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Fangxu L, Wenbin L, Pan Z, Dan C, Xi W, Xue X, Jihua S, Qingfeng L, Le X, Songbai Z. Chinese expert consensus on diagnosis and management of gastroesophageal reflux disease in the elderly (2023). Aging Med (Milton) 2024; 7:143-157. [PMID: 38725699 PMCID: PMC11077342 DOI: 10.1002/agm2.12293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 05/12/2024] Open
Abstract
Gastroesophageal reflux disease (GERD) in the elderly is characterized by atypical symptoms, relatively severe esophageal injury, and more complications, and when GERD is treated, it is also necessary to fully consider the general health condition of the elderly patients. This consensus summarized the epidemiology, pathogenesis, clinical manifestations, and diagnosis and treatment characteristics of GERD in the elderly, and provided relevant recommendations, providing guidance for medical personnel to correctly understand and standardize the diagnosis and treatment of GERD in the elderly.
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Affiliation(s)
- Liu Fangxu
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Li Wenbin
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Zhang Pan
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Chen Dan
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Wu Xi
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Xu Xue
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Shi Jihua
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Luo Qingfeng
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Xu Le
- Department of Gastroenterology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Zheng Songbai
- Department of GeriatricsHuadong Hospital Affiliated to Fudan UniversityShanghaiChina
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Kim SE. The Need for Updated Classification of Esophageal Motility Disorders Using High-resolution Impedance Manometry. J Neurogastroenterol Motil 2024; 30:1-3. [PMID: 38173152 PMCID: PMC10774804 DOI: 10.5056/jnm23185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Sung Eun Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Ha NY, Kim JW, Kim J. Clinical efficacy of Yukgunja-tang combined with a proton pump inhibitor for refractory gastroesophageal reflux disease: study protocol for randomized, double-blind, double-dummy clinical trial. BMC Complement Med Ther 2023; 23:444. [PMID: 38062418 PMCID: PMC10704821 DOI: 10.1186/s12906-023-04283-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Yukgunja-tang (YGJ) is an herbal prescription used to treat the symptoms of gastroesophageal reflux disease (GERD). Although many preclinical and clinical studies on YGJ have been conducted on GERD, there is a lack of evidence from blinded studies to exclude placebo effects. Therefore, this protocol proposes a clinical trial that is single-centered, randomized, double-blinded, double-dummy to objectively evaluate the efficacy and safety of co-administered YGJ and rabeprazole (RPZ) in patients with GERD previously treated with proton pump inhibitors (PPIs) and still experiencing symptoms. METHODS A total of 86 participants with refractory GERD (rGERD) will be randomized in a 1:1 ratio to the treatment [YGJ and RPZ (10 mg/d)] and control groups [double-dose RPZ (20 mg/d)] for 4 weeks of treatment (weeks 0-4) followed by 4 weeks of follow-up (weeks 4-8). The Frequency Scale for the Symptoms of GERD will be analyzed for the primary endpoint. Reflux Disease Questionnaire, Reflux Symptom Score, GERD-Health Related Quality of Life, Overall Treatment Evaluation, Spleen Qi Deficiency Questionnaire, Damum Questionnaire, and dyspepsia Visual Analogue Scale will be used to evaluate treatment effects on GERD related symptoms and quality of life and to compare treatment effects by subgroups. Safety tests will be analyzed by investigating adverse events. DISCUSSION This clinical trial will be the first rigorous double-blind, double-dummy, placebo-controlled study to precisely evaluate the efficacy and safety of the combination of YGJ and PPIs in the treatment of rGERD. The results of this study will provide a reliable clinical basis for selecting botanical drug treatments for patients with rGERD. TRIAL REGISTRATION Clinical Research Information Service (registration number: KCT0008600, July 13, 2023, https://cris.nih.go.kr ).
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Affiliation(s)
- Na-Yeon Ha
- Department of Digestive Diseases, College of Korean Medicine, Kyung Hee University, Seoul, 02447, Republic of Korea
- Division of Digestive Diseases, Department of Korean Internal Medicine, Kyung Hee University Korean Medicine Hospital, Seoul, 02447, Republic of Korea
| | - Jung-Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, 02447, Republic of Korea
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jinsung Kim
- Department of Digestive Diseases, College of Korean Medicine, Kyung Hee University, Seoul, 02447, Republic of Korea.
- Division of Digestive Diseases, Department of Korean Internal Medicine, Kyung Hee University Korean Medicine Hospital, Seoul, 02447, Republic of Korea.
