Chien-Lin Chen

Sleep symptoms and gastroesophageal reflux.

Background This study was to determine whether patients with significant nighttime heartburn had more disturbed sleep and more gastroesophageal acid reflux than those without significant nighttime heartburn. Methods Thirty-three reflux patients were stratified into 2 groups (nighttime heartburn, without nighttime heartburn). All patients completed questionnaires assessing daytime and nighttime heartburn and subjective sleep by Pittsburgh Sleep Quality Index. All participants underwent 24-hour esophageal pH monitoring and an overnight polysomnographic study. Results The number of reflux events longer than 5 minutes was significantly greater in patients with nighttime heartburn than in those without nighttime heartburn for the total (P=0.004) and upright (P=0.01) position periods. Acid contact time was significantly greater in patients with nighttime heartburn during the upright (P=0.003) period and during the total (P=0.001) period. Patients with nighttime heartburn reported significantly greater subjective sleep impairment (8.1±0.7) than those without nighttime heartburn (6.1±0.4; P=0.02), but no difference could be observed in any objective sleep parameter by an overnight polysomnographic study between the groups. Conclusions Patients with significant nighttime heartburn seem to have more acid reflux compared with those without nighttime heartburn. Nighttime heartburn together with sleep complaints is associated with excessive gastroesophageal reflux.

Sleep Dysfunction in Patients With GERD: Erosive Versus Nonerosive Reflux Disease

Background:Sleep disturbance has been observed in patients with gastroesophageal reflux disease (GERD), but very few studies have further characterized sleep quality in patients with nonerosive esophageal reflux disease (NERD). This study was undertaken to investigate whether there are differences in sleep quality among patients with erosive esophagitis, NERD, and control subjects. Methods:We performed symptom severity scoring and upper GI endoscopy in 20 healthy control subjects and 35 GERD patients, including 17 with NERD and 18 with erosive esophagitis. Sleep quality was measured by using Pittsburgh Sleep Quality Index (PSQI). Results:Sleep disturbance was noted in 11 of 17 NERD patients and 12 of 18 patients with erosive esophagitis (P = NS) but none of healthy control subjects. The patient groups, erosive esophagitis and NERD, had greater PSQI scores compared with healthy control subjects (both P < 0.05). Both groups had similar median PSQI score (5.5 vs 6.0; NERD vs erosive esophagitis; P = NS). There was no significant correlation between reflux symptom severity score and PSQI score. Conclusions:Despite no difference in sleep quality between erosive esophagitis and NERD, NERD can have a significant impact on sleep comparable to erosive esophagitis. It is suggested that NERD should be treated aggressively and at least similarly to erosive esophagitis.

Autonomic responses to heartburn induced by esophageal acid infusion.

Background and Aim:  Studies have shown that altered visceral perception and lower pain thresholds in patients with symptomatic gastroesophageal reflux disease (GERD) and non‐cardiac chest pain. Autonomic changes associated with the perception of heartburn in patients with GERD are poorly understood.

Cardiac autonomic regulation differentiates reflux disease with and without erosive esophagitis

Objective. Impaired autonomic function has been observed in patients with gastroesophageal reflex disease (GERD), but little is known about autonomic function in patients with non-erosive reflux disease (NERD). The objective of this study was to investigate potential differences in autonomic function by means of heart rate variability in GERD patients with and without erosive esophagitis. Material and methods. Thirty-five GERD patients and 20 healthy controls participated in the study. Seventeen subjects with NERD and 18 patients with erosive reflux disease (ERD) were identified based on typical reflux symptoms, endoscopic findings, and 24-h esophageal pH. Spectral analysis of heart rate variability was performed to calculate the low-frequency (LF) band, the high-frequency (HF) band, and the LF/HF ratio. Results. No significant differences were found in age, gender, body mass index, or current tobacco use among the reflux patients and controls. The Helicobacter pylori status and severity of reflux symptoms were similar between the two groups. The HF band power was significantly lower in patients with ERD than in NERD patients (p<0.01) and controls (p<0.05). LF band power (%) and LF/HF ratio were significantly lower in the NERD patients compared with ERD patients (p<0.05) and controls (p<0.05). There was no statistically significant correlation between any heart rate variability parameter and symptom severity score in either the ERD or NERD group. Conclusions. Patients with ERD and NERD display a similar degree of symptom severity, but the pattern of autonomic function appears to differ between NERD and ERD.

