Most Patients With Gastroesophageal Reflux Disease Who Failed Proton Pump Inhibitor Therapy Also Have Functional Esophageal Disorders.
Aged; Humans; Male; Adult; Female; Prospective Studies; Middle Aged; Treatment Failure; Prognosis; Quality of Life; Follow-Up Studies; Proton Pump Inhibitors/therapeutic use; Esophagus; Esophageal pH Monitoring; Gastroesophageal Reflux; Heartburn; Impedance Test; Proton Pump Inhibitor; Regurgitation; Electric Impedance; Endoscopy Digestive System; Esophagus/diagnostic imaging/physiopathology; Gastroesophageal Reflux/diagnosis/drug therapy/physiopathology
BACKGROUND & AIMS: As many as 45% of patients with gastroesophageal reflux disease (GERD) still have symptoms after receiving once-daily proton pump inhibitor (PPI) therapy. We aimed to compare reflux characteristics and patterns between responders and non-responders to once-daily PPI therapy using combined impedance-pH monitoring. METHODS: Patients who reported heartburn and/or regurgitation at least twice per week for 3 months while receiving standard-dose PPI therapy were assigned to the PPI failure group (n = 16). Patients who reported a complete resolution of symptoms on once-daily PPIs for at least 4 weeks were assigned to the PPI success group (n = 13). We collected demographic data and subjects completed the short-form 36 and the GERD health-related quality of life questionnaires. Patients then underwent upper endoscopy and combined esophageal impedance-pH monitoring while on PPI therapy. RESULTS: Four patients in the PPI success group (31%) and 4 patients in the PPI failure group (25%) had abnormal results from the pH test (P = 1.00). Most of the patients in the PPI failure group (75%) were found to have either functional heartburn or reflux hypersensitivity with GERD. Impedance and pH parameters did not differ significantly between the PPI failure and success group. CONCLUSIONS: We found no difference in reflux characteristics between patients with GERD who had successful vs failed once-daily PPI therapy. Most patients in the PPI failure group (75%) had functional esophageal disorders.
Abdallah J; George N; Yamasaki T; Ganocy S; Fass R
Clinical Gastroenterology and Hepatology
2019
2019-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.cgh.2018.06.018" target="_blank" rel="noreferrer noopener">10.1016/j.cgh.2018.06.018</a>
The Physiologic Impact of Unilateral Recurrent Laryngeal Nerve (RLN) Lesion on Infant Oropharyngeal and Esophageal Performance.
Animal; Animals; Aspiration; Biological; Deglutition; Deglutition – Physiology; Deglutition disorders; Deglutition Disorders – Etiology; Deglutition Disorders – Physiopathology; Deglutition Disorders/*etiology/physiopathology; Deglutition/*physiology; Disease Models; Esophagus; Esophagus – Physiopathology; Esophagus/*physiopathology; Human; Infant; Laryngeal Nerves – Injuries; Laryngeal Nerves – Physiopathology; Models; Oropharynx – Physiopathology; Oropharynx/*physiopathology; Recurrent laryngeal nerve; Recurrent Laryngeal Nerve Injuries/*complications/physiopathology; Recurrent Laryngeal Nerve/*physiopathology; Swine
Recurrent laryngeal nerve (RLN) injury in neonates, a complication of patent ductus arteriosus corrective surgery, leads to aspiration and swallowing complications. Severity of symptoms and prognosis for recovery are variable. We transected the RLN unilaterally in an infant mammalian animal model to characterize the degree and variability of dysphagia in a controlled experimental setting. We tested the hypotheses that (1) both airway protection and esophageal function would be compromised by lesion, (2) given our design, variability between multiple post-lesion trials would be minimal, and (3) variability among individuals would be minimal. Individuals' swallowing performance was assessed pre- and post-lesion using high speed VFSS. Aspiration was assessed using the Infant Mammalian Penetration-Aspiration Scale (IMPAS). Esophageal function was assessed using two measures devised for this study. Our results indicate that RLN lesion leads to increased frequency of aspiration, and increased esophageal dysfunction, with significant variation in these basic patterns at all levels. On average, aspiration worsened with time post-lesion. Within a single feeding sequence, the distribution of unsafe swallows varied. Individuals changed post-lesion either by increasing average IMPAS score, or by increasing variation in IMPAS score. Unilateral RLN transection resulted in dysphagia with both compromised airway protection and esophageal function. Despite consistent, experimentally controlled injury, significant variation in response to lesion remained. Aspiration following RLN lesion was due to more than unilateral vocal fold paralysis. We suggest that neurological variation underlies this pattern.
Gould Francois D H; Lammers Andrew R; Ohlemacher Jocelyn; Ballester Ashley; Fraley Luke; Gross Andrew; German Rebecca Z
Dysphagia
2015
2015-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s00455-015-9648-8" target="_blank" rel="noreferrer noopener">10.1007/s00455-015-9648-8</a>