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Bitnar P, Stovicek J, Hlava S, Kolar P, Arlt J, Arltova M, Madle K, Busch A, Kobesova A. Manual Cervical Traction and Trunk Stabilization Cause Significant Changes in Upper and Lower Esophageal Sphincter: A Randomized Trial. J Manipulative Physiol Ther 2021; 44:344-351. [PMID: 34090551 DOI: 10.1016/j.jmpt.2021.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/09/2020] [Accepted: 01/20/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Dysfunctions in the lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) levels can occur owing to poor muscle coordination, contraction, or relaxation. Such condition can possibly be addressed by functional rehabilitation. The aim of this study was to measure pressure changes in the UES and LES at rest and during routine rehabilitation techniques, that is, cervical manual traction and trunk stabilization maneuver. METHODS This study was conducted in a University Hospital Gastrointestinal Endoscopy Center. Cervical manual traction and a trunk stabilization maneuver were performed in a convenient group of 54 adult patients with gastroesophageal reflux disease. High-resolution manometry was used to measure pressure changes in the LES and UES at rest and during manual cervical traction and trunk stabilization maneuver. RESULTS Average initial resting UES pressure was 90.91 mmHg. A significant decrease was identified during both cervical traction (average UES pressure = 42.13 mmHg, P < .001) and trunk stabilization maneuver (average UES pressure = 62.74 mmHg, P = .002). The average initial resting LES pressure was 14.31 mmHg. A significant increase in LES pressure was identified both during cervical traction (average LES pressure = 21.39 mmHg, P < .001) and during the trunk stabilization maneuver, (average pressure = 24.09 mmHg, P < .001). CONCLUSION Cervical traction and trunk stabilization maneuvers can be used to decrease pressure in the UES and increase LES pressure in patients with gastroesophageal reflux disease.
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Affiliation(s)
- Petr Bitnar
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jan Stovicek
- Department of Internal Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Stepan Hlava
- Department of Internal Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Pavel Kolar
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Josef Arlt
- Department of Statistics and Probability, Faculty of Informatics and Statistics, Prague University of Economics and Business, Prague, Czech Republic
| | - Marketa Arltova
- Department of Public Finance, Faculty of Finance and Accounting, Prague University of Economics and Business, Prague, Czech Republic
| | - Katerina Madle
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Andrew Busch
- Department of Health and Human Kinetics, Ohio Wesleyan University, Delaware, Ohio
| | - Alena Kobesova
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.
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Nirwan JS, Hasan SS, Babar ZUD, Conway BR, Ghori MU. Global Prevalence and Risk Factors of Gastro-oesophageal Reflux Disease (GORD): Systematic Review with Meta-analysis. Sci Rep 2020; 10:5814. [PMID: 32242117 PMCID: PMC7118109 DOI: 10.1038/s41598-020-62795-1] [Citation(s) in RCA: 173] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 03/19/2020] [Indexed: 12/13/2022] Open
Abstract
Although gastro-oesophageal reflux disease (GORD) is a common medical complaint, there is currently no consensus on the global prevalence of GORD. The aim of this study was to conduct a systematic review and meta-analysis on GORD prevalence and risk factors at a global level. MEDLINE, EMBASE, CINAHL, Scopus, Cochrane library, and Google Scholar were systematically searched, without language restrictions, for studies on the prevalence and risk factors of GORD. Data were pooled using a random effects model (95% confidence interval), and the odds ratio and relative risk for each risk factor were calculated. Out of 34,355 search results, 96 records reporting the results from 102 studies fulfilled the inclusion criteria, representing 37 countries and all regions of the UN geoscheme. The global pooled prevalence of GORD was 13.98% and varied greatly according to region (12.88% in Latin America and the Caribbean to 19.55% in North America) and country (4.16% in China to 22.40% in Turkey). Using the United Nations 2017 Revision of World Population Prospects, the estimated number of individuals suffering from GORD globally is 1.03 billion. Multiple risk factors associated with a significant increase in the risk of GORD were also identified. This systematic review and meta-analysis revealed that although a substantial proportion (13.98%) of the global population suffers from GORD, there are significant variations between regions and countries. Risk factors for GORD were also identified which may allow clinicians to recognise individuals most at risk.
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Affiliation(s)
- Jorabar Singh Nirwan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, HD1 3DH, Huddersfield, UK
| | - Syed Shahzad Hasan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, HD1 3DH, Huddersfield, UK
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, HD1 3DH, Huddersfield, UK
| | - Barbara R Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, HD1 3DH, Huddersfield, UK
| | - Muhammad Usman Ghori
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, HD1 3DH, Huddersfield, UK.
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Morozov S, Isakov V, Konovalova M. Fiber-enriched diet helps to control symptoms and improves esophageal motility in patients with non-erosive gastroesophageal reflux disease. World J Gastroenterol 2018; 24:2291-2299. [PMID: 29881238 PMCID: PMC5989243 DOI: 10.3748/wjg.v24.i21.2291] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/27/2018] [Accepted: 05/11/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the effect of dietary fiber on symptoms and esophageal function testing parameters in non-erosive gastroesophageal reflux disease (GERD) (NERD) patients. METHODS Thirty-six NERD patients with low (< 20 g/d) dietary fiber intake were enrolled in the study. They were examined with the use of symptom questionnaire (GERD-Q), high-resolution esophageal manometry, 24-h esophageal pH-impedance examinations, and food frequency questionnaire before and after 10 d of usual diet supplemented by psyllium 5.0 g TID. Complete data of 30 patients were available to the final analysis. The obtained results were analyzed with the use of non-parametric statistics (Wilcoxon matched pairs test). RESULTS The number of patients experiencing heartburn was less (93.3% at baseline vs 40% at the end of the study, P < 0.001) and the GERD-Q score decreased (mean ± SD: 10.9 ± 1.7 vs 6.0 ± 2.3, P < 0.001) after the treatment period. Minimal resting lower esophageal sphincter (LES) pressure increased from 5.41 ± 10.1 to 11.3 ± 9.4 mmHg (P = 0.023), but no change in residual LES pressure and mean resting pressure was found. Total number of gastroesophageal refluxes (GER) decreased from 67.9 ± 17.7 to 42.4 ± 13.5 (P < 0.001) predominantly by acid and weak acid types of GERs. No significant change in mean esophageal pH and % of time pH < 4 was registered. Maximal reflux time decreased from 10.6 ± 12.0 min to 5.3 ± 3.7 min (P < 0.05). CONCLUSION Fiber-enriched diet led to a significant increase of minimal lower esophageal sphincter resting pressure, a decrease of number of gastroesophageal refluxes, and a decrease of heartburn frequency per week in NERD.