Comparison of Esophageal Motility in Patients with Solid Dysphagia and Mixed Dysphagia

It is unclear whether there is any difference in esophageal motor abnormalities between patients complaining of dysphagia for solids or both solids and liquids. The aim of this study was to determine any difference in the manometric findings between patients with dysphagia for solids and those with mixed dysphagia. Manometric tracings were performed in 200 consecutive patients (66M, 134F; mean age = 51 years) with nonobstructive dysphagia. Ambulatory pH studies were performed in all patients. Subjects were divided into two groups: patients with solid dysphagia (n = 94, 33M, 61 F; mean age = 51 years) and those with mixed dysphagia (n = 106, 33M, 73F; mean age = 51 years). A normal motility study was the most frequent finding. Achalasia occurred more frequently in patients with mixed dysphagia than in those with solid dysphagia (12% vs. 3%, p < 0.01). Gastroesophageal reflux disease (GERD) was observed in 59% of patients with solid dysphagia compared with 29% of patients with mixed dysphagia (p < 0.02). The most common esophageal motility abnormality is nonspecific esophageal motility disorders. This study has shown that abnormal esophageal motility occurs slightly more in mixed dysphagia than solid dysphagia. The clinical utility of a symptomatic differentiation of patients with solid or mixed dyphagia appears to be limited.

Atypical Symptoms in Patients With Gastroesophageal Reflux Disease

Background/Aims Atypical symptoms are common in gastroesophageal reflux disease (GERD). Patients with non-erosive reflux disease (NERD) and erosive reflux disease (ERD) exhibit different clinical characteristics and responses to acid suppression treatment. We aimed to compare atypical characteristics in patients with NERD and ERD. We also investigated the presence of histological esophagitis in patients with NERD and ERD. Methods Eligible patients completed a questionnaire regarding reflux symptoms and concomitant atypical symptoms. Endoscopic biopsies with histological examination were performed. Results Of the 210 patients with GERD, 90 patients with ERD and 120 patients with NERD were studied. ERD patients were characterized by higher prevalence of hiatal hernia (P = 0.001) and smoking (P = 0.047). The prevalence of GERD was greater in the age group between 41 and 60 years regardless of endoscopic finding. There was no difference in the prevalence of atypical symptoms or histological esophagitis between NERD and ERD. In all subjects, heartburn was associated with dysphagia (r = 0.16, P = 0.01), dyspepsia (r = 0.22, P = 0.008) and hiccup (r = 0.19, P = 0.003), whereas acid regurgitation was associated with dyspepsia (r = 0.21, P = 0.014), belching (r = 0.15, P = 0.018) and hiccup (r = 0.19, P = 0.002). Conclusions Atypical symptoms did not correlate with the presence of histological esophagitis. Atypical symptoms were equally prevalent in patients with NERD and ERD. The existence of atypical symptoms appears to be associated with the presence of typical reflux symptoms irrespective of endoscopic and histological reflux esophagitis.

Electrogastrography Differentiates Reflux Disease With or Without Dyspeptic Symptoms

Many patients with gastroesophgeal reflux disease (GERD) may also have overlapping symptoms of dyspepsia. This study was to examine if GERD patients could be separated into meaningful groups based on their gastric myoelectrical characteristics. The study included 20 GERD patients with dyspeptc symptoms (GERD+) and 17 patients with GERD. Gastric myoelectrical activity was assessed using cutaneous electrodes to record electrogastrograms (EGGs). The GERD+ patients ingested smaller volumes of water compared to patients with GERD (P<0.05). At baseline, the percentage of gastric myoelectrical power in the normal 3-cpm range was significantly less in patients with GERD+ compared with the GERD subjects (P = 0.01). Power in the bradygastria range was significantly greater in patients with GERD+ (P = 0.005). The GERD+ group had a significant increase in the percentage of power in the tachygastria range later after ingesting the water load (P < 0.01). In conclusion, this study has shown that more gastric dysrhythmias were detected in the GERD+ patients accompanied with altered perception of stomach fullness.

