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Mengistie FA, Shewaye AB, Tasamma AT, Ayalew ZS. Clinical features of gastroesophageal reflux disease and erosive esophagitis: Insights from patients undergoing esophagogastroduodenoscopy in resource-limited Ethiopia. World J Gastroenterol 2024; 30:3883-3893. [PMID: 39350789 PMCID: PMC11438650 DOI: 10.3748/wjg.v30.i34.3883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/24/2024] [Accepted: 08/30/2024] [Indexed: 09/10/2024] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a common disease worldwide with varying clinical presentations and risk factors. Prevalence data for Africa is lacking, but an increasing trend is expected due to demographic and epidemiological transitions. Although endoscopic studies for general gastrointestinal disorders have shown some patients with erosive esophagitis (EE), no studies in Ethiopia have investigated the clinical characteristics, risk factors, and severity of GERD using esophagogastroduodenoscopy (EGD). AIM To assess the clinical features of GERD in Ethiopian patients who underwent EGD and determine the severity and risk factors of EE. METHODS We conducted a multicenter, retrospective cross-sectional study of 221 patients diagnosed with GERD and endoscopic findings of EE at Trauma Associated Severe Hemorrhage and Amniotic Membrane Stem Cell between January 2019 and August 2022. Data were collected from electronic medical records and phone call interviews. We used descriptive statistics and binary logistic regression analysis with SPSS version 26 to identify the association between variables with a statistical significance set at P value < 0.05. RESULTS The mean ± SD age of the patients was 44.8 (± 15.9) years, with a male-to-female ratio of 1.6:1. The most commonly reported symptom was epigastric pain (80.5%), followed by heartburn (43%). Los Angeles (LA)-A EE was diagnosed in 71.1% of patients, followed by LA-B (14.9%), LA-C (7.7%), and LA-D (5.9%). Multivariate analysis showed that age 50 or above, presence of bleeding, and endoscopic findings of duodenitis/duodenopathy were significantly associated with severe EE (P < 0.05). Stricture and Barrett's esophagus were observed in 4.5% and 1.36% of patients with EE, respectively. CONCLUSION Most of the patients had milder EE with fewer complications. However, severe EE was more prevalent in older patients and those with duodenitis/duodenopathy.
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Affiliation(s)
- Firehiwot A Mengistie
- Department of Internal Medicine, Addis Ababa University, Addis Ababa 1176, Addis Ababa, Ethiopia
- Department of Internal Medicine, Rheum Rheumatology and Internal Medicine Specialty Clinic, Addis Ababa 1000, Addis Ababa, Ethiopia
| | - Abate B Shewaye
- Department of Internal Medicine, Addis Ababa University, Addis Ababa 1176, Addis Ababa, Ethiopia
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Adera Medical and Surgical Center, Addis Ababa 1000, Addis Ababa, Ethiopia
| | - Abel T Tasamma
- Department of Internal Medicine, Addis Ababa University, Addis Ababa 1176, Addis Ababa, Ethiopia
| | - Zekarias S Ayalew
- Department of Internal Medicine, Addis Ababa University, Addis Ababa 1176, Addis Ababa, Ethiopia
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Barberio B, Visaggi P, Savarino E, de Bortoli N, Black CJ, Ford AC. Comparison of acid-lowering drugs for endoscopy negative reflux disease: Systematic review and network Meta-Analysis. Neurogastroenterol Motil 2023; 35:e14469. [PMID: 36153790 PMCID: PMC10078414 DOI: 10.1111/nmo.14469] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/29/2022] [Accepted: 09/12/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The comparative efficacy and safety of medical therapies for gastro-esophageal reflux symptoms in endoscopy-negative reflux disease is unclear. We conducted a network meta-analysis to evaluate efficacy and safety of proton pump inhibitors (PPIs), histamine-2-receptor antagonists, potassium-competitive acid blockers (PCABs), and alginates in patients with endoscopy-negative reflux disease. METHODS We searched MEDLINE, EMBASE, EMBASE Classic, and the Cochrane central register of controlled trials from inception