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[PMID]:28452210
[Au] Autor:Talley NJ
[Ad] Endereço:Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia.
[Ti] Título:Functional Dyspepsia: Advances in Diagnosis and Therapy.
[So] Source:Gut Liver;11(3):349-357, 2017 May 15.
[Is] ISSN:2005-1212
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:Functional dyspepsia (FD) is a common but under-recognized syndrome comprising bothersome recurrent postprandial fullness, early satiety, or epigastric pain/burning. Epidemiologically, there are two clinically distinct FD syndromes (although these often overlap clinically): postprandial distress syndrome (PDS; comprising early satiety or meal-related fullness) and epigastric pain syndrome. Symptoms of gastroesophageal reflux disease overlap with FD more than expected by chance; a subset has pathological acid reflux. The pretest probability of FD in a patient who presents with classical FD symptoms and no alarm features is high, approximately 0.7. Coexistent heartburn should not lead to the exclusion of FD as a diagnosis. One of the most exciting observations in FD has been the consistent finding of increased duodenal eosinophilia, notably in PDS. Small bowel homing T cells, signaling intestinal inflammation, and increased cytokines have been detected in the circulation, and elevated tumor necrosis factor-α levels have been significantly correlated with increased anxiety. Postinfectious gastroenteritis is a risk factor for FD. Therapeutic options remain limited and provide only symptomatic benefit in most cases. Only one therapy is known to change the natural history of FD- eradication. Treatment of duodenal eosinophilia is under investigation.
[Mh] Termos MeSH primário: Dispepsia/diagnóstico
Dispepsia/terapia
Período Pós-Prandial
Avaliação de Sintomas
[Mh] Termos MeSH secundário: Diagnóstico Diferencial
Duodenopatias/complicações
Duodenopatias/diagnóstico
Dispepsia/etiologia
Eosinofilia/complicações
Eosinofilia/diagnóstico
Refluxo Gastroesofágico/complicações
Refluxo Gastroesofágico/diagnóstico
Azia/complicações
Azia/diagnóstico
Infecções por Helicobacter/complicações
Infecções por Helicobacter/tratamento farmacológico
Helicobacter pylori
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.5009/gnl16055


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[PMID]:28464343
[Au] Autor:Coyle C; Crawford G; Wilkinson J; Thomas SJ; Bytzer P
[Ad] Endereço:RB, Slough, Berkshire, UK.
[Ti] Título:Randomised clinical trial: addition of alginate-antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms.
[So] Source:Aliment Pharmacol Ther;45(12):1524-1533, 2017 06.
[Is] ISSN:1365-2036
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Symptomatic breakthrough in proton pump inhibitor (PPI)-treated gastro-oesophageal reflux disease (GERD) patients is a common problem with a range of underlying causes. The nonsystemic, raft-forming action of alginates may help resolve symptoms. AIM: To assess alginate-antacid (Gaviscon Double Action, RB, Slough, UK) as add-on therapy to once-daily PPI for suppression of breakthrough reflux symptoms. METHODS: In two randomised, double-blind studies (exploratory, n=52; confirmatory, n=262), patients taking standard-dose PPI who had breakthrough symptoms, assessed by Heartburn Reflux Dyspepsia Questionnaire (HRDQ), were randomised to add-on Gaviscon or placebo (20 mL after meals and bedtime). The exploratory study endpoint was change in HRDQ score during treatment vs run-in. The confirmatory study endpoint was "response" defined as ≥3 days reduction in the number of "bad" days (HRDQ [heartburn/regurgitation] >0.70) during treatment vs run-in. RESULTS: In the exploratory study, significantly greater reductions in HRDQ scores (heartburn/regurgitation) were observed in the Gaviscon vs placebo (least squares mean difference [95% CI] -2.10 [-3.71 to -0.48]; P=.012). Post hoc "responder" analysis of the exploratory study also revealed significantly more Gaviscon patients (75%) achieved ≥3 days reduction in "bad" days vs placebo patients (36%), P=.005. In the confirmatory study, symptomatic improvement was observed with add-on Gaviscon (51%) but there was no significant difference in response vs placebo (48%) (OR (95% CI) 1.15 (0.69-1.91), P=.5939). CONCLUSIONS: Adding Gaviscon to PPI reduced breakthrough GERD symptoms but a nearly equal response was observed for placebo. Response to intervention may vary according to whether symptoms are functional in origin.
