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Refractory reflux disease

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https://www.readbyqxmd.com/read/29681623/lack-of-improvement-of-impaired-chemical-clearance-characterizes-ppi-refractory-reflux-related-heartburn
#1
Marzio Frazzoni, Leonardo Frazzoni, Salvatore Tolone, Nicola De Bortoli, Vincenzo Savarino, Edoardo Savarino
OBJECTIVE: Heartburn is the most specific symptom of reflux disease and is highly responsive to proton pump inhibitor (PPI) therapy. Some patients do not respond to PPIs, but mechanisms of refractoriness have not yet been fully elucidated. Impedance-pH monitoring, allowing comprehensive on-therapy assessment of reflux, represents a valuable test to investigate PPI refractoriness. METHODS: Prospective multicenter study comparing endoscopy-negative patients with PPI-refractory and PPI-responsive heartburn...
April 23, 2018: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/29679337/revisional-bariatric-surgery-for-weight-regain-and-refractory-complications-in-a-single-mbsaqip-accredited-center-what-are-we-dealing-with
#2
Jeffrey Qiu, Peter W Lundberg, T Javier Birriel, Leonardo Claros, Jill Stoltzfus, Maher El Chaar
BACKGROUND: Revisional surgery is the fastest growing area in bariatric surgery, constituting 13.6% of all procedures performed as of 2015. This reflects a rising need to treat adverse sequelae of primary bariatric procedures. Despite the increase in revisions, their safety and efficacy remain controversial. The objective of this study is to review the experience of revisional bariatric surgery in our center and the relevant literature to date. METHODS: We performed an IRB-approved review of prospectively collected data from all patients undergoing revisional bariatric surgery between 2012 and 2015...
April 20, 2018: Obesity Surgery
https://www.readbyqxmd.com/read/29625507/efficacy-of-transoral-incisionless-fundoplication-for-refractory-gastroesophageal-reflux-disease-a-systematic-review-and-meta-analysis
#3
Thomas R McCarty, Michael Itidiare, Basile Njei, Tarun Rustagi
BACKGROUND:  Given poor symptomatic response rates and rising awareness of the adverse events associated with the long-term use of proton pump inhibitors (PPIs), endoscopic modalities for treatment of refractory gastroesophageal reflux disease (GERD) have become more prominent. The aim of this study was to perform a systematic review and meta-analysis to evaluate feasibility, efficacy, and tolerability of transoral incisionless fundoplication (TIF) for the treatment of refractory GERD...
April 6, 2018: Endoscopy
https://www.readbyqxmd.com/read/29606884/proton-pump-inhibitor-refractory-gastroesophageal-reflux-disease-challenges-and-solutions
#4
REVIEW
Joseph Mermelstein, Alanna Chait Mermelstein, Maxwell M Chait
A significant percentage of patients with gastroesophageal reflux disease (GERD) will not respond to proton pump inhibitor (PPI) therapy. The causes of PPI-refractory GERD are numerous and diverse, and include adherence, persistent acid, functional disorders, nonacid reflux, and PPI bioavailability. The evaluation should start with a symptom assessment and may progress to imaging, endoscopy, and monitoring of esophageal pH, impedance, and bilirubin. There are a variety of pharmacologic and procedural interventions that should be selected based on the underlying mechanism of PPI failure...
2018: Clinical and Experimental Gastroenterology
https://www.readbyqxmd.com/read/29567054/electrical-stimulation-of-the-lower-esophageal-sphincter-to-address-gastroesophageal-reflux-disease-after-sleeve-gastrectomy
#5
Yves Borbély, Nicole Bouvy, Henning G Schulz, Leonardo Antonio Rodriguez, Camilo Ortiz, Alejandro Nieponice
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) can result in de novo and worsen preexisting gastroesophageal reflux disease (GERD). Post-LSG patients with GERD refractory to proton pump inhibitors (PPI) usually undergo more invasive, anatomy-altering Roux-en-Y gastric bypass surgery. Lower esophageal sphincter (LES) electrical stimulation (ES) preserves the anatomy and has been shown to improve outcomes in GERD patients. OBJECTIVE: To evaluate the safety and efficacy of LES-ES in post-LSG patients with GERD not controlled with maximal PPI therapy...
