To analyze the differences in high-resolution esophageal manometry （HREM）results between side-lying position and supine position.
Methods
A total of 137 patients with the symptoms of gastroesophageal reflux disease （GERD） such as heartburn, acid reflux, chest pain, and food regurgitation,who visited the department of gastroenterology at Xuanwu Traditional Chinese Medicine Hospital in Beijing from November 2019 to December 2022 were included in this study. were tested for HREM in a lateral position first, followed by a supine position, and then the similarities and differences in HREM results between the two positions were analyzed.
Results
The average residual pressure of the upper esophageal sphincter （UES） in side-lying position were significantly lower than those in supine position （P＜0.05）, but no statistically significant difference was found in the resting pressure and peak pressure of UES （P＞0.05）.Except of the average peak value and initial velocity of esophageal peristalsis in side-lying position were significantly lower than those in supine position （P＜0.001）, other parameters of the esophageal body in two positions （P＜0.05） were not different from each other in statistics. The length of the esophagus and the distance from the lower esophageal sphincter （LES） to the nasal cavity measured in side-lying position were significantly longer than those in supine position （P＜0.05）, and the resting pressure of LES was significantly lower than that in the supine position （P＜0.05）. However, differences with regard to the residual LES pressure between side-lying position and supine position （P＞0.05） were not significant. When lying on the side position, the distal contractile integral and maximum pressure inside the food mass were significantly lower than those in the supine position （P＜0.05）, but there was no significant difference in contractile front velocity （P＞0.05）. According to the Chicago classification analysis, except for a significantly higher percentage of small peristalsis interruption in side-lying position compared to supine position （P＜0.05）, there was no statistically significant difference in all other analysis parameters compared to supine position （P＞0.05）, as well as the final diagnosis for esophageal motor abnormality.
Conclusions
Although there were some differences in parameters of esophageal pressure measurement between side-lying and supine position, the degree of LES relaxation achieved after swallowing was consistent, as well as the integrity of peristaltic waves. There had no significant impact on the final diagnosis of esophageal pressure measurement, and the Chicago classification.
Clinical studies of Anti-reflux mucosal ablation （ARMA） for gastroesophageal reflux disease （GERD） are rare. This study observed the clinical efficacy of ARMA on GERD through a retrospective study.
Methods
Retrospective analysis of the efficacy of ARMA in patients identified as GERD by 24 h dynamic esophageal pH monitoring. Efficacy was observed by 24 h dynamic esophageal pH monitoring, GERD-Q scale score and quality-of-life rating scale （SF-36） before and after 6 months. The efficacy of ARMA in different gastroesophageal reflux valve （GEFV） grades was also observed.
Results
Thirty-six patients were included in this study. Six months after ARMA, 30 patients with positive GERD-Q scores turned negative or decreased scores, with a response rate of 83.3% （30/36）. 25 patients with positive GERD-Q score were cured without taking PPI, with a cure rate of 69.4% （25/36）. In patients with grades Ⅰ-Ⅲ of GEFV, 24 h dynamic esophageal pH monitoring showed 6 months after surgery,with a statistically significant improvement in GERD-Q score and SF-36 score （P＜0.05）. At the same time,the dosage and frequency of acid reflux, heartburn, chest pain and PPI drugs were significantly improved.Meanwhile, GEFV patients with 24 h after surgery had acid mixed reflux, and their GERD-Q scores and SF-36 scores were not statistically different compared with preoperative ones （P ＞0.05）.
Conclusion
ARMA has good efficacy in GERD patients with GEFV grade Ⅰ-Ⅲ and poor efficacy in patients with GEFV gradeⅣ.
To explore the effect of gastroesophageal reflux disease surgery on the quality of life and psychology of patients.
Methods
The clinical data of 36 patients with gastroesophageal reflux disease （GERD） who underwent surgery in the General Surgery Department of Jiangyin People's Hospital from January 2019 to November 2023 were retrospectively analyzed. The GERD health-related quality of life scale （GERD-HRQL） was used to evaluate the quality of life of the patients before and after surgery. Selfrating anxiety scale （SAS） and self-rating depression scale （SDS） were used to evaluate the psychological status of patients before and after surgery.
