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- by
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- Complementary and Alternative Medicine, Melatonin, Gerd, Nutritional Medicine

Groundwater is a valuable source in Egypt. However, it is expected to face many challenges in next few decades due to climate changes, rapid population increase and development in the upper Nile Basin countries. All of these factors are putting more stresses on this source. Groundwater sector in Egypt is expected to suf er of rapid declination in levels due to the reduction of water recharge in the renewable aquifers (Nile Valley and Delta aquifers). This decline is expected due to climate change (on the long term) and due to GERD reservoir filling and operation stages (on the short term), which will cut large volumes of water which used to reach to Egypt from August to October/November.
Moreover, the availability of the water all the year time and turning the flow into controlled instead of natural flow will encourage for more uses of the water in Sudan, which means more shortage in water supply to Egypt. Such decline in surface water source will put more pressure on the renewable and non-renewable aquifers in Egypt. Other concerns, due to decline of surface water, are seawater intrusion and land salinization which will af ect the groundwater quality and adversely af ect the agricultural activities and production

- by IAEME Publication
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- Groundwater, Water Management, Gerd, Saltwater Intrusion

Hydro-politics the controversy over the Grand Ethiopian Renaissance Dam (GERD)

- by Dan Mbaria
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- Watershed Hydrology, Hydropolitics, Gerd, Hydropolitics In the Nile Basin

Laporan LP & LK GERD by Firdaus Nurul Azmi

- by Oktaviani Rahayu
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- Askep, Gerd, Resume Writing, Laporan Praktikum

A previous anecdotal survey of acid reflux patients (Aspiration of Upper Oesophageal Reflux – August 2014, Robinson C) had identified over 14 extra-oesophageal reflux symptoms evinced extensively amongst acid refluxers. Based on those findings, this study sought to confirm the prevalence of those symptoms and the efficacy of Acid Suppressant Medication and Anti-Reflux Surgery to manage them. Conclusion. Two thirds of patients on ASM still suffered with symptoms of EOR whilst ARS reduced symptoms by 57%. Recommendation: Patients predominantly exhibiting reflux symptoms should be considered for anti-reflux intervention rather than continued acid suppressant medication. Methodology Three parallel surveys were set up targetting different patient groups but using the same questions based on a rationalisation of the symptom list established by the 2014 study into 8 symptom groups concentrating on throat, chest, ears, eyes, nose and mouth manifestations. Surveys were set up using Survey Monkey and targetted at different Facebook groups. Analyses and results Survey 1 targetted refluxers from the " Acid Reflux / GERD /LPR " Facebook support group who didn't use daily pre-emptive medication but who may use occasional on-demand antacids as and when required. Over the collection period, 51 responses were garnered. As will be seen in Table 1, throat symptoms were most commonly identified with 63% reporting hoarseness, sore throat, loss of voice, throat clearing as a symptom. The prevalence of the other symptom categories may be seen in table 1: 45% reporting globus, 43% post nasal drip, sinusitis of catarrh, 33% bad breath or taste in mouth, 31% dry or gritty eyes, 31% ear problems: waxing, glue ear, tinnitus or dizziness, 27% chest complaints, cough or asthma like symptoms and 22% dental problems. Survey 2 targetted refluxers using daily medication from the " Barretts Esophagus Awareness " Facebook group. An initial question identified their usage of H2 blockers or Proton Pump Inhibitors at different doses. The maximum 100 responses were collected within 24 hours. Of those, 5 relied on H2 blockers, 13 on low dose PPI, 44 on high dose PPI (with 2 using H2 blockers to supplement) and 37 on high dose PPI (with 4 using H2 blockers to supplement). (A medium dose was identified as 20mg omeprazole = 30mg lansoprazole = 40mg pantoprazole = 20mg rabeprazole = 20mg esomeprazole = 30mg dexlansoprazole with anything less regarded as low dose and anything more as high dose.)

- by Chris Robinson
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- Reflux, Gerd, Esophagitis, Barrett's esophagus

Obat penghilang bau mulut karena asam lambung naik "JELLY GAMAT QNC" Solusi cara menghilangkan bau mulut karena asam lambung naik terbukti mujarab ,100% Aman Utk semua usia termasuk untuk ibu hamil & ibu menyusui, Proses penyembuhannya pun 3X LEBIH CEPAT, Mampu hilangkan bau mulut akibat kadar asam lambung tinggi/naik, Mengatasi radang dan infeksi lambung, Menyembuhkan sakit maag dan tukak lambung, Serta mengobati berbagai masalah lambung lainnya.( Sumber: https://lapakkesehatanherbal.blogspot.com/2018/12/cara-menghilangkan-bau-mulut-karena.html )

