Exploring Diseases related to Digestive and Neurologic System - A Disease Analysis Journal

Clinical Guidelines for Gastro-Oesophageal Reflux Disease in Children and Young People

Disease Analysis Journal Unlocked: Saturday, April 4, 2020 12:00 Am Mdt Saturday, April 11, 2020 11:59 Pm Mdt. Must Post First. Overview In Your Exploration Of Readings This Module, You Will Find Articles Of Interest Around The Following Areas: Digestive System Diseases And Neurologic Diseases. The Key Terms In The Explore Section Might Give You Some Ideas For Diseases To Search. As You Read The Articles, Be Sure To Consider How Many Of Them Have Multiple Issues Going On Within Different Systems. Is There a Connection Between The Systems Discussed?

Disease Analysis Journal Discussion Board. This Will Alert Your Peers And Instructor That You Have Completed Your Journal Assignment For This Module. It Should Include All Your Journal Assignments From The Past Modules. In Your Post, Identify How Many Systems Are Discussed Or Impacted By The Disease You Read About In The Reading. Is There a Connection Between Systems?

Rachel Russell discusses in this article regarding the clinical guideline draft for practice developed by the “National Institute for Health and Care Excellence (NICE)” in 2014 for “gastro-oesophageal reflux disease (GORD)” in children and young people. The article enumerates the various symptoms, treatment procedures, and managing of GORD in children based on the guidelines by NICE, and highlights the dissimilarities between gastro-oesophageal reflux (GOR) and GORD. It is challenging to separate between these two syndromes in the clinical setting as they are often confusing to diagnose, but the primary difference is that GOR is a spontaneous regurgitation of gastric substances such as milk into the esophagus that occurs naturally, while GORD is a condition in which troublesome symptoms or complications of gastro-oesophageal reflux occur along with significant associated with morbidities. The symptoms relevant to GOR diseases in infants and young people, such as recurring regurgitation episodes, excessive crying, aversion to food, and frequent irritability, are often presented as markers of the conditions in children and infants. This article points out the importance of medical history and thorough assessment for health professionals, and priority management guidelines proposed NICE strongly focusing on revising the established plan of care frequently and providing support and reassurance to the affected children’s family. Such comprehensive care management helps to offer best-practice assistance for infants and young people.

Karl et al., 2015 presents a consensus statement via a project undertaken by the European Association of Endoscopic Surgery (EAES). It aims to analyze and investigate the current understanding of pathophysiology, diagnosis methods, clinical therapy of gastroesophageal reflux disease (GERD) concerning distinct conditions such as pediatric GERD, Barrett’s esophagus, and special considerations in entero-esophageal and duodenal gastroesophageal reflux. A panel of clinical and scientific experts was formed who performed extensive and systemic literature review based on the current evidence available to develop new guidelines for EAES regarding GERD, which were then transformed to recommendations and strategies at a plenary session conducted in this regard. The primary features of GERD highlighted in this paper include diagnostic evaluation techniques and criteria for the selection of therapeutic strategies, considering the nature of disease, symptoms, and presence of complications. Recommendations are formulated based on the disease pathophysiology, epidemiological scenario, symptom identification, and interventions required. Since the manifestation of GERD is multifaceted, its management entails an approach combining enhanced diagnostic tools, efficient medical therapy, and laparoscopic surgical treatment. Overall, this paper displays comprehensive information with the support of reliable evidence that can be adequately used and adopted by health professionals working in the field of gastroesophageal disorders.

Consensus Statement on Gastroesophageal Reflux Disease (GERD) by European Association of Endoscopic Surgery (EAES)

This review article presents the prevailing gender differences in the manifestation of GERD in terms of incidence, pathophysiology, clinical appearances, and treatment with a preliminary investigation of the predominance of GERD in the global scenario. The prevalence of GERD is subdivided into occurrence at community-level and endoscopic examinations. The studies based on population frequency indicated no significant difference between sexes, and the endoscopic studies revealed a lower prevalence among women than men for reflux esophagitis with contrasting results in case of non-erosive reflux disease, which is more common in women. Studies on pathophysiology indicate more rapid changes in men than women, whereas women have a higher mean age for the development of cancer, elucidating the role of estrogen in deferring the inception of Barett’s esophagus and esophageal adenocarcinoma. The underlying factors associated with the prevailing epidemiological gender difference include anti-inflammatory properties of estrogen and refluxate resistance by the esophageal epithelial lining. Women experience increased symptoms such as heartburn, belching, and tendencies of acid reflux. Hence, the paper also identifies the necessity of considering differential diagnostic methods for disease recognition and symptoms for men and women to deliver specialized therapeutic implications.