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Herdiana Y. Chitosan Nanoparticles for Gastroesophageal Reflux Disease Treatment. Polymers (Basel) 2023; 15:3485. [PMID: 37631542 PMCID: PMC10460071 DOI: 10.3390/polym15163485] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Gastroesophageal Reflux Disease (GERD) is a chronic ailment that results from the backward flow of stomach acid into the esophagus, causing heartburn and acid regurgitation. This review explores nanotechnology as a novel treatment approach for GERD. Chitosan nanoparticles (CSNPs) offer several advantages, including biocompatibility, biodegradability, and targeted drug delivery capabilities. CSNPs have been extensively studied due to their ability to encapsulate and release medications in a controlled manner. Different nanoparticle (NP) delivery systems, including gels, microspheres, and coatings, have been developed to enhance drug retention, drug targeting, and controlled release in the esophagus. These nanoparticles can target specific molecular pathways associated with acid regulation, esophageal tissue protection, and inflammation modulation. However, the optimization of nanoparticle formulations faces challenges, including ensuring stability, scalability, and regulatory compliance. The future may see CSNPs combined with other treatments like proton pump inhibitors (PPIs) or mucosal protectants for a synergistic therapeutic approach. Thus, CSNPs provide exciting opportunities for novel GERD treatment strategies.
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Affiliation(s)
- Yedi Herdiana
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang 45363, Indonesia
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Ugliono E, Rebecchi F, Mantova S, Osella G, Mansour AMFMH, Morino M. Laparoscopic antireflux surgery for refractory gastroesophageal reflux disease: long-term clinical outcomes. Updates Surg 2023:10.1007/s13304-023-01483-x. [PMID: 36862352 DOI: 10.1007/s13304-023-01483-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/23/2023] [Indexed: 03/03/2023]
Abstract
Persistent symptoms despite adequate Proton Pump Inhibitors (PPI) treatment are described in up to 40% of patients with Gastroesophageal Reflux Disease (GERD). The efficacy of Laparoscopic Antireflux Surgery (LARS) in PPI non-responder patients is still unclear. This observational study aims to report the long-term clinical outcomes and predictors of dissatisfaction in a cohort of refractory GERD patients submitted to LARS. Patients with preoperative refractory symptoms and objective GERD evidence submitted to LARS between 2008 and 2016 were included in the study. Primary endpoint was overall satisfaction with the procedure, secondary endpoints were long-term GERD symptom relief and endoscopic findings. Univariate and multivariate analyses were performed to compare satisfied and dissatisfied patients, in order to identify preoperative predictors of dissatisfaction. A total of 73 refractory GERD patients who underwent LARS were included in the study. At a mean follow-up of 91.2 ± 30.5 months, the satisfaction rate was 86.3%, with a statistically significant reduction in typical and atypical GERD symptoms. Causes of dissatisfaction were severe heartburn (6.8%), gas bloat syndrome (2.8%), and persistent dysphagia (4.1%). Multivariate analysis showed that a number of Total Distal Reflux Episodes (TDRE) > 75 was a predictive factor of long-term dissatisfaction after LARS while a partial response to PPI was a protective factor against dissatisfaction. LARS guarantees a high level of long-term satisfaction for selected refractory GERD patients. An abnormal TDRE at 24 h-multichannel intraluminal impedance-pH monitoring and the lack of response to preoperative PPI were predictors of long-term dissatisfaction.
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Affiliation(s)
- Elettra Ugliono
- Department of Surgical Sciences, University of Turin, Corso A.M. Dogliotti 14, 10126, Turin, Italy. .,Department of Mechanical and Aerospacial Engineering, Politecnico of Turin, Corso Duca Degli Abruzzi 24, 10129, Turin, Italy.
