BACKGROUND Heartburn is identically the key symptom of both,gastroesophageal reflux disease(GERD)and functional heartburn(FHB),making the differential diagnosis resource-intensive.Oral manifestations of GERD can be ea...BACKGROUND Heartburn is identically the key symptom of both,gastroesophageal reflux disease(GERD)and functional heartburn(FHB),making the differential diagnosis resource-intensive.Oral manifestations of GERD can be easily examined;therefore,their exploration might be a cheap,widely available,and useful tool in the differentiation of GERD and FHB.AIM To evaluate the prevalence of dental erosions(DE)and periodontal diseases(PD)in patients with heartburn and their association with GERD and FHB.METHODS A total of 116[M/F:51/65,mean age:54(17-80)years]consecutive patients with heartburn were enrolled for detailed esophageal function and orodental examinations.RESULTS Dental disorders were detected in 89%(103/116).Patients with PD+DE had significantly more often pathologic reflux(90.0%vs 27.8%;P<0.05),higher esophagitis scores(1.8 vs 0.9;P<0.05),and a significantly different mean impedance curve(P=0.04)than those without any dental diseases.The opposite approach established that patients with GERD had significantly higher prevalence of DE and PD,especially if both were present(28.9%vs 2.0%;P<0.01),more severe PD(1.5 vs 1.0;P<0.01),and longer history of heartburn(15 years vs 9 years;P<0.01)than those with FHB.CONCLUSION The dental evaluation of patients with heartburn seems to be useful in the differential diagnosis of GERD and FHB.Among the studied parameters,the co-appearance of DE and PD seems to be the best predictor of GERD,whereas the absence of dental disorders was mostly observed in FHB.展开更多
AIM:To investigate the pathophysiology of functional heartburn(FH) in Japanese patients.METHODS:A total of 111 patients with proton pump inhibitor(PPI)-refractory non-erosive gastroesophageal reflux disease underwent ...AIM:To investigate the pathophysiology of functional heartburn(FH) in Japanese patients.METHODS:A total of 111 patients with proton pump inhibitor(PPI)-refractory non-erosive gastroesophageal reflux disease underwent intraesophageal pressure testing and 24-h multichannel intraluminal impedancep H(24MII-p H) testing.The patients also completed several questionnaires while they were receiving the PPI treatment, including the questionnaire for the diagnosis of reflux disease(QUEST), the frequency scale for the symptoms of gastroesophageal reflux disease(FSSG), the gastrointestinal symptoms rating scale(GSRS), SF-36, and the Cornell Medical Index(CMI).The subjects were classified into FH and endoscopy-negative reflux disease(ENRD) groups based on the Rome Ⅲ criteria.RESULTS:Thirty-three patients with esophageal motility disorder were excluded from this study, while 22 patients with abnormal esophageal acid exposure time(p H-POS) and 34 with hypersensitive esophagus(HE) were included in the ENRD group.The FH group included 22 patients with no reflux involvement.Sex, age, and body mass index did not differ significantly between the groups.The mean SF-36 values were < 50(normal) for all scales in these groups, with no significant differences.The GSRS scores in these groups were not different and showed overlap with other gastrointestinal symptoms.The QUEST and the FSSG scores did not differ significantly between the groups.Neuroticism was diagnosed using the CMI questionnaire in 17 of the 78 included subjects within the p H-POS(n=4),HE(n=8),and FH(n=5)groups,with no significant differences.CONCLUSION:Clinical characteristics of the FH and PPI-refractory ENRD groups were similar.Therefore,esophageal function should be examined via manometry and 24MII-p H testing to differentiate between them.展开更多
Graves' disease is an autoimmune disease, which can manifest with a variety of extrathyroidal clinical syndromes like ophthalmopathy, pretibial myxedema(dermopathy), acropathy, cardiomyopathy, and encephalopathy. ...Graves' disease is an autoimmune disease, which can manifest with a variety of extrathyroidal clinical syndromes like ophthalmopathy, pretibial myxedema(dermopathy), acropathy, cardiomyopathy, and encephalopathy. Though quite rare, this disease can also manifest with gastrointestinal symptoms such as dysphagia, heartburn, nausea, vomiting and diarrhea. We report a clinical case of Graves' disease manifesting with dysfunction of the esophagus and heartburn in a 61-year-old man. In the muscular layer of the esophagus we found dystrophic changes led to its atony, which was documented by endoscopy and high-resolution manometry. The pathology features of esophageal symptoms were: focal proliferation of the basal cells, vascular distension, and dystrophy of the epithelial cells. Antithyroid treatment led to decrease of all clinical symptoms after 5 d of Thiamazole administration. Complete restoration of peristalsis in the esophagus, according to manometry, was observed in 1 mo after initiation of treatment.展开更多
AIM: To investigate whether autofluorescence imaging(Af I) endoscopy can distinguish non-erosive reflux disease(NERD) from functional heartburn(fh).METHODS: In this prospective observational trial, 127 patients presen...AIM: To investigate whether autofluorescence imaging(Af I) endoscopy can distinguish non-erosive reflux disease(NERD) from functional heartburn(fh).METHODS: In this prospective observational trial, 127 patients presenting with typical reflux symptoms for > 6 mo were screened. All the participants underwent endoscopy, during which white light imaging(WLI) was followed by Af I. finally 84 patients with normal esophageal appearance on WLI were enrolled. It was defined as being suggestive of NERD if one or more longitudinal purple lines longer than one centimeter were visualized in the distal part of the esophagus during Af I endoscopy. Ambulatory 24-h multichannel intraluminal impedance and ph monitoring was also performed. After standard proton-pump inhibitor(PPI) tests, subjects were divided into an NERD group and an fh group and the diagnostic performance of Af I endoscopy to differentiate NERD from fh was evaluated.RESULTS: Of 84 endoscopy-negative patients, 36(42.9%) had a normal ph/impedance test. Of these, 26 patients with favorable responses to PPI tests were classified as having NERD. finally 10 patients were diagnosed with fh and the others with NERD. Altogether, 68(81.0%) of the 84 patients were positive on Af I endoscopy. In the NERD group, there were 67(90.5%) patients with abnormal esophageal findings on Af I endoscopy while only 1(10%) patient was positive on Af I endoscopy in the fh group. The sensitivity and specificity of AFI in differentiating NERD from FH were 90.5%(95%CI: 81.5%-96.1%) and 90.0%(95%CI: 55.5%-99.7%), respectively. Meanwhile, the accuracy, positive predictive value and negative predictive value of Af I in differentiating between NERD and fh were 90.5%(95%CI: 84.2%-96.8%), 98.5%(95%CI: 92.1%-99.9%) and 56.3%(95%CI: 30.0%-80.2%), respectively.CONCLUSION: Autofluorescence imaging may serve as a complementary method in evaluating patients with NERD and fh.展开更多
