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Refractory reflux disease

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https://www.readbyqxmd.com/read/29209919/association-between-cyp2c19-extensive-metabolizer-phenotype-and-childhood-anti-reflux-surgery-following-failed-proton-pump-inhibitor-medication-treatment
#1
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)...
December 6, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/29201809/long-esophageal-stricture-in-a-brittle-diabetic
#2
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
#3
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
https://www.readbyqxmd.com/read/29193785/contribution-of-hiatal-hernia-to-asthma-in-patients-with-gastroesophageal-reflux-disease
#4
Zhi-Tong Li, Feng Ji, Xin-Wei Han, Lin-Xia Gu, Li Wang, Yong-Qiang Yue, Zhong-Gao Wang
BACKGROUND: To determine the correlation between asthma and hiatal hernia (HH) in patients with gastroesophageal reflux disease (GERD)-related asthma requiring laparoscopic anti-reflux surgery. METHODS: One hundred thirty-six GERD patients with medically refractory asthma with (80 patients) or without HH (56 patients) were enrolled. GERD was assessed by endoscopy, esophageal manometry, reflux monitoring, and symptom questionnaires, and treated with laparoscopic Nissen fundoplication (LNF) or LNF with concomitant hiatal hernia repair (LNF-HHR)...
November 28, 2017: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/29110162/recent-advances-in-the-pharmacological-management-of-gastroesophageal-reflux-disease
#5
REVIEW
Yu-Min Kung, Wen-Hung Hsu, Meng-Chieh Wu, Jiunn-Wei Wang, Chung-Jung Liu, Yu-Chung Su, Chao-Hung Kuo, Fu-Chen Kuo, Deng-Chyang Wu, Yao-Kuang Wang
The management of proton pump inhibitor-refractory GERD (rGERD) is a challenge in clinical practice. Since up to one-third of patients with typical GERD symptoms (heartburn and/or acid regurgitation) are not satisfied with proton pump inhibitor (PPI) therapy, new drug development targeting different pathophysiologies of GERD is imperative. At present, no other drugs serve as a more potent acid suppression agent than PPIs. As an add-on therapy, histamine type-2 receptor antagonists, alginates, prokinetics and transient lower esophageal sphincter relaxation inhibitors have some impact on the subgroups of rGERD, but greater effectiveness and fewer adverse effects for widespread use are required...
December 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/29109876/debut-of-gastroesophageal-reflux-concomitant-with-administration-of-sublingual-immunotherapy
#6
Jacob Juel
Gastroesophageal reflux disease (GORD) is an often debilitating condition characterised by retrograde flow of content from stomach into the oesophagus, where the low pH of the stomach acid irritates the mucosa of the oesophagus. The most dominant symptoms in GORD are pyrosis, regurgitation, and dysphagia. Sublingual immunotherapy (SLIT) was first described in 1986. Following this description, the use has greatly increased in the treatment of allergic rhinitis, as an alternative to subcutaneously administered immunotherapy...
2017: Case Reports in Gastrointestinal Medicine
https://www.readbyqxmd.com/read/29104130/diaphragmatic-breathing-reduces-belching-and-proton-pump-inhibitor-refractory-gastroesophageal-reflux-symptoms
#7
Andrew Ming-Liang Ong, Laura Teng-Teng Chua, Christopher Jen-Lock Khor, Ravishankar Asokkumar, Vikneswaran Namasivayam, Yu-Tien Wang
BACKGROUND & AIMS: In patients with gastroesophageal reflux disease (GERD) and excessive belching, most belches are supragastric, and can induce reflux episodes and worsen GERD. Supragastric belching (SGB) might be reduced with diaphragmatic breathing exercises. We investigated whether diaphragmatic breathing therapy is effective in reducing belching and proton pump inhibitor (PPI) refractory gastroesophageal reflux symptoms. METHODS: We performed a prospective study of 36 consecutive patients with GERD refractory to PPI therapy and a belching visual analogue scale (VAS) score of 6 or more, seen at a gastroenterology clinic at a tertiary hospital in Singapore from April 2015 through October 2016...
November 2, 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/29094873/chronic-cough-evaluation-and-management
#8
REVIEW
Charlie Michaudet, John Malaty
Although chronic cough in adults (cough lasting longer than eight weeks) can be caused by many etiologies, four conditions account for most cases: upper airway cough syndrome, gastroesophageal reflux disease/laryngopharyngeal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis. Patients should be evaluated clinically (with spirometry, if indicated), and empiric treatment should be initiated. Other potential causes include angiotensin-converting enzyme inhibitor use, environmental triggers, tobacco use, chronic obstructive pulmonary disease, and obstructive sleep apnea...
