Less than 2 centuries have elapsed since the identification of hydrochloric acid in the stomach. The clarification of the molecular mechanisms allowed the effective therapeutic suppression of gastric acid secretion. The spectacular advances in the treatment of acid-related disorders represent a synthesis of the contributions of several brilliant pharmacologists, basic scientists, and clinical physicians. Effective gastric acid suppressive therapy has dramatically improved the therapy and outcome of acid-related disorders. The introduction of proton pump inhibitors (PPIs) in clinical practice has significantly changed the medical management of upper gastrointestinal disorders. PPIs represent the “gold-standard” therapy in acid-related disorders. However, some challenges persist in the therapy of acid related diseases, including management of patients who respond inadequately to PPI therapy, more effective gastroprotection, or more powerful antisecretory treatment for the eradication of Helicobacter pylori infection. New antisecretory drugs are currently being developed and investigated to further provide a more effective and profound gastric acid secretion inhibition. The major advance has been the development of acid pump antagonists, the potassium channel acid blocking drugs (P-CABs). Long-term studies comparing P-CABs with PPIs will help to define the exact place and safety profile of this class of drug in the management of acid-related disorders.
Background: An occupation-related susceptibility of professional singers to experience gastroesophageal reflux has been suggested. Aims: To investigate the prevalence of gastroesophageal reflux symptoms in a series of professional opera choristers, wind players, glassblowers and water polo players in comparison with a sample of general population. Subjects and Methods: A total of 202 professional opera choristers from well-known choirs in different Hungarian regions, 71 professional wind players, 43 glassblowers, 54 water polo players were identified and 115 control subjects were compared prospectively. Reflux symptoms together with selected individual characteristics and lifestyle habits were investigated in study groups through a reflux questionnaire. Results:Professional opera choristers reported a statistically significantly higher prevalence of heartburn, regurgitation and hoarseness than control subjects (p < 0.001). Among professional wind players, heartburn and regurgitation were significantly more frequent compared with controls (p < 0.05 and p < 0.01, respectively). Glassblowers reported a significantly higher prevalence of acid regurgitation in comparison with controls (p < 0.01). The prevalence of reflux symptoms in water polo players was similar to that of controls. In opera choristers, wind players and glassblowers, reflux symptoms appeared to be significantly correlated with the cumulative lifetime duration of professional singing, playing and working activity, respectively (p < 0.05). Conclusions: Our results demonstrate that professional opera choristers, professional wind players and glassblowers have a higher prevalence of reflux symptoms compared with control subjects. Gastroesophageal reflux in these professions should be considered as a work-related disorder that may have an impact on quality of life and may negatively interfere with professional performance.
Összefoglaló. Bevezetés: A musculus cricopharyngeus flexibilis endoszkópos myotomiája a tüneteket okozó Zenker-diverticulum hatékony, biztonságos kezelési módszere. Célkitűzés és módszer: Retrospektíven elemeztük a hagyományos flexibilis endoszkópos myotomia eljárással szerzett tapasztalatainkat. Eredmények és megbeszélés: 2012. szeptember és 2020. február között 38 betegnél történt flexibilis endoszkópos myotomia tüneteket okozó Zenker-diverticulum miatt; összesen 47 myotomiát végeztünk. Betegeink többsége férfi (23/38), az átlagéletkor 71,5 év (40–88) volt. A diverticulumok átlagos mérete 3,94 (2–10) cm volt. A legtöbb esetben divertikuloszkópot alkalmaztunk, szabad kezes vágási technikára 8 esetben volt szükség. Betegeink tüneteit a kezelés előtt és azt követően a DRC- (dysphagia, regurgitatio, komplikációk) skála szerint értékeltük. A jelentősebb szövődmények előfordulása 4,2% (2/47) volt, a beavatkozással összefüggésbe hozható mortalitás nem fordult elő. Pneumomediastinum 1 betegnél alakult ki, melyet konzervatívan sikeresen kezeltünk. Beavatkozás közbeni vérzés 8 esetben (17%) jelentkezett, ezeket a beavatkozás során sikeresen megállítottuk. 1 esetben korai, kiújuló masszív vérzés miatt sürgős műtétre volt szükség. Mind a 38 beteget követtük, átlagosan 34,7 hónapig. A klinikai sikeresség 1,5 hónapnál 91,9% volt (34/37). 3 betegnek maradtak tünetei, kettőjüknél remyotomia történt, egyikük később műtétre szorult, 1 beteg pedig percutan endoszkópos gastrostomián esett át 18 hónap után. A hosszú távú követés során a teljes sikeresség (DRC<2) 78,4% volt (29/37), míg lényeges klinikai javulást (DRC: 0/1/2) a betegek 89,2%-ában (33/37) sikerült elérnünk. Következtetés: Eredményeink megerősítik, hogy a hagyományos flexibilis endoszkópos myotomia biztonságos, hatékony a tüneteket okozó Zenker-diverticulum kezelésében. Orv Hetil. 2022; 163(17): 677–687. Summary. Introduction: In the treatment of symptomatic Zenker’s diverticulum, the flexible endoscopic myotomy of the cricopharyngeal muscle is considered to be a safe and effective technique. Objective and method: We retrospectively analyzed our experiences with conventional flexible endoscopic myotomy. Results and discussion: 38 patients with symptomatic Zenker’s diverticulum were treated with flexible endoscopic myotomy and 47 myotomies were performed from September 2012 until February 2020. Most of our patients were male (23/38), with an average age of 71.5 (40–88) years. The mean size of diverticula was 3.94 (2–10) cm. In most cases, we used diverticuloscope, while free-hand technique was needed in 8 cases. We assessed our patients’ symptoms by applying DRC (dysphagia, regurgitation, complication) score before the treatment and during follow-up. The overall rate of significant complications was 4.2% (2/47), and there was no procedure-related mortality. We observed pneumomediastinum in one patient that was treated conservatively. Intraprocedural bleeding occurred in several (8/47) cases, in all of them the bleeding was successfully stopped during intervention. In one of them, early recurrent massive bleeding required urgent surgery. All 38 patients were followed (mean 34.7 months). Clinical success at 1.5 months was 91.9% among endoscopically treated patients (34/37). 3 patients remained symptomatic, 2 of them were treated with re-myotomy, 1 of them needed surgery later on, another patient underwent percutan endoscopic gastrostomy at 18 months. Over long-term period, complete success (DRC<2) was 78.4% (29/37), while clinical success (DRC: 0/1/2) reached in 89.2% (33/37). Conclusion: Our experiences confirmed that conventional method of flexible endoscopic myotomy is safe and effective for the treatment of Zenker’s diverticulum symptoms. Orv Hetil. 2022; 163(17): 677–687.
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