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1.  GERD assessment including pH metry predicts a high response rate to PPI standard therapy 
BMC Gastroenterology  2013;13:12.
Background
Inadequate response to proton pump inhibitor (PPI) therapy in patients with gastroesophageal reflux disease (GERD) is reported in up to 40%. Patients with non erosive reflux disease (NERD) have lower response rates compared to patients with erosive reflux disease (ERD); pH metry contributes to GERD diagnosis and is critical for proper diagnosis of NERD.
Aim of the study was to assess the need for doubling esomeprazole standard dose (40 mg) for 4 weeks in PPI naive patients with typical reflux symptoms and diagnosis of GERD based on endoscopy and 48 hours, wireless pH metry.
Methods
All patients underwent upper GI endoscopy. Symptoms were recorded with a structured questionnaire (RDQ) and acid exposure was determined by 48 hours, wireless pH monitoring (BRAVO). In case of abnormal acid exposure, patients received a short term treatment with esomeprazole 40 mg q.d. for 4 weeks. If symptoms persisted, patients underwent a second pH metry on PPI and the dose was increased to 40 mg b.i.d.
Results
31 consecutive patients with typical reflux symptoms underwent 48 hours pH monitoring. 22 patients (71%) had abnormal acid exposure, 9 patients had normal pH metry (29%). Of the 9 patients with normal pH metry, 2 were found with erosive esophagitis and 7 without endoscopic abnormalities.
24 patients with documented GERD received esomeprazole treatment. 21 patients achieved complete symptom resolution with 40 mg q.d. after 4 weeks (88%). Only 2 patients required doubling the dose of esomeprazole for complete symptom resolution, 1 patient remained with symptoms.
Conclusions
Patients with typical reflux symptoms and abnormal acid exposure have a high response rate to standard dose esomeprazole regardless of whether they have ERD or NERD.
doi:10.1186/1471-230X-13-12
PMCID: PMC3562521  PMID: 23324360
GERD; NERD; PPI; Esomeprazole; Treatment; ph metry; Diagnosis; Therapy
2.  Role of tight junction proteins in gastroesophageal reflux disease 
BMC Gastroenterology  2012;12:128.
Background
Gastroesophageal reflux disease (GERD) is associated with impaired epithelial barrier function that is regulated by cell-cell contacts. The aim of the study was to investigate the expression pattern of selected components involved in the formation of tight junctions in relation to GERD.
Methods
Eighty-four patients with GERD-related symptoms with endoscopic signs (erosive: n = 47) or without them (non-erosive: n = 37) as well as 26 patients lacking GERD-specific symptoms as controls were included. Endoscopic and histological characterization of esophagitis was performed according to the Los Angeles and adapted Ismeil-Beigi criteria, respectively. Mucosal biopsies from distal esophagus were taken for analysis by histopathology, immunohistochemistry and quantitative reverse-transcription polymerase chain reaction (RT-PCR) of five genes encoding tight junction components [Occludin, Claudin-1, -2, Zona occludens (ZO-1, -2)].
Results
Histopathology confirmed GERD-specific alterations as dilated intercellular spaces in the esophageal mucosa of patients with GERD compared to controls (P < 0.05). Claudin-1 and −2 were 2- to 6-fold upregulation on transcript (P < 0.01) and in part on protein level (P < 0.015) in GERD, while subgroup analysis of revealed this upregulation for ERD only. In both erosive and non-erosive reflux disease, expression levels of Occludin and ZO-1,-2 were not significantly affected. Notably, the induced expression of both claudins did not correlate with histopathological parameters (basal cell hyperplasia, dilated intercellular spaces) in patients with GERD.
Conclusions
Taken together, the missing correlation between the expression of tight junction-related components and histomorphological GERD-specific alterations does not support a major role of the five proteins studied in the pathogenesis of GERD.
doi:10.1186/1471-230X-12-128
PMCID: PMC3503771  PMID: 22994974
Gastroesophageal reflux disease; Tight junction; Claudins; Esophagitis; Inflammation
3.  Serological Prevalence of Helicobacter pylori Infection in Saxony-Anhalt, Germany, in 2010 ▿ 
Clinical and Vaccine Immunology : CVI  2011;18(12):2109-2112.
Epidemiological studies from different countries have shown a steady decline of the prevalence of Helicobacter pylori infection. In order to investigate the current seroprevalence of H. pylori infection in the area of Magdeburg, a city of the former East Germany, H. pylori antibodies of patients presenting in our emergency wards were analyzed. In total, 2,318 patients (1,181 males and 1,137 females) enrolled between September 2009 and August 2010 were tested for immunoglobulin G (IgG) against H. pylori and anti-CagA antibodies by specific enzyme immunoassay (EIA). Patients with either anti-H. pylori IgG or anti-CagA antibodies were classified as H. pylori positive, whereas the lack of both antibodies led to the assignment of an H. pylori-negative status. The overall seroprevalence of H. pylori infection was 44.4% (n = 1,029 out of 2,318) and did not differ in relation to sex. The proportion of CagA-positive samples was 43.3% of all H. pylori-positive individuals (446 out of 1,029). The seroprevalence showed a birth cohort effect (0 to 20 years of age, 14.6%; 21 to 30 years, 22.4%; 31 to 40 years, 40.6%; 41 to 50 years, 45.5%; 51 to 60 years, 50.8%) up to the age of 60, while it remained between 40.7% and 50.5% for the following decades. Patients younger than 30 years were significantly less H. pylori positive (21.1%) than those older than 30 years of age (47.7%; P < 0.01), whereas CagA status was similar (44.3 versus 43.3%). Notably, young women (<30 years old) had significantly higher CagA positivity (59.3%) than corresponding men (32.5%; P = 0.016). Taken together, seroprevalence of H. pylori infection shows a significant drop in subjects born after 1980 in Saxony-Anhalt but still remains in the range of 40 to 50% in subjects born earlier.
doi:10.1128/CVI.05308-11
PMCID: PMC3232689  PMID: 22012975
4.  Inflammatory Myofibroblastic Tumor of the Pancreatic Head: An Unusual Cause of Recurrent Acute Pancreatitis – Case Presentation of a Palliative Approach after Failed Resection and Review of the Literature 
Case Reports in Gastroenterology  2010;4(3):443-451.
Inflammatory myofibroblastic tumors (IMTs) are a rare cause of echo-poor pancreatic head enlargement. Histologically, IMTs are characterized by spindle-shaped myofibroblasts or fibroblasts accompanied by a mixed immune cell infiltration. The most common localizations of IMTs have been reported in lung, mesentery and omentum, especially in children and young adults. IMTs show infiltrating growth, multilocular appearance and also metastasis have been reported. Curative resection is the only therapeutic option so far. In the palliative situation, evident data and clear guidelines for this rare tumor entity are missing. We report on a 44-year-old male with an unresectable IMT of the pancreatic head causing recurrent episodes of acute pancreatitis that resulted in a chronic obstructive course of the disease. The patient entered a palliative therapeutic regimen including radiation therapy and antiinflammatory medication. In a regular follow-up of 12 months, he presented with stable disease after initial progression. This case of local progressive IMT of the pancreatic head was managed with a palliative therapeutic regimen and is discussed based on the current literature.
doi:10.1159/000320953
PMCID: PMC2988857  PMID: 21113286
Inflammatory myofibroblastic tumor; Pancreas; Recurrent acute pancreatitis; Chronic obstructive pancreatitis

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