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Affiliation(s)
- Sergey Morozov
- Department of Gastroenterology and Hepatology, Federal Research Center of Nutrition, Biotechnology, and Food Safety, Moscow 115446, Russia
| | - Vasily Isakov
- Department of Gastroenterology and Hepatology, Federal Research Center of Nutrition, Biotechnology, and Food Safety, Moscow 115446, Russia
| | - Mariya Konovalova
- Department of Gastroenterology and Hepatology, Federal Research Center of Nutrition, Biotechnology, and Food Safety, Moscow 115446, Russia
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Prakash D, Campbell B, Wajed S. Introduction into the NHS of magnetic sphincter augmentation: an innovative surgical therapy for reflux - results and challenges. Ann R Coll Surg Engl 2018; 100:251-256. [PMID: 29364013 DOI: 10.1308/rcsann.2017.0224] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction Gastro-oesophageal reflux disease (GORD) is a common, chronic debilitating condition. Surgical management traditionally involves fundoplication. Magnetic sphincter augmentation (MSA) is a new definitive treatment. We describe our experience of introducing this innovative therapy into NHS practice and report the early clinical outcomes. Methods MSA was introduced into NHS practice following successful acceptance of a cost-effective business plan and close observation of National Institute for Health and Care Excellence (NICE) recommendations for new procedures, including a carefully planned prospective data collection over a two-year follow-up period. Results Forty-seven patients underwent MSA over the 40-month period. Reflux health-related quality of life (GERD-HRQL) was significantly improved after the procedure and maintained at one- and two-year (P < 0.0001) follow-up. Drug dependency went from 100% at baseline to 2.6% and 8.7% after one and two years. High levels of patient satisfaction were reported. There were no adverse events. Conclusions MSA is highly effective in the treatment of uncomplicated GORD, with durable results and an excellent safety profile. This laparoscopic, minimally invasive procedure provides a good alternative for patients where surgical anatomy is unaltered. Our experience demonstrates that innovative technology can be incorporated into NHS practice with an acceptable business plan and compliance with NICE recommendations.
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Affiliation(s)
- D Prakash
- Department of Upper Gastrointestinal Surgery, Royal Devon and Exeter Hospital , Exeter , UK
| | - B Campbell
- University of Exeter Medical School , Exeter , UK
| | - S Wajed
- Department of Upper Gastrointestinal Surgery, Royal Devon and Exeter Hospital , Exeter , UK.,University of Exeter Medical School , Exeter , UK
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Ness-Jensen E, Lagergren J. Tobacco smoking, alcohol consumption and gastro-oesophageal reflux disease. Best Pract Res Clin Gastroenterol 2017; 31:501-508. [PMID: 29195669 DOI: 10.1016/j.bpg.2017.09.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/14/2017] [Accepted: 09/03/2017] [Indexed: 01/31/2023]
Abstract
Gastro-oesophageal reflux disease (GORD) develops when reflux of gastric content causes troublesome symptoms or complications. The main symptoms are heartburn and acid regurgitation and complications include oesophagitis, strictures, Barrett's oesophagus and oesophageal adenocarcinoma. In addition to hereditary influence, GORD is associated with lifestyle factors, mainly obesity. Tobacco smoking is regarded as an aetiological factor of GORD, while alcohol consumption is considered a triggering factor of reflux episodes and not a causal factor. Yet, both tobacco smoking and alcohol consumption can reduce the lower oesophageal sphincter pressure, facilitating reflux. In addition, tobacco smoking reduces the production of saliva rich in bicarbonate, which is important for buffering and clearance of acid in the oesophagus. Alcohol also has a direct noxious effect on the oesophageal mucosa, which predisposes to acidic injury. Tobacco smoking cessation reduces the risk of GORD symptoms and avoidance of alcohol is encouraged in individuals where alcohol consumption triggers reflux.
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Affiliation(s)
- Eivind Ness-Jensen
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden; HUNT Research Centre, Department of General Practice and Nursing, NTNU, Norwegian University of Science and Technology, Forskningsvegen 2, 7600 Levanger, Norway; Medical Department, Levanger Hospital, Nord-Trøndelag Hospital Trust, P.O. Box 333, 7601 Levanger, Norway.
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, 171 76 Stockholm, Sweden; School of Cancer Sciences, King's College London, SE1 9RT, United Kingdom.
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Kwasnicki RM, Ley Greaves R, Ali R, Gummett PA, Yang GZ, Darzi A, Hoare J. Implementation of objective activity monitoring to supplement the interpretation of ambulatory esophageal PH investigations. Dis Esophagus 2016; 29:255-61. [PMID: 25625191 DOI: 10.1111/dote.12312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Conventional catheter-based systems used for ambulatory esophageal pH monitoring have been reported to affect patient behavior. As physical activity has been associated with gastroesophageal reflux disease (GERD), there is a risk that abnormal behavior will degrade the value of this diagnostic investigation and consequent management strategies. The aim of this study was to quantify the effect of conventional pH monitoring on behavior and to investigate the temporal association between activity and reflux. A total of 20 patients listed for 24 hours pH monitoring underwent activity monitoring using a lightweight ear-worn accelerometer (e-AR sensor, Imperial College London) 2 days prior to, and during their investigation. PH was measured and recorded using a conventional nasogastric catheter and waist-worn receiver. Daily activity levels, including subject-specific activity intensity quartiles, were calculated and compared. Physical activity was added to the standard pH output to supplement interpretation. Average patient activity levels decreased by 26.5% during pH monitoring (range -4.5 to 51.0%, P = 0.036). High-intensity activity decreased by 24.4% (range -4.0 to 75.6%, P = 0.036), and restful activity increased on average by 34% although this failed to reach statistical significance (-24.0 to 289.2%, P = 0.161). Some patients exhibited consistent associations between bouts of activity and acidic episodes. The results of this study support the previously reported reduction in activity during ambulatory esophageal pH monitoring, with the added reliability of objective data. In the absence of more pervasive pH monitoring systems (e.g. wireless), quantifying activity changes in the setting of activity-induced reflux might guide the physicians' interpretation of patient DeMeester scores resulting in more appropriate management of GERD.
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Affiliation(s)
- R M Kwasnicki
- Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - R Ley Greaves
- Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - R Ali
- Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - P A Gummett
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - G Z Yang
- Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - A Darzi
- Hamlyn Centre, Institute of Global Health Innovation, Imperial College London, London, UK
| | - J Hoare
- Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
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Lifestyle Intervention in Gastroesophageal Reflux Disease. Clin Gastroenterol Hepatol 2016; 14:175-82.e1-3. [PMID: 25956834 PMCID: PMC4636482 DOI: 10.1016/j.cgh.2015.04.176] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/28/2015] [Accepted: 04/28/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Gastroesophageal reflux disease (GERD) affects up to 30% of adults in Western populations and is increasing in prevalence. GERD is associated with lifestyle factors, particularly obesity and tobacco smoking, which also threatens the patient's general health. GERD carries the risk of several adverse outcomes and there is widespread use of potent acid-inhibitors, which are associated with long-term adverse effects. The aim of this systematic review was to assess the role of lifestyle intervention in the treatment of GERD. METHODS Literature searches were performed in PubMed (from 1946), EMBASE (from 1980), and the Cochrane Library (no start date) to October 1, 2014. Meta-analyses, systematic reviews, randomized clinical trials (RCTs), and prospective observational studies were included. RESULTS Weight loss was followed by decreased time with esophageal acid exposure in 2 RCTs (from 5.6% to 3.7% and from 8.0% to 5.5%), and reduced reflux symptoms in prospective observational studies. Tobacco smoking cessation reduced reflux symptoms in normal-weight individuals in a large prospective cohort study (odds ratio, 5.67). In RCTs, late evening meals increased time with supine acid exposure compared with early meals (5.2% point change), and head-of-the-bed elevation decreased time with supine acid exposure compared with a flat position (from 21% to 15%). CONCLUSIONS Weight loss and tobacco smoking cessation should be recommended to GERD patients who are obese and smoke, respectively. Avoiding late evening meals and head-of-the-bed elevation is effective in nocturnal GERD.
