Association between baseline impedance values and response proton pump inhibitors in patients with heartburn

BACKGROUND & AIMS

Esophageal impedance measurements have been proposed to indicate the status of the esophageal mucosa, and might be used to study the roles of the impaired mucosal integrity and increased acid sensitivity in patients with heartburn. We compared baseline impedance levels among patients with heartburn who did and did not respond to proton pump inhibitor (PPI) therapy, along with the pathophysiological characteristics of functional heartburn (FH).

METHODS

In a case-control study, we collected data from January to December 2013 on patients with heartburn and normal findings from endoscopy who were not receiving PPI therapy and underwent impedance pH testing at hospitals in Italy. Patients with negative test results were placed on an 8-week course of PPI therapy (84 patients received esomeprazole and 36 patients received pantoprazole). Patients with more than 50% symptom improvement were classified as FH/PPI responders and patients with less than 50% symptom improvement were classified as FH/PPI nonresponders. Patients with hypersensitive esophagus and healthy volunteers served as controls. In all patients and controls, we measured acid exposure time, number of reflux events, baseline impedance, and swallow-induced peristaltic wave indices.

RESULTS

FH/PPI responders had higher acid exposure times, numbers of reflux events, and acid refluxes compared with FH/PPI nonresponders (P < .05). Patients with hypersensitive esophagus had mean acid exposure times and numbers of reflux events similar to those of FH/PPI responders. Baseline impedance levels were lower in FH/PPI responders and patients with hypersensitive esophagus, compared with FH/PPI nonresponders and healthy volunteers (P < .001). Swallow-induced peristaltic wave indices were similar between FH/PPI responders and patients with hypersensitive esophagus.

CONCLUSIONS

Patients with FH who respond to PPI therapy have impedance pH features similar to those of patients with hypersensitive esophagus. Baseline impedance measurements might allow for identification of patients who respond to PPIs but would be classified as having FH based on conventional impedance-pH measurements.

Prucalopride decreases esophageal acid exposure and accelerates gastric emptying in healthy subjects

BACKGROUND

The 5-HT4 receptor agonist prucalopride is a prokinetic drug which improves colonic motility. Animal data and in vitro studies suggest that prucalopride also affects gastric and esophageal motor function. We aimed to assess the effect of prucalopride on gastric emptying, esophageal motility, and gastro-esophageal reflux in man.

METHODS

In this double-blind, placebo-controlled, randomized, crossover study, we included 21 healthy volunteers who received 4 mg prucalopride or placebo per day for 6 days. We performed high-resolution manometry (HRM) followed by 120-min HRM-pH-impedance monitoring after a standardized meal, ambulatory 24-h pH-impedance monitoring, and gastric emptying for solids.

KEY RESULTS

Prucalopride decreased (median [IQR]) total acid exposure time (3.4 [2.5-5.6] vs 1.7 [0.8-3.5] %, p < 0.05). The total number of reflux events was unaffected by prucalopride, however, the number of reflux events extending to the proximal esophagus was reduced by prucalopride (15.5 [9.8-25.5] vs 10.5 [5.3-17.5], p < 0.05). Furthermore, prucalopride improved acid clearance time (77.5 [47.8-108.8] vs 44.0 [30.0-67.8] s, p < 0.05). Prucalopride did not affect the number of transient lower esophageal sphincter (LES) relaxations or their association with reflux events. Esophageal motility and basal pressure of the LES were not affected by prucalopride. Prucalopride increased gastric emptying (T1/2 ; 32.7 [27.9-44.6] vs 49.8 [37.7-55.0] min, p < 0.05) and decreased residue after 120 min (8.8 [4.4-14.8] vs 2.7 [1.3-5.4] %, p < 0.05).

CONCLUSIONS & INFERENCES

Prucalopride reduces esophageal acid exposure and accelerates gastric emptying in healthy male volunteers. These findings suggest that the drug could be effective for treatment of patients with reflux disease and functional dyspepsia.

Does helicobacter pylori have a role in the etiology of adenoid hypertrophy?

To investigate whether there is any association between nasopharyngeal reflux and adenoid hypertrophy in children by using 24-h pH monitoring with dual probe and to determine whether Helicobacter pylori simply colonises in adenoid tissue or it is present there temporarily due to extraesophageal reflux. A prospective study at a tertiary referral center. Thirty-two patients who underwent adenoidectomy, aged ranged between 4 and 13 were included. All children with adenoid hypertrophy underwent 24-h pH monitoring with a dual probe. Proximal probe was placed in the nasopharynx. The presence of nasopharyngeal reflux and gastroesophageal reflux were investigated by 24-h pH monitoring. The presence of H. pylori was investigated in adenoidectomy samples by HP-fast test. Of the 32 patients who underwent adenoidectomy, 5 had nasopharyngeal reflux positivity while 27 patients did not show nasopharyngeal reflux positivity with pH monitorisation. Helicobacter pylori could not be detected in 5 nasopharyngeal reflux positive children while 3 of 27 nasopharyngeal reflux negative children showed H. pylori positivity, one of them in the mucosa and others in the core. This study demonstrated the high incidence of nasopharyngeal reflux and gastroesophageal reflux in adenoid hypertrophy and the possible colonisation of H. pylori in the adenoid tissue. This may change the assesment of children with adenotonsillar hypertrophy in near future. However, more placebo controlled and double blind studies and larger series are still needed to support this hypothesis.

Pathological features of primary bile reflux gastritis in adolescents: an analysis of 40 cases

AIM: To analyze the pathological features of primary bile reflux gastritis (BRG) in adolescents.

METHODS: Forty adolescents clinically diagnosed with primary BRG by endoscopy and 24-hour gastric pH and bile monitoring were included in the study. Thirty healthy adolescent volunteers were enrolled as controls. Gastric antrum and corpus mucosa biopsy specimens were taken and subjected to routine HE staining and modified Giemsa staining to conduct pathological examination.

RESULTS: Lymphocyte infiltration was mild in BRG adolescents, and grade 2 or less lymphocyte infiltration was noted in 87.5% of patients. Neutrophil infiltration was often concurrent with Helicobacter pylori (H. pylori) infection. Lengthening of gastric pits, trichangiectasia, interstitial edema, mucosal atrophy, intestinal metaplasia and H. pylori infection were observed in 22.5%, 40.0%, 40.0%, 12.5%, 20.0% and 22.5% of patients, respectively. Except intestinal metaplasia and H. pylori infection, the prevalences of other pathological alterations were significantly different between healthy adolescents and BRG adolescents (P < 0.05). Additionally, these pathological alterations were more severe in the antrum than in the corpus.

CONCLUSION: Primary BRG in adolescents shows some features of chemical gastritis and has a tendency to evolve towards mucosal atrophy and intestinal metaplasia.