to February 1, 2022. We included randomized controlled trials (RCTs) comparing efficacy of all drugs versus each other, or versus a placebo, in adults with endoscopy-negative reflux disease. Results were reported as pooled relative risks with 95% confidence intervals to summarize effect of each comparison tested, with treatments ranked according to P-score. KEY RESULTS We identified 23 RCTs containing 10,735 subjects with endoscopy-negative reflux disease. Based on failure to achieve complete relief of symptoms between ≥2 and <4 weeks, omeprazole 20 mg o.d. (P-score 0.94) ranked first, with esomeprazole 20 mg o.d. or 40 mg o.d. ranked second and third. In achieving adequate relief, only rabeprazole 10 mg o.d. was significantly more efficacious than placebo. For failure to achieve complete relief at ≥4 weeks, dexlansoprazole 30 mg o.d. (P-score 0.95) ranked first, with 30 ml alginate q.i.d. combined with omeprazole 20 mg o.d., and 30 ml alginate t.i.d. second and third. In terms of failure to achieve adequate relief at ≥4 weeks, dexlansoprazole 60 mg o.d. ranked first (P-score 0.90), with dexlansoprazole 30 mg o.d. and rabeprazole 20 mg o.d. second and third. All drugs were safe and well-tolerated. CONCLUSIONS & INFERENCES Our results confirm superiority of PPIs compared with most other drugs in treating endoscopy-negative reflux disease. Future RCTs should aim to better classify patients with endoscopy-negative reflux disease, and to establish the role of alginates and PCABs in achieving symptom relief in both the short- and long-term.
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Affiliation(s)
- Brigida Barberio
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Pierfrancesco Visaggi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Nicola de Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Christopher J Black
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
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Maneerattanaporn M, Pittayanon R, Patcharatrakul T, Bunchorntavakul C, Sirinthornpanya S, Pitisuttithum P, Sudcharoen A, Kaosombatwattana U, Tangvoraphongchai K, Chaikomin R, Harinwan K, Techathuvanan K, Jandee S, Kijdamrongthum P, Tangaroonsanti A, Rattanakovit K, Chirapongsathorn S, Gonlachanvit S, Surangsrirat S, Werawatganon D, Chunlertrith K, Mahachai V, Leelakusolvong S, Piyanirun W. Thailand guideline 2020 for medical management of gastroesophageal reflux disease. J Gastroenterol Hepatol 2022; 37:632-643. [PMID: 34907597 PMCID: PMC9303339 DOI: 10.1111/jgh.15758] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
- Monthira Maneerattanaporn
- Division of Gastroenterology, Department of Internal MedicineSiriraj Hospital, Mahidol UniversityBangkokThailand
| | - Rapat Pittayanon
- Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | | | | | | | | | - Asawin Sudcharoen
- Department of Medicine, Faculty of MedicineThe HRH Princess MahaChakri Sirindhorn Medical CenterOngkharakThailand
| | - Uayporn Kaosombatwattana
- Division of Gastroenterology, Department of Internal MedicineSiriraj Hospital, Mahidol UniversityBangkokThailand
| | | | - Reawika Chaikomin
- Division of Gastroenterology, Department of Internal MedicineSiriraj Hospital, Mahidol UniversityBangkokThailand
| | - Kamin Harinwan
- Division of Gastroenterology and Hepatology, Department of MedicinePhramongkutklao HospitalBangkokThailand
| | - Karjpong Techathuvanan
- Department of Medicine, Faculty of Medicine, Vajira HospitalNavamindradhiraj UniversityBangkokThailand
| | - Sawangpong Jandee
- Department of Medicine, Faculty of MedicinePrince of Songkla UniversityHat YaiThailand
| | | | | | | | - Sakkarin Chirapongsathorn
- Division of Gastroenterology and Hepatology, Department of MedicinePhramongkutklao HospitalBangkokThailand
| | - Sutep Gonlachanvit
- Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Surapol Surangsrirat
- Division of Gastroenterology and Hepatology, Department of MedicinePhramongkutklao HospitalBangkokThailand
| | | | | | - Varocha Mahachai
- Department of Medicine, Faculty of MedicineChulalongkorn UniversityBangkokThailand,GI and Liver CenterBangkok HospitalBangkokThailand
| | - Somchai Leelakusolvong
