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Moraes-Filho JPP, Domingues G, Chinzon D. BRAZILIAN CLINICAL GUIDELINE FOR THE THERAPEUTIC MANAGEMENT OF GASTROESOPHAGEAL REFLUX DISEASE (BRAZILIAN FEDERATION OF GASTROENTEROLOGY, FBG). ARQUIVOS DE GASTROENTEROLOGIA 2024; 61:e23154. [PMID: 38511797 DOI: 10.1590/s0004-2803.24612023-154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/29/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Gastroesophageal Reflux Disease (GERD) is a prevalent condition in Brazil, affecting 12% to 20% of the urban population, with significant implications for patient quality of life and potential for complications. OBJECTIVE This paper focuses on the recent update of the Brazilian guidelines for GERD, a necessary revision due to advancements in knowledge and practice since the last publication over a decade ago. The update pays particular attention to the role and safety of proton pump inhibitors (PPIs), acknowledging the growing concerns about their long-term use, adverse events, and overprescription. METHODS The methodology of the guideline update involved an extensive literature review in multiple languages (English, French, Italian, Spanish, and Portuguese), drawing from major databases such as Medline, Embase, and SciELO-Lilacs. RESULTS This comprehensive approach resulted in a carefully curated selection of studies, systematic reviews, and meta-analyses, specifically focusing on PPIs and other therapeutic strategies for GERD. The updated guidelines are presented in a user-friendly question-and-answer format, adhering to the PICO system (Population, Intervention, Comparison, Outcomes) for clarity and ease of interpretation. The recommendations are supported by robust scientific evidence and expert opinions, enhancing their practical applicability in clinical settings. To ensure the reliability and clarity of the recommendations, the GRADE system (Grading of Recommendations Assessment, Development, and Evaluation) was employed. This system categorizes the strength of recommendations as strong, weak, or conditional and classifies evidence quality as high, moderate, low, or very low. These classifications provide insight into the confidence level of each recommendation and the likelihood of future research impacting these guidelines. CONCLUSION The primary aim of these updated guidelines is to offer practical, evidence-based advice for the management of GERD in Brazil, ensuring that healthcare professionals are equipped with the latest knowledge and tools to deliver optimal patient care. BACKGROUND •Gastrointestinal specialists rely heavily on guidelines to manage digestive pathologies effectively. The Brazilian clinical guideline for therapeutic management of gastroesophageal reflux disease (GERD) is an invaluable tool for these specialists. BACKGROUND •It critically analyzes practical aspects of therapy through 12 questions covering a wide range of topics, from behavioral measures to surgical and endoscopic indications. BACKGROUND •The recommendations in this guideline are justified using the GRADE system (Grading of Recommendations Assessment, Development, and Evaluation), and experienced experts provide comments and suggestions at the end of each question.
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Affiliation(s)
| | - Gerson Domingues
- Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Decio Chinzon
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Valdovinos Díaz MA, Amieva-Balmori M, Carmona-Sánchez R, Coss-Adame E, Gómez-Escudero O, González-Martínez M, Huerta-Iga F, Morel-Cerda E, Remes-Troche JM, Tamayo-de la Cuesta JL, Torres-Villalobos G, Valdovinos-García LR, Vázquez-Elizondo G, Villar-Chávez AS, Arenas-Martínez JA. Good clinical practice recommendations for the diagnosis and treatment of gastroesophageal reflux disease. An expert review from the Asociación Mexicana de Gastroenterología. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:121-143. [PMID: 38580493 DOI: 10.1016/j.rgmxen.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/06/2023] [Indexed: 04/07/2024]
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) is very prevalent in the general population, with a broad spectrum of clinical manifestations, requiring accurate diagnosis and treatment. AIM The aim of this expert review is to establish good clinical practice recommendations for the diagnosis and personalized treatment of GERD. METHODS The good clinical practice recommendations were produced by a group of experts in GERD, members of the Asociación Mexicana de Gastroenterología (AMG), after carrying out an extensive review of the published literature and discussing each recommendation at a face-to-face meeting. This document does not aim to be a clinical practice guideline with the methodology such a document requires. RESULTS Fifteen experts on GERD formulated 27 good clinical practice recommendations for recognizing the symptoms and complications of GERD, the rational use of diagnostic tests and medical treatment, the identification and management of refractory GERD, the overlap with functional disorders, endoscopic and surgical treatment, and GERD in the pregnant woman, older adult, and the obese patient. CONCLUSIONS An accurate diagnosis of GERD is currently possible, enabling the prescription of a personalized treatment in patients with this condition. The goal of the good clinical practice recommendations by the group of experts from the AMG presented in this document is to aid both the general practitioner and specialist in the process of accurate diagnosis and treatment, in the patient with GERD.
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Affiliation(s)
| | - M Amieva-Balmori
- Laboratorio de Fisiología Digestiva y Motilidad Intestinal, Instituto de Investigaciones Médico-Biológicas de la Universidad Veracruzana, Veracruz, Mexico
| | - R Carmona-Sánchez
- Servicio de Gastroenterología, Práctica privada, San Luis Potosí, Mexico
| | - E Coss-Adame
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - O Gómez-Escudero
- Clínica de Gastroenterología, Endoscopia y Motilidad Gastrointestinal, Endoneurogastro, Hospital Ángeles Puebla, Puebla, Mexico
| | - M González-Martínez
- Departamento de Endoscopia, Hospital de Especialidades del CMN Siglo XXI IMSS, Mexico City, Mexico
| | - F Huerta-Iga
- Servicio de Gastroenterología, Hospital Ángeles Torreón, Torreón, Mexico
| | - E Morel-Cerda
- Departamento de Gastroenterología, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
| | - J M Remes-Troche
- Laboratorio de Fisiología Digestiva y Motilidad Intestinal, Instituto de Investigaciones Médico-Biológicas de la Universidad Veracruzana, Veracruz, Mexico
| | - J L Tamayo-de la Cuesta
- Servicio de Gastroenterología y Endoscopia Gastrointestinal, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, Mexico
| | - G Torres-Villalobos
- Cirugía Experimental, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - G Vázquez-Elizondo
- Servicio de Gastroenterología, Centro de Enfermedades Digestivas ONCARE, Monterrey, Mexico
| | - A S Villar-Chávez
- Servicio de Gastroenterología, Hospital Ángeles Acoxpa, Mexico City, Mexico
| | - J A Arenas-Martínez
- Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Dutta AK, Jain A, Jearth V, Mahajan R, Panigrahi MK, Sharma V, Goenka MK, Kochhar R, Makharia G, Reddy DN, Kirubakaran R, Ahuja V, Berry N, Bhat N, Dutta U, Ghoshal UC, Jain A, Jalihal U, Jayanthi V, Kumar A, Nijhawan S, Poddar U, Ramesh GN, Singh SP, Zargar S, Bhatia S. Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship. Indian J Gastroenterol 2023; 42:601-628. [PMID: 37698821 DOI: 10.1007/s12664-023-01428-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/10/2023] [Indexed: 09/13/2023]
Abstract
Proton pump inhibitors (PPIs) have been available for over three decades and are among the most commonly prescribed medications. They are effective in treating a variety of gastric acid-related disorders. They are freely available and based on current evidence, use of PPIs for inappropriate indications and duration appears to be common. Over the years, concerns have been raised on the safety of PPIs as they have been associated with several adverse effects. Hence, there is a need for PPI stewardship to promote the use of PPIs for appropriate indication and duration. With this objective, the Indian Society of Gastroenterology has formulated guidelines on the rational use of PPIs. The guidelines were developed using a modified Delphi process. This paper presents these guidelines in detail, including the statements, review of literature, level of evidence and recommendations. This would help the clinicians in optimizing the use of PPIs in their practice and promote PPI stewardship.
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Affiliation(s)
- Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College and Hospital, Vellore, 632 004, India.
| | | | - Vaneet Jearth
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ramit Mahajan
- Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | | | - Vishal Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | | | | | - Govind Makharia
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | | | - Richard Kirubakaran
- Center of Biostatistics and Evidence Based Medicine, Vellore, 632 004, India
| | - Vineet Ahuja
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Neha Berry
- BLK Institute of Digestive and Liver Disease, New Delhi, 201 012, India
| | - Naresh Bhat
- Aster CMI Hospital, Bengaluru, 560 092, India
| | - Usha Dutta
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Uday Chand Ghoshal
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Ajay Jain
- Choithram Hospital and Research Center, Indore, 452 014, India
| | | | - V Jayanthi
- Sri Ramachandra Medical College, Chennai, 600 116, India
| | - Ajay Kumar
- Institute of Digestive and Liver Diseases, BLK - Max Superspeciality Hospital, New Delhi, 201 012, India
| | | | - Ujjal Poddar
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226 014, India
| | | | - Shivram P Singh
- Kalinga Gastroenterology Foundation, Cuttack, 753 001, India
| | - Showkat Zargar
- Department of Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Kashmir, 190 011, India
| | - Shobna Bhatia
- Sir H N Reliance Foundation Hospital, Mumbai, 400 004, India
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Zhang D, Liu S, Li Z, Wang R. Global, regional and national burden of gastroesophageal reflux disease, 1990-2019: update from the GBD 2019 study. Ann Med 2022; 54:1372-1384. [PMID: 35579516 PMCID: PMC9122392 DOI: 10.1080/07853890.2022.2074535] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Because trends in the epidemiology and burden of gastroesophageal reflux disease (GERD) are changing, reinvestigating the geographical differences and trend changes is essential. Here we evaluated the latest epidemiologic patterns and trends for GERD, using data from Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHODS Annual case numbers, age-standardized rates of prevalence, incidence, and years of life lived with disability (YLDs), and their estimated annual percentage changes (EAPCs) for GERD between 1990 and 2019 were derived from the GBD 2019 study. Association between GERD burden and socio-demographic index (SDI) was also investigated. RESULTS In 2019, there were 783.95 million cases of GERD globally. Between 1990 and 2019, the total number of prevalent cases, incident cases, and YLDs increased by 77.53%, 74.79%, and 77.19%, respectively. The global age-standardized incidence rate (ASIR) and age-standardized YLD rate (ASYR) increased during this period (EAPC = 0.06 and 0.05, respectively). Tropical Latin America and East Asia had the highest and lowest age-standardiZed prevalence rate (ASPR), ASIR, and ASYR in 2019, respectively. From 1990 to 2019, prevalent cases, incident cases, YLDs, and their corresponding age-standardized rates of GERD were higher in females than males in all years. Higher SDI was associated with lower ASPR, ASIR, and ASYR of GERD in 2019. CONCLUSIONS GERD will continue to be a major public health burden due to increasing numbers of prevalent cases, incident cases, and YLDs. In order to tackle this troublesome disease, it is crucial to understand the changes in both global and regional trends in epidemiology and the burden for policymakers and other stakeholders. Key messagesThis is the most updated estimate on GERD epidemiology globally, including 204 countries, some of which were not assessed before.The overall burden of GERD continued to worsen with the prevalent cases increasing by 77.53% from 441.57 million in 1990 to 783.95 million in 2019.GERD is likely to remain a common reason for consultation in primary care, and our data may allow for health service provision planning.
