418 Effect of Baclofen on the Mechanism of Reflux Protection in Healthy Volunteers and Patients With Gastro-Esophageal Reflux Disease (GERD) Assessed by Magnetic Resonance Imaging (MRI) and High Resolution Manometry (HRM): A Randomized Controlled Study

Curcic, Jelena; Schwizer, Alexandra; Kaufman, Elad; Banerjee, Sreerup; Pal, Anupam; Forras-Kaufman, Zsofia; Fried, Michael; Schwizer, Werner; Boesiger, Peter; Steingoetter, Andreas; Fox, Mark

doi:10.1016/s0016-5085(12)60354-0

Cited by 6 publications

(5 citation statements)

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“…In line with this, MRI reveals subtle anatomical diff erences in GERD patients vs. healthy volunteers. Th ese changes create structural disruption of the EGJ, albeit in a less severe manner than hiatus hernia ( 42 ). Th e insertion angle of the esophagus is more obtuse than that in healthy volunteers, with the position of insertion being more displaced from the midline, off ering less resistance to fl ow from the acid pocket when the stomach is full.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to this pool of acid, and in line with Pandolfi no ' s " acid fi lm " hypothesis , they also observed an acid coating of the distal esophagus, up to 6 cm above the SCJ in GERD patients with a large hiatus hernia ( Figure 3 ). Furthermore, direct observation using MRI aft er a large meal suggests that, in contrast to TLESR-associated refl ux that is observed in health and GERD, such proximal acid migration is a phenomenon thus far seen only in GERD patients ( 42 ). Th e cause of acid migration into the esophagus has not been established; however, initial observations suggest that these events occur only when LES pressure is very low and may be attributable to a primary abnormality of sphincter closure with resultant increased thickness of the luminal wet layer.…”

Section: Acid Pocket Extensionmentioning

confidence: 99%

“…pressure ( 48 ). More recently, data have been presented suggesting that baclofen may reduce the insertion angle of the esophagus in GERD patients, which may also help protect from refl ux ( 42 ).…”

Section: Acid Pocket and Hiatus Herniamentioning

confidence: 99%

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The Acid Pocket: A Target for Treatment in Reflux Disease?

Kahrilas

McColl

Fox³

et al. 2013

American Journal of Gastroenterology

129

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The nadir esophageal pH of refl ux observed during pH monitoring in the postprandial period is often more acidic than the concomitant intragastric pH. This paradox prompted the discovery of the " acid pocket " , an area of unbuffered gastric acid that accumulates in the proximal stomach after meals and serves as the reservoir for acid refl ux in healthy individuals and gastroesophageal refl ux disease (GERD) patients. However, there are differentiating features between these populations in the size and position of the acid pocket, with GERD patients predisposed to upward migration of the proximal margin onto the esophageal mucosa, particularly when supine. This upward migration of acid, sometimes referred to as an " acid fi lm " , likely contributes to mucosal pathology in the region of the squamocolumnar junction. Furthermore, movement of the acid pocket itself to a supradiaphragmatic location with hiatus hernia increases the propensity for acid refl ux by all conventional mechanisms. Consequently, the acid pocket is an attractive target for GERD therapy. It may be targeted in a global way with proton pump inhibitors that attenuate acid pocket development, or with alginate / antacid combinations that colocalize with the acid pocket and displace it distally, thereby demonstrating the potential for selective targeting of the acid pocket in GERD.

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Section: Discussionmentioning

confidence: 99%

Section: Acid Pocket Extensionmentioning

confidence: 99%

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The Acid Pocket: A Target for Treatment in Reflux Disease?

