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Introduction: Sleeve gastrectomy (SG) is currently the most frequently performed bariatric procedure in the world. However, the occurrence of gastroesophageal reflux disease (GERD) after SG remains controversial and questionable. Aim: To determine the occurrence of GERD after SG using a pH-monitoring study. Material and methods: This is a prospective study involving patients undergoing SG in one surgical centre. Inclusion criteria were eligibility for bariatric surgery, no symptoms of GERD, normal gastroscopy, and pH-monitoring before the surgery. Postoperative examinations were performed 6 months after surgery. Results: A total of 38 patients were analysed in the study. The mean age was 44.9 years, and the mean preoperative BMI was 42.6 kg/m² . Before surgery, all patients had normal pH values. After surgery, mean acid exposure time (AET), number of refluxes, and DeMeester score increased statistically significantly (p < 0.001). 27 (71.1%) patients each had AET > 6%, but only 9 (23.7%) reported GERD symptoms and the need for PPIs. The correlation between AET and %TWL was moderate positive, and the correlation between DeMeester score and %TWL was low positive (p = 0.011, p = 0.014, respectively). Conclusions: GERD after SG seems to be a significant problem. More than two-thirds of patients had de novo GERD after SG in pH-monitoring, but only one-quarter of them required PPIs. [ABSTRACT FROM AUTHOR]

Scientific and technicalinnovations done since 1960s resulted in successful development and implementation in medical practice active implantable devices. Most of them are using traditional chemical batteries with limited longevity. Further research progress and development of semiconductors and passive elements base are allowing now to develop fully battery-free implants that could do same tasks, but with much lower sizes, less complication and more ease of use. In this article will be shared results of own development of an wireless-powered, remote controlled, fully implantable electrostimulator of lower esophageal sphincter (WIPLES) aimed to treat gastroesophageal reflux disease, that is very common in current days.

Background: Gastroesophageal reflux disease (GERD) is a challenging condition that involves different physicians, such as general practitioners (GPs), gastroenterologists, and ears, nose and throat (ENT) specialists. A common approach consists of proton-pump inhibitors (PPIs) administration. Adjunctive pharmacological treatment may have a role in the management of non-responders to PPIs. Objectives: We aimed to survey GPs and different medical specialists to investigate the medical approaches to patients reporting GERD symptoms. In addition, we examined the use of adjunctive pharmacological treatments in patients with GERD symptoms who do not respond to PPIs. Design: Retrospective observational study. Methods: A survey was conducted among a large sample of gastroenterologists, GPs, and ENT specialists. Symptoms were divided into typical and extraesophageal, and their severity and impact on quality of life were explored with the GERD Impact Scale and with Reflux Symptom Index (RSI). All therapies administered usually for GERD were investigated. Results: A total of 6211 patients were analyzed in this survey. Patients with typical symptoms were 53.5%, while those with extraesophageal symptoms were 46.5%. The latter were more frequently reported by ENT patients (53.6%, p < 0.0001). The GSI was higher in patients followed by gastroenterologists (9 points) and GPs (9 points) than ENT specialists (8 points), but the RSI was higher in the ENT group (14.3 ± 6.93) than in GPs and gastroenterologist groups (10.36 ± 6.36 and 10.81 ± 7.30, p < 0.0001). Chest pain had the highest negative impact on quality of life (p < 0.0001). Of the 3025 patients who used PPIs, non-responders showed a lower GSI when treated with a combination of adjunctive pharmacological treatments and bioadhesive compounds, than with single-component drugs. Conclusion: Patients with GERD referred to a gastroenterologist had more severe disease and poorer quality of life. The combination of adjunctive pharmacological treatments and bioadhesive compounds seems to be effective in the management of PPI refractory patients. Plain language summary: Gastroesophageal reflux disease management: real-world perspectives from Italian gastroenterologists, primary care physicians and ENT specialists Gastroesophageal reflux disease (GERD) is a prevalent and chronic condition that affects millions of individuals worldwide, causing significant discomfort and impacting their overall quality of life. In the comprehensive management of GERD, a collaborative approach involving different physicians is essential to address the various aspects of this complex condition. Given the wide range of diagnostic and therapeutic possibilities in clinical practice, we aimed to investigate how GERD is managed in clinical practice by general practitioners and different medical specialists, including gastroenterologists and ears, nose, and throat (ENT) specialists. A total of 6,211 observations were carried out from a survey. The severity and impact of GERD on quality-of-life was higher in patients followed by gastroenterologists and general practitioners than ENT specialists. Non-cardiac chest pain had the highest negative impact on quality-of-life. Of the 3,025 patients who used PPIs, non-responders showed an improved quality of life when treated with a combination of adjunctive pharmacological treatments and bio adhesive compounds. [ABSTRACT FROM AUTHOR]

Introduction: Eosinophilic esophagitis (EoE) is a chronic, inflammatory, antigendriven disease of the esophagus. Tissue EoE pathology has previously been extensively characterized by novel transcriptomics and proteomic platforms, however the majority of surface marker determination and screening has been performed in blood due to mucosal tissue size limitations. While eosinophils, CD4+ T cells, mast cells and natural killer (NK) T cells were previously investigated in the context of EoE, an accurate picture of the composition of peripheral blood mononuclear cells (PBMC) and their activation is missing. Methods: In this study, we aimed to comprehensively analyze the composition of peripheral blood mononuclear cells and their activation using surface marker measurements with multicolor flow cytometry simultaneously in both blood and mucosal tissue of patients with active EoE, inactive EoE, patients with gastroesophageal reflux disease (GERD) and controls. Moreover, we set out to validate our data in co-cultures of PBMC with human primary esophageal epithelial cells and in a novel inducible mouse model of eosinophilic esophagitis, characterized by extensive IL-33 secretion in the esophagus. Results: Our results indicate that specific PBMC populations are enriched, and that they alter their surface expression of activation markers in mucosal tissue of active EoE. In particular, we observed upregulation of the immunomodulatory molecule CD38 on CD4+ T cells and on myeloid cells in biopsies of active EoE. Moreover, we observed significant upregulation of PD-1 on CD4+ and myeloid cells, which was even more prominent after corticosteroid treatment. With coculture experiments we could demonstrate that direct cell contact is needed for PD-1 upregulation on CD4+ T cells. Finally, we validated our findings of PD-1 and CD38 upregulation in an inducible mouse model of EoE. Discussion: Herein we show significant alterations in the PBMC activation profile of patients with active EoE in comparison to inactive EoE, GERD and controls, which could have potential implications for treatment. To our knowledge, this study is the first of its kind expanding the multi-color flow cytometry approach in different patient groups using in vitro and in vivo translational models. [ABSTRACT FROM AUTHOR]