Results
The mean GERD-HRQL scores before operation and 1 month after operation were （18.69±7.88） and （4.72±3.50） points, the difference is statistically significant（P＜0.05）. The mean SAS scores before operation and 1 month after operation were （33.25±3.35） and（30.56±2.91） points, the difference is statistically significant（P＜0.05）. The mean SDS scores before operation and 1 month after operation were （29.89±2.54） and （27.97±1.98）points, the difference is statistically significant （P＜ 0.05）. The mean GERD-HRQL score of 35 patients half a year after operation was （4.06±2.45） points, SAS score and SDS score were （30.40±2.16） and （28.49±1.29） points,respectively.
Conclusion
The symptoms of gastroesophageal reflux, the quality of life and the symptoms of anxiety and depression were significantly improved after surgery.
To explore the influencing factors of atrial fibrillation in patients with gastroesophageal reflux disease （GERD）, and to establish a clinical model to predict the risk of atrial fibrillation in patients with GERD.
Methods
We collected the data of 268 patients diagnosed with GERD from 2015 to 2017 in the People's Hospital of Xinjiang Uygur Autonomous Region. According to the patients' condition, we divided them into GERD with atrial fibrillation group and GERD group. The influencing factors of atrial fibrillation in patients with GERD were identified by univariate regression and multivariate regression. A clinical prediction model for predicting atrial fibrillation in GERD patients was established by nomogram method, and a scoring scale was established according to the prediction model.After that, 75% of the participating patients were used as the modeling group and the remaining 25% as the verification group, the observed model was verified externally. Meanwhile, ROC curve was drawn, AUC was calculated, and DCA curve was drawn to further verify the built scale internally.
Results
Among 268 patients with GERD, 35 patients were complicated with atrial fibrillation. Univariate and multivariate logistic regression models were used to analyze the influence of related indexes on atrial fibrillation in patients with GERD. It was found that age, BMI, coronary heart disease or heart failure, and sleep apnea could significantly affect atrial fibrillation in GERD （P＜0.05）, but gender, nationality, diabetes, smoking and hypertension had no significant influence （P＞）. Further trend test showed that the risk of atrial fibrillation increased gradually with the increase of age and BMI （P for trend＜0.05）. Then a clinical prediction model was established. The AUC of the patients in the modeling group was 0.6858, while that in the external verification group was 0.6473. There was no significant difference between the two groups （P＞0.05）, and the C index of the model was 0.7041.
Conclusion
Age, BMI, coronary heart disease or heart failure, sleep apnea, etc. can significantly affect the occurrence of atrial fibrillation in GERD. At the same time, we initially constructed a practical and effective clinical model to predict atrial fibrillation in patients with GERD.
To investigate the effects of luole weimi ointment on oxidative stress and inflammatory cytokines expression in human esophageal epithelial cells （HEEC） induced by acid stimulation.
Methods
HEEC cells were cultured and the experiment was further divided into 5 groups：Control group（n=6）, acid stimulation group（n=6）, luoliwei pretreatment group （LL group, n=6）, pingkui jiawarixi maierwayite honey ointment pretreatment group （PK group, n=6） and esomeprazole pretreatment group（AS group, n=6）. The acid was stimulated with pH value acid medium （pH=4） 3 times a day, 15min each time, for 48 h； LL group, PK group and AS group were added with 1 mmol/L LL, PK and AS for 4 h, and then were stimulated with acid for 48 h. Total ribonucleic acid （RNA） was extracted from each group, and quantitative real-time polymerase chain reaction （RT-PCR） was performed to detect the mRNA expression levels of nicotinamide adenine dinucleotide phosphate oxidase-4 （Nox-4）, antioxidant enzymes ［manganese superoxide dismutase （Mn SOD）, glutathione peroxidase （GSH-Px）, catalase （CAT）］ and inflammatory factor indicators ［monocyte chemotactic protein 1 （MCP-1）, interleukin-6 （IL-6） and tumor necrosis factor α （TNF-α）］.
