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Refractory reflux disease

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https://www.readbyqxmd.com/read/28427116/current-trends-in-the-management-of-gastroesophageal-reflux-disease
#1
REVIEW
Dalbir S Sandhu, Ronnie Fass
Gastroesophageal reflux disease (GERD) defined as heartburn and/or regurgitation is one of the most common gastrointestinal disorder managed by gastroenterologists and primary care physicians. There is an increase in GERD prevalence since 1995 particularly in North America and East Asia. Over the past three decades proton pump inhibitors (PPIs) had become the mainstay medical therapy for management of GERD. However, over the last decade there is an increasing awareness amongst physicians and patient population regarding the side effects of otherwise considered safe PPIs...
April 24, 2017: Gut and Liver
https://www.readbyqxmd.com/read/28405322/specific-dyspeptic-symptoms-are-associated-with-poor-response-to-therapy-in-patients-with-gastroesophageal-reflux-disease
#2
A D'Alessandro, F P Zito, M Pesce, P Andreozzi, E Efficie, M Cargiolli, F Maione, G D De Palma, R Cuomo, G Sarnelli
INTRODUCTION: In patients with gastroesophageal reflux disease (GORD), co-existence of functional dyspepsia (FD) is known to be associated with poor response to proton pump inhibitors (PPIs), but the contribution of specific dyspepsia symptoms has not yet been systematically investigated. OBJECTIVE: We aimed to characterize the impact of dyspepsia symptoms on response to PPIs in patients with GORD. METHODS: The enrolled subjects were consecutive patients with a diagnosis of GORD...
February 2017: United European Gastroenterology Journal
https://www.readbyqxmd.com/read/28393826/-possibilities-of-ph-impedance-and-high-resolution-manometry-in-managing-patients-with-refractory-gastroesophageal-reflux-disease
#3
I V Maev, E V Barkalova, M A Ovsepyan, Yu A Kucheryavyi, D N Andreev
Gastroesophageal reflux disease (GERD) is a common condition that has a substantial impact on quality of life in patients and is a leading risk factor for esophageal adenocarcinoma. Now therapy with proton pump inhibitors (PPIs) is a basic method in the treatment of patients with GERD; however, one third of the patients do not respond to the therapy used. The causes of refractory GERD are a fairly large group of heterogeneous factors contributing to the inefficacy of PPIs in adequate dosage. Among these factors, there is low compliance by patients to the prescribed treatment regimen; nocturnal acid breakthrough; СУР2С19 gene polymorphism; chiasm syndrome with functional diseases of the gastrointestinal tract; non-acidic refluxes in a patient; thoracic esophageal motility disorders; the increased number and duration of transient lower esophageal sphincter relaxation periods; hiatus hernia; and misdiagnosis...
2017: Terapevticheskiĭ Arkhiv
https://www.readbyqxmd.com/read/28387090/-how-to-approach-a-chronic-cough
#4
R Louis
Cough is the most common symptom for which patients seek medical attention. Chronic cough is defined when the symptom lasts for more than 8 weeks. It significantly alters quality of life. Chronic cough may be the dominant symptom which reveals a large number of diseases, not only respiratory. It is classic to distinguish chronic cough according to the chest X Ray results. In case of normal chest X ray, which is the most frequent condition, the diagnosis of tobacco-associated chronic bronchitis, drug induced cough, asthma, oesophageal reflux and rhinosinusitis should be considered...
February 2017: Revue Médicale de Liège
https://www.readbyqxmd.com/read/28367330/factors-predicting-renal-function-outcome-after-augmentation-cystoplasty
#5
Shahbaz Mehmood, Raouf Seyam, Sadia Firdous, Waleed Mohammad Altaweel
We determined the cause of renal deterioration after augmentation cystoplasty (AC). Twenty-nine adult patients with refractory bladder dysfunction and who underwent ileocystoplasty from 2004 to 2015 were studied. Patients with a decline in glomerular filtration rate (GFR) after augmentation were reviewed. The primary outcome was to determine the factors that might lead to deterioration of estimated GFR. Median follow-up was 7.0 ± 2.6 years. Significant bladder capacity, end filling pressure, and bladder compliance were achieved from median 114 ± 53...