- Division of Gastroenterology, Department of Internal MedicineSiriraj Hospital, Mahidol UniversityBangkokThailand
| | - Wanich Piyanirun
- Division of Gastroenterology and Hepatology, Department of MedicinePhramongkutklao HospitalBangkokThailand
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Ye B, Wang Y, Lin L, Jiang L, Wang M. Sex-Based Differences in pH Parameters and Esophageal Impedance of Patients With Gastroesophageal Reflux Disease. Front Med (Lausanne) 2021; 8:629302. [PMID: 34124085 PMCID: PMC8192704 DOI: 10.3389/fmed.2021.629302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/23/2021] [Indexed: 12/22/2022] Open
Abstract
Background/Aims: The incidence of reflux esophagitis (RE) has a striking predominance in males. Conversely, non-erosive reflux disease (NERD) is more common in females. This imbalance of gastroesophageal reflux disease (GERD) implies sex-related differences in its pathogenesis. However, limited studies have analyzed the sex-based differences in pH parameters and esophageal impedance of GERD patients. Methods: This study evaluated sex-based pathogenesis differences by comparing reflux episodes, mean nocturnal baseline impedance (MNBI) values, and post-reflux swallow-induced peristaltic wave (PSPW) index values of males with GERD and females with GERD using 24-h multichannel intraluminal impedance and pH monitoring. Results: We analyzed 181 patients (102 males and 79 females) with GERD. Reflux symptom index (RSI) scores were higher in females than that in males (P < 0.05). Males had significantly longer acid exposure times, higher DeMeester scores, and more acid reflux episodes than females (P < 0.05). Females had more instances of weakly acidic reflux than males (P < 0.01). The PSPW index values of males and females were similar (P > 0.05). Compared with females, males had lower MNBI values for the mid and distal esophagus (P < 0.05). However, with increasing age, the MNBI values of females decreased more rapidly than those of males. MNBI values of elderly patients of both sexes older than 60 years were similar. Conclusions: Acid reflux is more likely to occur in males; however, females tend to have more instances of weakly acid reflux. The integrity of the esophageal mucosa is more fragile in males than in females; however, the esophageal mucosal barrier attenuates more rapidly with increasing age in females than in males.
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Affiliation(s)
- Bixing Ye
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanjuan Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lin Lin
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liuqin Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meifeng Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Lee SW, Chang CS. Impact of Overlapping Functional Gastrointestinal Disorders on the Quality of Life in Patients With Gastroesophageal Reflux Disease. J Neurogastroenterol Motil 2021; 27:176-184. [PMID: 33795540 PMCID: PMC8026382 DOI: 10.5056/jnm19006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 05/04/2020] [Accepted: 01/02/2021] [Indexed: 12/13/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) and functional gastrointestinal disorders (FGIDs), including irritable bowel syndrome and functional dyspepsia, are common afflictions within the general population. Both conditions have a considerable impact on the daily health related quality of life (HRQoL) of affected individuals. Risk factors surrounding any impaired HRQoL in patients with GERD involve those of younger age, obesity, an increase in reflux symptom frequency, and overlapping FGIDs. The risk factors for subjects experiencing an overlap in FGIDs and GERD involve those who are female, younger age, cigarette smoking, non-erosive reflux disease, more GERD symptoms, and psychological performances including anxiety, somatization, and more frequent healthcareseeking behavior. The overlap of GERD and FGIDs is associated with a worsening of both physical and mental health, an increase in bothersome symptoms, impaired functional capacity, and a higher likelihood of consulting a physician. Acid secretion suppressors could offer therapeutic efficacy to some patients experiencing overlapping GERD and FGIDs.