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Affiliation(s)
- Decai Zhang
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Changsha, China
| | - Shaojun Liu
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Changsha, China
| | - Zhaoqi Li
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Changsha, China
| | - Rui Wang
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China.,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, Changsha, China
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ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol 2022; 117:27-56. [PMID: 34807007 PMCID: PMC8754510 DOI: 10.14309/ajg.0000000000001538] [Citation(s) in RCA: 308] [Impact Index Per Article: 154.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/30/2021] [Indexed: 01/30/2023]
Abstract
Gastroesophageal reflux disease (GERD) continues to be among the most common diseases seen by gastroenterologists, surgeons, and primary care physicians. Our understanding of the varied presentations of GERD, enhancements in diagnostic testing, and approach to patient management have evolved. During this time, scrutiny of proton pump inhibitors (PPIs) has increased considerably. Although PPIs remain the medical treatment of choice for GERD, multiple publications have raised questions about adverse events, raising doubts about the safety of long-term use and increasing concern about overprescribing of PPIs. New data regarding the potential for surgical and endoscopic interventions have emerged. In this new document, we provide updated, evidence-based recommendations and practical guidance for the evaluation and management of GERD, including pharmacologic, lifestyle, surgical, and endoscopic management. The Grading of Recommendations, Assessment, Development, and Evaluation system was used to evaluate the evidence and the strength of recommendations. Key concepts and suggestions that as of this writing do not have sufficient evidence to grade are also provided.
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Abstract
Gastroesophageal reflux disease (GERD) continues to be among the most common diseases seen by gastroenterologists, surgeons, and primary care physicians. Our understanding of the varied presentations of GERD, enhancements in diagnostic testing, and approach to patient management have evolved. During this time, scrutiny of proton pump inhibitors (PPIs) has increased considerably. Although PPIs remain the medical treatment of choice for GERD, multiple publications have raised questions about adverse events, raising doubts about the safety of long-term use and increasing concern about overprescribing of PPIs. New data regarding the potential for surgical and endoscopic interventions have emerged. In this new document, we provide updated, evidence-based recommendations and practical guidance for the evaluation and management of GERD, including pharmacologic, lifestyle, surgical, and endoscopic management. The Grading of Recommendations, Assessment, Development, and Evaluation system was used to evaluate the evidence and the strength of recommendations. Key concepts and suggestions that as of this writing do not have sufficient evidence to grade are also provided.
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Ruiz de León San Juan A, Pérez de la Serna Bueno J, Sevilla Mantilla MC, Esteban López-Jamar JM, Sánchez Pernaute A. Gastro-esophageal reflux disease: limits of medical treatment and surgical indications. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:356-363. [PMID: 33393330 DOI: 10.17235/reed.2020.7648/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Proton-pump inhibitors (PPI) have long been considered as the ideal treatment for gastroesophageal reflux disease (GERD), and their limitations and side effects have revealed a need for new therapeutic approaches. At present, the therapeutic gains achieved are relatively small or limited to groups of patients with specific characteristics. This article updates the contributions, indications, and limitations of pharmacological, endoscopic, and surgical treatment.
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Ivashkin VT, Maev IV, Trukhmanov AS, Lapina TL, Storonova OA, Zayratyants OV, Dronova OB, Kucheryavyy YA, Pirogov SS, Sayfutdinov RG, Uspenskiy YP, Sheptulin AA, Andreev DN, Rumyantseva DE. Recommendations of the Russian Gastroenterological Association in Diagnosis and Treatment of Gastroesophageal Reflux Disease. RUSSIAN JOURNAL OF GASTROENTEROLOGY, HEPATOLOGY, COLOPROCTOLOGY 2020; 30:70-97. [DOI: 10.22416/1382-4376-2020-30-4-70-97] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
- V. T. Ivashkin
- Sechenov First Moscow State Medical University (Sechenov University)
| | - I. V. Maev
- Moscow State University of Medicine and Dentistry
| | - A. S. Trukhmanov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - T. L. Lapina
- Sechenov First Moscow State Medical University (Sechenov University)
| | - O. A. Storonova
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | | | | | - S. S. Pirogov
- Herzen Moscow Oncology Research Center — Branch of the National Medical Research Radiology Center
| | - R. G. Sayfutdinov
- Kazan State Medical Academy — Branch of the Russian Medical Academy of Continuous Professional Education
| | | | - A. A. Sheptulin
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | - D. E. Rumyantseva
- Sechenov First Moscow State Medical University (Sechenov University)
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The role of preoperative upper endoscopy in adolescents undergoing laparoscopic vertical sleeve gastrectomy. Surg Obes Relat Dis 2020; 16:1212-1217. [PMID: 32576512 DOI: 10.1016/j.soard.2020.04.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/17/2020] [Accepted: 04/21/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Vertical sleeve gastrectomy (VSG) has been associated with gastroesophageal reflux symptoms and, in adults, with a development of Barrett's esophagus. Adults with Barrett's esophagus identified at baseline before bariatric operation are generally advised against VSG operations. The role of preoperative esophagogastroduodenoscopy (EGD) in adolescents preparing for bariatric surgery is not clearly defined. OBJECTIVE The goal of this study was to report the frequency of abnormalities identified on EGD performed at baseline in adolescents undergoing VSG for severe obesity. SETTING Free-standing academic children's hospital. United States. METHODS A retrospective chart review was conducted to describe findings of EGD performed just before VSG in a cohort of 40 adolescents and young adults (age range 14-25 yr) immediately before VSG. Review of findings from gross and histopathological evaluation of the esophagus, resected stomach, and duodenum was performed. RESULTS Five individuals reported preoperative symptoms of gastroesophageal reflux. Anatomic findings at EGD were normal in 98% of individuals. Histopathology of the esophagus, stomach, and duodenum was normal in 88%, 70%, and 95%, respectively. Abnormal findings of gastritis (18%), esophagitis (13%), and/or Helicobacter pylori (10%) infection were most common. Those with evidence of H. pylori in gastric resection specimens were treated appropriately with eradication therapy postoperatively. With the exception of 2 patients with incidentally detected esophageal mucosal eosinophilia, EGD findings did not lead to additional changes in medical or surgical management. There were no complications of the EGD procedure. CONCLUSIONS Routine EGD at the time of VSG was safe but resulted in low yield of abnormal findings requiring a change in clinical management.
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Bhatia SJ, Makharia GK, Abraham P, Bhat N, Kumar A, Reddy DN, Ghoshal UC, Ahuja V, Rao GV, Devadas K, Dutta AK, Jain A, Kedia S, Dama R, Kalapala R, Alvares JF, Dadhich S, Dixit VK, Goenka MK, Goswami BD, Issar SK, Leelakrishnan V, Mallath MK, Mathew P, Mathew P, Nandwani S, Pai CG, Peter L, Prasad AVS, Singh D, Sodhi JS, Sud R, Venkataraman J, Midha V, Bapaye A, Dutta U, Jain AK, Kochhar R, Puri AS, Singh SP, Shimpi L, Sood A, Wadhwa RT. Indian consensus on gastroesophageal reflux disease in adults: A position statement of the Indian Society of Gastroenterology. Indian J Gastroenterol 2019; 38:411-440. [PMID: 31802441 DOI: 10.1007/s12664-019-00979-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023]
Abstract
The Indian Society of Gastroenterology developed this evidence-based practice guideline for management of gastroesophageal reflux disease (GERD) in adults. A modified Delphi process was used to develop this consensus containing 58 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 10 on epidemiology, 8 on clinical presentation, 10 on investigations, 23 on treatment (including medical, endoscopic, and surgical modalities), and 7 on complications of GERD. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The prevalence of GERD in India ranges from 7.6% to 30%, being < 10% in most population studies, and higher in cohort studies. The dietary factors associated with GERD include use of spices and non-vegetarian food. Helicobacter pylori is thought to have a negative relation with GERD; H. pylori negative patients have higher grade of symptoms of GERD and esophagitis. Less than 10% of GERD patients in India have erosive esophagitis. In patients with occasional or mild symptoms, antacids and histamine H2 receptor blockers (H2RAs) may be used, and proton pump inhibitors (PPI) should be used in patients with frequent or severe symptoms. Prokinetics have limited proven role in management of GERD.