February 26, 2018: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/29509533/new-minimally-invasive-endoscopic-and-surgical-therapies-for-gastroesophageal-reflux-disease-gerd
#6
Alexandru Eugen Nicolau, Adrian Lobonţiu, Silviu Constantinoiu
GERD has become one of the most frequent pathology of the upper GI tract. It is a spectrum disease and is a progressive disease as well. Serious and severe complications are possible. The mainstream therapy in most of the patients is the medical therapy with PPI's. The most severe cases with an impaired LES (Lower Esophageal Sphincter) function as well as important anatomical disruptions are of surgical indication, the gold standard being laparoscopic fundoplication, an elective therapy with long term follow up outcomes at the expense of de novo symptoms associated with fundoplications in general...
January 2018: Chirurgia
https://www.readbyqxmd.com/read/29488430/endoscopic-management-of-refractory-gastroesophageal-reflux-disease
#7
Waseem M Seleem, Amr Shaaban Hanafy, Samir I Mohamed
OBJECTIVE: Despite the therapeutic and surgical interventions for the management of gastroesophageal reflux disease (GERD), yet the high cost and the post-operative complications had led to a significant socioeconomic burden. The aim was to evaluate the safety and efficacy of endoscopic band ligation (EBL) in the management of refractory GERD. METHODS: A total of 150 patients with refractory GERD were assigned to an EBL group (banding was done at four quadrants just at the gastroesophageal junction (GEJ) (n = 75) or to a control group (optimized dose of PPI, n = 75)...
February 28, 2018: Scandinavian Journal of Gastroenterology
https://www.readbyqxmd.com/read/29447372/small-fiber-polyneuropathy-is-prevalent-in-patients-experiencing-complex-chronic-pelvic-pain
#8
Annie Chen, Elise De, Charles Argoff
Objective: To demonstrate the prevalence of small fiber polyneuropathy (SFPN) in patients with refractory chronic pelvic pain (CPP). Design: Retrospective study of prospective database. Subjects: Participants were complex CPP patients recruited from subspecity referral clinics defined as those who were refractory to initial treatment and/or exhibited comorbid pain syndromes at initial presentation. Methods: Comprehensive treatment history for CPP was obtained, and participants referred as above; 3-mm punch biopsies were obtained of the lower extremity and sent to diagnostic reference labs to evaluate for SFPN...
February 13, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29435273/efficacy-of-vonoprazan-for-24-week-maintenance-therapy-of-patients-with-healed-reflux-esophagitis-refractory-to-proton-pump-inhibitors
#9
Hideki Mizuno, Kazutoshi Yamada, Keiji Minouchi, Shinji Kamiyamamoto, Yoshinobu Hinoue
The aim of the present study was to evaluate the efficacy of a potassium-competitive acid blocker (P-CAB), vonoprazan, for the maintenance therapy of healed reflux esophagitis (RE). A total of 60 patients were enrolled in this open-label, single-center, prospective study. All patients were diagnosed with RE with a frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) total score ≥8 following treatment with standard proton pump inhibitors (PPIs) for a minimum of 8 weeks. Standard PPI treatment was switched to vonoprazan 20 mg once daily for 4 weeks...
February 2018: Biomedical Reports
https://www.readbyqxmd.com/read/29405886/the-tempo-trial-at-5-years-transoral-fundoplication-tif-2-0-is-safe-durable-and-cost-effective
#10
Karim S Trad, William E Barnes, Elizabeth R Prevou, Gilbert Simoni, Jennifer A Steffen, Ahmad B Shughoury, Mamoon Raza, Jeffrey A Heise, Mark A Fox, Peter G Mavrelis
BACKGROUND: Questions remain about the therapeutic durability of transoral incisionless fundoplication (TIF). In this study, clinical outcomes were evaluated at 5 years post-TIF 2.0. METHODS: A total of 63 chronic gastroesophageal reflux disease (GERD) sufferers with troublesome symptoms refractory to proton pump inhibitor (PPI) therapy, absent or ≤2 cm hiatal hernia, and abnormal esophageal acid exposure were randomized to the TIF group or PPI group. Following the 6-month evaluation, all patients in the PPI group elected for crossover to TIF; therefore, all 63 patients underwent TIF 2...