[Mh] Termos MeSH primário: Alginatos/administração & dosagem
Hidróxido de Alumínio/administração & dosagem
Antiácidos/administração & dosagem
Dor Irruptiva/tratamento farmacológico
Refluxo Gastroesofágico/tratamento farmacológico
Inibidores da Bomba de Prótons/administração & dosagem
Ácido Silícico/administração & dosagem
Bicarbonato de Sódio/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Idoso
Alginatos/efeitos adversos
Hidróxido de Alumínio/efeitos adversos
Antiácidos/efeitos adversos
Antiulcerosos/administração & dosagem
Antiulcerosos/efeitos adversos
Método Duplo-Cego
Combinação de Medicamentos
Feminino
Azia/tratamento farmacológico
Seres Humanos
Masculino
Meia-Idade
Inibidores da Bomba de Prótons/efeitos adversos
Ácido Silícico/efeitos adversos
Bicarbonato de Sódio/efeitos adversos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Alginates); 0 (Antacids); 0 (Anti-Ulcer Agents); 0 (Drug Combinations); 0 (Proton Pump Inhibitors); 1343-98-2 (Silicic Acid); 5QB0T2IUN0 (Aluminum Hydroxide); 66220-44-8 (alginate, aluminium hydroxide, magnesium trisilicate, sodium bicarbonate drug combination); 8MDF5V39QO (Sodium Bicarbonate)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171220
[Lr] Data última revisão:
171220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1111/apt.14064


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[PMID]:28450281
[Au] Autor:Chen H
[Ad] Endereço:Department of radiology, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China poetyoung@163.com.
[Ti] Título:A woman with intermittent heartburn.
[So] Source:BMJ;357:j1936, 2017 04 27.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Azia/diagnóstico
Hérnia Hiatal/diagnóstico por imagem
[Mh] Termos MeSH secundário: Idoso
Diagnóstico Diferencial
Feminino
Azia/etiologia
Hérnia Hiatal/complicações
Hérnia Hiatal/cirurgia
Seres Humanos
Radiografia Torácica
Tomógrafos Computadorizados
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j1936


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[PMID]:28953640
[Au] Autor:Li MJ; Li Q; Sun M; Liu LQ
[Ad] Endereço:aSchool of Pharmacy, Shanxi Medical University bDepartment of Pharmacy, The First Hospital of Shanxi Medical University, Taiyuan cDepartment of Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors & Hubei Cancer Clinical Study Center, Wuhan dDepartment of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China.
[Ti] Título:Comparative effectiveness and acceptability of the FDA-licensed proton pump inhibitors for erosive esophagitis: A PRISMA-compliant network meta-analysis.
[So] Source:Medicine (Baltimore);96(39):e8120, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This study compared the effectiveness and acceptability of all Food and Drug Administration (FDA)-recommended dose proton pump inhibitors (PPIs) in erosive esophagitis (EE): Dexlansoprazole 60 mg, Esomeprazole 40 mg, Esomeprazole 20 mg, Pantoprazole 40 mg, Lansoprazole 30 mg, Rabeprazole 20 mg, Omeprazole 20 mg. METHODS: A systematic literature search was performed using PubMed, Embase, and Cochrane Library. Totally, 25 randomized controlled trials (RCTs) met study selection criteria and were incorporated in this network meta-analysis (NMA) study. RESULTS: For the NMA, eligible RCTs of adults with EE verified by endoscopic examination were randomly assigned to the licensed PPIs at least 4 weeks of continuous therapy. The primary efficacy outcome was the endoscopic healing rates at 4 and 8 weeks. Heartburn relief rates were a secondary efficacy outcome. The rates of withdrawal were analyzed as a safety outcome. In comparison to the common comparator omeprazole 20 mg, esomeprazole 40 mg provided significantly healing rates at 4 weeks [odds ratio (OR), 1.46 (95% confidence interval, 95% CI, 1.24-1.71)] and 8 weeks [1.58 (1.29-1.92)], and improved the heartburn relief rates [1.29 (1.07-1.56)]. In comparison to lansoprazole 30 mg, esomeprazole 40 mg provided significantly healing rates at 4 weeks [1.30 (1.10-1.53)] and 8 weeks [1.37 (1.13-1.67)], and improved the heartburn relief rates [1.29 (1.03-1.62)]. In terms of acceptability, only dexlansoprazole 60 mg had significantly more all-cause discontinuation than omeprazole 20 mg [1.54 (1.03-2.29)], pantoprazole 40 mg [1.68 (1.08-2.63)], and lansoprazole 30 mg [1.38 (1.02-1.88)]. CONCLUSION: The standard-dose esomeprazole 40 mg had more superiority in mucosal erosion healing and heartburn relief. Esomeprazole 40 mg, pantoprazole 40 mg, esomeprazole 20 mg, and lansoprazole 30 mg showed more benefits in effectiveness and acceptability than other interventions.