Background: Melatonin is a safe and effective treatment for patients with functional pain and gastrointestinal disorders. Objective: To evaluate the efficacy and safety of melatonin for 3 months in patients with funct...Background: Melatonin is a safe and effective treatment for patients with functional pain and gastrointestinal disorders. Objective: To evaluate the efficacy and safety of melatonin for 3 months in patients with functional heartburn. Methods: In the randomized, placebo-controlled pilot study, patients with functional heartburn were treated with omeprazole 20 mg before breakfast and randomized to receive either melatonin 6 mg (n = 20), nortripty line 25 mg (n = 20), or placebo (n = 20) at bedtime for 3 months. Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQOL) scores were assessed at baseline and at the end of the study. Results: Melatonin improved GERD-HRQOL scores compared with nortriptyline (P = 0.0015) and placebo (P < 0.0001). Fewer adverse events were reported by patients receiving melatonin compared with those receiving nortriptyline or placebo. Conclusions: Melatonin was a safe and effective treatment for functional heartburn.展开更多
AIM To investigate the efficacy and safety of mineralwater with a high content of hydrogen carbonate inpatients with heartburn.METHODS： This open, single-center, single-armclinical pilot study enrolled 50 patients, 1...AIM To investigate the efficacy and safety of mineralwater with a high content of hydrogen carbonate inpatients with heartburn.METHODS： This open, single-center, single-armclinical pilot study enrolled 50 patients, 18-64 yearsold, who had been suffering from heartburn at leasttwice a week for at least 3 mo before entering thestudy. Pharmacological treatment of heartburn was notpermitted, and patients with severe organic diseaseswere excluded. After a run-in period of one week, theparticipants received 1.5 L of the test water for thefollowing 6 wk; 300 mL with meals t.i.d., the remainderto be drunk throughout the day. During the trial, therewere five visits at the study center （screening, baseline,two interim visits and the final visit）. The efficacyendpoints included incidence and duration of heartburnepisodes per week by patient＇s self-assessment （heartburndiary） as well as changes in symptom severity asper symptom specific questionnaires [Reflux Disease Questionnaire （RDQ）; Quality of Life in Reflux andDyspepsia （QOLRAD）; Gastrointestinal Quality of LifeIndex] and overall health-related quality of life per SF-12（12-question short form） at each visit. At the end of thestudy, patients and investigators independently ratedthe overall efficacy of the test water on a 4-point Likertscale. Safety was assessed by evaluation of adverseevents （AEs）, vital signs （heart rate, blood pressure）and laboratory parameters. Changes from initial to finalexaminations were assessed by the non-parametricWilcoxon test; categorical variables were comparedusing the χ 2 test, and for more than 5 categories, by theU-test.RESULTS： Twenty-eight participants were men, 22women. The mean age of the patients in the fullanalysis set/intention-to treat population （FAS/ITT） was40.6 years. Forty-two participants completed the studyaccording to the study protocol and formed the perprotocolset （PP population）; 48 participants drank thewater at least once as requested and were analyzedas ITT population. The occurrence of heartburn wasstatistically significantly reduced at wk 6 in both the ITTand the PP populations. At wk 6, the mean number ofheartburn episodes/week decreased by 5.1 episodes（P 〈 0.001） and the mean duration of heartburnsymptoms by 19 min （ITT） （P = 0.002）. The frequencyof heartburn symptoms was reduced in 89.6% of thepatients （P 〈 0.001）, and the duration of symptoms in79.2% of patients （ITT） （P 〈 0.001）. All dimensions ofthe RDQ （heartburn, regurgitation, gastro-esophagealreflux disease symptoms, dyspepsia） showed asignificant improvement at 6 wk. Likewise, diseasespecificquality of life improved significantly （QOLRAD,GIQLI）. Overall, 89.4% of patients rated the efficacyof the test water as ＂good＂ or ＂very good＂, as did theinvestigators for 91.5% of the patients. There wereno serious AEs. After 6 wk, systolic and diastolic bloodpressure values decreased slightly but significantly [-3.5and -3.0 mmHg, respectively （P = 0.008 and P = 0,002）].Ninety-six percent of patients and investigators for thesame percentage of patients rated the tolerability of thewater as ＂good＂ or ＂very good＂.CONCLUSION： The data demonstrate effectiveness ofa hydrogen carbonate-rich mineral water in alleviatingheartburn frequency and severity, thereby improvingquality of life. The water has excellent tolerability.展开更多
Heartburn is among the most common gastrointestinal symptoms presenting to both generalist physicians and gastroenterologists.In the era of high utilization of proton pump inhibitors,a substantial proportion of patien...Heartburn is among the most common gastrointestinal symptoms presenting to both generalist physicians and gastroenterologists.In the era of high utilization of proton pump inhibitors,a substantial proportion of patients presenting to the gastroenterologist with chronic symptoms of heartburn do not have a reflux-mediated disease.Subjects without objective evidence of reflux as a cause of their symptoms have functional heartburn(FH).FH has no evidence of abnormal esophageal acid exposure on ambulatory reflux monitoring,major esophageal motor disorders on high resolution manometry,or esophageal mucosal pathology,such as eosinophilic esophagitis on endoscopy with esophageal biopsies.The pathophysiology of FH is unknown but it is often associated with visceral hypersensitivity,and psychiatric disease.Importantly,anti-reflux surgery or other invasive anti-reflux modalities should be avoided.Although there are limited supporting data,modulation of pain perception,traditional Chinese medicine and psychological intervention may be potential therapeutic options in this population.展开更多