February 1, 2018: Surgical Innovation
https://www.readbyqxmd.com/read/29372566/symptom-association-probability-does-not-reliably-distinguish-functional-heartburn-from-reflux-hypersensitivity
#11
Y Choksi, J C Slaughter, R Sharda, T Higginbotham, P Lal, M F Vaezi
BACKGROUND: Symptom association probability (SAP) is thought to distinguish reflux hypersensitivity from functional disorders. A diagnosis of hypersensitive oesophagus (SAP-positive) indicates that gastro-oesophageal reflux disease (GERD) is the cause of continued symptoms. AIM: To conduct an analysis of pH and symptom criteria that lead to a diagnosis of SAP-positivity METHODS: We calculated SAP for 205 patients with GERD symptoms refractory to proton pump inhibitor (PPI) therapy who underwent endoscopy with wireless pH monitoring from 2007 to 2014...
April 2018: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29352757/refractory-heartburn-a-challenging-problem-in-clinical-practice
#12
REVIEW
Gerson Domingues, Joaquim Prado P Moraes-Filho, Ronnie Fass
Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Heartburn and regurgitation are the typical symptoms of GERD. The treatment of GERD encompasses lifestyle modifications, pharmacological, endoscopic, and surgical therapy. The majority of the patients respond to 4-8 weeks of proton-pump inhibitors therapy, but 20-42% will demonstrate partial or complete lack of response to treatment. While these patients have been considered as having refractory heartburn, a subset of them does not have GERD or have not been adequately treated...
March 2018: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/29346118/mycobacterium-avium-complex-pulmonary-disease-new-epidemiology-and-management-concepts
#13
Leah Lande, Jason George, Theodore Plush
PURPOSE OF REVIEW: The prevalence of Mycobacterium avium complex (MAC)-related pulmonary disease has been increasing because of environmental factors, changes in organism virulence, and evolving host susceptibility. Treatment is often complicated by adverse effects, development of drug resistance, and refractory disease, with recurrence rates as high as 25-45%. RECENT FINDINGS: Aerosolization of water, soil, or dusts are the likely sources of MAC-related pulmonary disease in susceptible individuals...
April 2018: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/29340828/hiatal-hernia-recurrence-following-magnetic-sphincter-augmentation-and-posterior-cruroplasty-intermediate-term-outcomes
#14
Kais A Rona, James M Tatum, Joerg Zehetner, Katrin Schwameis, Carol Chow, Kamran Samakar, Adrian Dobrowolsky, Caitlin C Houghton, Nikolai Bildzukewicz, John C Lipham
BACKGROUND: We have previously reported short-term outcomes after hiatal hernia repair (HHR) at the time of magnetic sphincter augmentation (MSA) for gastroesophageal reflux disease (GERD). Here we report intermediate-term outcomes and hernia recurrence rate after concomitant MSA and HHR. METHODS: This is a retrospective cohort study of patients who underwent repair of a hiatal hernia 3 cm or larger at the time of MSA implantation between May 2009 and December 2015...
January 16, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29282192/mast-cell-activation-syndrome
#15
Owen N Kramer, Marla S Barkoff, Claudia Hernandez
A 51-year-old woman with a history of asthma and Hashimoto's thyroiditis presented to the dermatology service with a chief complaint of "itchy bumpy rashes" that persisted beyond 24 hours. She noted that, 3 days prior to the onset of urticaria, a pyrroloquinoline quinone supplement had been started. The urticaria was accompanied by variable episodes of transient facial swelling and difficulty breathing. The patient noted that exposure to fish, nuts, and nonsteroidal anti-inflammatory drugs triggered facial swelling...
