СУТОЧНАЯ МНОГОКАНАЛЬНАЯ РН-ИМПЕДАНСОМЕТРИЯ ПИЩЕВОДА В ДИАГНОСТИКЕ ГАСТРОЭЗОФАГЕАЛЬНОЙ РЕФЛЮКСНОЙ БОЛЕЗНИ (КЛИНИЧЕСКИЕ СЛУЧАИ)

Background. Gastroesophageal reflux disease (GERD) is an urgent problem of modern gastroenterology as well as the most common pathology of the upper gastrointestinal tract; it is a chronic disease that significantly reduces the patient's quality of life, increases the risk of developing Barrett's esophagus and esophageal adenocarcinoma. Objective. To assess the potentials of multichannel intraluminal pH impedance monitoring in the diagnosis of esophageal diseases. Material and methods. In 3 patients with clinical and endoscopic signs of GERD esophageal multichannel intraluminal pH-impedance monitoring was performed using the diagnostic equipment Digitrapper pH-Z from Given Imaging (USA). Results. 24-hour esophageal pH monitoring enabled to verify the diagnosis of GERD, to reveal a hypersensitive esophagus and manifestations of nocturnal acid breakthrough. Conclusions. Multichannel intraluminal pH-impedance monitoring is the "gold standard" for the diagnosis of esophageal diseases; it significantly expands opportunities of gastroenterologists in the treatment of GERD.

Inhibition of Fenton Reaction of Glucose by Alcohols and Tetrahydrofuran in Catalytic Concentrations. Calculation of the Stability Constants of ROH/Fe2+ Complexes

Background: The Fenton reaction is of growing interest due to its primary function in bodily processes and industrial waste disposal. However, the effects of alcohol on this reaction have not been addressed. Therefore, we analyze for the first time the role that catalytic concentrations of alcohols play in the Fenton reaction. Methods: The Fenton reaction was carried out by measuring oxidation-reduction potential and pH monitoring under dark conditions to avoid photochemical reactions. The reaction end point was established using the first derivative of plotting potential versus time. This point was also checked by the dichromate test for hydrogen peroxide detection. Gas-liquid chromatography was used to measure alcohol content. The Fenton reaction of glucose was performed first, and then each alcohol, including ethanol, methanol, iso-propanol, and ter-butanol, was added separately in catalytic amounts, as well as the cyclic ether tetrahydrofuran. The reaction rate constants and the stability constants of each complex formed were measured. Results : Alcohols were shown to inhibit the Fenton reaction by forming iron-alcohol complexes. An iron-tetrahydrofuran complex was also formed. The crucial oxygen role in the functional group of alcohols and ethers is supported by a reaction with tetrahydrofuran. These results also explain the difficulties in the disposal of sugar-enriched alcoholic industrial effluents. Conclusion: Our findings show that alcohols, such as ethanol, methanol, iso-propanol, and ter-butanol at catalytic concentrations, slow down the Fenton reaction due to decreased iron availability by forming iron(II)-alcohol complexes. The method is also useful for calculating stability constants for iron-alcohol and iron-tetrahydrofuran complexes, which are not otherwise easy to assess.

Evaluation of gastrointestinal transit times and pH in healthy cats using a continuous pH monitoring system