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Affiliation(s)
- Shou-Wu Lee
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chi-Sen Chang
- Division of Gastroenterology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan
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Wu KL, Kuo CM, Yao CC, Tai WC, Chuah SK, Lim CS, Chiu YC. The effect of dietary carbohydrate on gastroesophageal reflux disease. J Formos Med Assoc 2018; 117:973-978. [PMID: 29339035 DOI: 10.1016/j.jfma.2017.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/10/2017] [Accepted: 11/02/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Acid changes in gastroesophageal reflux with vary component in the food have less been studied, especially carbohydrate. We plan to clarify the effect of different carbohydrate density on low esophageal acid and reflux symptoms of patients with gastroesophgeal reflux disease. METHODS Twelve patients (52 ± 12 years old; five female) with gastroesophageal reflux disease were recruited for the prospective crossover study. Each patient was invited for panendoscope, manometry and 24 h pH monitor. The two formulated liquid meal, test meal A: 500 ml liquid meal (containing 84.8 g carbohydrate) and B: same volume liquid meal (but 178.8 g carbohydrate) were randomized supplied as lunch or dinner. Reflux symptoms were recorded. RESULTS There are significant statistic differences in more Johnson-DeMeester score (p = 0.019), total reflux time (%) (p = 0.028), number of reflux periods (p = 0.026) and longest reflux (p = 0.015) after high carbohydrate diet than low carbohydrate. Total reflux time and number of long reflux periods more than 5 min are significant more after high carbohydrate diet. CONCLUSION More acid reflux symptoms are found after high carbohydrate diet. High carbohydrate diet could induce more acid reflux in low esophagus and more reflux symptoms in patients with gastroesophageal reflux disease.
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Affiliation(s)
- Keng-Liang Wu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chung-Mou Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Chien Yao
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan
| | - Wei-Chen Tai
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chee-Sang Lim
- Department of Hepatology, Hospital Selayang, Lebuh Raya Selayang-kepong, 68100 Batu Caves, Selangor, Malaysia
| | - Yi-Chun Chiu
- Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Nobakht H, Boghratian A, Sohrabi M, Panahian M, Rakhshani N, Nikkhah M, Ajdarkosh H, Hemmasi G, Khonsari M, Gholami A, Rabiei N, Zamani F. Association between Pattern of Gastritis and Gastroesophageal Reflux Disease in Patients with Helicobacter Pylori Infection. Middle East J Dig Dis 2016; 8:206-211. [PMID: 27698970 PMCID: PMC5045673 DOI: 10.15171/mejdd.2016.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND
Reflux disease is a common gastrointestinal problem. The association between reflux disease and gastritis pattern is controversial.
AIM: To determine the association between reflux disease and gastritis pattern in patients with Helicobacter pylori (H. pylori) infection.
METHODS
470 patients with dyspepsia and reflux disease were enrolled in this study. The inclusion criteria were willing to participate in the study, age over 40 years, and having the criteria of ROME III for at least 3 months. Patients with history of H. pylori eradication therapy during the 3 months before the study, a history of gastric surgery, and gastric cancer were excluded. All of the participants underwent upper endoscopy and two biopsy samples were taken from antrum, body, and fundal areas.
RESULTS H. pylori infection rate was 367 (78.1%) with mean age of 59.8 ± 11.4 years. Of them 131 patients (35.7%) were male. Reflux disease was detected in 273 (74.4%) patients. 216 (58.9%) and 102 (27.8%) patients had non-erosive reflux disease (NERD) and gastroesophageal reflux disease (GERD), respectively. Corpus predominant and antral predominant gastritis were seen in 72 (19.6%) and 129 (35.2%) patients, respectively. Antral gastritis was significantly associated with GERD (p<0.01). In regression analysis, antral predominant gastritis had a significant association with GERD (OR=1.92; 95%CI: 1.22- 3.12). The same result was observed in mild to moderate antral and greater curvature gastritis (OR= 1.26; 95%CI: 0.25-6.40 and OR= 3.0; 95%CI: 0.63-14.17, respectively).
CONCLUSION
According to these finding ,we could suggest that the pattern of gastritis could be associated with reflux disease and GERD.
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Affiliation(s)
- Hossein Nobakht
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran ; Department of Internal Medicine , Semnan University of Medical Sciences , Semnan ,Iran
| | - Amirhossein Boghratian
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran ; Department of Gastroenterology, RasolAkram Hospital, Iran University of Medical Sciences.Tehran,Iran
| | - Masoudreza Sohrabi
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Panahian
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Naser Rakhshani
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Nikkhah
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Ajdarkosh
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Hemmasi
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoodreza Khonsari
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Gholami
- Department of Public Health, School of Health, Neyshabour University of Medical Sciences, Neyshabur, Iran ; Department of Epidemiology, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Rabiei
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Zamani
- GastroIntestinal and Liver Disease Research Centre (GILDRC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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