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Gastroesophageal Reflux Disease and Esophageal Motility Disorders

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Gastroenterology & Hepatology".

Deadline for manuscript submissions: closed (28 February 2025) | Viewed by 26133

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Dr. Almantas Maleckas

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1. Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2. Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
Interests: surgery of GERD and esophageal motility disorders; minimally invasive esophageal and gastric surgery; esophageal carcinoma; gastric carcinoma; bariatric surgery; metabolic surgery

Special Issue Information

Dear Colleagues,

Gastroesophageal reflux disease (GERD) and esophageal motility disorders are benign conditions that have significant impacts on quality of life. The prevalence of GERD is high in the general population and treatment may vary from pharmacological acid suppression to surgical intervention if hiatal hernia is present. The treatment of PPI-resistant GERD is debatable, and surgery can be offered if GERD symptoms are recalcitrant, including pronounced regurgitation. Barrett esophagus is a severe complication of chronic GERD. The endoscopic surveillance of Barrett esophagus is essential for the early detection of dysplasia and adenocarcinoma. Minimally invasive nonendoscopic diagnostic tools are currently being developed, and the main treatment is endoscopic resection and ablation. Obesity is an important risk factor for the development of GERD and GERD-related complications. The impact of weight loss procedures on existing GERD or de novo GERD are still under investigation. High-resolution manometry is key to diagnosing primary esophageal motility disorders, but their pathogenesis is still mysterious and classification is based on changes in motility rather than histological characteristics. The most common esophageal motility disorder is achalasia. The treatment is concentrated on reducing resistance to outflow in the lower esophageal sphincter by different medical and surgical therapies. Another important aspect is the treatment after failed surgical procedures performed for GERD or achalasia. More data about diagnostics and repeated surgical interventions are needed.

This Special Issue aims to present current trends in the diagnosis and treatment of GERD and esophageal motility disorders. We welcome the submission of cutting-edge research on topics including the long-term effects of GERD treatment with PPIs and surgical procedures, newer minimally invasive modalities in GERD treatment, nonendoscopic diagnostics of Barrett esophagus, results of the endoscopic treatment of Barrett esophagus, the impact of weight loss surgery on GERD, the pathogenesis of esophageal motility disorders, and the diagnosis and treatment of GERD and esophageal motility disorders after failed surgical interventions. We are soliciting original research and review articles.

Dr. Almantas Maleckas
Guest Editor

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Keywords

gastroesophageal reflux disease
esophageal motility disorders
Barrett esophagus
achalasia
obesity

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Published Papers (8 papers)

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Research

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10 pages, 1579 KiB

Open AccessArticle

Real-World Clinical Utility of a Methylated DNA Biomarker Assay on Samples Collected with a Swallowable Capsule-Balloon for Detection of Barrett’s Esophagus (BE)

by Dan Lister, Andy Fine, Shail Maheshwari, Paul S. Bradley, Kimberly Lister, Victoria T. Lee, Brian J. deGuzman, Suman Verma and Lishan Aklog

Medicina 2024, 60(12), 2052; https://doi.org/10.3390/medicina60122052 - 13 Dec 2024

Viewed by 1160

Abstract

Background: Barrett’s Esophagus (BE) is the only known precursor for esophageal adenocarcinoma (EAC). Patients with multiple risk factors for BE/EAC are recommended for screening; however, few eligible patients undergo evaluation by endoscopy. EsoGuard^® (EG) is a commercially available biomarker assay used to analyze esophageal cells collected non-endoscopically with EsoCheck^® (EC) for the qualitative detection of BE/EAC. This study evaluates the real-world clinical utility of EG on cells collected with EC in patients defined by U.S. gastroenterology societies to be at-risk for BE and EAC. Methods: This multi-center, observational CLinical Utility of EsoGuard (CLUE) study enrolled screening-eligible patients as defined by the American College of Gastroenterology (ACG) and the American Gastroenterological Association (AGA). Clinical utility was evaluated by the provider decision impact of EG and additionally by assessing patient compliance outcomes with recommended follow-up testing. Results: There were 551 patients enrolled, with a mean age of 62.0 ± 12.4 years and 56.1% (309/551) meeting ACG guideline criteria for BE screening. EC cell collection was successful in 97.1% (535/551), among which the EG positivity rate was 27.3% (n = 146). The provider decision impact was high, with 100% of EG-positive patients being referred for esophagogastroduodenoscopy (EGD), while 98% of EG negative patients were not referred. Among the EG-positive patients, the overall compliance with follow-up EGD was 85.4%. Conclusions: Combining EC non-endoscopic esophageal cell collection with the EG biomarker assay is effective in guiding provider decision-making for the detection of BE and EAC. Patients with positive EG results demonstrate high compliance with recommended follow-up EGD. Full article

