Background: pH monitoring 24h is used to diagnose atypical gastroesophageal reflux disease or can be applied to consider surgery for cases poorly respond with medical treatment. Objective: To study clinical signs, gastroscopic and oesophageal histopathologic features, pH monitoring 24h in the patients with gastroesophageal reflux disease (GERD). Subjects and method: The descriptive, cross-sectional study was conducted in patients with gastroesophageal reflux disease treated at Bach Mai Hospital from November 2005 to October 2006. 73 patients with GERD diagnosed according to Romell criteria were underwent gastroscopy and biopsy. 15 patients having extraesophageal manifestations of gastroesophageal reflux disease were underwent gastroesophageal reflux monitoring pH. Results: 31 (42.4%) patients had oesophagitis in which 67.7% grade A, 6.5% grade D and C, 2.7% Barret, and 53.4% having gastritis associated. 61 % oesophagitis and 13.9% Barret were seen on the biopsy. 40% (6/15) patients had abnormal pH monitoring but there was no statistically significant difference in pH monitoring between the group having oesophagitis from those without oesophagitis (p > 0.05). Conclusions: Among 15 patients underwent Ph monitoring, the rate of patients with abnormal pH monitoring was 40%. There was no statistically significant difference of pH monitoring result between patients with or without esophagus lesion.
Gastroesophageal Reflux/pathology ; etiology

Gastroesophageal reflux disease (GERD) is defined as a condition which develops when the reflux of gastric contents causes troublesome symptoms and long-term complications. GERD can be divided into erosive reflux disease and non-erosive reflux disease based on endoscopic findings defined by the presence of mucosal break. The Los Angeles classification excludes minimal changes as an evidence of reflux esophagitis because of poor interobserver agreement. In the Asian literature, minimal changes are considered as one of the endoscopic findings of reflux esophagitis, but the clinical significance is still controversial. Minimal change esophagitis is recognized quite frequently among patients with GERD and many endoscopists recognize such findings in their clinical practice. This review is intended to clarify the definition of minimal change esophagitis and their histology, interobserver agreement, and symptom association with GERD.
Esophagitis/pathology ; Esophagoscopy ; Gastroesophageal Reflux/classification/*diagnosis ; Humans ; Mucous Membrane/pathology

OBJECTIVETo compare the difference of mucosal damage in the remnant esophagus with similar postoperative reflux after esophagectomy and gastric interposition between Chinese and Canadian population.

METHODSA prospective 1 to 1 paired study based on the same surgical approach was performed in Medical Centre of University of Montreal and West China Hospital of Sichuan University during the period from September 2010 to October 2013. The patients were followed up and evaluated by reflux symptom scoring, endoscopic assessment of mucosal damage, pathologic examination of biopsies and proliferation index test of esophageal epithelium.

RESULTSEighteen Han Chinese and 18 Caucasian Canadian patients with esophagectomy and gastric interposition were included in this study, with a follow-up period of 45 (28-67) months. There were no significant differences between the two groups in the incidence of postoperative reflux symptom, reflux symptom scoring, histological reflux esophagitis, erosion or stricture of remnant esophagus (all P>0.05). However, the incidence of mucosal metaplasia [44.4% (8/18) versus 11.1% (2/18), P=0.026], quantitative MUSE scoring [1.5 (1.0-2.0) versus 1.0 (0-2.0), P=0.042] and proliferation index [0.40 (0.30-0.45) versus 0.35 (0.30-0.50), P=0.038] of esophageal epithelium were significantly higher in Canadian patients than those in Chinese patients.

CONCLUSIONUnder similar reflux situation, esophageal mucosa of Canadian population is more sensitive to the gastroesophageal reflux damage compared with Chinese population, resulting in more severe reflux damage of remnant esophagus in Canadian patients.