Results
After pH=4 acid stimulation for 48 h, the mRNA expression level of Nox-4 in HEEC cells was significantly increased （P＜0.0001）； the high expression of Nox-4 mRNA was inhibited in LL, PK and AS group （P＜0.0001）； the effect of LL group on inhibiting Nox-4 mRNA was better than that of PK group （P＜0.01）. pH=4 acid stimulation significantly reduced the expression of antioxidant enzymes （MnSOD,GSH-Px, CAT） mRNA in HEEC cells （P＜0.0001）. The mRNA expression levels of the above antioxidant enzymes were significantly increased in LL group, PK group and AS group （P＜0.0001）； compared with the PK group, the mRNA expression level of the antioxidant enzymes in LL group was significantly increased（P＜0.05）. Acid stimulation significantly increased the mRNA expression levels of inflammatory factors（MCP-1, IL-6, TNF-α） in HEEC cells （P＜0.0001）. The mRNA expression levels of the above inflammatory factors were significantly decreased in LL, PK and AS group （P＜0.0001）； it is noteworthy that compared with the PK group, the mRNA expression level of the inflammatory factors in LL group was significantly decreased （P＜0.01）.
Conclusion
Luole weimi ointment can significantly inhibit the oxidative stress and the inflammatory cytokines in HEEC cells induced by acid stimulation, and its mechanism needs further study.
To explore the causal relationship between gastroesophageal reflux disease（GERD） and hepatobiliary-pancreatic diseases.
Methods
Both the exposure factors and outcome events were selected from the European population. The exposure data on GERD were obtained from the genome-wide association studies （GWAS） database, and data on 11 hepatobiliary-pancreatic diseases were obtained from the FinnGen database. The selection criteria for instrumental variables were single nucleotide polymorphisms with P＜5×108, r2＜0.001, genetic distance of 10,000kb, and F＞10. The statistical methods for Mendelian randomization included inverse variance weighting, weighted median method, MR-Egger, weighted mode,and simple model method. Among these, the results from the inverse variance weighting method were taken as the main basis, with other methods used as supplementary evidence and validation, followed by sensitivity analysis.
Results
GERD increases the incidence of acute pancreatitis, cholecystitis, cholelithiasis, chronic pancreatitis, pancreatic malignancy, non-alcoholic fatty liver disease, and primary sclerosing cholangitis, with OR values and 95%CI of 1.431 （1.237-1.656）, 1.235 （1.028-1.484）, 1.262 （1.169-1.363）, 1.481 （1.194-1.838）, 1.517 （1.114-2.065）, 1.519 （1.205-1.914）, 1.524 （1.182-1.965）, respectively. Sensitivity analysis showed no horizontal pleiotropy among the data. There is no causal relationship between GERD and benign liver tumors, liver cirrhosis, hepatocellular carcinoma, or cholangiocarcinoma.
Conclusion
GERD increases the risk of certain hepatobiliary-pancreatic diseases, providing new insights for the prevention and treatment of these diseases and contributing to more comprehensive health management.
Gastroesophageal reflux with esophageal dysmotility is a low-incidence digestive system disease. The pathogenesis is currently unclear.High-resolution manometry is the preferred method for diagnosing gastroesophageal reflux disease （GERD） and esophageal dysmotility （ED）. Other diagnostic methods include endoscopy and barium swallow imaging of the esophagus.In clinical practice, GERD and ED can be classified as primary and secondary. In primary cases, achalasia is a relatively common condition,while in secondary diseases, systemic sclerosis is more prevalent.Treatment for GERD and ED includes conservative and surgical options. Conservative treatment methods include endoscopic botulinum toxin injection and the use of 5-HT receptor agonists.Surgical treatment adopts different methods for primary and secondary GERD with ED. Primary GERD typically includes procedures such as pneumatic dilation,laparoscopic Heller myotomy, and peroral endoscopic myotomy.For secondary GERD and ED, common surgical methods include laparoscopic fundoplication, Roux-en-Y gastric bypass surgery, electrical stimulation therapy,and laparoscopic magnetic sphincter augmentation.This review aims to explore the progress in the diagnosis and treatment of GERD and ED, providing references and guidance for clinical practice and future research.
