Barrett’s esophagus (BE) is currently recognized as a precancerous lesion of esophageal adenocarcinoma. Gender, age, obesity, smoking and some other factors are closely related to BE, but the exact pathogenesis is still unclear. Gastrointestinal microecology is of great significance to the human body. It is closely related to human immunity, tumor, chronic inflammation, nutrient absorption, material metabolism. It may be closely related to the occurrence and development of BE. This article reviews the research progress of the relationship between BE and gastrointestinal microecology, aiming to provide a basis for further clarifying the pathogenesis of BE and targeting intervention in BE.
ObjectiveTo explore and analyze the clinical diagnosis and treatment of gastroesophageal reflux disease (GERD) which is manifested mainly as stubborn pharyngitis. MethodsFrom February 2010 to December 2012, 79 cases were diagnosed as stubborn pharyngitis and otolaryngology standard treatment was invalid. GERD questionnaire ratings and conventional endoscopy were performed for patients with obvious manifestations of stubborn pharyngitis shown on the laryngoscopy. They were randomly divided into treatment group (n=40) and control group (n=39). Patients in the treatment group accepted esomeprazole 40 mg, qd, for 12 weeks; and patients in the control group had sucralfate suspension 15 mL bid for 12 weeks. At the three observation points which are 4, 8, and 12 weeks after treatment began, clinical symptom score and pharyngeal inflammatory changes were recorded, and at the end of the treatment, all patients underwent endoscopy, and esophageal mucosal healing was observed. ResultsThere was no significant difference between the two groups of patients in terms of general data. After the treatment, the symptom scores were significantly decreased in the treatment group at the three observation points (P<0.05). The same situation happened also in the control group, but the difference was not significant (P>0.05). The symptom scores between the two groups after treatment were significantly different (P<0.5). And the effective rate for local pharyngeal infection was 83.9% and 41.4% in the treatment group and the control group respectively (P<0.05). ConclusionSome atypical GERDs feature by the symptoms of stubborn pharyngitis. Clinically, patients with long-term stubborn pharyngitis should be screened to exclude the possibility of GERD. esomeprazole therapy can significantly improve the pharyngitis symptoms and relieve local inflammation.
Non-erosive gastroesophageal reflux disease (NERD) refers to a disease with symptoms such as acid reflux, heartburn and pathological reflux, but no significant esophageal mucosal damage under endoscopy. Its pathogenesis may be related to factors such as lower esophageal sphincter dysfunction, weakened esophageal clearance ability, visceral hypersensitivity, and disordered intestinal microecology, but the specific mechanism is still unclear. Small intestinal bacterial overgrowth (SIBO) is a common intestinal flora disorder syndrome. A number of studies have shown that SIBO has a certain correlation with NERD, and SIBO may be involved in the occurrence and development of NERD through mechanisms such as inflammatory response, gas production, and increased short-chain fatty acids. Therefore, this article reviews the correlation between NERD and SIBO, aiming to provide new ideas for the diagnosis and treatment of NERD.
【摘要】目的 探討胃食反流管病(GERD)患者牙周疾病的發生情況,以及GERD與牙周炎之間的關系。方法2008年7月2009年6月對360例GERD患者,396名正常人進行牙周健康狀況和全身一般情況檢查,牙周檢查以社區牙周指數(CPI)和附著喪失(AL)作為診斷標準。結果GERD患者牙周炎患病率及嚴重程度、牙列缺損率及缺牙數目均高于正常人, GERD患者無牙頜比例高于正常人。結論長期患GERD可能是牙周病的危險因素。
ObjectiveTo analyze the causal relationship between the intake of cheese or tea and the risk of gastroesophageal reflux disease (GERD). MethodsUsing a two-sample Mendelian randomization approach, single nucleotide polymorphisms (SNPs) associated with milk or tea intake were used as instrumental variables. The causal effect of milk or tea intake on the risk of GERD was investigated using the MR Egger method, the weighted median method, the inverse-variance weighted (IVW) random-effects model, and the IVW fixed-effects model. Multivariable analysis was conducted using the MR Egger method, and leave-one-out sensitivity analysis was performed to validate the reliability of the data. ResultsCheese intake could reduce the occurrence of GERD [IVW random-effects model β=–1.010, 95%CI (0.265, 0.502), P<0.05], while tea intake could lead to the occurrence of GERD [IVW random-effects model β=0.288, 95%CI (1.062, 1.673), P<0.05]. ConclusionCheese intake may have a positive causal relationship with reducing the risk of GERD occurrence, while tea intake may have a positive causal relationship with increasing the risk of GERD occurrence.