2017: International Journal of Nephrology
https://www.readbyqxmd.com/read/28366995/effects-of-rikkunshito-on-quality-of-life-in-patients-with-gastroesophageal-reflux-disease-refractory-to-proton-pump-inhibitor-therapy
#6
Takashi Kawai, Yoji Hirayama, Aiko Oguchi, Fumi Ishii, Masanao Matushita, Naoya Kitayama, Shinji Morishita, Noboru Hiratsuka, Ken Ohata, Hiroyuki Konishi, Maiko Kishino, Shinichi Nakamura
We investigated the effects of rikkunshito, in combination with a proton pump inhibitor, on symptoms and quality of life in patients with proton pump inhibitor-refractory gastroesophageal reflux disease. The subjects were 47 patients with gastroesophageal reflux disease with residual symptoms such as heartburn following 8 weeks of proton pump inhibitor therapy. We administered these subjects rikkunshito in combination with a proton pump inhibitor for 6-8 weeks. We scored their symptoms of heartburn, fullness, abdominal discomfort, and abdominal pain, and surveyed their quality of life using the Reflux Esophagitis Symptom Questionnaire, comprising questions concerning daily activities, meals (changes in amount and favorite foods), and sleep (getting to sleep and early morning waking)...
March 2017: Journal of Clinical Biochemistry and Nutrition
https://www.readbyqxmd.com/read/28363401/neutrophilic-steroid-refractory-recurrent-wheeze-and-eosinophilic-steroid-refractory-asthma-in-children
#7
Tamazoust Guiddir, Philippe Saint-Pierre, Elsa Purenne-Denis, Nathalie Lambert, Yacine Laoudi, Rémy Couderc, Rahelé Gouvis-Echraghi, Flore Amat, Jocelyne Just
BACKGROUND: Little is known about inflammatory pathways of severe recurrent wheeze in preschool children and severe asthma in children. OBJECTIVES: The aim of the Severe Asthma Molecular Phenotype cohort was to characterize phenotypes of severe recurrent wheeze and severe asthma during childhood in terms of triggers (allergic or not), involved cells (eosinophil or neutrophil), and corticoid responsiveness. METHODS: Children with moderate-to-severe asthma and preschool children with moderate-to-severe recurrent wheeze were enrolled prospectively...
March 28, 2017: Journal of Allergy and Clinical Immunology in Practice
https://www.readbyqxmd.com/read/28336550/the-effect-of-intravenous-corticotropin-releasing-hormone-administration-on-esophageal-sensitivity-and-motility-in-health
#8
Charlotte Broers, Chloé Melchior, Lukas Van Oudenhove, Tim Vanuytsel, Brecht Van Houtte, Charlotte Scheerens, Nathalie Rommel, Jan F Tack, Ans Pauwels
BACKGROUND: Esophageal hypersensitivity is important in gastro-esophageal reflux disease (GERD) patients refractory to acid-suppressive therapy. Stress affects visceral sensitivity and exacerbates heartburn in GERD. Peripheral CRH is a key mediator of the gut stress response. We hypothesize that CRH increases esophageal sensitivity and alters esophageal motility in health. METHODS: Esophageal sensitivity to thermal, mechanical, electrical and chemical stimuli was assessed in 14 healthy subjects after placebo or CRH (100μg IV)...
March 23, 2017: American Journal of Physiology. Gastrointestinal and Liver Physiology
https://www.readbyqxmd.com/read/28294958/seventeen-year-outcome-of-a-randomized-clinical-trial-comparing-laparoscopic-and-conventional-nissen-fundoplication-a-plea-for-patient-counseling-and-clarification
#9
Jelmer E Oor, David J Roks, Joris A Broeders, Eric J Hazebroek, Hein G Gooszen
OBJECTIVE: To analyze long-term outcome of a randomized clinical trial comparing laparoscopic Nissen fundoplication (LNF) and conventional Nissen fundoplication (CNF) for the treatment of gastroesophageal reflux disease (GERD). BACKGROUND: LNF has replaced CNF, based on positive short and mid-term outcome. Studies with a follow-up of over 15 years are scarce, but are desperately needed for patient counselling. METHODS: Between 1997 and 1999, 177 patients with proton pump inhibitor (PPI)-refractory GERD were randomized to CNF or LNF...
