ObjectiveTo investigate the short-term effects of Da Vinci robot-assisted Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease (rGERD), and to evaluate the safety and efficacy of its surgical treatment.MethodsA total of 40 patients with rGERD treated by Da Vinci robot-assisted surgery from October 2016 to November 2019 in our hospital were collected. There were 23 males and 17 females at age of 34-76 (61±23) years. The related clinical data were retrospectively analyzed, and the operation skills of Da Vinci robot-assisted Nissen fundoplication with rGERD were summarized.ResultsThere was no perioperative death or serious complication such as esophagogastric fistula. Postoperative reflux symptoms were significantly improved. DeMeester scores after surgery (39.79±35.01 points vs. 2.61±2.40 points, P=0.029), lower esophageal sphincter pressure (8.74±7.21 mm Hg vs. 24.56±8.76 mm Hg, P=0.020), integrated relaxation pressure (7.29±7.21 mm Hg vs. 16.49±9.99 mm Hg, P=0.023), distal contractile integral (600.49 ± 665.30 mm Hg·s·m vs. 510.99 ± 580.60 mm Hg·s·m, P=0.042), GERD-Q scale score (12.98±2.39 points vs. 7.59±1.11 points, P=0.033) were significantly improved compared with those before surgery. Postoperative dysphagia was found in 2 patients. And dysphagia was alleviated after diet adjustment and other treatments.ConclusionDa Vinci robot-assisted Nissen fundoplication is a safe and effective treatment for rGERD.
ObjectiveTo evaluate laparoscopic anti-reflux surgery for treatment of chronic obstructive pulmonary disease (COPD) associated with gastroesophageal reflux disease (GERD).MethodsA total of 20 patients with GERD and COPD underwent laparoscopic anti-reflux procedure in the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2017. The reflux diagnostic questionnaire, pulmonary function, COPD assessment test scale, 24-hour esophageal pH-impedance monitoring and esophageal pressure measurement were performed in all patients. All drug-refractory patients underwent the laparoscopic anti-reflux surgery. After 12 months follow-up, the parameters of COPD and GERD were evaluated again.ResultsTwenty patients with COPD and GERD were successfully performed laparoscopic anti-reflux surgery, no hernia patch repair patient and death patient occurred. There was no esophageal rupture, bleeding, infection, and other serious postoperative complications. Although 8 patients had the different degree dysphagia and 10 patients had the different degree abdominal distention, they all relieved themselves. Twenty patients with GERD and COPD were followed up for 1 year. Compared with the values before treatment, the GERD symptom score, reflux times, DeMeester score, and COPD assessment test score of the patients were significantly reduced (P<0.05), the lower esophageal sphincter pressure, percentage of forced expiratory volume in one second (FEV1) in the predicted value and FEV1/forced vital capacity (FVC) were significantly increased (P<0.05) after the treatment. According to the grading standard of The Global Initiative for Chronic Obstructive Lung Disease (GOLD), 5 cases of grade Ⅰ, 2 cases of grade Ⅱ and 1 case of grade Ⅲ were cured; 1 case of grade Ⅰ, 4 cases of grade Ⅱ and 4 cases of grade Ⅲ were improved; 1 case of grade Ⅰ, 1 case of grade Ⅱ and 1 case of grade Ⅳ were ineffective. The total effective rate was 85% (17/20).ConclusionsCOPD is closely related to GERD. Laparoscopic anti-reflux surgery can not only effectively treat GERD, but also markedly improve COPD.
Barrett’s esophagus (BE) is currently recognized as a precancerous lesion of esophageal adenocarcinoma. Gender, age, obesity, smoking and some other factors are closely related to BE, but the exact pathogenesis is still unclear. Gastrointestinal microecology is of great significance to the human body. It is closely related to human immunity, tumor, chronic inflammation, nutrient absorption, material metabolism. It may be closely related to the occurrence and development of BE. This article reviews the research progress of the relationship between BE and gastrointestinal microecology, aiming to provide a basis for further clarifying the pathogenesis of BE and targeting intervention in BE.
