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R Yadlapati, R N Keswani, K B Dunbar, A J Gawron, C P Gyawali, P J Kahrilas, P O Katz, D Katzka, S J Spechler, R Tatum, J E Pandolfino
BACKGROUND: Competent interpretation of esophageal high-resolution manometry (HRM) is integral to a quality study. Currently, methods to assess physician competency for the interpretation of esophageal HRM do not exist. The aim of this study was to use formal techniques to (i) develop an HRM interpretation exam, and (ii) establish minimum competence benchmarks for HRM interpretation skills at the trainee, physician interpreter, and master level. METHODS: A total of 29 physicians from 8 academic centers participated in the study: 9 content experts separated into 2 study groups-expert test-takers (n=7) and judges (n=2), and 20 HRM inexperienced trainees ("trainee test-taker"; n=20)...
October 13, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Dustin A Carlson, Peter J Kahrilas, Zhiyue Lin, Ikuo Hirano, Nirmala Gonsalves, Zoe Listernick, Katherine Ritter, Michael Tye, Fraukje A Ponds, Ian Wong, John E Pandolfino
OBJECTIVES: Esophagogastric junction (EGJ) distensibility and distension-mediated peristalsis can be assessed with the functional lumen imaging probe (FLIP) during a sedated upper endoscopy. We aimed to describe esophageal motility assessment using FLIP topography in patients presenting with dysphagia. METHODS: In all, 145 patients (aged 18-85 years, 54% female) with dysphagia that completed upper endoscopy with a 16-cm FLIP assembly and high-resolution manometry (HRM) were included...
October 11, 2016: American Journal of Gastroenterology
Dustin A Carlson, Zhiyue Lin, Peter J Kahrilas, Joel Sternbach, Eric S Hungness, Nathaniel J Soper, Michelle Balla, Zoe Listernick, Michael Tye, Katherine Ritter, Jenna Craft, Jody D Ciolino, John E Pandolfino
OBJECTIVES: We aimed to evaluate the value of novel high-resolution impedance manometry (HRIM) metrics, bolus flow time (BFT), and esophagogastric junction (EGJ) contractile integral (CI), as well as EGJ pressure (EGJP) and the integrated relaxation pressure (IRP), as indicators of treatment response in achalasia. METHODS: We prospectively evaluated 75 patients (ages 19-81, 32 female) with achalasia during follow-up after pneumatic dilation or myotomy with Eckardt score (ES), timed-barium esophagram (TBE), and HRIM...
October 4, 2016: American Journal of Gastroenterology
Christie L M Petrenko, Mary E Pandolfino, Rachael Roddenbery
BACKGROUND AND AIMS: Limited research has focused on parenting practices used by caregivers raising children with fetal alcohol spectrum disorders (FASD). The current study hypothesized that parental attributions of children's misbehavior would relate to the parenting strategies caregivers utilize with children with FASD. This study also aimed to develop a coding scheme to allow quantification of these treatment-relevant constructs in future intervention trials. METHODS: Thirty-one caregivers of children with FASD (age 4-8) were interviewed with the Parenting Practices Interview (PPI), a study-developed qualitative interview...
September 20, 2016: Research in Developmental Disabilities
D A Carlson, T Omari, Z Lin, N Rommel, K Starkey, P J Kahrilas, J Tack, J E Pandolfino
BACKGROUND: High-resolution impedance manometry (HRIM) allows evaluation of esophageal bolus retention, flow, and pressurization. We aimed to perform a collaborative analysis of HRIM metrics to evaluate patients with non-obstructive dysphagia. METHODS: Fourteen asymptomatic controls (58% female; ages 20-50) and 41 patients (63% female; ages 24-82), 18 evaluated for dysphagia and 23 for reflux (non-dysphagia patients), with esophageal motility diagnoses of normal motility or ineffective esophageal motility, were evaluated with HRIM and a global dysphagia symptom score (Brief Esophageal Dysphagia Questionnaire)...
September 20, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Salih Samo, Dustin A Carlson, Dyanna L Gregory, Susan H Gawel, John E Pandolfino, Peter J Kahrilas
BACKGROUND & AIMS: Reported global incidence and prevalence values for achalasia vary widely, from 0.03 to 1.63 per 100,000 persons per year and from 1.8 to 12.6 per 100,000 persons per year, respectively. This study aimed to reconcile these low values with findings from a major referral center, in central Chicago (which began using high-resolution manometry in 2004 and used in it all clinical studies since 2005), and has determined the incidence and prevalence of achalasia to be much greater...
