Introduction: Several studies identified a link between gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA). GERD is a condition in which acid reflux from the stomach to the esophagus causes troublesome symptoms. On the other hand, OSA is defined as a sleep-related breathing disorder in which airflow significantly decreases or ceases due to upper airway obstruction, leading to arousal from sleep. OSA was found to be associated with GERD. In this study, we aim to study the characteristics and concurrent risk factors associated with GERD and OSA in a large population-based study.Methods: Patients with the diagnosis of GERD were extracted from the National Inpatient Database (NIS) for the years 2016 to 2019. Patients' age, gender, race, and hospital information, including region and bed size, were extracted and considered as baseline characteristics. The comorbidities included are hypertension (HTN), atrial fibrillation (AFib), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), pulmonary hypertension (PHTN), obesity, and smoking. Patients younger than 18 years old were excluded from this study.Results: Out of 22,677,620 patients with the diagnosis of GERD, 12.21% had a concurrent diagnosis of OSA (compared to 4.79% in patients without GERD, p-value <0.001). The mean age of patients with GERD and OSA was 64.47 years vs 65.42 years in patients without OSA (p-value <0.001). The GERD and OSA group had almost identical gender distribution compared to the GERD only group, as it was predominantly female patients. The white and black races were slightly more prevalent in the GERD and OSA group compared to the GERD only group. Regarding comorbidities, the prevalence of obesity was more clear in the GERD and OSA group. It was noted that the group of patients who carry a diagnosis of GERD and OSA have more prevalence of diabetes (DM), hypertension (HTN), obesity, atrial fibrillation (Afib), congestive heart failure (CHF), and pulmonary hypertension (PHTN). Patients with GERD and OSA were 21% less likely to be older than 65 years rather than younger (95% CI: 0.79-0.8, p-value <0.001), 35% less likely to be females (95% CI: 0.65-0.65, p-value <0.001), and 22% less likely to be non-white (95% CI: 0.77-0.8, p-value <0.001). Obesity was found to be the strongest association with this population, followed by PHTN, CHF, DM, HTN, Afib, and lastly smoking.Conclusion: Patients with GERD and OSA were found more likely to be female, white, living in the southern part of the United States, obese, diabetes mellitus type 2, and being active smokers.
In patients with a functional gastrointestinal (GI) tract, enteral feeding is preferred over parenteral feeding as it has fewer complications and a relatively lower cost. Nasogastric and nasoenteric feeding tubes are available options but when long-term enteral feeding is desired, a percutaneous endoscopic gastrostomy (PEG) tube is more convenient. PEG tube can be associated with multiple complications; however, its displacement which causes gastric outlet obstruction (GOO) is a rare one. Here we present a case of an 81year-old woman with dementia who presented with upper GI bleeding and was found to have GOO causing reflux esophagitis due to PEG tube displacement.
While retrospective studies have shown conflicting outcomes in septic patients who received hydrocortisone, vitamin C, and thiamine compared to placebo, randomized controlled trials (RCTs) failed to show significant differences between the two groups in 30-day and in hospital mortality, hospital length of stay, and change in sequential organ failure (SOFA) score. We conducted a systematic review and meta-analysis to evaluate the beneficial effect of hydrocortisone, vitamin C, and thiamine compared to placebo in septic patients. METHODS:We conducted a systematic search of the PubMed, EMBASE, and Cochrane databases from inception through March 2021 for RCTs comparing hydrocortisone, vitamin C, and thiamine vs placebo in septic patients. Outcome of interests were 30-day and in hospital mortality, hospital length of stay, and change in SOFA score from hospital presentation and day 3 or day 4. Relevant data were extracted and analyzed using Comprehensive Meta-Analysis software. The random-effects model was used for all variables, and publication bias was assessed using Egger's test.RESULTS: Three RCTs published between April 2020 and February 2021 examining 717 patients were included in our analysis. The outcomes of these studies evaluated 30-day and in hospital mortality, hospital length of stay, and change in SOFA score from hospital presentation. Our analysis showed no significant difference in 30-day and in hospital mortality rates between the treatment group and placebo group with relative risk ratio of 0.975 (95% CI 0.766 to 1.241) (I2 =0.000) and 1.066 (95% CI 0.724 to 1.571) (I2=0.000) respectively. Our analysis also suggested no difference in the length of hospital stay and change is SOFA score from hospital presentation to day 3 or day 4 in the two groups with standardized mean difference of -0.031 (95% CI -0.204 to 0.141, P-value = 0.722) and 0.074 (95% CI -0.234 to 0.381, P-value = 0.639).CONCLUSIONS: Our analysis suggests no significant improvement in 30-day and in hospital mortality rate, hospital length of stay, or change in SOFA score in septic patients treated with hydrocortisone, vitamin C and thiamine compared to placebo.CLINICAL IMPLICATIONS: Hydrocortisone, vitamin C and thiamine administration provides no mortality benefit, decrease in hospital stay, or improvement in SOFA scores in patients with sepsis.
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