Astegiano gastroenterology Unit ASLTO4Ivrea 10015TurinItaly General Practitioner ASL CN2Alba-Bra 12051CuneoItaly Specialist in Nephrology International Academy of Physiological Regulating Medicine Milan 20100Italy Specialist in Endocrinology Territorial Social and Health Authority of BrianzaMonza 20900Italy gastroenterology Specialist Retired from Gastroenterology and Hepatology UnitAOU Cittàdella Salute e della ScienzaTurin 10123Italy

BACKGROUND gastro-esophageal reflux disease(GERD)may affect the upper digestive tract;up to 20%of population in Western nations are affected by ***,histamine H2-receptor antagonists,and Proton Pump Inhibitors(PPIs)are considered the referring medications for ***,PPIs must be managed carefully because their use,especially chronic,could be linked with some adverse *** effective and safe alternative pharmacological tool for GERD is *** the identification of potentially new medications to flank PPIs,it is mandatory to revise and improve good clinical practices even through a consensus *** To optimize diagnosis and treatment guidelines for GERD through a consensus based on Delphi *** The availability of clinical studies describing the action of the multicomponent/multitarget medication Nux vomica-Heel,subject of the consensus,is the basic prerequisite for the consensus itself.A modified Delphi process was used to reach a consensus among a panel of Italian GERD specialists on the overlapping approach PPIs/Nux vomica-Heel as a new intervention model for the management of *** Voting Consensus group was composed of 49 Italian Medical Doctors with different specializations:gastroenterology,otolaryngology,geriatrics,and general medicine.A scientific committee analyzed the literature,determined areas that required investigation(in agreement with the multiple-choice questionnaire results),and identified two topics of interest:(1)GERD disease;and(2)GERD *** for each of these topics were then formulated and *** Delphi process involved two rounds of questioning submitted to the panel experts using an online *** According to their routinary GERD practice and current clinical evidence,the panel members provided feedback to each questionnaire *** experts evaluated 15 statements and reached consensus on all *** statements regarding the GERD disease showed high levels of

关键词： gastro-esophageal reflux disease Proton Pump Inhibitors Consensus Nux vomica-Heel Overlapping Decalage

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Investigating causal links between gastroesophageal reflux disease and essential hypertension

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World Journal of Clinical Cases 2024年第14期12卷 2304-2307页

作者： Gowthami Sai Kogilathota Jagirdhar Yatinder Bains Salim Surani Department of Medicine Saint Francis Health Science CenterNewarkNJ 07107United States Department of gastroenterology Saint Michaels Medical CenterNewarkNJ 07102United States Department of Medicine and Pharmacology Texas A&M UniversityCollege StationTX 77843United States

gastroesophageal reflux disease(GERD)is a prevalent global health concern with a rising *** risk factors,including obesity,hiatal hernia,and smo-king,contribute to its *** research suggests associations bet-ween GERD and metabolic syndrome,cardiac diseases,and hypertension(HTN).Mechanisms linking GERD to HTN involve autonomic dysfunction,inflammatory states,and endothelial ***,GERD medications such as pro-ton-pump inhibitors may impact blood pressure ***,antihy-pertensive medications like beta-blockers and calcium channel blockers can exacerbate GERD *** bidirectional causality exists between GERD and HTN,longitudinal studies are warranted to elucidate the precise *** of GERD,including anti-reflux surgery,may positively influence HTN ***,the interplay of lifestyle factors,comorbidities,and medications necessitates further investigation to comprehensively understand this *** this editorial,we comment on the article published by Wei et al in the recent issue of the World Journal of Clinical *** evaluate their claims on the causal association between GERD and HTN.

关键词： gastroesophageal reflux disease Hypertension Metabolic syndrome gastro-esophageal reflux disease Hiatal hernia

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