Jeannette Powers

Comparison of the degree of duodenogastroesophageal reflux and acid reflux between patients who failed to respond and those who were successfully treated with a proton pump inhibitor once daily.

OBJECTIVES:The objective of this study was to compare the degree of esophageal acid exposure and duodenogastroesophageal reflux (DGER) during treatment between gastroesophageal reflux disease (GERD) patients who responded fully to proton pump inhibitor (PPI) once a day and those who failed to respond.METHODS:Gastroesophageal reflux disease patients who continued to report symptoms 3 times a week for 3 months while on PPI once a day were assigned to the PPI failure group. GERD patients who were asymptomatic on PPI once a day for 3 months were assigned to the PPI success group. All patients underwent upper endoscopy to assess esophageal mucosal injury. Subsequently, all patients underwent simultaneous 24-h esophageal Bilitec 2000 and pH testing while on treatment. Patients recorded GERD-related symptoms during the test.RESULTS:Twenty-four patients were enrolled in the PPI failure group and 23 patients were enrolled in the PPI success group. Endoscopy was normal in 63% of PPI failure patients and 76% of PPI success patients. Abnormal DGER was documented in 82% of PPI success patients vs. 67% of PPI failure patients (P=NS). All pH testing and Bilitec parameters in the PPI failure group were similar to those in the PPI success group (P=NS). Of the 34 GERD symptoms recorded by the PPI failure group, 64% were associated with acid reflux and 41% were associated with DGER (P<0.05).CONCLUSIONS:There is no difference in the degree of DGER and acid exposure during treatment between patients who failed to respond and those who achieved complete symptom resolution on PPI once daily. GERD symptoms in the PPI failure group are more commonly associated with acid reflux than with DGER.

Comparisons of the distribution of oesophageal acid exposure throughout the sleep period among the different gastro‐oesophageal reflux disease groups

Background  Nocturnal gastro‐oesophageal reflux diseases (GERD) can lead to oesophageal mucosal injury and extra‐oesophageal complications.

The effect of esomeprazole 20 mg twice daily on acoustic and perception parameters of the voice in laryngopharyngeal reflux.

Background  Randomized, placebo‐controlled studies have failed to demonstrate a significant treatment effect for laryngopharyngeal reflux (LPR) using traditional clinical endpoints. We compared the effect of esomeprazole 20 mg twice daily (b.i.d.) vs placebo on voice and acoustic‐related measures in patients with LPR.

Clinical trial: the effect of Johrei on symptoms of patients with functional chest pain.

Background  Patients with functional chest pain (FCP) represent a therapeutic challenge for practising physicians.

Assessment of 24-h oesophageal pH monitoring should be divided to awake and asleep rather than upright and supine time periods*

Abstract  Oesophageal acid exposure analysis is divided to upright and supine, based on the assumption that the supine–awake period is similar to the supine–asleep period. To determine if the principal acid‐reflux characteristics of supine–awake are closer to supine–asleep or upright period. Patients with heartburn underwent an upper endoscopy and pH testing. The patients were instructed to carefully document their upright, supine–awake and supine–asleep periods. A total of 64 patients were enrolled into this study (M/F 35/29; mean age 52.4 ± 13.3). The mean percentage total time pH <4, frequency of acid‐reflux events (per h) and number of sensed reflux events was not different between upright and the supine–awake period (P = ns). In contrast, the mean percentage total time pH <4, frequency of acid‐reflux events and number of sensed reflux events was significantly higher in both upright and supine–awake periods vs supine–asleep (4.3 ± 6.9, 1.86 ± 2.7 and 0.01 ± 0.05, P < 0.0001, respectively). The principal characteristics of the acid‐reflux events in the supine–awake period are closer to the upright period than to the supine–asleep period.

Increased oesophageal acid exposure at the beginning of the recumbent period is primarily a recumbent‐awake phenomenon

Background  A significant increase in oesophageal acid exposure during early recumbent period has been demonstrated.

Reassessment of the Principal Characteristics of Gastroesophageal Reflux During the Recumbent Period Using Integrated Actigraphy-Acquired Information

OBJECTIVES:Characterization of gastroesophageal reflux (GERD) events during the sleep period has been hampered by lack of any patient-friendly technique that allows accurate assessment of sleep duration and awakening time, without confining patients to a sleep laboratory. Our aim was to compare principal reflux characteristics during the upright, recumbent-awake, and recumbent-asleep periods as well as to determine the effect of sleep awakenings on the principal reflux characteristics of the recumbent-asleep period using novel technology that allows integration of recorded actigraphy data into collected pH information.METHODS:Patients with heartburn at least three times a week for the previous 3 months were invited to participate in this study. All participants were evaluated by the demographics and the GERD Symptom Checklist questionnaires. Thereafter, patients underwent ambulatory 24-h esophageal pH monitoring concomitantly with actigraphy. A novel technique was used to superimpose simultaneously recorded raw actigraphy data over pH data, resulting in more accurate information about reflux events during upright, recumbent-awake, recumbent-asleep, and conscious awakening periods as well as the relationship between symptoms and acid reflux events in the aforementioned periods.RESULTS:Thirty-nine subjects (M/F: 26/13, mean age 56.6±14 years) with an abnormal pH test were enrolled into the study. The recumbent period appeared heterogeneous and was clearly divided into recumbent-awake (123.0±20.2 min) and recumbent-asleep (485.6±23.6 min) periods. The percent total time pH<4, the mean number of acid reflux events, and the number of symptoms associated with reflux events were significantly greater in the recumbent-awake as compared with the recumbent-asleep period. The mean duration of an acid reflux event was not different among upright, recumbent-awake, and recumbent-asleep periods. However, short-duration reflux events during the sleep period were associated with conscious awakenings as compared with those during sleep (0.74±0.11 min vs. 1.64±0.3 min, P=0.01).CONCLUSIONS:The recumbent period is divided into recumbent-awake and recumbent-asleep periods. The recumbent-awake period has significantly different principal reflux characteristics than the recumbent-asleep period. Duration of an acid reflux event during the recumbent-asleep period is not uniformly prolonged. Short-duration acid reflux events during the sleep period are likely due to conscious awakenings.

Riser’s reflux – an eye-opening experience

Background  Patients with gastro‐oesophageal reflux disease (GORD) commonly report waking up in the morning with a sour or bitter taste in their mouth. The aim of the study was to compare the prevalence and frequency of acid reflux events prior to and immediately after awakening from sleep in the morning between GORD patients and normal subjects.

Night-time intra-oesophageal bile and acid: a comparison between gastro-oesophageal reflux disease patients who failed and those who were treated successfully with a proton pump inhibitor.

Aliment Pharmacol Ther 2011; 33: 837–844

The effect of antireflux treatment on patients with gastroesophageal reflux disease undergoing a mental arithmetic stressor.

Background  Acute stress exacerbates heartburn in gastroesophageal reflux disease (GERD) patients by enhancing the perceptual responses to intraesophageal acid. The aim of the study was to determine if antireflux treatment can still alter stimulus response functions to acid in patients undergoing acute stress as compared with placebo.