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Johannessen R, Skogaker N, Halgunset J, Petersen H, Kleveland PM. A standardized method for measuring intercellular spaces in esophageal biopsies in patients with suspected gastroesophageal reflux disease (the intercellular space ratio). Scand J Gastroenterol 2013; 48:1235-41. [PMID: 24079906 DOI: 10.3109/00365521.2013.838996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Dilated intercellular space (DIS) in esophageal biopsies is regarded as a possible early sign of mucosal injury in gastroesophageal reflux disease (GERD). This study presents a standardized approach of intercellular space measurement. MATERIAL AND METHODS Distal and proximal esophageal biopsies were taken from 19 patients with suspected GERD, and examined with TEM. A grid containing 150 line-crossing points was applied upon each photomicrograph. The number of points falling on the intercellular space was divided by the total number of points of the grid, thereby creating a ratio called the intercellular space ratio (ISR). The ISR method was validated with regard to intra- and interobserver agreement, and was compared to a widely used method for measuring intercellular space diameter developed by Tobey et al. (Tobey NA, Carson JL, Alkiek RA, Orlando RC. Dilated intercellular spaces: a morphological feature of acid reflux-damaged human esophageal epithelium. Gastroenterology 1996;111(5):1200-1205). The ISR was also compared to other markers for GERD. Results. Pearson's correlation coefficients for intra- and interobserver agreement were 0.91 (p < 0.001) and 0.82 (p < 0.001), respectively. The Pearson's correlation coefficient between the ISR and the intercellular space diameter according to Tobey et al., measured in the same micrographs, was 0.32 (p < 0.001). The proximal ISR correlated significantly with the distal ISR (Spearman's rho = 0.57, p = 0.010), and with heartburn symptom score (Spearman's rho = 0.50, p = 0.028). CONCLUSIONS The ISR showed a high intraobserver and interobserver agreement. It also displayed good external validity when compared to other markers for gastroesophageal reflux. A rather poor correlation was however found between the ISR and the intercellular space diameter measured as described by Tobey et al.
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Affiliation(s)
- Rune Johannessen
- Unit for Gastroenterology, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology , Trondheim , Norway
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Mearin F, Ponce J, Ponce M, Balboa A, González MA, Zapardiel J. Clinical usefulness of adherence to gastro-esophageal reflux disease guideline by Spanish gastroenterologists. World J Gastroenterol 2012; 18:4885-91. [PMID: 23002360 PMCID: PMC3447270 DOI: 10.3748/wjg.v18.i35.4885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 07/24/2012] [Accepted: 08/14/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate usefulness of adherence to gastro-esophageal reflux disease (GERD) guideline established by the Spanish Association of Gastroenterology.
METHODS: Prospective, observational and multicentre study of 301 patients with typical symptoms of GERD who should be managed in accordance with guidelines and were attended by gastroenterologists in daily practice. Patients (aged > 18 years) were eligible for inclusion if they had typical symptoms of GERD (heartburn and/or acid regurgitation) as the major complaint in the presence or absence of accompanying atypical symptoms, such as dyspeptic symptoms and/or supraesophageal symptoms. Diagnostic and therapeutic decisions should be made based on specific recommendations of the Spanish clinical practice guideline for GERD which is a widely disseminated and well known instrument among Spanish in digestive disease specialists.
RESULTS: Endoscopy was indicated in 123 (41%) patients: 50 with alarm symptoms, 32 with age > 50 years without alarm symptom. Seventy-two patients (58.5%) had esophagitis (grade A, 23, grade B, 28, grade C, 18, grade D, 3). In the presence of alarm symptoms, endoscopy was indicated consistently with recommendations in 98% of cases. However, in the absence of alarm symptoms, endoscopy was indicated in 33% of patients > 50 years (not recommended by the guideline). Adherence for proton pump inhibitors (PPIs) therapy was 80%, but doses prescribed were lower (half) in 5% of cases and higher (double) in 15%. Adherence regarding duration of PPI therapy was 69%; duration was shorter than recommended in 1% (4 wk in esophagitis grades C-D) or longer in 30% (8 wk in esophagitis grades A-B or in patients without endoscopy). Treatment response was higher when PPI doses were consistent with guidelines, although differences were not significant (95% vs 85%).
CONCLUSION: GERD guideline compliance was quite good although endoscopy was over indicated in patients > 50 years without alarm symptoms; PPIs were prescribed at higher doses and longer duration.
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Johannessen R, Petersen H, Olberg P, Johnsen G, Fjøsne U, Kleveland PM. Airway symptoms and sleeping difficulties in operated and non-operated patients with gastroesophageal reflux disease. Scand J Gastroenterol 2012; 47:762-9. [PMID: 22571295 DOI: 10.3109/00365521.2012.683041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Anti-reflux treatment studies have not succeeded in proving a causal relationship between gastroesophageal reflux disease (GERD), airway symptoms and sleeping difficulties. In a recent follow-up study we showed that patients operated for GERD have significantly less heartburn/acid regurgitation symptoms than matched non-operated patients. These two groups probably had different degrees of reflux over a long period of time. It is thus hypothesized that operated patients would report less airway symptoms and sleeping difficulties than comparable non-operated patients. A new follow-up study of the same patients was therefore conducted. MATERIAL AND METHODS A total of 179 patients operated for GERD and 179 matched non-operated patients with confirmed GERD were sent the Reflux, Airway & Sleep Questionnaire (RASQ), which is a new, validated questionnaire dealing with heartburn/acid regurgitation, airway symptoms, and sleeping difficulties. Answers are given on a 7-point Likert scale and the assessment period is 1 year. RESULTS Response rates were 68% in both groups. Operated patients reported significantly less reflux symptoms than non-operated patients (p < 0.001). Patients in the surgery group also reported less symptoms in two subscales of the RASQ dealing with airway symptoms: Laryngopharyngitis (p = 0.04) and Bronchitis (p = 0.01). There was a tendency toward less sleeplessness in operated patients, but this was not statistically significant. Snoring was less bothersome in operated patients (p = 0.02). CONCLUSIONS Patients operated for GERD have less heartburn/acid regurgitation symptoms and less airway symptoms than non-operated patients. The findings lend support to the hypothesis of a causal relationship between gastroesophageal reflux, airway symptoms, and sleeping difficulties.
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Affiliation(s)
- Rune Johannessen
- Department of Cancer Research and Molecular Medicine, Unit for Gastroenterology, Norwegian University of Science and Technology, Trondheim, Norway.