Kahrilas

McColl

Fox³

et al. 2013

American Journal of Gastroenterology

129

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“…However, the exact mechanisms how this compound work are not entirely clear. From imaging studies, the alginate in formulation is found to form a physical barrier at the GOJ and that it also displaces the acid pocket away from the GOJ 20,21 . However, despite the alginate action on acid pocket, studies by Sweis et al, 21 Kwiatek et al 22 and De Ruigh et al 23 did not demonstrate an effect on pH at the lower oesophagus and also the number of proximal refluxates.…”

Section: Discussionmentioning

confidence: 98%

Randomised clinical trial: the effectiveness of Gaviscon Advance vs non‐alginate antacid in suppression of acid pocket and post‐prandial reflux in obese individuals after late‐night supper

Deraman

Hafidz

Lawenko

et al. 2020

Aliment Pharmacol Ther

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Background: Late-night supper increases the risk of postprandial reflux from the acid pocket especially in obesity. An alginate-based, raft-forming medication may be useful for obese patients with GERD. Aims: To compare the efficacy of Gaviscon Advance (Reckitt Benckiser, UK) and a non-alginate antacid in post-supper suppression of the acid pocket and post-prandial reflux among obese participants. Methods: Participants underwent 48 h wireless and probe-based pH-metry recording of the acid pocket and lower oesophagus, respectively, and were randomised to single post-supper (10 pm) dose of either Gaviscon Advance or a non-alginate antacid on the second night. Primary outcomes were suppression of median pH of acid pocket and lower oesophagus, measured every 10-minutes post-supper for 1 h. Secondary outcomes were suppression of % time pH < 4 at lower oesophagus and improvement in frequency and visual analogue score (VAS) of regurgitation.Results: Of the 81 screened participants, 55 were excluded and 26 (mean age 33.5 years, males 77.8% and BMI 32.8 kg/m 2 ) were randomised to Gaviscon Advance (n = 13) or antacid (n = 13). Median pH of the acid pocket but not the lower oesophagus was suppressed with Gaviscon Advance vs antacid (all P < 0.04) Gaviscon Advance but not antacid significantly reduced in % time pH < 4, symptom frequency and VAS on day 2 vs day 1 (all P < 0.05). Conclusions: Among obese individuals, Gaviscon Advance was superior to a nonalginate antacid in post-supper suppression of the acid pocket. (Clinical trial registration unique identifier: NCT03516188). | 1015 DERAMAN Et Al.

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“…Therefore, InFroMs represent a novel nanoplatform that can be used for multimodal imaging of the intestine . Beyond that, other novel imaging strategies are adding new possibilities to the field of theranostics and molecular imaging …”

Section: Perspectivesmentioning

confidence: 99%

Ingestible Contrast Agents for Gastrointestinal Imaging

2019

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Gastrointestinal (GI) ailments cover a wide variety of diseases involving the esophagus, stomach, small intestine, large intestine, and rectum. They bring about many inconveniences in daily life in chronic diseases and can even be life threatening in acute cases. Rapid and safe detection approaches are essential for early diagnosis and timely management. Contrast agents for GI imaging can enhance contrast to distinguish abnormal lesions from normal structures. Computed tomography and magnetic resonance imaging are two important diagnostic tools for the evaluation of GI conditions. This review mainly involves several common GI diseases, including inflammatory diseases, intestinal tumors, diarrhea, constipation, and gastroesophageal reflux diseases. Selected contrast agents, such as barium sulfate, iodine‐based agents, gadolinium‐based agents, and others, are summarized. Going forward, continued endeavors are being made to develop more emerging contrast agents for other imaging modalities.

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418 Effect of Baclofen on the Mechanism of Reflux Protection in Healthy Volunteers and Patients With Gastro-Esophageal Reflux Disease (GERD) Assessed by Magnetic Resonance Imaging (MRI) and High Resolution Manometry (HRM): A Randomized Controlled Study

Cited by 6 publications

References 0 publications

The Acid Pocket: A Target for Treatment in Reflux Disease?

The Acid Pocket: A Target for Treatment in Reflux Disease?

Randomised clinical trial: the effectiveness of Gaviscon Advance vs non‐alginate antacid in suppression of acid pocket and post‐prandial reflux in obese individuals after late‐night supper

Ingestible Contrast Agents for Gastrointestinal Imaging

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