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Prenatal Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Gabriele Saccone, Kerri Sendek
A consensus document has recommended that lifestyle and dietary modifications should remain first-line treatment for heartburn in pregnancy. The measures include reducing and avoiding intake of reflux-inducing foods (e.g., greasy and spicy foods, tomatoes, highly acidic citrus products, and carbonated drinks) and substances such as caffeine. Nonsteroidal antiinflammatory drugs (NSAIDs) should also be avoided. Other lifestyle changes to reduce the risk of reflux, such as avoiding lying down within 3 hours after eating, are advised. However, if heartburn is severe enough to warrant this action, medication should begin after consultation with a health care professional. Antacids, H2 blockers, and proton pump inhibitors all have acceptable safety profiles for the pregnant woman [143–146].
Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
A variety of complications can result from reflux esophagitis: Stricture formationBleedingPulmonary aspirationBarrett’s esophagus—Chronic esophageal inflammation is thought to lead to Barrett’s esophagus, in which the normal squamous esophageal epithelium is replaced by specialized columnar epithelium. This diagnosis is made by endoscopy with biopsy; routine surveillance with periodic endoscopic examination and biopsies is indicated because of an increased risk of esophageal cancer.
Non-Metastatic Esophageal Cancer with Enlarged Carinal Lymph Nodes with Previous Sleeve Gastrectomy
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Apurva Ashok, Devayani Niyogi, Sabita Jiwnani, George Karimundackal, C.S. Pramesh
Obese patients with gastroesophageal reflux disease are at increased risk of reflux symptoms, esophagitis, Barrett’s esophagus, and subsequent possibility of developing an esophagogastric cancer. The effect of bariatric surgery on pre-existing gastroesophageal reflux disease, mainly after sleeve gastrectomy, is variable and the chance of progressing to adenocarcinoma of esophagus is a rare event. Isolated case reports have been published in literature linking bariatric surgery to esophageal cancer. After bariatric surgery, a total of 33 cases of esophageal adenocarcinoma and one case of squamous cell carcinoma have been reported in a systematic review in 2013 [1]. However, only four cases have been reported to date in patients who have undergone sleeve gastrectomy.
Endoscopic measurement of hiatal hernias: is it reliable and does it have a clinical impact? Results from a large prospective database
Published in Postgraduate Medicine, 2023
Charles Christian Adarkwah, Oliver Hirsch, Merlissa Menzel, Joachim Labenz
It is thus conceivable that gastroesophageal reflux disease (GERD) is often associated with the presence of a hiatal hernia, thereby the hernia can be the precipitating as well as the maintaining factor [4]. However, small hernias frequently remain asymptomatic, while larger hernias often cause a variety of symptoms [5]. According to the Montreal definition, typical reflux symptoms are troublesome heartburn and/or regurgitation [6]. Both GERD and hiatal hernias occur more frequently with increasing age and weight. The risk factors for a hiatal hernia are very similar to those of reflux disease, i.e. especially high intra-abdominal pressure, caused e.g. by obesity or pregnancy, and increasing age play a decisive role here. After the age of 50, about 55–60% of people have a hiatal hernia, but only 9% suffer from clinical symptoms [5,7].
Reflux scintigraphy in gastro-esophageal reflux disease: a comparison study with 24 hour pH-impedance monitoring
Published in Scandinavian Journal of Gastroenterology, 2022
Lisa S. E. Shim, Meng C. Ngu, Yunki Yau, Robert Russo
Gastro-esophageal reflux disease (GERD) is a common condition with a prevalence of up to 20% in population studies [1]. It occurs due to the retrograde reflux of stomach contents into the esophagus resulting in troublesome symptoms [2]. It may present with typical symptoms such as heartburn or regurgitation, or atypical symptoms such as cough [3,4], throat clearing or chest pain [5]. Ambulatory 24 h pH study is routinely used to detect episodes of acid reflux in patients with GERD. The addition of impedance monitoring to pH-alone test increases the sensitivity of detection due to its ability to identify retrograde flow of liquid in the esophagus, therefore allowing detection of both acid and nonacid reflux [6]. A study using combined 24 h pH-impedance study in patients with typical reflux symptoms found a diagnostic yield of more than 50% of patients compared to standard pH study. This technique is therefore now regarded as the gold standard for assessment of GERD [7].
The interplay between Helicobacter pylori and gastrointestinal microbiota
Published in Gut Microbes, 2021
Chieh-Chang Chen, Jyh-Ming Liou, Yi-Chia Lee, Tzu-Chan Hong, Emad M El-Omar, Ming-Shiang Wu
Chronic gastric acid exposure or duodenal bile in the distal esophagus is considered to be the primary factor in the pathogenesis of reflux esophagitis. It was widely accepted that reflux may cause chronic esophageal injury and promote carcinogenesis in Barrett’s esophagus. A culture-independent study by Yang et al. classified the esophageal microbiota into two distinct types.19 The healthy esophagus harbored Gram-positive taxa from the Firmicutes phylum, of which Streptococcus was the dominant genus (Type I microbiome), while an inflamed esophagus (reflux esophagitis or Barrett’s esophagus) was dominated by Gram-negative taxa from the Bacteroidetes, Proteobacteria, and Fusobacteria phyla (Type II microbiome). These findings are consistent with other studies,18,20,21 reliably demonstrating a change in esophageal microbiota in cases of reflux disease that most likely reflects physiological changes due to excess gastric acid. Studies investigating the microbiota in cases of esophageal adenocarcinoma (EAC) are rare. The studies by Elliott et al. and Snider et al. identified reduced microbial diversity in EAC samples compared with controls.22,23 Some EAC samples were dominated by a single bacterial species belonging to the order Lactobacillales in the study by Elliott et al., while Snider et al. found more Enterobacteriaceae and Akkermansia muciniphila in patients with high-grade dysplasia or EAC. Both studies had relatively small sample sizes and further research is required before an EAC microbiome signature can be defined.