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Sleep and gastrointestinal functioning
Published in S.R. Pandi-Perumal, Meera Narasimhan, Milton Kramer, Sleep and Psychosomatic Medicine, 2017
In a recent study with high-resolution manometry (HRM) and 24-h multichannel impedance pH monitoring,35 total bolus clearing time in the upright and supine positions and acid exposure time were evaluated in 40 GERD patients without hiatal hernia. It was shown that patients with a pathological number of large breaks in esophageal transit on HRM had significantly impaired supine bolus clearance time and higher acid exposure time. GERD patients with esophageal erosions were characterized by significantly higher supine bolus clearance time and longer acid exposure time. It was concluded that GERD patients with a pathological number of large breaks are characterized by a significantly prolonged supine reflux clearance and subsequently higher acid exposure time.
Gastroesophageal reflux in the neonate and small infant
Published in Prem Puri, Newborn Surgery, 2017
A pathological reflux may be considered to exist when the infant has a history of significant regurgitation and flaccid vomiting, suffers from recurrent respiratory tract infections and/or pain, is restless at night, or has other typical symptoms (Table 50.4).20 As the risk of esophagitis is very low at this age, an endoscopic investigation does not need to be performed if no other indications in consequence of a congenital anomaly are present. In addition to a 24-hour pH monitoring or impedance pH monitoring, a contrast swallow of the esophagus and an ultrasound investigation of the pylorus are usually needed to exclude any pathologies that would hinder spontaneous healing of the reflux disease, such as HH, chronic organoaxial gastric volvulus, gastric stenosis, pylorus hypertrophy, or other anatomic problems.
Tight junctions: from molecules to gastrointestinal diseases
Published in Tissue Barriers, 2023
Aekkacha Moonwiriyakit, Nutthapoom Pathomthongtaweechai, Peter R. Steinhagen, Papasara Chantawichitwong, Wilasinee Satianrapapong, Pawin Pongkorpsakol
An intra-esophageal pH of <4 caused by acid reflux from the stomach can disrupt the esophageal barrier integrity and can be detected by 24-h ambulatory esophageal impedance pH monitoring.302,305,306 The early morphological lesions caused by unanticipated acidic changes are dilated intercellular spaces related to the expression of tight junctions, which are found in the non-erosive form of gastroesophageal reflux disease (GERD).307 CLDN 1 and 4 were found to be decreased in patients with GERD.308 Consistent with this, the expression of CLDN 4 was downregulated and the esophageal barrier function was attenuated in acid-disrupted esophageal epithelial models.309,310 The damaged esophageal squamous mucosal layers can be replaced with metaplastic columnar epithelium, which is more acid-resistant and contributed by CLDN 18, as found in patients with Barrett’s esophagus.307,311 Moreover, the overexpression of CLDN 2 was found to be related to the reflux of bile acid and the development of BE.312 In eosinophilic esophagitis, CLDN 7 expression was suppressed by the presence of transforming growth factor-β1 (TGF-β1), whereas the upregulation of CLDN 7 relieved TGF-β1-induced esophageal barrier dysfunction.313 Moreover, in esophageal squamous cell carcinoma, reduced expression of CLDN 1, 4, and 7 was identified, which might be candidate prognostic biomarkers for esophageal cancer.314–316 CLDN 18, meanwhile, was found to be expressed in esophageal adenocarcinoma.317
Esophageal chemical clearance and mucosa integrity values in refractory gastroesophageal reflux disease patients with different esophageal dynamics
Published in Scandinavian Journal of Gastroenterology, 2023
Yanqiu Li, Lixia Wang, Dong Yang, Zhifeng Zhang, Xiaoyu Sun, Xiaoling Geng, Jiarong Lin, Zhijun Duan
Esophageal 24-h impedance-pH monitoring was performed using a Sleuth® Multichannel Intraluminal Impedance ambulatory system (Sleuth; Sandhill Scientific, Inc., Highlands Ranch, CO, USA) [46]. The pH electrode is 5 cm above the LES and impedance electrodes at 3, 5, 7, 9, 15 and 17 cm proximal to the LES in order to record pH at 5 cm and impedance at 3, 5, 7, 9, 15 and 17 cm above the LES. Patients were encouraged to maintain daily activities, sleep and meals, and they were also asked to record the reflux symptoms they experienced during the study period. All the pH and impedance signals were stored in a data-collection device. The data were downloaded into a computer and analyzed using dedicated software (BioViewanalysis®; Sandhill Scientific, Inc.).
The diagnostic utility of the frequency scale for the symptoms of gastroesophageal reflux disease questionnaire (FSSG) for patients with subacute/chronic cough
Published in Journal of Asthma, 2021
Ryota Kurokawa, Yoshihiro Kanemitsu, Kensuke Fukumitsu, Norihisa Takeda, Jennifer Maries Yap, Motohiko Suzuki, Yuta Mori, Satoshi Fukuda, Takehiro Uemura, Tomoko Tajiri, Hirotsugu Ohkubo, Ken Maeno, Yutaka Ito, Tetsuya Oguri, Masaya Takemura, Akio Niimi
A modified version of FSSG is now available which consists of 12 original symptoms (seven with acid-related symptoms and five with dysmotility one) and two additional dysmotility symptoms, the latter two of which are newly combined as dyspepsia symptoms (23). In the present study, we used the original one as the modified one was not yet available when we started this survey. In the original version, eight points was the optimal cutoff value for predicting diagnosis of GERD (8), and the cutoff that we have identified (seven points) is different from the original one. Although the cutoff value of FSSG for the diagnosis was almost similar between erosive GERD and GERD-related cough, discordance of the cutoff value might reflect the predominance of non-erosive reflux disease in the pathophysiology of GERD-related cough. GERD-related cough is considered predominantly due to non-erosive reflux disease (NERD) or based on nonacid reflux mechanism (3). Baldi et al. (24) have demonstrated that the presence of erosive reflux disease (ERD) accounts for only 15% in a group of 45 patients with cough while over 50% of the group had pH-metry positive and PPIs test positive without erosive findings, suggesting that GERD-related cough could occur without erosion of the esophagus mucosa. In our previous study. we found that 24 of 37 patients (65%) with GERD-related cough had NERD (17), which was comparable to the report of Baldi et al. Additionally, some epidemiological studies have reported that NERD is more frequent than ERD worldwide (18,25,26). Indeed, both plasma and sputum substance P levels were significantly decreased by PPIs and prokinetic agents in GERD-related cough irrespective of the presence or absence of erosive findings (17). Although we did not confirm findings of acid-reflux with the use of endoscopy or pH monitoring methods, FSSG would be a sensitive questionnaire for the diagnosis of GERD-related cough in patients with subacute/chronic cough. Validation studies using impedance-pH monitoring may be necessary to further clarify the accuracy of subjective measures of GERD including FSSG as its diagnosis.