Esophageal cancer (EC) is a leading cause of cancer-related death in the west 1. Esophageal squamous cell carcinoma (SCC) is the most common type of EC worldwide. However, in Western countries, including the United States, esophageal adenocarcinoma (EAC) is the most common 2. EAC is most common in the lower esophagus whereas SCC is most common in the middle and upper esophagus 3. The incidence of EAC has increased dramatically in western countries over the past few decades. 2 3 The exact reason for this rise in EAC has not been clearly understood. However, an increase in the prevalence of EAC risk factors is postulated as a potential explanation 4. Although there are many identifiable EAC risk factors, including gastroesophageal reflux disease (GERD), obesity, male sex, White race, and smoking 5 6 7, Barrett’s esophagus (BE) remains the major precursor lesion of esophageal adenocarcinoma. BE develops when there is a change in the normal squamous lining of the esophageal mucosa into intestinal metaplasia 8 9. The incidence has also increased in the population over the past few decades 10 11. There is a well-described progression within BE from non-dysplastic BE (NDBE), low-grade dysplasia (LGD), high-grade dysplasia (HGD), intramucosal carcinoma (IMC), to invasive EAC 12 13. Recent data suggest that the increased incidence of EAC may have plateaued 1. However, we questioned whether the prevalence of EAC is still increasing, especially at younger ages in lieu of recent trends showing an increase in the prevalence of colorectal cancer in younger patients. These findings resulted in a lowering of the colorectal cancer screening age cutoff to 45 years from 50 years 14 15 16. Therefore, we aimed to assess the time trends in the prevalence and incidence of EAC and some of its risk factors in a large population of patients in Florida and to assess these trends based on age categories. We hypothesized that the prevalence of EAC and BE has increased over time at younger age groups.

IntroductionEosinophilic esophagitis (EoE) is a chronic, inflammatory, antigen-driven disease of the esophagus. Tissue EoE pathology has previously been extensively characterized by novel transcriptomics and proteomic platforms, however the majority of surface marker determination and screening has been performed in blood due to mucosal tissue size limitations. While eosinophils, CD4+ T cells, mast cells and natural killer (NK) T cells were previously investigated in the context of EoE, an accurate picture of the composition of peripheral blood mononuclear cells (PBMC) and their activation is missing.MethodsIn this study, we aimed to comprehensively analyze the composition of peripheral blood mononuclear cells and their activation using surface marker measurements with multicolor flow cytometry simultaneously in both blood and mucosal tissue of patients with active EoE, inactive EoE, patients with gastroesophageal reflux disease (GERD) and controls. Moreover, we set out to validate our data in co-cultures of PBMC with human primary esophageal epithelial cells and in a novel inducible mouse model of eosinophilic esophagitis, characterized by extensive IL-33 secretion in the esophagus.ResultsOur results indicate that specific PBMC populations are enriched, and that they alter their surface expression of activation markers in mucosal tissue of active EoE. In particular, we observed upregulation of the immunomodulatory molecule CD38 on CD4+ T cells and on myeloid cells in biopsies of active EoE. Moreover, we observed significant upregulation of PD-1 on CD4+ and myeloid cells, which was even more prominent after corticosteroid treatment. With co-culture experiments we could demonstrate that direct cell contact is needed for PD-1 upregulation on CD4+ T cells. Finally, we validated our findings of PD-1 and CD38 upregulation in an inducible mouse model of EoE.DiscussionHerein we show significant alterations in the PBMC activation profile of patients with active EoE in comparison to inactive EoE, GERD and controls, which could have potential implications for treatment. To our knowledge, this study is the first of its kind expanding the multi-color flow cytometry approach in different patient groups using in vitro and in vivo translational models.

Background and Aims: Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disorder that may complicate conditions such as obstructive airway disease. Our group has identified predictive biomarkers of GERD in particulate exposed first responders with obstructive airway disease. In addition, GERD diagnosis and treatment is costly and invasive. In light of these clinical concerns, we aimed to systematically review studies identifying noninvasive, multiOmic, and multicompartmental biomarkers of GERD. Methods: A systematic review of PubMed and Embase was performed using keywords focusing on reflux disease and biomarkers and registered with PROSPERO. We included original human studies in English, articles focusing on noninvasive biomarkers of GERD published after December 31, 2009. GERD subtypes (non-erosive reflux disease and erosive esophagitis) and related conditions (Barrett’s Esophagus [BE] and Esophageal Adenocarcinoma). Predictive measures were synthesized and risk of bias assessed (Newcastle-Ottawa Scale). Results: Initial search identified n = 238 studies and n = 13 articles remained after applying inclusion/exclusion criteria. Salivary pepsin was the most studied biomarker with significant sensitivity and specificity for GERD. Serum assessment showed elevated levels of Tumor Necrosis Factor- alpha in both GERD and Barrett’s. Exhaled breath volatile sulfur compounds and acetic acid were associated with GERD. Oral Microbiome: Models with Lautropia, Streptococcus, and Bacteroidetes showed the greatest discrimination between BE and controls vs Lautropia; ROCAUC 0.94 (95% confidence interval; 0.85–1.00). Conclusion: Prior studies identified significant multiOmic, multicompartmental noninvasive biomarker risks for GERD and BE. However, studies have a high risk of bias and the reliability and accuracy of the biomarkers identified are greatly limited, which further highlights the need to discover and validate clinically relevant noninvasive biomarkers of GERD.

