• Humans
• Gastroesophageal Reflux/physiopathology
• Gastroesophageal Reflux/therapy
• Gastroesophageal Reflux/diagnosis
• Eructation/therapy
• Eructation/physiopathology
• Esophageal Motility Disorders/physiopathology
• Esophageal Motility Disorders/therapy
• Esophageal Motility Disorders/diagnosis
• Manometry/methods
• Proton Pump Inhibitors/therapeutic use
• Esophageal Sphincter, Lower/physiopathology
• Esophagogastric Junction/physiopathology

• Barrett’s esophagus
• esophageal adenocarcinoma
• gastroesophageal reflux disease
• hiatal hernia
• meta-analysis

• esophagogastric junction
• heartburn
• hernia
• hiatal
• manometry
• motility

Lower esophageal sphincter (LES) plays a key role in gastroesophageal reflux disease (GERD) pathogenesis. In retroflexion and under sufficient insufflation, it can be seen how the lower esophagus grasps the endoscope, which we named scope holding sign (SHS). This study aimed to compare the SHS and LES pressure on high‐resolution manometry (HRM), to elucidate whether the sphincter can be visualized endoscopically.

This was a single‐center, prospective pilot study. Patients with symptoms of GERD, who underwent endoscopy and HRM between February 2021 and April 2021, were included. A manometry catheter and an ultra‐slim endoscope were inserted, and the resting LES pressure was measured. The lower esophagus holding (SHS‐positive) and releasing (SHS‐negative) the endoscope and catheter were observed. The LES pressures during SHS‐positive and SHS‐negative were compared.

Eleven patients (median age: 57 years; eight men) with normal esophageal motility were analyzed. The median LES pressure in SHS‐positive was significantly higher than the resting LES pressure (40.4 [22.9–74.0] vs. 25.9 [2.0–66.7] mm Hg; p = 0.001) and the LES pressure in SHS‐negative (4.6 [1.5–9.3]; p = 0.001). Furthermore, the LES pressure in SHS‐negative was significantly lower than the resting LES pressure (4.6 [1.5–9.3] vs. 25.9 [2.0–66.7] mm Hg; p = 0.005).

This study demonstrated that the SHS parallels LES pressure, indicating that the sphincter can be observed endoscopically. This may enable us to evaluate LES function during endoscopy in patients with GERD, thus, deserving further evaluation in future studies.

In some patients, reflux at esophagogastric junction (EGJ) can be seen on the impedance portion of the high-resolution esophageal manometry with impedance (HREMI) studies. How this correlates with reflux on conventional esophageal reflux monitoring studies is unknown. We aimed to: (1) determine prevalence of reflux seen on HREMI, (2) correlate reflux during HREMI with reflux on esophageal reflux monitoring studies.

Patients undergoing HREMI and ambulatory reflux monitoring (7/2019 to 2/2020) were studied. Healthy volunteers (HVs) underwent HREMI.

Sixteen HVs underwent HREMI (no reflux on HREMI = 13, reflux on 1 swallow on HREMI = 3). Of 229 patients (mean age 56.4 ± 1.0, 68.1% females) undergoing HREMI, 47 (20.5%) had pathologic reflux at EGJ on HREMI (reflux on ≥ 2 swallows). The patients with reflux on HREMI had more frequent reflux events on multichannel intraluminal impedance-pH (MII-pH) than patients without reflux on HREMI (63.5 ± 7.1 vs 42.1 ± 2.3, p = 0.01). On ambulatory pH monitoring, 113 (49.3%) had GERD and 42 (18.3%) borderline results. Patients with reflux on HREMI more commonly had GERD (56.3% vs 48.6%) and borderline results (28.1% vs 18.3%) than patients without reflux on HREMI (p = 0.01). Reflux on ≥ 2 swallows on HREMI had a specificity of 83.6% and sensitivity of 24.8% for GERD. Reflux on ≥ 5 swallows on HREMI improved specificity to 91.4%, with sensitivity of 14.2% for GERD.

Amongst patients undergoing HREMI, 20.5% had pathologic reflux at EGJ on HREMI. Patients with reflux on HREMI more frequently had GERD on ambulatory pH monitoring. Reflux on HREMI had good specificity but low sensitivity for GERD.

• Esophageal manometry
• Esophagogastric junction
• GERD
• Impedance
• Reflux

Introduction: Several studies identified a link between gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA). GERD is a condition in which acid reflux from the stomach to the esophagus causes troublesome symptoms. On the other hand, OSA is defined as a sleep-related breathing disorder in which airflow significantly decreases or ceases due to upper airway obstruction, leading to arousal from sleep. OSA was found to be associated with GERD. In this study, we aim to study the characteristics and concurrent risk factors associated with GERD and OSA in a large population-based study.

