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A Trial Of Position Control Therapy For Treatment Of Infantile Gastro-oesophageal Reflux
Funder
National Health and Medical Research Council
Funding Amount
$533,290.00
Summary
Reflux of stomach contents into the gullet and mouth is a very common condition which interrupts feeding and sleep routine in infants. If reflux is not treated, more severe problems may manifest and patients may require anti-reflux surgery. Left-side positioning after feeding is the only non-drug approach proven to reduce the frequency of reflux in infants. This project will determine, by clinical trial, the role for left side positioning for reducing reflux related symptoms in infants.
Risk Factors For Gastro-oesophageal Reflux Disease And Barretts Oesophagus In A Prospective Cohort Study
Funder
National Health and Medical Research Council
Funding Amount
$960,867.00
Summary
Heartburn caused by acid reflux is a common problem in Australia. In 2003, drugs used to treat disorders caused by acid problems, such as heartburn, cost the PBS more than $500 million. Heartburn probably causes a disease of the oesophagus called Barrett's oesophagus, which in turn is a cause of cancer of the oesophagus. The aim of this study is to identify risk factors for heartburn and Barrett's oesophagus, so that we can find ways to prevent them occurring.
Neuromodulation Of Triggering Of Transient Lower Oesophageal Sphincter Relaxation And Gastro-oesophageal Reflux
Funder
National Health and Medical Research Council
Funding Amount
$369,779.00
Summary
Reflux of stomach contents into the gullet is a very common condition. If reflux is not treated, more severe problems may manifest. In patients with reflux disease the anatomy of the junction between the gullet and the stomach is altered. This research program will undertake novel studies to explore how this alteration exacerbates the triggering reflux after a meal and potentially identify new targets for pharmacological therapy for this common problem.
Barrett's Oesophagus And Reflux Oesophagitis : Efficacy Of Medical Vs Surgical Management
Funder
National Health and Medical Research Council
Funding Amount
$510,750.00
Summary
Gastro-oesophageal reflux disease is very common. In some people it leads to oesophageal cancer, which is increasing in incidence more rapidly than any other cancer in the developed world. Significant resources are required for its diagnosis, surveillance and treatment. There are two main forms of treatment, acid suppressing drugs which may be required for the rest of the person's life, or surgery. The goal of treatment is the control of the symptoms such as heartburn, and the prevention of canc ....Gastro-oesophageal reflux disease is very common. In some people it leads to oesophageal cancer, which is increasing in incidence more rapidly than any other cancer in the developed world. Significant resources are required for its diagnosis, surveillance and treatment. There are two main forms of treatment, acid suppressing drugs which may be required for the rest of the person's life, or surgery. The goal of treatment is the control of the symptoms such as heartburn, and the prevention of cancer. It is relatively easy to determine if the symptoms are controlled, and both medical and surgical treatments do this. It is not as easy to measure if a treatment will reduce the risk of cancer, because it takes so long to develop. We will compare a group of patients with reflux disease treated with drugs with a group treated by surgery. In each group we will take oesophageal tissue before treatment and compare it with similar tissue taken after treatment. We will look for reductions in abnormal cells and genes that are in diseased tissue and are important in the development of cancer. This study will help us understand the mechanisms by which reflux causes damage to the oesophagus and how it ultimately leads to cancer. We will learn if medical or surgical treatment is better in healing the underlying damage in the oesophagus, and which treatment is more likely to prevent cancer developing. It may result in more effective management of reflux in our community and help reduce the number of cases of oesophageal cancer.Read moreRead less
Impact Of Oesophageal Afferent Processing On Regulatory And Protective Reflexes, And Perception Of Symptoms
Funder
National Health and Medical Research Council
Funding Amount
$247,500.00
Summary
Symptoms of acid reflux, heartburn and regurgitation, are extremely common, occurring weekly in 20% of the population. Curiously, about 1-4 of people with heartburn don't have any more acid exposing their oesophagus than do normal people. We do not understand this apparent increased sensitivity. Many patients with reflux present with cough, asthma, hoarseness, sore throat or even lung fibrosis. Regurgitation of acid causes some of these conditions. It is estimated that 60% of adult asthmatics ha ....Symptoms of acid reflux, heartburn and regurgitation, are extremely common, occurring weekly in 20% of the population. Curiously, about 1-4 of people with heartburn don't have any more acid exposing their oesophagus than do normal people. We do not understand this apparent increased sensitivity. Many patients with reflux present with cough, asthma, hoarseness, sore throat or even lung fibrosis. Regurgitation of acid causes some of these conditions. It is estimated that 60% of adult asthmatics have reflux for example. The purpose of this research is to examine the notion that the sensory nerves coming from the oesophagus are somehow tuned up to fire off too readily. If true this phenomenon may well underlie the inappropriate relaxation of the oesophageal valve mechanisms that normally prevent acid flowing up into the throat and into the airways. Additionally it may explain why so many sufferers seem to be hypersensitive to even small amounts of acid. These studies will better define the nerve pathways involved in heartburn and regurgitation and help us target these diseases with specific drugs in the future.Read moreRead less