Hiatus hernia （HH） refers to the protrusion of the gastro-esophageal junction through an enlarged esophageal hiatus. The main treatment options include laparoscopic surgery, robotic surgery, etc.,with laparoscopic surgery accompanied by fundoplication and mesh repair being a common procedure. HH recurrence often occurs due to factors such as high or ruptured diaphragmatic tension, weak diaphragm, short esophagus, obesity, etc. Different fundoplication techniques in traditional laparoscopic surgery and roboticassisted surgery have not effectively reduced recurrence. Innovative surgical techniques such as posterior rectus sheath flap hiatal augmentation and falciform ligament flap diaphragm plication have shown promise in reducing HH recurrence after surgery. In addition, the use of patches in HH repair can effectively reduce early postoperative recurrence rates. Advances in patch materials and shapes have also contributed to the decreased recurrence rates.
This article elaborates on the diagnosis and treatment methods of esophageal squamous cell carcinoma and precancerous lesions. In terms of diagnosis, electronic endoscopic technology, including narrowband spectral imaging magnifying endoscopy, ultrasound endoscopy and endoscopic iodine response,as well as pathological specimen examination and X-ray barium meal examination, provides important means for accurate diagnosis of early esophageal cancer and squamous cell carcinoma. In terms of treatment,surgery is a commonly used treatment method, and combined with comprehensive treatment methods such as radiotherapy, chemotherapy, and proton therapy, it can help improve the treatment effect. The comprehensive application of these diagnostic and treatment methods is of great significance for the accurate diagnosis and effective treatment of early esophageal cancer and squamous cell carcinoma.
To analyze the application effect of cluster nursing intervention in the prevention of stress injury during Bariatric metabolic surgery, and to provide clinical basis for the protection of stress injury during this kind of surgery.
Methods
A total of 89 patients who underwent laparoscopic sleeve gastrectomy or laparoscopic gastric bypass in our hospital from January 2020 to December 2021 were randomly divided into control group（n = 44） and cluster nursing group（n = 45）. The control group received routine postural health education, while the cluster nursing group received cluster nursing intervention. The incidence of intraoperative stress injury, perioperative comfort and doctor satisfaction were compared between the two groups.
Results
The incidence of stress injury in control group was higher than that in cluster nursing group, the difference was statistically significant （P=0.003）. The perioperative comfort of cluster nursing group was higher than that of control group, the difference was statistically significant（P=0.001）. The satisfaction of doctors in cluster nursing group was higher than that in control group, and the difference was statistically significant （P=0.024）.
Conclusion
Cluster nursing intervention can reduce the incidence of stress injury in this kind of surgery, improve patients' body comfort and enhance doctors'satisfaction, and the implementation of cluster nursing intervention has a positive preventive effect on the occurrence of stress injury in weight-loss metabolic surgery.
To investigate the effect of preoperative visit in operating room in patients with gastroesophageal reflux disease and its influence on psychological state.
Methods
A total of 100 patients who received anti-reflux surgery for gastroesophageal reflux disease from January 2022 to March 2024 were selected as the study objects, and were divided into control group （50 cases, traveling nurses on the day of surgery） and observation group （50 cases, preoperative visits by specialist nurses in the operating room） according to random number table method. The need for surgery-related knowledge and the negative emotions before visit and entry were compared between the two groups.
Results
After the visit, the scores of preoperative preparation, disease knowledge, operating room environment, surgical process and postoperative precautions in the observation group were higher than those in the control group, and the differences were statistically significant （P＜ 0.05）. Before entering the operating room, the scores of self-rating Depression Scale （SDS） and self-rating Anxiety Scale （SAS） in the observation group were lower than those in the control group, and the difference was statistically significant （P＜ 0.05）.
Conclusion
Preoperative visit by specialist nurses in the operating room has an ideal effect in patients undergoing surgery for gastroesophageal reflux disease, which can improve negative emotions and promote patients to actively cope with the upcoming surgery and nursing, and is worthy of clinical promotion and application.