August 28, 2016: Clinical Gastroenterology and Hepatology
Eric S Hungness, Joel M Sternbach, Ezra N Teitelbaum, Peter J Kahrilas, John E Pandolfino, Nathaniel J Soper
OBJECTIVE: We aimed to report long-term outcomes for patients undergoing per-oral endoscopic myotomy (POEM) after our initial 15-case learning curve. BACKGROUND: POEM has become an established, natural-orifice surgical approach for treating esophageal motility disorders. To date, published outcomes and comparative-effectiveness studies have included patients from the early POEM experience. METHODS: Consecutive patients undergoing POEM after our initial 15 cases, with a minimum of 1-year postoperative follow-up, were included...
September 2016: Annals of Surgery
S Roman, R Holloway, J Keller, F Herbella, F Zerbib, Y Xiao, L Bernard, A J Bredenoord, S Bruley des Varannes, M Chen, M Fox, P J Kahrilas, R K Mittal, R Penagini, E Savarino, D Sifrim, J Wu, E Decullier, J E Pandolfino, F Mion
BACKGROUND: Criteria for transient lower esophageal sphincter relaxations (TLESRs) are well-defined for Dentsleeve manometry. As high-resolution manometry (HRM) is now the gold standard to assess esophageal motility, our aim was to propose a consensus definition of TLESRs using HRM. METHODS: Postprandial esophageal HRM combined with impedance was performed in 10 patients with gastroesophageal reflux disease. Transient lower esophageal sphincter relaxations identification was performed by 17 experts using a Delphi process...
July 31, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Rena Yadlapati, Rajesh N Keswani, Jody D Ciolino, David P Grande, Zoe I Listernick, Dustin A Carlson, Donald O Castell, Kerry B Dunbar, Andrew J Gawron, C Prakash Gyawali, Philip O Katz, David Katzka, Brian E Lacy, Stuart J Spechler, Roger Tatum, Marcelo F Vela, John E Pandolfino
BACKGROUND & AIMS: Quality esophageal high-resolution manometry (HRM) studies require competent interpretation of data. However, there is little understanding of learning curves, training requirements, or measures of competency for HRM. We aimed to develop and use a competency assessment system to examine learning curves for interpretation of HRM data. METHODS: We conducted a prospective multicenter study of 20 gastroenterology trainees with no experience in HRM, from 8 centers, over an 8-month period (May through December 2015)...
July 27, 2016: Clinical Gastroenterology and Hepatology
T H Taft, M Riehl, J B Sodikoff, P J Kahrilas, L Keefer, B Doerfler, J E Pandolfino
BACKGROUND: Esophageal dysphagia is common in gastroenterology practice and has multiple etiologies. A complication for some patients with dysphagia is food impaction. A valid and reliable questionnaire to rapidly evaluate esophageal dysphagia and impaction symptoms can aid the gastroenterologist in gathering information to inform treatment approach and further evaluation, including endoscopy. METHODS: 1638 patients participated over two study phases. 744 participants completed the Brief Esophageal Dysphagia Questionnaire (BEDQ) for phase 1; 869 completed the BEDQ, Visceral Sensitivity Index, Gastroesophageal Reflux Disease Questionnaire, and Hospital Anxiety and Depression Scale for phase 2...
July 5, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Froukje B van Hoeij, Jan F Tack, John E Pandolfino, Joel M Sternbach, Sabine Roman, André J P M Smout, Albert J Bredenoord
In achalasia and spastic esophageal motility disorders, botulinum toxin (botox) injection is considered an effective and low-risk procedure for short-term symptom relief. It is mainly offered to medically high-risk patients. However, no analysis of risks of botox injections has been performed. To determine the incidence and risk factors of procedure-related complications after esophageal botox injections, we analyzed the records of all patients undergoing botox injection therapy for esophageal motility disorders at four university hospitals in Europe and North America between 2008 and 2014...
June 24, 2016: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
D A Carlson, Z Lin, I Hirano, N Gonsalves, A Zalewski, J E Pandolfino
BACKGROUND: Distensibility evaluation of the esophageal body using the functional lumen imaging probe (FLIP) offers an objective measure to characterize patients with eosinophilic esophagitis (EoE), though this analysis may be limited by unrecognized catheter movement and esophageal contractility. The aims of this study were to report novel FLIP analytic methods of esophageal distensibility measurement in EoE and to assess the effect of contractility. METHODS: Nine healthy controls (six female; ages 20-49) and 20 EoE patients (four female; ages 19-64; grouped by degree of distension-mediated contractility identified on FLIP) were evaluated with a 16-cm FLIP device during step-wise balloon distension during upper endoscopy...