[Mh] Termos MeSH primário: Esofagite Péptica/tratamento farmacológico
Inibidores da Bomba de Prótons/administração & dosagem
[Mh] Termos MeSH secundário: 2-Piridinilmetilsulfinilbenzimidazóis/administração & dosagem
Adulto
Pesquisa Comparativa da Efetividade
Dexlansoprazol/administração & dosagem
Esomeprazol/administração & dosagem
Esofagite Péptica/complicações
Feminino
Azia/tratamento farmacológico
Azia/etiologia
Seres Humanos
Lansoprazol/administração & dosagem
Masculino
Meia-Idade
Metanálise em Rede
Omeprazol/administração & dosagem
Rabeprazol/administração & dosagem
Resultado do Tratamento
Estados Unidos
United States Food and Drug Administration
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Nome de substância:
0 (2-Pyridinylmethylsulfinylbenzimidazoles); 0 (Proton Pump Inhibitors); 0K5C5T2QPG (Lansoprazole); 32828355LL (Rabeprazole); D8TST4O562 (pantoprazole); KG60484QX9 (Omeprazole); N3PA6559FT (Esomeprazole); UYE4T5I70X (Dexlansoprazole)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171013
[Lr] Data última revisão:
171013
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008120


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[PMID]:28916953
[Au] Autor:Gold BD; Pilmer B; Kierkus J; Hunt B; Perez MC; Gremse D
[Ad] Endereço:Children's Center for Digestive Healthcare, LLC, 993D Johnson Ferry Rd. NE, Suite 440, Atlanta, GA, 30342, USA. bgold@gicareforkids.com.
[Ti] Título:Dexlansoprazole for Heartburn Relief in Adolescents with Symptomatic, Nonerosive Gastro-esophageal Reflux Disease.
[So] Source:Dig Dis Sci;62(11):3059-3068, 2017 Nov.
[Is] ISSN:1573-2568
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Proton pump inhibitors are commonly used to treat gastro-esophageal reflux disease (GERD) and nonerosive GERD (NERD) in adolescents and adults. Despite the efficacy of available medications, many patients have persisting symptoms, indicating a need for more effective agents. AIMS: To assess the safety and efficacy of dexlansoprazole dual delayed-release capsules in adolescents for treatment of symptomatic NERD. METHODS: A phase 2, open-label, multicenter study was conducted in adolescents aged 12-17 years. After a 21-day screening period, adolescents with endoscopically confirmed NERD received a daily dose of 30-mg dexlansoprazole for 4 weeks. The primary endpoint was treatment-emergent adverse events (TEAEs) experienced by ≥5% of patients. The secondary endpoint was the percentage of days with neither daytime nor nighttime heartburn. Heartburn symptoms and severity were recorded daily in patient electronic diaries and independently assessed by the investigator, along with patient-reported quality of life, at the beginning and end of the study. RESULTS: Diarrhea and headache were the only TEAEs reported by ≥5% of patients. Dexlansoprazole-treated patients (N = 104) reported a median 47.3% of days with neither daytime nor nighttime heartburn. Symptoms such as epigastric pain, acid regurgitation, and heartburn improved in severity for 73-80% of patients. Pediatric Gastroesophageal Symptom and Quality of Life Questionnaire-Adolescents-Short Form symptom and impact subscale scores (scaled 1-5) each decreased by an average of 0.7 units at week 4. CONCLUSIONS: Use of 30-mg dexlansoprazole in adolescent NERD was generally well tolerated and had beneficial effects on improving heartburn symptoms and quality of life. TRIAL REGISTRATION: This study has the ClinicalTrials.gov identifier NCT01642602.
