Reflux Hypersensitivity: How to Approach Diagnosis and Management

Aggarwal, Pankaj; Kamal, A. N.

doi:10.1007/s11894-020-00779-x

Cited by 9 publications

(11 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is the first study to evaluate the role of TRPV1 and CGRP in the distal esophageal mucosa of reflux hypersensitivity patients. TRPV1 and CGRP are often co-exist in the esophagus [ 20 ]; they are well-known biochemical markers of sensory afferent fibers [ 12 , 14 ] and may play an important role in esophageal hypersensitivity [ 21 – 26 ]. The density of TRPV1 and CGRP was much lower 12 mo after radiofrequency ablation in our patients.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Endoscopic Radiofrequency Ablation for Treatment of Reflux Hypersensitivity: A Study Based on Rome IV Criteria

Jiang

Dong

Wang

et al. 2022

Gastroenterology Research and Practice

View full text Add to dashboard Cite

Objective. Effective therapies for reflux hypersensitivity are lacking. Endoscopic radiofrequency ablation may reduce the sensitivity of the distal esophagus through direct interference with nociceptors or vagal afferent fibers and thus may be useful in reflux hypersensitivity. The aim of this study is to assess the effectiveness and possible mechanisms of endoscopic radiofrequency ablation in reflux hypersensitivity patients. Methods. Patients with reflux hypersensitivity who fulfilled the Rome IV criteria and who wished to receive further treatment were recruited. Endoscopic radiofrequency ablation was delivered to the gastroesophageal junction. Data were collected by questionnaire using a 6-point Likert scale. The primary outcome measure was effect on symptoms including heartburn, regurgitation, and chest pain. The secondary outcomes were degree of satisfaction, medication use, acid exposure time (AET), low esophageal sphincter (LES) pressure, and total reflux episodes. We also assessed positive cell density of transient receptor potential vanilloid type 1 receptor (TRPV1) and calcitonin gene-related peptide (CGRP), both of which are biomarkers of afferent fibers, in biopsies obtained from esophageal mucosa 0.5 cm-1 cm above the Z line. These scales will be administered at baseline, 3-month follow-up, 6-month follow-up, and 12-month follow-up. Results. A total of 22 reflux hypersensitivity patients were enrolled (14 males, median age 50.0 years). A significant improvement in symptom scores (heartburn, regurgitation, and chest pain) was noted at 3 months, 6 months, and 12 months ( P < 0.001 ). Satisfaction with life increased to 72.7% (16/22), 72.7% (16/22), and 68.2% (15/22) at 3, 6, and 12 mo, respectively, compared with baseline ( P < 0.001 ). Nineteen patients reduced their medication use after treatment. Of these, 22.7% (5/22), 31.8% (7/22), and 40.9% (9/22) subjects stopped medication use at 3 mo, 6 mo, and 12 mo, respectively. No statistical differences were noted in AET, LES pressure, or total reflux episodes from preoperation to 12 mo postoperation. After treatment, the positive cell density of both TRPV1 and CGRP decreased significantly; however, only TRPV1 had a positive correlation with heartburn ( r = 0.51 , P = 0.03 ) and chest pain ( r = 0.77 , P < 0.01 ). Conclusion. Endoscopic radiofrequency ablation was an effective and safe therapeutic option in reflux hypersensitivity patients. Further studies with large sample size are required to validate the role of radiofrequency in reflux hypersensitivity.

show abstract

Section: Discussionmentioning

confidence: 99%

Efficacy of Endoscopic Radiofrequency Ablation for Treatment of Reflux Hypersensitivity: A Study Based on Rome IV Criteria

Jiang

Dong

Wang

et al. 2022

Gastroenterology Research and Practice

View full text Add to dashboard Cite

show abstract

“…4) [60]. Патофизиология ГП до конца не изучена, предполагается, что в основе этого состояния лежит феномен висцеральной гиперчувствительности (нарушение оси «головной мозг -желудочно-кишечный тракт»), а также избыточное количество слабокислых рефлюксов [61][62][63].…”

Section: диагностика гэрбunclassified

“…Отсутствие своевременной диагностики может приводить к неверным терапевтическим решениям и персистированию симптома изжоги, т. к. терапия ИПП, как правило, неэффективна у этой группы пациентов, а применение хирургического антирефлюксного лечения оказывает непоправимый вред. При этом возможен перекрест обоих состояний с ГЭРБ [57,63].…”