December 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Kwong Ming Fock, Nicholas Talley, Khean Lee Goh, Kentaro Sugano, Peter Katelaris, Gerald Holtmann, John E Pandolfino, Prateek Sharma, Tiing Leong Ang, Michio Hongo, Justin Wu, Minhu Chen, Myung-Gyu Choi, Ngai Moh Law, Bor-Shyang Sheu, Jun Zhang, Khek Yu Ho, Jose Sollano, Abdul Aziz Rani, Chomsri Kositchaiwat, Shobna Bhatia
OBJECTIVE: Since the publication of the Asia-Pacific consensus on gastro-oesophageal reflux disease in 2008, there has been further scientific advancement in this field. This updated consensus focuses on proton pump inhibitor-refractory reflux disease and Barrett's oesophagus. METHODS: A steering committee identified three areas to address: (1) burden of disease and diagnosis of reflux disease; (2) proton pump inhibitor-refractory reflux disease; (3) Barrett's oesophagus...
September 2016: Gut
David A Katzka, Lawrence S Friedman, John M Inadomi, Anthony M Kalloo, Lawrence S Kim, Johannes Koch, David Lieberman, Gary R Lichtenstein, Joseph K Lim, John E Pandolfino, Andrea S Shin, Madelin R Siedler
No abstract text is available yet for this article.
July 2016: Gastroenterology
Joan W Chen, John E Pandolfino, Zhiyue Lin, Jody D Ciolino, Nirmala Gonsalves, Peter J Kahrilas, Ikuo Hirano
BACKGROUND/AIMS: A grading system for the endoscopic features of eosinophilic esophagitis (EoE) has recently been validated. The EoE Endoscopic Reference Score (EREFS) incorporates both inflammatory and remodeling features of EoE. High resolution impedance planimetry using the functional luminal imaging probe (FLIP) is a technique for quantification of esophageal remodeling. The aim of this study was to evaluate the association between endoscopic severity with EREFS and esophageal distensibility as measured with the FLIP...
September 2016: Endoscopy
Qasim Aziz, Ronnie Fass, C Prakash Gyawali, Hiroto Miwa, John E Pandolfino, Frank Zerbib
Functional esophageal disorders consist of a disease category that present with esophageal symptoms (heartburn, chest pain, dysphagia, globus) not explained by mechanical obstruction (stricture, tumor, eosinophilic esophagitis), major motor disorders (achalasia, EGJ outflow obstruction, absent contractility, distal esophageal spasm, jackhammer esophagus), or gastroesophageal reflux disease (GERD). While mechanisms responsible are unclear, it is theorized that visceral hypersensitivity and hypervigilance play an important role in symptom generation, in the context of normal or borderline function...
February 15, 2016: Gastroenterology
John E Pandolfino
No abstract text is available yet for this article.
December 2015: Gastroenterology & Hepatology
Dustin A Carlson, John E Pandolfino
High-resolution manometry (HRM) is the primary method used to evaluate esophageal motor function. Displayed and interpreted by esophageal pressure topography (EPT), HRM/ EPT provides a detailed assessment of esophageal function that is useful in the evaluation of patients with nonobstructive dysphagia and before foregut surgery. Esophageal motility diagnoses are determined systematically by applying objective metrics of esophageal sphincter and peristaltic function to the Chicago Classification of esophageal motility disorders...
June 2015: Gastroenterology & Hepatology
Rena Yadlapati, John E Pandolfino, Alcina K Lidder, Nadine Shabeeb, Diana-Marie Jaiyeola, Christopher Adkins, Neelima Agrawal, Andrew Cooper, Caroline P E Price, Jody D Ciolino, Andrew J Gawron, Stephanie S Smith, Michiel Bove, Bruce K Tan
OBJECTIVES: Predicting response to proton pump inhibitor (PPI) therapy in patients with laryngeal symptoms is challenging. The Restech Dx-pH probe is a transnasal catheter that measures oropharyngeal pH. In this study, we aimed to investigate the prognostic potential of oropharyngeal pH monitoring to predict responsiveness to PPI therapy in patients with laryngeal symptoms. METHODS: We conducted a physician-blinded prospective cohort study at a single academic institution between January 2013 and October 2014...
November 2016: American Journal of Gastroenterology
Dustin A Carlson, Michael D Crowell, Jessica N Kimmel, Amit Patel, C Prakash Gyawali, Monique Hinchcliff, W Leroy Griffing, John E Pandolfino, Marcelo F Vela
We assessed peristaltic reserve using multiple rapid swallows (MRS) during esophageal high-resolution manometry (HRM) of 111 patients with systemic sclerosis (89 women; ages, 42-64 y). We performed a retrospective analysis of HRM studies that included MRS in patients with systemic sclerosis, performed at 2 tertiary referral centers, and compared data with those from 18 healthy volunteers (controls). HRM findings were analyzed according to the Chicago Classification to provide an esophageal motility diagnosis...
October 2016: Clinical Gastroenterology and Hepatology
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