Su1813 The Effects of Long-Term Therapy With Proton Pump Inhibitors (PPIs) on Meal Stimulated Gastrin

Autor: Andrew D. Rhim, Yu-Xiao Yang, Einar Bjornsson, David C. Metz, Holmfridur Helgadottir
Rok vydání: 2013
Předmět:
Zdroj: Gastroenterology. 144:S-480
ISSN: 0016-5085
Popis: Background: There are a limited number of studies on the prevalence of gastroesophageal reflux disorder (GERD) in persons with spinal cord injury (SCI), and those performed have shown conflicting results reporting prevalence ranging from 15-86%, compared to the reported 20-40% in the healthy able-bodied population. Difficulty in diagnosing GERD in the SCI population based on self report is compounded by the loss of sensory innervation. Methods: 24-hour pH and impedence monitoring (Digitrapper pH-Z, Given Imaging, Yokneam, Israel), was performed in 11 with SCI; all subjects were not currently taking medications which would alter stomach acidity. A multiple sensor catheter was introduced into the esophagus of each subject and secured at 5 cm above the high pressure zone of the LES (as determined by a previous motility study) after checking the stomach for acidity (pH ,3.0). A Demeester Score (DS), which measures the exposure of the esophagus to pH level below 4.0, was calculated for each subject. A positive GERD test was defined by a DS ≥ 14.72. A GERD questionnaire was administered consisting of the likert scale items: (nighttime) chest pain, coughing, antacid use, chest and throat discomfort, hoarse voice, sensation of a lump in the throat after eating, shortness of breath, nausea and belching. Results: In the SCI group, 7 of the 11 subjects (64%) tested positive for GERD according to DS values. Mean ± SD for DS for SCI groups delineated by level of injury (LOI) are as follows; tetraplegia (LOI between C5-7) = 15.7 ±18.3, high paraplegia (HP) (LOI between T4-6)= 49.7 ± 68.6 and low paraplegia (LP) (LOI between T8-10)= 32.9 ±28.8. Mean ± SD for total number of reflux episodes corresponded; tetraplegia= 62 ±84, HP= 660 ± 846 and LP= 153 ±149. Using impedence data, one additional individual with SCI was identified who scored above the normal threshold (number of total reflux episodes .73) for nonacidic gastroesophageal reflux; the range of the total number of reflux episodes for all subjects was 2-100 episodes, with a mean score of 27 episodes. 1 of 11 subjects reported occasional chest pain and chest and throat discomfort; no other symptoms were reported. Conclusion: Our study revealed a high prevalence of GERD in persons with SCI despite a low rate of reported symptoms. This indicates that GERD is a prominent problem in this population and less likely to be clinically diagnosed due to underreporting of symptoms stemming from lack of sensory input. This is especially problematic in this population, given the state of chronic respiratory weakness and propensity to microaspiration of reflux materials. This could result in a state of chronic inflammation and a higher rate of respiratory infections and subsequent hospitalizations.
Databáze: OpenAIRE
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