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Fulltext Epiphrenic pulsion diverticulum: an uncommon cause of dysphagia and heartburn

Qua CS, Saravannan K, Goh KL

BMJ Case Rep, 2021 Apr 07;14(4).
PMID: 33827890 DOI: 10.1136/bcr-2021-242920
Matched MeSH terms: Heartburn
Fulltext Ageing Study of Palm Oil and Coconut Oil in the Presence of Insulation Paper for Transformers Application

Mohamad NA, Azis N, Jasni J, Ab Kadir MZA, Yunus R, Yaakub Z

Materials (Basel), 2018 Mar 30;11(4).
PMID: 29601520 DOI: 10.3390/ma11040532

This paper presents a sealed ageing study of palm oil (PO) and coconut oil (CO) in the presence of insulation paper. The type of PO under study is refined, bleached, and deodorized palm oil (RBDPO) olein. Three different variations of RBDPO and one sample of CO are aged at temperatures of 90 °C, 110 °C, and 130 °C. The properties of RBDPO and CO as well as paper under ageing are then analysed through dielectric and physicochemical measurements. It is found that the effect of ageing is not significant on the alternating current (AC) breakdown voltages and relative permittivities of RBDPO and CO. There is a slight increment trend of the resistivity for CO, while for all of the RBDPO, the resistivity slightly decreases as the ageing progresses. Only CO shows an apparent reduction of the dielectric dissipation factor. Throughout the ageing time, the acidities of all of the RBDPO and CO remain at low level, while the moisture in oils decreases. The tensile index (TI) of the papers for all of the RBDPO and CO retain more than 50% of the TI. A significant increment of the paper ageing rates of all of the RBDPO and CO is observed at an ageing temperature of 130 °C.

Matched MeSH terms: Heartburn
Management of Patients With Functional Heartburn

Lee YY, Wu JCY

Gastroenterology, 2018 06;154(8):2018-2021.e1.
PMID: 29730025 DOI: 10.1053/j.gastro.2018.04.030
Matched MeSH terms: Heartburn/diagnosis; Heartburn/etiology; Heartburn/therapy*
Fulltext The effect of calcium silicate and ground magnesium limestone (GML) on the chemical characteristics of acid sulfate soil

Azman EA, Ismail R, Ninomiya S, Jusop S, Tongkaemkaew U

PLoS One, 2023;18(9):e0290703.
PMID: 37713375 DOI: 10.1371/journal.pone.0290703

Acid sulfate soil characterized by pyrite (FeS2) which produces high acidity (soil pH < 3.5) and release high amount of Al3+ and Fe2+. Application of 4 t ha-1 Ground Magnesium Limestone (GML), is a common rate used for acid sulfate soil by the rice farmers in Malaysia. Therefore, this study was conducted to evaluate the integral effect of ground magnesium limestone (GML) and calcium silicate and to determine the optimal combination on acid sulfate soils in Malaysia. The acid sulfate soils were incubated under the submerged condition for 120 days with GML (0, 2, 4, 6 t ha-1) in combination with calcium silicate (0, 1, 2, 3 t ha-1) arranged in a Completely Randomized Design (CRD). The soil was sampled after 30, 60, 90 and 120 days of incubation and analyzed for soil pH, exchangeable Al, Ca, Mg, K and available Si. A total of 2 out of 16 combinations met the desired soil requirement for rice cultivation. The desired chemical soil characteristics for rice cultivation are soil pH > 4, exchangeable Al < 2 cmolc Kg-1, exchangeable Ca > 2 cmolc kg-1, exchangeable Mg > 1 cmolc kg-1 and Si content > 43 mg kg-1. The combinations are i) 2 t ha-1 calcium silicate + 2 t ha-1 GML, and ii) 3 t ha-1 calcium silicate + 2 t ha-1 GML, respectively. These combination rates met the desired requirement of soil chemical characteristics for rice cultivation. Soil acidity was reduced by a gradual release of Ca2+ and SiO32- from calcium silicate continuously filling the exchange sites and reducing the potential of extra (free) H+ availability in the soil system. Combination of calcium silicate and GML, shows the ameliorative effect with; i) release of Ca, ii) binding of Al3+ making it inert Al-hydroxides and, iii) bind H+ to produce water molecules.