This research article aimed to study whether patients with GERD follow recommended dietary advice and the association of diet adherence with the extent and regularity of the symptoms of reflux. The health care cost and productivity loss caused by GERD is severe. Since no population-based study had been conducted previously, this study resolved to estimate the proportion of GERD patients who follow the diet recommendations actively through a sizeable community within the US population. The relations among GERD identification, reflux indications, and dietary consumption were considered. The developed hypothesis of the study stated that patients having severe or recurrent symptoms tend to exhibit non-adherence to modified dietary recommendations that are commonly suggested to them. It was found that GERD patients who maintain a stable diet are inclined towards high consumption of tea, fatty foods, and alcohol than the control group. Also, the results indicated that these patients are not likely to avoid altogether the intake of foods known to worsen GERD symptoms. This study recognizes the need for randomized clinical trials to assess the effectiveness of GERD diet guidelines to better understand the nonpharmacologic therapeutic management in treating GERD.

This systematic review aimed to assess the role of lifestyle management in GERD treatment by comparing the available evidence in literature with current guidelines in practice. Western populations experience a prevalence of GERD of up to 30% in adults, and this increasing burden can be attributable to lifestyle factors, such as obesity or smoking, with the risk of adverse consequences, including esophageal adenocarcinoma. Results showed a pattern of weight reduction followed by shortened time along with exposure of esophageal acid in a few controlled trials, and observational studies displayed decreased reflux symptoms. Cessation of Tobacco smoking significantly lowered the reflux symptoms in individuals with a healthy BMI in another prospective cohort study. Besides, the randomized trials observed that the exposure to supine acid is increased by late evening meals rather than timely meals, and an elevated “head of the bed” position lessened time of contact with supine acid exposure in comparison to a horizontal posture. In a placebo-controlled trial, it was seen that a diet rich in dietary fiber could potentially decrease symptoms of heartburn. Effective lifestyle modifications to be considered for a GERD patient include weight loss, abstinence from tobacco smoking for obese individuals and smokers, consuming early meals, maintaining a “head of the bed” position, and adherence to a high dietary fiber diet.

Prevalence of GERD, Differential symptoms and Diagnosis between Genders

This observational study aimed to estimate the link between the efficacy of “proton pump inhibitors (PPI)” and “health-related quality of life (HRQOL)” in GERD patients within a Japanese population receiving PPI therapy. The study was performed with the use of premade questionnaires prepared to evaluate predictive factors that affect the response to PPI treatment. Population studies in western countries provide evidence that the prevalence of GERD symptoms increases the disorders of physical and mental health, particularly sleep disturbances. Since PPIs strongly inhibit the secretion of gastric acid, they are generally considered to be the first choice of GERD treatment. However, several reports point out the  presence of persistent symptoms even with the PPI administration, which negatively affects their HRQOL and sleep cycle. The questionnaire thus evaluated the GERD patients undergoing PPI treatment, classified them as the respondents for the survey, and assessed them in terms of their quality of life parameters. Non-erosive reflux disease (NERD) and double proton pump inhibitor doses were the prognostic aspects of respondents. The consequences of stubborn reflux symptoms in the Japanese population were found to be impaired mental shape, troubled sleep, and emotional distress, in spite of receiving adequate PPI therapy.

Globally, the cornerstone GERD treatments are represented by PPI, and low potential “histamine type-2 receptor antagonists (H2RAs)”. This review demonstrates the areas of GERD treatment that remain unmet even though marked therapeutic improvements in medical, surgical, and endoscopic therapy have been possible so far. The concerning issues which lack treatment interventions include erosive esophagitis (EE) in the advanced stage and its maintenance therapy, non-erosive reflux disease (NERD), noncompliant GERD, postprandial heartburn, atypical and extraesophageal manifestations of GERD, Barrett’s esophagus, chronic protein pump inhibitor treatment, and GERD induced by bariatric surgery. Superior grades of EE exhibit the lowermost healing rates in patients receiving a daily dose of PPI, while often, NERD patients do not respond sufficiently to PPIs. Moreover, the current experience of clinical management in atypical and extra-esophageal expressions of GERD, such as noncardiac chest pain (NCCP), has been extremely unsatisfactory. Also, treatments with PPI for patients with GERD induced pharyngeal, laryngeal, or pulmonary distress or symptoms have failed to validate any advantage over placebo.