Background: Dyspepsia and heartburn are among the most frequent complaints of the upper gastrointestinal tract impacting quality of life. The present study aimed to investigate the impact of drinking a natural mineral...Background: Dyspepsia and heartburn are among the most frequent complaints of the upper gastrointestinal tract impacting quality of life. The present study aimed to investigate the impact of drinking a natural mineral water (medicinal product category “Heilwasser” in Germany) high in hydrogen carbonate (Staatl. Fachingen STILL) on functional dyspeptic complaints and heartburn. Methods: 56 men and women with self-reported heartburn were enrolled to this one-arm pilot study. They had to drink 1.5 L of a hydrogen carbonate rich mineral water each day over a course of six weeks. Participants reported the number and duration of heartburn episodes in a daily dairy. The Reflux Disease Questionnaire (RDQ), Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD) and the Gastrointestinal Quality of Life Index (GILQI) were used to assess the therapeutic course of the treatment and the Short Form Health Survey (SF-12) to assess general quality of life. Mean ± standard deviation were calculated and pre- and post-treatment changes were compared using the Wilcoxon test. Results: The consumption of a hydrogen carbonate rich mineral water decreased the number of heartburn episodes per week significantly by 4.8 ± 8.2 at the end of the study (p < 0.001). The duration of episodes was also significantly reduced by 25.7 minutes after six weeks of intervention (p < 0.001). Accordingly, the subjectively perceived severity of heartburn, regurgitation and dyspeptic complaints as well as the GERD dimension as assessed by Reflux Disease Questionnaire improved significantly. There was a significant improvement in the disease-specific quality of life as measured by the Gastrointestinal Quality of Life Index (p < 0.001) and by the Quality Of Life in Reflux and Dyspepsia (p < 0.001) questionnaires and the general health-related quality of life as assessed by SF-12 (p < 0.007). Conclusions: The present pilot study provides evidence that supplementation with natural mineral water rich in hydrogen carbonate may improve heartburn and dyspeptic symptoms, which finally resulted in an improvement of the subjectively perceived quality of life. Drinking mineral water rich in hydrogen carbonate may be an alternative remedy for the treatment of dyspeptic symptoms and heartburn. Trial Registration: Eudra CT No 2013-001256-36.展开更多
Aims: To determine the prevalence and risk factors of heartburn in Abidjan, a black African city. Patients and Methods: cross-sectional study from June 15 to September 30, 2003. One thousand nine hundred forty (1940) ...Aims: To determine the prevalence and risk factors of heartburn in Abidjan, a black African city. Patients and Methods: cross-sectional study from June 15 to September 30, 2003. One thousand nine hundred forty (1940) persons from five health zones of the city Abidjan were included after their informed consent. Socio demographic and clinical parameters were collected using a questionnaire in an interview format. Heartburn was defined as a discomfort or burning sensation extending from the sternal manubrium to the base of the neck. Factors related to the complaint were asked such as predisposing factors, habits (tobacco, alcohol and coffee intake) and body mass index. Stepwise multiple logistic regression analyses were used to examine associations between these factors and heartburn. Results: Among 1940 respondents (mean age 28 ± 9 years;sex ratio (M:F) 0.86), heartburn occurred in 433 persons (once a week in 9.2% of case (178 persons)). Five factors were statistically associated with heartburn: male sex (p = 0.025, OR = 0.555 [CI95% 0.331 - 0.930]), heartburn in a family member (p = 0.010, OR = 1.765 [95%CI 1.143 - 2.725]), constipation (p = 0.011, OR = 2.182 [95%CI 11,953,983]), right lateral decubitus (p = 0.001, OR = 6.247 [95%CI 2.079 - 18.775]) and after a meal (p = 0.000, OR = 2.643 [95%CI 1.594 4.383]). Conclusion: Heartburn is common in this black African population. Male sex appears to be less associated. Constipation, right lateral decubitus and after a meal are trigger factors for heartburn. Heartburn in a family member is a risk factor.展开更多
AIM:To study the natural history and prevalence of heartburn at a 10-year interval,and to study the effect of heartburn on various symptoms and activities.METHODS:A population-based postal study was carried out.Questi...AIM:To study the natural history and prevalence of heartburn at a 10-year interval,and to study the effect of heartburn on various symptoms and activities.METHODS:A population-based postal study was carried out.Questionnaires were mailed to the same age-and gender-stratified random sample of the Icelandic population(aged 18-75 years) in 1996 and again in 2006.Subjects were classified with heartburn if they reported heartburn in the preceding year and/or week,based on the definition of heartburn.RESULTS:Heartburn in the preceding year was reported in 42.8%(1996) and 44.2%(2006) of subjects,with a strong relationship between those who experienced heartburn in both years.Heartburn in the preceding week was diagnosed in 20.8%.There was a significant relationship between heartburn,dyspepsia and irritable bowel syndrome.Individuals with a body mass index(BMI) below or higher than normal weight were more likely to have heartburn.Heartburn caused by food or beverages was reported very often by 20.0% of subjects.CONCLUSION:Heartburn is a common and chronic condition.Subjects with a BMI below or higher than normal weight are more likely to experience heartburn.Heartburn has a great impact on daily activities,sleep and quality of life.展开更多