Non-erosive gastroesophageal reflux disease (NERD) refers to a disease that has typical gastroesophageal reflux symptoms but lacks endoscopic esophageal mucosal damage. Its exact pathogenesis remains unclear. Studies have shown that the occurrence and development of NERD may be related to the gastrointestinal flora. The digestive tract flora can directly or indirectly participate in the occurrence and development of NERD by affecting the body’s immune, metabolic, neurological and other functions. In order to further clarify the possible correlation between NERD and gastrointestinal flora, this article reviews the research progress on the correlation between NERD and gastrointestinal flora, with a view to providing new ideas for the diagnosis and treatment of NERD.
ObjectiveTo summarize the mechanism of effects of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) and the research progress of LSG in combination with fundoplication on obesity with GERD. MethodThe literatures of studies relevant to relation between LSG and GERD and effect of LSG combined with fundoplication on obesity accompanying GERD at home and abroad were searched and reviewed. ResultsAlthough there was considerable disagreement over the effect of LSG on GERD, the evidence showed that the LSG alone might worsen the existing GERD or promote new GERD, which mainly due to the destruction of the lower esophageal sphincter, deactivation of His angle, elevated intragastric pressure, and shape of sleeve stomach. Currently, the LSG in combination with fundoplication had been gradually applied in the clinical treatment of obese patients with GERD. And the short-term results of follow-up showed that the effects of weight loss and anti-reflux could be obtained, which needed to be evaluated by more studies and longer follow-up. ConclusionsThere is a risk of worsening existing GERD or promoting new GERD after LSG surgery. The LSG in combination with fundoplication is safe and feasible, which not only makes up for the adverse effects of LSG only on GERD after surgery, but also achieves the same similar effect of weight loss as LSG, providing a new choice for obese patients with GERD.
ObjectiveTo investigate the individualized management of severe gastroesophageal reflux disease (GERD) secondary to scleroderma, particularly the safety and feasibility of laparoscopic Toupet fundoplication for this entity. MethodsFrom June, 2011 to June, 2014 six inpatient cases had severe GERD secondary to scleroderma were documented. Endoscopy, esophageal high-resolution manometry and 24 hours reflux monitoring were applied for GERD evaluation. Maintenance of conservative treatment was carried out for the 2 cases who responsed well to medication therapy, laparoscopic Toupet fundoplication was done for the 4 cases who had extraesophageal symptom and not well controlled by medication. The patients were followed-up for an average of 2.2 years (1 to 4 years) after discharge, and endoscopic was rechecked during the followed-up. ResultsThe esophageal symptom of regurgitation, heartburn and dysphagia, as well as the extraesophageal symptom of cough and asthma significantly relieved during followed-up, meanwhile the anti-reflux medication was reduced or stopped in all the patients. For the 4 surgical patient, one had partial recurrence and no complication occurred. ConclusionsThe management of severe GERD secondary to scleroderma could follow the strategy of controlling the primary disease, living adjustment, anti-reflux medication and surgery step by step. The laparoscopic Toupet fundoplication may be safe, effective and feasible for the medication unmet patients, it deserves further studies.
