The Effect of Gastroesophageal Flap Valve Appearance on the Management of Patients with Symptoms of Gastroesophageal Reflux Disease

Xirouchakis, Elias; Kamberoglou, Dimitrios; Kalos, Dimitrios; Zambeli, Evanthia; Doulgeroglou, V.; Tzias, V.

doi:10.1007/s10620-008-0347-2

Cited by 8 publications

(4 citation statements)

References 28 publications

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“…In contrast, none of the subjects with GEFV Hill grade I or II was indicated for a doubling of the PPI dose. This is consistent with previous reports which suggested that an abnormal GEFV configuration could serve as an independent factor predicting a poor response to PPI therapy [30], [31]. Taken together, we suggest that GEFV grading is a prognostic factor for the long-term medical management of GERD.…”

Section: Discussionsupporting

confidence: 93%

Impacts of Endoscopic Gastroesophageal Flap Valve Grading on Pediatric Gastroesophageal Reflux Disease

Chang

Wu²,

Hsu³

et al. 2014

PLoS ONE

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BackgroundGastroesophageal flap valve (GEFV) endoscopic grading is reported to be associated with gastroesophageal reflux disease (GERD) in adults; however its role in pediatric groups remains unknown. This study aimed to investigate the significance of GEFV grading and the associations to multichannel intraluminal impedance and pH monitoring (MII-pH) in children with GERD.MethodsA total of 48 children with GERD symptoms who received esophagogastroduodenoscopy and MII-pH monitoring were enrolled. The degree of GEFV was graded from I to IV according to the Hill classification, and classified into two groups: normal GEFV (Hill grades I and II), and abnormal GEFV (Hill grades III and VI). Endoscopic findings and MII-pH monitoring were analyzed among the groups.ResultsThirty-six patients had normal GEFV while 12 had abnormal GEFV. The presence of erosive esophagitis was significantly more common in the patients with abnormal GEFV (p = 0.037, OR 9.84, 95% CI 1.15–84.42). Pathological acidic gastroesophageal reflux (GER) determined by MII-pH was more prevalent in the patients with loosened GEFV geometry (p = 0.01, OR 7.0, 95% CI 1.67–27.38). There were significant positive correlations between GEFV Hill grading I to IV and the severity of erosive esophagitis (r = 0.49, p<0.001), percentage of supine acid reflux (r = 0.37, p = 0.009), percentage of total acid reflux (r = 0.3284, p = 0.023), and DeMeester score (r = 0.36, p = 0.01) detected by pH monitoring. In the impedance study, GEFV Hill grading also positively correlated to median number of acid reflux events (r = 0.3015, p = 0.037).ConclusionsGEFV dysfunction highly associated with acid GER and severe erosive esophagitis. An abnormal GEFV is a sign of acid GER in children.

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Section: Discussionsupporting

confidence: 93%

Impacts of Endoscopic Gastroesophageal Flap Valve Grading on Pediatric Gastroesophageal Reflux Disease

Chang

Wu²,

Hsu³

et al. 2014

PLoS ONE

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“…Some studies also reported that abnormal GEFV was associated with poor response to PPI treatment, more PPIs usage during on demand therapy after remission and surgery indication for either failed medical management or complications. 3,20,21 Our study has some limitations. Firstly, it is a single-center study with relatively small number of patients.…”

Section: Discussionmentioning

confidence: 94%

Abnormal Gastroesophageal Flap Valve Is Associated With High Gastresophageal Reflux Disease Questionnaire Score and the Severity of Gastroesophageal Reflux Disease in Vietnamese Patients With Upper Gastrointestinal Symptoms