Methods: Patients with the diagnosis of GERD were extracted from the National Inpatient Database (NIS) for the years 2016 to 2019. Patients' age, gender, race, and hospital information, including region and bed size, were extracted and considered as baseline characteristics. The comorbidities included are hypertension (HTN), atrial fibrillation (AFib), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), pulmonary hypertension (PHTN), obesity, and smoking. Patients younger than 18 years old were excluded from this study. 

Results: Out of 22,677,620 patients with the diagnosis of GERD, 12.21% had a concurrent diagnosis of OSA (compared to 4.79% in patients without GERD, p-value <0.001). The mean age of patients with GERD and OSA was 64.47 years vs 65.42 years in patients without OSA (p-value <0.001). The GERD and OSA group had almost identical gender distribution compared to the GERD only group, as it was predominantly female patients. The white and black races were slightly more prevalent in the GERD and OSA group compared to the GERD only group. Regarding comorbidities, the prevalence of obesity was more clear in the GERD and OSA group. It was noted that the group of patients who carry a diagnosis of GERD and OSA have more prevalence of diabetes (DM), hypertension (HTN), obesity, atrial fibrillation (Afib), congestive heart failure (CHF), and pulmonary hypertension (PHTN). Patients with GERD and OSA were 21% less likely to be older than 65 years rather than younger (95% CI: 0.79-0.8, p-value <0.001), 35% less likely to be females (95% CI: 0.65-0.65, p-value <0.001), and 22% less likely to be non-white (95% CI: 0.77-0.8, p-value <0.001). Obesity was found to be the strongest association with this population, followed by PHTN, CHF, DM, HTN, Afib, and lastly smoking.

Conclusion: Patients with GERD and OSA were found more likely to be female, white, living in the southern part of the United States, obese, diabetes mellitus type 2, and being active smokers. 

• gerd pathophysiology
• obstructive sleep apnea
• osa
• prevalance
• prevalence of gerd

• Bariatric Surgery
• Barrett’s Esophagus
• Esophageal Adenocarcinoma
• Reflux

• P30 CA008748 NCI NIH HHS

• Biliopancreatic diversion with duodenal switch
• Gastro-esophageal
• Laparoscopic
• Reflux

• endoscopic diagnosis
• endoscopy
• esophagus
• gastroesophageal reflux disease

• LES and EGJ opening
• distension-induced EGJ relaxation
• energy
• mechanical work
• pressure-volume work

• Bariatric surgery
• Laparoscopic sleeve gastrectomy
• Omentopexy

• Esophagogastric junction
• Gastroesophageal reflux
• High-resolution manometry
• Lower esophageal sphincter
• Swallow-induced transient hiatal hernia
• tHH

• Barrett’s esophagus
• diagnosis
• endoscopy
• erosive esophagitis
• gastroesophageal reflux

Gastroesophageal reflux disease (GERD) affects approximately 20% of Australians. Patients suffer a burning sensation known as heartburn due to the movement of acidic stomach content into the esophagus. There is anecdotal evidence of the effectiveness of prebiotic sugarcane flour in controlling symptoms of GERD. This pilot study aimed to investigate the effectiveness of a prebiotic sugarcane flour in alleviating symptoms in medically-diagnosed GERD patients. This pilot study was a single center, double-blinded, placebo-controlled randomized trial conducted on 43 eligible participants. The intervention group (n = 22) were randomized to receive 3 g of sugarcane flour per day, and the control group (n = 21) received 3 g of cellulose placebo per day. Symptoms of gastroesophageal reflux disease were assessed before and after three weeks treatment using the validated Gastroesophageal Reflux Disease-Health Related Quality of Life questionnaire (GERD-HRQL). After three weeks there were significant differences in symptoms for heartburn, regurgitation, and total symptoms scores (p < 0.05) between the sugarcane flour and placebo. Mean GERD-HRQL scores increased in the placebo group for regurgitation (mean increase 1.7; 95% CI 0.23 to 3.2; p = 0.015) and total symptom scores (2.9; 95% CI 0.26 to 5.7; p = 0.033). In contrast, there were significant reductions in heartburn (mean decrease −2.2; 95% CI −4.2 to −0.14; p = 0.037) and total symptom scores (−3.7; 95% CI −7.2 to −0.11; p = 0.044) in the intervention group. This pilot study has shown significant positive effects of sugarcane flour in the reduction of GERD symptoms, and a larger randomized controlled trial is warranted.

