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PubMed2002

Helicobacter pylori infection and hiatal hernia do not affect acid reflux and esophageal motility in patients with gastro-esophageal reflux.

BACKGROUND: The association of H. pylori and hiatal hernia in patients with gastroesophageal reflux disease, in terms of acidity and esophageal motility, is not well defined. The purpose of this work was to assess whether, in patients with gastroesophageal reflux, the presence of H. pylori and hiatal hernia affects the severity of esophagitis. METHODS: Reflux symptoms, endoscopy, H. pylori, esophageal manometry, and 24-h pH monitoring were evaluated in 37 patients with esophageal reflux and 14 healthy volunteers. RESULTS: A total of 75.6% of patients with esophageal reflux was positive for H. pylori; 81% had hiatal hernia, and only 43.2% showed an acid score by 24-h pHmetry. Esophageal reflux patients with H. pylori, hiatal hernia, and an acid score demonstrated higher acid parameters compared with those in healthy volunteers. Patients with an acid score who were negative for H. pylori tended toward more acid reflux events than patients with an acid score who were positive for H. pylori, a difference that did not reach significance. The same situation existed with patients with an acid score and hiatal hernia who were negative for H. pylori, but the tendency did not achieve significance. Independent analysis of patients with Savary-Miller stage II and III esophagitis showed results that were not different from the combined analysis of stage II and III patients. Amplitude and contraction-duration parameters of the esophageal wave, and the number of high-pressure and prolonged contractions were not different among the reflux groups. Wave amplitude in the lower third of the esophagus was significantly lower in esophagitis stage III patients with hiatal hernia and in esophagitis stage II and III patients, combined, with H. pylori, compared with findings in the healthy volunteers. CONCLUSIONS: These results suggest that H. pylori and hiatal hernia in patients with esophageal reflux do not constitute risk factors that affect the severity of esophagitis.

Adult↗
PubMed1983

[Postgastrectomy syndromes with special reference to reflux esophagitis].

60 patients without suspicion of recurrence of stomach cancer have had a follow-up by mean of 65 months after the procedure of a total gastrectomy. In 16 cases an additional esophagomanometric and endoscopic-bioptic examination was performed. Up to 1975 the operative procedure of stomach replacement was a jejunal interposition, afterwards the technique of a jejunoplicationn. Clinical signs of an esophageal reflux were found in one half of the patients with a jejunoplicatio and in a third of the cases with a jejunal interposition. Endoscopic-bioptic evidence of a reflux-esophagitis has been found in 13 of 16 patients. A functioning sphincter mechanism of the lower esophagus could be demonstrated in 5 of 16 cases. There was no proof of a correlation between the results of endoscopic-bioptic and manometric examinations. A prevention or reduction of esophageal reflux is as well possible by the technique of jejunal interposition as by jejunoplication.

Esophagitis, Peptic↗
PubMed1994

[Early phase II study of FUT-187 (sepimostat mesilate) on reflux esophagitis--mainly on postgastrectomy reflux esophagitis].

An early phase II clinical study with the proteolysis inhibitor FUT-187 was carried out on patients with reflux esophagitis. FUT-187 was administered orally at the dose of 300 mg/day or 400 mg/day four times daily, after meals and at bedtime, for 4 consecutive weeks. The total number of patients admitted to this study was 40, of whom 9 were assigned to 300 mg/day group and 31 to 400 mg/day group. The rate of effectiveness on postgastrectomy reflux esophagitis was 88% (7/8) in 300 mg/day group and 85%(22/26) in 400 mg/day group when "improved" or better final general improvement ratings were taken into consideration, and 75% (6/8) in 300 mg/day group and 69% (9/13) in 400 mg/day group when "improved" or better endoscopic general improvement ratings were used. The overall safety rating "no problem as to the drug safety" was 89% (8/9) in 300 mg/day group and 71% (22/31) in 400 mg/day group. The main side effect was diarrhea, which was experienced in 6 patients in 400 mg/day group. However, it was resolved by discontinuation of the drug treatment. Other symptoms of gastrointestinal upsets, such as nausea and anorexia, were also induced. Based on these results, it may be concluded that FUT-187 can be a drug with clinical utility that benefits postgastrectomy reflux esophagitis at the dose level of 300 mg/day or less.

