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Gastroesophageal Reflux Disease I: Meaning and Pathophysiology01:29

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Gastroesophageal Reflux Disease (GERD) involves the recurrent backflow of the stomach or duodenal contents into the esophagus, leading to troublesome symptoms and potential esophageal mucosal damage. Although GERD is often referred to as a disease, it is more accurately described as a syndrome, as it encompasses a range of symptoms and complications rather than a singular pathological entity, impacting a large number of individuals as the most prevalent upper gastrointestinal problem. Roughly...
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Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
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Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
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Related Experiment Video

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Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
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Correlation between reflux burden, peristaltic function, and mucosal integrity in GERD patients.

Mentore Ribolsi1, Chandra Prakash Gyawali2, Edoardo Savarino3

  • 1Unit of Gastroenterology, Campus Bio Medico University, Rome, Italy.

Neurogastroenterology and Motility
|November 1, 2019
PubMed
Summary

Esophageal motility, specifically disrupted esophageal-gastric junction (EGJ) and absent contractility, significantly impacts mean nocturnal baseline impedance (MNBI) values during multichannel intraluminal impedance-pH (MII-pH) monitoring. These findings enhance the diagnostic utility of MII-pH testing.

Keywords:
GERDesophagogastric junctionhigh-resolution manometrymean nocturnal baseline impedancepH-impedance monitoring

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Area of Science:

  • Gastroenterology
  • Esophageal Physiology
  • Diagnostic Monitoring

Background:

  • Mean nocturnal baseline impedance (MNBI) improves multichannel intraluminal impedance-pH (MII-pH) monitoring.
  • The influence of esophageal motility on MNBI remains unclear, despite its correlation with acid exposure time (AET).

Purpose of the Study:

  • To investigate the independent roles of esophageal motor function and AET in determining MNBI values.
  • To identify predictors of pathological MNBI in GERD patients.

Main Methods:

  • Retrospective analysis of high-resolution manometry (HRM) and 24-hour MII-pH monitoring data.
  • Inclusion of endoscopy-negative GERD patients with typical symptoms.
  • Univariate and multivariate analyses to assess predictors of MNBI at 3 cm and 5 cm above the lower esophageal sphincter (LES).

Main Results:

  • Pathological AET, type 3 EGJ, and absent contractility were associated with lower MNBI values.
  • Absent contractility and disrupted EGJ (types 2 and 3) significantly predicted pathological MNBI.
  • Lower MNBI values were observed at 3 cm and 5 cm above the LES in patients with these motility abnormalities.

Conclusions:

  • Esophageal-gastric junction (EGJ) disruption and absent contractility on HRM are linked to reduced MNBI.
  • HRM findings provide complementary information to MII-pH monitoring for GERD diagnosis.