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Affiliation(s)
- Shobna J Bhatia
- Seth GS Medical College and KEM Hospital, Mumbai, 400 012, India.
| | | | - Philip Abraham
- P D Hinduja Hospital and MRC, and Hinduja Heathcare Surgical, Mumbai, 400 016, India
| | - Naresh Bhat
- Aster CMI Hospital, Bengaluru, 560 092, India
| | - Ajay Kumar
- Fortis Escorts Liver and Digestive Diseases Institute, Delhi, 110 025, India
| | | | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Vineet Ahuja
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - G Venkat Rao
- Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | | | - Amit K Dutta
- Christian Medical College, Vellore, 632 004, India
| | - Abhinav Jain
- Seth GS Medical College and KEM Hospital, Mumbai, 400 012, India
| | - Saurabh Kedia
- All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rohit Dama
- Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Rakesh Kalapala
- Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | | | | | - Vinod Kumar Dixit
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221 005, India
| | | | - B D Goswami
- Gauhati Medical College, Dispur Hospitals, Guwahati, 781 032, India
| | - Sanjeev K Issar
- JLN Hospital and Research Center, Bhilai Steel Plant, Bhilai, 490 009, India
| | | | | | | | - Praveen Mathew
- Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, 560 066, India
| | | | - Cannanore Ganesh Pai
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576 104, India
| | | | - A V Siva Prasad
- Institute of Gastroenterology, Visakhapatnam, 530 002, India
| | | | | | - Randhir Sud
- Medanta - The Medicity, Gurugram, 122 001, India
| | | | - Vandana Midha
- Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Amol Bapaye
- Deenanath Mangeshkar Hospital and Research Center, Pune, 411 004, India
| | - Usha Dutta
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ajay K Jain
- Choithram Hospital and Research Centre, Indore, 452 014, India
| | - Rakesh Kochhar
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | | | | | | | - Ajit Sood
- Dayanand Medical College and Hospital, Ludhiana, 141 001, India
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Lei WY, Chang WC, Wen SH, Yi CH, Liu TT, Hung JS, Wong MW, Chen CL. Predicting factors of recurrence in patients with gastroesophageal reflux disease: a prospective follow-up analysis. Therap Adv Gastroenterol 2019; 12:1756284819864549. [PMID: 31391868 PMCID: PMC6669842 DOI: 10.1177/1756284819864549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/11/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Recurrence of gastroesophageal reflux disease (GERD) is common among patients who are no longer receiving proton pump inhibitors (PPIs). This study investigated factors associated with GERD recurrence. METHODS We included 499 consecutive GERD patients who completed validated reflux and psychological questionnaires before undergoing upper endoscopy. All patients were treated with PPIs and followed up. RESULTS Recurrence was observed in 89 (30.4%) of 293 patients during the 1-year follow up. Patients with recurrence had a higher prevalence of diabetes mellitus (p = 0.037), higher baseline GERD Questionnaire (GERDQ) scores (p = 0.002), and higher Pittsburgh Sleep Quality Index scores (p = 0.045). Log-rank analysis showed that a GERDQ score of ⩾8 was independently associated with an increased recurrence risk (p = 0.002). The scores of all psychological questionnaires and health-related quality of life questionnaire worsened more at the end of follow up in patients with recurrence than in those without recurrence. Multivariate analysis revealed that a higher GERDQ score was the only independent risk factor for GERD recurrence (p = 0.024). GERD patients who have greater initial symptom burden will have a higher recurrence rate after discontinuing PPIs. CONCLUSIONS GERD patients with greater initial symptom burden are more likely to have recurrence after discontinuing PPIs. This study highlights the importance of developing a new strategy to prevent GERD recurrence in the management of this common disorder.
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Affiliation(s)
- Wei-Yi Lei
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien,Institute of Medical Sciences, Tzu Chi University, Hualien
| | - Wei-Chuan Chang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi, Medical Foundation, Hualien
| | - Shu-Hui Wen
- Department of Public Health, Tzu Chi University, Hualien
| | - Chih-Hsun Yi
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien
| | - Tso-Tsai Liu
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien
| | - Jui-Sheng Hung
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien
| | - Ming-Wun Wong
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien
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de Bortoli N, Tolone S, Frazzoni M, Martinucci I, Sgherri G, Albano E, Ceccarelli L, Stasi C, Bellini M, Savarino V, Savarino EV, Marchi S. Gastroesophageal reflux disease, functional dyspepsia and irritable bowel syndrome: common overlapping gastrointestinal disorders. Ann Gastroenterol 2018; 31:639-648. [PMID: 30386113 PMCID: PMC6191868 DOI: 10.20524/aog.2018.0314] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 08/26/2018] [Indexed: 12/11/2022] Open
Abstract
Several studies have indicated an overlap between gastroesophageal reflux disease (GERD) and various functional gastrointestinal disorders (FGIDs). The overlapping conditions reported have mainly been functional dyspepsia (FD) and irritable bowel syndrome (IBS). The available literature is frequently based on symptomatic questionnaires or endoscopic procedures to diagnose GERD. Rarely, among patients with heartburn, pathophysiological evaluations have been considered to differentiate those with proven GERD from those without. Moreover, both GERD and IBS or FD showed enormous heterogeneity in terms of the criteria and diagnostic procedures used. The GERD-IBS overlap ranges from 3-79% in questionnaire-based studies and from 10-74% when GERD has been diagnosed endoscopically. The prevalence of functional dyspepsia (after normal upper endoscopy) is 12-15% and an overlap with GERD has been reported frequently. Only a few studies have considered a potential overlap between functional heartburn (FH) and IBS using a 24-h pH-metry or impedance-pH evaluation. Similar data has been reported for an overlap between FH and FD. Recently, a revision of the Rome criteria for esophageal FGIDs identified both FH and hypersensitive esophagus (HE) as potential functional esophageal disorders. This might increase the potential overlap between different FGIDs, with FH and HE rather than with GERD. The aim of the present review article was to appraise and discuss the current evidence supporting the possible concomitance of GERD with IBS and FD in the same patients and to evaluate how various GERD treatments could impact on the quality of life of these patients.
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Affiliation(s)
- Nicola de Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Nicola de Bortoli, Giulia Sgherri, Eleonora Albano, Linda Ceccarelli, Massimo Bellini, Santino Marchi), Caserta, Italy
| | - Salvatore Tolone
- Surgery Unit, Department of Surgery, University of Campania Luigi Vanvitelli, Caserta (Salvatore Tolone), Italy
| | - Marzio Frazzoni
- Division of Pathophysiology, Baggiovara Hospital, Modena (Marzio Frazzoni), Italy
| | - Irene Martinucci
- Division of Gastroenterology, Versilia Hospital, Lido di Camaiore-Lucca (Irene Martinucci), Italy
| | - Giulia Sgherri
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Nicola de Bortoli, Giulia Sgherri, Eleonora Albano, Linda Ceccarelli, Massimo Bellini, Santino Marchi), Caserta, Italy
| | - Eleonora Albano
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Nicola de Bortoli, Giulia Sgherri, Eleonora Albano, Linda Ceccarelli, Massimo Bellini, Santino Marchi), Caserta, Italy
| | - Linda Ceccarelli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Nicola de Bortoli, Giulia Sgherri, Eleonora Albano, Linda Ceccarelli, Massimo Bellini, Santino Marchi), Caserta, Italy
| | - Cristina Stasi
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence (Cristina Stasi), Italy
| | - Massimo Bellini
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Nicola de Bortoli, Giulia Sgherri, Eleonora Albano, Linda Ceccarelli, Massimo Bellini, Santino Marchi), Caserta, Italy
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa (Vincenzo Savarino), Italy
| | - Edoardo V. Savarino
- Gastroenterology Unit, Department Surgery, Oncology and Gastroenterology, University of Padua (Edoardo V. Savarino), Italy
| | - Santino Marchi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa (Nicola de Bortoli, Giulia Sgherri, Eleonora Albano, Linda Ceccarelli, Massimo Bellini, Santino Marchi), Caserta, Italy
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Ali Khan M, Howden CW. The Role of Proton Pump Inhibitors in the Management of Upper Gastrointestinal Disorders. Gastroenterol Hepatol (N Y) 2018; 14:169-175. [PMID: 29928161 PMCID: PMC6004044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Proton pump inhibitors (PPIs) have been in use since the early 1990s and play a crucial role in the management of a number of conditions affecting the upper gastrointestinal tract, including gastroesophageal reflux disease, Barrett esophagus, eosinophilic esophagitis, and dyspepsia. PPIs also play an important role in the treatment of Helicobacter pylori infection and in the prevention of upper gastrointestinal tract ulcers and bleeding among patients taking antiplatelet therapy and/or nonsteroidal anti-inflammatory drugs. Despite recent concerns regarding the long-term safety of PPIs, their risk-benefit profiles strongly favor their appropriate use in patients who have genuine indications for them. As with all drugs, PPIs should be administered in the lowest effective dose and only for as long as clinically indicated. However, for at least some of their approved indications, PPIs are likely to be required indefinitely. This article outlines the current indications for PPIs for the management of upper gastrointestinal disorders and reviews safety concerns.
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Affiliation(s)
- Muhammad Ali Khan
- Dr Khan is a third year gastroenterology fellow and Dr Howden is the Hyman Professor of Medicine and Chief of the Division of Gastroenterology at the University of Tennessee Health Science Center in Memphis, Tennessee
| | - Colin W Howden
- Dr Khan is a third year gastroenterology fellow and Dr Howden is the Hyman Professor of Medicine and Chief of the Division of Gastroenterology at the University of Tennessee Health Science Center in Memphis, Tennessee
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Optimal acid suppressive treatment for adequate symptom relief and prevention of the complications of gastroesophageal reflux disease: differences in long-term clinical course and pathophysiology among disease subtypes. Esophagus 2016. [DOI: 10.1007/s10388-016-0558-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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Huerta-Iga F, Bielsa-Fernández MV, Remes-Troche JM, Valdovinos-Díaz MA, Tamayo-de la Cuesta JL. Diagnosis and treatment of gastroesophageal reflux disease: recommendations of the Asociación Mexicana de Gastroenterología. REVISTA DE GASTROENTEROLOGIA DE MEXICO 2016; 81:208-222. [PMID: 27595382 DOI: 10.1016/j.rgmx.2016.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 12/12/2022]
Abstract
Emerging concepts in the pathophysiology of gastroesophageal reflux disease (GERD) and the constant technologic advances in the diagnosis and treatment of this clinical condition make it necessary to frequently review and update the clinical guidelines, recommendations, and official statements from the leading academic groups worldwide. The Asociación Mexicana de Gastroenterología (AMG), aware of this responsibility, brought together national experts in this field to analyze the most recent scientific evidence and formulate a series of practical recommendations to guide and facilitate the diagnostic process and efficacious treatment of these patients. The document includes algorithms, figures, and tables for convenient consultation, along with opinions on GERD management in sensitive populations, such as pregnant women and older adults.
