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Background: Incontinence or hypercontinence of the fundic wrap depends primarily on the length of the valve or the type of procedure. Much less attention has been paid to the fundic wrap length. This study aimed to compare the effectiveness of two different wrap lengths among the patients undergoing partial or total fundoplication., Methods: For this study, 153 patients were randomized to either Nissen (1.5- or 3-cm wrap) or Toupet (1.5- or 3-cm wrap) laparoscopic fundoplication. The groups were compared according to intensity of dysphagia, esophageal manometry data, ambulatory 24-h pH monitoring data, postoperative esophagitis rate, and overall treatment failure rate., Results: In all the groups, the tone of the lower esophageal sphincter was significantly increased and the DeMeester score significantly decreased, reaching normal levels. At 6 months after surgery, the Toupet 1.5-cm group had significantly more cases of esophagitis than the 3-cm wrap group (24.2% vs 3.3%; p<0.05). At 12 months after surgery, only one patient in the Nissen 3-cm group had moderate to severe dysphagia. In all cases, failures were associated with persistent erosive esophagitis. At the 12-month follow-up assessment, treatment failures were significantly more common in Toupet 1.5-cm group than in the Toupet 3-cm group (17.5% vs 2.7%; p<0.05). However, such differences were not observed in the Nissen groups (7.8% for 1.5 cm and 15.6% for 3 cm; p>0.05)., Conclusions: Evaluation of the treatment results suggests that the wrap length is important in partial Toupet fundoplication to avoid treatment failures. The 3-cm wrap is superior to the 1.5-cm wrap in cases of partial posterior Toupet fundoplication. The influence of wrap length on treatment failure remains unconfirmed for the Nissen procedure.

Unlabelled: The aim of this study was to evaluate the course of gastroesophageal reflux disease in gastric ulcer patients after successful Helicobacter pylori eradication (group A), in patients with persistent infection after attempt to eradicate Helicobacter pylori (group B), and in control group without Helicobacter pylori eradication treatment (group C)., Materials and Methods: Gastric ulcer patients (n=88) were assigned either to the group receiving Helicobacter pylori eradication treatment (54 patients) or to the control group (34 patients; omeprazole treatment for 4 weeks) and were followed up for 1-year or until gastric ulcer relapsed. Gastroesophageal reflux disease was diagnosed in patients who had erosive esophagitis and/or without esophagitis if they experienced heartburn and/or regurgitation at least 2 times a week and it was associated with impairment of daily activities (Genval consensus)., Results: The study was completed by 69 patients: 25 in group A, 19 in group B, and 25 in group C. At the beginning and at the end of the follow-up, gastroesophageal reflux disease was diagnosed in 10 (40%) and 9 (36%) group A patients, respectively (P>0.05); in 12 (63%) and 8 (42%) group B patients, respectively (P>0.05); and in 9 (36%) and 5 (20%) group C patients, respectively (P>0.05). At the beginning and at the end of the follow-up, reflux esophagitis was found in 3 (12%) and 5 (20%) group A patients, respectively (P>0.05); in 5 (26%) and 5 (26%) group B patients (P>0.05); in 4 (16%) and 3 (12%) group C patients (P>0.05)., Conclusion: There was no statistically significant difference regarding the development of gastroesophageal reflux disease in gastric ulcer patients after Helicobacter pylori eradication, in the patients with persistent infection after attempt to eradicate, and in the control group without Helicobacter pylori eradication treatment.

Objective: To assess the diagnostic sensitivity and specificity of the laryngoscopic signs of reflux laryngitis., Material and Methods: Using original quantitative evaluation system, the laryngoscopic signs of 108 patients with reflux laryngitis and 90 healthy people were subjected to comparative analysis in this study. Summing up all evaluations of laryngeal changes, laryngoscopic reflux index was proposed., Results: Mucosal lesions and edema of vocal cords along with mucosal lesions of the interarytenoid notch were found to be most significant for diagnostics of reflux laryngitis. Presence of mucosal lesions of the interarytenoid notch (roughness, hypertrophy, keratosis, granuloma) increases the odds ratio to attribute the patient to the reflux laryngitis patient group 21 times (OR=21.32, 95% CI 4.38-103.93; P<0.001). Mucosal lesions (hypertrophy, keratosis, granuloma) and edema of vocal cords were determined as the most sensitive and rather specific laryngoscopic signs. Roughness and grade II hypertrophy of interarytenoid notch were found to be the most specific (98%) and sensitive (56%) laryngoscopic signs of reflux laryngitis. Abnormal values of laryngoscopic reflux index (higher than 5 points) reflect a diagnostic sensitivity of 96% and specificity of 97% differentiating patients with reflux laryngitis from healthy persons., Conclusions: Mucosal lesions and edema of vocal cords along with mucosal lesions of the interarytenoid notch are found to be the most significant laryngoscopic signs for diagnostics of reflux laryngitis. Laryngoscopic reflux index was found to be the most sensitive and specific diagnostic criterion for reflux laryngitis.