(This article belongs to the Special Issue Gastroesophageal Reflux Disease and Esophageal Motility Disorders)

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14 pages, 2702 KiB

Open AccessArticle

Gemini-Assisted Deep Learning Classification Model for Automated Diagnosis of High-Resolution Esophageal Manometry Images

by Stefan Lucian Popa, Teodora Surdea-Blaga, Dan Lucian Dumitrascu, Andrei Vasile Pop, Abdulrahman Ismaiel, Liliana David, Vlad Dumitru Brata, Daria Claudia Turtoi, Giuseppe Chiarioni, Edoardo Vincenzo Savarino, Imre Zsigmond, Zoltan Czako and Daniel Corneliu Leucuta

Medicina 2024, 60(9), 1493; https://doi.org/10.3390/medicina60091493 - 13 Sep 2024

Cited by 5 | Viewed by 1802

Abstract

Background/Objectives: To develop a deep learning model for esophageal motility disorder diagnosis using high-resolution manometry images with the aid of Gemini. Methods: Gemini assisted in developing this model by aiding in code writing, preprocessing, model optimization, and troubleshooting. Results: The model demonstrated an overall precision of 0.89 on the testing set, with an accuracy of 0.88, a recall of 0.88, and an F1-score of 0.885. It presented better results for multiple categories, particularly in the panesophageal pressurization category, with precision = 0.99 and recall = 0.99, yielding a balanced F1-score of 0.99. Conclusions: This study demonstrates the potential of artificial intelligence, particularly Gemini, in aiding the creation of robust deep learning models for medical image analysis, solving not just simple binary classification problems but more complex, multi-class image classification tasks. Full article

(This article belongs to the Special Issue Gastroesophageal Reflux Disease and Esophageal Motility Disorders)

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11 pages, 472 KiB

Open AccessArticle

Comparative Prevalence of Ineffective Esophageal Motility: Impact of Chicago v4.0 vs. v3.0 Criteria

by Teodora Surdea-Blaga, Stefan-Lucian Popa, Cristina Maria Sabo, Radu Alexandru Fărcaş, Liliana David, Abdulrahman Ismaiel, Dan Lucian Dumitrascu, Simona Grad and Daniel Corneliu Leucuta

Medicina 2024, 60(9), 1469; https://doi.org/10.3390/medicina60091469 - 8 Sep 2024

Viewed by 1581

Abstract

Background and Objectives: The threshold for ineffective esophageal motility (IEM) diagnosis was changed in Chicago v4.0. Our aim was to determine IEM prevalence using the new criteria and the differences between patients with definite IEM versus “inconclusive diagnosis”. Materials and Methods: We retrospectively selected IEM and fragmented peristalsis (FP) patients from the high-resolution esophageal manometries (HREMs) database. Clinical, demographic data and manometric parameters were recorded. Results: Of 348 HREMs analyzed using Chicago v3.0, 12.3% of patients had IEM and 0.86% had FP. Using Chicago v4.0, 8.9% of patients had IEM (IEM-4 group). We compared them with the remaining 16 with an inconclusive diagnosis of IEM (borderline group). Dysphagia (77% vs. 44%, Z-test = 2.3, p = 0.02) and weight loss were more commonly observed in IEM-4 compared to the borderline group. The reflux symptoms were more prevalent in the borderline group (87.5% vs. 70.9%, p = 0.2). Type 2 or 3 esophagogastric junction morphology was more prevalent in the borderline group (81.2%) vs. 64.5% in IEM-4 (p = 0.23). Distal contractile integral (DCI) was lower in IEM-4 vs. the borderline group, and resting lower esophageal sphincter (LES) pressure and mean integrated relaxation pressure (IRP) were similar. The number of ineffective swallows and failed swallows was higher in IEM-4 compared to the borderline group. Conclusions: Using Chicago v4.0, less than 10% of patients had a definite diagnosis of IEM. The dominant symptom was dysphagia. Only DCI and the number of failed and inefficient swallows were different between definite IEM patients and borderline cases. Full article

