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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
Dustin A Carlson, Peter J Kahrilas
No abstract text is available yet for this article.
September 28, 2016: Gastroenterology
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
Genevieve A Kahrilas, Jens Blotevogel, Edward R Corrin, Thomas Borch
Hydraulic fracturing fluid (HFF) additives are used to enhance oil and gas extraction from unconventional shale formations. Several kilometers downhole, these organic chemicals are exposed to temperatures up to 200 °C, pressures above 10 MPa, high salinities, and a pH range from 5-8. Despite this, very little is known about the fate of HFF additives under these extreme conditions. Here, stainless steel reactors are used to simulate the downhole chemistry of the commonly used HFF biocide glutaraldehyde (GA)...
October 18, 2016: Environmental Science & Technology
Peter J Kahrilas, Kenneth W Altman, Anne B Chang, Stephen K Field, Susan M Harding, Andrew P Lane, Kaiser Lim, Lorcan McGarvey, Jaclyn Smith, Richard S Irwin
BACKGROUND: We updated the 2006 ACCP clinical practice guidelines for management of reflux-cough syndrome. METHODS: Two PICO questions were addressed by systematic review: 1) can therapy for gastroesophageal reflux improve or eliminate cough in adults with chronic and persistently troublesome cough? and 2) are there minimal clinical criteria to guide practice in determining that chronic cough is likely to respond to therapy for gastroesophageal reflux? RESULTS: We found no high quality studies pertinent to either question...
September 7, 2016: Chest
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
Peter J Kahrilas
No abstract text is available yet for this article.
June 2016: Gastroenterology & Hepatology
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
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
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
Peter J Kahrilas
No abstract text is available yet for this article.
May 17, 2016: JAMA: the Journal of the American Medical Association
Leila Kia, Peter J Kahrilas
No abstract text is available yet for this article.
May 2016: Nature Reviews. Gastroenterology & Hepatology
Laurie Keefer, Peter J Kahrilas
Limsrivilai et al. report on a randomized control trial (RCT) testing the efficacy of imipramine for treating esophageal hypersensitivity and functional heartburn, the first RCT to test this therapy in this indication. Among 43 functional heartburn and esophageal hypersensitivity patients randomized to treatment with 25 mg qhs imipramine and 40 randomized to matched placebo, the response rates, judged by a 50% reduction in gastroesophageal reflux disease symptoms, were 37.2% and 37.5%, respectively, with no observed difference between patients with hypersensitivity and those with functional heartburn...
February 2016: American Journal of Gastroenterology
N Nativ-Zeltzer, J A Logemann, S G Zecker, P J Kahrilas
BACKGROUND: We aimed to define normative values for novel pressure topography metrics for high-resolution pharyngeal-esophageal manofluorography. The effects of age, gender, and bolus properties were examined. METHODS: Concurrent high-resolution manometry (HRM) and videofluoroscopy data were collected from 22 younger (aged 21-40) and 22 older (aged 60-80) healthy subjects. Pressure topography was analyzed by correlating pressure domains with videofluoroscopic events...
May 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Ala' A Abdel Jalil, Donald O Castell
Ineffective esophageal motility (IEM) is characterized by distal esophageal contraction amplitude of <30 mmHg on conventional manometry (Blonski et al. Am J Gastroenterol. 103(3):699-704, 2008), or a distal contractile integral (DCI) < 450 mmHg*s*cm on high-resolution manometry (HRM) (Kahrilas et al. Neurogastroenterol Motil. 27(2):160-74, 2015) in≥50 % of test swallows. IEM is the most common abnormality on esophageal manometry, with an estimated prevalence of 20-30 % (Tutuian and Castell Am J Gastroenterol...
January 2016: Current Gastroenterology Reports
Philip Katz, Peter J Kahrilas, David A Johnson, Tore Lind, Kerstin Röhss, Barry Traxler, Vincent Hugo, John Dent
OBJECTIVES: In mild gastroesophageal reflux disease, which accounts for the great majority of cases, the major burden of reflux occurs during daytime hours, after food intake. The aim of these analyses was to evaluate intragastric pH control during the typical 14-hour daytime awake period by proton-pump inhibitors (PPIs) given at over-the-counter (OTC) dosages. METHODS: In one double-blind and three open-label, randomized, crossover studies, intragastric pH was monitored for 24 hours on day 5 of treatment...
November 2015: Therapeutic Advances in Gastroenterology
J B Sodikoff, A A Lo, B B Shetuni, P J Kahrilas, G-Y Yang, J E Pandolfino
BACKGROUND: Achalasia has three distinct manometric phenotypes. This study aimed to determine if there were corresponding histopathologic patterns. METHODS: We retrospectively examined surgical muscularis propria biopsies obtained from 46 patients during laparoscopic esophagomyotomy. Pre-operative (conventional) manometry tracings were reviewed by two expert gastroenterologists who categorized patients into Chicago Classification subtypes. Pathology specimens were graded on degree of neuronal loss, inflammation, fibrosis, and muscle changes...
January 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
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