| | - Fabrizio Rebecchi
- Department of Surgical Sciences, University of Turin, Corso A.M. Dogliotti 14, 10126, Turin, Italy
| | - Serena Mantova
- Department of Surgical Sciences, University of Turin, Corso A.M. Dogliotti 14, 10126, Turin, Italy
| | - Giulia Osella
- Department of Surgical Sciences, University of Turin, Corso A.M. Dogliotti 14, 10126, Turin, Italy
| | - Ahmed Mohammed Farid Mahmoud Hamdy Mansour
- Department of Surgical Sciences, University of Turin, Corso A.M. Dogliotti 14, 10126, Turin, Italy.,Department of Mechanical and Aerospacial Engineering, Politecnico of Turin, Corso Duca Degli Abruzzi 24, 10129, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Corso A.M. Dogliotti 14, 10126, Turin, Italy
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Saboo B, Mulwani N, Petare AU, Veligandla KC, Pinto CS, Mane A, Rathod R, Kotak B. A real-world retrospective study of omeprazole-domperidone combination in managing acid peptic disease with PRoton-pump Inhibitors in patients with type 2 DiabEtes mellitus (PRIDE-2). Drugs Context 2023; 12:dic-2022-10-3. [PMID: 36816461 PMCID: PMC9933899 DOI: 10.7573/dic.2022-10-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023] Open
Abstract
Background Proton-pump inhibitors, along with a prokinetic agent, are widely used to provide symptomatic relief amongst patients with acid peptic disease (APD). This article evaluates the effectiveness and safety of the omeprazole-domperidone combination amongst patients with type 2 diabetes mellitus for the management of APD. Methods PRIDE-2 (PRoton-pump Inhibitor in patients with type 2 DiabEtes mellitus) is a retrospective study reviewing electronic medical records of patients with type 2 diabetes mellitus and APD who were receiving the omeprazole-domperidone combination and visiting multiple Indian healthcare settings between March 2018 and April 2021. The effectiveness outcome of the therapy was evaluated in terms of resolution of APD symptoms at visit 5 (120 days after baseline visit) compared with visit 1 (baseline visit). Safety was determined in terms of reported adverse events (AEs) during the treatment period (120 days). Results A total of 174 patients were included in the study. The mean age of the patients was 51.5±9.6 years, with the majority (59.8%) being men. A significant proportion of patients reported relief from APD symptoms, including abdominal pain (91.6%), epigastric burning (68.7%), nausea (89.5%), flatulence (100.0%), loss of appetite (93.6%), and altered bowel movements (94.7%) (p<0.001 for each) at visit 5 compared with visit 1. No serious AEs were reported. Conclusion Omeprazole-domperidone combination was beneficial in providing symptomatic relief to patients with diabetes and APD. The combination therapy was well tolerated, with few reports of minor AEs.
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Affiliation(s)
- Bharat Saboo
- Department of Diabetology, Prayas Diabetes Centre, Indore, Madhya Pradesh, India
| | - Nimmi Mulwani
- Department of Diabetology, Dr. Nimmi’s Diabetes Care, Chandkheda, Ahmedabad, Gujarat, India
| | - Anup Uttam Petare
- Medical Affairs, Dr. Reddy’s Laboratories Ltd, Hyderabad, Telangana, India
| | | | | | - Amey Mane
- Medical Affairs, Dr. Reddy’s Laboratories Ltd, Hyderabad, Telangana, India
| | - Rahul Rathod
- Medical Affairs, Dr. Reddy’s Laboratories Ltd, Hyderabad, Telangana, India
| | - Bhavesh Kotak
- Medical Affairs, Dr. Reddy’s Laboratories Ltd, Hyderabad, Telangana, India
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Meyer JC, MacBride-Stewart S, Fadare JO, Abdulrahman Jairoun A, Haque M, Massele A, Kumar S, Sefah IA, P Skosana P, Godman B. Key Considerations From a Health Authority Perspective When Proton Pump Inhibitors Are Used to Treat Gastroesophageal Reflux Disease (GERD) and Their Implications. Cureus 2022; 14:e31918. [DOI: 10.7759/cureus.31918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 11/28/2022] Open
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Armstrong D, Hungin AP, Kahrilas PJ, Sifrim D, Sinclair P, Vaezi MF, Sharma P. Knowledge gaps in the management of refractory reflux-like symptoms: Healthcare provider survey. Neurogastroenterol Motil 2022; 34:e14387. [PMID: 35502888 PMCID: PMC9787909 DOI: 10.1111/nmo.14387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/28/2022] [Accepted: 04/11/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Refractory reflux-like symptoms have a substantial impact on patients and healthcare providers. The aim of the survey was to qualitatively assess the needs and attitudes of practicing clinicians around the management of refractory reflux symptoms and refractory gastroesophageal reflux disease (rGERD). METHODS An International Working Group for the Classification of Oesophagitis (IWGCO) steering committee invited clinicians to complete an online survey including 17 questions. KEY RESULTS Of the 113 clinicians who completed the survey, 70% were GIs, 20% were primary care physicians, and 10% were other specialties. Functional heartburn was considered the most common reason for an incomplete response to proton pump inhibitor (PPI) therapy (82%), followed by stress/anxiety (69%). More GIs identified esophageal hypersensitivity as a cause, while more non-GIs identified esophageal dysmotility and non-reflux-related esophageal conditions. As the first step, most clinicians would order investigations (70-88%). Overall, 72% would add supplemental therapy for patients with partial response, but only 58% for those with non-response. Antacid/alginate was the most common choice overall, while non-GIs were more likely to add a prokinetic than were GIs (47.8 vs. 24.1%). Approximately 40% of clinicians would switch PPIs in patients with partial response, but only 29% would do so in non-responders. Preferences for long-term therapy were highly variable. The most common initial investigation was upper endoscopy. Choice of esophageal manometry and pH monitoring was more variable, with no clear preference for whether pH monitoring should be conducted on, or off, PPI therapy. CONCLUSIONS AND INFERENCES The survey identified a number of challenges for clinicians, especially non-GI physicians, treating patients with refractory reflux-like symptoms or rGERD on a daily basis.