November 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/29071486/fragments-of-e-cadherin-as-biomarkers-of-non-erosive-reflux-disease
#9
Biljana Jovov, Craig C Reed, Nicholas J Shaheen, Amy Pruitt, Kathleen Ferrell, Geraldine S Orlando, Zorka Djukic, Roy C Orlando
BACKGROUND: Approximately, 20% of patients with heartburn and normal endoscopic findings do not symptomatically improve on proton pump inhibitor (PPI) therapy making diagnosis and treatment uncertain. A biomarker distinguishing PPI-responsive from PPI-refractory heartburn is desirable. AIMS: We performed a pilot study assessing whether carboxy(C)-terminal fragments (CTFs) of e-cadherin in esophageal biopsies or amino(N)-terminal fragments (NTFs) of e-cadherin in serum could serve this purpose...
October 25, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/29060954/-the-additional-role-of-symptom-reflux-association-analysis-of-diagnosis-of-gastroesophageal-reflux-disease-using-bravo-capsule-ph-test
#10
Kyoungwon Jung, Moo In Park, Seun Ja Park, Won Moon, Sung Eun Kim, Jae Hyun Kim
Background/Aims: Since the development of ambulatory esophageal pH monitoring test to diagnose gastroesophageal reflux disease (GERD), several parameters have been introduced. The aim of this study was to assess whether using the symptom index (SI), symptom sensitivity index (SSI), and symptom association probability (SAP), in addition to the DeMeester score (DS), would be useful for interpreting the Bravo pH monitoring test. Methods: A retrospective study, which included 68 patients with reflux symptoms refractory to proton pump inhibitor (PPI) therapy who underwent a Bravo capsule pH test between October 2006 and May 2015, was carried out...
October 25, 2017: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
https://www.readbyqxmd.com/read/29032661/a-prospective-study-of-eosinophilic-esophagitis-and-the-expression-of-tight-junction-proteins-in-patients-with-gastroesophageal-reflux-disease-symptoms
#11
Kenichiro Okimoto, Makoto Arai, Hideaki Ishigami, Keiko Saito, Shoko Minemura, Daisuke Maruoka, Tomoaki Matsumura, Tomoo Nakagawa, Tatsuro Katsuno, Masaki Suzuki, Yukio Nakatani, Osamu Yokosuka
Background/Aims: Eosinophilic esophagitis (EoE) is often erroneously diagnosed as gastroesophageal reflex disease (GERD). The aim of this study is to investigate the prevalence of EoE and the expression of tight junction (TJ) proteins in patients with GERD symptoms. Methods: One hundred patients with GERD symptoms and 10 healthy controls were prospectively studied. Sixty-two patients had symptoms refractory to proton pump inhibitors (PPI). All patients underwent esophageal biopsy...
October 17, 2017: Gut and Liver
https://www.readbyqxmd.com/read/28895583/psychosocial-distress-and-quality-of-life-impairment-are-associated-with-symptom-severity-in-ppi-non-responders-with-normal-impedance-ph-profiles
#12
Rena Yadlapati, Michael Tye, Laurie Keefer, Peter J Kahrilas, John E Pandolfino
OBJECTIVES: Up to 50% of patients with reflux symptoms do not manifest a satisfactory symptom response to proton pump inhibitor (PPI) therapy. Our primary aim in this study was to identify factors associated with symptom perception among PPI non-responder phenotypes. METHODS: This prospective observational cohort study was performed from September 2014 to January 2017 at a single academic medical center and included PPI non-responders who underwent 24-h impedance-pH monitoring and completed a questionnaire set measuring patient-reported symptom severity, quality of life (QOL), and psychosocial distress...
September 12, 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/28894571/vonoprazan-10-mg-daily-is-effective-for-the-treatment-of-patients-with-proton-pump-inhibitor-resistant-gastroesophageal-reflux-disease
#13
Satoshi Shinozaki, Hiroyuki Osawa, Yoshikazu Hayashi, Hirotsugu Sakamoto, Yasutoshi Kobayashi, Alan Kawarai Lefor, Hironori Yamamoto
Gastroesophageal reflux disease (GERD) is commonly treated by primary care physicians. Although proton pump inhibitors (PPI) have been the mainstay of GERD treatment for two decades, in some patients GERD is refractory to standard dose PPI for more than eight weeks and is referred to as PPI-resistant GERD. Vonoprazan, a novel competitive acid blocker, became available in Japan for the treatment of patients with GERD, and has greater acid inhibition than existing PPIs. The aim of the present study was to determine the effect of vonoprazan 10 mg daily on PPI-resistant GERD...
September 2017: Biomedical Reports
https://www.readbyqxmd.com/read/28891136/helicobacter-pylori-infection-and-nonmalignant-diseases
#14
REVIEW
Olga Sjomina, Frederic Heluwaert, Driffa Moussata, Marcis Leja
A substantial decrease in Helicobacter pylori-associated peptic ulcer disease has been observed during the last decades. Drug-related ulcers as well as idiopathic ulcers are becoming predominant and are more refractory to treatment; however, H. pylori infection still plays an important role in ulcer bleeding and recurrence after therapy. The effect of H. pylori eradication upon functional dyspepsia symptoms has been reviewed in this article and generally confirms the results of previous meta-analyses. Additional evidence suggests a lack of impact upon the quality of life, in spite of improvement in symptoms...