(This article belongs to the Special Issue Gastroesophageal Reflux Disease and Esophageal Motility Disorders)

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10 pages, 270 KiB

Open AccessArticle

GERD after Roux-en-Y Gastric Bypass: Prevalence and Risk Factors Analysis

by Matas Pažusis, Gabrielė Gerasimovič, Rūta Petereit, Rita Gudaitytė and Almantas Maleckas

Medicina 2024, 60(8), 1221; https://doi.org/10.3390/medicina60081221 - 28 Jul 2024

Cited by 2 | Viewed by 1841

Abstract

Background and Objectives: The prevalence of GERD is increasing among individuals with obesity, and RYGB is an effective procedure to control GERD and obesity. However, some patients continue to have GERD after RYGB. The aim of this study was to investigate the prevalence and the risk factors for GERD after RYGB. Material and Methods: This prospective study included 180 RYGB patients followed for an average of 12.2 (0.6) years. In total, 126 (70%) patients agreed to participate and provided data on their weight, GERD symptoms, and filled the GERD-HRQL, TFEQ-18, and GSRS questionnaires. Results: The average age before surgery was 42.7 (10.5) years, and BMI was 45.2 (6.4) kg/m². Moreover, 128 (71.1%) were females, and preoperative GERD was diagnosed in 74 (41.1%) patients. At the 12-year follow-up, the mean %EBMIL and %TWL was 60.37 and 25.73, respectively. The median %WR was 18.0 (39.0). Postoperative GERD was present in 30 (23.8%) patients, of whom 12 (40%) continued to have GERD symptoms and 18 (60%) developed de novo GERD. The GERD-HRQL score significantly decreased from 3.0 (9.0) at baseline to 2.0 (5.0) (p = 0.028) at 12 years. GSRS Diarrhea and Indigestion scores increased significantly from 1.33 (0.67) to 1.5 (2.42) (p < 0.001) and from 2.0 (1.25) to 2.25 (1.25) (p < 0.001), respectively. No change in the cognitive restraint score was observed. Uncontrolled eating and emotional eating scores decreased from 51.85 (22.22) to 40.74 (33.33) (p < 0.001) and from 44.44 (44.44) to 33.33 (22.22) (p < 0.001), respectively. In the multivariate analysis, %WR > 11 (OR = 3.22, p = 0.029) and GSRS Diarrhea score (OR = 3.21, p = 0.027) were significant predictors of GERD 12 years after RYGB. Conclusions: RYGB was an effective procedure to control GERD; however, 23.8% had persistent or de novo GERD after 12 years. The independent risk factors associated with GERD after RYGB were weight regain and GSRS Diarrhea score. Full article

(This article belongs to the Special Issue Gastroesophageal Reflux Disease and Esophageal Motility Disorders)

17 pages, 689 KiB

Open AccessArticle

Endoscopic Resections for Barrett’s Neoplasia: A Long-Term, Single-Center Follow-Up Study

by Per Löfdahl, Anders Edebo, Mats Wolving and Svein Olav Bratlie

Medicina 2024, 60(7), 1074; https://doi.org/10.3390/medicina60071074 - 30 Jun 2024

