Asymptomatic Barrett’s Oesophagus-Complicated Gastroesophageal Reflux Disease at Ineffective Antisecretory Therapy

Aim. A clinical description of gastroesophageal reflux disease (GERD) complicated by Barrett’s oesophagus (BO) at inadequate antisecretory therapy and the assessment of functional tests in control of conservative treatment.Key points. A 63-yo patient with no complaints in a proton pump inhibitor (PPI) therapy was admitted for a follow-up examination for BO-complicated GERD using oesophagogastroduodenoscopy (OGDS) with biopsy, high-resolution oesophageal manometry and 24-h pH-impedance. Endoscopy revealed signs of BO (long segment C1M3), erosive reflux oesophagitis (grade B in Los Angeles classification). Non-contractile oesophagus in manometry. Antisecretory therapy was stated ineffective and subject to correction in 24-h pH-impedance.Conclusion. Asymptomatic BO-complicated GERD patients comprise a special cohort. The main challenge to prevent progression into oesophageal adenocarcinoma is an adequate personalised patient management leveraging the modern diagnostic techniques, control of antisecretory treatment and its correction a situ.

Semi-embedded valve anastomosis a new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction

Background There is a high probability of gastroesophageal reflux after laparoscopic proximal gastrectomy for adenocarcinoma of the oesophagogastric junction (AEG). Various anti-reflux anastomotic methods are emerging in clinical practice; however, none of them have been widely accepted. We have innovated a new type of anti-reflux anastomotic method, named semi-embedded valve anastomosis. The aim of this study was to explore the feasibility and anti-reflux effect of the new anastomotic method. Methods The clinical data of 28 patients with Siewert II AEG who were treated by semi-embedded valve anastomosis were collected. The key point of the operation is to reconstruct a simulated valve and form an anti-reflux barrier similar to the physiological mechanism. The gastroesophageal reflux disease questionnaire (GerdQ) and classification of gastroesophageal reflux under electron microscopy were used to evaluate gastroesophageal reflux after the operation. Results The mean operative duration was 164.3 ± 19.0 min, the median intraoperative haemorrhage volume was 65 ml, the average number of lymph nodes dissected was 23 ± 2.6, the time for valve construction was 15.8 ± 3.2 min, the time for anastomotic reconstruction was 35.4 ± 4.8 min, the median time to first flatus was 3 d, and the median hospitalization duration was 12 d. There was one case of postoperative anastomotic stenosis. The GerdQ score [median (range)] was as follows: 2 (0–6), preoperation; 0 (0–8), 1 month postoperation; 2 (0–12), 3 months postoperation; and 3 (0–12), 6 months postoperation. The Wilcoxon signed-rank sum test was carried out at different times after the operation and the day before the operation, and the differences were not significant. There was one case of grade B gastroesophageal reflux according to the Los Angeles classification system among the gastrofibroscopic re-examination reports of 28 cases. Conclusion Semi-embedded valve anastomosis is safe and feasible after proximal gastrectomy for Siewert II AEG and has good anti-reflux effects.

Semi-embedded Valve Anastomosis: A new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction

Background: There is a high probability of gastroesophageal reflux after laparoscopic proximal gastrectomy for adenocarcinoma of the oesophagogastric junction (AEG). Various anti-reflux anastomotic methods are emerging in clinical practice; however, none of them have been widely accepted. We have innovated a new type of anti-reflux anastomotic method, named semi-embedded valve anastomosis. The aim of this study was to explore the feasibility and anti-reflux effect of the new anastomotic method.Methods: The clinical data of 28 patients with Siewert II AEG who were treated by semi-embedded valve anastomosis were collected. The key point of the operation is to reconstruct a simulated valve and form an anti-reflux barrier similar to the physiological mechanism. The gastroesophageal reflux disease questionnaire (GerdQ) and classification of gastroesophageal reflux under electron microscopy were used to evaluate gastroesophageal reflux after the operation.Results: The mean operative duration was 164.3±19.0 min, the median intraoperative haemorrhage volume was 65 ml, the average number of lymph nodes dissected was 23±2.6, the time for valve construction was 15.8±3.2 min, the time for anastomotic reconstruction was 35.4±4.8 min, the median time to first flatus was 3 d, and the median hospitalization duration was 12 d. There was one case of postoperative anastomotic stenosis. The GerdQ score [median (range)] was as follows: 2 (0-6), preoperation; 0 (0-8), 1 month postoperation; 2 (0-12), 3 months postoperation; and 3 (0-12), 6 months postoperation. The Wilcoxon signed-rank sum test was carried out at different times after the operation and the day before the operation, and the differences were not significant (P<0.05). There was one case of grade B gastroesophageal reflux according to the Los Angeles classification system among the gastrofibroscopic re-examination reports of 28 cases.Conclusion: Semi-embedded valve anastomosis is safe and feasible after proximal gastrectomy for Siewert II AEG and has good anti-reflux effects.