Objective: Transnasal esophagoscopy (TNE) in the awake patient and esophagogastroduodenoscopy (EGD) in sedation are both used in the assessment of laryngopharyngeal reflux (LPR). The objective of this study was to compare these two endoscopic methods in contributing to the diagnosis of LPR. Methods: This study included 54 patients presenting with signs and symptoms suspicious for LPR, which were examined both by TNE and EGD. The contribution of each method to the diagnosis of LPR was evaluated separately and then compared with each other. Results: In detecting LPR, TNE showed a significant higher sensitivity (94% vs. 60%) and accuracy (93% vs. 59%) than EGD, but their specificity was equal (50% each). The most common pathologic findings in both methods were a hiatal hernia (70% vs. 48%) and gaping cardia (69% vs. 24%), followed by peptic esophagitis (41% vs. 24%). Conclusion: The value of EGD is limited in the workup of LPR, as sedation tends to mask the subtle findings in this kind of reflux disease. [ABSTRACT FROM AUTHOR]

Introduction and purpose of the work: The mechanism of gastroesophageal reflux disease depends on reflux of gastric contents into the esophagus as a result of reduced tone of the lower esophageal sphincter. It presents itself in the form of symptoms coming from the esophagus, e.g. heartburn, as well as from outside of it. The aim of this paper is to collect and present current knowledge on gastroesophageal reflux disease as well as diagnosis and treatment through a review of the available literature. Brief description of the state of the art: Gastroesophageal reflux disease affects 18.1 - 27.8% of the US population and 8.8 - 25.9% of the European population. It is defined as the presence of troublesome symptoms or complications of reflux of gastric contents into the esophagus. The etiology consists of many factors, such as improper diet, and low physical activity. The disease can manifest itself with symptoms from and outside the esophagus. Diagnosis is based primarily on the history, and in the presence of typical symptoms, therapy with proton pump inhibitors is initiated. Endoscopy and reflux measurement is used when there is no response to pharmacotherapy. The basic drugs are proton pump inhibitors, other drugs are complementary to the basic therapy. A lifestyle change is also recommended. Surgical treatment is an alternative, but it may not be a permanent solution. Other treatments include endoscopic incisionless fundoplication and radiofrequency treatment of the lower esophageal sphincter. Summary: Diagnosis of gastroesophageal reflux disease begins with an interview with the patient and empirical pharmacotherapy. If treatment is ineffective, endoscopy and pH measurement are performed. Proton pump inhibitors are the most effective drugs in the treatment of the disease, other drugs are used as a supplement. Surgical and endoscopic procedures are an alternative to chronic pharmacotherapy.

Inappropriate prescription of proton pump inhibitors (PPI) has been widely reported, often lacking initial exclusion of Helicobacter pylori (HP) infection and evaluation of gastric functional status. The aim of this study was to evaluate the utility of gastric functional tests to define the acid output, as well as HP status, in order to better direct PPI therapy prescription. Dyspeptic patients without alarm symptoms from a primary care population were evaluated. For each patient, serum Pepsinogen I (PGI) and II (PGII), gastrin 17 (G17) and anti-HP IgG antibodies (Biohit, Oyj, Finland) were determined. For each subject, data were collected regarding symptoms, past medical history of HP infection, and PPI use. Therapeutic response to PPIs was determined according to PGI and G17 values, where G17 > 7 in the presence of elevated PGI and absence of chronic atrophic gastritis (CAG) was considered an adequate response. Among 2583 dyspeptic patients, 1015/2583 (39.3%) were on PPI therapy for at least 3 months before serum sampling, and were therefore included in the study. Active HP infection and CAG were diagnosed in 206 (20.2%) and 37 (3.6%) patients, respectively. Overall, an adequate therapeutic response to PPIs was observed in 34.9%, reaching 66.7% at the highest dose. However, 41.1% and 20.4% of patients showed low (G17 1-7) or absent (G17 < 1) response to PPI, regardless of the dosage used. According to gastric functional response, most patients currently on PPI maintenance therapy lack a proper indication for continuing this medication, either because acid output is absent (as in CAG) or because gastrin levels fail to rise, indicating absence of gastric acid negative feedback. Lastly, HP eradication is warranted in all patients, and gastric function testing ensures this pathogen is sought for and adequately treated prior to initiating long-term PPI therapy. [ABSTRACT FROM AUTHOR]

Background. The number of patients with proton pump inhibitor (PPI)-refractory reflux symptoms is underestimated since many patients resign after an unsuccessful therapy attempt. Thus, it would be useful having a non-invasive tool that can help identify true gastroesophageal reflux disease (GERD) patients in order to manage them early and properly. The GerdQ is a validated tool developed for this purpose but its applicability in PPI-refractory patients has not yet been investigated. Our aim was to investigate if reflux symptoms per se, the GerdQ and patients characteristics are suitable for non-invasive diagnosis of GERD in patients with PPI refractory reflux symptoms. Methods. A total of 500 patients from a prospectively recorded data base with PPI-refractory reflux symptoms were retrospectively analyzed. All patients received comprehensive diagnostic workup including EGD, pH-impedance measurement and manometry. GERD was diagnosed according to the recent Lyon consensus. Results. Of all patients enrolled in the study, 280 (56%) finally fulfilled the criteria for objectively verified GERD according to the Lyon consensus. There were no significant differences in age and gender between the patients with and without GERD, whereas the body mass index was significantly higher in the group with verified GERD, but the discriminative value was low (Welch-Test, p<:001, Cohen's d D 0.39). Furthermore, there were no significant differences in the GerdQ values between the two groups. A GerdQ cutoff value - 9 resulted in a sensitivity of 43% and specificity of 57% with a positive predictive value of 56% and a negative predictive value of 44%. Conclusion. Based on our study, neither symptoms and the GerdQ score nor patients' characteristics are appropriate tools to distinguish between GERD and other causes for reflux symptoms in patients with PPI-refractory reflux symptoms. [ABSTRACT FROM AUTHOR]

