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A randomized, placebo-controlled, double-blind, parallel-group clinical study was conducted to examine the effects of ingesting a heat-killed lactic acid bacterium, Lactobacillus johnsonii No. 1088 (LJ88) on temporal gastroesophageal reflux-related symptoms in healthy volunteers. A total of 120 healthy Japanese volunteers of both sexes, aged between 21 and 63 years, whose Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) total score was 8 or greater, but who were not diagnosed with functional dyspepsia according to the Rome IV classification, were enrolled. They were randomly assigned to either the LJ88 or placebo group and instructed to ingest the test food (1 billion heat-killed LJ88 or placebo) once a day for six weeks. Gastroesophageal reflux-related symptoms were evaluated using FSSG scores as a primary endpoint. The Gastrointestinal Symptoms Rating Scale (GSRS), stomach state questionnaire, and serum gastrin concentration were used as secondary endpoints. In the FSSG evaluation, the heartburn score was significantly improved at 6 weeks in the LJ88 group compared to the placebo group. No severe adverse events related to the test food were observed. In conclusion, daily ingestion of heat-killed LJ88 improved temporal heartburn symptoms in non-diseased individuals.

Background/aims: Gastric bubble is present in approximately 70% of normal chest and abdominal radiograph. Most swallowed air is regurgitated and belching is a physiological phenomenon to expel ingested gas from the stomach and is a common symptom in normal adults. In the present study it was investigated whether gastric bubble detected on abdominal radiograph is associated with GERD symptoms., Methodology: All of the patients who first attend our hospital were asked to respond the F-scale questionnaire regardless of their chief complaints to diagnose GERD. Plain abdominal films in the erect position were used to measure the size of gastric bubble and to classify the form of gastric bubble into four groups: dome-type; irregular-type; stomach-type; and undetected-type. The quantity of gastric bubble (gastric bubble score) was determined as the pixel value on image collected from hospital's digital database., Results: The gastric bubble score of irregular-type was significant lower than that of dome-type and stomach-type. GERD was most frequently detected in stomach-type group, followed by undetected-type, irregular-type, and dome-type. The mean score of F-scale was significantly higher in stomach-type than in dome-type., Conclusions: It is concluded that gastric bubble detected on plain abdominal films is an informative marker for evaluating the functional disorder of upper digestive tracts. Physicians have to recognize the importance of plain films of the abdomen in the diagnostic process of GERD.

Aim: To evaluate the association between gastroesophageal reflux diseases (GERD) and coronary heart diseases., Methods: One thousand nine hundred and seventy consecutive patients who attended our hospital were enrolled. All of the patients who first attend our hospital were asked to respond to the F-scale questionnaire regardless of their chief complaints. All patients had a careful history taken, and resting echocardiography (ECG) was performed by physicians if the diagnostic necessity arose. Patients with ECG signs of coronary artery ischemia were defined as ST-segment depression based on the Minnesota code., Results: Among 712 patients (36%) with GERD, ECG was performed in 171 (24%), and ischemic changes were detected in eight (5%). Four (50%) of these patients with abnormal findings upon ECG had no chest symptoms such as chest pain, chest oppression, or palpitations. These patients (0.6%; 4/712) were thought to have non-GERD heartburn, which may be related to ischemic heart disease. Of 281 patients who underwent ECG and did not have GERD symptoms, 20 (7%) had abnormal findings upon ECG. In patients with GERD symptoms and ECG signs of coronary artery ischemia, the prevalence of linked angina was considered to be 0.4% (8/1970 patients)., Conclusion: The present study suggested that ischemic heart disease might be found although a patient was referred to the hospital with a complaint of GERD symptoms. Physicians have to be concerned about missing clinically important coronary artery disease while evaluating patients for GERD symptoms.