- by Jujun Dai
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- Internet Marketing, The Internet, Gerd, Kesehatan
- by THE STETHO
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- Heartburn, Gerd, Gastritis, Acif Reflux

BACKGROUND: Hiatal hernia repair (HHR) is still controversial during bariatric procedures, especially in case of laparoscopic sleeve gastrectomy (LSG). Aims: to report the long-term results of concomitant HHR, evaluating the safety and efficacy of posterior cruroplasty (PC), simple or reinforced with biosynthetic, absorbable Bio-A® mesh (Gore, Flagstaff, AZ, USA). Primary endpoint: PC’s failure, defined as symptomatic HH recurrence, nonresponding to medical treatment and requiring revisional surgery.
METHODS: The prospective database of 1876 bariatric operations performed in a center of excellence between 2011-2019 was searched for concomitant HHR. Intraoperative measurement of the hiatal surface area (HSA) was performed routinely.
RESULTS: A total of 250 patients undergone bariatric surgery and concomitant HHR (13%). Simple PC (group A, 151 patients) was performed during 130 LSG, 5 re-sleeves and 16 gastric bypasses; mean BMI 43.4±5.8 kg/m2, HSA mean size 3.4±2 cm2. Reinforced PC (group B) was performed in 99 cases: 62 primary LSG, 22 LGB and 15 revisions of LSG; mean BMI 44.6±7.7 kg/m2, HSA mean size 6.7±2 cm2. PC’s failure, with intrathoracic migration (ITM) of the LSG was encountered in 12 cases (8%) of simple vs. only 4 cases (4%) of reinforced PC (P=0.23); hence, a repeat, reinforced PC and R-en-Y gastric bypass (LRYGB) was performed laparoscopically in all cases. No mesh-related complications were registered perioperatively or after long-term follow-up (mean 50 months). One case of cardiac metaplasia without goblet cells was detected 4 years postoperatively; conversion to LRYGB, with reinforced redo of the PC was performed. The Cox hazard analysis showed that the use of more than four stitches for cruroplasty represents a negative factor on recurrence (HR=8; P<0.05).
CONCLUSIONS: An aggressive search for and repair of HH during any bariatric procedure seems advisable, allowing a low HH recurrence rates. Additional measures, like mesh reinforcement of crural closure with biosynthetic, absorbable mesh, seem to improve results on long term follow-up, especially in case of larger hiatal defects. In our experience, reinforcement of even smaller defects seems advisable in obese population.

- by Cristian E Boru
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- Bariatric Surgery, Gerd, Hiatal hernia

Gastroesophageal reflux disease (GERD) is a common and chronic gastrointestinal disorder with a significant negative impact on health-related quality of life. Gastroesophageal refers to the stomach and oesophagus. Reflux means to flow back or return. Therefore, gastroesophageal reflux is the return of the stomach's contents back up into the oesophagus and mouth. Our mouth is the mirror that can reflect the overall health of our body. It has long been believed that the mouth is an easily accessible window of the body perhaps because the health status of our mouth can give us a strong indication of the health of our body. This article highlights the potential effects of Gastroesophageal reflux disease (GERD) on the general and oro-dental health.

- by Ashutosh Shukla
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- Management, Mathematics, Statistics, Toxicology

Background: Gastro-esophageal Reflux disorder is return of the stomach's contents back up into the esophagus. Whereas diabetes is a metabolic disorder in which there is either no production of insulin or there is resistance to insulin being produced by body. Objectives: The aim of the systematic review is to study the pharmacotherapeutic consideration of GERD among elderly type 2 diabetes patients. Methods: This study analyzed 15 articles identified and selected according to the study criteria. PRISMA guidelines were used for identification and screening of literature. Data search covered several primary databases, including PubMed/MedLine, Wiley library, Scopus, Clinical Trial Registry, etc. Result and Findings: The data shows obese patients with BMI > 30kg/m2 with type 2 diabetes have higher chances of GERD. The findings also suggested increase in socioeconomic status shows increase incidence of type 2 diabetes mellitus with time and it also plays vital role to lifestyle modifications such as physical exercise e and dietary habits. The prevalence values of GERD by skipping breakfast, snacking during bedtime, late night eating and eating fast were 32.0%, 13.7%, 27.1%, 28.8% and 44.4%, respectively. Late night eating was independently positively associated with GERD in patients with type 2 diabetes; the adjusted odds ratio was 1.46 (95% CI 1.03 to 2.05). No relationships were found between not eating breakfast, snacking at bedtime or eating fast and GERD. Conclusion: The review findings suggested that patients with type 2 diabetes are at double risk of GERD as the metabolic disorder are making it worst. GERD can be avoided by minimizing the risk of type 2 diabetes either by controlling obesity by bariatric surgery or by exercise and more active lifestyle. There are some important considerations to decrease the incidence of GERD by evaluation and treatment in the older patients.