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Affiliation(s)
- F Huerta-Iga
- Hospital Ángeles Torreón, Torreón, Coahuila, México.
| | - M V Bielsa-Fernández
- Servicio de Gastroenterología, Universidad Autónoma de Guadalajara, Guadalajara, Jalisco, México
| | | | - M A Valdovinos-Díaz
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
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Diagnosis and treatment of gastroesophageal reflux disease: recommendations of the Asociación Mexicana de Gastroenterología. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2016. [DOI: 10.1016/j.rgmxen.2016.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Abstract
Several key areas in gastroenterology pharmacotherapy are rapidly evolving, including the treatment of hepatitis C virus (HCV), irritable bowel syndrome, gastroesophageal reflux disease (GERD) and peptic ulcer disease. HCV treatment has radically changed in the past 2 years and now most patients are treatment candidates and have a high likelihood of permanent cure. Pharmacotherapy is now first-line treatment for patients with moderate to severe symptoms of irritable bowel syndrome. Proton pump inhibitors (PPIs) are the mainstay of therapy in gastric and duodenal ulcers and GERD, although long-term use carries the risk of several side effects that should be considered.
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Affiliation(s)
- Rena K Fox
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco School of Medicine, 1545 Divisadero St, Ste 307, San Francisco, CA, USA.
| | - Thiruvengadam Muniraj
- Section of Digestive Diseases, Department of Medicine, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, New Haven, CT 06520-8019, USA
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Min YW, Shin YW, Cheon GJ, Park KS, Kim HS, Sohn CI, Kim TN, Moon HC, Rhee PL. Recurrence and Its Impact on the Health-related Quality of Life in Patients with Gastroesophageal Reflux Disease: A Prospective Follow-up Analysis. J Neurogastroenterol Motil 2015; 22:86-93. [PMID: 26486229 PMCID: PMC4699725 DOI: 10.5056/jnm15124] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/03/2015] [Accepted: 09/07/2015] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Limited data exist on the outcome of gastroesophageal reflux disease (GERD) treatment and its impact on the health-related quality of life (HRQoL) in the Asian population. This study aims to evaluate the treatment outcomes, to investigate the factors associated with recurrence, and to evaluate the impact of the treatment outcome on the HRQoL in a Korean GERD population. Methods This was a prospective, multicenter study involving a total of 824 GERD patients. The response to treatment was assessed at week 4 (or week 8 for the patients who did not achieve complete resolution [CR] at week 4). The EQ-5D questionnaire was used at baseline, end of treatment, and first recurrence to assess the HRQoL. To assess GERD symptoms, contact of patients by phone at 1, 6, and 12 months following treatment was carried out. Results CR was achieved in 65.6% and recurrence was observed in 47.8% following treatment. CR and recurrence rates did not differ by the presence of esophagitis. Multivariate analysis revealed that acid regurgitation (odds ratio 2.249; 95% confidence interval 1.293–3.912; P = 0.004) and both acid regurgitation and heartburn (odds ratio 2.330; 95% confidence interval 1.392–3.901; P = 0.001) were independent risk factors for GERD recurrence. EQ-5D scores were more improved in patients with CR than in those without CR, and worsened more during follow-up in patients with recurrence than in those without recurrence. Conclusions We should achieve complete symptom relief and attempt to prevent recurrence in GERD patients to improve their HRQoL.
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Affiliation(s)
- Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Woon Shin
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Gab Jin Cheon
- Department of Internal Medicine, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | - Kyung Sik Park
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hyun Soo Kim
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Chong-Il Sohn
- Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Nyeun Kim
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Hyeung Cheol Moon
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Esmaillzadeh A, Keshteli AH, Tabesh M, Feizi A, Adibi P. Smoking status and prevalence of upper gastrointestinal disorders. Digestion 2015; 89:282-90. [PMID: 25034636 DOI: 10.1159/000358169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 12/20/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lifestyle and environmental factors affecting upper gastrointestinal (GI) disorders are different in developing countries than those in developed nations. OBJECTIVE This study aimed to examine the association between smoking status and upper GI disorders among a large group of the Iranian adult population. METHODS This cross-sectional study was conducted among 1,933 adult men in Isfahan, Iran. Smoking status was assessed by a self-administered questionnaire. Required information on GI health was collected through the use of the validated ROME III questionnaire. Individuals who reported having heartburn sometimes, often, or always in the last 3 months were considered as having epidemiologic gastroesophageal reflux disease (GERD), and those who reported having heartburn often or always were considered as having clinical GERD. Subjects who reported having functional dyspepsia (FD) symptoms (based on the ROME III criteria) sometimes, often, or always in the last 3 months were considered as having epidemiologic FD, and those who reported having these disorders often or always were considered as having clinical FD. RESULTS Smoking was prevalent among 7.8% of the study population. FD and GERD was prevalent among 12.6% (n = 244) and 22.3% (n = 432), respectively. Smoking was not associated with GERD by either the epidemiologic or clinical definition. Although the association between smoking and FD (epidemiologic definition) was not statistically significant, smokers had an 83% higher risk of suffering from clinical FD compared with nonsmokers after taking potential confounders into account [odds ratio (OR) = 1.83, 95% CI: 1.12-3.00; p = 0.01]. Smokers had a 57% higher risk for epidemiologic postprandial fullness (OR = 1.57, 95% CI: 1.05-2.33; p = 0.02) and a 92% higher risk for clinical epigastric pain compared with nonsmokers (OR = 1.92, 95% CI: 1.02-3.62; p = 0.04). We found no significant association between smoking and severity of upper GI disorders. CONCLUSION This large population-based study indicated that smoking was not associated with GERD and epidemiologic FD. However, smoking was significantly associated with clinical FD, postprandial fullness, and epigastric pain.
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Affiliation(s)
- Ahmad Esmaillzadeh
- Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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Tielemans MM, van Oijen MGH. Online follow-up of individuals with gastroesophageal reflux disease using a patient-reported outcomes instrument: results of an observational study. BMC Gastroenterol 2013; 13:144. [PMID: 24083342 PMCID: PMC3851875 DOI: 10.1186/1471-230x-13-144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 09/20/2013] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Many individuals with gastroesophageal reflux disease (GERD) never visit their general practitioner. Therefore, prospective data about GERD and its natural history in the general population are scarce. The aims of this study were to assess symptoms over time and consultation reasons in an Internet population with GERD. METHODS Visitors (18-79 years) to a GERD information website who completed the GerdQ self-assessment questionnaire were invited to participate. Follow-up GerdQ questionnaires were sent after 4, 12 and 24 weeks, and those who had a total GerdQ score ≥ 8 and responded to at least the baseline and 4-week questionnaires (within 2-7 weeks) were included in the analyses. Outcome in proton pump inhibitor (PPI) and non-PPI users was classified as symptom improvement, symptom persistence/stable symptoms, or symptom relapse according to GerdQ scores. RESULTS A total of 403 non-PPI users (mean age 48 years, 40% male) and 304 PPI users (mean age 51 years, 41% male) were included. After 24 weeks, symptom improvement was present in 66% of non-PPI users (45/68) and 8% of PPI users (6/73), while persisting symptoms were reported by 24% (16/68) and 89% (65/73) respectively (baseline symptoms did not influence outcome at 24 weeks). Fifty-five percent of PPI users (116/210) and 37% of non-PPI users (76/207) who intended to visit a healthcare practitioner, performed one or more healthcare visits in the interim. Most frequently reported reason for consultation was persistence of symptoms. CONCLUSIONS GERD symptoms were persistent in the majority of PPI users during our 24-week follow-up, while almost two thirds of non-PPI users reported symptom improvement. Online follow-up of an Internet population with GERD is feasible.
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Affiliation(s)
- Merel M Tielemans
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, PO Box 9101, Internal code 455, Nijmegen 6500 HB, The Netherlands.
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Abstract
Gastro-oesophageal reflux disease develops when the reflux of gastric contents into the oesophagus results in troublesome symptoms and/or complications [1]. Refluxate contains predominantly acid which causes tissue injury at oesophageal and extra-oesophageal sites. It is one of the commonest gastrointestinal diagnosis worlds over. It is associated with chronic symptoms, reduced QOL, significant cost and serious complications. Goals of therapy are to provide symptom relief, heal oesophagitis and prevent long-term complications. Therapeutic measures are directed at reducing the noxiousness of the refluxate; reducing the gastro-oesophageal reflux; enhancing clearance; protecting the mucosa; reducing the mucosal sensitivity and improving healing. Acid suppression with proton pump inhibitors remains the cornerstone of therapy. Recent studies have resulted in better understanding of disease and relative efficacies of various strategies. This has paved way for a better evidence based approach. The therapy however needs to be individualized depending upon the clinical profile, disease severity, the dominant pathophysiological mechanism, cost, availability and individual preferences.
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Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013; 108:308-28; quiz 329. [PMID: 23419381 DOI: 10.1038/ajg.2012.444] [Citation(s) in RCA: 1051] [Impact Index Per Article: 95.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Philip O Katz
- Division of Gastroenterology, Einstein Medical Center, Philadelphia, Pennsylvania, USA
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Erosive esophagitis is a risk factor for Barrett's esophagus: a community-based endoscopic follow-up study. Am J Gastroenterol 2011; 106:1946-52. [PMID: 21946284 DOI: 10.1038/ajg.2011.326] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Symptomatic gastroesophageal reflux disease (GERD) is associated with a significantly increased risk of esophageal adenocarcinoma, but its natural history in the general population is poorly understood. Whether nonerosive reflux disease (NERD) is a risk factor for Barrett's esophagus (BE), the precursor of esophageal adenocarcinoma, is unknown. Furthermore, quantifying the risk of incident BE in those with untreated reflux esophagitis has not been possible. We aimed, in a prospective follow-up study with endoscopy, to evaluate the risk of BE in a cohort from the Swedish general population (the Kalixanda Study). METHODS Those with endoscopic or histological findings suggestive of GERD and randomly half of those with NERD (n=481) were invited for follow-up investigation including endoscopy and a validated symptom questionnaire 5 years after the initial study. Multinomial logistic regression was used to estimate relative risk ratios (RRRs) and 95% confidence intervals (CIs) for change in presentation of GERD. RESULTS Of the 405 subjects available for inclusion, endoscopy was performed in 284 (response rate 70.1%). The incidence of BE was 9.9/1,000 person-years. Of those with NERD at baseline (n=113), progression to erosive esophagitis was found in 11; 2 developed BE. Erosive esophagitis (n=90) progressed to a more severe grade in 12 and to BE in 8 cases. Erosive esophagitis at baseline was independently associated with BE at follow-up (RRR 5.2; 95% CI 1.2-22.9). CONCLUSIONS Compared with being free of GERD at follow-up, erosive esophagitis is a major risk factor for BE (with a fivefold increased risk) after 5 years in the general population.