December 6, 2016: Annals of Surgery
https://www.readbyqxmd.com/read/28270118/a-case-of-type-1-multiple-endocrine-neoplasia-with-esophageal-stricture-successfully-treated-with-endoscopic-balloon-dilation-and-local-steroid-injection-combined-with-surgical-resection-of-gastrinomas
#10
Hiroyuki Matsubayashi, Noboru Kawata, Naomi Kakushima, Masaki Tanaka, Kohei Takizawa, Yoshimi Kiyozumi, Yasue Horiuchi, Keiko Sasaki, Teiichi Sugiura, Katsuhiko Uesaka, Hiroyuki Ono
BACKGROUND: In type 1 multiple endocrine neoplasia (MEN1), esophageal diseases association with excessive gastrin secretion in Zollinger-Ellison syndrome (ZES) sometimes develop. Here, we reported a case of MEN1/ZES, who developed dysphagia due to reflux esophagitis with severe esophageal stricture. Treatment for his esophageal stricture and ZES was discussed. CASE PRESENTATION: A 43-year-old man with progressive dysphagia and diarrhea was referred to the teaching hospital...
March 7, 2017: BMC Gastroenterology
https://www.readbyqxmd.com/read/28260353/is-there-a-role-for-high-resolution-manometry-in-gerd-diagnosis
#11
Salvatore Tolone, Edoardo Savarino, Ludovico Docimo
Gastroesophageal reflux disease (GERD) is a condition, which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. In patients with alarm symptoms or signs or in those refractory to antiacid therapy, it is indicated to perform instrumental tests to correctly diagnose GERD presence. Esophageal manometry is currently considered the gold standard test for the diagnosis of esophageal dysmotility. However, it has shown limited capability in diagnosing GERD. With the advent of high resolution manometry (HRM), more accurate evaluations of esophageal motility are now possible...
March 3, 2017: Minerva Gastroenterologica e Dietologica
https://www.readbyqxmd.com/read/28260352/extra-esophageal-presentation-of-gerd-new-understanding-in-a-new-era
#12
Irene Martinucci, Eleonora Albano, Santino Marchi, Corrado Blandizzi
Associations of gastroesophageal reflux disease (GERD) with extraesophageal manifestations, such as chronic cough, asthma, and laryngitis, are reported frequently, and there is a strong evidence of biological plausibility in support of this relationship. On the other hand, extraesophageal reflux disease (EERD) is usually multifactorial in nature with reflux being just one of the several potential contributing cofactors. Moreover, the accuracy of currently available diagnostic tests for EERD is suboptimal, and therefore the causal relationship between GERD and EERD remains far from being conclusively proven...
March 3, 2017: Minerva Gastroenterologica e Dietologica
https://www.readbyqxmd.com/read/28251845/ppi-refractory-gerd-current-diagnosis-and-management
#13
Leonardo Frazzoni, Lorenzo Fuccio, Marzio Frazzoni
Proton pump inhibitor (PPI) therapy is the mainstay of treatment for gastroesophageal reflux disease (GERD). However, up to 30% of patients with reflux symptoms report inadequate symptom control with PPI therapy. PPI-refractory GERD should be suspected when troublesome reflux symptoms persist after 4-week standard dosage and 8-week high-dosage PPI therapy. Impedance-pH monitoring represents the gold standard for investigating the mechanism(s) of PPI refractoriness and for distinguishing patients with reflux-related from those with reflux- unrelated PPI-refractory syndromes...
March 1, 2017: Minerva Gastroenterologica e Dietologica
https://www.readbyqxmd.com/read/28239077/a-review-of-diagnosis-of-gerd
#14
REVIEW
In Du Jeong
The prevalence of gastroesophageal reflux disease (GERD) and the incidence of some of its complications have risen strikingly over the last few decades. With the accumulation in our understanding on the pathophysiology of GERD along with the development of proton pump inhibitors, the diagnostic and therapeutic approaches to the GERD have changed dramatically over the past decade. However, The GERD still poses a problem to many clinicians since the spectrum of the disease has evolved to encompass more challenging presentations such as refractory GERD and extraesophageal manifestations...
February 25, 2017: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
https://www.readbyqxmd.com/read/28197221/factors-leading-to-refractory-asthma-in-patients-from-saudi-arabia
#15
Amal M Al-Moamary, Mohamed S Al-Hajjaj, Mohamed S Al Moamary
AIM: The aim of this study was to study the clinical characteristic of patient with refractory asthma (RA) from Saudi Arabia. METHODS: This paper prospectively studied in a university hospital factors leading to RA in a cohort of patients who have inadequately controlled asthma or with frequent exacerbations despite optimum controller therapy. It also studied patients with asthma that requires extended periods of oral steroids to control. RESULTS: The mean age was 45...
