Role of acid and duodenogastroesophageal reflux in gastroesophageal reflux disease

Vaezi, Micheal F.; Richter, J. E.

doi:10.1053/gast.1996.v111.pm8898632

Cited by 499 publications

(372 citation statements)

References 3 publications

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“…El efecto del RGE es un factor importante en el desarrollo del EB. La exposición del esófago distal al refl ujo ácido del estómago está usualmente asociado a EB, pero el refl ujo de biliar es más común en esta enfermedad 13 . Aunque la bilis por sí sola pareciera no contribuir, existiría un efecto sinérgico entre el ácido y la bilis en la aparición de metaplasia intestinal 14,15 .…”

Section: Discussionunclassified

Efectos del bypass gástrico en el esófago de Barrett de pacientes con obesidad mórbida

et al. 2012

Rev Chil Cir

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Effects of gastric bypass for morbid obesity on Barrett esophagusBackground: Besides the weight reducing effects of gastric bypass, it is also a good antirefl ux procedure since there is no acid production by the gastric pouch and there is no duodenal refl ux due to the presence of a Roux en Y. Aim: To describe the effect of gastric bypass on Barrett esophagus among patients with morbid obesity. Material and Methods: Among 896 patients subjected to gastric bypass, 14 patient with a Barrett esophagus diagnosed with endoscopy and biopsy, were followed. A new endoscopy was performed one to 30 months after the surgical procedure. Results: Short (< = 30 mm) and long segment (> = 31 mm) Barrett esophagi were present in eight and six patients, respectively. Gastroesophageal refl ux symptoms relieved in 70% of these cases in a mean lapse of 6.5 months. There was regression from intestinal metaplasia to cardial mucosa in six patients (75%) with short-segment, and in one patient (16%) with long-segment Barrett esophagus. Conclusions: Gastric bypass in patients with morbid obesity and Barrett esophagus is a very good antirefl ux operation. This was proved by the disappearance of symptoms in almost all patients and by the regression of the intestinal metaplasia which is time and length dependent.

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Section: Discussionunclassified

Efectos del bypass gástrico en el esófago de Barrett de pacientes con obesidad mórbida

et al. 2012

Rev Chil Cir

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“…Moreover, it is unknown whether a proton pump inhibitor or other medication is necessary to inhibit acid reflux in PGS patients. However there have been reports of a relationship between prolonged acid exposure and the degree of esophageal injury [30,31] , while recent cohort studies with prolonged follow-up showed progression from NERD to EE and from uncomplicated to complicated GERD [32,33] . We therefore recommend future studies to observe disease progression and response to medication in PGS over a long duration.…”

Section: Discussionmentioning

confidence: 99%

Prolapse gastropathy syndrome may be a predictor of pathologic acid reflux

Kim¹,

Cho²,

Chae³

et al. 2008

WJG

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AIM:To assess the occurrence of gastric acid reflux into the esophagus in endoscopically confirmed prolapse gastropathy syndrome (PGS). METHODS: Using ambulatory esophageal pH measurement (BRAVO TM wireless esophageal pH monitoring system), twenty-six patients with PGS were compared with twenty-one patients with erosive esophagitis (EE) as controls. We assessed several reflux parameters, including the percentage of total time at pH < 4, and the DeMeester score. RESULTS: There were no statistical differences between the PGS group and the EE group as to mean age, sex ratio and pH recording time. The EE group showed more severe reflux than the PGS group, as evaluated in terms of the longest duration of reflux, the number of reflux episodes, the number of reflux episodes lasting > 5 min, the total time with pH < 4 during acid reflux episodes, and the DeMeester score, but none of these parameters showed statistically significant difference. Although 53.8% (14/26) of the PGS group and 76.2% (16/21) of the EE group demonstrated pathologic acid reflux (DeMeester score > 14.72), there was no statistically significant difference between the two groups in the incidence of pathologic acid reflux (P = 0.11). CONCLUSION: There was no statistically significant difference in pathologic acid reflux between the PGS and EE group. These data suggest that endoscopically diagnosed PGS might be a predictor of pathologic acid reflux.© 2008 The WJG Press. All rights reserved. K e y w o r d s : P r o l a p s e g a s t r o p a t h y s y n d r o m e ;Pathologic acid reflux; Erosive esophagitis; Ambulatory esophageal pH monitoring; Retching

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“…They concluded that complications of Barrett's esophagus might be related to synergism between bile and acid rather than the effect of either constituent alone. Acid and duodenal refluxate occur simultaneously in the majority of the reflux episodes and both acid and duodenal refluxate showed a graded increase across the GERD spectrum (Vaezi and Richter, 1996).…”

Section: Role Of Duodenal Reflux In Esophagitismentioning

confidence: 97%

Review Article; Duodeno-Gastro-Esophageal Reflux Combined and Isolated

Nasr¹

2013

American Medical Journal

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Barrett's esophagus is the chief risk factor for esophageal adenocarcinoma. Reflux of gastric acid has long been related to the development of esophagitis and Barrett's esophagus, but the role of duodenal contents is controversial. We review the literature on the role of duodenal contents in the development of esophagitis, Barrett's esophagus and adenocarcinoma in addition to the role of acid suppressant therapy in the development or prevention of these changes. A computer-based search of the literature using the terms "Bilirubin, Barrett, Bile Reflux, duodeno-gastric reflux and oesophagus/esophagus" was performed. The role of bile and other constituents of duodenal refluxate were examined. Techniques for identifying nonacid reflux were also reviewed, as were the role of pH, medication and surgery in modulating disease severity. Complicated Barrett's esophagus is associated with increased exposure to gastric and duodenal refluxate. Biological effect of bile acids depends on the conjugation status, the pH of the milieu and the pKa of bile acids. While Proton Pump Inhibitors reduce the levels of DGER, they also produce changes in gastric and lower esophageal pH that activate different bile acids at different pH levels resulting in unexpected injury. Conjugated bile acids are harmful in acidic environment while unconjugated bile acids are harmful at neutral pH environment. An overlap of toxicity among conjugated and unconjugated bile acids occurs between strongly acidic and neutral pH levels. Normalisation of gastric and duodenal refluxate should ideally be the goal of treatment.

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Role of acid and duodenogastroesophageal reflux in gastroesophageal reflux disease

Cited by 499 publications

References 3 publications

Efectos del bypass gástrico en el esófago de Barrett de pacientes con obesidad mórbida

Efectos del bypass gástrico en el esófago de Barrett de pacientes con obesidad mórbida

Prolapse gastropathy syndrome may be a predictor of pathologic acid reflux

Review Article; Duodeno-Gastro-Esophageal Reflux Combined and Isolated

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