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Darbà J, Kaskens L, Plans P, Elizalde JI, Coma M, Cuomo R, Santoiemma L, Geldmacher J. Epidemiology and societal costs of gastroesophageal reflux disease and Barrett's syndrome in Germany, Italy and Spain. Expert Rev Pharmacoecon Outcomes Res 2011; 11:225-32. [PMID: 21476824 DOI: 10.1586/erp.11.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIM To estimate the economic consequences for society arising from populations with poorly treated gastroesophageal reflux disease (GERD) and Barrett's esophagus in Germany, Italy and Spain. METHODS The following epidemiologic data were used: total population figures, the prevalence and incidence of GERD and its complications, and data on patients with poorly treated GERD, as well as data on treatment costs and active workers' presenteeism and absenteeism. These data were used to calculate the economic consequences arising from the population with poorly treated GERD and Barrett's esophagus for the healthcare system and employers in each country. RESULTS The size of the population with poorly treated GERD with Barrett's esophagus was estimated to be 29,678 in Spain, 19,327 in Germany and 10,079 in Italy. Costs for the healthcare systems in Spain, Germany and Italy for the population with poorly treated GERD with Barrett's esophagus were estimated to be €18, 12 and 7 million, respectively, for each country. Total costs for absenteeism and presenteeism for employers due to poorly treated GERD with Barrett's esophagus were €10 million for Germany, €1 million for Italy and none for Spain. CONCLUSION Costs due to poorly treated GERD with Barrett's esophagus represent a substantial burden for the healthcare systems of all three studied countries. Costs for employers owing to absenteeism or presenteeism of employees were low or no costs were found.
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Affiliation(s)
- Josep Darbà
- Universitat de Barcelona, Diagonal 690, 08034, Barcelona, Spain.
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Disease definition, clinical manifestations, epidemiology and natural history of GERD. Best Pract Res Clin Gastroenterol 2010; 24:759-64. [PMID: 21126691 DOI: 10.1016/j.bpg.2010.09.009] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 09/06/2010] [Accepted: 09/30/2010] [Indexed: 01/31/2023]
Abstract
Gastro-esophageal reflux disease is a global problem and affects children, adolescents and adults. The incidence of the disease appears to be increasing particularly in Asia where reflux disease has not traditionally been a major health problem in the past. Recent consensus efforts to define and classify the disease in both adults and children make it possible to obtain epidemiologic and natural history data using a universally acceptable definition and classification.
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Takahashi M, Katayama Y. Reversal of the tolerance phenomenon by the intermittent administration of a histamine H2-receptor antagonist. J Gastroenterol Hepatol 2010; 25:1493-7. [PMID: 20796145 DOI: 10.1111/j.1440-1746.2010.06308.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM The attenuated antisecretory activity of H2-receptor antagonists (H2RA) during continuous administration is referred to as the tolerance phenomenon. A previous study indicated that Helicobacter pylori (H. pylori) infection prevents the occurrence of tolerance to H2RA. In the present study, we investigated whether intermittent (every other day) administration prevents the tolerance phenomenon in H. pylori-negative patients. METHODS Ten H. pylori-negative, healthy volunteers were included in the study. All of the patients underwent two courses of H2RA (lafutidine) administration: 21-day continuous administration (every day), followed by 21-day intermittent administration (every other day), with at least a 21-day lafutidine-free period between the first and second courses. All of the patients were examined by ambulatory intragastric pH monitoring five times: before medication, and on days 1 and 21 of the first (continuous) and second (intermittent) courses of lafutidine (10 mg b.d.) in a crossover fashion. RESULTS The continuous administration of lafutidine had a significantly attenuated, acid-suppressing effect in H. pylori-negative patients, and showed evidence of the tolerance phenomenon. However, the tolerance phenomenon was not observed through intermittent administration. CONCLUSIONS These results demonstrated that in H. pylori-negative patients, tolerance to H2RA, induced by continuous lafutidine administration, was reversed by subsequent intermittent administration.
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Affiliation(s)
- Morio Takahashi
- Department of Gastroenterology and Hepatology, Dokkyo Medical University, Koshigaya Hospital, Saitama, Japan.
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Pace F, Pallotta S, Manes G, de Leone A, Zentilin P, Russo L, Savarino V, Neri M, Grossi E, Cuomo R. Outcome of nonerosive gastro-esophageal reflux disease patients with pathological acid exposure. World J Gastroenterol 2009; 15:5700-5. [PMID: 19960567 PMCID: PMC2789223 DOI: 10.3748/wjg.15.5700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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 shows that progression to ERD occurs in about 5% of NERD cases per year, despite therapy. Only two factors consistently and independently influence progression: smoking and absence of PPI therapy.
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Mastracci L, Spaggiari P, Grillo F, Zentilin P, Dulbecco P, Ceppa P, Baccini P, Mansi C, Savarino V, Fiocca R. Microscopic esophagitis in gastro-esophageal reflux disease: individual lesions, biopsy sampling, and clinical correlations. Virchows Arch 2008; 454:31-9. [PMID: 19048292 DOI: 10.1007/s00428-008-0704-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 11/12/2008] [Accepted: 11/13/2008] [Indexed: 01/10/2023]
Abstract
Patients with non-erosive reflux disease may show microscopic damage. This study is aimed to describe distribution, sensitivity, and specificity of histological lesions (i.e., basal cell hyperplasia-BH, papillae elongation-PE, dilatation of intercellular spaces-DIS, intraepithelial eosinophils-IE, neutrophils, and erosions) and sampling criteria. Four groups were identified on the basis of symptoms, endoscopy, and pH monitoring: (1) erosive esophagitis (n = 48), (2) non-erosive esophagitis with abnormal pH (n = 59), (3) non-erosive esophagitis with normal pH (n = 12), and (4) controls (n = 20). Biopsies were taken at the Z-line and 2 and 4 cm above it. BH, PE, DIS, IE, neutrophils, and erosions were assessed. A global severity score was calculated on the basis of the above parameters and allowed the distinction of patients from controls with 80% sensitivity and 85% specificity. Lesions were more severe at Z-line than proximally and more expressed in erosive than in non-erosive disease, although more than 70% of latter patients still showed histological damage. Esophageal biopsy seems very attractive in non-erosive disease where it may contribute to diagnosis and play a role in the comparative evaluation of different therapies.
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Affiliation(s)
- Luca Mastracci
- Department of Anatomic Pathology, University of Genova, Genova, Italy
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29
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Kahrilas PJ, Shaheen NJ, Vaezi MF. American Gastroenterological Association Institute technical review on the management of gastroesophageal reflux disease. Gastroenterology 2008; 135:1392-1413, 1413.e1-5. [PMID: 18801365 DOI: 10.1053/j.gastro.2008.08.044] [Citation(s) in RCA: 245] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Peter J Kahrilas
- Department of Medicine, Gastroenterology Division, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Pace F, Casini V, Pallotta S. Heterogeneity of endoscopy negative heartburn: Epidemiology and natural history. World J Gastroenterol 2008; 14:5233-6. [PMID: 18785272 PMCID: PMC2744050 DOI: 10.3748/wjg.14.5233] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
It has now become clear that only about 40% or less of patients with heartburn and/or regurgitation have esophagitis, and that the majority of them lack visible distal esophageal mucosa breaks. These subjects are referred to as non-erosive gastroesophageal reflux disease (NERD) patients. It has been estimated that in the Western world at least one tenth of the general population has at least weekly heartburn. This proportion seems to be lower in Asia, while prevalence is rapidly increasing. Although it would be extremely useful to have prospective information regarding the fate of such patients, the natural history of NERD is largely unknown, and very few studies in the literature have addressed this issue. These studies are for the greater part old, not well conducted, and suffer from methodological drawbacks including ill-defined entry criteria. However, a review of these studies indicates that a consistent minority of NERD patients may develop erosive disease at an approximate rate of about 10% per year.
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Abstract
Histology in reflux disease is still regarded as having low sensitivity and specificity. During the last three decades several histological parameters have been developed, including thickness of basal cell layer, length of epithelial papillae, intraepithelial inflammatory cells and dilation of intercellular spaces. Unfortunately classification of these parameters was often not related to the clinical symptoms of the reflux affected individuals, proper control subjects were often missing and often no interobserver variation was given. Another reason for the proposed low value of biopsies is the fact that biopsies were often taken in a non-standardised way. Recent studies point towards an area of predominantly epithelial damage close to the lesser curvature or around the right oesophageal wall. In parallel, some large, careful studies carried out recently showed a good correlation with the clinical picture of reflux disease due to a standardised biopsy protocol and proper controls. But biopsies are not recommended in all routine classical cases of reflux disease since it is believed that little further information in addition to endoscopy can be obtained. However, histology can deliver much more information than the diagnosis of reflux induced lesions (e.g. the exclusion of malignancy or other oesophageal diseases).
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Affiliation(s)
- Michael Vieth
- Institute of Pathology, Klinikum Bayreuth, Preuschwitzer Strasse 101, 95445 Bayreuth, Germany.
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32
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Esophagus Benign Diseases of the Esophagus. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Piretta L, Alghisi F, Anzini F, Corazziari E. Prevalence of overweightedness in patients with gastro-esophageal reflux. World J Gastroenterol 2007; 13:4602-5. [PMID: 17729414 PMCID: PMC4611835 DOI: 10.3748/wjg.v13.i34.4602] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate whether the prevalence of overweight and obese conditions is increased in gastro-esophageal reflux disease (GERD) patients (with 24-h pathological pH recordings) in comparison to general population.
METHODS: A total of 196 consecutive patients (103 females, age range 18-83 years) with symptoms of gastro-esophageal reflux (GER) and 24-h pathological esophageal pH-metry. Body mass index (BMI) of the patients was calculated and its distribution (%) was compared with that of the Italian general population as assessed by National Bureau of Census (ISTAT). To evaluate the association of GERD with weight categories, the binomial test was employed. P < 0.05 was considered statistically significant.
RESULTS: In males, overweightedness (BMI 25-25.9) was present in 43% of GERD patients vs 41.8% of Italian population (IP) (ns), obesity (BMI ≥ 30) in 10.9% vs 9.1% (ns). In females overweight was present in 34.9% of GERD patients vs 25.7% of IP (P < 0.01), obesity in 13.6% of GERD patients vs 9.1% of IP (P < 0.01). No statistically significant differences were noted in different age classes.