[Mh] Termos MeSH primário: Dexlansoprazol/uso terapêutico
Refluxo Gastroesofágico/tratamento farmacológico
Azia/tratamento farmacológico
Inibidores da Bomba de Prótons/uso terapêutico
[Mh] Termos MeSH secundário: Administração Oral
Adolescente
Idade de Início
Cápsulas
Criança
Preparações de Ação Retardada
Dexlansoprazol/administração & dosagem
Dexlansoprazol/efeitos adversos
Europa (Continente)
Feminino
Refluxo Gastroesofágico/diagnóstico
Azia/diagnóstico
Seres Humanos
América Latina
Masculino
América do Norte
Inibidores da Bomba de Prótons/administração & dosagem
Inibidores da Bomba de Prótons/efeitos adversos
Qualidade de Vida
Indução de Remissão
Índice de Gravidade de Doença
Inquéritos e Questionários
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE II; JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Capsules); 0 (Delayed-Action Preparations); 0 (Proton Pump Inhibitors); UYE4T5I70X (Dexlansoprazole)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170917
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1007/s10620-017-4743-3


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[PMID]:28550489
[Au] Autor:Frazzoni M; de Bortoli N; Frazzoni L; Tolone S; Savarino V; Savarino E
[Ad] Endereço:Digestive Pathophysiology Unit, Baggiovara Hospital, Viale Giardini 1355, 41100, Modena, Italy. marziofrazzoni@gmail.com.
[Ti] Título:Impedance-pH Monitoring for Diagnosis of Reflux Disease: New Perspectives.
[So] Source:Dig Dis Sci;62(8):1881-1889, 2017 Aug.
[Is] ISSN:1573-2568
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Heartburn is the most specific symptom of gastroesophageal reflux disease (GERD). In clinical practice, heartburn relief by a proton pump inhibitor (PPI) trial does suffice to confirm GERD. However, an objective diagnosis of GERD is required before anti-reflux endoscopic or surgical interventions, independently from PPI response. Thus, since normal findings at upper endoscopy are detected in the majority of patients with heartburn, reflux monitoring is often required. When traditional catheter-based or wireless pH tests are used, reflux episodes are conventionally identified by pH drops below 4.0 units. Combined impedance-pH monitoring has the advantage to provide a comprehensive assessment of both physical and chemical properties of refluxate and the distinction between acid and weakly acidic refluxes, both proven to cause heartburn. Unfortunately, the conventional impedance-pH parameters, namely acid exposure time and number of reflux events, are characterized by suboptimal diagnostic sensitivity, and the reliability of symptom-reflux association indexes remains questionable. Therefore, novel impedance parameters, namely the post-reflux swallow-induced peristaltic wave (PSPW) index and the mean nocturnal baseline impedance (MNBI), have recently been proposed in order to achieve a better diagnostic yield. In fact, they proved to be highly accurate in distinguishing reflux-related from reflux-unrelated heartburn, off- as well as on-PPI therapy. Currently, manual review of impedance-pH tracings is needed because of the modest accuracy of available software tools for automated analysis. PSPW index and MNBI are highly applicable and reproducible, and their calculation requires a few additional minutes during the manual review of impedance-pH tracings. So far, we believe that PSPW index and MNBI are ready for prime time and should become part of the standard analysis of impedance-pH tracings for GERD diagnosis in patients with endoscopy-negative heartburn.
[Mh] Termos MeSH primário: Impedância Elétrica
Monitoramento do pH Esofágico/métodos
Refluxo Gastroesofágico/diagnóstico
[Mh] Termos MeSH secundário: Esôfago/química
Esôfago/fisiopatologia
Refluxo Gastroesofágico/complicações
Refluxo Gastroesofágico/fisiopatologia
Azia/tratamento farmacológico
Azia/etiologia
Seres Humanos
Concentração de Íons de Hidrogênio
Peristaltismo
Inibidores da Bomba de Prótons/uso terapêutico
Reprodutibilidade dos Testes
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Proton Pump Inhibitors)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170528
[St] Status:MEDLINE
[do] DOI:10.1007/s10620-017-4625-8


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[PMID]:28431766
[Au] Autor:Katz PO; Le Moigne A; Pollack C
[Ad] Endereço:Albert Einstein Medical Center, Philadelphia, Pennsylvania. Electronic address: philipokatz@gmail.com.