January 2017: Annals of Thoracic Medicine
https://www.readbyqxmd.com/read/28151867/an-analysis-of-342-patients-with-refractory-gastroesophageal-reflux-disease-symptoms-using-questionnaires-high-resolution-manometry-and-impedance-ph-monitoring
#16
Fei Wang, Ping Li, Guo-Zhong Ji, Lin Miao, Zhining Fan, Sihong You, Xueqin Pan, Xia Chen
Symptoms of refractory gastroesophageal reflux disease (GERD) are commonly encountered in clinical practice. The aim of this study was to analyze the data obtained from questionnaires, high-resolution manometry (HRM), and ambulatory impedance-pH monitoring in patients with persisting GERD symptoms and to explore the possible underlying causes for this clinical presentation. After completing the questionnaires, the selected patients underwent endoscopy, HRM, and ambulatory impedance-pH monitoring. Based on the results of these investigations, we divided the patients into 4 groups: reflux esophagitis (RE), hypersensitive esophagus (HE), functional heartburn (FH), and nonerosive gastroesophageal reflux disease (NERD)...
February 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28135121/robotic-assisted-minimally-invasive-total-esophagogastric-dissociation-for-children-with-severe-neurodisability
#17
Girolamo Mattioli, Francesco Molinaro, Irene Paraboschi, Lorenzo Leonelli, Cinzia Mazzola, Serena Arrigo, Margherita Mancardi, Alessio Pini Prato, Rossella Angotti, Mario Messina, Adrian Bianchi
BACKGROUND: Around 70% of children with neurodisability (ND) present pharyngeal neuromuscular incoordination and severe gastroesophageal reflux disease (GORD). METHODS: This is a pilot study with the Robotic-assisted minimally invasive total esophagogastric dissociation (TOGD). RESULTS: We included 4 patients, 2 males and 2 females, with ND and severe GORD refractory to medical treatment. CONCLUSIONS: Pharmacological management of GORD is often unsuccessful and antireflux surgery is common, but it has a high failure rate with symptom recurrence, requiring re-do surgery...
January 30, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/28124156/helicobacter-pylori-induced-changes-in-gastric-acid-secretion-and-upper-gastrointestinal-disease
#18
Adam J Smolka, Mitchell L Schubert
Appropriate management of Helicobacter pylori infection of the human stomach is evolving and remains a significant clinical challenge. Acute infection results in hypochlorhydria, whereas chronic infection results in either hypo- or hyperchlorhydria, depending upon the anatomic site of infection. Acute hypochlorhydria facilitates survival of the bacterium and its infection of the stomach. Interestingly, most patients chronically infected with H. pylori manifest a pangastritis with reduced acid secretion due to bacterial virulence factors, inflammatory cytokines, and various degrees of gastric atrophy...
2017: Current Topics in Microbiology and Immunology
https://www.readbyqxmd.com/read/28120127/a-novel-prostanoid-ep1-receptor-antagonist-ono-8539-reduces-acid-induced-heartburn-symptoms-in-healthy-male-volunteers-a-randomized-clinical-trial
#19
Takashi Kondo, Hiroo Sei, Takahisa Yamasaki, Toshihiko Tomita, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Jiro Watari, Hiroto Miwa
BACKGROUND: Patients with proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD) have unmet clinical needs. Recently, we reported that esophageal prostaglandin E2 (PGE2) plays a crucial role in the generation of heartburn. In the present study, we focused on the PGE2 receptor, EP1, and investigated the effects of ONO-8539, a novel EP1 receptor antagonist, on heartburn symptoms in healthy male volunteers. METHODS: This prospective, double-blind, placebo-controlled, two-period crossover study was performed in 20 healthy male subjects...
January 24, 2017: Journal of Gastroenterology
https://www.readbyqxmd.com/read/28116591/prism-a-patient-reported-outcome-instrument-accurately-measures-symptom-change-in-refractory-gastroesophageal-reflux-disease
#20
Garth Fuller, Roger Bolus, Cynthia Whitman, Jennifer Talley, M Haim Erder, Alain Joseph, Debra G Silberg, Brennan Spiegel
BACKGROUND: Most patients with gastroesophageal reflux disease (GERD) experience relief following treatment with proton pump inhibitors (PPIs) (Vakil et al. in Am J Gastroenterol 101:1900-1920, 2006; Everhart and Ruhl in Gastroenterology 136:376-386, 2009). As many as 17-44% of patients, however, exhibit only partial response to therapy. Most extant GERD patient-reported outcome (PRO) instruments fail to meet development best practices as described by the FDA (Talley and Wiklund in Qual Life Res 14:21-33, 2005; Van Pinxteren et al...
March 2017: Digestive Diseases and Sciences
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