• dietary fiber
• gastroesophageal reflux disease
• heartburn
• regurgitation
• sugarcane flour

• Crural diaphragm
• Esophagogastric junction
• Gastroesophageal reflux disease
• Hiatal hernia

• Biomarkers
• Case-Control Studies
• Chromosomes, Human, Pair 6/genetics
• Esophageal Mucosa/diagnostic imaging
• Esophageal Mucosa/pathology
• Esophagitis, Peptic/diagnosis
• Esophagitis, Peptic/epidemiology
• Esophagitis, Peptic/genetics
• Esophagitis, Peptic/pathology
• Esophagoscopy
• Female
• Gastroesophageal Reflux/complications
• Gastroesophageal Reflux/genetics
• Genetic Loci
• Genetic Predisposition to Disease
• Genome-Wide Association Study
• Humans
• Male
• Middle Aged
• Polymorphism, Single Nucleotide
• Predictive Value of Tests
• Prevalence
• Receptors, Kainic Acid/genetics
• Republic of Korea/epidemiology
• Risk Assessment/methods
• Severity of Illness Index
• Sex Factors
• GluK2 Kainate Receptor

• Coffee
• Gastroesophageal reflux disease
• Helicobacter pylori
• Hiatus hernia
• Tea

• GERD
• adiponectin
• comorbidity
• leptin
• obesity
• оverweight

Central obesity is suggested as a risk factor for gastroesophageal reflux diseases. The aim of this study was to evaluate the influences of a visceral fat area on the site of mucosal breaks in the esophagogastric junction (EGJ).

Subjects who underwent abdomen-computerized tomography and esophagogastroduodenoscopy for screening on the same day were evaluated between 2007 and 2016. We enrolled 178 subjects who had erosive esophagitis (LA classifications A-D). Abdominal obesity was evaluated by measuring visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), VAT-to-SAT ratio, total adipose tissue (TAT), body mass index (BMI), and waist circumference (WC).

The lesser curvature (LC) of EGJ was the most frequent site of mucosal breaks (104 cases, 58.4%). BMI, WC, VAT, the VAT-to-SAT ratio, and TAT were higher in the LC group. In multivariate analysis, higher VAT (odds ratio (OR) 2.90, 95% confidence interval (CI) 1.18 to 7.13, 3rd vs. 1st quartile, P = 0.021; OR 3.63, 95% CI 1.44 to 9.10, 4th vs. 1st quartile, P = 0.006) and the VAT/SAT ratio (OR 2.91, 95% CI 1.11 to 7.61, 3rd vs. 1st quartile, P = 0.03; OR 3.02, 95% CI 1.17 to 7.83, 4th vs. 1st quartile, P = 0.023) were significantly associated with mucosal breaks in the LC group. However, BMI, WC, and TAT were not significant in the multivariate analysis.

The VAT and the VAT/SAT ratio were significantly associated with the mucosal breaks in the LC of EGJ. Visceral obesity could influence the location of the mucosal breaks on EGJ.

Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder with an increasing prevalence. GERD develops when the reflux of stomach contents causes troublesome typical and atypical symptoms and/or complications. Several risk factors of GERD have been identified and evaluated over the years, including a considerable amount of genetic factors. Multiple mechanisms are involved in the pathogenesis of GERD including: (1) motor abnormalities, such as impaired lower esophageal sphincter (LES) resting tone, transient LES relaxations, impaired esophageal acid clearance and delayed gastric emptying; and (2) anatomical factors, such as hiatal hernia and obesity. Genetic contribution seems to play a major role in GERD and GERD- related disorders development such Barrett’s esophagus and esophageal adenocarcinoma. Twin and family studies have revealed an about 31% heritability of the disease. Numerous single-nucleotide polymorphisms in various genes like FOXF1, MHC, CCND1, anti-inflammatory cytokine and DNA repair genes have been strongly associated with increased GERD risk. GERD, Barrett’s esophagus and esophageal adenocarcinoma share several genetic loci. Despite GERD polygenic basis, specific genetic loci such as rs10419226 on chromosome 19, rs2687201 on chromosome 3, rs10852151 on chromosome 15 and rs520525 on the paired related homeobox 1 gene have been mentioned as potential risk factors. Further investigation on the risk genes may elucidate their exact function and role and demonstrate new therapeutic approaches to this increasingly common disease.

• Single nucleotide polymorphisms
• Genetic risk loci
• Risk factors
• Gastroesophageal reflux disease
• Gastroesophageal reflux disease development

• Acotiamide
• Esophageal motility
• Esophagogastric junction
• Gastroesophageal reflux disease
• Manometry

• Hiatal hernia
• barium esophagogram
• esophagogastric junction
• high resolution manometry
• upper endoscopy

• Endoscopy
• Fundoplication
• Gastroesophageal junction anatomy
• Gastroesophageal valve
• Post-fundoplication
• Redo fundoplication

• Central obesity
• gastroesophageal reflux
• risk factor

• Demography
• Endoscopy, Digestive System
• Female
• Gastroesophageal Reflux/etiology
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Obesity, Abdominal/complications
• Propensity Score
• Risk Factors
• Surveys and Questionnaires

