Introduction

Gastroesophageal reflux is responsible for various extresophageal symptoms that are commonly labelled as laryngopharyngeal reflux (LPR). These mostly include cough, throat clearing, globus sensation and hoarseness. The pathophysiological link between reflux and symptoms likely includes direct effect of the refluxate on the upper airways epithelium and reflex that is initiated by stimulation of the afferent nociceptive fibres in the distal esophagus by acidic gastroesophageal reflux. Arguably, the relationship between reflux and laryngopharyngeal symptoms might involve other, yet not well explored mechanisms. In our previous research we found that LPR patients have impaired mucociliary clearance of the respiratory epithelium of the upper airways. This could contribute to the inflammation persistence and the presence of symptoms. We therefore aimed to determine whether any parameter of the reflux burden as detected by 24-hour pH/impedance correlates with ciliary beat frequency (CBF), the major quantifiable aspect of mucociliary clearance.

Aims & Methods

Consecutive patients with LPR confirmed by off PPI 24-hour pH/impedance had a sample of the ciliated epithelium obtained from the nose using a cytology brush. Nasal CBF was analysed using a digital high‐speed video microscope and the dedicated software application Ciliary Analysis (NI LabVIEW). Healthy volunteers without either esophageal or extraesophageal reflux symptoms served as a control group. Both patients’ and healthy volunteers’ group were without any airway inflammation at least 3 months prior to the evaluation and were at least 10 days of PPI therapy. Maximal, minimal, and the median value of the CBF (Hz) was obtained. We performed correlation analyses between the acid exposure time (AET), number of reflux episodes, mean nocturnal baseline impedance (MNBI) in all impedance segments (Z1-Z6) and CBF values.

Results

32 patients with LPR confirmed by 24-hour pH/impedance that had positive reflux symptom index (RSI>13) were included in the final analysis. Of them, 12 patients had confirmed by positive acid exposure time (AET>6%) and/or abnormal number of reflux episodes (>80). Firstly, we confirmed our previous observations that LPR patients had lower CB frequency (median value) compared to the healthy individuals (6,37±2,17 vs. 10,9±1,9; p<0.0001). Separate analysis of patients with proven GERD showed no CBF difference from the remaining (pH negative patients) (6,26±2,53 vs. 6,43±1,94; p=0,42). Secondly, we performed correlation analysis between AET/number of reflux episodes and CBF. We found no significant correlation between reflux burden and median value of CBF (N=32, R=-0.18, p=NS and R=0.05, p=NS for AET and number of refluxes, resp.). Thirdly, we performed correlation analyses between CBF and MNBI values of all impedance segments. Indeed, correlation analysis between median CBF and MNBI Z1-Z6 showed no significant correlations (N=32, R=-0.16, 0.09, 0.28, 0.01, 0.14 for Z1, Z2, Z3, Z4, Z5, Z6, resp., resulting in p=NS in all segments).

Conclusion

pH positive LPR patients had no difference in CBF values from the remaining (pH negative) patients. Reflux burden in the esophagus as determined by pH recording does not seem to be related to ciliary beat frequency. We observed no significant correlation between the MNBI values in any impedance segment and the median CBF value. Further research should be performed to determine the putative mechanism between the impairment of CBF and reflux.
Supported by: VEGA 1/0060/23

Introduction

Studies using a variety of diagnostic techniques confirm the importance of the gut microbiota in the pathogenesis of ulcerative colitis (UC), as well as its possible influence on the effectiveness of drug therapy and the prognosis of the disease. In different phases of the UC course, structural and quantitative changes in the gut microbiota suggest its use as a non-invasive diagnostic tool and the tool predicting the achievement of clinical and endoscopic remission of the disease.

Aims & Methods

The objective of the study was to determine the taxonomic diversity of the gut microbiota in patients with UC in various phases of the disease and to identify microorganisms that are predictors of remission. The study included 21 patients (age from 20 to 41 years, 13 men and 8 women) in the relapse phase of UC - left-sided UC with mild to moderate activity (Truelov-Witts scale, Mayo index); and 20 patients (age from 26 to 52 years, 10 men and 10 women) in the phase of clinical endoscopic remission. The gut microbiota was assessed by NGS sequencing of the bacterial 16S ribosomal RNA gene structure using the IlluminaMiSeq platform. After the normality test, we performed statistical analysis using the nonparametric Mann-Whitney test, the analysis is presented by median and quartiles.