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• Different collection methods for analysis of bile acids in saliva were compared. • Simple spitting was found to be the most suitable for bile acid analysis in saliva. • UHPLC-MS analysis of bile acids showed that saliva is stable for up to 14 days. This study investigated methods for sampling bile acids in saliva, a potential non-invasive diagnostic biofluid. Bile acids have been implicated in causing damage and permanent changes to the esophageal mucosa and increasing the risk of developing Barrett's esophagus, a condition that can potentially progress to esophageal cancer. Three saliva collection methods were compared: spitting, Salivette® swabs, and Salivette Cortisol® swabs. Spitting emerged as the superior method with the highest recoveries and the least interference, likely due to Salivette swabs retaining bile acids or introducing unknown interferences. All saliva samples were analyzed by UHPLC-MS/MS using the Zorbax RRHD Eclipse Plus C18 column (3 × 50 mm, 1.8 µm) in gradient elution of 0.1 % formic acid in water and methanol. Saliva sample stability was assessed over 14 days, reflecting typical storage times. The levels of detected bile acids were stable for the measured period (RSD ≤ 22 %) and no degradation was observed. Bile acid levels in saliva fluctuated throughout the day, with the greatest changes observed for glycine-conjugated bile acids after meals. To minimize sampling variability, saliva collection by spitting after overnight fasting is recommended for future studies. Our findings are applicable for standardized bile acid sampling and are currently applied in a large clinical study evaluating bile acids as potential susceptibility markers for Barrett's esophagus diagnostics. [ABSTRACT FROM AUTHOR]

Background The number of patients with proton pump inhibitor (PPI)-refractory reflux symptoms is underestimated since many patients resign after an unsuccessful therapy attempt. Thus, it would be useful having a non-invasive tool that can help identify true gastroesophageal reflux disease (GERD) patients in order to manage them early and properly. The GerdQ is a validated tool developed for this purpose but its applicability in PPI-refractory patients has not yet been investigated. Our aim was to investigate if reflux symptoms per se, the GerdQ and patients characteristics are suitable for non-invasive diagnosis of GERD in patients with PPI refractory reflux symptoms. Methods A total of 500 patients from a prospectively recorded data base with PPI-refractory reflux symptoms were retrospectively analyzed. All patients received comprehensive diagnostic workup including EGD, pH-impedance measurement and manometry. GERD was diagnosed according to the recent Lyon consensus. Results Of all patients enrolled in the study, 280 (56%) finally fulfilled the criteria for objectively verified GERD according to the Lyon consensus. There were no significant differences in age and gender between the patients with and without GERD, whereas the body mass index was significantly higher in the group with verified GERD, but the discriminative value was low (Welch-Test, p

Background: The functional lumen imaging probe (Endoflip™) is increasingly used for evaluation of patients with esophageal symptoms. To improve the interpretation of Endoflip™ in clinical practice, normative values with appropriate cut‐off values are required. Methods: Original clinical studies describing Endoflip™ use for measurements of esophageal motility in healthy adults were considered. Meta‐analysis was performed based on published values. Results: A total of 17 articles were included in the systematic review, 15 of which were included in the meta‐analysis, representing 154 unique subjects. At 40 ml distention, the 5th–95th and 10th–90th percentiles for esophagogastric junction distensibility index (EGJ‐DI) were 1.96–10.95 mm2/mmHg and 2.36–8.95 mm2/mmHg, respectively. An EGJ‐DI below 2 mm2/mmHg was found in 5.4%, and below 3 mm2/mmHg in 20.1% of healthy subjects. At 50 ml distention, the 5th–95th and 10th–90th percentiles for EGJ‐DI are 2.86–10.66 mm2/mmHg and 3.28–9.12 mm2/mmHg, respectively (below 2 mm2/mmHg: 0.6%, 3 mm2/mmHg: 6.3%). The 5th–95th and 10th–90th percentiles for EGJ‐DI at 60 ml distention were 3.06–8.14 mm2/mmHg and 3.33–7.18 mm2/mmHg, respectively (below 2 mm2/mmHg: 0.0%, 3 mm2/mmHg: 7%). A clear cut‐off for lower values was identified while a large spread in values was observed for upper limits of normal for EGJ‐DI for all filling volumes. Conclusions: Given these observations, we recommend using a cut‐off of 2 mm2/mmHg for clinical practice, values below can be considered abnormal. Given that 5.4% of the healthy subjects will have an EGJ‐DI below 2 mm2/mmHg at 40 ml, we recommend using the 50 and 60 ml distention volumes. The clinical use of an upper limit for normality of EGJ‐DI seems questionable. [ABSTRACT FROM AUTHOR]