Association of Rheumatoid Arthritis and Hepatitis B Infection: A Nationwide Nested Case-Control Study From 1999 to 2009 in Taiwan.

AbstractRheumatoid arthritis (RA) is a disorder with altered immunologic function and increased risks of infection, while the association between HBV and RA remains largely unknown.To determine the prevalence and risk of HBV infection in patients with RA, 2 cohort datasets were sourced from Taiwans National Health Insurance Research Database to capture National Health Insurance claims data between 1999 and 2009. One set was a specially requested RA subjects dataset extracted from the whole 23 million beneficiaries, and a total of 38,969 aged ≧18 years RA subjects were identified (RA cohort). The other one was a randomly selected 1 million patients’ longitudinal dataset, and from which an additional 701,476 aged ≧18 years non-RA subjects were identified (non-RA cohort). An epidemiological approach was used to compare the prevalence and risk for HBV infection between RA and non-RA subjects.During the followed interval between 1999 and 2009, 3260 in RA cohort and 63,588 in non-RA cohort had a diagnosis of HBV infection. The annual age- and sex-standardized prevalence of HBV infection in the RA cohort was generally higher than that in the non-RA cohort. The RA patients had a higher HBV period prevalence than did the non-RA subjects (RA vs. non-RA = 69.9 vs. 60.1 cases per 1000 subjects). Compared with the non-RA cohort, the RA cohort had an increased risk of HBV infection after adjustment for potential prognostic factors (1.13, 95% CIs: 1.08–1.17).RA patients are characterized by an increased risk of HBV infection than non-RA subjects.

Clinical, metabolic, and psychological characteristics in patients with gastroesophageal reflux disease overlap with irritable bowel syndrome.

ObjectivesGastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) are highly prevalent in the general population, with significant symptom overlap, whereas the interaction between both remains poorly understood. We aim to identify the clinical and psychological factors that contribute toward the overlap of GERD and IBS. Patients and methodsWe carried out a case–control study among 806 GERD and 176 IBS patients from a health check-up cohort (n=2604). All participants were evaluated using the Reflux Disease Questionnaire score, the Pittsburgh Sleep Quality Index score, the Taiwanese Depression Questionnaire score, and the State-Trait Anxiety Inventory score. Endoscopic findings were classified according to the Los Angeles classification. IBS was diagnosed on the basis of Rome III criteria, and metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III definition. ResultsAmong the study population, 727 individuals had GERD, 97 individuals had IBS, and 79 individuals had a diagnosis of both GERD and IBS (GERD-I). GERD-I patients had more severe GERD symptoms compared with patients with GERD or IBS alone (P<0.0001). Moreover, GERD-I patients had more frequent healthcare-seeking behavior, decreased quality of sleep, and higher depression scores than patients with GERD (P<0.0001) or IBS alone (P<0.05). In addition, GERD-I patients had lower blood pressure, waist-to-hip ratio, and higher serum high-density lipoprotein levels than those with GERD alone (P<0.05). ConclusionGERD patients overlapping with IBS have different clinical and psychological profiles than those with GERD or IBS alone. Our study suggests that awareness of these symptom presentations will help optimize the treatment of these conditions.

Cardiac autonomic dysregulation in patients with acute hepatitis.

Background: Autonomic dysfunction is common in patients with chronic liver disease, but it is still unclear whether acute hepatitis coincides with alterations in autonomic functions. Methods: We evaluated the heart rate variability (HRV) of 10 patients with acute hepatitis (6 males, 4 females; mean age, 44.0 y; range, 20–69 y). Frequency-domain analysis of short-term and stationary R-R intervals was performed on the first day of admission to detect low-frequency power (LF; 0.04–0.15 Hz), high-frequency power (HF, 0.15–0.40 Hz), the ratio of LF to HF (LF/HF), and LF in normalized units (LF%). The same measurement was repeated on the 7th day of admission. Results: We found that there was a significant increase of HF as well as variance of the R-R interval on the 7th day after admission (P < 0.05). There was a significant negative correlation between HF and the change of total bilirubin (P < 0.05). Conclusions: The study demonstrates a change in cardiac vagal tone associated with acute hepatitis by analysis of HRV, and such alteration is less pronounced later during the clinical course of acute hepatitis.