Results

We predicted clinical and endoscopic remission of UC using a logistic regression model, including microorganisms, the number of which in absolute values changed more significantly. In cases of achieving clinical and endoscopic remission of the disease, we recorded a statistically significant increase in the levels of Streptococcus, NK4A214_group and Pelomonas and a decrease in Enterococcus and Actinomyces. The developed logistic regression model is statistically significant and statistically reliable using evaluation criteria: chi-square (p = 0.002), Cox & Snell's pseudo R-squared is 0.556, Nagelkerk is 0.741, which allows its use in wide gastroenterological practice to make decisions on modifying the course of drug therapy for UC (Table 1).

Conclusion

The study results provide a prognostic model for non-invasive diagnosis of achieving UC remission. Predictors of achieving clinical and endoscopic remission of UC are high levels of Streptococcus, NK4A214_group and Pelomonas, as well as a decrease in the number of Enterococcus and Actinomyces.

Introduction

A sedentary lifestyle, poor fiber intake and other unhealthy dietary habits have been associated with diverticular disease (DD). On the contrary, the Mediterranean Diet (MD), which involves factors such as consuming locally grown food products, family meals, conviviality, involvement in the preparation of meals, as well as high intake of vegetables, legumes, fruit and cereals, medium intake of fish, low intake of meat and saturated fat, high intake of unsaturated fat (particularly olive oil), a medium-low intake of dairy products (yogurt and cheese), and a moderate intake of wine, seems to protect against DD. Moreover, populations that follow the MD pattern show a 50% lower rate of cardiovascular mortality due to cardiovascular disease and show highest longevity. (1)

Aims & Methods

Aim: to compare adherence to MD as a whole and its different components in subjects with and without diverticular disease.

Materials and methods: all patients undergoing colonoscopy at our Endoscopy Unit of a Tertiary Hospital in Northeastern Italy from January to June 2022 were invited to participate in the study, completing three questionnaires including personal/medical history and medications, symptoms, physical activity questionnaire, and Medi-Lite (ML) questionnaire for the assessment of adherence to MD. Subjects were then divided in two groups based on the endoscopic diagnosis of diverticular disease (DD).

Results

A total of 3757 patients underwent colonoscopy at our center during the 6-month study period, 1112 of whom completed the questionnaires and therefore constituted the study population. Overweight (BMI>25 kg/cm²) was observed in 61% of males and 40.2% of females, and correlated inversely (OR<1) with higher education attainment, daily physical activity of at least 30 minutes, and, in females, the performance of a structured physical activity/sport for at least 60 minutes a week. Moreover, being married or widowed and consuming meals preferably at home, as opposed to consuming meals at restaurants or cafeterias, were significantly associated with overweight (OR>1), especially in female patients. In the overall population, normal weight was more frequently associated with consumption of meat, while in females, it is associated with greater consumption of raw vegetables. Overweight was more frequently associated with consumption of salami and cheese, especially in the female population, and it correlated with the presence of cardiovascular diseases (especially hypertension). DD was present in 400/1112 (35.9%) of subjects and this condition was significantly associated with (OR>1) male sex, older age (61-75 years), overweight (BMI>25 kg/cm²), cardiovascular disease, polypharmacy, cigarette smoking, alcohol use, cheese consumption, abdominal pain as the chief complaint, and lower education attainment. No correlation was found between DD and the MD score or its components. In patients with DD, abdominal pain was inversely and significantly associated with an elevated ML score (OR=0.085) and consumption of meat (OR=0,096) and legumes (OR=0,079) (p<0.05).

Conclusion

Subjects undergoing colonoscopy share similar dietary and lifestyle habits, while in the presence of DD, ingestion of certain products seems to have an impact on symptoms.

References

1. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008 Sep 11;337:a1344.