Viewed by 1290

Abstract

Background and Objectives: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are both well-established and effective treatments for dysplasia and early cancer in Barrett’s esophagus (BE). This study aims to compare the short- and long-term outcomes associated with these procedures in treating Barrett’s neoplasia. Materials and Methods: This single-center retrospective cohort study included 95 patients, either EMR (n = 67) or ESD (n = 28), treated for Barrett’s neoplasia at Sahlgrenska University Hospital between 2004 and 2019. The primary outcome was the complete (en-bloc) R0 resection rate. Secondary outcomes included the curative resection rate, additional endoscopic resections, adverse events, and overall survival. Results: The complete R0 resection rate was 62.5% for ESD compared to 16% for EMR (p < 0.001). The curative resection rate for ESD was 54% versus 16% for EMR (p < 0.001). During the follow-up, 22 out of 50 patients in the EMR group required additional endoscopic resections (AERs) compared to 3 out of 21 patients in the ESD group (p = 0.028). There were few adverse events associated with both EMR and ESD. In both the stratified Kaplan–Meier survival analysis (Log-rank test, Chi-square = 2.190, df = 1, p = 0.139) and the multivariate Cox proportional hazards model (hazard ratio of 0.988; 95% CI: 0.459 to 2.127; p = 0.975), the treatment group (EMR vs. ESD) did not significantly impact the survival outcomes. Conclusions: Both EMR and ESD are effective and safe treatments for BE neoplasia with few adverse events. ESD resulted in higher curative resection rates with fewer AERs, indicating its potential as a primary treatment modality. However, the survival analysis showed no difference between the methods, highlighting their comparable long-term outcomes. Full article

(This article belongs to the Special Issue Gastroesophageal Reflux Disease and Esophageal Motility Disorders)

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9 pages, 1185 KiB

Open AccessArticle

Impact of Age on Long-Term Outcomes of Laparoscopic Nissen Fundoplication—A Single Center Study

by Natalia Dowgiałło-Gornowicz, Justyna Kacperczyk, Anna Masiewicz, Karolina Osowiecka and Paweł Lech

Medicina 2024, 60(5), 688; https://doi.org/10.3390/medicina60050688 - 24 Apr 2024

Cited by 1 | Viewed by 3832

Abstract

Background and objectives: Gastroesophageal reflux disease (GERD) is a common disease affecting approximately 20% of the adult population. This study aimed to compare the results of laparoscopic Nissen fundoplication (LNF) in the treatment of GERD in patients of different age groups. Materials and Methods: A retrospective analysis was performed on patients who underwent LNF in one surgical department between 2014 and 2018. Patients were divided into three groups based on age: under 40 years of age, 40–65 years of age, and over 65 years of age. Results: A total of 111 patients (44.1% women) were analyzed in this study. The mean age was 50.2 ±15 years, and the mean follow-up was 50 months ± 16.6 months. Recurrence of symptoms occurred in 23%, 20%, and 23% in each age group, respectively (p = 0.13), and 85%, 89%, and 80% of patients from the respective groups reported that they would recommend the surgery to their relatives (p = 0.66). Furthermore, 83%, 92%, and 73% of patients from the respective age groups reported that they would undergo the surgery again with the knowledge they now had (p = 0.16). Conclusions: Given these results and observations, LNF has been shown to be a good method of treatment for GERD in every age group. In our study, there were no differences found in terms of satisfaction with surgery and associated recommendations between the studied age groups. Full article

(This article belongs to the Special Issue Gastroesophageal Reflux Disease and Esophageal Motility Disorders)

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10 pages, 1025 KiB

Open AccessArticle

A Three-Arm Randomized Controlled Trial of Primary One-Anastomosis Gastric Bypass: With FundoRing or Nissen Fundoplications vs. without Fundoplication for the Treatment of Obesity and Gastroesophageal Reflux Disease

by Oral Ospanov, Nurlan Zharov, Bakhtiyar Yelembayev, Galymjan Duysenov, Irina Volchkova, Kassymkhan Sultanov and Adil Mustafin

Medicina 2024, 60(3), 405; https://doi.org/10.3390/medicina60030405 - 27 Feb 2024