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Affiliation(s)
- David Armstrong
- Division of Gastroenterology & Farncombe Family Digestive Health Research InstituteMcMaster UniversityHamiltonOntarioCanada
| | - Amrit Pali Hungin
- Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Peter J. Kahrilas
- Division of GastroenterologyNorthwestern UniversityChicagoIllinoisUSA
| | - Daniel Sifrim
- Barts and The London School of Medicine and DentistryQueen Mary, University of LondonLondonUK
| | | | - Michael F. Vaezi
- Division of GastroenterologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Prateek Sharma
- Division of Gastroenterology and HepatologyVeterans Affairs Medical CenterUniversity of Kansas School of MedicineKansas CityMissouriUSA
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Zamani NF, Sjahid AS, Tuan Kamauzaman TH, Lee YY, Islam MA. Efficacy and Safety of Domperidone in Combination with Proton Pump Inhibitors in Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. J Clin Med 2022; 11:jcm11185268. [PMID: 36142915 PMCID: PMC9505562 DOI: 10.3390/jcm11185268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 11/30/2022] Open
Abstract
The aims of gastroesophageal reflux disease (GERD) treatment are symptom relief and healing of oesophagitis. Besides proton pump inhibitors (PPIs), prokinetic agents are also commonly prescribed to treat GERD. Domperidone, a well-known antiemetic, is an example of a prokinetic agent. It is a dopaminergic blocker that increases lower oesophagus sphincter pressure and activates gastric motility. We carried out a systematic review and meta-analysis to explore the benefits of domperidone in addition to PPI therapy for GERD. We searched for publications comparing PPI plus domperidone to PPI monotherapy in terms of symptom improvement in GERD (until 21 April 2022) on PubMed, Scopus, Google Scholar, Web of Science, Cochrane Library, WHO’s International Clinical Studies Registry Platform, and ClinicalTrials.gov without restricting date, language, or study design. The protocol was registered in PROSPERO (CRD42021242076). This meta-analysis incorporated 11 studies with a total of 841 participants (419 in the PPI plus domperidone group and 422 in the PPI monotherapy group). The combination of a PPI and domperidone resulted in a significant reduction in global GERD symptoms. Adverse events associated with PPI plus domperidone treatment were similar to those associated with PPI monotherapy. In conclusion, the combination of domperidone and a PPI is generally safe and effective in treating GERD as compared with that of PPI alone.
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Affiliation(s)
- Nur Fathurah Zamani
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Hospital Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
| | - Afifah Sjamun Sjahid
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Hospital Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Correspondence: (A.S.S.); or (M.A.I.)
| | - Tuan Hairulnizam Tuan Kamauzaman
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Hospital Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
| | - Yeong Yeh Lee
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- GI Function & Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
| | - Md Asiful Islam
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK
- Correspondence: (A.S.S.); or (M.A.I.)
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Jiang W, Chen G, Dong C, Zhu S, Pan J, Liu Z, Li M, Yu C, Shen Z. The safety and efficacy of peroral endoscopic cardial constriction in gastroesophageal reflux disease. Scand J Gastroenterol 2022; 57:878-883. [PMID: 35196940 DOI: 10.1080/00365521.2022.2039285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Gastroesophageal reflux disease (GERD) is one of the most common digestive disorders, which seriously affects the quality of life and brings a heavy burden to the medical care. Peroral endoscopic cardial constriction (PECC) can narrow the cardia through mucosal ligation to alleviate acid reflux symptoms. This study aims to assess the clinical efficacy of PECC. METHODS This was a retrospective case series including patients diagnosed with GERD and undergoing PECC from September 2019 to July 2021. GERD-Q questionnaire and GERD-QOL questionnaire were applied to evaluate the symptom severity and the impact of life because of GERD. RESULTS A total of 16 patients were included in our study. The mean GERD-Q score was 10.94 ± 2.11 before PECC, while 5.38 ± 3.90 after PECC. The mean GERD-QOL score was 43.60 ± 16.94 before PECC, while 73.65 ± 22.08 after PECC. 62.5% of patients were satisfied with the symptom control and no serious complications were reported in our study. CONCLUSIONS PECC is an efficient and safe minimally invasive endoscopic intervention for GERD. It can significantly improve GERD-related symptoms and quality of life.