[Ti] Título:Analysis of 2-Week Data from Two Randomized, Controlled Trials Conducted in Subjects with Frequent Heartburn Treated with Esomeprazole 20 mg.
[So] Source:Clin Ther;39(5):960-970, 2017 May.
[Is] ISSN:1879-114X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: These secondary analyses used data from 2 similarly designed studies in subjects experiencing frequent heartburn to evaluate the efficacy of esomeprazole 20 mg once daily for 2 weeks, which reflects the approved over-the-counter dosage and duration. METHODS: Subjects without endoscopically identified erosive esophagitis who were experiencing heartburn for ≥6 months and ≥4 of 7 days prior to baseline (study 1, N = 368; study 2, N = 349) were randomly assigned to receive double-blind treatment with esomeprazole 40 or 20 mg (administered as esomeprazole magnesium trihydrate 44.5 and 22.3 mg, respectively) or placebo once daily for 4 weeks. Subjects recorded the severity of heartburn in a daily diary, and investigators assessed subjects at each study visit. Two-week assessments were the primary end points of interest in these analyses and included the percentage of subjects with complete heartburn resolution (no episodes during 7 consecutive days), time to sustained complete heartburn resolution (the first of 7 consecutive episode-free days), and heartburn relief (no episodes other than ≤1 mild episode during 7 consecutive days). FINDINGS: At week 2, the percentages of subjects who experienced complete heartburn resolution were significantly greater with esomeprazole 40 mg (study 1, 26.1%; study 2, 35.3%) and 20 mg (study 1, 25.2%; study 2, 35.7%) compared with placebo (study 1, 9.0%; study 2, 3.4%) (all, P ≤ 0.001). Beginning on day 1, the percentages of subjects who experienced sustained heartburn resolution was significantly greater in the groups treated with esomeprazole 40 mg (study 1, 19%; study 2, 19%; P < 0.0001) and 20 mg (study 1, 10%; study 2, 15%; P < 0.05) compared with the group that received placebo (study 1, 2%; study 2, 1%). Additionally, at week 2, the percentages of subjects experiencing heartburn relief were significantly greater with esomeprazole 40 mg (study 1, 35.3%; study 2, 40.5%) and 20 mg (study 1, 34.5%; study 2, 46.4%) compared with placebo (study 1, 16.5%; study 2, 8.6%) (all, P ≤ 0.001). IMPLICATIONS: The results of this study demonstrate that once-daily treatment with esomeprazole 20 mg for 2 weeks effectively resolved subjects׳ heartburn compared with placebo, beginning on day 1. Studies precede FDA Act 801 clinical trial registration and results submission requirements.
[Mh] Termos MeSH primário: Esomeprazol/uso terapêutico
Azia/tratamento farmacológico
Inibidores da Bomba de Prótons/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Método Duplo-Cego
Esquema de Medicação
Esomeprazol/administração & dosagem
Esofagite Péptica/tratamento farmacológico
Feminino
Seres Humanos
Masculino
Meia-Idade
Inibidores da Bomba de Prótons/administração & dosagem
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Proton Pump Inhibitors); N3PA6559FT (Esomeprazole)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171108
[Lr] Data última revisão:
171108
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170423
[St] Status:MEDLINE


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[PMID]:28384225
[Au] Autor:Chu C; Du Q; Li C; Zhang L; Zhou X; Zuo F; Zhang Y; Li F; Xie G; Li Y
[Ad] Endereço:Department of Gastroenterology, Jinan Central Hospital, Shandong University, Jinan, Shandong province, China.
[Ti] Título:Ambulatory 24-hour multichannel intraluminal impedance-pH monitoring and high resolution endoscopy distinguish patients with non-erosive reflux disease from those with functional heartburn.