Cited by 2 | Viewed by 2755

Abstract

Background and Objectives: Obesity and gastroesophageal reflux disease (GERD) are steadily increasing world weight and antireflux surgery must be performed simultaneously with bariatric surgery in obese patients. The purpose of this study is to compare bariatric and antireflux results after OAGB with different methods of fundoplication using the excluded stomach and without fundoplication. Materials and methods: This open-label, randomized, parallel three-arm trial was conducted from March 2019 and December 2021. All patients underwent laparoscopic one-anastomosis gastric bypass and suture cruroplasty, and then had a follow-up at 24 months. Group 1 of patients had fundoplication FundoRing using the excluded stomach (FundoRingOAGB); Group 2, with Nissen fundoplication using the excluded stomach (NissenOAGB); and Group 3, without fundoplication (OAGB). We studied changes in BMI, GERD symptoms (GERD-HRQL), and the VISICK score. Results: Of 219 participants screened, 150 were randomly allocated to 3 groups: FundoRingOAGB group (n = 50), NissenOAGB group (n = 50), and OAGB group (n = 50). At post-treatment month 24, BMI changes were as follows: from 40.7 ± 5.9 (31–53) to 24.3 ± 2.8 (19–29) kg/m² in FundoRingOAGB group; from 39.9 ± 5.3 (32–54) to 26.3 ± 2.9 (23–32) kg/m² in Nissen group; and from 40.9 ± 6.2 (32–56) to 28.5 ± 3.9 (25–34) kg/m² in OAGB group. The mean pre-operative GERD-HRQL heartburn score improved post-op in FundoRingOAGB group from 20.6 ± 2.24 (19.96, 21.23) to 0.44 ± 0.73 (0.23, 0,64); in NissenOAGB group from 21.34 ± 2.43 (20.64, 22.03) to 1.14 ± 1.4 (0.74, 1.53); and in OAGB group 20.5 ± 2.17 (19.9, 21.25) to 2.12 ± 1.36 (1.73, 2.5). GERD-HRQL total scores were from pre-op 25.2 ± 2.7 (24.4, 25.9) to 4.34 ± 1.3 (3.96, 4.7) post-op in FundoRingOAGB group; 24.8 ± 2.93 (24, 25.67) pre-op to 5.42 ± 1.7 (4.9, 5.9) in the NissenOAGB group; and from 21.46 ± 2.7 (20.7, 22.2) to 7.44 ± 2.7 (6.6, 8.2) in the OAGB group. The mean VISICK score improved from 3.64 ± 0.94 (3.7, 3.9) to 1.48 ± 1.26 (1.12, 1.84) in FundoRingOAGB, from 3.42 ± 0.97 (3.1, 3,7) to 2.5 ± 1.46 (2.06, 2.9) in NissenOAGB group and from 3.38 ± 0.88 (3.1, 3,69) to 2.96 ± 1.19 (2.62, 3.2) in OAGB group. Conclusions: Antireflux and bariatric results of FundoRingOAGB are better than using the NissenOAGB method and significantly better than OAGB without the use of fundoplication. Full article

(This article belongs to the Special Issue Gastroesophageal Reflux Disease and Esophageal Motility Disorders)

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27 pages, 5151 KiB

Open AccessFeature PaperReview

Endoscopic Advances in the Diagnosis and Management of Gastroesophageal Reflux Disease

by Priyadarshini Loganathan, Mahesh Gajendran, Abhilash Perisetti, Hemant Goyal, Rupinder Mann, Randy Wright, Shreyas Saligram, Nirav Thosani and Chandraprakash Umapathy

Medicina 2024, 60(7), 1120; https://doi.org/10.3390/medicina60071120 - 11 Jul 2024

Cited by 2 | Viewed by 10933

Abstract

Gastroesophageal reflux disease (GERD) is one of the most common diseases that occurs secondary to failure of the antireflux barrier system, resulting in the frequent and abnormal reflux of gastric contents to the esophagus. GERD is diagnosed in routine clinical practice based on the classic symptoms of heartburn and regurgitation. However, a subset of patients with atypical symptoms can pose challenges in diagnosing GERD. An esophagogastroduodenoscopy (EGD) is the most common initial diagnostic test used in the assessment for GERD, although half of these patients will not have any positive endoscopic findings suggestive of GERD. The advanced endoscopic techniques have improved the diagnostic yield of GERD diagnosis and its complications, such as Barrett’s esophagus and early esophageal adenocarcinoma. These newer endoscopic tools can better detect subtle irregularities in the mucosa and vascular structures. The management options for GERD include lifestyle modifications, pharmacological therapy, and endoscopic and surgical interventions. The latest addition to the armamentarium is the minimally invasive endoscopic interventions in carefully selected patients, including the electrical stimulation of the LES, Antireflux mucosectomy, Radiofrequency therapy, Transoral Incisionless Fundoplication, Endoscopic Full-Thickness plication (GERDx™), and suturing devices. With the emergence of these advanced endoscopic techniques, it is crucial to understand their selection criteria, advantages, and disadvantages. Full article

(This article belongs to the Special Issue Gastroesophageal Reflux Disease and Esophageal Motility Disorders)

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