CONCLUSION: In comparison to the Italian general population, the prevalence of overweightedness and obesity is increased in female but not in male patients with ascertained gastro-esophageal reflux disease.
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Affiliation(s)
- Luca Piretta
- Dipartimento di Scienze Cliniche, Gastroenterologia A, Università di Roma La Sapienza, Viale del Policlinico, 155-00161, Roma, Italy
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Calabrese C, Trerè D, Fabbri A, Cenacchi G, Vici M, Derenzini M, Di Febo G. Endoscopic appearance of GERD: putative role of cell proliferation. Dig Liver Dis 2007; 39:713-9. [PMID: 17606421 DOI: 10.1016/j.dld.2007.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 05/03/2007] [Accepted: 05/07/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND Erosive esophagitis is a frequent endoscopic feature in patients with gastro-oesophageal reflux disease. However, most of patients with heartburn/regurgitation have a non-erosive reflux disease. The reason for this heterogeneous impact of gastro-oesophageal reflux disease on oesophageal mucosa is unknown to date. AIM To evaluate the cell proliferation status of oesophageal epithelium in both healthy normal subjects and patients with gastro-oesophageal reflux disease with or without erosions. MATERIALS AND METHODS All the subjects underwent endoscopy and biopsies were taken at 5 cm from the squamo-columnar junction. Specimens were analysed both at histology and at transmission electron microscopy. Cell proliferation was evaluated by MIB1 immunostaining. Of the 85 subjects were studied, 10 were healthy controls with normal pH-testing and macroscopical, histological and ultrastructural patterns; 37 were patients with erosive esophagitis, and 38 patients with non-erosive reflux disease. RESULTS At histology, of the 37 patients affected by erosive esophagitis, 30 had normal mucosa and 7 showed mild oesophagitis. One patient with non-erosive reflux disease showed signs of oesophagitis at histology. At TEM, all patients with gastro-oesophageal reflux disease had ultrastructural patterns of damage i.e. dilations of intercellular spaces (DIS), and all controls had a normal ultrastructural pattern. The mean (+/-SD) MIB1-LI values of normal subjects and non-erosive reflux disease and erosive oesophagitis patients were 62.2% (+/-9.1), 29.7% (+/-7.2) and 16.2% (+/-5.2), respectively; there were significant differences among the three groups (p<0.001). CONCLUSIONS Oesophageal mucosa of patients with reflux symptoms presents a decrease in MIB1 immunostaining of 50% and 25% in non-erosive reflux disease and erosive esophagitis patients with respect to normal subjects.
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Affiliation(s)
- C Calabrese
- Department of Internal Medicine and Gastroenterology, University of Bologna, Italy.
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Sharma P, Wani S, Bansal A, Hall S, Puli S, Mathur S, Rastogi A. A feasibility trial of narrow band imaging endoscopy in patients with gastroesophageal reflux disease. Gastroenterology 2007; 133:454-64; quiz 674. [PMID: 17681166 DOI: 10.1053/j.gastro.2007.06.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Accepted: 05/10/2007] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Narrow band imaging (NBI) endoscopy system enhances visualization of microvasculature and mucosal patterns. This study assessed the utility of NBI in patients with gastroesophageal reflux disease (GERD) symptoms. METHODS Patients with and without GERD symptoms completed 2 validated GERD questionnaires prior to enrollment. The distal esophagus was examined by standard white light endoscopy followed by NBI. The features seen only by NBI were compared between GERD patients and controls. RESULTS Overall, 80 patients (50 GERD, 30 controls) were eligible for final analysis (mean age, 58.4 years; males, 93.7%; white, 82.5%). A significantly higher proportion of patients with GERD had increased number (OR, 12.6; 95% CI: 3.7-42; P < .0001), dilatation (OR, 20; 95% CI: 6.1-65.3; P < .0001), tortuosity of intrapapillary capillary loops (IPCLs) (OR, 6.9; 95% CI: 2.5-19; P < .0001), presence of microerosions (P < .0001), and increased vascularity at the squamocolumnar junction (OR, 9.3; 95% CI: 1.9-43.6; P = .001) compared with controls. On multivariate analysis, increased number (OR, 5.5; 95% CI: 1.4-21.6) and dilatation (OR, 11.3; 95% CI: 3.2-39.9) of IPCLs were the best predictors for diagnosing GERD. The maximum, minimum, and average number of IPCLs/field were significantly greater in the GERD group compared with controls (P < .0001). Although the interobserver agreement for the various NBI findings was very good, the intraobserver agreement was modest. CONCLUSIONS NBI endoscopy may represent a significant improvement over standard endoscopy for the diagnosis of GERD. These preliminary findings including inter- and intraobserver agreement need to be evaluated in future prospective, controlled, and blinded GERD trials.
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Affiliation(s)
- Prateek Sharma
- Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Missouri 64128-2295, USA.
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Wu JCY, Cheung CMY, Wong VWS, Sung JJY. Distinct clinical characteristics between patients with nonerosive reflux disease and those with reflux esophagitis. Clin Gastroenterol Hepatol 2007; 5:690-5. [PMID: 17481961 DOI: 10.1016/j.cgh.2007.02.023] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS It has been postulated that nonerosive reflux disease (NERD) and erosive reflux disease (ERD) are 2 distinct entities of gastroesophageal reflux disease. The aim of this study was to compare the clinical characteristics between patients with NERD and those with ERD. METHODS We prospectively recruited consecutive patients presenting with weekly attacks of heartburn or acid regurgitation. Exclusion criteria included gastric surgery, recent use of nonsteroidal anti-inflammatory drug or proton pump inhibitor, and peptic ulcer disease. Concomitant functional dyspepsia, irritable bowel syndrome, and psychological disorders were documented. Endoscopy, esophageal manometry, acid perfusion test, and 24-hour ambulatory pH monitoring were performed. Risk factors of NERD were determined by multivariate analysis. RESULTS Two hundred fourteen patients (NERD, 113; ERD, 111) were studied. NERD patients were characterized by higher prevalence of Helicobacter pylori (36.3% vs 18%, P = .005), functional dyspepsia (64.6% vs 42.3%, P = .003), irritable bowel syndrome (44.2% vs 15.3%, P < .001), psychological disorders (9% vs 0.9%, P = .04), and positive acid perfusion test (40.7% vs 19.8%, P = .004). ERD patients had more hiatal hernias (35.1% vs 17.1%, P = .009), higher esophageal acid exposure (total time esophageal pH <4, 4.2% +/- 2.1% vs 5.9% +/- 2.3%; P = .01), and esophageal dysmotility (P < .05). With multivariate analysis, H pylori (odds ratio, 1.8; 95% confidence interval [CI], 1.1-3.2), irritable bowel syndrome (odds ratio, 2.8; 95% CI, 1.6-5.3), and positive acid perfusion test (odds ratio, 1.9; 95% CI, 1.4-2.8) were independent risk factors for NERD. CONCLUSIONS Patients with NERD and ERD have distinct differences in clinical characteristics. NERD is characterized by higher prevalence of functional gastrointestinal disorders and esophageal acid hypersensitivity.
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Affiliation(s)
- Justin C Y Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Pace F, Pallotta S, Vakil N. Gastroesophageal reflux disease is a progressive disease. Dig Liver Dis 2007; 39:409-14. [PMID: 17379585 DOI: 10.1016/j.dld.2006.11.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Revised: 11/13/2006] [Accepted: 11/23/2006] [Indexed: 12/11/2022]
Abstract
It is controversial whether gastrooesophageal reflux disease represents a spectrum disease from a nonerosive to a complicated one, or whether it is a categorial disease, i.e. it can be divided into three categories, such as nonerosive gastrooesophageal reflux disease, erosive gastrooesophageal reflux disease and Barrett's esophagus (BE) with little or no transition from one category to the other. This controversy might be of general interest, because it has some implications in the management of the patient. However, literature data concerning the natural history of gastrooesophageal reflux disease are very limited, and in particular very few papers have dealt with the issue of describing the natural history of patients with nonerosive gastrooesophageal reflux disease. Aim of the present review is to reassess these scanty data, and to try to demonstrate that progression from milder to more severe forms of gastrooesophageal reflux disease is possible and documented.
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Affiliation(s)
- F Pace
- Department of Gastroenterology, L. Sacco University Hospital, Milan, Italy.
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38
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Marie I, Moutot A, Tharrasse A, Hellot MF, Robaday S, Hervé F, Lévesque H. Adéquation aux recommandations des prescriptions des inhibiteurs de la pompe à protons dans un service de médecine interne. Rev Med Interne 2007; 28:86-93. [PMID: 17092611 DOI: 10.1016/j.revmed.2006.09.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2006] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Proton pump inhibitors (PPIs) are an efficient therapy, being widely used by physicians. In 2004, cost of PPIs' therapy was as high as 748 millions of euros (for The Caisse primaire d'Assurance Maladie) in France. Although validated indications of PPIs are well known, numerous un-necessary prescriptions of PPIs are common. The aim of this prospective study was to evaluate PPIs' prescriptions of patients in a department of internal medicine. PATIENTS AND METHODS This is a 12-week assessment of medical charts of patients, receiving PPI therapy in patients in our department of internal medicine. Data were collected by a standardized questionnaire, with regards to: PPIs' nature and regimen, PPIs' indications as well as duration of therapy. RESULTS The medical charts of 729 consecutive patients, with a mean age of 67 years, were collected. Two hundred (and) twenty-four patients (30.7%) received PPI therapy; 157 of these patients were given PPI before admission in our department. Omeprazole was used in 71% of patients. Duration of PPI therapy was over one year in 45% of cases. Thirty-five per cent of family physicians' PPI prescription were validated and 23.8% of those of physicians working in the department of internal medicine. The main non-conform PPI's indications, by family physicians and internists were as follows: prevention of hemorrhagic risk of anti-platelet agent (21 vs 16.4%), anticoagulant (17.8 vs 16.4%), steroids (8.3 vs 13.4%) or non-steroid anti-inflammatory therapy without risk factor (1.9 vs 9%). Finally, in patients receiving PPI therapy before admission, this therapy was maintained in 76% of cases. CONCLUSION This prospective study confirms the frequent prescription of PPI therapy in a department of internal medicine (31% of patients). It also underscores the importance of PPIs' use by family physicians and physicians working in a department of internal medicine; this series further highlights the difficulties to interrupt this well tolerated therapy. To date, PPI therapy should be prescribed with a cautious consideration of cost and benefit.
