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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.
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.
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.
A Novel Strategy For The Early Diagnosis Of Cows Milk Protein Allergy In Infants.
Funder
National Health and Medical Research Council
Funding Amount
$607,764.00
Summary
Infantile Cow's Milk Protein Allergy (CMPA) is becoming increasingly more common. Symptoms due to CMPA (feeding difficulties, feed refusal, vomiting, crying and irritability) are clinically indistinguishable from reflux disease, leading to unnecessary anti-reflux treatments and delaying appropriate therapy. By using a state-of-the art system which more easily differentiates symptoms due to reflux disease from those due to CMPA, this project will improve the speed and accuracy of diagnosis.
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
Ablative Therapies For Barrett's Oesophagus - Evaluation Of New Clinical And Experimental Therapies
Funder
National Health and Medical Research Council
Funding Amount
$302,310.00
Summary
Barrett's oesophagus arises when repeated episodes of gastro-oesophageal reflux lead to the oesophageal lining undergoing change to a lining more like that of the intestine. This new lining predisposes to cancer, a problem which is rapidly becoming more common. Recent research has focused on techniques which could reverse this process. Destruction (ablation) of Barrett s oesophagus can be followed by regeneration with a normal looking lining. A range of techniques have been used for this. Howeve ....Barrett's oesophagus arises when repeated episodes of gastro-oesophageal reflux lead to the oesophageal lining undergoing change to a lining more like that of the intestine. This new lining predisposes to cancer, a problem which is rapidly becoming more common. Recent research has focused on techniques which could reverse this process. Destruction (ablation) of Barrett s oesophagus can be followed by regeneration with a normal looking lining. A range of techniques have been used for this. However, the behavior of the regenerated lining is unknown, and there still remains potential for cancer. We are currently evaluating endoscopic ablation using Argon Plasma Coagulation within clinical trials. There is also scope for the development of better approaches to ablation. We hypothesize that an suitable liquid has the potential to more evenly and more easily ablate the lining. Delivery of a liquid substance to lower oesophagus can be achieved through a tube which confines liquid to the lower oesophagus. However, to make this approach acceptable it is necessary to determine the best treatment agent, and to test the delivery system. We will first do this using animal models, before future application in patients. A further key issue is whether the cells which repopulate the oesophagus are genetically normal or abnormal. After ablation it is likely that the cells which repopulate the lining are sourced from the same cells which were the source of the abnormal lining, and these cells could inherit genetic alterations. This could increase the risk of cancer. Hence, we plan to assess certain genes in biopsies taken from tissue before and after ablation to determine genetic normality. In Australia endoscopic ablative techniques are currently being introduced into clinical practice without evaluation. Hence the question of whether ablation actually reduces the risk of cancer and how to best perform ablation should be addressed before clinical application becomes widespread.Read moreRead less