Matched MeSH terms: Heartburn
Fulltext Evaluation of Gastroesophageal Reflux Disease Using the Bravo Capsule pH System

Lawenko RM, Lee YY

J Neurogastroenterol Motil, 2016 Jan 31;22(1):25-30.
PMID: 26717929 DOI: 10.5056/jnm15151

Gastroesophageal reflux disease (GERD) is a disease predominantly seen in the West but there is a rising trend in Asia. Ambulatory 24-hour catheter-based pH monitoring has been the de facto gold standard test for GERD that correlates symptoms with acid reflux episodes. However, drawbacks such as patients' discomfort, and catheter displacement render the test as cumbersome and error-prone. The Bravo pH wireless system is designed to be user-friendly and has an added advantage of prolonged pH monitoring. The system is comparable to the catheter-based pH monitoring system in terms of diagnostic yield and symptom-reflux association. Indications include evaluation of patients with refractory GERD symptoms and prior to anti-reflux surgery. Bravo utilizes a wireless pH-sensing capsule with a complete prepackaged system, and a data processing software. The capsule may be positioned indirectly using endoscopic or manometric landmarks or under direct endoscopic guidance. Optimal threshold cut-off values are yet to be standardized but based on available studies, for the Asian population, it may be recommended for total % time pH < 4 of 5.8 over 48 hours. Cost is a limitation but capsule placement is relatively safe although technical failures may be seen in small percentage of cases.

Matched MeSH terms: Heartburn
It's not just a heartburn and reflux disease: a case report of distal oesophageal spasm and review of literature

Nawawi KNM, Wong Z, Ngiu CS, Raja Ali RA

Med J Malaysia, 2019 12;74(6):540-542.
PMID: 31929483

Distal oesophageal spasm is a rare condition that affects the motility of the oesophagus. It can be diagnosed by highresolution oesophageal manometry and the diagnosis is supported by other modalities such as barium swallow and esophagogastroduodenoscopy examinations. Treatment options include pharmacological therapy, endoscopy and surgical interventions. We described a case of distal oesophageal spasm in an elderly patient who presented with chronic dyspepsia.

Matched MeSH terms: Heartburn/diagnosis*
Fulltext Gastro-oesophageal reflux disorders among Nepalese residing in Southeast Asia

Chong VH, Chand PB, Gautam HR, Jalihal A

Med J Malaysia, 2013 Jun;68(3):234-8.
PMID: 23749013

Gastro-oesophageal reflux disorders (GORD) are common in Western countries and has been reported to be increasing in the East. This study assessed the prevalence of GORD among the Nepalese residing in the Brunei Darussalam.

Matched MeSH terms: Heartburn
Fulltext Reassessment of functional dyspepsia: a topic review

Chua AS

World J Gastroenterol, 2006 May 07;12(17):2656-9.
PMID: 16718748 DOI: 10.3748/wjg.v12.i17.2656

Dyspepsia itself is not a diagnosis but stands for a constellation of symptoms referable to the upper gastrointestinal tract. It consists of a variable combination of symptoms including abdominal pain or discomfort, postprandial fullness, abdominal bloating, early satiety, nausea, vomiting, heartburn and acid regurgitation. Patients with heartburn and acid regurgitation invariably have gastroesophageal reflux disease and should be distinguished from those with dyspepsia. There is a substantial group of patients who do not have a definite structural or biochemical cause for their symptoms and are considered to be suffering from functional dyspepsia (FD). Gastrointestinal motor abnormalities, altered visceral sensation, dysfunctional central nervous system-enteral nervous system (CNS-ENS) integration and psychosocial factors have all being identified as important pathophysiological correlates. It can be considered as a biopsychosocial disorder with dysregulation of the brain-gut axis being central in origin of disease. FD can be categorized into different subgroups based on the predominant single symptom identified by the patient. This subgroup classification can assist us in deciding the appropriate symptomatic treatment for the patient.

