Helicobacter pylori infection is associated with milder gastro‐oesophageal reflux disease
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Background: We have previously demonstrated a negative relationship between the prevalence of Helicobacter pylori and gastro‐oesophageal reflux disease (GERD). Aim: To study the effects of H. pylori infection on the severity of GERD. Methods: Ethnic Chinese patients with frequent heartburn and/or endoscopic oesophagitis were studied. Endoscopic examination was performed to assess the severity of oesophagitis (modified Savary–Miller grading) and the presence of hiatus hernia. Biopsies were taken for rapid urease testing and confirmation of Barrett’s oesophagus. Risk factors which may affect the severity of oesophagitis (age, sex, smoking, drinking, diabetes mellitus, hiatus hernia, H. pylori status and body mass index) were evaluated by a multiple regression model. The cagA status of H. pylori infected GERD and age‐and‐sex matched controls were determined by Western blot. Age‐and‐sex matched non‐reflux patients were recruited as controls for comparison. Results: Two hundred and twenty‐five patients with GERD were studied, of whom 77 (34%) were infected with H. pylori . Oesophagitis and Barrett’s oesophagus were found in 140 patients (62%) and six patients (3%), respectively. H. pylori infected patients had significantly less severe oesophagitis compared to the uninfected group ( P =0.022). All patients with Barrett’s oesophagus were uninfected. Factors that predicted severe oesophagitis included age over 60 years ( P < 0.001) and hiatus hernia ( P < 0.001). H. pylori infection was the only factor that showed a negative correlation with severe oesophagitis ( P =0.011). The prevalence of the cagA positive strain in endoscopy‐negative GERD, erosive oesophagitis and control subjects was 70, 76 and 78%, respectively ( P =0.75). Conclusions: H. pylori infection is associated with milder GERD.Keywords:
Esophagitis
Heartburn
CagA
Hiatal Hernia
Abstract Background and Aim: Epidemiological studies have shown that 10–48% of people in developed countries have gastroesophageal reflux disease (GERD) symptoms such as heartburn and acid regurgitation. The present study aimed to examine the prevalence of GERD symptoms and GERD in Japanese subjects. Methods: A cross‐sectional study of Japanese subjects who visited a clinic for a routine health check up was carried out. Subjects were asked to fill out a self‐report questionnaire. GERD was defined as the presence of heartburn and/or acid regurgitation at least twice per week. Results: Of the 6035 eligible subjects, 2662 (44.1%) reported having had heartburn and/or acid regurgitation during the past year: 124 (2.1%) daily, 275 (4.6%) twice per week, 773 (12.8%) twice per month and 1490 (24.7%) less than twice per month. Three hundred and ninety‐nine (6.6%) subjects were diagnosed as having GERD and there was no relationship between the prevalence of GERD and either sex or age. The prevalence of bothersome GERD symptoms was significantly higher in subjects with GERD than in those without GERD. Conclusion: Approximately 6.6% of Japanese have GERD and most persons with GERD described heartburn or acid regurgitation as bothersome.
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In the past there has been reliance on heartburn and acid regurgitation as the cardinal symptoms of gastro-esophageal reflux. Now it is recognized that diverse additional symptoms including extraesophageal manifestations are essential components of gastroesophageal reflux disease (GERD). Furthermore, previous reliance in mucosal damage at endoscopy as evidence of therapeutic success in the management of GERD has proven of only limited value in the diverse world of GERD symptoms. Indeed is now apparent that the relationship between symptoms and lesions is modest at best. Most patients with GERD have no overt erosions or ulceration at endoscopy and they frequently suffer from a wide array of complaints other than heartburn that contribute to their diminished perception of life's quality. To address these problems, multidimensional questionnaires designed to encompass the diverse symptomatology of GERD have been investigated, principally, to provide a reproducible metric of change in the subjective response to pharmacologic therapy during trials for patients with nonerosive reflux disease. The most promising of these instruments is The ReQuest questionnaire, because it has been extensively validated in multiple patient groups and cultures, appears highly promising in this regard and for erosive disease too and may ultimately prove to be of value for the initial evaluation of patients with GERD. We propose that accurate symptom delineation complemented with endoscopy performed in selected groups of patients will become the mainstay in diagnosis of GERD and the assessment of therapy efficacy.
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Symptomatic gastroesophageal reflux disease (GERD) is a common problem that affects a substantial proportion of the American population. It is estimated that the symptoms of GERD may afflict 40% to 45% of Americans each month. The diagnosis of GERD can be difficult, as its symptoms vary from typical symptoms like heartburn to atypical symptoms such as hoarseness, coughing, and chest pain. Most patients present with typical symptoms and are diagnosed with GERD if they respond to empiric trials of acid suppression. Many tests are available to help with diagnosing GERD in patients who either present with atypical symptoms or who do not respond to acid suppression; however, each test has its own shortcomings. The only test that directly measures whether acid is refluxing into the esophagus is the pH probe, but this test is uncomfortable for the patient, can be difficult to interpret, and may not be necessary in all cases. This article reviews the indications for pH monitoring, its technique, its advantages and limitations, and its role the diagnosis of GERD.