ObjectiveTo investigate the short-term effects of Da Vinci robot-assisted Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease (rGERD), and to evaluate the safety and efficacy of its surgical treatment.MethodsA total of 40 patients with rGERD treated by Da Vinci robot-assisted surgery from October 2016 to November 2019 in our hospital were collected. There were 23 males and 17 females at age of 34-76 (61±23) years. The related clinical data were retrospectively analyzed, and the operation skills of Da Vinci robot-assisted Nissen fundoplication with rGERD were summarized.ResultsThere was no perioperative death or serious complication such as esophagogastric fistula. Postoperative reflux symptoms were significantly improved. DeMeester scores after surgery (39.79±35.01 points vs. 2.61±2.40 points, P=0.029), lower esophageal sphincter pressure (8.74±7.21 mm Hg vs. 24.56±8.76 mm Hg, P=0.020), integrated relaxation pressure (7.29±7.21 mm Hg vs. 16.49±9.99 mm Hg, P=0.023), distal contractile integral (600.49 ± 665.30 mm Hg·s·m vs. 510.99 ± 580.60 mm Hg·s·m, P=0.042), GERD-Q scale score (12.98±2.39 points vs. 7.59±1.11 points, P=0.033) were significantly improved compared with those before surgery. Postoperative dysphagia was found in 2 patients. And dysphagia was alleviated after diet adjustment and other treatments.ConclusionDa Vinci robot-assisted Nissen fundoplication is a safe and effective treatment for rGERD.
Objective We aimed to evaluate the prevalence of H.pylori infection and the prevalence of cagA+ strains in patients with and without Barrett’s esophagus. Methods A full literature search to February 2008 was conducted in PubMed, MEDLINE and EMbase databases to identify case-control studies or cohort studies evaluating the prevalence of H.pylori in patients with or without Barrett’s esophagus. Summary odds ratios (OR) and 95% confidence interval (CI) were calculated by RevMan 4.2.8. Results Nineteen studies were identified (16 case-controlled studies and 3 cohort studies). In case controlled studies, the prevalence of H.pylori infection significantly decreased in patients with Barrett’s esophagus as compared subjects with normal endoscopic appearance, with a overall OR of 0.56 (95%CI 0.40 to 0.79). The prevalence of H.pylori infection was no statistically significant difference in patients with Barrett’s esophagus as compared to those with gastroesophageal reflux disease, with a overall OR of 0.86 (95% CI 0.74 to 1.00). In cohort studies, the prevalence of H. pylori was no statistically significant difference in patients with Barrett’s esophagus as compared to patients with normal endoscopic appearance or patients with gastroesophageal reflux disease, with a overall OR of 1.12 (95%CI 0.77 to 1.61) and 1.10 (95%CI 0.32 to 3.83). When the analysis was stratified by the status of cagA, the prevalence of cagA positive strains significantly decreased in patients with Barrett’s esophagus as compared both to subjects with normal endoscopic appearance with OR 0.30 and 95% CI 0.12 to 0.74, and to those with gastroesophageal reflux disease (OR 0.55; 95%CI 0.33 to 0.94). Irrespective of the presence of intestinal metaplasia, similar magnitude for the reduction of H.pylori infection was observed for patients with Barrett’s esophagus and those with normal endoscopic appearance. While accompared with the presence of intestinal metaplasia, Barrett’s esophagus was associated with a significantly reduction as compared to the patients with gastroesophageal reflux disease (OR 0.81, 95%CI 0.68 to 0.98). When stratified analyses were performed, a significant reduction of H.pylori infection was observed only in patients with long-segment Barrett’s esophagus (OR 0.54; 95%CI 0.35 to 0.82), but not in those with short-segment Barrett’s esophagus (OR 0.72; 95%CI 0.43 to 1.20). Conclusion This meta-analysis indicated that the prevalence of H.pylori infection, especially the prevalence of cagA positive strains was significantly lower in patients with Barrett’s esophagus than in subjects with normal endoscopic appearance. However, the prevalence of H. pylori infection was no statistical difference in patients with Barrett’s esophagus as compared to those with gastroesophageal reflux disease. Colonization with cagA positive strains may be protective against the formation of Barrett’s esophagus.