Administration, Oral↗
PubMed2001

[Role of endogenous cholinergic nerve in esophageal dysmotility with reflux esophagitis].

OBJECTIVE: To study the role of endogenous cholinergic nerve in esophageal dysmotility with reflux esophagitis in a feline model. METHODS: In 16 healthy cats under ketamine anesthesia (20 mg/kg), the abdominal parts of lower esophageal sphincter were cut open to establish the animal model for reflux esophagitis; esophageal motility was measured respectively preoperation and post-esophagitis. The activities of choline acetyltransferase (CHAT) and acetylcholinesterase(ACHE) in medial and distal esophageal body muscle was measured respectively with spectrophotometry, and compared to the normal cats(n = 8). RESULTS: Reflux esophagitis can make distal esophageal peristaltic amplitude decrease, the distal esophageal peristaltic amplitude of cats with reflux esophagitis [above LES 1 cm: (22.65 +/- 16.53) mm Hg; above LES 3 cm:(39.94 +/- 14.78) mm Hg, P < 0.0001] was significantly lower than that of normal cats [above LES 1 cm: (63.71 +/- 21.34) mm Hg; above LES 3 cm: (73.65 +/- 23.42) mm Hg] and the conducting velocity of distal esophagus was slower than that of normal cats [(1.04 +/- 0.36) cm/s vs (1.39 +/- 0.46) cm/s, P < 0.05]. In the esophagus of reflux esophagitis group, CHAT activity was lower in the model, especially in the distal part [(81.01 +/- 22.03) U/g vs (230.13 +/- 30.10) U/g, P < 0.0001] and ACHE activity remains unchanged. CONCLUSION: CHAT activity and pressure level were lower in the distal esophagus with reflux esophagitis compared to the normal cats. This study supported that reflux esophagitis can results in dysmotility of the distal esophagus and the abnormality of endogenous cholinergic innervation is one of the important mechanisms as far as the disorder of esophageal movement in reflux esophagitis.

Acetylcholinesterase↗
PubMed1997

Assessment of non-acid esophageal reflux: comparison between long-term reflux aspiration test and fiberoptic bilirubin monitoring.

Reflux esophagitis may result from the action of both acid and non-acid agents. The aim of this study was to test a new system able to measure the quantity of the bilirubin contained in the esophageal lumen. The analysis of esophageal reflux composition was conducted in two phases. In the first bile and pancreatic enzyme, concentration of 136 fluid samples obtained with ambulatory esophageal long-term reflux aspiration test were measured. For the second, the total bilirubin content of each sample was measured in vitro with a fiberoptic probe (Bilitec 2000, Synetics Medical Inc., Sweden). Studies were performed on 48 subjects: 43 patients with esophageal reflux and five healthy volunteers. The results of both techniques were then compared. Higher concentration of bile and pancreatic enzymes were found in esophageal fluid samples of patients with endoscopic esophagitis. Bile and pancreatic enzyme concentrations of esophageal fluid samples were higher in patients after gastrectomy compared to patients with intact stomachs. There was a significant correlation between the total bilirubin concentration of fluid specimens and the fiberoptic probe reading of bilirubin (r = 0.72, P < 0.001). The presence of bilirubin and bile acids within the esophageal refluxate can be determined reliably with continuous fiberoptic measurement. The correlation between total bilirubin content and the concentrations of pancreatic enzymes contained in the esophageal refluxate suggests that bilirubin is a good tracer for non-acid, duodenal or intestinal reflux in the esophagus.

Adolescent↗
PubMed1978

[Current views concerning the etiopathogenesis of reflux esophagitis in children].

Esophagitis is caused by a gastro-esophageal reflux sometimes reflecting anatomical inadequacy of structures that secure the relationships between the cardia and the diaphragm, fundus of the stomach, and other surrounding viscera, but more often due to functional deficiency of lower esophageal sphincter (LES), this representing the main factor for maintenance of the mechanism of cardial continence. Manometric studies of intraluminal pressures in the esophagus have revealed the presence of a high-pressure segment in the distal esophagus, where a mean pressure of 12-13 mm Hg obtains over a length of 3 or 4 cm. In the first two weeks of extrauterine life the LES is between 0.5 and 1 cm long, with a pressure of 3 mm Hg; pressure values in the LES equal adult values at about one month of age, showing that neuromuscular control of the sphincter has been achieved. Gastro-esophageal reflux, however, is very common in the newborn and not enough by itself to cause peptic disease of the esophagus; this requires the concomitance of morphological defects of the esophageal mucosa and/or dynamic-functional disturbances. This, according to the authors, is why esophagitis actually occurs in only about 60% of patients with radiologically and pHmetrically demonstrated gastro-esophageal reflux.