OBJECTIVE:To provide a basis for the clinical identification of true and false reflux,integrated traditional Chinese and Western medicine,and psychosomatic treatment,we conducted a retrospective study of the etiology ...OBJECTIVE:To provide a basis for the clinical identification of true and false reflux,integrated traditional Chinese and Western medicine,and psychosomatic treatment,we conducted a retrospective study of the etiology and epidemiological and Traditional Chinese Medicine(TCM) syndrome characteristics of patients with reflux/heartburn symptoms.METHODS:The 210 10 patients with reflux/heartburn treated at Tianjin Nankai Hospital from January 1,2016,to December 31,2019,were divided into four groups according to their pathogenesis.Sex,age,course of disease,incidence rate,gastroscopy,24-h p Himpedance,esophageal manometry,Hamilton Anxiety Scale(HAMA)/Hamilton Depression Scale(HAMD) score,8-week proton pump inhibitor(PPI) treatment effect,and TCM syndrome characteristics were statistically analyzed.RESULTS:A total of 21010 patients(8864 men and 12146 women),with reflux/heartburn symptoms were screened,including 6284(29.9%) patients with reflux esophagitis(RE),10427(49.6%) patients with nonerosive reflux esophagitis(NERD),2430(11.6%) patients with reflux hypersensitivity(RH),and 1870(8.9%) patients with functional heartburn(FH).The incidence of the disease was higher in women than in men(P <0.0001).The ranking of the incidence of anxiety and depression in these four groups was FH > RH > NERD > RE(P < 0.0001).There were more women than men in the groups with anxiety and more men than women in the groups with depression(P < 0.0001),and there was no significant difference in the distribution of anxiety and depression between men and women(P = 0.5689).There were significant differences in TCM syndrome characteristics between NERD,RE,and functional esophageal diseases(P < 0.01).The highest proportion of functional esophageal disease TCM symptoms was Qi stagnation and phlegm obstruction syndrome(36.16%),and there was no significant difference between RH and FH.The effective rates of PPI treatment at 8 weeks in patients in the RE,NERD,RH,and FH groups were 89%,72%,54%,and 0%,respectively.RE was classified into grades A,B,C,and D according to the Los Angeles grading system.The ranking of the incidence of these four grades was A > B > C > D(P < 0.0001).The effective rates of PPI treatment at 8 weeks were 91%,81%,69%,and 63% in patients with grade A,B,C,and D RE,respectively(P < 0.0001).The highest proportion of TCM syndrome types of NERD and RE was the stagnated heat syndrome in the liver and stomach syndrome,38.99% and 33.90%,respectively.CONCLUSION:Reflux/heartburn symptoms are relatively common in middle-aged women,and NERD is the most common etiology,followed by RE,RH,and FH.The most common TCM syndrome characteristics in NERD and RE were stagnated heat syndrome in the liver and stomach syndrome,and Qi stagnation and phlegm obstruction syndrome in functional esophageal diseases.Most patients with reflux/heartburn symptoms also experienced anxiety and depression.展开更多
Purpose: Ranitidine hydrochloride (HCl) remains an important medication for treating acid-peptic ailments such as Gastroesophageal reflux disease (GERD). The main objective of this Post Marketing Surveillance (PMS) cl...Purpose: Ranitidine hydrochloride (HCl) remains an important medication for treating acid-peptic ailments such as Gastroesophageal reflux disease (GERD). The main objective of this Post Marketing Surveillance (PMS) clinical study was to test the efficacy and safety of Ranitidine HCl in Indian patients suffering from GERD. Patients and Methods: Data of 2446 patients (1307 males;1121 females) from 21 centers across India were analyzed. Patients received either of the three treatments: Ranitidine HCl 150 mg twice a day (BID) (ARM-A), Ranitidine HCl 300 mg once daily (OD) or BID (ARM-B), and Ranitidine HCl 300 mg OD (ARM-C). Gastroesophageal Reflux Disease Symptom Assessment Scale (GSAS) score and Heartburn Severity score were used to assess the drug’s efficacy. The adverse events reported by patients or investigators were analyzed to assess the safety profile of Ranitidine. Results: Of the 2446 subjects screened, 2428 were enrolled. There was a significant reduction in GSAS scores from baseline to the end of the study visit in all three ARMs. The GSAS scores reduced from 2.02 to 0.23 in ARM-A, 2.01 to 0.24 in ARM-B, and 2.07 to 0.26 in ARM-C patients. In ARM A, 72.82% had 24 hours heartburn-free days, and 66.89% had 7 consecutive heartburn-free days, which was more significant than the other two ARMs. 128 (5.27%) patients reported ADRs due to Ranitidine HCl at different doses. The most frequently reported ADR was constipation (17.18%), followed by oliguria (14.06%), cold (13.28%), and dysuria (12.5%). Of 128 ADRs, 113 (88.28%) were mild, and only 11 (8.59%) ADRs were related to the study drug. No severe ADRs were reported during the study. Conclusion: Ranitidine HCl 150/300 mg tablet was found to be an effective and safe H2-receptor antagonist for treating GERD in Indian Patients.展开更多
Although gastroesophageal reflux disease(GERD)is a common disorder in Western countries,with a significant impact on quality of life and healthcare costs,the mechanisms involved in the pathogenesis of symptoms remain ...Although gastroesophageal reflux disease(GERD)is a common disorder in Western countries,with a significant impact on quality of life and healthcare costs,the mechanisms involved in the pathogenesis of symptoms remain to be fully elucidated.GERD symptoms and complications may result from a multifactorial mechanism,in which acid and acid-pepsin are the important noxious factors involved.Prolonged contact of the esophageal mucosa with the refluxed content,probably caused by a defective anti-reflux barrier and luminal clearance mechanisms,would appear to be responsible for macroscopically detectable injury to the esophageal squamous epithelium.Receptors on acid-sensitive nerve endings may play a role in nociception and esophageal sensitivity,as suggested in animal models of chronic acid exposure.Meanwhile,specific cytokine and chemokine profiles would appear to underlie the various esophageal phenotypes of GERD,explaining,in part,the genesis of esophagitis in a subset of patients.Despite these findings,which show a significant production of inflammatory mediators and neurotransmitters in the pathogenesis of GERD,the relationship between the hypersensitivity and esophageal inflammation is not clear.Moreover,the large majority of GERD patients(up to 70%)do not develop esophageal erosions,a variant of the condition called non-erosive reflux disease.This summary aims to explore the inflammatory pathway involved in GERD pathogenesis,to better understand the possible distinction between erosive and non-erosive reflux disease patients and to provide new therapeutic approaches.展开更多
基金the University of Szeged Open Access Fund,No.6373.