The clinical diagnosis of gastro-esophageal reflux disease (GERD) is based on the presence of typical esophageal troublesome symptoms. In clinical practice, heartburn relief following a proton pump inhibitor (PPI) trial or endoscopy can confirm a diagnosis of GERD. In cases of diagnostic uncertainty or before anti-reflux interventions, combined impedance-pH monitoring (MII-pH) provides a comprehensive assessment of both physical and chemical properties of the refluxate, allowing to achieve a conclusive diagnosis of GERD. Recently, the Lyon Consensus proposed the use of mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave index (PSPW-I) as novel MII-pH metrics to support the diagnosis of GERD. The calculation of MNBI and PSPW-I currently needs to be performed manually, but artificial intelligence systems for the automated analysis of MII-pH tracings are being developed. Several studies demonstrated the increased diagnostic yield MNBI and PSPW-I for the categorization of patients with GERD at both on- and off-PPI MII-pH monitoring. Accordingly, we performed a narrative review on the clinical use and diagnostic yield of MNBI and PSPW-I when the diagnosis of GERD is uncertain. Based on currently available evidence, we strongly support the evaluation of PSPW-I and MNBI as part of the standard assessment of MII-pH tracings for the evaluation of GERD, especially in patients with endoscopy-negative heartburn. [ABSTRACT FROM AUTHOR]

Objectives: Congenital laryngomalacia (CLM) is the most common cause of stridor in neonates and is commonly associated with reflux disease (RD) such as gastroesophageal reflux and newborn esophageal reflux. This study investigates the impact of RD on the management and outcomes of neonates with CLM., Methods: The 2016 Kids' Inpatient Database (KID) was queried for neonates with CLM (ICD-10: Q31.5). RD status, procedures, and complications were identified with ICD-10 codes. Univariate and multivariable analyses were implemented to determine statistical associations., Results: Of 2212 neonates identified with CLM, 585 (26.45%) had RD. Patients with RD were more often female ( p  = .038) and premature ( p  < .001). Upon multivariable analysis, patients with RD had greater total charges (Mean $457,810.87 vs. $259,020.90, p  < .001) and longer length of stay (Mean 46.03 vs. 26.44 days, p  < .001). Those with RD had more diagnoses recorded (Mean 14.15 vs. 9.66, p  < .001), underwent more procedures (Mean 5.47 vs. 3.49, p  < .001), and had a longer wait until their first procedure (Mean 13.27 vs. 7.02 days, p  < .001). Patients with RD had increased odds for undergoing laryngoscopy (OR 1.799, 95% CI 1.382-2.321, p  < .001), bronchoscopy (OR 2.179, 95% CI 1.598-2.801, p  < .001), and ventilator use (OR 1.526, 95% CI 1.197-1.886, p  < .001) on multivariable regression adjusting for patient demographics, hospital characteristics, and comorbidities. Patients with and without RD had similar odds for undergoing tracheotomy (OR 1.540, 95% CI 0.934-2.522, p  = .088) and mortality (OR 1.084, 95% CI 0.397-2.646, p  = .874)., Conclusion: CLM is a common diagnosis in neonates that is associated with RD. In our cohort of neonates with CLM, those with RD had overall poorer outcomes., Level of Evidence: 4., Competing Interests: The authors report no conflicts of interest., (© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Background: Gastroesophageal reflux disease is one of the most common chronic diseases, affecting up to 28% of the western population. Therapeutic management ranges from conservative measures to endoscopic or surgical interventions. Laparoscopic Nissen fundoplication (LNF) still is considered as gold standard, but alternative procedures have been developed and evaluated within the past years., Summary: Magnetic sphincter augmentation (MSA), which aims to be a less disruptive and possibly more standardized laparoscopic procedure than LNF, shows satisfying results regarding short- and long-term follow-up as well as comorbidities. Alternatives, such as the RefluxStop™ procedure or Transoral incisionless fundoplication (TIF), combined with laparoscopic hiatal hernia repair (cTIF) show promising results for short-term follow-up, nevertheless further studies regarding long-term follow-up are necessary., Key Message: Although there definitely are upcoming and promising trends in upper GI surgery, LNF still represents today's gold standard and MSA is an equivalent alternative. RefluxStop™ and cTIF show promising results, nevertheless, further studies are necessary., Competing Interests: Lisa Gensthaler has no conflict of interest or financial support to declare. Sebastian F. Schoppmann has no conflict of interest to declare., (© 2024 S. Karger AG, Basel.)

Increased salivary acidity is responsible for numerous negative effects at the dentoparodontal level. In oral implantology, in which titanium implants are mainly used, the effects of low oral pH are less studied, even though numerous in vitro studies have demonstrated titanium's remarkable resistance to corrosion. In this paper, we present the results of follow-up checkups of a group of patients undergoing implant surgery with and without elevated salivary acidity. [ABSTRACT FROM AUTHOR]

Gastroesophageal reflux disease (GERD) is one of the most prevalent and bothersome functional gastrointestinal disorders worldwide, including in Thailand. After a decade of the first Thailand GERD guideline, physician and gastroenterologist encountered substantially increase of patients with GERD. Many of them are complicated case and refractory to standard treatment. Concurrently, the evolution of clinical characteristics as well as the progression of investigations and treatment have developed and changed tremendously. As a member of Association of Southeast Asian Nations, which are developing countries, we considered that the counterbalance between advancement and sufficient economy is essential in taking care of patients with GERD. We gather physicians from university hospitals, as well as internist and general practitioners who served in rural area, to make a consensus in this updated version of GERD guideline focusing in medical management of GERD. This clinical practice guideline was constructed adhering with standard procedure. We categorized the guideline in to four parts including definition, investigation, treatment, and long‐term follow up. We anticipate that this guideline would improve physicians' proficiency and help direct readers to choose investigations and treatments in patients with GERD wisely. Moreover, we wish that this guideline would be applicable in countries with limited resources as well. [ABSTRACT FROM AUTHOR]