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Affiliation(s)
- I Marie
- Département de médecine interne, CHU de Rouen-Boisguillaume, 1, rue de Germont, 76031 Rouen cedex, France.
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Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101:1900-20; quiz 1943. [PMID: 16928254 DOI: 10.1111/j.1572-0241.2006.00630.x] [Citation(s) in RCA: 2287] [Impact Index Per Article: 127.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES A globally acceptable definition and classification of gastroesophageal reflux disease (GERD) is desirable for research and clinical practice. The aim of this initiative was to develop a consensus definition and classification that would be useful for patients, physicians, and regulatory agencies. METHODS A modified Delphi process was employed to reach consensus using repeated iterative voting. A series of statements was developed by a working group of five experts after a systematic review of the literature in three databases (Embase, Cochrane trials register, Medline). Over a period of 2 yr, the statements were developed, modified, and approved through four rounds of voting. The voting group consisted of 44 experts from 18 countries. The final vote was conducted on a 6-point scale and consensus was defined a priori as agreement by two-thirds of the participants. RESULTS The level of agreement strengthened throughout the process with two-thirds of the participants agreeing with 86%, 88%, 94%, and 100% of statements at each vote, respectively. At the final vote, 94% of the final 51 statements were approved by 90% of the Consensus Group, and 90% of statements were accepted with strong agreement or minor reservation. GERD was defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. The disease was subclassified into esophageal and extraesophageal syndromes. Novel aspects of the new definition include a patient-centered approach that is independent of endoscopic findings, subclassification of the disease into discrete syndromes, and the recognition of laryngitis, cough, asthma, and dental erosions as possible GERD syndromes. It also proposes a new definition for suspected and proven Barrett's esophagus. CONCLUSIONS Evidence-based global consensus definitions are possible despite differences in terminology and language, prevalence, and manifestations of the disease in different countries. A global consensus definition for GERD may simplify disease management, allow collaborative research, and make studies more generalizable, assisting patients, physicians, and regulatory agencies.
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Affiliation(s)
- Nimish Vakil
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53233, USA
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40
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Abstract
PURPOSE OF REVIEW The aim of this article is to identify and to balance the arguments in favor of and against lumping together gastroesophageal reflux disease and functional dyspepsia. RECENT FINDINGS In at least half of the patients diagnosed with gastroesophageal reflux disease no organic abnormalities are found. Hypersensitivity of the esophagus to various stimuli plays a key role in the genesis of symptoms in these patients. The association between symptoms and acid reflux events can be quantified by 24-h esophageal pH monitoring. It has also become possible to detect non-acid reflux, using the intraluminal impedance monitoring technique. Functional dyspepsia is still defined by a combination of symptoms for which no organic cause can be found. No positive diagnostic tools have yet become available and treatment with acid secretion inhibitors, Helicobacter pylori eradication or prokinetic drugs remains marginally effective. SUMMARY Gastroesophageal reflux disease is a well defined disease which can be diagnosed objectively with endoscopy or 24-h pH/impedance monitoring with symptom association analysis. Functional dyspepsia is a functional disorder for which no objective test has yet been discovered. Treatment of gastroesophageal reflux disease is based on objectively identified abnormalities and highly effective. Treatment of functional dyspepsia is empiric and marginally effective. For these reasons, the lumping together of gastroesophageal reflux disease and functional dyspepsia is not to be advised.
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Affiliation(s)
- André J P M Smout
- Department of Gastroenterology, University Medical Center, Utrecht, The Netherlands.
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Fullard M, Kang JY, Neild P, Poullis A, Maxwell JD. Systematic review: does gastro-oesophageal reflux disease progress? Aliment Pharmacol Ther 2006; 24:33-45. [PMID: 16803601 DOI: 10.1111/j.1365-2036.2006.02963.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Gastro-oesophageal reflux disease affects approximately 20% of western populations. Barrett's oesophagus, associated with severe gastro-oesophageal reflux disease, is premalignant and regular endoscopic surveillance is generally performed. In contrast, mild gastro-oesophageal reflux disease is thought not to progress and is not generally subjected to endoscopic follow-up. Aim To investigate whether gastro-oesophageal reflux disease progresses endoscopically. METHODS Systematic review of the literature. RESULTS Well-designed prospective studies are few, diagnostic criteria were not always standardized, management strategies varied and various sources of bias could not be excluded. Whilst most patients do not progress to more severe forms of gastro-oesophageal reflux disease, and some cases actually regress, progression is seen in a small proportion of patients. Annual progression rates for non-erosive gastro-oesophageal reflux disease developing erosive oesophagitis ranged from 0% to 30%. About 1-22% of patients with mild erosive oesophagitis developed more severe inflammation annually, while 1-13% of patients with erosive oesophagitis developed Barrett's oesophagus each year. CONCLUSION Although most patients with gastro-oesophageal reflux disease do not progress, and some actually regress, progression does occur in a minority. Better data are required to determine whether patients with mild gastro-oesophageal reflux disease would benefit from increased surveillance with the aim of detecting more advanced disease.
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Affiliation(s)
- M Fullard
- Department of Gastroenterology, St George's Hospital, London, UK
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Sontag SJ, Sonnenberg A, Schnell TG, Leya J, Metz A. The long-term natural history of gastroesophageal reflux disease. J Clin Gastroenterol 2006; 40:398-404. [PMID: 16721220 DOI: 10.1097/00004836-200605000-00007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Long-term gastric acid suppression has been suggested as a means to prevent complications of reflux esophagitis. We report on the 20-year follow-up of 2,306 patients with at least two endoscopic examinations who were taking no antisecretory medication before baseline endoscopy and whose long-term treatment was determined by reflux symptoms. METHODS From 1979 through 1998, endoscopy and biopsy were performed in the Hines Veterans Affairs Hospital endoscopy clinic by three endoscopists. Antireflux treatment was symptom-driven, and endoscopies were repeated mostly for symptomatic recurrence due to cessation of therapy. RESULTS Of 4,633 patients undergoing endoscopy for reflux symptoms, 2,306 had at least one follow-up endoscopy and biopsy. Over a mean follow-up period of 7.6 years (range, 1-20 years), the esophageal mucosa of 67% of patients remained unchanged, that of 21% improved, and that of 11% worsened. Esophageal stricture requiring dilation developed from a normal baseline mucosa in one of 1,313 patients (0.08%) and from an erosive baseline mucosa in 18 of 957 patients (1.9%). The overall incidence of stricture in patients with gastroesophageal reflux (GER) disease was <1/1,000 per year. Nonsteroidal anti-inflammatory drug (NSAID) consumption was associated with less mucosal improvement (odds ration [OR] = 0.67; confidence interval [CI] = 0.46-0.98). Use of histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) was associated with mucosal improvement (OR for PPIs = 1.49; CI = 1.14-2.17). Cohn's kappa was 42%, confirming the results that demonstrate stability of esophageal mucosal disease in the majority of patients. CONCLUSIONS Symptom-driven treatment of GER disease after a thorough endoscopic examination to exclude premalignant or malignant esophageal mucosal disease is practical and safe for the vast majority of patients with uncomplicated GER symptoms.
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Domínguez-Muñoz JE, Sobrino M. Clinical response (remission of symptoms) in erosive and non-erosive gastro-oesophageal reflux disease. Drugs 2005; 65 Suppl 1:43-50. [PMID: 16335857 DOI: 10.2165/00003495-200565001-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Complete remission of symptoms and prevention of symptomatic recurrence are among the main therapeutic aims in gastro-oesophageal reflux disease (GORD). In this context, a potent pharmacologic inhibition of gastric acid secretion plays a central role. The goal of antisecretory treatment in GORD is to maintain an intragastric pH greater than 4.0 for the longest possible time. This is best achieved by the administration of proton pump inhibitors (PPIs). Tolerability and safety of different PPIs are similar and consistently high, but therapeutic efficacy may differ among them. Esomeprazole appears to achieve an intragastric pH greater than 4.0 for a larger number of hours compared with any other PPI. This is associated with a greater therapeutic efficacy of esomeprazole compared with omeprazole, lansoprazole and pantoprazole in both complete remission of symptoms and prevention of symptomatic recurrence in GORD. This review provides evidence-based recommendations for the treatment of GORD-related symptoms in clinical practice.
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Zentilin P, Savarino V, Mastracci L, Spaggiari P, Dulbecco P, Ceppa P, Savarino E, Parodi A, Mansi C, Fiocca R. Reassessment of the diagnostic value of histology in patients with GERD, using multiple biopsy sites and an appropriate control group. Am J Gastroenterol 2005; 100:2299-306. [PMID: 16181384 DOI: 10.1111/j.1572-0241.2005.50209.x] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Histology is generally considered as a tool of limited value in the diagnosis of gastro-esophageal reflux disease (GERD). AIM To reevaluate the diagnostic role of histological alterations in GERD, using multiple biopsy sites and an appropriate control group. METHODS We studied 135 patients with typical and atypical symptoms of GERD. They underwent upper GI endoscopy and Los Angeles classification was used for grading cases with mucosal breaks. Biopsies were taken at the Z-line, 2 and 4 cm above it. Microscopic esophagitis was identified by necrosis/erosion, neutrophil/eosinophil intraepithelial infiltration, basal cell hyperplasia, elongation of papillae, dilation of intercellular spaces and a score (range: 0-2) was given for each lesion. Twenty-four-hour esophageal pH monitoring was performed in each patient. Twenty subjects without reflux symptoms, and with normal endoscopy and pH testing were considered as controls. RESULTS Histological alterations were found in 100 of 119 GERD patients (84%) and in 3 of 20 controls (15%) with a significant difference (p < 0.00001). Histology was abnormal in 96% of patients with erosive esophagitis and in 76% of patients with nonerosive reflux disease (NERD). The sum of scores of microscopic lesions found in all biopsy sites ranged from 0 to 22 and we identified a cut-off value (score 2) that distinguished efficiently controls from GERD patients. CONCLUSIONS In contrast with previous reports on the marginal role of histology in patients with GERD, our study shows that this technique can be a useful diagnostic tool, particularly in patients with NERD, when biopsies are taken at two sites including Z-line and 2 cm above it.