Objectives The aim of this study was to characterize gastrointestinal (GI) transit times and pH in healthy cats. Methods GI transit times and pH were measured in six healthy, colony-housed, purpose-bred spayed female cats using a continuous, non-invasive pH monitoring system in a sequential order design. For the first period (‘pre-feeding’), food was withheld for 20 h, followed by oral administration of a pH capsule. Five hours post-capsule administration, cats were meal-fed by offering them their daily allowance of food for 1 h. For the second period (‘post-feeding’), food was withheld for 24 h and cats were fed for 1 h, after which a pH capsule was orally administered. Studies in both periods were repeated three times. GI transit times and pH were compared between the two periods. Results The median transit times for the pre- and post-feeding periods, respectively, were: gastric –94 mins (range 1–4101) and 1068 mins (range 484–5521); intestinal –1350 mins (range 929–2961) and 1534 mins (range 442–2538); and GI –1732 mins (range 1105–5451) and 2795 mins (range 926–6563). The median GI pH values for the first and second periods, respectively, were: esophageal –7.0 (range 3.5–7.8) and 4.5 (range 2.9–6.4); gastric –2.7 (range 1.7–6.2) and 2.0 (range 1.1–3.3); intestinal –8.2 (range 7.6–8.7) and 7.8 (range 6.7–8.5); first-hour small intestinal –8.2 (range 7.4–8.7) and 8.3 (range 7.9–8.6); and last-hour large intestinal –8.5 (range 7.0–8.9) and 7.8 (range 6.3–8.7). Gastric ( P <0.0020) and intestinal pH ( P <0.0059) were significantly increased in the pre-feeding period compared with the post-feeding period. Conclusions and relevance Gastric and intestinal pH differed significantly when the capsule was administered 5 h prior to feeding compared with 1 h after feeding. Transit times for both periods showed high degrees of intra- and inter-individual variability.

Associations of Obstructive Sleep Apnea, Obestatin, Leptin, and Ghrelin with Gastroesophageal Reflux

Gastroesophageal reflux disease (GERD) is commonly observed in patients with obstructive sleep apnea (OSA). Hormonal disorders observed in OSA may be relevant in the development of GERD. The aim of the study was to assess the correlations between ghrelin, obestatin, leptin, and the intensity of GERD in patients with OSA. The study included 58 patients hospitalized due to clinical suspicion of sleep disorders during sleep. All patients underwent a sleep study, and blood samples were collected overnight for hormonal tests. Survey data concerning symptoms of GERD, gastroscopy, and esophageal pH monitoring results were included in the study. In patients with OSA, GERD was twice as common when compared to the group without OSA. Among subjects with severe sleep apnea (AHI > 30; n = 31; 53%), we observed lower ghrelin levels, especially in the second half of the night and in the morning (p5.00 = 0.0207; p7.00 = 0.0344); the presence of OSA had no effect on obestatin and leptin levels. No significant differences in hormonal levels were observed between the groups depending on the diagnosis of GERD. However, correlations of ghrelin levels with the severity of esophagitis, leptin and ghrelin levels with the severity of GERD symptoms, and leptin levels with lower esophageal pH were found. GERD is more frequent among patients with OSA. In both GERD and OSA, deviations were observed in the levels of ghrelin and leptin. However, our analysis demonstrates that the relationship between OSA and GERD does not result from these disorders.

Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease: a systematic review and meta-analysis

Background and study aims Antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) are new endoscopic procedures for patients with gastroesophageal reflux disease (GERD). We conducted a meta-analysis to systematically assess the feasibility, clinical success, and safety of these procedures. Patients and methods We searched Embase, PubMed, and Cochrane Central from inception to October 2020. Overlapping reports, animal studies, and case reports were excluded. Our primary outcomes were clinical success and adverse events (AEs). Secondary outcomes included technical success, endoscopic esophagitis, 24-hour pH monitoring, and proton pump inhibitor (PPI) use. A random effects model was used to pool data. Results In total, 15 nonrandomized studies (12 ARMS, n = 331; 3 ARMA, n = 130) were included; 10 were conducted in patients with refractory GERD. The technical success rate was 100 %. The pooled short-term (first assessment within the first 6 months), 1-year, and 3-year clinical success rates were 78 % (95 % confidence interval [95 %CI] 70 %–85 %), 72% (95 %CI 47 %–92 %), and 73 % (95 %CI 65 %–81 %), respectively. ARMS and ARMA yielded similar clinical success. The proportion of patients off PPIs at 1 year was 64 % (95 %CI 52 %–75 %). There were significant drops (P < 0.01) in validated clinical questionnaires scores, presence of esophagitis, and acid exposure time. The most common AE (11 %, 95 %CI 8 %–15 %) was dysphagia requiring dilation (7%, 95 %CI 5 %–11 %). Four cases of perforation were recorded, all in patients undergoing ARMS. Conclusions Our meta-analysis of nonrandomized studies suggests that ARMS and ARMA are safe and effective for patients with GERD.