Erosive Tooth Wear and Erosive Esophagitis in Children: An Observational Study in Porto Alegre, Brazil

The aim of this study was to establish and compare the prevalence and severity of erosive tooth wear (ETW) in children with and without erosive esophagitis. Children aged 5–12 years, scheduled for upper digestive endoscopy at the Pediatric Gastroenterology Service of the Children’s Hospital Santo Antonio, Porto Alegre, Brazil, were eligible to participate in this study. Patients who presented erosive esophagitis at endoscopy were defined as gastroesophageal reflux disease (GERD) carriers, and the severity was described according to the Los Angeles classification. The oral cavity examination was performed by a trained and calibrated dentist and ETW was classified using the Basic Erosive Wear Examination (BEWE) index. Parents/guardians answered a questionnaire about the patients’ diets and frequency of consumption of acidic foods and beverages. A total of 110 children were included in the study. Erosive esophagitis was observed in 24 patients (21.8%) and all of them (100%) presented ETW, showing a statistically significant association between these 2 conditions (p < 0.05). Among children who did not present with erosive esophagitis (n = 86), 54 (64.3%) had an ETW risk level of none according to their BEWE scores (0–2). The results of this study showed a statistically significant association between erosive esophagitis and ETW, thus it can be concluded that it is important to recognize groups at risk of ETW and act together with medical professionals to ensure adequate oral health for these patients.

Phase III, randomised, double-blind, multicentre study to evaluate the efficacy and safety of vonoprazan compared with lansoprazole in Asian patients with erosive oesophagitis

ObjectiveTo establish the non-inferior efficacy of vonoprazan versus lansoprazole in the treatment of Asian patients with erosive oesophagitis (EO).DesignIn this phase III, double-blind, multicentre study, patients with endoscopically confirmed EO were randomised 1:1 to receive vonoprazan 20 mg or lansoprazole 30 mg, once daily for up to 8 weeks. The primary endpoint was EO healing rate at 8 weeks. The secondary endpoints were EO healing rates at 2 and 4 weeks. Safety endpoints included treatment-emergent adverse events (TEAEs).ResultsIn the vonoprazan (n=238) and lansoprazole (n=230) arms, 8-week EO healing rates were 92.4% and 91.3%, respectively (difference 1.1% (95% CI –3.822% to 6.087%)). The respective 2-week EO healing rates were 75.0% and 67.8% (difference 7.2% (95% CI –1.054% to 15.371%)), and the respective 4-week EO healing rates were 85.3% and 83.5% (difference 1.8% (95% CI –4.763% to 8.395%)). In patients with baseline Los Angeles classification grade C/D, 2-week, 4-week and 8-week EO healing rates were higher with vonoprazan versus lansoprazole (2 weeks: 62.2% vs 51.5%, difference 10.6% (95% CI –5.708% to 27.002%); 4 weeks: 73.3% vs 67.2%, difference 6.2% (95% CI –8.884 to 21.223); and 8 weeks: 84.0% vs 80.6%, difference 3.4% (95% CI –9.187% to 15.993%)). Overall, EO healing rates appeared higher with vonoprazan versus lansoprazole. TEAE rates were 38.1% and 36.6% in the vonoprazan and lansoprazole group, respectively.ConclusionOur findings demonstrate the non-inferior efficacy of vonoprazan versus lansoprazole in terms of EO healing rate at 8 weeks in this population. Safety outcomes were similar in the two treatment arms.Trial registration numberNCT02388724.

Profil pasien endoskopi gastrointestinal di RSUP Prof. Dr. R. D. Kandou periode Januari 2018 - Agustus 2019