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Affiliation(s)
- Patrizia Zentilin
- Dipartimento di Medicina Interna e Specialità Mediche, University of Genoa, Genoa, Italy
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45
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Westbrook JI, Duggan AE, Duggan JM, Westbrook MT. A 9 year prospective cohort study of endoscoped patients with upper gastrointestinal symptoms. Eur J Epidemiol 2005; 20:619-27. [PMID: 16119436 DOI: 10.1007/s10654-005-4304-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Despite the high prevalence of upper gastrointestinal symptoms and associated costs of diagnosis and management, evidence regarding long-term outcomes is scant. We studied symptom outcomes 18 months (FU1) and 8/9 years (FU2) post-index endoscopy to identify demographic, diagnostic and treatment factors associated with outcomes. A retrospective review of medical records at two Australian teaching hospitals identified a cohort of 302 patients who had an index endoscopy (performed by 23 endoscopists) 18 months previously. Patients were interviewed at FU1 and FU2. In total 34% (95%CI: 29.0 39.8) of patients were asymptomatic at FUI and 41% (95%CI: 35.6-46.6) at FU2. For 63%, outcomes at FUI predicted long-term outcome, with 19% (95%CI: 14.6-23.4) asymptomatic and 44% (95%CI: 38.4-50.0) symptomatic at both times. Those whose symptom status changed were as likely to deteriorate as improve (p > 0.05). Number and severity of presenting symptoms (F = 3.3, df = 3,277, p < 0.05) and older age (F = 2.8, df = 2,301, p < 0.05) were associated with poorer outcomes. Long-term outcome was unrelated to endoscopic diagnosis. Those symptomatic were significantly more likely to be on proton pump inhibitors (PPIs) or Histamine2 Receptor Antagonists (H2RAs) than those who were asymptomatic. Use of PPIs at FU2 was associated with a significantly better outcome than use of H2RAs. However this impact was relatively small, with 69% of patients on PPIs and 84% on H2RAs symptomatic at FU2. Upper gastrointestinal symptoms prompting endoscopy are chronic for the majority of patients regardless of diagnosis. Endoscopic diagnosis is of limited value in predicting long-term outcomes. The association between poor outcome and use of H2RAs and PPIs challenges views about their long-term effectiveness in symptom control.
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Affiliation(s)
- Johanna I Westbrook
- Centre for Health Informatics, University of NSW, Kensington, NSW, Australia.
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46
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Zacny J, Zamakhshary M, Sketris I, Veldhuyzen van Zanten S. Systematic review: the efficacy of intermittent and on-demand therapy with histamine H2-receptor antagonists or proton pump inhibitors for gastro-oesophageal reflux disease patients. Aliment Pharmacol Ther 2005; 21:1299-312. [PMID: 15932360 DOI: 10.1111/j.1365-2036.2005.02490.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIM To perform a systematic review on the efficacy of intermittent and on-demand therapy with either histamine H2-receptor antagonists or proton pump inhibitors for patients with erosive oesophagitis or symptomatic heartburn. METHOD We conducted randomized-controlled trials of non-continuous therapy in gastro-oesophageal reflux disease patients. RESULTS Fourteen studies met inclusion criteria. Because of variation in outcome measures statistical pooling of results was not possible. Results were analysed qualitatively. Four studies evaluated intermittent therapy of treatment 3 days a week with omeprazole 20 mg or daily with ranitidine which were not efficacious compared to a daily proton pump inhibitor. Famotidine 10 and 20 mg, ranitidine 75 mg and cimetidine 200 mg were efficacious in five on-demand studies for relief of symptomatic heartburn episodes. In three of four studies, evaluating only non-erosive (endoscopy-negative) gastro-oesophageal reflux disease patients, esomeprazole 20 and 40 mg and omeprazole 10 and 20 mg a day were efficacious using willingness to continue as an endpoint. Lansoprazole 30 mg and omeprazole 20 mg maintained symptom control in 60-70% of healed oesophagitis patients. CONCLUSIONS Intermittent proton pump inhibitor or H2-receptor antagonist therapy is not effective in maintaining control in oesophagitis patients. H2-receptor antagonists are effective for relief of heartburn episodes. On-demand proton pump inhibitor therapy may work in a proportion of non-erosive gastro-oesophageal reflux disease patients.
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Affiliation(s)
- J Zacny
- Division of Gastroenterology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
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Oh DS, Ohning GV, Pisegna JR. Rabeprazole controls GERD symptoms in a patient for whom treatment with lansoprazole failed: first report of "cluster GERD.". Dig Dis Sci 2005; 50:853-7. [PMID: 15912621 PMCID: PMC6719682 DOI: 10.1007/s10620-005-2652-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- David S Oh
- Veterans Administration Greater Los Angeles Healthcare System and CURE: VA/UCLA Digestive Diseases Research Center, Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, California 90073, USA
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48
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Zimmerman J. Irritable bowel, smoking and oesophageal acid exposure: an insight into the nature of symptoms of gastro-oesophageal reflux. Aliment Pharmacol Ther 2004; 20:1297-303. [PMID: 15606391 DOI: 10.1111/j.1365-2036.2004.02216.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND In gastro-oesophageal reflux disease, oesophageal acid exposure correlates with symptoms but explains only a small fraction of their variance. AIMS To elucidate the effects of irritable bowel syndrome and smoking on gastro-oesophageal reflux disease symptoms and to clarify whether they modulate the relationship between oesophageal acid exposure and symptoms. METHODS The relationship between oesophageal acid exposure, irritable bowel syndrome (Rome I criteria), smoking status and symptoms was investigated in patients with a normal gastroscopy who underwent a 24-h oesophageal pH monitoring. RESULTS Of 256 patients with gastro-oesophageal reflux disease, 16% were smokers and 50% met the criteria for irritable bowel syndrome (irritable bowel syndrome+). The extent of oesophageal acid exposure was unrelated to smoking or irritable bowel syndrome status. Oesophageal acid exposure, irritable bowel syndrome status and current smoking independently predicted symptoms. Irritable bowel syndrome and smoking modulated the effect of oesophageal acid exposure on symptoms: oesophageal acid exposure was predictive of symptoms only in non-smokers. However, irritable bowel syndrome was a significant predictor of symptoms both in smokers and in non-smokers. Smoking was associated with symptoms only in irritable bowel syndrome+, while oesophageal acid exposure was associated with symptoms irrespective of irritable bowel syndrome status. CONCLUSIONS In patients with non-erosive gastro-oesophageal reflux disease, smoking and irritable bowel syndrome independently predicted symptoms, without affecting the extent of oesophageal acid exposure. The relationship between oesophageal acid exposure and symptoms was affected significantly, and in opposite directions, by smoking and irritable bowel syndrome.
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Affiliation(s)
- J Zimmerman
- Gastroenterology Unit, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.
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Quigley EMM. Functional dyspepsia (FD) and non-erosive reflux disease (NERD): overlapping or discrete entities? Best Pract Res Clin Gastroenterol 2004; 18:695-706. [PMID: 15324708 DOI: 10.1016/j.bpg.2004.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
As the incidence of both gastric cancer and peptic ulcer disease have declined, that of gastro-oesophageal reflux disease (GORD) and non-ulcer, or functional dyspepsia (FD) have reached virtually epidemic proportions. As we come to appreciate the expression of these disorders in the community, the real spectrum of each disease has become evident. FD and non-erosive reflux disease (NERD), the most prevalent manifestation of GORD, frequently overlap. Where then does GORD end and FD begin? Is it realistic, or even clinically relevant, to attempt a clear separation between these entities? These are more than issues of mere semantics; therapeutic options may be dictated by the classification of the patient as one or the other. Recent work indicates clearly that NERD is a heterogeneous disorder incorporating some patients who may well harbour subtle manifestations of oesophagitis and others who have entirely normal 24-hour pH studies. These differences may be crucial to the concept of NERD/FD overlap. While evidence in support of this concept is far from complete, it would appear that this overlap is most relevant to those NERD patients who do not exhibit abnormal esophageal acid exposure. These patients truly belong in the spectrum of functional gastrointestinal disorders rather than in GORD; attempts to shoe-horn these individuals into the spectrum of GORD will result in therapeutic disappointment and surgical disaster.
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Affiliation(s)
- Eamonn M M Quigley
- Department of Medicine, Cork University Hospital, Clinical Sciences Building, Cork, Ireland.
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50
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Ponce J, Argüello L, Bastida G, Ponce M, Ortiz V, Garrigues V. On-demand therapy with rabeprazole in nonerosive and erosive gastroesophageal reflux disease in clinical practice: effectiveness, health-related quality of life, and patient satisfaction. Dig Dis Sci 2004; 49:931-6. [PMID: 15309880 DOI: 10.1023/b:ddas.0000034551.39324.c3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
On-demand therapy is effective for maintaining symptoms control in nonerosive gastroesophageal reflux disease (GERD). Our aim was to assess the clinical effectiveness of on-demand therapy with a proton pump inhibitor (PPI) in mild GERD (nonerosive and low-grade esophagitis), its impact on health-related quality of life (HRQoL), and the degree of patient satisfaction. Fifty-five patients (17 with nonerosive GERD and 38 with low-grade esophagitis) were treated with rabeprazole, 20 mg/day. The healed patients started on-demand therapy. We evaluated symptoms (clinical questionnaire), HRQoL (SF-36 questionnaire), and patient satisfaction (visual analogue scale). Of the 55 patients included, 51 started on-demand therapy for 6 months. Symptom control (heartburn <twice a week) was achieved in over 85% of the patients. The mean (SD) amount of PPI used was 0.3 (0.19) tablet/day. The patient satisfaction score at the end of the acute phase was 98 (range, 0-100) and remained high (90; range, 10-100) and stable during on-demand therapy. Short-term treatment normalized the HRQoL scores, which were subsequently maintained during on-demand therapy. On-demand therapy is useful for the clinical management of patients with mild GERD, allowing adequate symptoms control, limiting PPI consumption, and affording important patient satisfaction with normalization of HRQoL.
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Affiliation(s)
- Julio Ponce
- Gastroenterology Unit, La Fe University Hospital, Valencia, Spain
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