Tesi etd-06122026-125859 |
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Tipo di tesi
Tesi di laurea magistrale LM6
URN
etd-06122026-125859
Titolo
Refractory GERD Unmasked: Gut–Brain Interaction vs Anti-Reflux Barrier Failure.
Dipartimento
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
MEDICINA E CHIRURGIA
Relatori
.
relatore Prof. de Bortoli, Nicola
correlatore Dott. Visaggi, Pierfrancesco
correlatore Dott. Visaggi, Pierfrancesco
Parole chiave
- AET
- Anti-reflux barrier
- Barrett esophagus
- Endoscopy
- Esophageal disorders
- Esophagitis
- GERD
- Gut-brain interaction
- High resolution manometry
- Milan Score
- MNBI
- Proton pump inhibitors
- Refractory GERD
Data inizio appello
14/07/2026
Consultabilità
Non consultabile
Data di rilascio
14/07/2066
Riassunto (Inglese)
BACKGROUND & AIMS: Esophageal disorders of gut-brain interaction (E-DGBIs) and a residual pathological esophageal acid exposure despite a maximal dose of proton pump inhibitors (PPIs) are the two main important reason of persistent symptoms in patients with proven gastroesophageal reflux disease (GERD) who do not respond to PPIs. The aim of this study was to determine the prevalence and characteristics of confirmed refractory GERD (ReGERD) and E-DGBIs in consecutive patients with refractory reflux symptoms.
METHODS: Patients with typical refractory reflux symptoms and a previous actionable GERD diagnosis were prospectively enrolled. Data on age, sex, main complain, endoscopy, high resolution manometry (to rule out achalasia and to calculate Milan score) pH-impedance monitoring were collected on double dose PPI. Patients were classified as proven GERD, E-DGBI alone, ReGERD, and overlap between GERD and E-DGBI. All data are reported as median and IQR.
RESULTS: we enrolled 44 patients (18 female, aged 62yrs, BMI 24.1): 28 (63.6%) had GERD with E-DGBI overlap (8 female; age 56yrs; BMI 23) and 16 (36.4%) had Refractory GERD (10 female; age 64.5yrs; BMI 27.3). At baseline the proven GERD diagnosis was made with upper endoscopy in 15 patients (5 Barrett esophagus; 9 grade C esophagitis; 1 grade D esophagitis) and 29 patients with pathophysiologic test: AET 11 (8.6-17.4), with MNBI 953 (763-1131) and Milan score 178.5 (156.7-197). No difference at baseline in terms of AET (p=0.733) or MNBI (p=0.734). Milan score was significantly higher in Re-GERD compared to E-DGBI (p=0.[EOT]). No difference in term of symptom presentation or response to PPI treatment.
CONCLUSIONS: Esophageal-DGBI is the most frequent reason of persistent symptoms in patients with proven GERD and appropriate acid suppression. No clinical or reflux related parameter reliably distinguished E-DGBI overlap from true refractory GERD. Only a significantly higher Milan score consistently identified confirmed refractory GERD, supporting impaired anti-reflux barrier integrity as its defining mechanism.
METHODS: Patients with typical refractory reflux symptoms and a previous actionable GERD diagnosis were prospectively enrolled. Data on age, sex, main complain, endoscopy, high resolution manometry (to rule out achalasia and to calculate Milan score) pH-impedance monitoring were collected on double dose PPI. Patients were classified as proven GERD, E-DGBI alone, ReGERD, and overlap between GERD and E-DGBI. All data are reported as median and IQR.
RESULTS: we enrolled 44 patients (18 female, aged 62yrs, BMI 24.1): 28 (63.6%) had GERD with E-DGBI overlap (8 female; age 56yrs; BMI 23) and 16 (36.4%) had Refractory GERD (10 female; age 64.5yrs; BMI 27.3). At baseline the proven GERD diagnosis was made with upper endoscopy in 15 patients (5 Barrett esophagus; 9 grade C esophagitis; 1 grade D esophagitis) and 29 patients with pathophysiologic test: AET 11 (8.6-17.4), with MNBI 953 (763-1131) and Milan score 178.5 (156.7-197). No difference at baseline in terms of AET (p=0.733) or MNBI (p=0.734). Milan score was significantly higher in Re-GERD compared to E-DGBI (p=0.[EOT]). No difference in term of symptom presentation or response to PPI treatment.
CONCLUSIONS: Esophageal-DGBI is the most frequent reason of persistent symptoms in patients with proven GERD and appropriate acid suppression. No clinical or reflux related parameter reliably distinguished E-DGBI overlap from true refractory GERD. Only a significantly higher Milan score consistently identified confirmed refractory GERD, supporting impaired anti-reflux barrier integrity as its defining mechanism.
Riassunto (Italiano)
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