[So] Source:PLoS One;12(4):e0175263, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:AIMS: To assess the contribution of 24-h esophageal multichannel intraluminal impedance and pH (MII-pH) monitoring and high resolution endoscopy (HRE) with i-scan imaging in differentiating non erosive reflux disease (NERD) from functional heartburn (FH). METHODS: This is a retrospective cohort study of patients with heartburn from the Endoscopy Unit. NERD patients and FH patients were defined by 24-h MII-pH monitoring and white light endoscopy. Minimal mucosal changes were assessed by HRE with i-scan imaging. RESULTS: Total of 156 consecutive patients with heartburn but without esophageal mucosal erosions were studied. Forty-eight of these subjects had NERD, with increased acid exposure time (AET) and positive SAP and/or SI. Eighteen had FH with normal AET and negative SAP and SI. When compared to FH patients and healthy controls, NERD patients had significantly increased number of total acid reflux episodes, as well as increased number of weakly acidic reflux episodes (p<0.01). The rate of proximal reflux episodes in NERD patients was higher than that of FH patients and healthy controls (p<0.01). Irregular or blurring of the Z-line (58.3%) and white mucosal turbidity (47.9%) were the most common endoscopic findings of minimal mucosal changes observed in this study. NERD patients had more prevalent minimal changes than FH patients and the controls (87.5%vs. 66.6%vs. 61.9%; p = 0.004) with sensitivity of 87.5%. Histopathological evaluation showed that NERD patients had significantly higher average scores of intercellular spaces dilation (2.82±0.9 vs. 1.2±0.6, p = 0.005) and papillae elongation (2.65±1.0 vs. 1.5±0.8, p = 0.014), but not for basal cell proliferation (1.6±1.3 vs. 1.0±0.9, p = 0.070). The histological scores of the NERD patients were 7.1±1.2, which were higher than those of FH patients (3.4±1.0, p = 0.004). CONCLUSIONS: Minimal mucosal changes could be useful markers to support clinical diagnosis of NERD. Combination of 24-h MII-pH monitoring and i-scan high resolution endoscopy can distinguish patients with NERD from those with FH.
[Mh] Termos MeSH primário: Refluxo Gastroesofágico/diagnóstico
Azia/diagnóstico
Concentração de Íons de Hidrogênio
Monitorização Fisiológica/métodos
[Mh] Termos MeSH secundário: Adulto
Diagnóstico Diferencial
Feminino
Refluxo Gastroesofágico/patologia
Azia/patologia
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170907
[Lr] Data última revisão:
170907
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170407
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0175263


  9 / 1829 MEDLINE  
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[PMID]:28375482
[Au] Autor:Su A; Gandhy R; Barlow C; Triadafilopoulos G
[Ad] Endereço:Medicine, Stanford University School of Medicine, Stanford, CA, USA.
[Ti] Título:Clinical and manometric characteristics of patients with Parkinson's disease and esophageal symptoms.
[So] Source:Dis Esophagus;30(4):1-6, 2017 Apr 01.
[Is] ISSN:1442-2050
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Dysphagia is a common problem in patients with Parkinson's disease (PD); its etiology is multifactorial and its management is challenging. In this retrospective cohort analysis using prospectively collected data, we aimed to objectively characterize dysphagia and/or other esophageal symptoms in patients with PD, assess the prevalence of outflow obstruction as well as major or minor disorders of esophageal peristalsis leading to impaired esophageal clearance and highlight objective parameters that can help in the current management algorithm. Thirty-three consecutive patients with PD presenting with dysphagia, odynophagia, heartburn, regurgitation, chest pain, and weight loss underwent clinical and functional evaluation by high-resolution manometry (HRM). Esophagogastric junction (EGJ) outflow obstruction and major as well as minor disorders of peristalsis were then assessed using the Chicago classification (v3). Thirty-three PD patients with esophageal symptoms were enrolled in the study; 12 of them reported weight loss that was considered as potentially reflecting underlying esophageal dysfunction. The median age of the patients was 70 years (range: 53-89 years), 24 (75%) were men. The majority (62%) experienced dysphagia, likely contributing to weight loss in 41% of patients. Odynophagia was rare (6%) while GER symptoms, such as heartburn, regurgitation, and chest pain were noted in 37%, 31%, and 28% of patients, respectively. Using the hierarchy of the Chicago classification, 12 patients (39%) exhibited EGJ outflow obstruction, 16 (48%) diffuse esophageal spasm (DES), 18 (55%), ineffective esophageal peristalsis (IEM), 16 (48%) fragmented peristalsis, and only 2 patients (6%) had normal HRM tracings. There were no patients with HRM features of achalasia. Dysphagia is common in patients with PD and is associated with a high prevalence of underlying motility disturbances as identified by HRM. The exact impact of these motility abnormalities on symptom induction and their role in influencing clinical management are unclear and will require further study.