September 2017: Helicobacter
https://www.readbyqxmd.com/read/28884817/association-between-cyp2c19-17-alleles-and-ph-probe-testing-outcomes-in-children-with-symptomatic-gastroesophageal-reflux
#15
James P Franciosi, Edward B Mougey, Andre Williams, Roberto A Gomez-Suarez, Cameron Thomas, Christa L Creech, Katherine George, Diana Corao, John J Lima
Esophageal pH monitoring remains a primary diagnostic tool for detecting gastroesophageal reflux disease (GERD). GERD that is refractory to proton pump inhibitor (PPI) medications may be related to CYP2C19 variants. Current PPI dosing practices in children do not take into account CYP2C19 allelic variants, which may lead to underdosing and subsequently to a misperception of PPI therapy failure. We hypothesized that pH probe acid exposure outcomes associate with CYP2C19*17 alleles among children with clinical concern for GERD...
September 8, 2017: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28880273/tailored-therapy-guided-by-multichannel-intraluminal-impedance-ph-monitoring-for-refractory-non-erosive-reflux-disease
#16
Nunzio Ranaldo, Giuseppe Losurdo, Andrea Iannone, Mariabeatrice Principi, Michele Barone, Massimo De Carne, Enzo Ierardi, Alfredo Di Leo
A relevant percentage of non-erosive reflux disease (NERD) is refractory to proton pump inhibitors (PPIs) treatment. Multichannel intraluminal impedance pH (MII-pH) monitoring should give useful pathophysiological information about refractoriness. Therefore, our aim was to assess whether this technique could be useful to guide a 'tailored' therapy in refractory NERD. We retrospectively recruited NERD patients undergoing MII-pH monitoring for unsuccessful treatment. All patients had undergone upper endoscopy, and those with erosive esophagitis were excluded...
September 7, 2017: Cell Death & Disease
https://www.readbyqxmd.com/read/28827001/laparoscopic-nissen-fundoplication-controls-reflux-symptoms-and-improves-disease-specific-quality-of-life-in-patients-with-class-i-and-ii-obesity
#17
Sara E Martin Del Campo, Umer I Chaudhry, Aliyah Kanji, Andrew J Suzo, Kyle A Perry
BACKGROUND: Patients with class I obesity and refractory gastroesophageal reflux disease may not qualify for bariatric surgery, and the effectiveness of laparoscopic Nissen fundoplication remains controversial. This study evaluates the early efficacy of laparoscopic Nissen fundoplication in patients with class I and II obesity. METHODS: Data for patients who underwent laparoscopic Nissen fundoplication between 2009 and 2014 were collected prospectively. Cohorts were stratified based on body mass index at the time of surgery: Nonobese (body mass index <30 kg/m2), class I obese (body mass index 30-34...
November 2017: Surgery
https://www.readbyqxmd.com/read/28821410/laparoscopic-redo-anti-reflux-surgery-case-series-of-different-presentations-varied-management-and-their-outcomes
#18
Hari Nageswaran, Ali Haque, Mohammed Zia, Ahmed Hassn
BACKGROUND: A minority of patients undergoing surgery for refractory gastroesophageal reflux disease (GORD) will require revision antireflux surgery ("redo-ARS") for persistent symptoms or complications. Although a repeat minimally invasive procedure for revision may be technically challenging due to post-operative changes, studies are beginning to show favourable data for the laparoscopic approach. METHOD: From a single institution 41 consecutive cases of laparoscopic redo-ARS performed by the same surgeon were classified by mode of presentation to analyse their intra-operative findings, management and post-operative outcomes...
October 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28768356/-singultus-diagnostic-workup-and-therapy
#19
Ohlrich Marcus, Georg Royl
A hiccup is a reflex movement with diffusely distributed afferents and efferents in the thorax; its functional relevance is controversial. In its physiological form, it is mostly a minor complaint that stops spontaneously and rarely leads to medical consultation. However, prolonged agonizing hiccups represent serious deterioration of quality of life. Chronic hiccups by definition last for more than 48 h, with gastroesophageal reflux being the frequent underlying disease. Various other causes affect multiple organ systems, some with serious underlying diseases...
July 2017: Laryngo- Rhino- Otologie
https://www.readbyqxmd.com/read/28761578/esophageal-motility-and-rikkunshito-treatment-for-proton-pump-inhibitor-refractory-nonerosive-reflux-disease-a-prospective-uncontrolled-open-label-pilot-study-trial
#20
Takeo Odaka, Shigeru Yamato, Osamu Yokosuka
BACKGROUND: Only a few reports focused on esophageal motility in patients with proton pump inhibitor (PPI)-refractory nonerosive reflux disease (NERD) and there has been no established strategy for treatment. OBJECTIVE: To clarify the characteristics of esophageal motility in patients with PPI-refractory NERD, we evaluated esophageal function using combined multichannel intraluminal impedance and esophageal manometry (MII-EM). In addition, we evaluated the efficacy of rikkunshito (RKT), which is a gastrointestinal prokinetic agent...
2017: Current Therapeutic Research, Clinical and Experimental
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