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Frequency and clinical implications of supraesophageal and dyspeptic symptoms in gastroesophageal reflux disease. Eur J Gastroenterol Hepatol 2012; 24:665-74. [PMID: 22330237 DOI: 10.1097/meg.0b013e3283512139] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We studied the frequency of supraesophageal and dyspeptic symptoms and their impact on the quality of life (QoL) and treatment response in patients with gastroesophageal reflux disease (GERD). METHODS Multicenter, prospective, observational study of patients who consulted a gastroenterologist because of typical GERD symptoms. Upper digestive symptoms were assessed using direct interviews. The Short Form-12 and the Quality of Life in Reflux and Dyspepsia questionnaires were used to measure QoL. Patients were treated with proton pump inhibitors (PPIs). RESULTS A total of 301 patients (58% men; mean age, 45 years) were included. Baseline symptoms were heartburn (99% of cases; nocturnal heartburn 78%), regurgitation (86%), both heartburn and regurgitation (85%), dyspeptic symptoms (91%; epigastric pain syndrome 20%, postprandial distress syndrome 4%, both 75%), and supraesophageal symptoms (58%). In 56% of cases of heartburn, 35% of regurgitation, and 34% of nocturnal heartburn, symptoms were severe or very severe. One in six patients had dysphagia. Supraesophageal and/or dyspeptic symptoms were associated with worse scores on the Short Form-12 and Quality of Life in Reflux and Dyspepsia instruments. After treatment, heartburn and regurgitation disappeared in 93 and 87% of the patients, respectively. The percentage of patients responding to PPI treatment was significantly higher (P<0.05) in those with heartburn than those without heartburn (96 vs. 86%) and in those with regurgitation than without regurgitation (95 vs. 83%), whereas no differences were observed in those with and without supraesophageal or dyspeptic symptoms. CONCLUSION Patients with typical GERD symptoms (heartburn and/or regurgitation) very frequently have dyspeptic and supraesophageal manifestations, which are related to a worse QoL but unrelated to PPI response.
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12
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Close H, Mason JM, Wilson D, Hungin APS. Hormone replacement therapy is associated with gastro-oesophageal reflux disease: a retrospective cohort study. BMC Gastroenterol 2012; 12:56. [PMID: 22642788 PMCID: PMC3411455 DOI: 10.1186/1471-230x-12-56] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 05/29/2012] [Indexed: 01/11/2023] Open
Abstract
Background Oestrogen and progestogen have the potential to influence gastro-intestinal motility; both are key components of hormone replacement therapy (HRT). Results of observational studies in women taking HRT rely on self-reporting of gastro-oesophageal symptoms and the aetiology of gastro-oesophageal reflux disease (GORD) remains unclear. This study investigated the association between HRT and GORD in menopausal women using validated general practice records. Methods 51,182 menopausal women were identified using the UK General Practice Research Database between 1995–2004. Of these, 8,831 were matched with and without hormone use. Odds ratios (ORs) were calculated for GORD and proton-pump inhibitor (PPI) use in hormone and non-hormone users, adjusting for age, co-morbidities, and co-pharmacy. Results In unadjusted analysis, all forms of hormone use (oestrogen-only, tibolone, combined HRT and progestogen) were statistically significantly associated with GORD. In adjusted models, this association remained statistically significant for oestrogen-only treatment (OR 1.49; 1.18–1.89). Unadjusted analysis showed a statistically significant association between PPI use and oestrogen-only and combined HRT treatment. When adjusted for covariates, oestrogen-only treatment was significant (OR 1.34; 95% CI 1.03–1.74). Findings from the adjusted model demonstrated the greater use of PPI by progestogen users (OR 1.50; 1.01–2.22). Conclusions This first large cohort study of the association between GORD and HRT found a statistically significant association between oestrogen-only hormone and GORD and PPI use. This should be further investigated using prospective follow-up to validate the strength of association and describe its clinical significance.
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Affiliation(s)
- Helen Close
- Durham Clinical Trials Unit, Queen's Campus, Wolfson Research Institute, University of Durham, University Boulevard, Stockton-on-Tees, TS17 6BH, UK.
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Johannessen R, Petersen H, Sue-Chu M, Aasebøstøl AK, Løge I, Kleveland PM. Validation of the Reflux, Airway and Sleep Questionnaire (RASQ). Scand J Gastroenterol 2012; 47:499-508. [PMID: 22364577 DOI: 10.3109/00365521.2012.660543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Airway symptoms and sleeplessness in patients with gastroesophageal reflux disease (GERD) may be of importance. This study validates a new questionnaire dealing with such symptoms. MATERIAL AND METHODS The Reflux, Airway and Sleep Questionnaire (RASQ) is self-administered, asks about 18 symptoms or diagnoses possibly related to GERD answered on a seven-point Likert scale and with a 1-year recall period. There are questions about heartburn/regurgitation, sleeplessness, snoring, pneumonia, and upper airway infections, as well as various bronchial and laryngeal symptoms. The study included 305 patients diagnosed with GERD (n = 65), laryngitis (n = 32), asthma (n = 30), chronic obstructive pulmonary disease (n = 45), acute bronchitis (n = 39), pneumonia (n = 42), or upper airway infection (n = 52) during the last year, and 708 matched healthy controls. Concurrent validity was based on comparisons between patients and controls. Convergent validity for sleeplessness and snoring were tested by comparing the RASQ with the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Test-retest reliability was examined in patients with GERD with stable symptoms (n = 29). RESULTS Response rates were 64% for patients and 55% for controls. Scores for RASQ as a total and all subscales were significantly higher in patients than in controls. Sleeplessness scores correlated significantly to the global PSQI score. Snoring correlated significantly with both the ESS and relevant aspects of the PSQI. Test-retest reliability and Cronbach's alpha were satisfactory, with coefficients ranging between 0.65-0.95 and 0.88-0.92, respectively. CONCLUSION The RASQ appears to be well suited for measuring typical reflux symptoms as well as airway symptoms and sleep disturbances.
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Affiliation(s)
- Rune Johannessen
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Unit for Gastroenterology, Trondheim, Norway.
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Tseng PH, Chen CC, Chiu HM, Liao WC, Wu MS, Lin JT, Lee YC, Wang HP. Performance of narrow band imaging and magnification endoscopy in the prediction of therapeutic response in patients with gastroesophageal reflux disease. J Clin Gastroenterol 2011; 45:501-506. [PMID: 20733514 DOI: 10.1097/mcg.0b013e3181eeb115] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Imaging-enhanced endoscopy enhances the contrast of the mucosal surface and helps in the diagnosis of gastroesophageal reflux disease. However, whether the increased detection of subtle erosive foci corresponds to the effect of acid suppression remains elusive. GOALS We aim to evaluate the utility of narrow band imaging with and without magnification endoscopy in the prediction of therapeutic response in patients with reflux. STUDY Endoscopic evaluation with conventional white light, narrow band imaging, and narrow band imaging with magnification was performed sequentially in consecutive patients with reflux. All patients received proton pump inhibitor for 14 days. Their therapeutic responses were correlated with the baseline endoscopic findings, including mucosal breaks under standard endoscopy, mucosal brownish changes under narrow band imaging, and increased and/or dilated intrapapillary capillary loops or microerosions under narrow band imaging with magnification. RESULTS Of a total of 82 patients, 22 (26.8%) patients were diagnosed with erosive disease under standard endoscopy. Among the remaining 60 (73.2%) patients, 14 (23.3%) and 30 (50%) were considered erosive under narrow band imaging and narrow band imaging with magnification, respectively. Sixty-five (79.3%) patients showed a positive therapeutic response. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting therapeutic response were 33.8%, 100%, 100%, 28.3%, and 47.6%, respectively, for standard endoscopy; 52.3%, 88.2%, 94.4%, 32.6%, and 59.8%, respectively, for narrow band imaging; and 70.8%, 64.7%, 88.4%, 36.6%, and 69.5%, respectively, for narrow band imaging with magnification. CONCLUSIONS Narrow band imaging with and without magnification endoscopy substantially improve our ability to predict therapeutic response in patients with gastroesophageal reflux.