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Department of Internal Medicine, SungkyunGastroesophageal reflux disease (GERD) is characterized by the presence of esophageal mucosal injury or by the occurrence of reflux-induced symptoms which are severe enough to impair quality of life. GERD is a common GI disorder in the West, but not in the East including Korea. Heartburn is the most common symptom of GERD in the West, but it is rare in a substantial proportion of patients with GERD in Korea. Epigastric soreness or pain of Korean patients could result from gastroesophageal reflux. The suppression of acid is the mainstay of therapy for GERD. Proton pump inhibitors can be an attractive choice of initial treatment because of rapid symptom relief and healing of esophagitis. Because GERD is a chronic relapsing disorder, most of patients require long-term management. For long-term management of GERD, step-down approach is recommendable considering clinical and economic effectiveness.
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OBJECTIVES: Nocturnal heartburn and related sleep disturbances are common among patients with gastroesophageal reflux disease (GERD). This study evaluated the efficacy of dexlansoprazole MR 30 mg in relieving nocturnal heartburn and GERD-related sleep disturbances, improving work productivity, and decreasing nocturnal symptom severity in patients with symptomatic GERD. METHODS: Patients (N=305) with frequent, moderate-to-very severe nocturnal heartburn and associated sleep disturbances were randomized 1:1 in a double-blind fashion to receive dexlansoprazole MR or placebo once daily for 4 weeks. The primary end point was the percentage of nights without heartburn. Secondary end points were the percentage of patients with relief of nocturnal heartburn and of GERD-related sleep disturbances over the last 7 days of treatment. At baseline and week 4/final visit, patients completed questionnaires that assessed sleep quality, work productivity, and the severity and impact of nocturnal GERD symptoms. RESULTS: Dexlansoprazole MR 30 mg (n=152) was superior to placebo (n=153) in median percentage of nights without heartburn (73.1 vs. 35.7%, respectively;P<0.001). Dexlansoprazole MR was significantly better than placebo in percentage of patients with relief of nocturnal heartburn and GERD-related sleep disturbances (47.5 vs. 19.6%, 69.7 vs. 47.9%, respectively;P<0.001), and led to significantly greater improvements in sleep quality and work productivity and decreased nocturnal symptom severity. Adverse events were similar across treatment groups. CONCLUSIONS: In patients with symptomatic GERD, dexlansoprazole MR 30 mg is significantly more efficacious than placebo in providing relief from nocturnal heartburn, in reducing GERD-related sleep disturbances and the consequent impairments in work productivity, and in improving sleep quality/quality of life.
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Operational definitions of gastroesophageal reflux disease (GERD) reflect that the term covers a wide spectrum of clinical conditions, ranging from symptomatic syndromes to local or systemic complications, which result from gastroesophageal reflux of gastric content. The majority of GERD patients experience heartburn and acid regurgitation, which are considered to be typical reflux symptoms. However, a considerable number of patients with GERD have no or nondominant typical symptoms but report nontypical gastrointestinal symptoms or present with extraesophageal syndromes, like noncardiac chest pain, broncho-pulmonary and ENT manifestations, or sleep-related alterations. Reasons to base the definition of GERD on symptoms are the high prevalence of GERD patients in primary and secondary care without overt mucosal damage [nonerosive reflux disease (NERD)], the suboptimal sensitivity and specificity of technical measures, and the close association between impairment in quality of life and symptom load in erosive GERD (eGERD) and NERD. Symptom characteristics (ie, intensity, frequency, and symptom pattern) in GERD patients are of limited value in clinical practice to predict the severity of lesions and are useless to differentiate between subjects suffering from eGERD or NERD. Also, typical symptoms, like heartburn and acid regurgitation, have limited sensitivity and specificity compared with technical measures, like esophageal pH-metry, and the accuracy of diagnosis based on these symptoms is unsatisfactory. Among other reasons, this is due to widespread occurrence of nontypical symptoms in GERD patients, phasic courses of the disease, and overlap of GERD with other entities, like functional dyspepsia and irritable bowel syndrome. Thus, one should consider GERD also if atypical symptoms are present, and outcome criteria in GERD treatment trials should recognize the broad spectrum of symptoms in GERD. This is feasible with the ReQuest, a questionnaire considering typical and atypical symptoms, which has been validated in patients with eGERD and NERD. Probatory proton pump inhibitor treatment can be helpful to identify typical and atypical symptoms related to gastroesophageal acid reflux in selected patients.
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Gastroesophageal reflux disease (GERD) is a common upper gastrointestinal disorder characterized by troublesome symptoms, including heartburn and acid regurgitation. GERD is associated with complications such as peptic stricture, Barrett's esophagus, and esophageal adenocarcinoma, and it negatively affects quality of life (QoL).
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