Objectives: There is currently no reference standard test for the detection of the extra-esophageal manifestations of gastroesophageal reflux disease (GERD). The current suite of diagnostic tests principally assesses reflux events in the esophagus. A new scintigraphic technique has been developed and validated against reference standards. It allows direct visualization of refluxate in the laryngopharynx and lungs., Methods: Fifty patients were assessed by scintigraphy before and after fundoplication at a single nuclear medicine facility. Standardized reflux symptom indices (RSIs) were obtained from each patient before and after surgery. Patients were scanned after oral 99 m technetium Fyton administration with early dynamic images and delayed SPECT/CT images of the head, neck, and lungs. ANOVA, Spearman correlation, and the Student's t-test were utilized for analysis., Results: The study population (35F, 15 M) had a mean age of 63.9 years. Mean BMI was 26.8 with 67% being overweight or obese. All patients had significant reflux. SPECT/CT showed LPR events in 45/50 and pulmonary micro-aspiration (PMA) in 45/50 preoperatively and in 36/50 and 20/50 postoperatively, respectively. The RSI, cough, and throat clearing indices showed a significant fall postoperatively (p < 0.001). Frequency of scintigraphic reflux events was reduced from a mean of 4.5 in 30 min to 2.9 (t = 9.1, p = 0.004)., Conclusion: The novel scintigraphic test detects esophageal and extra-esophageal reflux events and permits direct visualization of refluxate in the head and neck structures and lungs. It correlates well with symptoms of reflux in the esophagus and extra-esophageal structures and the response to therapy., Level of Evidence: Although prospective, the study did not randomize patients and in effect each patient became their own control following an intervention (fundoplication). Thus, the study is Level 3 evidence Laryngoscope, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

The condition of dental erosion is defined as acid-related loss of tooth structure which does not involve microorganisms. Depending on the origin of the acid, extrinsic (usually caused by acids in food) and intrinsic (caused by endogenous acid) erosion can be distinguished. The presence and severity of erosive defects depend on various parameters such as nutrition, saliva, general diseases, and mechanical stress by abrasion and attrition. As an example, dietary habits which involve frequent intake of acidic food and beverages, occupational acid exposure, as well as certain drugs or diseases that affect saliva flow rate are accompanied by an increased risk of erosive dental hard tissue defects. By a thorough clinical examination and an accurate anamnesis, various erosion-related risk factors can be identified and strategies to reduce or eliminate these factors be identified. [ABSTRACT FROM AUTHOR]

Purpose: The surgical thyroid disease includes upper aerodigestive complaints with not homogenous prevalence and specific features. The purpose was to analyze before and after total thyroidectomy (TT) the prevalence and severity of voice, swallowing, respiratory, and reflux airway symptoms in relation with thyroid weight. Methods: A total of 98 consenting patients undergoing TT were enrolled. Preoperatively, 1 and 3 months after TT, patients underwent videolaryngoscopy, subjective evaluation of voice (VIS), swallowing (SIS and EAT-10), respiratory (mMRC), and reflux symptoms (RSI, Gerd-Q). The scores were analyzed based on thyroid weight (<25 gr, 26–50 gr, 51–75 gr, >75 gr) and post-operative score gain was calculated from the score before TT and the follow-up examination. Results: In total, 40/98 selected cases of uncomplicated TT completed the postoperative evaluation. Endoscopic signs suggestive of reflux disease were observed in 1/40 (2.5%) and 0/19 cases before and after TT respectively. The prevalence of cases with abnormal reflux symptom index decreased significantly after surgery (8/40 vs 1/40) (p < 0.05), similarly occurred for the Gerd-Q (4/40 vs 1/40) (p < 0.05). Three months after TT the voice, swallowing and respiratory scores were significantly lower than the preoperative ones (p < 0.05). The SIS correlated positively with EAT-10 and RSI. After 3 months the postoperative score gain of voice, swallowing, respiratory, and reflux symptoms (Gerd-Q) was statistically higher (p < 0.05) in the cases with heaviest gland. Conclusions: The surgical thyroid disease is associated to mild aerodigestive preoperative compressive symptoms, that include respiratory abnormalities and reflux like symptoms, regardless of the gland weight. In absence of endoscopic signs of airway reflux the presence of reflux symptoms suggests an overlapping with thyroid neck complaints. The patients undergoing uncomplicated TT had improvement in compressive symptoms and the greatest improvement is seen in larger goiters. [ABSTRACT FROM AUTHOR]

Matteo Ghisa1, Carla Marinelli1, Vincenzo Savarino2, Edoardo Savarino1 1Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; 2Gastrointestinal Unit, Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, ItalyCorrespondence: Edoardo SavarinoGastrointerology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, Padova 351258, ItalyTel +39 049 821 7749Fax +39 049 876 0820Email edoardo.savarino@unipd.itAbstract: Gastroesophageal reflux disease (GERD) and idiopathic pulmonary fibrosis (IPF) are two pathological conditions often strictly related, even if a clear relationship of causality has not been demonstrated. GERD is a frequent comorbidity in IPF patients, as demonstrated using combined multichannel intraluminal impedance-pH, despite being mostly clinically silent. According to that, it has been hypothesized that microaspiration of gastric material may play a fundamental role in the fibrotic transformation of pulmonary parenchyma. In contrast, it cannot be excluded that IPF may favor GERD by increasing the negative intrathoracic pressure. Therefore, this relationship is uncertain as well as not univocal. Nevertheless, the latest international guidelines recommend the use of proton pump inhibitors (PPIs) in IPF based on several data showing that PPIs can stabilize lung function, reduce disease flares and hospitalizations. On the contrary, recent studies not only question the relevance of these results, but also associate the use of PPIs with an increased risk of lung infections and a negative prognostic outcome. The aim of this review is to analyze the possible links between GERD and IPF and their possible therapeutic implications, trying to translate this scientific evidence into useful information for clinical practice.Keywords: idiopathic pulmonary fibrosis, microaspiration, chronic cough, GERD, reflux disease, motility