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Affiliation(s)
- Ping-Huei Tseng
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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15
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Non-pharmacological intervention for gastro-oesophageal reflux disease in primary care. Br J Gen Pract 2011; 60:e459-65. [PMID: 21144190 DOI: 10.3399/bjgp10x544050] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Up to 50% of patients with gastro-oesophageal reflux disease (GORD) have persistent symptoms despite taking proton pump inhibitors (PPIs) regularly. Lifestyle advice is available to patients, but no previous UK study has tested a behavioural change intervention to help patients self-manage their symptoms. AIM To determine whether a primary care, nurse-led intervention to address behaviours that promote GORD symptoms results in symptom improvement, an increased sense of control, and a reduced requirement for prescribed medication. DESIGN OF STUDY A group intervention focusing on diet and stress was delivered to patients with reflux symptoms, recruited in rural general practices. SETTING General practice in England. METHOD Forty-two subjects (male 19, female 23) aged 31-86 years took part. Pre- and post-intervention data were gathered using the Brief Illness Perception Questionnaire (BIPQ), the GORD Impact Scale (GIS), and the Hospital Anxiety and Depression Scale (HAD). RESULTS There was a significant improvement (BIPQ P<0.001, GIS P = 0.008) 3 months after the intervention. There was no reduction in PPI use or change in HAD score. The greatest improvements were demonstrated in domains measuring the patient's sense of control, perception of symptoms, and understanding of reflux. Patients reported benefits including understanding relevant anatomy and physiology, learning behavioural techniques to change eating patterns and manage stress, identifying actual and potential triggers, and developing and executing action plans. CONCLUSION An education programme for GORD enhances self-management, brings perceived symptom improvement, and promotes a sense of control at 3 months. This type of behavioural intervention, alongside medical management, could improve symptom control for reflux patients with refractory symptoms and should be the subject of a controlled trial.
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16
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The gain in quality-adjusted life months by switching to esomeprazole in those with continued reflux symptoms in primary care: EncomPASS--a cluster-randomized trial. Am J Gastroenterol 2010; 105:2341-6. [PMID: 20842110 DOI: 10.1038/ajg.2010.368] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Proton pump inhibitors (PPIs) are effective in gastroesophageal reflux disease (GERD), but their cost effectiveness is unknown. This is usually determined by cost/quality-adjusted life year (QALY) gained, but whether PPI therapy improves QALYs has not been assessed in a randomized trial. The PPI acid suppression symptom (PASS) test is a five-item questionnaire that identifies patients with persistent acid-related symptoms. We evaluated whether a PASS test-based management strategy of changing GERD therapy to esomeprazole in those with continued symptoms on another PPI or H(2) receptor antagonist therapy would be cost effective. We expressed the data in terms of cost per quality-adjusted life months (QALM), as this was a 4-week trial. METHODS This is a multicenter, cluster-randomized, open-label study in primary care physician centers across Canada. Primary care physician centers were randomized to intervention or control arms. Patients on acid-suppressing medication were identified from primary care records and asked to complete the PASS test. PASS test failures at baseline assessment continued current therapy in control practices or switched to esomeprazole 20 or 40 mg daily (the dose was at the clinician's discretion) for 4 weeks in intervention practices. A planned secondary end point was QALM gain, measured using the validated Euroqol (EQ-5D) completed at baseline and 4 weeks. Medication use was also assessed by questionnaire. Canadian unit generic costs were applied to all GERD drugs, except to esomeprazole and lansoprazole, wherein proprietary costs were used (all costs in Canadian $). Data were analyzed using bootstrap sampling. RESULTS A total of 1,564 patients were recruited from 134 intervention sites and 92 control sites. Data were evaluable for 808 intervention and 445 control patients. The mean (±standard deviation) QALM at 4 weeks in the intervention group was 0.885±0.164 compared with 0.814±0.179 in the control group, resulting in a mean 0.071 (95% CI=0.091-0.051) QALM gain (P<0.0001). Esomeprazole was cost effective for PASS test failures, with a mean cost of $763 (95% CI=456-1,414) per QALM gain. CONCLUSIONS Esomeprazole was associated with a statistically significant gain in QALMs and was cost effective in primary care patients with persistent acid-related symptoms identified by the PASS test.
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Breckan RK, Paulssen EJ, Asfeldt AM, Mortensen L, Straume B, Florholmen J. The impact of body mass index and Helicobacter pylori infection on gastro-oesophageal reflux symptoms: a population-based study in Northern Norway. Scand J Gastroenterol 2010; 44:1060-6. [PMID: 19593688 DOI: 10.1080/00365520903093728] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Increased body mass index (BMI) has been proposed as a risk factor for gastro-oesophageal reflux symptoms. The aim of this study was to evaluate the effect of BMI and Helicobacter pylori on reflux symptoms in an adult population. MATERIAL AND METHODS For this cross-sectional, population-based study from Bodø and Sørreisa communities in Northern Norway, a total of 3927 adults were invited to complete a questionnaire on gastrointestinal symptoms and to provide stool samples for the assessment of H. pylori. Reflux symptoms were considered present when a reflux syndrome score was > or =2 according to the Gastrointestinal Symptom Rating Scale (GSRS). RESULTS The response rate was 44.2%, and 44.7% of the respondents were male. Age-adjusted prevalences were: for overweight, 35.6% (95% CI (32.4%; 38.8%)); for obesity, 10.0% (8.4%; 11.6%); for H. pylori: 21.2% (19.1%; 23.9%) and for reflux symptoms: 21.7% (19.5%; 23.9%). In the logistic regression analyses, H. pylori and smoking were not risk factors for reflux symptoms, whereas male gender (OR 4.78 (95%CI (1.88; 12.1)), age (1.01 (1.00; 1.03)) and overweight (1.51 (1.14; 2.00)) were. When stratified by gender, overweight and age were independent risk factors for reflux symptoms in females only, whereas H. pylori infection was protective against such symptoms in men. Models including these parameters could only explain 3% of the variations in reflux symptoms. CONCLUSIONS BMI is an independent risk factor for gastro-oesophageal reflux symptoms among healthy female adults, but contributes only to a minor part of the variation in these symptoms. H. pylori is protective against reflux symptoms in men.
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Affiliation(s)
- Ragnar K Breckan
- Department of Internal Medicine, Nordland Hospital, Bodø, Norway.