Proton pump inhibitors (PPIs) are used as a remedy for GI disorders, specifically in peptic ulcers and reflux symptoms, for their ability to suppress gastric acid secretion. However, they have recently been linked to developing risks of Clostridium difficile infection. The research was aimed at investigating the association between PPI therapy and the gut microbiota via 16SrRNA profiling of fecal samples assimilated from a large number of healthy volunteers, permitting alterations for ecological and genetic factors inducing both PPI usage and the gut microflora. Substantial adjustments were found to occur in the PPI users, which impacted their gut microbiome variety and composition. The underlying mechanism of action of PPIs in causing such influences were also identified. The most prominent feature in the PPI users is a proliferation in Lactobacillales, particularly Streptococcaceae count. Overall, there is a rise in the number of bacterial families in the gut with subsequent use of PPIs, which are likely to be pharyngeal in nature and not of commensal origin. The impact of such noticeable fluctuations in the gut microbe composition of PPI users may reflect in the clinical practice. The observed gut modifications may be responsible for exposure to infection for those individuals, and render them susceptible to further decrease in gut functions.

Role of Diet Adherence on Symptoms of GERD

This review article outline the role of intestinal microbiota in the manifestation of gastrointestinal tract cancers. The positive association between natural microbiota and the eukaryotic hosts contributes to different metabolic actions of the body as well as maintain the balance of temperature and pH. Culturing studies indicate that the esophagus is either aseptic or comprises a small number of transient microbes originating from the oropharynx by swallowing or from the gut by gastroesophageal reflux mechanisms. Nonetheless, the field of metagenomics provide evidence regarding the origin of a pool of uncultured microorgaisms within the gut, which further sheds light on the utilization of gut microbiota modulation as a useful therapeutic approach in the prevention and management of chronic gastrointestinal ailments. It is established that bacteria do not exist in seclusion; instead, they populate in groups forming bacterial communities, where several diverse organisms with an analogous biological niche cohabit. In this aspect, the enhancement in metagenomics may significantly influence the comprehension of the complex human microbiota, as well as the foundations of genomic and evolutionary interactions amid species and, therefore, pave the way for further elaboration on the precise roles of intestinal microflora in immune functioning and disease pathogenesis.

In this paper, the evidence connecting obstructive sleep apnea syndrome (OSA) and gastroesophageal reflux (GER) with “difficult to control” asthma has been explored. The paper critically weighs the supporting evidence, which suggests that the detection and cure of OSA and GER affect asthma control. The paper highlights the link between asthma and GER, the effect of asthma and GER on each other, the role of proton pump inhibitors in asthma control, uncertain concerns about the relationship between GER and asthma, and the pathophysiology associated between OSA and asthma. Treatment efficacy of continuous positive airway pressure with OSA or without its presence. There is a congregation of evidence that establishes the incidence of asthma predisposition to be a developing factor for OSA and that this possibility rises with the severity of growing asthma. Similarly, asthma and interrelated conditions, including GER, rhinitis, and obesity, may escalate the chances of OSA progression. There are numerous plausible actions by which asthma and OSA may be linked and by which each circumstance may influence the consequence of the other. There is a dearth of controlled trials in clinical settings substantiating the argument that OSA treatment influences outcomes of asthma control, is also investigated. Exploring the effect of CPAP treatment in asthma, explicitly pointing at bronchial hyperreactivity treatment even in conditions without OSA, may form a nonpharmacologic addition in the management of asthma. It will also encourage an understanding of underlying mechanisms that have not been previously targeted in severe asthma treatments with pharmaceutical approaches.