文摘BACKGROUND Heartburn is identically the key symptom of both,gastroesophageal reflux disease(GERD)and functional heartburn(FHB),making the differential diagnosis resource-intensive.Oral manifestations of GERD can be easily examined;therefore,their exploration might be a cheap,widely available,and useful tool in the differentiation of GERD and FHB.AIM To evaluate the prevalence of dental erosions(DE)and periodontal diseases(PD)in patients with heartburn and their association with GERD and FHB.METHODS A total of 116[M/F:51/65,mean age:54(17-80)years]consecutive patients with heartburn were enrolled for detailed esophageal function and orodental examinations.RESULTS Dental disorders were detected in 89%(103/116).Patients with PD+DE had significantly more often pathologic reflux(90.0%vs 27.8%;P<0.05),higher esophagitis scores(1.8 vs 0.9;P<0.05),and a significantly different mean impedance curve(P=0.04)than those without any dental diseases.The opposite approach established that patients with GERD had significantly higher prevalence of DE and PD,especially if both were present(28.9%vs 2.0%;P<0.01),more severe PD(1.5 vs 1.0;P<0.01),and longer history of heartburn(15 years vs 9 years;P<0.01)than those with FHB.CONCLUSION The dental evaluation of patients with heartburn seems to be useful in the differential diagnosis of GERD and FHB.Among the studied parameters,the co-appearance of DE and PD seems to be the best predictor of GERD,whereas the absence of dental disorders was mostly observed in FHB.
文摘AIM:To investigate the pathophysiology of functional heartburn(FH) in Japanese patients.METHODS:A total of 111 patients with proton pump inhibitor(PPI)-refractory non-erosive gastroesophageal reflux disease underwent intraesophageal pressure testing and 24-h multichannel intraluminal impedancep H(24MII-p H) testing.The patients also completed several questionnaires while they were receiving the PPI treatment, including the questionnaire for the diagnosis of reflux disease(QUEST), the frequency scale for the symptoms of gastroesophageal reflux disease(FSSG), the gastrointestinal symptoms rating scale(GSRS), SF-36, and the Cornell Medical Index(CMI).The subjects were classified into FH and endoscopy-negative reflux disease(ENRD) groups based on the Rome Ⅲ criteria.RESULTS:Thirty-three patients with esophageal motility disorder were excluded from this study, while 22 patients with abnormal esophageal acid exposure time(p H-POS) and 34 with hypersensitive esophagus(HE) were included in the ENRD group.The FH group included 22 patients with no reflux involvement.Sex, age, and body mass index did not differ significantly between the groups.The mean SF-36 values were < 50(normal) for all scales in these groups, with no significant differences.The GSRS scores in these groups were not different and showed overlap with other gastrointestinal symptoms.The QUEST and the FSSG scores did not differ significantly between the groups.Neuroticism was diagnosed using the CMI questionnaire in 17 of the 78 included subjects within the p H-POS(n=4),HE(n=8),and FH(n=5)groups,with no significant differences.CONCLUSION:Clinical characteristics of the FH and PPI-refractory ENRD groups were similar.Therefore,esophageal function should be examined via manometry and 24MII-p H testing to differentiate between them.
文摘Graves' disease is an autoimmune disease, which can manifest with a variety of extrathyroidal clinical syndromes like ophthalmopathy, pretibial myxedema(dermopathy), acropathy, cardiomyopathy, and encephalopathy. Though quite rare, this disease can also manifest with gastrointestinal symptoms such as dysphagia, heartburn, nausea, vomiting and diarrhea. We report a clinical case of Graves' disease manifesting with dysfunction of the esophagus and heartburn in a 61-year-old man. In the muscular layer of the esophagus we found dystrophic changes led to its atony, which was documented by endoscopy and high-resolution manometry. The pathology features of esophageal symptoms were: focal proliferation of the basal cells, vascular distension, and dystrophy of the epithelial cells. Antithyroid treatment led to decrease of all clinical symptoms after 5 d of Thiamazole administration. Complete restoration of peristalsis in the esophagus, according to manometry, was observed in 1 mo after initiation of treatment.