- by Journal of Pharmacy Practice and Community Medicine
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- Geriatrics, Type 2 Diabetes, Medicine, Gerd

Background: Extraesophageal reflux (EER) is a heterogeneous disease, caused by the regur-gitation of gastroduodenal contents into the larynx. The Upper Esophageal Sphincter (UES) Assist Device is a novel medical device designed to prevent gastroduodenal reflux into the laryngopharynx. Objective: A multicenter prospective study assessing safety and effectiveness of the UES Assist Device in patients with EER. Methods: Patients with Reflux Symptom Index (RSI) >13 were enrolled. The device was fit and adjusted to at least 20 mmHg applied external cricoid pressure. The primary effectiveness end-point was reduction in RSI at 4-weeks compared to baseline. 36-Item Short Form Health Survey or SF-36 ® Health Survey (SF-36), patient and physician satisfaction, and Functional Outcomes of Sleep Questionnaire (FOSQ) were secondary end-points. Safety was based on reported adverse reactions. Results: Eighty-nine of 95 patients completed the study [mean(Standard Deviation (SD)) age=48.8(+/-13.7); mean(SD) Body Mass Index (BMI)=25.5(+/-4.2); 69.5% female, 81.1% Caucasian]. Most common troublesome symptoms included chronic cough (21.3%) and excess mucus/post nasal drip (20.2%). There was a significant (p<0.0001) reduction in median (Intelligence Quotient (IQ)) RSI at 2-and 4-weeks [12.5(8.0-20.0) and 10.0(5.8-16.5), respec-tively] compared to baseline [25.6(21.0-30.0)]. Eighty-two percent (82%) reported improvement greater than 25% with 30.1% having an improvement of 75% or more. 84.7% of patients and 95.2% of providers reported satisfaction. Adverse events were generally mild and transient with no withdrawals due to adverse events. Conclusion: The UES Assist Device is a safe and effective for the treatment of extraesophageal symptoms and may be an alternative for the many patients that do not respond to Proton Pump Inhibitors (PPI) therapy.

The traditional approach to diet in gastroenterology practice is to advise
patients to avoid certain foods to control their symptoms and /or diseases.
The classic example of causative role of food in a disease is celiac disease
for which the main management is gluten free diet (GFD).1 In patients with
lactase or fructase deficiency, ingestion of lactose or fructose would lead to
flatulence. Many such patients have learned to avoid certain foods. Food allergy
is yet another example of food as a cause of disease. Examples include
milk and wheat allergy. The latter should not be confused with celiac disease
because of different pathogenesis and clinical presentations

- by Kamran Lankarani
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- Nutrition and Dietetics, Dyspepsia, Gerd, Irritable Bowel Syndrome

Background: We hypothesized that obesity was associated with long-term failure of antireflux procedures, and that in obese patients antireflux operations were easier to perform via thoracotomy, and therefore likely to have a higher success rate than transabdominal (laparoscopic or open) anti-reflux procedures. The aims of this study was to determine the impact of obesity on the success of antireflux operations, and to compare the success rates of transthoracic and lapa-roscopic approaches in obese patients with gastroesopha-geal reflux. Methods: The records of 224 consecutive patients undergoing antireflux surgery by two surgeons in a university-based tertiary care center were reviewed and patients contacted for follow-up assessment. The patients were classified into groups based on the type of operation performed and the calculated body mass index (BMI): normal (BMI < 25), overweight (BMI = 25-29.9), and obese (BMI > 30). Recurrences were documented by symptoms responsive to acid-suppressive medication and radiologic or pH probe studies. Results: Among the 224 patients included in this study, 187 underwent laparoscopic Nissen fundoplications (LNF) and 37 underwent Belsey Mark IV(BM4) procedures. The mean follow-up period was 37 months. The three groups included 89 (39.7%) patients classified as having normal weight, 87 (38.8%) as overweight and 48 (21.4%) as obese. Normal, overweight, and obese patients were similar in terms of age, gender, hiatal hernia size, degree of esophagitis, and comor-bid conditions. A total of 26 recurrences occurred, giving an overall recurrence rate of 11.6%. There were 4 recurrences in the normal group (4.5%), 7 in the overweight group (8.0%; p not significant vs normal), and 15 in the obese group (31%; p < 0.001 vs normal; p <.001 vs overweight). The recurrence rate was similar between LNF and BM4 in each BMI subgroup, although in aggregate, the recurrence rate after BMW was greater than after LNF (10/37 vs 16/ 187; p < 0.02). Conclusions: Obesity adversely affects the long-term suc-Correspondence to: D. W. Rattner cess of antireflux operations. Although athoracotomy provides optimal exposure of the hiatal structures in obese patients , a transthoracic approach was associated with a higher recurrence rate than LNF. Given the high failure rate of antireflux operations in obese patients, intensive efforts at sustained weight loss should be made before consideration of surgery.