Lifestyle Modifications for GERD Treatment

The motive of this study was to elucidate the hostile effects of commonly used pharmacological treatment reported in the case of pediatric GERD. A summarized elaboration is presented in the paper of a drug-by-drug basis literature search, concerning their action mechanisms and medical uses. An extensive review based on the reported adverse effects and toxicological aspects of each drug revealed that administration of histamine H2receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) to 23% and 34% of the patients resulted in negative impacts, such as headaches, diarrhea, nausea, and constipation. Acid suppression caused by these drugs, expose the immunologically compromised infants and children to the risk of developing conditions like lower respiratory tract infections and nosocomial sepsis. The paper identifies the principle of “primum nonnocere (’first, do no harm’)” as the primary recommendation which must be applied in these situations of pediatric GERD. Additional suggestions underline the importance of considering nonpharmacological measures for the infants and the children before moving to GERD treatments. In cases where such consideration is deemed unfit or unsuccessful, these prokinetic medications can be used but with proper caution. Their use should be at the lowest dose and frequency, administered for a minimum period, which assists in minimizing the rate and the severity of adverse effects. Constant attention by prescribers and the recording of hostile events should be executed in order to increase awareness and decrease the chances of deterioration.

The current knowledge regarding immune disruption in functional gastrointestinal disorders (FGIDs) has been intricately discussed in this review article. Underlying mechanisms that interlink immune involvement and the cohesion between the diverse manifestations of FGIDs provide the possibility of a novel hypothesis that illustrates the potential immunological pathway associated with these conditions. Recent evidence supports the substantial rise in the circulating lymphocytes of patients experiencing Inflammatory bowel disorders. With a rise in the systemic pro-inflammatory cytokines, gastrointestinal (GI) microbiota may mediate these inflammatory deviations due to newly recognized variations in the gut microbiome of FGID patients. This perhaps indicates that FGID are allied to a disparity in the commensal-immune homeostasis of the body. The latest research on intestinal immunology advocates the non-functional causality of FGIDs, as compared to the functional concept of the origin of FGIDS, shaped mainly by the lack of active inflammation, as is the case in chronic organic conditions, such as IBD. Instead, FGIDs should rather be deliberated as disorders of the dysfunctional intestinal immune system, related to instabilities in the intestinal microbiota. This hypothesis could potentially justify the diversity observed in FGIDs. The inflammation detected in FGIDs is dependable with lower immune activation, presumably indicating a ‘loss of homeostasis’. Systematically, FGIDs may have a similar pathology to obesity. There is an increasing acceleration of inflammatory progressions in obese individuals who display tissue-inflammation of low grade coupled with mental stress. This may be associated with dysbiosis and incorrect triggering of bacterial pattern recognition receptors. As a result, there is a budding interest in evaluating the incidence of FGID within obese populations. Thus, the arrangement of the immune involvement in FGIDs may be aided better by an analysis of what is absent, rather than what is present, permitting a directed therapy for treatment rather than ineffectual symptomatic relief.

This study was piloted to describe the occurrence and severity of gastrointestinal symptoms in group analysis of celiac disease patients treated with long-term diet therapy and to match their results with those observed in short-range treated patients and fit controls. Furthermore, the severity of symptoms was linked with other commonly seen gastrointestinal syndromes by searching the literature. The current management for celiac disease is only devotion to a gluten-free diet for life. Initiation of a stringent diet typically results in discomfort relief, and clinical signs, while reclamation of small-bowel mucosal impairment may require a long time. There is some evidence that several patients encounter ongoing distress of celiac symptoms while sustaining on a gluten-free diet rigorously. These consistent symptoms, regardless of severe dietary constraints, could be frustrating and predispose to reduced dietary adherence worsening the situation further. The main approach of celiac disease appearance during diagnostic steps was further categorized into “gastrointestinal symptoms (e.g., indigestion, diarrhea and signs of malabsorption), extraintestinal symptoms (e.g., dermatitis herpetiformis, dental enamel defects and neurological symptoms) and patients detected by screening at-risk groups (celiac disease in family, type I diabetes, thyroid disease, Sjögren’s syndrome, Addison’s disease and IgA nephropathy)”. Analyis of clinical data and medical history, and dietary adherence were prepared. Symptoms were assessed by the authorized “GSRS questionnaire”. Altogether, a stringent Gluten-free diet and improved mucosa were observed in 93% of the temporarily treated and 94% of the extensively treated patients, respectively. It was shown that the proper clinical reaction in initial stages to a gluten-free diet continue to be long lasting. Nevertheless, physicians need to recognize that a year may not be sufficient to treat the symptoms collectively as certain patients will still be experiencing minor to moderate gastrointestinal symptoms even with firm adherence to a long-term dietary pattern.

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