Age Factors↗
PubMed2005

Esophageal motor activity in children with gastro-esophageal reflux disease and esophagitis.

OBJECTIVE: To evaluate esophageal body motor contractions occurring during esophageal reflux in pediatric patients with gastro-esophageal reflux disease (GERD). METHODS: Patients referred for the evaluation of GERD who were evaluated with combined 24-hour pH probe and esophageal manometry test (MP24) were included. Patients were separated into the following groups: Group C -- normal pH probe and normal EGD; Group 1 -- abnormal pH probe and normal EGD; and Group 2 -- abnormal pH probe and EGD with histologic esophagitis. Esophageal motor function during reflux episodes was analyzed. RESULTS: Twenty-five patients were included. All had a normal stationary esophageal manometry. Patients in Groups 1 and 2 had significantly more gastroesophageal reflux by pH probe than Group C (P < 0.01). During the MP24, patients in Group 1 and 2 had significantly fewer contractions per minute pre-, during, and post-GER (P < 0.05). There were significant differences in the number of isolated and prolonged contractions (>7 sec) during prolonged GERD episodes >5 minutes (P < 0.05). CONCLUSION: Children with GERD have a decreased number and abnormal esophageal body contractions with esophageal reflux. This suggests that children with GERD with and without esophagitis have impaired esophageal body acid clearance.

Adolescent↗
PubMed1992

Vicryl-scarf-induced scarring around esophagogastric junction as treatment of esophageal reflux disease. An experimental study in the dog.

A ringlike structure around the cardia has proven to be sufficient in preventing gastroesophageal reflux, as seen with the Angelchick prosthesis. To avoid the insertion of a nonabsorbable foreign body, a scarring was induced by implanting a Vicryl scarf around the esophagogastric junction. Reflux disease was induced in 18 dogs by circular cardiomyomectomy. In 12 dogs, a Vicryl scarf was laid around the cardia; six dogs served as controls. All of the dogs in the control group either died or had to be sacrificed due to severe reflux esophagitis. All animals receiving the scarf survived the entire duration of the experiment. Endoscopically, only one case of temporary reflux esophagitis could be detected. Long-term pH-metry demonstrated complete reflux suppression after the third postoperative month. Radiographically, esophagogastric transit was always unimpaired. On autopsy, the scarf was found to have changed into a slim scarring after the sixth postoperative month and then remained unaltered. We conclude that inducing scarring around the cardia is as effective in reflux prevention as the silicone ring.

Animals↗
PubMed1977

Complications of repeated operations to control esophageal reflux (esophagogastrocutaneous and esophagogastropericardial fistulas).

Iatrogenic injury to the distal esophagus and gastric cardia with subsequent fistula formation may occur at times following repeated direct operative attempts to control reflux esophagitis. At re-operation when this problem occurs, the indirect operative procedure of Roux-en-Y diversion is a safe, effective and preferable method to control persistent reflux esophagitis.

Aged↗
PubMed2001

Bile-induced adenosine triphosphate depletion and mucosal damage during reflux esophagitis.

BACKGROUND: This study was designed to investigate the role of bile in a large animal model of acute esophageal reflux disease. METHODS: An agar electrode was used to measure the transmucosal potential difference of the esophagus in anaesthetized dogs. The vascular permeability index and the epithelial permeability index of the mucosa were evaluated by means of the Evans blue and the sodium-fluorescein clearance method, respectively. The tissue adenosine triphosphate (ATP) level and the myeloperoxidase activity were determined from tissue biopsies, while the degree of mucosal damage was evaluated histologically on a grade 0-100 scale. Group 1 (n = 8) served as saline-treated control; groups 2 (n = 8), 3 (n = 5) and 4 (n = 5) were exposed for 4 h to canine bile alone, to hydrochloric acid + bile, or to hydrochloric acid alone, respectively. RESULTS: In Groups 2, 3 and 4 the degree of mucosal damage was significantly increased, and a 4-fold elevation in myeloperoxidase activity was observed. The transmucosal potential difference was decreased significantly below the control level, while the vascular and epithelial permeability indices were significantly increased compared with the control values. Bile, but not hydrochloric acid, evoked a significant (40%) decrease in the ATP level of the esophageal tissue. CONCLUSIONS: We propose that mucosal dysfunction, structural damage and leukocyte invasion during hydrochloric acid-induced esophageal injury are exacerbated by bile-induced changes in tissue ATP concentrations during experimental esophageal reflux disease.