Section: диагностика гэрбunclassified

Gastroesophageal reflux disease: risk factors, current possibilities of diagnosis and treatment optimisation

et al. 2022

View full text Add to dashboard Cite

Gastroesophageal reflux disease (GERD) is one of the most common causes of health care seeking at the primary care level in many countries. At an epidemiological level, GERD has been shown to be associated with a number of risk factors: obesity, tobacco smoking, alcohol abuse, certain patterns of eating behaviour, and the use of several medications. GERD is now regarded as a heterogeneous disease and includes different phenotypes (erosive reflux disease, non-erosive reflux disease, hypersensitive oesophagus, functional heartburn), the proper diagnosis of which improves the effectiveness of therapy in patients with heartburn symptoms. Daily impedance–pH monitoring is known to be an integral part of the diagnostic algorithm for GERD and is a functional diagnostic method to record all types of refluxes entering the oesophagus regardless of pH, to assess their association with symptoms, and to determine whether patients with heartburn symptoms belong to a particular phenotype. Esophageal manometry plays a key role in the evaluation of patients with heartburn symptoms, as it helps to rule out other conditions that may mimic GERD: achalasia cardia and scleroderma esophagus. This technique is used to assess thoracic esophageal motility and sphincter function and in the assessment of patients prior to antireflux surgery or in the refractory course of GERD. The article describes in detail GERD risk factors (triggers of heartburn), as well as diagnostic aspects, taking into account a differentiated approach to patients with heartburn based on daily impedance–pH monitoring data in accordance with the current guidelines and recommendations.

show abstract

“…4,10,11 Some clinicians ask for both SI and SAP positivity, while many studies rely on the positivity of one of them in order to set RH diagnosis. [12][13][14][15] Few studies compared PPI efficacy in RH versus FH. [16][17][18] Moreover, PPI nonresponsiveness is taken as a diagnostic criterion for FH diagnosis according to the Rome IV criteria.…”

mentioning

confidence: 99%

Improved diagnosis of reflux hypersensitivity

Voulgaris,

Hoshino,

Sifrim

et al. 2023

Neurogastroenterology Motil

View full text Add to dashboard Cite

BackgroundReflux hypersensitivity (RH) is characterized by normal esophageal exposure to acid and positive correlation of symptoms to reflux episodes. Positivity of Symptomatic Index (SI) and/or Symptom Association Probability (SAP) is used diagnostically, though experts support that concordance of both is needed. We evaluated differences among patients with RH and concordance of SI/SAP or not.MethodsPatients with typical reflux symptoms without previous GERD diagnosis, submitted simultaneously to Ph‐Impedance off PPI and high resolution manometry were included. Self‐response to PPI was evaluated. Patients showing SI and/or SAP positivity were considered having RH and further classified to definite RH if both SI/SAP were positive or indefinite if only one positive.Key ResultsTotally 2659 patients (M/F: 35.6%/64.7%, mean age: 45 ± 14) were included. Final diagnosis was; FH: 21.8%, RH: 29.3% (definite: 14.3%/indefinite: 15%), GERD: 36% and inconclusive GERD: 12.9%. Patients with definite RH showed increased total reflux time, total number of reflux episodes and length of hiatus hernia, and also numerically but not statistically significant increased rates of PPI responsiveness versus indefinite RH and decreased mean nocturnal baseline impedance. Moreover, they showed significantly increased rate of PPI response versus patients with functional heartburn (FH).Conclusion & InferencesSome PPI responsiveness is frequent among patients with RH as also with FH, and cannot discriminate those entities clinically when diagnosing RH using SI and/or SAP positive criterion. Patients with RH and SI/SAP concordance differ from patients without. Implementation of a strict RH definition (both SI and SAP positive) can better distinguish RH from FH and should be used in the future.

show abstract

Reflux Hypersensitivity: How to Approach Diagnosis and Management

Cited by 9 publications

References 55 publications

Efficacy of Endoscopic Radiofrequency Ablation for Treatment of Reflux Hypersensitivity: A Study Based on Rome IV Criteria

Efficacy of Endoscopic Radiofrequency Ablation for Treatment of Reflux Hypersensitivity: A Study Based on Rome IV Criteria

Gastroesophageal reflux disease: risk factors, current possibilities of diagnosis and treatment optimisation

Improved diagnosis of reflux hypersensitivity

Contact Info

Product

Resources

About