Objective: Although laryngopharyngeal reflux (LPR) is a common condition in daily practice, no gold standard exists for its diagnosis. The objective of this study was to establish a simple and reliable scoring system for evaluating LPR consisting of both subjective and objective criteria. Methods: This retrospective study includes 124 patients presenting with symptoms of LPR. In all patients, reflux symptom index (RSI), reflux finding score (RFS), oropharyngeal pH monitoring (PHM) and transnasal oesophagoscopy (TNE) were performed and rated in a special scoring system. Results: A Horvath Score of 4‐5 for severe LPR was found in 76 patients (61%), a score of 2‐3 for non‐severe LPR in 38 patients (31%) and a score of 0‐1 for non‐existing LPR in 10 patients (8%) by combining the 4 validated diagnostic methods. Conclusion: The proposed scoring system qualifies as a simple and reliable tool for evaluating LPR in daily practice, directly impacting patient management. [ABSTRACT FROM AUTHOR]

Digitalization spreads day by day around the world; thus, the amount of data collected is on the rise. An increasing amount of data leads us to use the data and get the advantage of it by using methods like Data mining. Data mining is used in several industries. Especially as medical data is essential to be understood, it is crucial to work on it. Reflux disease is a painful illness spreading around the world. Reflux is more common compared to formerly known numbers of patients. Even though reflux is not as fatal as cancer, it decreases the quality of life and makes many people suffer in their daily life. So, reflux is affecting mental health directly. If we can ease the process of diagnosis of reflux, we may provide a better quality of life for people. In this study, various data mining algorithms are applied, and it is seen from results that medical care can be improved by changing. Nowadays, artificial intelligence applications in the field of gastroenterology stand out in various sources in the literature. However, a large database required that is specific for Reflux disease to implement these applications is available only at the Reflux Research Center in Ege University in Turkey. By benefiting the Short Form36 and Quadrad12 questionnaire data in this database, 3,909 patients and many artificial intelligence algorithms were used to discover the hidden associations among responses in the quality of life of these patients. The algorithms used in the tests are Apriori, Frequent Pattern Growth, Density-Based Spatial Clustering of Applications with Noise, Self-Organizing Map, and KMeans. In the tests, it was observed that the most successful algorithm in terms of the structure of the data was KMeans, and a set of remarkable 27 rules according to the optimal Sum of Square Error value was obtained. [ABSTRACT FROM AUTHOR]

Background & Aims: In clinical practice, most patients with symptoms suggestive of gastroesophageal reflux disease (GERD) undergo esophago-gastro-duodenoscopy (EGD), despite its low sensitivity in detecting reflux stigmata. Gastrin 17 (G-17) has been proposed to be related with GERD, due to the negative feedback between acid secretion and this hormone. We assessed the clinical usefulness of fasting G-17 serum determination for a non-invasive diagnosis of GERD in patients with typical symptoms. Methods: We consecutively enrolled patients complaining of typical GERD symptoms in two different settings: a single referral center and a primary care setting. Control groups consisted of dyspeptic patients. All subjects underwent assessment of serum levels of G-17 and EGD. Results: At the academic hospital, 100 GERD patients (n=89 with erosive esophagitis and 11 with Barrett's esophagus) had statistically significant low levels of G-17 as compared with 184 dyspeptic patients (1.7±1.2 pg/L vs 8.9±5.7 pg/L p<0.0001). Similarly, in the primary care setting, 163 GERD patients had statistically significant low levels of G-17 as compared with 132 dyspeptic patients (0.5±0.2 pg/L vs. 4.0±2.6 pg/L, p<0.0001). Moreover, in the primary care setting, no statistically significant differences were found for G-17 levels between patients with erosive and non-erosive reflux pattern (0.4±0.2 vs 0.7±0.3; p=0.08). In primary care, the accuracy of G-17 less than 1 pg/L to diagnose non-invasively GERD was 94.3%. Conclusions: Low levels of G-17 were detected in patients with erosive esophagitis and Barrett's esophagus in a referral center and in patients with typical GERD symptoms in a sample of patients from a primary care setting. [ABSTRACT FROM AUTHOR]

The esophagus serves the principal purpose of transporting food from the pharynx into the stomach. A complex interplay between nerves and muscle fibers ensures that swallowing takes place as a finely coordinated event. Esophageal function can be tested by a variety of methods, endoscopy, manometry, and reflux monitoring being some of the most important. Regarding pathophysiology, motor disorders, such as achalasia, often cause dysphagia and/or chest pain. Functional esophageal disorders are a heterogeneous group with hypersensitivity as a dominant pathophysiological factor. Gastroesophageal reflux disease often causes symptoms, such as heartburn and regurgitation, and a spectrum of disease, ranging from minimal mucosal damage visible only in the microscope to esophageal ulcers and strictures in the most severe cases. Eosinophilic esophagitis is an immune‐mediated condition that can result in significant dysphagia and associated luminal narrowing. In the following, we will provide an overview of the most common esophageal disorders from a combined pathophysiological and clinical view. [ABSTRACT FROM AUTHOR]

Admission: Reflex disease is one of the most common diseases of the upper gastrointestinal tract. In the conservative treatment, non-pharmacological primary role proper nutrition and diet compliance. Objective: The aim of the study was to determine the impact diet has on reflux disease. Material and methods:The study has been given to people with gastroesophageal reflux disease. The study was conducted in Bydgoszcz and Wloclawek. The study used a survey of their own design on socio-demographic data and questions about dietary treatment. Statistical analysis was performed using SPSS statistical program. Results:The highest percentage of women-study group accounted for 58.1%, while men accounted for more than 41.9% of the study population. The study was dominated by two age groups. People aged 45-59 years - 34.9%, and 60-74 years - 30.2%. Respondents most frequently observed symptoms of gastroesophageal reflux disease after eating high-fat products - 34.9%. 7 persons adversely affected by the sharp spices, for 6 people - chocolate, for more than 10% of soda. For nearly half of the study population (44.2%) diet was too cumbersome to be able to be used. 10 people (23.3%) is not made trouble, 18.6% of respondents are aware that some products hurt them, but they can not give them up, and 14% of respondents often forgot about the use of supplements. Conclusions: 1. The symptoms of gastroesophageal reflux disease in subjects most often occur after eating high fat products. 2. The incidence of GERD increases with age. 3. For almost half of the population studied diet is too cumbersome to be able to use it. 4. Addictions such as alcohol and smoking have an impact on the incidence of gastroesophageal reflux disease.