Matched MeSH terms: Heartburn/complications
Rome Foundation-Asian working team report: Asian functional gastrointestinal disorder symptom clusters

Siah KTH, Gong X, Yang XJ, Whitehead WE, Chen M, Hou X, et al.

Gut, 2018 Jun;67(6):1071-1077.
PMID: 28592440 DOI: 10.1136/gutjnl-2016-312852

OBJECTIVE: Functional gastrointestinal disorders (FGIDs) are diagnosed by the presence of a characteristic set of symptoms. However, the current criteria-based diagnostic approach is to some extent subjective and largely derived from observations in English-speaking Western patients. We aimed to identify latent symptom clusters in Asian patients with FGID.
DESIGN: 1805 consecutive unselected patients with FGID who presented for primary or secondary care to 11 centres across Asia completed a cultural and linguistic adaptation of the Rome III Diagnostic Questionnaire that was translated to the local languages. Principal components factor analysis with varimax rotation was used to identify symptom clusters.
RESULTS: Nine symptom clusters were identified, consisting of two oesophageal factors (F6: globus, odynophagia and dysphagia; F9: chest pain and heartburn), two gastroduodenal factors (F5: bloating, fullness, belching and flatulence; F8 regurgitation, nausea and vomiting), three bowel factors (F2: abdominal pain and diarrhoea; F3: meal-related bowel symptoms; F7: upper abdominal pain and constipation) and two anorectal factors (F1: anorectal pain and constipation; F4: diarrhoea, urgency and incontinence).
CONCLUSION: We found that the broad categorisation used both in clinical practice and in the Rome system, that is, broad anatomical divisions, and certain diagnoses with long historical records, that is, IBS with diarrhoea, and chronic constipation, are still valid in our Asian societies. In addition, we found a bowel symptom cluster with meal trigger and a gas cluster that suggests a different emphasis in our populations. Future studies to compare a non-Asian cohort and to match to putative pathophysiology will help to verify our findings.

Matched MeSH terms: Heartburn
High-resolution oesophageal manometry and 24-hour impedance-pH study in systemic sclerosis patients: association with clinical features, symptoms and severity

Raja J, Ng CT, Sujau I, Chin KF, Sockalingam S

Clin Exp Rheumatol, 2016 Sep-Oct;34 Suppl 100(5):115-121.
PMID: 26843456

OBJECTIVES: To evaluate the associations between objectively measured gastroesophageal involvement using high-resolution manometry and 24- hour impedance-pH study, and clinical presentations in systemic sclerosis (SSc) patients.
METHODS: This cross-sectional study was conducted in University of Malaya Medical Centre (UMMC) with 31 consecutive SSc patients recruited into this study. Clinical symptoms of gastroesophageal involvement, high-resolution impedance-manometry and 24-hour impedance-pH monitoring were assessed. Their associations with serological features and other organ involvement were evaluated.
RESULTS: Twenty-five (80.6%) patients had gastroesophageal reflux disease (GORD) symptoms, mainly heartburn (45.1%), regurgitation (32.2%) and dysphagia (29%). Using manometry, oesophageal dysmotility was detected in 24 (88.9%) patients, while hypotensive lower oesophageal sphincter (LOS) was observed in 17 (63%) patients. 21 (84%) patients had GORD based on pH study. Hypotensive LOS was significantly associated with presence of digital ulcers. The main gastroesophageal symptoms were absent in majority of the SSc patients including in those with severe gastroesophageal manifestations demonstrating failed peristalsis >75%, hypotensive LOS, Demeester score >200 and acid reflux >200 per day. Demeester score >200 is associated with severity of GORD symptoms. Demeester score >200 was also associated with restrictive lung pattern (p=0.001). Significant association between GORD severity (daily number of acid reflux episodes >200) and pulmonary fibrosis was seen (p=0.030).
CONCLUSIONS: The presence and severity of gastroesophageal symptoms may not accurately reflect the seriousness of oesophageal involvement. GORD severity is associated with presence of restrictive lung pattern and pulmonary fibrosis. Oesophageal manometry and 24-hour pH study should be considered more frequently in the assessment of SSc patients.

Matched MeSH terms: Heartburn