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18
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Ponce J, Mearin F, Ponce M, Balboa A, Zapardiel J. [Symptom profile in gastroesophageal reflux disease in untreated patients and those with persistent symptoms despite treatment]. GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:271-9. [PMID: 20133018 DOI: 10.1016/j.gastrohep.2009.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 11/04/2009] [Accepted: 11/10/2009] [Indexed: 01/10/2023]
Abstract
AIM 1. To analyze the symptom profile of gastroesophageal reflux disease (GERD) with typical clinical manifestations (heartburn and/or regurgitation); 2. to compare untreated patients with those with persistent symptoms despite treatment; 3. to evaluate severity according to physicians' and patients' opinions; and 4. to determine the diagnostic and therapeutic approaches used. METHODS We performed a prospective, observational, cross-sectional study under conditions of standard clinical practice. RESULTS A total of 2356 patients were included. Dyspeptic symptoms were highly frequent (close to 90% in both groups) and supraesophageal symptoms were also common (50-60%). Patients with persistent symptoms despite treatment were older, and had more supraesophageal symptoms; in addition, the typical supraesophageal and dyspeptic symptoms of GERD were more severe in these patients. Severity evaluations by patients and doctors were concordant but patients considered severity to be greater. Older age was a risk factor for supraesophageal symptoms, female gender for dyspeptic symptoms and body mass index for greater severity of GERD symptoms. Endoscopy was requested in about 60% of the patients. Diet counseling was advised in most patients and postural recommendations were made in more than half. Proton pump inhibitors were prescribed in almost all patients, and were associated with prokinetics and/or antacids in many patients. CONCLUSIONS Dyspeptic symptoms should not be considered as independent of GERD, and typical and atypical symptoms are associated in 50% of patients. Gastroenterologists follow clinical practice guidelines fairly closely but diagnostic procedures seem to be overindicated.
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Affiliation(s)
- Julio Ponce
- Servicio de Medicina Digestiva, Hospital Universitario La Fe, Valencia, España.
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19
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Edwards SJ, Lind T, Lundell L, DAS R. Systematic review: standard- and double-dose proton pump inhibitors for the healing of severe erosive oesophagitis -- a mixed treatment comparison of randomized controlled trials. Aliment Pharmacol Ther 2009; 30:547-56. [PMID: 19558609 DOI: 10.1111/j.1365-2036.2009.04077.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND No randomized controlled trial (RCT) has compared all European-licensed standard- and double-dose PPIs for the healing of severe erosive oesophagitis. AIM To compare the effectiveness of licensed doses of PPIs for healing severe erosive oesophagitis (i.e. esomeprazole 40 mg, lansoprazole 30 mg, omeprazole 20 mg and 40 mg, pantoprazole 40 mg and rabeprazole 20 mg). METHODS Systematic review of CENTRAL, EMBASE and MEDLINE for RCTs in patients with erosive oesophagitis (completed October 2008). Endoscopically verified healing rates at 4 and 8 weeks were extracted and re-calculated if not analysed by intention-to-treat. A mixed treatment comparison was used to combine direct treatment comparisons with indirect trial evidence while maintaining randomization. Odds ratios (OR) are reported compared to omeprazole 20 mg. RESULTS A total of 3021 papers were identified in the literature search; 12 were of sufficient quality to be included in the analysis. Insufficient data were available to included rabeprazole. Esomeprazole 40 mg was found to provide significantly higher healing rates at 4 weeks [OR 1.84, 95% Credible Interval (95% CrI): 1.50 to 2.22] and 8 weeks (OR 1.91, 95% CrI: 1.13 to 2.88). No other PPI investigated had significantly higher healing rates than omeprazole 20 mg. CONCLUSION Esomeprazole 40 mg consistently demonstrates higher healing rates compared with licensed standard- and double-dose PPIs.
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Affiliation(s)
- S J Edwards
- Outcomes Research, AstraZeneca UK Ltd, Luton, UK.
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20
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Hungin APS, Hill C, Raghunath A. Systematic review: frequency and reasons for consultation for gastro-oesophageal reflux disease and dyspepsia. Aliment Pharmacol Ther 2009; 30:331-42. [PMID: 19660016 DOI: 10.1111/j.1365-2036.2009.04047.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Upper gastrointestinal symptoms impose a substantial illness burden and management costs. Understanding perceptions and reasons for seeking healthcare is a prerequisite for meeting patients' needs effectively. AIM To review systematically findings on consultation frequencies for gastro-oesophageal reflux disease (GERD) and dyspepsia and patients' reasons for consultation. METHODS Systematic literature searches. RESULTS Reported consultation rates ranged from 5.4% to 56% for GERD and from 26% to 70% for dyspepsia. Consultation for GERD was associated with increased symptom severity and frequency, interference with social activities, sleep disturbance, lack of timetabled work, higher levels of comorbidity, depression, anxiety, phobia, somatization and obsessionality. Some consulted because of fears that their symptoms represented serious disease; others avoided consultation because of this. Inconsistent associations were seen with medication use. Patients were less likely to consult if they felt that their doctor would trivialize their symptoms. Few factors were consistently associated with dyspepsia consultation. However, lower socio-economic status and Helicobacter pylori infection were associated with increased consultation. CONCLUSION Patients' perceptions of their condition, comorbid factors and external reasons such as work and social factors are related to consultation rates for GERD. Awareness of these factors can guide the clinician towards a more effective strategy than one based on drug therapy alone.
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Affiliation(s)
- A P S Hungin
- School of Medicine and Health, Durham University, Queen's Campus, Wolfson Research Institute, Stockton-on-Tees, UK.
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21
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Raghunath AS, Hungin APS, Mason J, Jackson W. Symptoms in patients on long-term proton pump inhibitors: prevalence and predictors. Aliment Pharmacol Ther 2009; 29:431-9. [PMID: 19035981 DOI: 10.1111/j.1365-2036.2008.03897.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Symptom control in primary care patients on long-term proton pump inhibitor (PPI) treatment is poorly understood. AIM To explore associations between symptom control and demographics, lifestyle, PPI use, diagnosis and Helicobacter pylori status. METHODS A cross-sectional survey (n = 726) using note reviews, questionnaires and carbon-13 urea breath testing. Determinants of symptom control [Leeds Dyspepsia Questionnaire (LDQ), Carlsson and Dent Reflux Questionnaire (CDRQ), health-related quality-of-life measures (EuroQoL: EQ-5D and EQ-VAS)] were explored using stepwise linear regression. RESULTS Moderate or severe dyspepsia symptoms occurred in 61% of subjects (LDQ) and reflux symptoms in 59% (CDRQ). Age, gender, smoking and body mass index had little or no influence upon symptom control or PPI use. Average symptom scores and PPI use were lower in patients with non-ulcer dyspepsia and gastro-protection than gastro-oesophageal reflux disease (GERD) and uninvestigated dyspepsia. H. pylori infection was associated with lower reflux symptom scores only in patients with GERD and uninvestigated dyspepsia. EQ-5D was not able to discriminate between diagnostic groups, although the EQ-VAS performed well. CONCLUSIONS A majority of patients suffered ongoing moderate or severe symptoms. GERD and uninvestigated dyspepsia were associated with poorer long-term symptom control; H. pylori appeared to have a protective effect on reflux symptoms in these patients.
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Affiliation(s)
- A S Raghunath
- School of Medicine and Health, Durham University, Wolfson Research Institute, University Boulevard, Stockton-on-Tees, UK.