ObjectiveTo summarize the mechanism of effects of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) and the research progress of LSG in combination with fundoplication on obesity with GERD. MethodThe literatures of studies relevant to relation between LSG and GERD and effect of LSG combined with fundoplication on obesity accompanying GERD at home and abroad were searched and reviewed. ResultsAlthough there was considerable disagreement over the effect of LSG on GERD, the evidence showed that the LSG alone might worsen the existing GERD or promote new GERD, which mainly due to the destruction of the lower esophageal sphincter, deactivation of His angle, elevated intragastric pressure, and shape of sleeve stomach. Currently, the LSG in combination with fundoplication had been gradually applied in the clinical treatment of obese patients with GERD. And the short-term results of follow-up showed that the effects of weight loss and anti-reflux could be obtained, which needed to be evaluated by more studies and longer follow-up. ConclusionsThere is a risk of worsening existing GERD or promoting new GERD after LSG surgery. The LSG in combination with fundoplication is safe and feasible, which not only makes up for the adverse effects of LSG only on GERD after surgery, but also achieves the same similar effect of weight loss as LSG, providing a new choice for obese patients with GERD.
Non-erosive gastroesophageal reflux disease (NERD) refers to a disease that has typical gastroesophageal reflux symptoms but lacks endoscopic esophageal mucosal damage. Its exact pathogenesis remains unclear. Studies have shown that the occurrence and development of NERD may be related to the gastrointestinal flora. The digestive tract flora can directly or indirectly participate in the occurrence and development of NERD by affecting the body’s immune, metabolic, neurological and other functions. In order to further clarify the possible correlation between NERD and gastrointestinal flora, this article reviews the research progress on the correlation between NERD and gastrointestinal flora, with a view to providing new ideas for the diagnosis and treatment of NERD.
Objective To investigate the association between neuroticism and gastroesophageal reflux disease (GERD) using Mendelian randomization (MR). Methods Exposure and outcome data were downloaded from the IEU database (https://gwas.mrcieu.ac.uk/), containing summary statistics from genome-wide association studies (GWAS) for neuroticism (n=374 323) and gastroesophageal reflux disease (n=602 604). Using the weighted median (WM), MR-Egger, inverse variance weighted (IVW), weighted mode and simple mode methods for Mendelian randomization analysis. Odds ratio (OR) values were used to assess the causal relationship, while sensitivity analysis was used to ensure the accuracy of the results. ResultsNeuroticism (OR=1.229, 95%CI 1.186-1.274, P<0.001) was associated with an increased risk of GERD. Meanwhile, gastroesophageal reflux disease (OR=1.786, 95%CI 1.623-1.965, P<0.001) was also associated with increased risk of neuroticism. Conclusion The study finds a bidirectional causal relationship between neuroticism and gastroesophageal reflux disease.
Non-erosive gastroesophageal reflux disease (NERD) refers to a disease with symptoms such as acid reflux, heartburn and pathological reflux, but no significant esophageal mucosal damage under endoscopy. Its pathogenesis may be related to factors such as lower esophageal sphincter dysfunction, weakened esophageal clearance ability, visceral hypersensitivity, and disordered intestinal microecology, but the specific mechanism is still unclear. Small intestinal bacterial overgrowth (SIBO) is a common intestinal flora disorder syndrome. A number of studies have shown that SIBO has a certain correlation with NERD, and SIBO may be involved in the occurrence and development of NERD through mechanisms such as inflammatory response, gas production, and increased short-chain fatty acids. Therefore, this article reviews the correlation between NERD and SIBO, aiming to provide new ideas for the diagnosis and treatment of NERD.