Randomised Controlled Trials Of Laparoscopic Techniques For Antireflux Surgery
Funder
National Health and Medical Research Council
Funding Amount
$1,031,381.00
Summary
Gastro-oesophageal reflux is common, with approximately 10% of Australians now using medication to control symptoms. Many Australians will need this medication for life, unless they undergo surgery. The cost of treating reflux is growing. Since 1992 the annual growth rate of the Pharmaceutical Benefits Scheme expenditure on reflux medication has been 13%, and the annual cost for the treatment of reflux now exceeds $1 billion. Not all patients with reflux are satisfied with medication, as some co ....Gastro-oesophageal reflux is common, with approximately 10% of Australians now using medication to control symptoms. Many Australians will need this medication for life, unless they undergo surgery. The cost of treating reflux is growing. Since 1992 the annual growth rate of the Pharmaceutical Benefits Scheme expenditure on reflux medication has been 13%, and the annual cost for the treatment of reflux now exceeds $1 billion. Not all patients with reflux are satisfied with medication, as some continue to experience symptoms. Surgery is the only treatment which will cure reflux. It has a clear role in the treatment of patients with ongoing symptoms, those who don t want to take tablets, and patients with a large hiatus hernia in whom symptoms occur due to the relocation of the stomach from the abdomen into the chest. Approximately 5,000 Australians per year undergo surgery for reflux. The standard operation achieves a good outcome in approximately 90%, although some patients are troubled by side effects. To reduce the risk of this, the original procedure has been modified. However, the evidence supporting modifications has until recently been limited. The best way to compare different operations is in randomised trials. The majority of the largest and best trials addressing this area have been undertaken in Adelaide. We have already entered 504 patients into 5 randomised trials, 4 conducted entirely in Adelaide, and one across multiple sites with the cooperation of 15 Australasian surgeons. These trials have provided a more reliable evidence base for surgeons undertaking surgery for reflux. However, long term follow-up is required to ensure that conclusions drawn are valid at late follow-up. In addition we are establishing 2 new randomised trials, which will determine how best to perform surgery for reflux, and how best to repair a large hiatus hernia. These studies will be undertaken in collaboration with more than 25 other surgeons throughout Australia.Read moreRead less
Randomised Controlled Trials Of Laparoscopic Techniques For Antireflux Surgery
Funder
National Health and Medical Research Council
Funding Amount
$275,923.00
Summary
Gastro-oesophageal reflux is common, and over the last decade there has been an exponential rise in the usage of acid suppressing medication. Current trends suggest that the national cost of medical treatment of reflux will become unaffordable unless new management or preventative strategies can be developed. Presently, surgery is the only treatment which can cure reflux. Laparoscopic fundoplication has recently become an acceptable, low morbidity keyhole surgical treatment for this problem. How ....Gastro-oesophageal reflux is common, and over the last decade there has been an exponential rise in the usage of acid suppressing medication. Current trends suggest that the national cost of medical treatment of reflux will become unaffordable unless new management or preventative strategies can be developed. Presently, surgery is the only treatment which can cure reflux. Laparoscopic fundoplication has recently become an acceptable, low morbidity keyhole surgical treatment for this problem. However, research is essential to develop a procedure which optimizes the outcome for patients undergoing surgical management of reflux, and minimizes the risk of complications. This may provide a better alternative to long term management with acid suppressing medication, and could eventually achieve long term savings to the nation's health budget. Since 1994 research conducted at the Royal Adelaide Hospital has evaluated a range of different key hole operations aimed at improving the outcome for patients undergoing surgery for gastro-oesophageal reflux. Over 100 patients have been entered into each of the following clinical trials: total fundoplication with or without division of the short gastric vessels, total versus anterior partial fundoplication and posterior or anterior hiatal repair. Further trials will compare a lesser degree of anterior partial fundoplication with total fundoplication. A common research protocol has been developed and applied to all of these trials. This involves the use of double blind randomised methodology, with independent follow-up obtained by an independent investigator. These trials will determine the best surgical technique for the surgical correction of reflux, and this should lead to a more widely accepted surgical alternative to existing non-operative strategies for pathological reflux.Read moreRead less