文摘AIM: To investigate whether autofluorescence imaging(Af I) endoscopy can distinguish non-erosive reflux disease(NERD) from functional heartburn(fh).METHODS: In this prospective observational trial, 127 patients presenting with typical reflux symptoms for > 6 mo were screened. All the participants underwent endoscopy, during which white light imaging(WLI) was followed by Af I. finally 84 patients with normal esophageal appearance on WLI were enrolled. It was defined as being suggestive of NERD if one or more longitudinal purple lines longer than one centimeter were visualized in the distal part of the esophagus during Af I endoscopy. Ambulatory 24-h multichannel intraluminal impedance and ph monitoring was also performed. After standard proton-pump inhibitor(PPI) tests, subjects were divided into an NERD group and an fh group and the diagnostic performance of Af I endoscopy to differentiate NERD from fh was evaluated.RESULTS: Of 84 endoscopy-negative patients, 36(42.9%) had a normal ph/impedance test. Of these, 26 patients with favorable responses to PPI tests were classified as having NERD. finally 10 patients were diagnosed with fh and the others with NERD. Altogether, 68(81.0%) of the 84 patients were positive on Af I endoscopy. In the NERD group, there were 67(90.5%) patients with abnormal esophageal findings on Af I endoscopy while only 1(10%) patient was positive on Af I endoscopy in the fh group. The sensitivity and specificity of AFI in differentiating NERD from FH were 90.5%(95%CI: 81.5%-96.1%) and 90.0%(95%CI: 55.5%-99.7%), respectively. Meanwhile, the accuracy, positive predictive value and negative predictive value of Af I in differentiating between NERD and fh were 90.5%(95%CI: 84.2%-96.8%), 98.5%(95%CI: 92.1%-99.9%) and 56.3%(95%CI: 30.0%-80.2%), respectively.CONCLUSION: Autofluorescence imaging may serve as a complementary method in evaluating patients with NERD and fh.
文摘Background: Melatonin is a safe and effective treatment for patients with functional pain and gastrointestinal disorders. Objective: To evaluate the efficacy and safety of melatonin for 3 months in patients with functional heartburn. Methods: In the randomized, placebo-controlled pilot study, patients with functional heartburn were treated with omeprazole 20 mg before breakfast and randomized to receive either melatonin 6 mg (n = 20), nortripty line 25 mg (n = 20), or placebo (n = 20) at bedtime for 3 months. Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQOL) scores were assessed at baseline and at the end of the study. Results: Melatonin improved GERD-HRQOL scores compared with nortriptyline (P = 0.0015) and placebo (P < 0.0001). Fewer adverse events were reported by patients receiving melatonin compared with those receiving nortriptyline or placebo. Conclusions: Melatonin was a safe and effective treatment for functional heartburn.
基金Supported by Deutsche Heilbrunnen im Verband Deutscher Mineralbrunnen e.V.,Kennedyallee 28,53175 Bonn,Germany,www.vdm-bonn.de
文摘AIM To investigate the efficacy and safety of mineralwater with a high content of hydrogen carbonate inpatients with heartburn.METHODS： This open, single-center, single-armclinical pilot study enrolled 50 patients, 18-64 yearsold, who had been suffering from heartburn at leasttwice a week for at least 3 mo before entering thestudy. Pharmacological treatment of heartburn was notpermitted, and patients with severe organic diseaseswere excluded. After a run-in period of one week, theparticipants received 1.5 L of the test water for thefollowing 6 wk; 300 mL with meals t.i.d., the remainderto be drunk throughout the day. During the trial, therewere five visits at the study center （screening, baseline,two interim visits and the final visit）. The efficacyendpoints included incidence and duration of heartburnepisodes per week by patient＇s self-assessment （heartburndiary） as well as changes in symptom severity asper symptom specific questionnaires [Reflux Disease Questionnaire （RDQ）; Quality of Life in Reflux andDyspepsia （QOLRAD）; Gastrointestinal Quality of LifeIndex] and overall health-related quality of life per SF-12（12-question short form） at each visit. At the end of thestudy, patients and investigators independently ratedthe overall efficacy of the test water on a 4-point Likertscale. Safety was assessed by evaluation of adverseevents （AEs）, vital signs （heart rate, blood pressure）and laboratory parameters. Changes from initial to finalexaminations were assessed by the non-parametricWilcoxon test; categorical variables were comparedusing the χ 2 test, and for more than 5 categories, by theU-test.RESULTS： Twenty-eight participants were men, 22women. The mean age of the patients in the fullanalysis set/intention-to treat population （FAS/ITT） was40.6 years. Forty-two participants completed the studyaccording to the study protocol and formed the perprotocolset （PP population）; 48 participants drank thewater at least once as requested and were analyzedas ITT population. The occurrence of heartburn wasstatistically significantly reduced at wk 6 in both the ITTand the PP populations. At wk 6, the mean number ofheartburn episodes/week decreased by 5.1 episodes（P 〈 0.001） and the mean duration of heartburnsymptoms by 19 min （ITT） （P = 0.002）. The frequencyof heartburn symptoms was reduced in 89.6% of thepatients （P 〈 0.001）, and the duration of symptoms in79.2% of patients （ITT） （P 〈 0.001）. All dimensions ofthe RDQ （heartburn, regurgitation, gastro-esophagealreflux disease symptoms, dyspepsia） showed asignificant improvement at 6 wk. Likewise, diseasespecificquality of life improved significantly （QOLRAD,GIQLI）. Overall, 89.4% of patients rated the efficacyof the test water as ＂good＂ or ＂very good＂, as did theinvestigators for 91.5% of the patients. There wereno serious AEs. After 6 wk, systolic and diastolic bloodpressure values decreased slightly but significantly [-3.5and -3.0 mmHg, respectively （P = 0.008 and P = 0,002）].Ninety-six percent of patients and investigators for thesame percentage of patients rated the tolerability of thewater as ＂good＂ or ＂very good＂.CONCLUSION： The data demonstrate effectiveness ofa hydrogen carbonate-rich mineral water in alleviatingheartburn frequency and severity, thereby improvingquality of life. The water has excellent tolerability.
文摘Heartburn is among the most common gastrointestinal symptoms presenting to both generalist physicians and gastroenterologists.In the era of high utilization of proton pump inhibitors,a substantial proportion of patients presenting to the gastroenterologist with chronic symptoms of heartburn do not have a reflux-mediated disease.Subjects without objective evidence of reflux as a cause of their symptoms have functional heartburn(FH).FH has no evidence of abnormal esophageal acid exposure on ambulatory reflux monitoring,major esophageal motor disorders on high resolution manometry,or esophageal mucosal pathology,such as eosinophilic esophagitis on endoscopy with esophageal biopsies.The pathophysiology of FH is unknown but it is often associated with visceral hypersensitivity,and psychiatric disease.Importantly,anti-reflux surgery or other invasive anti-reflux modalities should be avoided.Although there are limited supporting data,modulation of pain perception,traditional Chinese medicine and psychological intervention may be potential therapeutic options in this population.