Biopsy ; Canada ; China ; Esophagectomy ; adverse effects ; Gastroesophageal Reflux ; pathology ; Humans ; Metaplasia ; Mucous Membrane ; pathology ; Prospective Studies

Adenoid hypertrophy is a disease that mostly occurs among children of 3-5 years old. It is caused by repeated inflammation and infection of nasopharynx and its adjoin parts, or the adenoid itself, which will finally leads to pathological hyperplasia of adenoid. With so much information we have acquired about this disease, its specific mechanism remains unknown. In recent years, some researches have indicated that adenoid hypertrophy may have something to do with extra-gastroesophageal reflux, in which pepsin plays a very important role, and pepsin will do a series of pathological damages to the upper airway as it reaches the upper respiratory tract. Based on relative domestic and foreign literature, this paper attempts to make a review about the relationship between gastroesophageal reflux and adenoid hypertrophy.
Adenoids ; pathology ; Child ; Gastroesophageal Reflux ; complications ; Humans ; Hypertrophy ; complications ; Nasopharynx ; pathology ; Pepsin A ; metabolism

Barrett Esophagus ; diagnosis ; pathology ; Biopsy ; Consensus ; Epithelial Cells ; pathology ; Esophagitis ; pathology ; Esophagitis, Peptic ; pathology ; Esophagoscopy ; Gastroesophageal Reflux ; diagnosis ; pathology ; Humans

The electrophysiological activity of the gastrointestinal tract and the mechanical anti-reflux structure of the gastroesophageal junction are the basis of the anti-reflux function of the stomach. Proximal gastrectomy destroys the mechanical structure and normal electrophysiological channels of the anti-reflux. Therefore, the residual gastric function is disordered. Moreover, gastroesophageal reflux is one of the most serious complications. The emergence of various types of anti-reflux surgery through the mechanism of reconstructing mechanical anti-reflux barrier and establishing buffer zone, and the preservation of, the pacing area and vagus nerve of the stomach, the continuity of the jejunal bowel, the original gastroenteric electrophysiological activity of the gastrointestinal tract, and the physiological function of the pyloric sphincter, are all important measures for gastric conservative operations. There are many types of reconstructive approaches after proximal gastrectomy. The design based on the anti-reflux mechanism and the functional reconstruction of mechanical barrier, and the protection of gastrointestinal electrophysiological activities are important considerations for the selected of reconstructive approaches after proximal gastrectomy. In clinical practice, we should consider the principle of individualization and the safety of radical resection of tumor to select a rational reconstructive approaches after proximal gastrectomy.
Humans ; Stomach Neoplasms/surgery* ; Gastrectomy ; Gastroesophageal Reflux ; Esophagogastric Junction/surgery* ; Pylorus/pathology*

BACKGROUND/AIMS: Interobserver variation by experience was documented for the diagnosis of esophagitis using the Los Angeles classification. The aim of this study was to evaluate whether interobserver agreement can be improved by higher levels of endoscopic experience in the diagnosis of erosive esophagitis. METHODS: Endoscopic images of 51 patients with gastroesophageal reflux disease (GERD) symptoms were obtained with conventional endoscopy and optimal band imaging (OBI). Endoscopists were divided into an expert group (16 gastroenterologic endoscopic specialists guaranteed by the Korean Society of Gastrointestinal Endoscopy) and a trainee group (individuals with fellowships, first year of specialty training in gastroenterology). All endoscopists had no or minimal experience with OBI. GERD was diagnosed using the Los Angeles classification with or without OBI. RESULTS: The mean weighted paired kappa statistics for interobserver agreement in grading erosive esophagitis by conventional endoscopy in the expert group was better than that in the trainee group (0.51 vs 0.42, p<0.05). The mean weighted paired k statistics in the expert group and in the trainee group based on conventional endoscopy with OBI did not differ (0.42, 0.42). CONCLUSIONS: Interobserver agreement in the expert group using conventional endoscopy was better than that in the trainee group. Endoscopic experience can improve the interobserver agreement in the grading of esophagitis using the Los Angeles classification.
Clinical Competence/*standards ; Esophagitis/classification/*pathology ; Esophagoscopy/*standards ; Gastroenterology/*standards ; Gastroesophageal Reflux/classification/pathology ; Humans ; Observer Variation ; Retrospective Studies

Cough remains the most common reason for patients to seek medical attention. Although the exact prevalence is difficult to estimate, recurrent cough is reported in up to 40% of the population. For the investigation and treatment of chronic cough, it is important to understand its etiology, particularly when the underlying pathology exists outside the respiratory tract. Although there is no consensus as to the best diagnostic strategy for chronic cough, many protocols combine laboratory investigations with empirical trials of treatment. Specific treatment for the underlying disease of cough along with etiologic diagnosis should be emphasized rather than nonspecific antitussive therapy because nonspecific pharmacologic treatments have changed little during the last 50 years, without any significant advances from opiatebased compounds. Recently, molecular structures of cough receptors and mediators have been identified. Vanilloid receptor-1 is one of ion channel receptors expressed on the sensory neurons of cough reflex. Substances inhibiting ion channels and receptor antagonists of tachy-or bradykinins are being investigated. Thus safer and more effective agents to deal with this common problem are believed to be available in the near future.
Bradykinin ; Consensus ; Cough* ; Diagnosis* ; Gastroesophageal Reflux ; Humans ; Ion Channels ; Molecular Structure ; Pathology ; Prevalence ; Reflex ; Respiratory System ; Sensory Receptor Cells