The laryngopharyngeal form of gastroesophageal disease represents one of the atypical manifestations of supraesophageal gastroesophageal reflux disease characterized by morphologic and functional changes in the larynx and pharynx with the associated clinical symptoms. The article presents diagnostic algorithm (guidelines) for laryngopharyngeal form of gastroesophageal disease, elaborated by the group of Lithuanian experts in otorhinolaryngology and gastroenterology. The guidelines are based on the data of evidence-based medicine and results of the scientific studies in Lithuania. Diagnostics of laryngopharyngeal form of gastroesophageal disease has to be based on: (1) patient's complaints (permanent hoarseness, throat itching and clearing, cough, heartburn, "globus" sensation) for more than 3 months; (2) typical laryngoscopic findings (edema, erythema, roughness, hypertrophy of mucosa of the posterior glottis); (3) detection of reflux esophagitis as a subsequence of pathological gastroesophageal reflux; (4) assessment of relationship between reflux and morphological/functional changes. The guidelines are designed for the otorhinolaryngologists, gastroenterologists, and general practitioners.

The aim of this article is to introduce Lithuanian clinical practice guidelines for the management of laryngopharyngeal form of gastroesophageal reflux disease for standardization of the diagnosis and treatment of the disease and prevention of its complications. Composed guidelines provide recommendations for primary care physicians as well as otorhinolaryngologists and gastroenterologists for the management of adults with uncomplicated laryngopharyngeal form of gastroesophageal reflux disease. Committee composed of experts from Lithuanian Otorhinolaryngological and Gastroenterological Societies developed guidelines based on a comprehensive review of the evidence-based literature related to laryngopharyngeal form of gastroesophageal reflux disease and guidelines of other countries. The guidelines provide description of each medicine groups with emphasis on proton pump inhibitors as the most effective drugs for the treatment of laryngopharyngeal form of gastroesophageal reflux disease. Indications for empirical treatment with proton pump inhibitors are described, as well as duration of treatment, doses, optimal regimen of use, and assessment of treatment efficacy. The therapy should begin with the application of proton pump inhibitors twice daily, before meal for three months. Combined therapy for nonresponders is described. Algorithm for stopping the medication is recommended. These recommendations may provide an efficient and economical approach to the management of this problem.

The aim of the study was to outline the multidimensional perceptual, subjective, and instrumental acoustic voice changes in the group of reflux laryngitis (RL) patients. Data of multidimensional voice assessment of 108 RL patients and 90 healthy persons of the control group were subjected to comparative analysis. A slight hoarseness according to the GRB (G-grade, R- rough, B-breathy) scale was prevailing in the RL patients group. Statistically significant difference (P < 0.001) between RL patients group and the control group was found of all voice parameters measured, with the patients having worse results--increased mean jitter, shimmer, normalized noise energy, voice handicap index (VHI), and decreased parameters of phonetogram. The results of the study demonstrated that multidimensional voice assessment documented deteriorated voice quality and restricted phonation capabilities in the tested group of RL patients.

Objective: The laryngopharyngeal form of gastroesophageal reflux disease (LF GERD) is a frequent manifestation of supraesophageal GERD. Diagnosis of LF GERD is difficult: most of the common diagnostic methods of GERD have insufficient accuracy in establishing LF GERD. The purpose of this study was to evaluate the role of endoscopic and laryngologic examination in the diagnosis of LF GERD and to create a laryngoscopic reflux index (LRI)., Material and Methods: A total of 108 LF GERD patients and 90 controls were investigated. The criteria for LF GERD were: complaints, reflux-laryngitis, and esophagitis (endoscopically or histologically proven). Lesions in four laryngeal regions were evaluated: arytenoids (A), intraarytenoid notch (IAN), vestibular folds (VF), and vocal cords (VC). Three types of mucosal lesions were evaluated on a points basis: alterations of the epithelium, erythema, and edema. Total LRI was calculated by summing-up the indices in the separate laryngeal areas., Results: The LRI mean value (11.48+/-3.78 points) of LF GERD patients was statistically significantly greater than that (1.64+/-1.93 points) of the controls. The most significant laryngoscopic changes of LF GERD were: mucosal lesions of IAN, mucosal lesions of VC, and edema of VC. A combination of these three findings reliably distinguishes the LF GERD patients from controls in 95.9% of cases. The mucosal lesions of IAN have the greatest importance in diagnosing LF GERD: the odds ratio to LF GERD - 21.32, p<0.001. Endoscopic esophagitis was established in 36 (33.3%) cases. The severity of esophagitis did not correlate with the severity of the laryngeal findings., Conclusions: Laryngoscopy is superior to endoscopy in diagnosing LF GERD. Endoscopy has limited value in the diagnosis of LF GERD. Establishing the LRI could be helpful in the differential diagnosis of the disease in the everyday clinical practice.