Nonerosive reflux disease (NERD) is a gastrointestinal disorder that leads to symptoms such as heartburn and regurgitation without visible esophageal mucosal injury, and it is treated with proton-pump inhibitors (PPIs). CHETOGERD® gel or orosoluble (oro) formulations—an association of natural active ingredient: hyaluronic acid, altea, malva, apple active TM, Aloe vera, l-triptophan, calcium gluconate, sodium bicarbonate, Musa paradisiaca)—may be an alternative or a coadjutant treatment in patients with NERD. The aim of the study was to evaluate, prospectively, the efficacy of CHETOGERD® gel and oro in inducing symptom's reduction or remission, in consecutive patients with NERD. Patients were divided in two groups and treated with CHETOGERD® gel or CHETOGERD® oro, 3 sachets/day for 3 months, decreased to 1 sachet/day for other 3 months. Symptoms were evaluated at baseline, 3 and 6 months using the reflux disease questionnaire (RDQ). Symptoms' remission was defined as reduction of retrosternal pain or burning, epigastric pain or burning, regurgitation and acid sensation in mouth. Frequency, distribution analyses and non-parametric tests were used for the statistical analysis. Results were considered statistically significant for p values < 0.05. Four hundred and twenty-three patients (M/F 240/183; mean age 50 years) were diagnosed with NERD and were consecutively enrolled. 146 patients underwent therapy with CHETOGERD® gel, while 277 were treated with CHETOGERD® oro. 108 patients from the first group and 172 patients from the second group completed follow up at 3 months, while 100 patients from each group completed follow-up at 6 months. Both formulations were able to significantly reduce the frequency and intensity of symptoms analysed with RDQ. No adverse events were reported. CHETOGERD® gel and oro are two valid alternatives to control symptoms in patients with nonerosive reflux disease. [ABSTRACT FROM AUTHOR]

Introduction: Adenocarcinoma of the esophagus and cardia is a rare cancer, associated with chronic reflux disease. Its associated mortality is still very high, reflecting both aggressive biology and lack of adequate treatments. The aim of this article was to describe up to date management of these complex tumors. Materials and Methods: A systematic review of the literature was performed, using PubMed Central database. Articles published after the year 2000 were included, with no language exclusion. Results: Reflux disease and Barrett esophagus are strongly associated with esophageal adenocarcinoma. A strict surveillance should be initiated at diagnosis. Both proton pump inhibitors and antireflux surgery failed to influence the incidence of cancer. Surgery and multimodal therapies are keystones for curative treatment, but no clear consensus exists for the best option. A clear trend in standardization of the surgical approach is observed since last ten years. However, the optimal approach for the tumors of the cardia is still not completely set. Complication rate is still high, but real progresses are made, through the implementation of less invasive techniques. Conclusion: Progress has been made in the management of esophageal cancer. However, the multiplicity of choices failed to lead to standardization. The development of international consensus regarding multimodal treatment and surgical approaches is needed. [ABSTRACT FROM AUTHOR]

The aim of this study was to establish and compare the prevalence and severity of erosive tooth wear (ETW) in children with and without erosive esophagitis. Children aged 5-12 years, scheduled for upper digestive endoscopy at the Pediatric Gastroenterology Service of the Children's Hospital Santo Antonio, Porto Alegre, Brazil, were eligible to participate in this study. Patients who presented erosive esophagitis at endoscopy were defined as gastroesophageal reflux disease (GERD) carriers, and the severity was described according to the Los Angeles classification. The oral cavity examination was performed by a trained and calibrated dentist and ETW was classified using the Basic Erosive Wear Examination (BEWE) index. Parents/guardians answered a questionnaire about the patients' diets and frequency of consumption of acidic foods and beverages. A total of 110 children were included in the study. Erosive esophagitis was observed in 24 patients (21.8%) and all of them (100%) presented ETW, showing a statistically significant association between these 2 conditions (p < 0.05). Among children who did not present with erosive esophagitis (n = 86), 54 (64.3%) had an ETW risk level of none according to their BEWE scores (0-2). The results of this study showed a statistically significant association between erosive esophagitis and ETW, thus it can be concluded that it is important to recognize groups at risk of ETW and act together with medical professionals to ensure adequate oral health for these patients. [ABSTRACT FROM AUTHOR]

Chronic rhinitis, a diffuse disease with a prevalence of 40%, can be classified in allergic (AR) and non-allergic rhinitis (NAR). Nasal cytology allows for the identification of different NAR sub-types according to the inflammatory cell infiltrate. NAR etiopathogenesis is not well clarified and, for NARNE (non-allergic rhinitis with neutrophils) subtype, gastroesophageal reflux disease (GERD) has been suggested as one of the etiopathogenetic factors. Aim of this study is to evaluate the role of GERD in patients with NARNE. Fifty-one consecutive patients referred to our Ear, Nose and Throat (ENT) unit with nasal symptoms and cytology suggestive for NAR, were enrolled in the study. All the patients performed a gastroenterological evaluation, high resolution esophageal manometry and a 24-h pH-Impedance monitoring. Twenty-five (49%) patients tested positive at nasal cytology for NARNE. A pathologic pH-impedance was identified in seven patients (28%) with NARNE, as opposed to only one (4%) with different NAR subtypes. Statistical analysis showed that higher acid exposure time (AET) and weaker post nasal drainage were more common in NARNE vs. other NAR patients. NARNE strongly correlates with higher AET and refluxes number; thus, NARNE patients should be tested with pH-impedance monitoring in addition to nasal cytology. [ABSTRACT FROM AUTHOR]