Along with the development of medical technology, endoscopy is mostly used in determination of the diagnosis and examination of gastrointestinal diseases. This study was aimed to determine the indications of gastrointestinal endoscopy, diagnoses of pre and post endoscopy, sex and age of patients undergoing endoscopy, and the prevalence of endoscopic patients from January 2018 to August 2019 at Prof. Dr. R. D. Kandou Hospital Manado. This was a descriptive and retrospective study using data of Medical Record Installation at Prof. Dr. R. D. Kandou Hospital. The results obtained 495 patients who were endoscopy performed on them. Males were predominant (59.8%) as well as age group of 50-59 years old (22.8%). The most frequent indication of endoscopy was dyspepsia/epigastric pain (68.5%). Moreover, EGD plus colonoscopy was the most common endoscopy performed. GERD (20.45%) had the highest percentage of pre endoscopy diagnosis meanwhile esophagitis Los Angeles Classification Grade A (28.8%) had the highest percentage of post endoscopy diagnosis. In conclusion, gastrointestinal endoscopy was performed more common on males, age group of 50-59 years, with indication of dyspepsia (epigastric pain), and in EGD plus colonoscopy. The most common diagnosis of pre endoscopy was GERD and of post endoscopy was esophagitis Los Angeles Classification Grade A.Keywords: gastrointestinal endoscopy Abstrak: Seiring dengan berkembangnya teknologi dibidang kesehatan, endoskopi yang merupakan salah satu cara penetapan diagnosis dan pemeriksaan gastrointestinal yang banyak digunakan. Penelitian ini bertujuan untuk mengetahui indikasi endoskopi gastrointestinal, diagnosis yang banyak ditemukan sebelum dan sesudah endoskopi, jenis kelamin, usia pasien yang dilakukan endoskopi, dan prevalensi jumlah pasien endoskopi periode Januari 2018 - Agustus 2019 di RSUP Prof. Dr. R. D Kandou. Jenis penelitian ialah deskriptif retrospektif dengan menggunakan data sekunder pasien di Instalasi Rekam Medik RSUP Prof. Dr. R. D. Kandou Manado. Hasil penelitian mendapatkan 495 pasien yang dilakukan pemeriksaan endoskopi selama periode tersebut, dengan 296 pasien (59,8%) yang berjenis kelamin laki-laki. usia terbanyak ialah 50-59 tahun (22,8%), indikasi endoskopi terbanyak ialah dispepsia (nyeri epigastrium) (68,5%), tindakan endoskopi terbanyak dilakukan ialah EGD + kolonoskopi (48,7%). Diagnosis sebelum tindakan terbanyak ialah GERD (20,45%), dan setelah dilakukan endoskopi ialah esofagitis klasifikasi Los Angeles Grade A (28,8%). Simpulan penelitian ini ialah pasien yang melakukan pemeriksaan endoskopi terbanyak berjenis kelamin laki-laki, kelompok usia 50-59 tahun, dengan indikasi dispepsia (nyeri epigastrium). EGD + kolonoskopi merupakan tindakan tersering diterima oleh pasien, diagnosis sebelum tindakan endoskopi ialah GERD, dan setelah dilakukan endoskopi ialah esofagitis klasifikasi Los Angeles Grade A.Kata kunci: endoskopi gastrointestinal

Profil pasien endoskopi gastrointestinal di RSUP Prof. Dr. R. D. Kandou periode Januari 2018 - Agustus 2019

Along with the development of medical technology, endoscopy is mostly used in determination of the diagnosis and examination of gastrointestinal diseases. This study was aimed to determine the indications of gastrointestinal endoscopy, diagnoses of pre and post endoscopy, sex and age of patients undergoing endoscopy, and the prevalence of endoscopic patients from January 2018 to August 2019 at Prof. Dr. R. D. Kandou Hospital Manado. This was a descriptive and retrospective study using data of Medical Record Installation at Prof. Dr. R. D. Kandou Hospital. The results obtained 495 patients who were endoscopy performed on them. Males were predominant (59.8%) as well as age group of 50-59 years old (22.8%). The most frequent indication of endoscopy was dyspepsia/epigastric pain (68.5%). Moreover, EGD plus colonoscopy was the most common endoscopy performed. GERD (20.45%) had the highest percentage of pre endoscopy diagnosis meanwhile esophagitis Los Angeles Classification Grade A (28.8%) had the highest percentage of post endoscopy diagnosis. In conclusion, gastrointestinal endoscopy was performed more common on males, age group of 50-59 years, with indication of dyspepsia (epigastric pain), and in EGD plus colonoscopy. The most common diagnosis of pre endoscopy was GERD and of post endoscopy was esophagitis Los Angeles Classification Grade A.Keywords: gastrointestinal endoscopy Abstrak: Seiring dengan berkembangnya teknologi dibidang kesehatan, endoskopi yang merupakan salah satu cara penetapan diagnosis dan pemeriksaan gastrointestinal yang banyak digunakan. Penelitian ini bertujuan untuk mengetahui indikasi endoskopi gastrointestinal, diagnosis yang banyak ditemukan sebelum dan sesudah endoskopi, jenis kelamin, usia pasien yang dilakukan endoskopi, dan prevalensi jumlah pasien endoskopi periode Januari 2018 - Agustus 2019 di RSUP Prof. Dr. R. D Kandou. Jenis penelitian ialah deskriptif retrospektif dengan menggunakan data sekunder pasien di Instalasi Rekam Medik RSUP Prof. Dr. R. D. Kandou Manado. Hasil penelitian mendapatkan 495 pasien yang dilakukan pemeriksaan endoskopi selama periode tersebut, dengan 296 pasien (59,8%) yang berjenis kelamin laki-laki. usia terbanyak ialah 50-59 tahun (22,8%), indikasi endoskopi terbanyak ialah dispepsia (nyeri epigastrium) (68,5%), tindakan endoskopi terbanyak dilakukan ialah EGD + kolonoskopi (48,7%). Diagnosis sebelum tindakan terbanyak ialah GERD (20,45%), dan setelah dilakukan endoskopi ialah esofagitis klasifikasi Los Angeles Grade A (28,8%). Simpulan penelitian ini ialah pasien yang melakukan pemeriksaan endoskopi terbanyak berjenis kelamin laki-laki, kelompok usia 50-59 tahun, dengan indikasi dispepsia (nyeri epigastrium). EGD + kolonoskopi merupakan tindakan tersering diterima oleh pasien, diagnosis sebelum tindakan endoskopi ialah GERD, dan setelah dilakukan endoskopi ialah esofagitis klasifikasi Los Angeles Grade A.Kata kunci: endoskopi gastrointestinal