Objective To evaluate the potential causal relationship between asthma and the risk of gastroesophageal reflux disease (GERD) using a two-sample Mendelian randomization study. Methods A large sample of genome-wide association study was used to summarize the data, and the genetic loci [single nucleotide polymorphisms (SNPs)] closely related to asthma were selected as instrumental variables, and Mendelian randomization analysis was conducted by inverse variance weighting, weighted median and MR-Egger method, respectively. At the same time, the multi-effect of MR-Egger was detected and the sensitivity analysis was carried out by Leave-one-out method to ensure the robustness of the results. Results A total of 77 SNPs closely related to asthma were selected as instrumental variables. The results of inverse variance weighted analysis showed a significant positive correlation between asthma and the occurrence of gastroesophageal reflux disease [odds ratio (OR)=1.044, 95% confidence interval (CI) (1.006, 1.083), P=0.024]. Weighted median results showed similar causality [OR=1.075, 95%CI (1.021, 1.133), P=0.006]. The MR-Egger regression results showed that there was a positive correlation between asthma and GERD, but there was no statistical significance [OR=1.080, 95%CI (0.983, 1.187), P=0.115]. The heterogeneity test results showed that there was no heterogeneity in the causal relationship between asthma and GERD (P>0.05). The results of the horizontal pleiotropy test showed that there was no horizontal pleiotropy in SNPs (P>0.05). The results of the retention test showed that no SNPs with significant impact on the results were detected. Conclusion There is a positive causal relationship between asthma and GERD.
ObjectiveTo develop an experimental model of gastroesophageal reflux-induced esophageal stricture in rats and explore the mechanism of esophageal stricture. MethodsA total of 30 male Sprague-Dawley (SD) rats by random number table method were randomly divided into three groups as follows: an operation+acid perfusion group, first the models of lower esophageal sphincter relaxation and hiatal hernia were made, and then the rats’ esophagus were perfused with hydrochloric acid-pepsin; acid perfusion group, the rats’ esophagus were directly perfused with hydrochloric acid-pepsin; and control group, rats’ esophagus were perfused with normal saline. After 4 weeks of continuous perfusion, the esophageal mucosal injury of SD rats in each group were observed, and the concentrations of inflammatory cytokines [tumor necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-18] in esophageal tissues were detected by enzyme-linked immunosorbent assay. ResultsIn the operation+acid perfusion group, esophageal stricture was formed in 2 SD rats, but no esophageal stenosis was found in the acid perfusion group and the control group. The body weight of rats in the operation+acid perfusion group and the acid perfusion group were lower than that in the control group (P<0.05). The esophageal mucosal injury scores of rats in the operation+acid perfusion group and the acid perfusion group were higher than that in the control group (P<0.001), and the operation+acid perfusion group was higher than that in the acid perfusion group (P=0.014). The concentrations of TNF-α, IL-1β and IL-18 in esophageal tissues were higher in the operation+acid perfusion group and the acid perfusion group than that in the control group (P<0.001), and the operation+acid perfusion group was higher than that in the acid perfusion group (P<0.001). ConclusionsThe anti-reflux barrier is an important part of preventing gastroesophageal reflux disease. The destruction of anti-reflux barrier, hydrochloric acid-pepsin perfusion and inflammatory cytokines jointly induced esophageal inflammation and injury, and even caused esophageal stricture.
ObjectiveTo analyze the causal relationship between the intake of cheese or tea and the risk of gastroesophageal reflux disease (GERD). MethodsUsing a two-sample Mendelian randomization approach, single nucleotide polymorphisms (SNPs) associated with milk or tea intake were used as instrumental variables. The causal effect of milk or tea intake on the risk of GERD was investigated using the MR Egger method, the weighted median method, the inverse-variance weighted (IVW) random-effects model, and the IVW fixed-effects model. Multivariable analysis was conducted using the MR Egger method, and leave-one-out sensitivity analysis was performed to validate the reliability of the data. ResultsCheese intake could reduce the occurrence of GERD [IVW random-effects model β=–1.010, 95%CI (0.265, 0.502), P<0.05], while tea intake could lead to the occurrence of GERD [IVW random-effects model β=0.288, 95%CI (1.062, 1.673), P<0.05]. ConclusionCheese intake may have a positive causal relationship with reducing the risk of GERD occurrence, while tea intake may have a positive causal relationship with increasing the risk of GERD occurrence.