- by A. Perez
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- Gerd, Nissen Fundoplication

Reflux disease continues to be one of the most common pathologies in the world. There is much discussion regarding the mechanism of developing and the variety of possible symptoms. In recent years, the use of new technologies, like high-resolution manometry and pH impedance, brought new insights into this disease. Also, there are emerging therapies that are covering the gap between the patients treated with proton-pump inhibitor (PPI) therapy and those who benefit the most from laparoscopic treatment (hiatal hernia, complications of gastroesophageal reflux disease (GERD). Also, most of them are less invasive than a laparoscopic fundoplication. We present a short review of the treatment options in patients who need more than lifestyle changes and PPI therapy.

- by Silviu Constantinoiu
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- Gastroenterology, Reflux, Medicine, Internal Medicine

- by Fatima Bello
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- Geriatrics, Medicine, Gerd, Geriatric medicine

My op ed published in Beeld (Johannesburg), 4 July 2020. I traced the tensions between Ethiopia and Egypt regarding the Great Ethiopian Renaissance Dam (GERD), and the UN Security Council debate on the matter towards the end of June... more

- by Jo-Ansie van Wyk
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- Egypt, Ethiopia, International Water Law, Sudan

GERD has become one of the most frequent pathology of the upper GI tract. It is a spectrum disease and is a progressive disease as well. Serious and severe complications are possible. The mainstream therapy in most of the patients is the medical therapy with PPI's. The most severe cases with an impaired LES (Lower Esophageal Sphincter) function as well as important anatomical disruptions are of surgical indication, the gold standard being laparoscopic fundoplication, an elective therapy with long term follow up outcomes at the expense of de novo symptoms associated with fundoplications in general. 30% to 40% of the patients are PPI refractory with partial symptom control, but they are not willing to go for the laparoscopic fundoplication because of the invasive character and because of potential postfundoplications syndromes. There is a "treatment gap" for these patients with GERD. For a well selected patient population with GERD, with mild forms of the disease, withou...

- by Eugen Nicolau
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- Evidence Based Medicine, Quality of life, Treatment Outcome, Reflux
- by Giancarlo Freschi
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- Gastroenterology, Treatment Outcome, Clostridium difficile, Medicine

- by Peter Crookes
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- Gastroenterology, Esophageal Disorders, Humans, Female

This case report shows a very rare case series of one family with four children who had severe congenital sliding hiatus hernia (HH) with uncommon presentations, and they had one parent with sliding hernia and the other with ref lux symptoms. It is rarely described in the literature a direct link to a familial type that might refer to a common genetic factor. Hiatus hernia is protrusion of abdominal viscera through the oesophagus opening in the diaphragm into the thoracic cavity with sliding hernia being the most common. It can be either asymptomatic or accompanied by a variety of symptoms. We present a case series of one family in which four siblings had congenital sliding diaphragmatic hernia with atypical symptoms and gastro-oesophageal ref lux disease (GORD). It is a rare case that suggests a common factor that can cause such a common disease. All four had uncommon presentations which all required surgical repair. Few cases reported on the medical literature, and they were discussed and compared with our case. However, we need further studies in families that might have this phenomenon.

- by Ameer Kakaje
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- Genetics, Pediatrics, Family, General Surgery

IntroductionObesity and gastroesophageal reflux disease (GERD) are increasingly important health problems. Previous studies of the relationship between obesity and GERD focus on indirect manifestations of GERD. Little is known about the association between obesity and objectively measured esophageal acid exposure. The aim of this study is to quantify the relationship between body mass index (BMI) and 24-h esophageal pH measurements and the status of the lower esophageal sphincter (LES) in patients with reflux symptoms.MethodsData of 1,659 patients (50% male, mean age 51±14) referred for assessment of GERD symptoms between 1998 and 2008 were analyzed. These subjects underwent 24-h pH monitoring off medication and esophageal manometry. The relationship of BMI to 24-h esophageal pH measurements and LES status was studied using linear regression and multiple regression analysis. The difference of each acid exposure component was also assessed among four BMI subgroups (underweight, normal weight, overweight, and obese) using analysis of variance and covariance.ResultsIncreasing BMI was positively correlated with increasing esophageal acid exposure (adjusted R2=0.13 for the composite pH score). The prevalence of a defective LES was higher in patients with higher BMI (p<0.0001). Compared to patients with normal weight, obese patients are more than twice as likely to have a mechanically defective LES [OR=2.12(1.63–2.75)].ConclusionAn increase in body mass index is associated with an increase in esophageal acid exposure, whether BMI was examined as a continuous or as a categorical variable; 13% of the variation in esophageal acid exposure may be attributable to variation in BMI.