The Effect of Ramelteon on Heartburn Symptoms of Patients With Gastroesophageal Reflux Disease and Chronic Insomnia: A Pilot Study.

Background: There is a bidirectional relationship between gastroesophageal reflux disease (GERD) and sleep. It has been demonstrated that antireflux treatment can improve sleep quality in GERD patients with nighttime reflux.

Materials And Methods: Patients with heartburn and/or regurgitation ≥3 times/week and insomnia for ≥3 months were included.

The effect of antireflux treatment on the frequency of awakenings from sleep in patients with Gastroesophageal reflux disease.

Background: Up to half of gastroesophageal reflux disease (GERD) patients report having heartburn that awakens them from sleep during the night. Recumbent-awake and conscious awakenings from sleep during the night are commonly associated with acid reflux events. The aim of the study was to assess the effect of esomeprazole 40 mg once daily on nighttime acid reflux, frequency of conscious awakenings associated with acid reflux and the recumbent-awake period.

Therapeutic options for refractory gastroesophageal reflux disease.

Refractory gastroesophageal reflux disease may affect up to one-third of the patients that consume proton pump inhibitor (PPI) once daily. Treatment in clinical practice has been primarily focused on doubling the PPI dose, despite lack of evidence of its value. In patients who failed PPI twice daily, medical treatment has been primarily focused on reducing transient lower esophageal sphincter relaxation rate or attenuating esophageal pain perception using visceral analgesics.

Comparison of distribution of intraesophageal pH during nighttime recumbency among patients with gastroesophageal reflux disease.

Background: Nighttime reflux has been demonstrated to be associated with a more aggressive presentation of gastroesophageal reflux disease (GERD). However, it has remained unknown until now if the difference in nighttime reflux between the different GERD groups is related to the distribution of intraesophageal pH level or duration of acid exposure.

Aim: To compare distribution of intraesophageal pH during nighttime between patients with erosive esophagitis (EE) versus those with nonerosive reflux disease (NERD).

Step-by-step management of refractory gastresophageal reflux disease.

Up to a third of the patients who receive proton pump inhibitor (PPI) once daily will demonstrate lack or partial response to treatment. There are various mechanisms that contribute to PPI failure and they include residual acid reflux, weakly acidic and weakly alkaline reflux, esophageal hypersensitivity, and psychological comorbidity, among others. Some of these underlying mechanisms may coincide in the same patient.

Alternative therapeutic approaches to chronic proton pump inhibitor treatment.

Chronic consumption of proton pump inhibitors (PPIs) by patients with gastroesophageal reflux disease is very common, primarily because of their potent and profound effect on acid secretion that results in an unsurpassed rate of symptom resolution and esophageal healing. However, there have been a growing number of reports over the past few years about various side effects caused by chronic PPI treatment. Concerns have been raised by patients and physicians alike about the common practice of prescribing PPIs, often more than once daily, on a long-term basis.

Gastro-oesophageal reflux disease: beyond proton pump inhibitor therapy.

Gastro-oesophageal reflux disease (GORD or GERD) is a very common disorder, and advancement in drug development over the years has markedly improved disease management. Proton pump inhibitors (PPIs) remain the mainstay of treatment for GERD due to their profound and consistent inhibitory effect on acid secretion. However, PPIs do not reduce the number of reflux events and do not provide long-term cure for GERD.

Systematic review: the treatment of noncardiac chest pain.

Background: Treatment of noncardiac chest pain (NCCP) remains a challenge. This is in part due to the heterogeneous nature of this disorder. Several conditions are associated with NCCP including gastro-oesophageal reflux disease (GERD), oesophageal dysmotility, oesophageal hypersensitivity as well as others.

Systematic review: the relationship between interstitial lung diseases and gastro-oesophageal reflux disease.

BACKGROUND  A potential relationship has been suggested between gastro-oesophageal reflux disease (GERD) and interstitial lung diseases (ILDs). AIM  To evaluate whether there is a causal relationship between GERD and different ILDs. METHODS  We conducted a systematic search of literature published between 1980 and 2010.

The lower esophageal sphincter.

The lower esophageal sphincters (LES) together with the crural diaphragm are the major antireflux barriers protecting the esophagus from reflux of gastric content. However, reflux of gastric contents into the esophagus is a normal phenomenon in healthy individuals occurring primarily during episodes of transient lower esophageal sphincter relaxation (TLESR), defined as LES relaxation in the absence of a swallow. Transient lower esophageal sphincter relaxation is also the dominant mechanism of pathologic reflux in gastroesophageal reflux disorder (GERD) patients.

Oesophageal sensation in response to high PCO(2) and acidic solutions in nonerosive reflux disease.

Background: Heartburn is commonly associated with the presence of acid in the oesophageal lumen. However, in patients with nonerosive reflux disease (NERD), the mechanism by which acid traverses the mucosa is not clear. We hypothesized that the luminal acid signal traverses the oesophageal epithelium in the form of the highly permeant gas CO(2) , which then is reconverted to H(+) in the submucosa.

Pharmacological management of GERD: where does it stand now?