[Mh] Termos MeSH primário: Transtornos de Deglutição/etiologia
Gerenciamento Clínico
Esôfago/fisiopatologia
Manometria/métodos
Doença de Parkinson/complicações
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Algoritmos
Dor no Peito/etiologia
Dor no Peito/fisiopatologia
Transtornos de Deglutição/fisiopatologia
Junção Esofagogástrica/fisiopatologia
Feminino
Azia/etiologia
Azia/fisiopatologia
Seres Humanos
Refluxo Laringofaríngeo/etiologia
Refluxo Laringofaríngeo/fisiopatologia
Masculino
Meia-Idade
Doença de Parkinson/fisiopatologia
Peristaltismo/fisiologia
Estudos Prospectivos
Estudos Retrospectivos
Perda de Peso
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170405
[St] Status:MEDLINE
[do] DOI:10.1093/dote/dow038


  10 / 1829 MEDLINE  
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[PMID]:28295217
[Au] Autor:Roks DJ; Koetje JH; Oor JE; Broeders JA; Nieuwenhuijs VB; Hazebroek EJ
[Ad] Endereço:Department of Surgery, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
[Ti] Título:Randomized clinical trial of 270° posterior versus 180° anterior partial laparoscopic fundoplication for gastro-oesophageal reflux disease.
[So] Source:Br J Surg;104(7):843-851, 2017 Jun.
[Is] ISSN:1365-2168
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Partial fundoplications provide similar reflux control with fewer post-fundoplication symptoms compared with Nissen fundoplication for gastro-oesophageal reflux disease (GORD). The best choice of procedure for partial fundoplication remains unclear. The aim of this study was to compare the outcome of two different types of partial fundoplication for GORD. METHODS: A double-blind RCT was conducted between 2012 and 2015 in two hospitals specializing in antireflux surgery. Patients were randomized to undergo either a laparoscopic 270° posterior fundoplication (Toupet) or a laparoscopic 180° anterior fundoplication. The primary outcome was postoperative dysphagia at 12 months, measured by the Dakkak score. Subjective outcome was analysed at 1, 3, 6 and 12 months after surgery. Objective reflux control was assessed before and 6 months after surgery. RESULTS: Ninety-four patients were randomized to laparoscopic Toupet or laparoscopic 180° anterior fundoplication (47 in each group). At 12 months, 85 patients (90 per cent) were available for follow-up. Objective scores were available for 76 (81 per cent). Postoperative Dakkak dysphagia score at 12 months was similar in the two groups (mean 5·9 for Toupet versus 6·4 for anterior fundoplication; P = 0·773). Subjective outcome at 12 months demonstrated no significant differences in control of reflux or post-fundoplication symptoms. Overall satisfaction and willingness to undergo surgery did not differ between the groups. Postoperative endoscopy and 24-h pH monitoring showed no significant differences in mean oesophageal acid exposure time or recurrent pathological oesophageal acid exposure. CONCLUSION: Both types of partial fundoplication provided similar control of GORD at 12 months, with no difference in post-fundoplication symptoms. Registration number: NTR5702 (www.trialregister.nl).
[Mh] Termos MeSH primário: Fundoplicatura/métodos
Refluxo Gastroesofágico/cirurgia
Laparoscopia/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Transtornos de Deglutição/etiologia
Método Duplo-Cego
Esôfago/fisiologia
Feminino
Fundoplicatura/efeitos adversos
Refluxo Gastroesofágico/complicações
Refluxo Gastroesofágico/fisiopatologia
Azia/etiologia
Seres Humanos
Concentração de Íons de Hidrogênio
Laparoscopia/efeitos adversos
Masculino
Manometria
Meia-Idade
Complicações Pós-Operatórias
Estudos Prospectivos
Recidiva
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170719
[Lr] Data última revisão:
170719
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170316
[St] Status:MEDLINE
[do] DOI:10.1002/bjs.10500



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