2017: Skinmed
https://www.readbyqxmd.com/read/29275582/-effect-analysis-on-deanxit-combined-with-shuganjieyu-capsule-in-the-treatment-of-refractory-gastroesophageal-reflux-disease
#16
X Y Yang, C Y Guo, X Zhang, Y Q Zhong, C Tian
Objective: To investigate the curative effect of Deanxit combined with Shuganjieyu capsule on the treatment of refractory gastroesophageal reflux disease. Methods: A total of 125 patients with refractory gastroesophageal reflux disease who had failed in standard lansolazole capsule treatment in the Department of Gastroenterology, First People's Hospital of Neijiang were selected. According to the symptom scores and mood scores of gastroesophageal reflux disease, patients were randomly and double-blindly divided into five groups...
November 28, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29234939/the-role-of-preoperative-high-resolution-manometry-in-predicting-dysphagia-after-laparoscopic-nissen-fundoplication
#17
Sonam Kapadia, Turner Osler, Allen Lee, Edward Borrazzo
BACKGROUND: Laparoscopic fundoplication is an accepted surgical management of refractory gastro-esophageal reflux disease (GERD). The use of high resolution esophageal manometry (HRM) in preoperative evaluation is often applied to determine the degree of fundoplication to optimize reflux control while minimizing adverse sequela of postoperative dysphagia. OBJECTIVE: Assess the role of preoperative HRM in predicting surgical outcomes, specifically risk assessment of postoperative dysphagia and quality of life, among patients receiving laparoscopic Nissen fundoplication for GERD with immediate postoperative (< 4 weeks clinic), short-term (3-month clinic), and long-term (34 ± 10...
December 12, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/29209919/association-between-cyp2c19-extensive-metabolizer-phenotype-and-childhood-anti-reflux-surgery-following-failed-proton-pump-inhibitor-medication-treatment
#18
James P Franciosi, Edward B Mougey, Andre Williams, Roberto A Gomez Suarez, Cameron Thomas, Christa L Creech, Katherine George, Diana Corao, John J Lima
When pediatric gastroesophageal reflux disease (GERD) that is refractory to proton pump inhibitor (PPI) medication treatment is identified in clinical practice and anti-reflux surgery (ARS) is being considered, genetic factors related to PPI metabolism by the CYP2C19 enzyme are currently not part of the clinical decision-making process. Our objective was to test the hypothesis that the distribution of the extensive metabolizer (EM) phenotypes among children undergoing ARS after failing PPI therapy would differ compared to controls (children with no history of ARS)...
January 2018: European Journal of Pediatrics
https://www.readbyqxmd.com/read/29201809/long-esophageal-stricture-in-a-brittle-diabetic
#19
Stella C Pak, Umar Darr, Yaseen Alastal, Youngsook Yoon
Aim: We report a case of atypical esophageal stricture in a young diabetic woman. Background: Diabetes mellitus and gastroesophageal reflux disease (GERD) are two common disorders in modern society. Case report: A young diabetic woman developed a 6-cm-long esophageal stricture. This stricture was refractory to multiple esophageal dilation procedures. She underwent subtotal esophagectomy and had excellent treatment outcome. Conclusion: Gastroesophageal reflux disease can cause severe long esophageal stricture in a brittle diabetic...
July 2017: Euroasian Journal of Hepato-Gastroenterology
https://www.readbyqxmd.com/read/29199161/indications-of-24-h-esophageal-ph-monitoring-capsule-ph-monitoring-combined-ph-monitoring-with-multichannel-impedance-esophageal-manometry-radiology-and-scintigraphy-in-gastroesophageal-reflux-disease
#20
Rukiye Vardar, Muharrem Keskin
Ambulatory esophageal pH monitoring is an essential method in patients exhibiting signs of non-erosive reflux disease (NERD) to make an objective diagnosis. Intra-esophageal pH monitoring is important in patients who are non-responsive to medications and in those with extraesophageal symptoms, particularly in NERD, before surgical interventions. With the help of the wireless capsule pH monitoring, measurements can be made under more physiological conditions as well as longer recordings can be performed because the investigation can be better tolerated by patients...
December 2017: Turkish Journal of Gastroenterology: the Official Journal of Turkish Society of Gastroenterology
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