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22
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Ponce M. [In patients with typical symptoms of GERD and without alarm symptoms, what are the most appropriate dose and duration of empirical PPI therapy that would allow a definitive diagnosis of GERD?]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:126-127. [PMID: 19231690 DOI: 10.1016/j.gastrohep.2008.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 11/19/2008] [Indexed: 05/27/2023]
Affiliation(s)
- Marta Ponce
- Hospital Universitario La Fe, Valencia, España, CIBERehd.
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23
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Eslick GD, Talley NJ. Gastroesophageal reflux disease (GERD): risk factors, and impact on quality of life-a population-based study. J Clin Gastroenterol 2009; 43:111-117. [PMID: 18838922 DOI: 10.1097/mcg.0b013e31815ea27b] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND We aimed to determine the prevalence of gastroesophageal reflux disease (GERD) and associated risk factors, and assess quality of life (QoL) in relation to the frequency and severity of reflux symptoms. METHODS A random sample of 1000 residents of Western Sydney were mailed a validated self-report questionnaire. GERD symptoms, risk factors, psychologic distress, QoL, and demographics were measured. RESULTS The response rate was 73% (n=672; mean age, 46 y; 52% female). A total of 78 [12%, 95% confidence interval (CI): 9-14] had GERD (at least weekly heartburn and/or acid regurgitation). Independent risk factors for GERD were high cholesterol [odds ratio (OR) =3.28, 95% CI: 1.42-7.57, P=0.005] and current smoker (OR=2.47, 95% CI: 1.07-5.70, P=0.03). Anxiety, depression, and neuroticism were not risk factors. Worse physical functioning was the only QoL domain associated with GERD (OR=0.98, 95% CI: 0.97-0.99, P=0.006). QoL was significantly impaired regardless of the severity of GERD for the QoL domains physical function, body pain, vitality, and social function. The frequency of heartburn and acid regurgitation were not associated with significantly reduced QoL domain scores. CONCLUSIONS Cardiac risk factors (high cholesterol and smoking) were independently associated with GERD. Increasing GERD symptom severity is associated with worse QoL scores, whereas GERD symptom frequency did not impact the QoL scores.
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Affiliation(s)
- Guy D Eslick
- School of Public Health, The University of Sydney, Sydney, Australia.
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Mason JM, Raghunath AS, Hungin APS, Jackson W. Helicobacter pylori eradication in long-term proton pump inhibitor users is highly cost-effective: economic analysis of the HELPUP trial. Aliment Pharmacol Ther 2008; 28:1297-303. [PMID: 18793340 DOI: 10.1111/j.1365-2036.2008.03851.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Proton pump inhibitor (PPI) use is costly and about two-thirds of prescribing is long-term. Although 20-50% of patients may be infected with Helicobacter pylori, eradication is not normal clinical practice. AIM To establish if H. pylori eradication in long-term PPI users is cost-effective. METHODS Long-term PPI-using patients (n = 183) testing positive for H. pylori were randomly assigned to true or placebo eradication therapy. Patients provided 2-year resource data, and 1-year symptom severity scores. A within-trial cost effectiveness analysis was conducted from a British health service perspective. RESULTS Significant reductions in resource use occurred comparing eradication with placebo. After 2 years, PPI prescriptions (full-dose equivalents) fell by 3.9 (P < 0.0001); clinician (GP) consultations by 2.4 (P = 0.0001); upper gastrointestinal (GI) endoscopies by 14.8% (P = 0.008); clinician GI-related home visits by 19.9% (P = 0.005) and abdominal ultrasound scans fell by 20.3% (P = 0.005). Average net savings/patient were pound93 (95% CI: 33-153) after costs of detection and eradication had been deducted. At 1 year, Leeds Dyspepsia Questionnaire symptoms fell by 3.1 (P = 0.005) and quality-of-life measures improved (EuroQol-5D: 0.089, P = 0.08; visual analogue scale: 5.6, P = 0.002) favouring eradication. CONCLUSION Helicobacter pylori eradication in infected, long-term PPI users is an economically dominant strategy, significantly reducing overall healthcare costs and symptom severity.
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Affiliation(s)
- J M Mason
- School of Medicine and Health, Durham University, Queen's Campus, Wolfson Research Institute, University Boulevard, Stockton-on-Tees, UK.
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25
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Vemulapalli R. Diet and lifestyle modifications in the management of gastroesophageal reflux disease. Nutr Clin Pract 2008; 23:293-8. [PMID: 18595862 DOI: 10.1177/0884533608318106] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Gastroesophageal reflux disease is a chronic condition affecting 44% of the American population at least once a month, with daily occurrences affecting about 7% of the population. It is the most common gastrointestinal-related diagnosis given by physicians during clinic visits in the United States. Treatment of this disease is a step-wise approach that includes diet and lifestyle interventions as well as medications titrated based on symptom severity. This article reviews dietary and lifestyle factors that contribute to the physiology and symptoms of gastroesophageal reflux disease and modification of these factors as an adjunctive therapy.
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Affiliation(s)
- Roopa Vemulapalli
- Division of Gastroenterology, UT Southwestern Medical Center, Dallas, TX 75390, USA.
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Jayadevappa R, Chhatre S, Weiner M. Gastro-oesophageal acid-related disease, co-morbidity and medical care cost. Chronic Illn 2008; 4:209-18. [PMID: 18796510 DOI: 10.1177/1742395308092817] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyse the incremental medical care cost of gastro-oesophageal acid-related disease (GERD), and its interactive effects with other diagnoses. METHODS A retrospective cohort study was conducted. Six hundred GERD patients were randomly selected and 600 non-GERD patients were selected, matched by age, gender, prescription pharmaceutical benefits and insurance status. Information on demographics, direct medical care cost (DMC) (inpatient, ambulatory and pharmaceuticals) and health service utilization was obtained from a large, not-for-profit managed-care organization across 3 years (1996-1998). DMCs were compared between GERD and non-GERD groups using the bootstrap method. Random coefficient log linear regression models were used to analyse incremental cost and assess its association with other diagnoses. RESULTS The mean annual DMC for the GERD group was $4906, as compared to $2054 for the non-GERD group. The increase in the DMC in the GERD group was attributable to increased co-morbidity. Age and gender had no effect on total cost for the GERD population. Among costs of services, the GERD group had a 2.00-fold higher cost associated with outpatient services, a 1.70-fold higher cost associated with inpatient services, and a 2.70-fold higher cost associated with pharmacy. CONCLUSIONS GERD is a chronic disease often associated with other diagnoses that significantly affect total DMC. Although the direct cost of treating GERD is low, patients with GERD had significantly higher total medical care cost than those without GERD. The addition of one more disease to a person's existing group of diseases has an important long-term health cost impact.
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Affiliation(s)
- Ravishankar Jayadevappa
- Division of Geriatrics, Department of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104-2676, USA.