• Roux-en-Y gastric bypass
• gastroesophageal reflux disease
• laparoscopic fundoplication
• morbid obesity
• sleeve gastrectomy
• transdiaphragmatic pressure gradient

• Bariatric Surgery/methods
• Esophagogastric Junction/surgery
• Fundoplication
• Gastroesophageal Reflux/complications
• Gastroesophageal Reflux/surgery
• Humans
• Obesity, Morbid/complications
• Obesity, Morbid/surgery

• GERD
• HRM
• TLESR
• intra-bolus pressure
• trans-sphincteric pressure gradient

• GERD
• NERD
• belching
• esophagitis
• reflux

AIM: To investigate the functional change of esophageal motility in hiatal hernia (HH) patients using high resolution esophageal manometry (HRM), in order to determine the possible pathogenesis of HH and provide more evidence for detection and treatment of HH.

METHODS: We performed a retrospective study of 66 patients with hiatal hernia who underwent HRM from June 2014 to April 2015 as well as upper endoscopy and/or barium esophagogram within 3 mo at our hospital. Among them, 31 patients were diagnosed with reflux esophagitis (RE) by endoscopy. Besides, we selected 28 healthy volunteers as controls to compare clinical characteristics and HRM data between the three groups.

RESULTS: In total there were 35 patients with HH alone (Group A), of whom 16 had typical symptoms including acid reflux and heartburn, 12 suffered main symptoms resembling retrosternal pain, and the remainder had typical symptoms including dysphagia and belching. After HRM, 4 of them were diagnosed with esophagogastric junction (EGJ) outflow obstruction, 1 with severe esophageal motility disorder, and 9 with mild esophageal motility disorder. In total there were 31 patients with RE (Group B), of whom 20 had typical symptoms including acid reflux and heartburn, 6 suffered main symptoms resembling retrosternal pain, and the remainder had typical symptoms including dysphagia and belching. After HRM, 2 of them were diagnosed with esophagogastric junction (EGJ) outflow obstruction, 3 with severe esophageal motility disorder, and 10 with mild esophageal motility disorder. There was no significant difference in the above findings between groups A and B (P > 0.05). Lower esophageal sphincter (LES) pressure in groups A and B was significantly lower than that in the control group (P = 0.016), especially group A (13.43 mmHg ± 8.75 mmHg vs 21.66 mmHg ± 7.19 mmHg, P = 0.004). Upper esophageal sphincter (UES) pressure had no significant difference among the three groups (P = 0.854). However, the morbidity of UES hypotensive pressure was significantly higher in group A than the control group (25.7% vs 3.6%, P = 0.041).

CONCLUSION: About 40% of HH patients have esophageal motility disorders. HH patients have significantly lower LES and UES pressure than the health group. The reduced LES and UES pressure and esophageal motility disorder may play a crucial role in reflux events and even result in esophageal mucosal injury. HRM can provide accurate and exhaustive data to guide diagnosis and evaluate prognosis.

• Hiatal hernia
• High resolution esophageal manometry
• Esophageal motility
• Upper esophageal sphincter
• Lower esophageal sphincter

Prokinetic drugs such as metoclopramide are frequently used as second-line therapy for patients with gastroesophageal reflux disease. However, their beneficial effects remain unclear. Esophageal motor activities and compliance of the esophagogastric junction (EGJ) are important for prevention of gastroesophageal reflux. Although metoclopramide has been reported to increase lower esophageal sphincter (LES) pressure, its effects on EGJ compliance have not been evaluated. In the present study, we investigated the effects of metoclopramide on esophageal motor activities and EGJ compliance.

Nine healthy male volunteers without abdominal symptoms were enrolled. Peristaltic esophageal contractions and LES pressure were examined using high-resolution esophageal manometry, while EGJ compliance was evaluated with an endoluminal functional lumen-imaging probe. After obtaining baseline values for esophageal motor activities and EGJ compliance, metoclopramide (10 mg) was intravenously administered, then all measurements were repeated at 15 minutes after administration in each subject.

Following administration of metoclopramide, mean resting LES pressure was significantly increased as compared with the baseline (13.7 ± 9.2 vs 26.7 ± 8.8 mmHg, P < 0.05). In addition, metoclopramide significantly augmented peristaltic contractions, especially in the distal esophageal segment (P < 0.05). On the other hand, distensibility index did not change after administration (4.5 ± 0.5 vs 4.1 ± 0.5 mm²/mmHg), suggesting no significant effect of metoclopramide on EGJ compliance.

Metoclopramide augmented esophageal contractions without changing EGJ compliance in healthy adults.

• Esophageal sphincter
• Esophagogastric junction
• Manometry
• Metoclopramide
• Motor Activity
• lower

• GERD
• hiatus hernia
• lower esophageal sphincter
• pathophysiology
• reflux perception

• GERD
• esophagogastric junction
• high-resolution manometry
• impedance monitoring