文摘Background: Dyspepsia and heartburn are among the most frequent complaints of the upper gastrointestinal tract impacting quality of life. The present study aimed to investigate the impact of drinking a natural mineral water (medicinal product category “Heilwasser” in Germany) high in hydrogen carbonate (Staatl. Fachingen STILL) on functional dyspeptic complaints and heartburn. Methods: 56 men and women with self-reported heartburn were enrolled to this one-arm pilot study. They had to drink 1.5 L of a hydrogen carbonate rich mineral water each day over a course of six weeks. Participants reported the number and duration of heartburn episodes in a daily dairy. The Reflux Disease Questionnaire (RDQ), Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD) and the Gastrointestinal Quality of Life Index (GILQI) were used to assess the therapeutic course of the treatment and the Short Form Health Survey (SF-12) to assess general quality of life. Mean ± standard deviation were calculated and pre- and post-treatment changes were compared using the Wilcoxon test. Results: The consumption of a hydrogen carbonate rich mineral water decreased the number of heartburn episodes per week significantly by 4.8 ± 8.2 at the end of the study (p < 0.001). The duration of episodes was also significantly reduced by 25.7 minutes after six weeks of intervention (p < 0.001). Accordingly, the subjectively perceived severity of heartburn, regurgitation and dyspeptic complaints as well as the GERD dimension as assessed by Reflux Disease Questionnaire improved significantly. There was a significant improvement in the disease-specific quality of life as measured by the Gastrointestinal Quality of Life Index (p < 0.001) and by the Quality Of Life in Reflux and Dyspepsia (p < 0.001) questionnaires and the general health-related quality of life as assessed by SF-12 (p < 0.007). Conclusions: The present pilot study provides evidence that supplementation with natural mineral water rich in hydrogen carbonate may improve heartburn and dyspeptic symptoms, which finally resulted in an improvement of the subjectively perceived quality of life. Drinking mineral water rich in hydrogen carbonate may be an alternative remedy for the treatment of dyspeptic symptoms and heartburn. Trial Registration: Eudra CT No 2013-001256-36.
文摘Aims: To determine the prevalence and risk factors of heartburn in Abidjan, a black African city. Patients and Methods: cross-sectional study from June 15 to September 30, 2003. One thousand nine hundred forty (1940) persons from five health zones of the city Abidjan were included after their informed consent. Socio demographic and clinical parameters were collected using a questionnaire in an interview format. Heartburn was defined as a discomfort or burning sensation extending from the sternal manubrium to the base of the neck. Factors related to the complaint were asked such as predisposing factors, habits (tobacco, alcohol and coffee intake) and body mass index. Stepwise multiple logistic regression analyses were used to examine associations between these factors and heartburn. Results: Among 1940 respondents (mean age 28 ± 9 years;sex ratio (M:F) 0.86), heartburn occurred in 433 persons (once a week in 9.2% of case (178 persons)). Five factors were statistically associated with heartburn: male sex (p = 0.025, OR = 0.555 [CI95% 0.331 - 0.930]), heartburn in a family member (p = 0.010, OR = 1.765 [95%CI 1.143 - 2.725]), constipation (p = 0.011, OR = 2.182 [95%CI 11,953,983]), right lateral decubitus (p = 0.001, OR = 6.247 [95%CI 2.079 - 18.775]) and after a meal (p = 0.000, OR = 2.643 [95%CI 1.594 4.383]). Conclusion: Heartburn is common in this black African population. Male sex appears to be less associated. Constipation, right lateral decubitus and after a meal are trigger factors for heartburn. Heartburn in a family member is a risk factor.
基金Supported by (in part) The Medical Research Fund of the National Hospital of Icelandthe Medical Research Fund of Wyeth,Iceland+2 种基金AstraZeneca,IcelandGlaxoSmithKline,Icelandand the Icelandic College of Family Physicians
文摘AIM:To study the natural history and prevalence of heartburn at a 10-year interval,and to study the effect of heartburn on various symptoms and activities.METHODS:A population-based postal study was carried out.Questionnaires were mailed to the same age-and gender-stratified random sample of the Icelandic population(aged 18-75 years) in 1996 and again in 2006.Subjects were classified with heartburn if they reported heartburn in the preceding year and/or week,based on the definition of heartburn.RESULTS:Heartburn in the preceding year was reported in 42.8%(1996) and 44.2%(2006) of subjects,with a strong relationship between those who experienced heartburn in both years.Heartburn in the preceding week was diagnosed in 20.8%.There was a significant relationship between heartburn,dyspepsia and irritable bowel syndrome.Individuals with a body mass index(BMI) below or higher than normal weight were more likely to have heartburn.Heartburn caused by food or beverages was reported very often by 20.0% of subjects.CONCLUSION:Heartburn is a common and chronic condition.Subjects with a BMI below or higher than normal weight are more likely to experience heartburn.Heartburn has a great impact on daily activities,sleep and quality of life.