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Wang HS, Oh DS, Anderson A, Nieto J, Tien P, Ohning G, Pisegna JR. Comparative efficacy of rabeprazole and pantoprazole in the control of nocturnal Acid output and intragastric acidity. Gut Liver 2008; 2:30-8. [PMID: 20485608 DOI: 10.5009/gnl.2008.2.1.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Accepted: 04/15/2008] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Nocturnal reflux is a largely undiagnosed and unmanaged condition predisposing to multiple esophageal complications. We evaluated the effects of rabeprazole and pantoprazole on nocturnal intragastric pH and gastric acid output during Day 1 of therapy following the consumption of standard meals. METHODS The study had a double-blinded, randomized, two-way crossover design, and involved 15 patients with a history of mild reflux. Following an overnight fast, patients were given either rabeprazole (20 mg) or pantoprazole (40 mg) prior to the first of three standard Western meals. They then underwent overnight continuous intragastric pH monitoring and gastric acid output measurement. The drug effect was analyzed using a two-treatment, two-period crossover mixed model. RESULTS The percentage of time during which the mean intragastric pH was greater than 4.0 and gastric acid output was less than 2.0 was higher for oral rabeprazole (p<0.05). The inhibition of acid output was greater for rabeprazole at almost all time points. Furthermore, the mean time-matched pH values differed significantly over the first 8.3 hours (p<0.05). CONCLUSIONS On day 1, oral rabeprazole inhibited acid output to a greater extent and for a longer period than pantoprazole, and the intragastric pH was significantly higher for rabeprazole than for pantoprazole over the first 8.3 hours.
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Affiliation(s)
- Hank S Wang
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Giannini EG, Zentilin P, Dulbecco P, Vigneri S, Scarlata P, Savarino V. Management strategy for patients with gastroesophageal reflux disease: a comparison between empirical treatment with esomeprazole and endoscopy-oriented treatment. Am J Gastroenterol 2008; 103:267-75. [PMID: 18289194 DOI: 10.1111/j.1572-0241.2007.01659.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Whether patients with typical gastroesophageal reflux disease (GERD) symptoms and without alarm features should be treated empirically or undergo endoscopy first is a debated issue. In this study, our aim was to assess the efficacy, and to compare the direct costs and impact on health-related quality of life (HRQL), of two treatment strategies (empirical vs endoscopy-oriented treatment) in a large population of patients with GERD. METHODS In total, 612 patients were randomized to either empirical treatment with esomeprazole 40 mg once daily (od) (group 1, N = 309) or endoscopy and treatment according to endoscopic findings (group 2, N = 303, esomeprazole 40 mg od in patients with reflux esophagitis and esomeprazole 20 mg od in patients without esophagitis) for 4 wk, followed by esomeprazole 20 mg od maintenance treatment in both groups. Direct costs and HRQL were analyzed in both treatment arms. RESULTS At the end of the acute treatment phase (week 4), 267 patients in group 1 (86.4%) and 265 patients in group 2 (87.5%) were considered responders to treatment (intention-to-treat analysis, P= 0.878). Empirical treatment proved to be cost-effective by saving 38.72 euros per treated patient. At the end of the maintenance phase (week 24), a similar proportion of patients responded to treatment in the two groups (71.8%vs 68.3%, P= 0.389). HRQL improved from baseline to week 24 in both groups (difference between study groups not significant). CONCLUSIONS In patients with GERD, empirical treatment with esomeprazole proved to be cost-effective compared with endoscopy-oriented treatment, and did not negatively affect patient HRQL. These results should be taken into account in the management of GERD patients in clinical practice.
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Affiliation(s)
- Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
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Miwa H, Nakajima K, Yamaguchi K, Fujimoto K, Veldhuyzen VAN Zanten SJO, Kinoshita Y, Adachi K, Kusunoki H, Haruma K. Generation of dyspeptic symptoms by direct acid infusion into the stomach of healthy Japanese subjects. Aliment Pharmacol Ther 2007; 26:257-264. [PMID: 17593071 DOI: 10.1111/j.1365-2036.2007.03367.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The relationship between acid and dyspeptic symptoms has not been fully understood. AIM To investigate the type and severity of dyspeptic symptoms induced by direct acid infusion into the stomach of Japanese healthy subjects. METHODS This was a multi-centre, cross-over, randomized, double-blind study in 27 healthy subjects (mean age 27). Each fasted subject received two tests with 150 mL of 0.1 mol/L hydrochloric acid infusion (15 mL/min for 10 min) and the same volume of pure water infusion. The type and severity of symptoms were assessed by a 10 cm visual analogue scale administered every 2 min up to 30 min. RESULTS Various symptoms were reported after both acid and water infusions. Most of the symptoms were more severe after acid infusion compared with water infusion (acid vs. water: discomfort 1.8 +/- 0.4 vs. 0.5 +/- 0.1, pain 0.6 +/- 0.3 vs. 0.1 +/- 0.1, reflux 1.0 +/- 0.3 vs. 0.3 +/- 0.1 and satiety 1.1 +/- 0.4 vs. 0.2 +/- 0.1). The area under curve for dysmotility like symptoms (heavy feeling in the stomach, bloating, nausea or feeling sick, and belching) was significantly higher in acid infusion, and symptoms continued after infusion of the acid. CONCLUSION Acid induced into stomach induced dysmotility-like predominant dyspeptic symptoms in Japanese healthy control subjects, demonstrating the possible importance of acid in symptom generation.
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Affiliation(s)
- H Miwa
- Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
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Raghunath AS, Hungin APS, Mason J, Jackson W. Helicobacter pylori eradication in long-term proton pump inhibitor users in primary care: a randomized controlled trial. Aliment Pharmacol Ther 2007; 25:585-92. [PMID: 17305759 DOI: 10.1111/j.1365-2036.2006.03234.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Two-thirds of proton pump inhibitor prescribing in the UK is for long-term therapy. AIM To determine the impact of eradication in long-term proton pump inhibitor users infected with Helicobacter pylori. METHODS A total of 184 H. pylori-positive patients were randomly assigned to true or placebo eradication therapy. The primary outcome was the change in proton pump inhibitor usage measured by prescriptions; secondary outcomes were changes of proton pump inhibitor doses, dyspepsia symptoms, general practitioner consultations and quality of life measures. RESULTS In the year following H. pylori eradication proton pump inhibitor prescriptions fell compared with placebo (-1.7, 95% CI: -2.3 to -1.1, P < 0.001); when adjusted to full-dose equivalent prescriptions the reduction was more marked (-2.2, 95% CI: -3.0 to -1.4, P < 0.001). Both general practitioner consultations (-1.0, 95% CI: -1.8 to -0.1, P = 0.026) and symptoms measured on the Leeds Dyspepsia Questionnaire (-3.1, 95% CI: -5.3 to -0.9, P = 0.005) were reduced. Quality of life and self-rating measures also favoured eradication (EQ-5D: 0.09, P = 0.08 and VAS: 5.6, P = 0.002). The Carlsson and Dent Reflux Questionnaire found no difference between groups (-0.3, P = 0.65), possibly balancing decreased overall symptoms with increased prominence of heartburn in the eradication group. CONCLUSIONS Helicobacter pylori eradication in infected, long-term proton pump inhibitor users in primary care reduced both the overall severity of symptoms and use of health care.
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Affiliation(s)
- A S Raghunath
- School for Health, University of Durham, Queen's Campus, Wolfson Research Unit, University Boulevard, Stockton-on-Tees, UK.
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