BACKGROUNDSymptoms, endoscopy, and pH monitoring form the basis of diagnosis of gastroesophageal reflux disease (GERD). Their relationship was meaningful for primary care physicians, but still unclear. Our research aimed to compare questionnaire, endoscopy, and pH monitoring and to analyze their correlations.

METHODSThree hundred patients who underwent the Reflux Disease Questionnaire (RDQ), endoscopy, and esophageal 24-hour pH monitoring from March 2007 to December 2010 in Peking University People's Hospital were enrolled. We analyzed the characteristics of different investigations and their relationships.

RESULTSMale (OR for mild reflux esophagitis (RE) = 2.433, severe RE = 8.386), body mass index (BMI) (OR for mild RE = 1.222, severe RE = 1.297), and hernia (OR for mild RE = 6.059, severe RE = 17.547), were found to be the risk factors for RE; age (OR = 1.074) was correlated with severe RE. The consistency of questionnaire, endoscopy, and pH monitoring was poor: RDQ did not agree well with pH monitoring (κ = 0.061), nor with endoscopy (κ = 0.044); pH monitoring did not agree well with endoscopy (κ = 0.316). However, the severity of mucosa injury in RE was associated with pathological acid exposure (PAE): reflux episodes of >5 minutes (P = 0.035), the percentage time pH <4 (P = 0.017), and the DeMeester score (P = 0.016) increased significantly in patients with severe RE. Chest pain had poor relationship with RE or PAE.

CONCLUSIONSMale, age, BMI, and hernia were probably risk factors for esophagitis. RDQ, endoscopy, and pH monitoring have their own focus and reinforce each other in diagnosis. Of the GERD symptoms, chest pain had negative correlation with RE or PAE.

Adult ; Aged ; Body Mass Index ; Esophageal pH Monitoring ; Esophagitis ; etiology ; pathology ; physiopathology ; Female ; Gastroesophageal Reflux ; complications ; pathology ; physiopathology ; Hernia ; complications ; pathology ; physiopathology ; Humans ; Male ; Middle Aged ; Risk Factors

BACKGROUND/AIMS: Important lesions related to gastroesophageal reflux disease (GERD) are located around the gastroesophageal junction (GEJ). This study examined the distribution of endoscopic findings around the GEJ and elucidated their relationship to each other and esophageal manometric features. METHODS: Endoscopic data were collected prospectively from 2,450 consecutive diagnostic upper gastrointestinal endoscopies. The presence and degree of hiatal hernia (HH), columnar-lined esophagus (CLE), and reflux esophagitis (RE) were recorded. Esophageal manometric data were collected from 181 patients. RESULTS: The prevalence of HH, CLE, and RE was 9.8, 18.8, and 9.9%, respectively. Of all HH and CLE cases, 62.8 and 98.9%, respectively, were of the short-segment variety. Of all RE cases, 95.0% were mild. Younger age, male gender, the presence of HH, and a higher gastroesophageal flap valve (GEFV) grades were associated with the presence of RE. Increased ZAP grades were associated with increased prevalence and grades of HH, CLE, and RE. Higher GEFV grades were associated with increased prevalence and grades of HH, CLE, and RE. Lower esophageal sphincter pressure (LESP) decreased in patients with HH or RE compared to those without HH or RE. CONCLUSIONS: Endoscopic findings around the GEJ revealed that a substantial proportion of our patients showed features potentially related to GERD. In combination with other recent reports, our study implies that Korea is no longer a very-low-prevalence area of GERD, although it may predominate in silent or milder forms.
*Endoscopy, Gastrointestinal ; Esophageal Sphincter, Lower ; Esophagogastric Junction/*pathology ; Female ; Gastroesophageal Reflux/epidemiology/*pathology ; Hernia, Hiatal ; Humans ; Korea/epidemiology ; Male ; Manometry/instrumentation ; Middle Aged ; Prevalence ; Prospective Studies