A total of 536 patients with endoscopically confirmed GORD grade 0/I were included in this multicentre study. In the acute phase, patients were treated with pantoprazole 20 mg o.d. for 4 weeks to obtain symptom relief. Symptom-free patients were included in the subsequent long-term phase, and were randomly treated on demand with either pantoprazole 20 mg or placebo for 6 months (antacids as rescue medication). After the 4 weeks acute phase, 439 symptom-free patients entered the long-term phase. The perceived average daily symptom load remained significantly lower during the 6-month on-demand treatment with pantoprazole 20 mg as compared to placebo. Both the rates for unwillingness to continue and number of additional antacids taken were also significantly lower with pantoprazole 20 mg than with placebo. Hence, on-demand treatment with pantoprazole 20 mg is safe and effective in maintaining control of the symptoms heartburn, acid regurgitation and pain on swallowing symptoms in patients with GORD grade 0/I with superiority to placebo.

Background and Aim: Discussions concerning the increased incidence of gastro-oesophageal reflux disease (GORD) after Helicobacter pylori eradication continue. In this study we aimed to evaluate the presence of co-existing GORD in (1) duodenal ulcer patients after successful H. pylori eradication, (2) patients with persistent H. pylori infection after attempts at eradication, and (3) controls in whom H. pylori eradication had not been attempted., Methods: A prospective study of 255 patients with duodenal ulcer who were assigned to H. pylori eradication or to control treatment (omeprazole for 4 weeks) and followed up for 1 year or until peptic ulcer relapse. GORD was determined in the patients who had reflux oesophagitis on endoscopy at the beginning of the study and/or in patients without reflux oesophagitis if they experienced heartburn and/or regurgitation at least twice a week associated with impairment of daily activities., Results: The study revealed a significant decrease (from 44.6% to 21.7%; P < 0.001) of patients with GORD at the end of the follow-up among those in whom H. pylori eradication had been successful. There was no significant difference in the frequency of reflux oesophagitis before and after the follow-up regardless of H. pylori status., Conclusions: H. pylori eradication did not significantly influence the prevalence and incidence of reflux oesophagitis in patients with duodenal ulcer during a 1 year follow-up period, but there was a significantly lower prevalence of GORD after successful H. pylori eradication, as patients with non-erosive GORD had been cured.

It is still not known whether there are differences between erosive and nonerosive GERD. The aim of the present study is to evaluate the prevalence of Helicobacter pylori (HP) infection, and other differences between erosive and nonerosive gastroesophageal reflux disease (NERD) patients. One-hundred and four consecutive GERD patients (mean age: 41.6 +/- 12.3 years) were interviewed, endoscoped and tested for HP. Erosive GERD was defined according to the Los Angeles classification. Patients who had no erosions in the esophagus but complained of heartburn or/and acid regurgitation at least twice a week and for whom these symptoms had a negative impact on daily activities were considered to be NERD patients. Erosive GERD was identified in 53 (51%) patients (mean age: 41.0 +/- 12.7 years) and NERD in 51 (49.0%) patients (mean age: 42.2 +/- 11.9 years). HP infection was found in 32 (60.4%) erosive GERD patients, and 41 (80.4%) NERD patients, P < 0.05. Multivariate analysis revealed that there were two statistically significant prediction factors for NERD: female sex with odds ratio (OR) of 6.34 (95% CI: 2.41-16.64; P = 0.0002) and HP infection with odds ratio (OR) of 3.28 (95% CI: 1.26-8.58; P = 0.015). The presence of HP and female sex are found to be statistically significant predictors of NERD.