Gastroesophageal reflux disease (GERD) is very common and advances in drug development over recent years have markedly improved GERD management. A wide range of medications are currently used in GERD treatment, including antacids, Gaviscon, sucralfate, histamine-2 receptor antagonists and prokinetics. However, proton pump inhibitors (PPIs) remain the mainstay of treatment for GERD owing to their profound and consistent inhibitory effect on acid secretion.

The effect of antireflux treatment on patients with gastroesophageal reflux disease undergoing a mental arithmetic stressor.

Background: Acute stress exacerbates heartburn in gastroesophageal reflux disease (GERD) patients by enhancing the perceptual responses to intraesophageal acid. The aim of the study was to determine if antireflux treatment can still alter stimulus response functions to acid in patients undergoing acute stress as compared with placebo.

Methods: Symptomatic GERD patients with erosive esophagitis (EE) or an abnormal pH test were included.

Night-time intra-oesophageal bile and acid: a comparison between gastro-oesophageal reflux disease patients who failed and those who were treated successfully with a proton pump inhibitor.

Background: Little is known about the contribution of bile and acid reflux to night-time symptoms generation in patients who failed PPI treatment.

Aim: To compare the degree of night-time oesophageal acid and bile [by the surrogate duodenogastroesophageal reflux (DGER)] exposure between gastro-oesophageal reflux disease (GERD) patients who failed and those who fully responded to PPI once a day while on treatment.

Methods: Gastro-oesophageal reflux disease patients were assigned to the PPI failure group if they continued to report symptoms ≥3/week and to the PPI success group if they were asymptomatic for the last 3 months while on PPI once a day.

Increased oesophageal acid exposure at the beginning of the recumbent period is primarily a recumbent-awake phenomenon.

Background: A significant increase in oesophageal acid exposure during early recumbent period has been demonstrated.

Aim: To determine if acid reflux during the early recumbent period occurs in the recumbent-asleep or recumbent-awake period using a novel integrative actigraphy and pH programme.

Method: Thirty-nine subjects with heartburn at least three times a week were included.

Review: treatment of gastroesophageal reflux disease in the elderly.

The prevalence of gastroesophageal reflux disease (GERD) increases with age; older patients are more likely to develop severe disease. Common symptoms of GERD in the elderly include dysphagia, vomiting, and respiratory problems. Older patients are more likely to require aggressive therapy, and usually their management is compounded by the presence of comorbidities and consumption of various medications.

Nonerosive Reflux Disease (NERD) - An Update.

Recognizing nonerosive reflux disease (NERD) as a distinct presentation of gastroesophageal reflux disease (GERD) was one of the most important developments in the field of GERD in the last decade. Whilst the definition of NERD has not changed significantly over the years, the disorder accounts for the majority of the GERD patients and those who failed proton pump inhibitor (PPI) treatment. Recent developments in NERD focused primarily on understanding the pathophysiology and natural history.

Systematic review: the effects of carbonated beverages on gastro-oesophageal reflux disease.

Background: Carbonated beverages have unique properties that may potentially exacerbate gastro-oesophageal reflux disease (GERD), such as high acidity and carbonation. Cessation of carbonated beverage consumption is commonly recommended as part of lifestyle modifications for patients with GERD.

Aims: To evaluate the relationship of carbonated beverages with oesophageal pH, oesophageal motility, oesophageal damage, GERD symptoms and GERD complications.

The effect of esomeprazole 20 mg twice daily on acoustic and perception parameters of the voice in laryngopharyngeal reflux.

Background: Randomized, placebo-controlled studies have failed to demonstrate a significant treatment effect for laryngopharyngeal reflux (LPR) using traditional clinical endpoints. We compared the effect of esomeprazole 20 mg twice daily (b.i.

Management of heartburn not responding to proton pump inhibitors.

Patients with gastro-oesophageal reflux disease (GORD) who are not responding to proton pump inhibitors (PPIs) given once daily are very common. Various underlying mechanisms have been shown to contribute to the failure of PPI treatment. These include weakly acidic reflux, duodenogastro-oesophageal reflux, residual acid reflux and functional heartburn, as well as others.

Clinical trial: the effect of Johrei on symptoms of patients with functional chest pain.

Background: Patients with functional chest pain (FCP) represent a therapeutic challenge for practising physicians.

Aim: To determine the efficacy of Johrei as compared to wait-list in improving symptoms of FCP patients.

Methods: Patients with chest pain of noncardiac origin for at least 3 months were enrolled into the study.

Comparison of the different characteristics of sensed reflux events among different heartburn groups.

Background And Aim: Presently, there are no studies comparing sensed acid reflux event (SARE) characteristics among different heartburn groups. Our aim was to compare the different esophageal acid reflux characteristics of an SARE among the different heartburn groups.

Methods: Patients with heartburn underwent endoscopy and pH testing and were stratified into 3 groups: erosive esophagitis (EE), nonerosive reflux disease (NERD), and functional heartburn (FH).

The proton pump inhibitor (PPI) test in GERD: does it still have a role?

The proton pump inhibitor (PPI) test is a short course of high-dose PPI, used to diagnose gastroesophageal reflux disease (GERD). This diagnostic strategy is commonly used globally, primarily because of its availability, simplicity, and high sensitivity. The PPI test has been proven to be a sensitive tool for diagnosing GERD in noncardiac chest pain patients and in preliminary trials in extraesophageal manifestations of GERD.