Quach

Nguyen

Hiyama

2018

J Neurogastroenterol Motil

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Background/AimsThere have been no studies investigating the distribution of abnormal gastroesophageal flap valve (GEFV) among patients with dyspepsia, non-erosive reflux disease (NERD), and reflux esophagitis (RE) in the same set of patients. The aims of this study are to investigate (1) the association between GEFV and gastroesophageal reflux disease questionnaire (GERDQ) score, and (2) the distribution of abnormal GEFV in Vietnamese patients presenting with upper gastrointestinal symptoms.MethodsThree hundred and thirty-one patients recruited in this prospective cross-sectional study were classified into 3 groups: reflux esophagitis (RE), non-erosive reflux disease (NERD) (GERDQ score ≥ 8, no endoscopic mucosal injury), and dyspepsia (GERDQ score < 8, no endoscopic mucosal injury). The GEFV was graded endoscopically according to the Hill classification. GEFV grades I and II were regarded as normal, while grades III and IV were regarded as abnormal GEFV.ResultsThere were 215 (65.0%) patients with dyspepsia, 55 (16.6%) patients with NERD, and 61 (18.4%) patients with RE. Abnormal GEFV was an independent risk factor for GERD (OR, 2.93; CI 95%, 1.76–4.88) and RE (OR, 3.41; CI 95%, 1.78–6.53). The mean GERDQ score of patients with abnormal GEFV was significantly higher than that of patients with normal GEFV (5.7 ± 2.4 vs 4.9 ± 2.7, P = 0.011). The prevalence of abnormal GEFV gradually increased in patients with dyspepsia (27.4%), NERD (43.6%), grade A RE (56.8%), and grades B/C RE (80.0%) (P < 0.001).ConclusionsAbnormal GEFV was significantly associated with high GERDQ score. Its prevalence gradually increased in patients with dyspepsia, NERD, and RE, respectively.

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“…However, the endoscopic diagnosis of a hiatal hernia is poorly reproducible and depends largely on the distension of the stomach. Previous reports have suggested that an abnormal GEFV configuration may serve as an independent factor predicting a poor response to PPI therapy ( 21 , 22 ). The results of our survey showed that PPI use was more frequent in the severe erosive esophagitis group, suggesting the possibility of PPI resistance and that mucosal healing is limited with PPI therapy alone.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Severe Erosive Esophagitis among Patients with Erosive Esophagitis: A Case-control Study

Ida¹,

Inamori

Inoh

et al. 2017

Intern. Med.

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Objective The risk factors associated with severe erosive esophagitis are not well defined in Japan. We aimed to evaluate the risk factors associated with the endoscopic severity of esophageal mucosal injury. Methods Eighty consecutive Japanese patients with severe erosive esophagitis [Los Angeles (LA) classification grade C or D] who had undergone upper endoscopies in the Gastroenterology Division of Omori Red Cross Hospital between June 2010 and March 2013 were retrospectively analyzed. For each case, a control with mild erosive esophagitis (LA classification grade A or B) who was matched by sex and age was randomly selected during the same period. Among the endoscopic findings, the condition of the gastroesophageal flap valve (GEFV) was graded according to Hill's classification. We identified the risk factors for severe erosive esophagitis using a multivariable logistic regression model. Results A poor performance status (PS) (odds ratio [OR]=17.1201, 95% confidence interval [CI]=3.0268-140.3121, p=0.0008) and an abnormal GEFV (OR=3.0176, 95% CI=1.0589-9.4939, p=0.0385) were risk factors for severe erosive esophagitis, while the presence of open-type gastric mucosal atrophy (GMA) was inversely associated with severe erosive esophagitis (OR=0.2772, 95% CI=0.1087-0.6675, p=0.0040). Conclusion Among patients with erosive esophagitis, a poor PS and an abnormal GEFV were associated while GMA was inversely associated with severe erosive esophagitis. Drug therapy alone or in combination with physical therapy may improve the therapeutic effect on severe erosive esophagitis in patients with a poor PS.

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The Effect of Gastroesophageal Flap Valve Appearance on the Management of Patients with Symptoms of Gastroesophageal Reflux Disease

Abstract: Continuous treatment is effective in all groups of patients with reflux disease. Grading patients according to the gastroesophageal flap valve appearance is useful as a prognostic factor, especially when on-demand therapy is considered to be an option.

Cited by 8 publications

References 28 publications

Impacts of Endoscopic Gastroesophageal Flap Valve Grading on Pediatric Gastroesophageal Reflux Disease

Impacts of Endoscopic Gastroesophageal Flap Valve Grading on Pediatric Gastroesophageal Reflux Disease

Abnormal Gastroesophageal Flap Valve Is Associated With High Gastresophageal Reflux Disease Questionnaire Score and the Severity of Gastroesophageal Reflux Disease in Vietnamese Patients With Upper Gastrointestinal Symptoms

Clinical Characteristics of Severe Erosive Esophagitis among Patients with Erosive Esophagitis: A Case-control Study

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