基金Supported by the National Natural Science Foundation of China:the Study of Mucosa Repair Mechanism of Reflux Esophagitis Cure by the Method of Huoxuetongjiang(No.81573737)Mechanism of Huoxue Tongjiang Formula Treat Reflux Esophagitis based on the Effect of Esophageal Microbiome on TLR4/PAR2/TRPV1 Pathway(No.82074213)。
文摘OBJECTIVE:To provide a basis for the clinical identification of true and false reflux,integrated traditional Chinese and Western medicine,and psychosomatic treatment,we conducted a retrospective study of the etiology and epidemiological and Traditional Chinese Medicine(TCM) syndrome characteristics of patients with reflux/heartburn symptoms.METHODS:The 210 10 patients with reflux/heartburn treated at Tianjin Nankai Hospital from January 1,2016,to December 31,2019,were divided into four groups according to their pathogenesis.Sex,age,course of disease,incidence rate,gastroscopy,24-h p Himpedance,esophageal manometry,Hamilton Anxiety Scale(HAMA)/Hamilton Depression Scale(HAMD) score,8-week proton pump inhibitor(PPI) treatment effect,and TCM syndrome characteristics were statistically analyzed.RESULTS:A total of 21010 patients(8864 men and 12146 women),with reflux/heartburn symptoms were screened,including 6284(29.9%) patients with reflux esophagitis(RE),10427(49.6%) patients with nonerosive reflux esophagitis(NERD),2430(11.6%) patients with reflux hypersensitivity(RH),and 1870(8.9%) patients with functional heartburn(FH).The incidence of the disease was higher in women than in men(P <0.0001).The ranking of the incidence of anxiety and depression in these four groups was FH > RH > NERD > RE(P < 0.0001).There were more women than men in the groups with anxiety and more men than women in the groups with depression(P < 0.0001),and there was no significant difference in the distribution of anxiety and depression between men and women(P = 0.5689).There were significant differences in TCM syndrome characteristics between NERD,RE,and functional esophageal diseases(P < 0.01).The highest proportion of functional esophageal disease TCM symptoms was Qi stagnation and phlegm obstruction syndrome(36.16%),and there was no significant difference between RH and FH.The effective rates of PPI treatment at 8 weeks in patients in the RE,NERD,RH,and FH groups were 89%,72%,54%,and 0%,respectively.RE was classified into grades A,B,C,and D according to the Los Angeles grading system.The ranking of the incidence of these four grades was A > B > C > D(P < 0.0001).The effective rates of PPI treatment at 8 weeks were 91%,81%,69%,and 63% in patients with grade A,B,C,and D RE,respectively(P < 0.0001).The highest proportion of TCM syndrome types of NERD and RE was the stagnated heat syndrome in the liver and stomach syndrome,38.99% and 33.90%,respectively.CONCLUSION:Reflux/heartburn symptoms are relatively common in middle-aged women,and NERD is the most common etiology,followed by RE,RH,and FH.The most common TCM syndrome characteristics in NERD and RE were stagnated heat syndrome in the liver and stomach syndrome,and Qi stagnation and phlegm obstruction syndrome in functional esophageal diseases.Most patients with reflux/heartburn symptoms also experienced anxiety and depression.
文摘Purpose: Ranitidine hydrochloride (HCl) remains an important medication for treating acid-peptic ailments such as Gastroesophageal reflux disease (GERD). The main objective of this Post Marketing Surveillance (PMS) clinical study was to test the efficacy and safety of Ranitidine HCl in Indian patients suffering from GERD. Patients and Methods: Data of 2446 patients (1307 males;1121 females) from 21 centers across India were analyzed. Patients received either of the three treatments: Ranitidine HCl 150 mg twice a day (BID) (ARM-A), Ranitidine HCl 300 mg once daily (OD) or BID (ARM-B), and Ranitidine HCl 300 mg OD (ARM-C). Gastroesophageal Reflux Disease Symptom Assessment Scale (GSAS) score and Heartburn Severity score were used to assess the drug’s efficacy. The adverse events reported by patients or investigators were analyzed to assess the safety profile of Ranitidine. Results: Of the 2446 subjects screened, 2428 were enrolled. There was a significant reduction in GSAS scores from baseline to the end of the study visit in all three ARMs. The GSAS scores reduced from 2.02 to 0.23 in ARM-A, 2.01 to 0.24 in ARM-B, and 2.07 to 0.26 in ARM-C patients. In ARM A, 72.82% had 24 hours heartburn-free days, and 66.89% had 7 consecutive heartburn-free days, which was more significant than the other two ARMs. 128 (5.27%) patients reported ADRs due to Ranitidine HCl at different doses. The most frequently reported ADR was constipation (17.18%), followed by oliguria (14.06%), cold (13.28%), and dysuria (12.5%). Of 128 ADRs, 113 (88.28%) were mild, and only 11 (8.59%) ADRs were related to the study drug. No severe ADRs were reported during the study. Conclusion: Ranitidine HCl 150/300 mg tablet was found to be an effective and safe H2-receptor antagonist for treating GERD in Indian Patients.
文摘Although gastroesophageal reflux disease(GERD)is a common disorder in Western countries,with a significant impact on quality of life and healthcare costs,the mechanisms involved in the pathogenesis of symptoms remain to be fully elucidated.GERD symptoms and complications may result from a multifactorial mechanism,in which acid and acid-pepsin are the important noxious factors involved.Prolonged contact of the esophageal mucosa with the refluxed content,probably caused by a defective anti-reflux barrier and luminal clearance mechanisms,would appear to be responsible for macroscopically detectable injury to the esophageal squamous epithelium.Receptors on acid-sensitive nerve endings may play a role in nociception and esophageal sensitivity,as suggested in animal models of chronic acid exposure.Meanwhile,specific cytokine and chemokine profiles would appear to underlie the various esophageal phenotypes of GERD,explaining,in part,the genesis of esophagitis in a subset of patients.Despite these findings,which show a significant production of inflammatory mediators and neurotransmitters in the pathogenesis of GERD,the relationship between the hypersensitivity and esophageal inflammation is not clear.Moreover,the large majority of GERD patients(up to 70%)do not develop esophageal erosions,a variant of the condition called non-erosive reflux disease.This summary aims to explore the inflammatory pathway involved in GERD pathogenesis,to better understand the possible distinction between erosive and non-erosive reflux disease patients and to provide new therapeutic approaches.