Background/aims: Normal esophageal acid clearance depends on the neutralization of acid by swallowed saliva, as well as on esophageal peristalsis. This study therefore aimed to investigate the association between saliva production and transport from the oral cavity to the esophagus and developing gastroesophageal reflux disease (GERD) METHODOLOGY: Twenty-eight consecutive patients with GERD symptoms by gastroesophageal reflux self-report questionnaires and 13 healthy volunteers were recruited in the study. After intravenous administration of 99mTc-pertechnetate, anterior sequential imaging was performed every minute for 40 minutes. At 20 minutes after injection of radionuclide, a lemon candy was administered intra-orally to stimulate salivary secretion. Regions of interest (ROI) were selected on the individual oral cavity, the pharynx, and the upper esophagus and time activity curves were drawn for each of these. A time-activity curve in each ROI was subjectively graded, as zero to two-point. The sum of scores in 3 ROIs was considered as a saliva transit total score., Results: The mean transit score of the oral cavity did not differ significantly between GERD patients and healthy volunteers (1.38 vs. 1.61), whereas significantly lower transit scores of pharynx and upper esophagus were found in GERD patients. A 0-point saliva transit score of pharynx and upper esophagus was significantly more frequently detected in GERD patients than in healthy volunteers., Conclusions: This new modification of saliva scintigraphy is able to evaluate the esophageal motility simply, without a test meal, and to detect impaired saliva transit between pharynx and upper esophagus in GERD patients non-invasively.

Aim: To accurately assess the prevalence of GERD symptoms in general practice., Methods: 4139 consecutive patients (2025 men and 2114 women with a mean age of 43 years), who first attended the Outpatient Department of General Medicine and Emergency Care at Toho University Omori Hospital, were asked to respond to the F-scale questionnaire regardless of their chief complaints. The questionnaire is a self-report instrument, written in a simple and easy-to-understand language, containing 12 questions., Results: Of 4139 subjects, 1554 patients (37.6%) were identified as GERD according to their F-scale score (> 7). However, there were only 45 consultations (1.1%) for typical GERD symptoms. Although GERD symptoms are common in adults of all ages, the prevalence of GERD was highest in the 20-29 years age group and the age group 70-79 years had the lowest prevalence for both males and females., Conclusion: Although there was a high rate indicating GERD in our primary care population, only 1.1% of outpatients attended our hospital with a chief complaint of GERD symptoms. Since about one-third of GERD patients are affected by atypical symptoms, general physicians need to be cautious about extrapolating these results to patients with a chief complaint other than typical GERD symptoms.

Aim: Gastroesophageal reflux disease (GERD) is a heterogeneous, multi‐symptom disease. The Frequency Scale for the Symptoms of GERD (FSSG) is used to evaluate the disease severity and therapeutic response. We reported that objective tongue diagnosis would be a useful, non‐invasive screening tool for erosive gastritis, which makes it a useful complement to Kampo diagnosis. This study was done to investigate the utility of tongue color (TC) and FSSG in the diagnosis of GERD. Methods: A total of 886 healthy Japanese residents aged 28–86 years had a photograph of the tongue taken, completed the FSSG, and underwent esophagogastroduodenoscopy. FSSG ≥8 was defined as GERD, mucosal break on endoscopy as reflux esophagitis (RE), and no erosive esophagitis as non‐erosive reflux disease (NERD). TC was measured using the device‐independent International Commission on Illumination (CIE) 1976 L*a*b* color space standards at four points. Results: A total of 152 (17.2%) of the subjects had FSSG ≥8. On endoscopy 36 (4.1%) had RE and 116 (13.1%) had NERD. Age, sex, and smoking were significant in the multivariate analysis of GERD (OR, 0.64, P = 0.043; OR, 0.65, P = 0.036; and OR, 2.06, P = 0.014, respectively). Sex and TC (3b*/1b*) were significant in the multivariate analysis of RE (OR, 4.82, P < 0.001; OR, 3.59, P = 0.018, respectively). On receiver operating characteristics analysis, a combination of sex (male) and TC (3b*/1b*) ≥1.24 was more predictive of RE than sex (male) alone (area under the curve, 0.75 vs 0.70). Conclusion: Combining FSSG ≥8, sex, and a positive tongue color coating would be a useful, accurate, non‐invasive screening method for GERD, especially RE. [ABSTRACT FROM AUTHOR]