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Affiliation(s)
- Wenxi Jiang
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Guangwu Chen
- Center of Endoscopy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Caijuan Dong
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Shefeng Zhu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Jiaqi Pan
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Zhaoxue Liu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Meng Li
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Chaohui Yu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Zhe Shen
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
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11
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Xiao YL. Gastroesophageal reflux disease: When East meets West. J Dig Dis 2022; 23:192-195. [PMID: 35195924 DOI: 10.1111/1751-2980.13090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/20/2022] [Indexed: 12/11/2022]
Abstract
Gastroesophageal reflux disease (GERD) is common worldwide and poses a huge challenge to health. Consensuses and guidelines on the diagnosis and management of GERD in China and the USA have recently been updated. The divergence between these guidelines indicates the differences in the conception of this disease by experts in different countries, and is influenced by available medications and interventional procedures. Prompt endoscopy has been advocated in China due to a high prevalence of upper gastrointestinal (GI) cancer, while endoscopy has been reserved for those who are at a risk of malignancy or who are reisitant to proton pump inhibitors (PPIs) in the USA. A potassium channel acid-blocker is widely used in Asian countries and has proven efficacy. Moreover, it has been recommended, together with PPIs, as a primary therapy for GERD in China; while PPI alone is recommended as a first-line treatment in the USA. Although more prokinetics are available in China than in the USA and can alleviate GERD symptoms when combined with PPI, the choice of prokinetics is limited in the USA, leading to completely opposite attitudes to prokinetics in the two countries. Novel anti-reflux procedures have been introduced in both countries. Transoral incisionless fundoplication (TIF) is recommended as an endoscopic anti-reflux procedure, and magnetic sphincter augmentation (MSA) is recognized as equivocal to conventional laparoscopic fundoplication in the USA. However, radiofrequency ablation is more popular in China, and clinical trials on TIF and MSA are not complete, which results in diverse opinions about suitable anti-reflux procedures in China. A comparison of the guidelines may therefore shed light on the multiple dimensions of GERD and thus deepen our understanding of the disease.
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Affiliation(s)
- Ying Lian Xiao
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
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Randomized Controlled Trial Comparing the Efficacy of Sustained-Release Formula of Mosapride-Plus-Esomeprazole Combination Therapy to Esomeprazole Monotherapy in Patients with Gastroesophageal Reflux Disease. J Clin Med 2022; 11:jcm11071965. [PMID: 35407572 PMCID: PMC8999938 DOI: 10.3390/jcm11071965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022] Open
Abstract
We aimed to evaluate whether adding a sustained-release (SR) formula of mosapride to proton-pump inhibitors (PPIs) would be more effective in controlling symptoms than PPI alone in patients with gastroesophageal reflux disease (GERD). Sixty patients with heartburn and/or regurgitation were randomly assigned to two groups: mosapride SR 15 mg combined with esomeprazole 20 mg once daily (ME group) and esomeprazole 20 mg once daily alone (E group). The primary endpoint was the complete-resolution rate of GERD symptoms after eight-week medication, and the secondary endpoints were the complete-resolution rate of GERD symptoms after four-week medication, symptom-improvement rates ≥ 50% after four- and eight-week medication, and change in reflux-disease-questionnaire (RDQ) and GERD-health-related quality-of-life (GERD-HRQL) scores from baseline at four- and eight-week medication. No significant differences in complete-symptom-resolution rates at eight weeks and four weeks or in the changes in RDQ and GERD-HRQL scores from baseline at four- and eight-week medication were observed between the ME and E groups. The symptom-improvement rate of ≥50% after four and eight weeks was comparable between both groups. Adding mosapride SR to esomeprazole in patients with GERD provides no additional benefits in controlling GERD symptoms.
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Tariq MA, Ahmed B. Combination Treatment With Proton Pump Inhibitor Plus Prokinetic for Gastroesophageal Reflux Disease. J Neurogastroenterol Motil 2022; 28:164. [PMID: 34980701 PMCID: PMC8748851 DOI: 10.5056/jnm21134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Muhammad Ali Tariq
- Department of Internal Medicine, Dow University Hospital, Dow International Medical College, Karachi, Pakistan
| | - Bilal Ahmed
- Department of Internal Medicine, Dow University Hospital, Dow International Medical College, Karachi, Pakistan
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