It is still not known whether there are differences between erosive and nonerosive GERD. The aim of the present study is to evaluate the prevalence of Helicobacter pylori (HP) infection, and other differences between erosive and nonerosive gastroesophageal reflux disease (NERD) patients. One-hundred and four consecutive GERD patients (mean age: 41.6 ± 12.3 years) were interviewed, endoscoped and tested for HP. Erosive GERD was defined according to the Los Angeles classification. Patients who had no erosions in the esophagus but complained of heartburn or/and acid regurgitation at least twice a week and for whom these symptoms had a negative impact on daily activities were considered to be NERD patients. Erosive GERD was identified in 53 (51%) patients (mean age: 41.0 ± 12.7 years) and NERD in 51(49.0%) patients (mean age: 42.2 ± 11.9 years). HP infection was found in 32 (60.4%) erosive GERD patients, and 41(80.4%) NERD patients, P < 0.05. Multivariate analysis revealed that there were two statistically significant prediction factors for NERD: female sex with odds ratio (OR) of 6.34 (95% CI: 2.41-16.64; P = 0.0002) and HP infection with odds ratio (OR)of 3.28 (95% CI: 1.26-8.58; P = 0.015). The presence of HP and female sex are found to be statistically significant predictors of NERD. [ABSTRACT FROM AUTHOR]

Introduction: Controversial opinions exist concerning effect of H. pylori eradication on the development of gastroesophageal reflux disease (GERD) in DU patients. The aim of the study was to evaluate the natural course of two forms of GERD - EO and NERD in 3 groups of DU patients: 1) after successful HP eradication, 2) with persistent infection after attempt to eradicate, and 3) in control group without HP eradication treatment. Methods: Prospective one-year follow-up study. Consecutive 255 DU pts were assigned to either HP eradication treatment or to control group (omeprazole treatment for 4 weeks) and followed-up for 1-year or until DU relapsed. Endoscopy and HP testing were performed at entry, 6-8 weeks later and at the end of the follow-up. NERD was determined to the patients without EO on endoscopy and if they experienced heartburn and/or regurgitation at least 2 times a week associated with impairment of daily activities. Results: At the beginning and the end of the study NERD was found correspondingly in 19 (20.7%) and 0 (0%, p < 0.001) among 92 pts who were successfully treated for HP; in 14 (19.7%) and 5 (7%, p < 0.05) among 71 HP-positive after attempt to eradicate patients; in 6 (14.3%) and 5 (11.9%, p > 0.05) among 42 HP-positive control group pts. EO was found at the beginning and the end of the study correspondingly in 22 (23.9%) and 20 (21.7%, p > 0.05) successfully eradicated pts; in 22 (31%) and 23 (32.4%, p > 0.05) among HP-positive after attempt to eradicate patients; among 11 (26.2%) and 9 (21.4%, p > 0.05) HP-positive controls. Conclusions: A substantial proportion of DU patients have symptoms and/or signs of coexisting GERD at initial presentation. H. pylori eradication decreased prevalence of GERD in the DU patients after successful H. pylori eradication due to cure of non-erosive GERD cases. [ABSTRACT FROM AUTHOR]

Background: The incidence and prevalence of GERD increases all over the world. It is not known, if it could be related with decreasing prevalence of HP and weather or not the prevalence of HP is different among erosive versus non-erosive GERD (NERD) patients. Aim: To evaluate prevalence of HP infection among erosive and nonerosive GERD patients. Methods: 108 consecutive GERD patients (mean age — 42.0±12.3 yr) not using PPI, H2-blockers, bismuth compounds, antibiotics and NSAIDs were endoscoped and tested for HP. Erosive GERD was defined as presence of erosive esophagitis at endoscopy. NERD patients were those who had no erosions, but complained of heartburn or (and) acid regurgitation at least twice a week with impaired daily activities due to these symptoms (Genval consensus). HP was investigated using rapid urease test, Giemsa stained histological specimens and new, portable C14-urea breath test. HP positivity established if at least two of these tests were positive. Results: Erosive GERD was established to 56 (51.9%) patients, mean age — 41.8±12.9 yr, NERD to 52 (48.1%), mean age — 42.2±11.8 yr. In erosive GERD group there were 29 (51.8%) males, and 27 (48.2%) females. In NERD group there were 9 (17.3%) males and 43 (82.7%) females. P < 0.005 comparing genders among groups. In erosive GERD group mean age of male was 36.1±10.7 yr, of female — 47.0±12.4 yr, p0,05. Altogether HP was established in 73 (67.6%) cases. There were 32 (57.1%) HP-positive among erosive GERD patients, and 41 (78.8%) among NERD patients, p < 0.05. Conclusions: Prevalence of Helicobacter pylori is significantly higher in non-erosive GERD than in erosive esophagitis patients. In erosive GERD group mean age of males is significantly lower than of females. There was significantly higher proportion of female gender patients in NERD patients group. [ABSTRACT FROM AUTHOR]