Abstract:
BACKGROUND:Nocturnal gastroesophageal reflux disease (GERD) has been associated with severe complications including erosive esophagitis, peptic stricture, and even esophageal adenocarcinoma and is known to cause a decreased health-related quality of life. However, there is limited information on independent predictors of nocturnal GERD. AIM:The aim of this study was to examine the relationship between nocturnal GERD and patient demographics, symptoms, clinical and endoscopic findings. METHODS:Consecutive patients presenting to the gastrointestinal endoscopy unit for evaluation of GERD symptoms undergoing index endoscopy were asked to complete a validated GERD questionnaire. Demographics, clinical features, and endoscopic findings were recorded. Nocturnal GERD was defined as awakening at night by heartburn or acid regurgitation. Patient factors were compared using χ and Mann-Whitney U test. All factors that were statistically significant (P<0.05) were entered into a stepwise logistic regression to evaluate for independent predictors of nocturnal GERD. RESULTS:Of 908 GERD patients evaluated, 665 (73.2%) reported nocturnal symptoms. The majority of the patients were male (93%) and White (83%) with a mean age of 57.2 years (SD 12.7). On univariate analysis, younger age, higher body mass index, daily heartburn, heartburn duration of >5 years, severe heartburn, daily regurgitation, regurgitation duration >5 years (all P<0.05), and presence of hiatal hernia (P=0.02) were significantly associated with the presence of nocturnal GERD. On multivariate analysis, severe heartburn [3.3 (2.1 to 5.1), P<0.01] and daily heartburn [1.5(1.1 to 2.3), P=0.03], daily regurgitation [2.2 (1.1 to 4.2), P=0.025], and regurgitation duration of >5 years [1.7 (1.2 to 2.4), P<0.01], and presence of hiatal hernia [1.4 (1.1 to 2.0), P=0.03] were all independent risk factors for nocturnal GERD. CONCLUSIONS:Results of this large prospective cohort study of GERD patients suggest that nocturnal symptoms are reported by 3 quarters of patients. Patients with frequent and severe daytime symptoms are significantly more likely to experience nocturnal symptoms. There was no significant difference in the prevalence of Barrett esophagus between patients with and without nocturnal GERD. Finally, presence of a hiatus hernia on endoscopy is also an independent risk factor for nocturnal GERD.
journal_name
J Clin Gastroenteroljournal_title
Journal of clinical gastroenterologyauthors
Gaddam S,Maddur H,Wani S,Gupta N,Singh M,Singh V,Moloney B,Puli SR,Rastogi A,Bansal A,Sharma Pdoi
10.1097/MCG.0b013e318205e164subject
Has Abstractpub_date
2011-10-01 00:00:00pages
764-8issue
9eissn
0192-0790issn
1539-2031journal_volume
45pub_type
杂志文章abstract::The epithelial cells of the stomach and duodenum are normally protected from the damaging effects of acid and pepsin by a balancing mechanism of mucosal resistance. If an imbalance occurs, peptic ulcer may result. Traditional teaching has emphasized the importance of acid (and pepsin) as the cause of this imbalance; h...
journal_title:Journal of clinical gastroenterology
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abstract::To test our hypothesis that the erythrocytic sedimentation rate (ESR) correlates well with clinical activity in inflammatory disease of the colon, but not of the small bowel, we stratified 49 Crohn's disease patients according to their anatomic involvement and then measured the correlations between ESR and clinical ac...
journal_title:Journal of clinical gastroenterology
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