Acute Disease↗
PubMed1978

[Current trends in the treatment of reflux esophagitis in childhood].

A problem of some complexity is the management of pathological gastro-esophageal reflux due to the presence of cardio-hiatal malformation, malposition of the cardia and gastric tuberosity, a congenitally short esophagus, and the like. Sometimes, however, there is no demonstrable morphological aleration and the condition, characterized by primitive hypotonia of the LES, goes under the name of infant chalasia of the esophagus. The general policy is to try first a conservative treatment consisting of dietary and postural measures and the administration of metoclopramide and d;ugs that protect the esophageal mucosa; this stage, however, should not be prolonged beyond 6 weeks. The presence of gastro-esophageal reflux associated with hiatal hernia; the presence of severe esophagitis or peptic stenosis of the esophagus and the persistence of symptoms after an adequate period of conservative therapy constitute as many indications for surgical correction. Good results can be obtained by restoring or strengthening the failing function of the LES, as is done quite successfully with funduplication after Nissen or with method of Belsey-Mark IV.

Antacids↗
PubMed2002

Barrett's esophagus and reflux esophagitis: is there a missing link?

OBJECTIVES: Barrett's esophagus (BE) is associated with esophageal reflux. The development stage of BE is not well described. Epidemiological evidence indicates that the columnar epithelium in BE is acquired and reaches its full length rapidly. We tested the hypothesis that BE might result from direct replacement of erosions in reflux esophagitis (RE). METHODS: At endoscopy, we compared the length and distribution of esophageal erosions in 50 patients with RE with the length and distribution of columnar epithelium in 50 patients with BE. RESULTS: The median length of erosions in RE was 2 cm, less than the median length of columnar epithelium in BE, 5 cm (p < 0.001). Erosions in RE were usually multiple and scattered, involving the entire circumference of the esophagus in only 10% of cases, but circumferential involvement by columnar epithelium was found in 68% of BE cases (p < 0.001). Circumferential involvement, 3 cm or longer, was found in 0% of cases of RE versus 56% of BE cases (p < 0.001). Two patients without RE or BE had large areas of epithelial loss of uncertain etiology. CONCLUSIONS: The length and distribution of erosions in RE differ greatly from the length and distribution of columnar epithelium in BE. It is unlikely that BE arises directly from areas of esophagitis. We suggest that BE may develop after loss of a long segment of squamous epithelium, with columnar replacement in the presence of continuing acid reflux.

Adult↗
PubMed1990

[Nissen fundoplication for reflux esophagitis].

Nissen fundoplication was performed in 20 patients suffering from esophageal reflux. Failure of medical therapy was the indication in 60% of the patients, and complications of reflux (bleeding, stricture, Barrett's esophagus) in the others. There was no operative mortality; wound infection was the most common postoperative complication (4 patients). Follow-up after 1-8 years showed good results in 85%. The results of Nissen fundoplication in the world literature, as well as in this series, prove it to be effective for esophageal reflux. Those not responding to appropriate medical therapy should be referred earlier for surgery, prior to development of the complications of reflux.

Esophagitis, Peptic↗
PubMed1997

[Gastro-esophageal reflux successfully treated with transgastrostomal jejunal tube feeding].

An 82-year-old man suffered from recurrent melena due to reflux esophagitis and aspiration pneumonia, which were caused by severe gastroesophageal reflux. We constructed a gastric stoma by percutaneous endoscopic gastrostomy (PEG) and fixed a transgastrostomal jejunal tube (TGJ tube) in the jejunum through the stoma. Direct administration of fluid into the jejunum was followed by a significant reduction in gastro-esophageal reflux. The reflux esophagitis and aspiration pneumonia did not recur. There was no vomiting, self-extubation, or restlessness that might have been caused by dementia, and the patient was could discharged cared for at into home.

Aged↗