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JOURNAL ARTICLE
Domenico A Farina, Dylan A Olson, Dustin A Carlson, Peter J Kahrilas, Edoardo Vespa, Andree H Koop, Yadis Arroyo, Eric Goudie, John E Pandolfino
BACKGROUND: Despite the established efficacy of achalasia treatments on symptomatic outcomes, there are limited data evaluating the treatment effect on esophageal dilatation. This study aimed to assess the effect achalasia treatment on esophageal dilatation and the effect of esophageal width reduction ("recoil") on clinical outcomes. METHODS: Patients with type I or type II achalasia that completed high-resolution manometry (HRM), functional lumen imaging probe (FLIP), and timed barium esophagram (TBE) pre and post treatment were included...
March 24, 2024: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
#2
REVIEW
Peter Kahrilas, Foteini Anastasiou, Albert J Bredenoord, Hashem B El Serag, Joachim Labenz, Juan Mendive, Edoardo V Savarino, Daniel Sifrim, Mihaela Udrescu, Rena Yadlapati, A Pali Hungin
BACKGROUND: Despite deprescribing initiatives to curb overutilisation of proton pump inhibitors (PPIs), achieving meaningful reductions in PPI use is proving a challenge. SUMMARY: An international group of primary care doctors and gastroenterologists examined the literature surrounding PPI use and use-reduction to clarify: (i) what constitutes rational PPI prescribing; (ii) when and in whom PPI use-reduction should be attempted; and (iii) what strategies to use when attempting PPI use-reduction...
March 21, 2024: Digestive Diseases
#3
Guy Elisha, Sourav Halder, Xinyi Liu, Dustin A Carlson, Peter J Kahrilas, John E Pandolfino, Neelesh A Patankar
An understanding how neurological disorders lead to mechanical dysfunction of the esophagus requires knowledge of the neural circuit of the enteric nervous system. Historically, this has been elusive. Here, we present an empirically guided neural circuit for the esophagus. It has a chain of unidirectionally coupled relaxation oscillators, receiving excitatory signals from stretch receptors along the esophagus. The resulting neuromechanical model reveals complex patterns and behaviors that emerge from interacting components in the system...
March 1, 2024: ArXiv
#4
JOURNAL ARTICLE
Rapid Development of Achalasia After SARS-CoV-2 Infection: PCR Analysis of Esophageal Muscle Tissue.
Salih Samo, Falak Hamo, Ameer Hamza, Rena Yadlapati, Peter J Kahrilas, Ann Wozniak PhDAnn Wozniak
INTRODUCTION: Achalasia has been linked to viruses. We have observed cases of rapid-developing achalasia post-COVID-19. METHODS: We aimed to prospectively evaluate esophageal muscle for SARS-CoV-2 from patients with rapid-onset achalasia post-COVID-19 and compare them to achalasia predating COVID-19 and achalasia with no COVID-19. RESULTS: Compared to long-standing achalasia predating COVID-19 and long-standing achalasia with no COVID-19, the achalasia post- COVID-19 subjects had significantly higher levels of mRNA for the SARS-CoV-2 nucleocapsid (N) protein, which correlated with a significant increase in the inflammatory markers NLRP3 and TNF...
January 24, 2024: American Journal of Gastroenterology
#5
JOURNAL ARTICLE
Michelle M Lu, Peter J Kahrilas, Ezra N Teitelbaum, John E Pandolfino, Dustin A Carlson
BACKGROUND: The impact of esophageal dysmotility among patients with post-fundoplication esophageal symptoms is not fully understood. This study aimed to investigate secondary peristalsis and esophagogastric junction (EGJ) opening biomechanics using functional lumen imaging probe (FLIP) panometry in symptomatic post-fundoplication patients. METHODS: Eighty-seven adult patients post-fundoplication who completed FLIP for symptomatic esophageal evaluation were included...
April 2024: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
#6
JOURNAL ARTICLE
Edoardo Vespa, Domenico A Farina, John E Pandolfino, Peter J Kahrilas, Andree H Koop, Dustin A Carlson
BACKGROUND AND AIMS: Some achalasia patients exhibit esophageal contractile activity on follow-up after treatment, yet its importance remains unclear. We aimed to identify factors associated with presence of contractility after treatment and to assess its impact on timed barium esophagram (TBE) and clinical outcomes. METHODS: Patients with type I or II achalasia on baseline high-resolution manometry (HRM) who completed HRM, TBE, and functional lumen imaging probe (FLIP) after treatment were retrospectively identified...
December 28, 2023: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
#7
JOURNAL ARTICLE
A Pali Hungin, Rena Yadlapati, Foteini Anastasiou, Albert J Bredenoord, Hashem El Serag, Pierluigi Fracasso, Juan M Mendive, Edoardo V Savarino, Daniel Sifrim, Mihaela Udrescu, Peter J Kahrilas
Patients with reflux-like symptoms (heartburn and regurgitation) are often not well advised on implementing individualised strategies to help control their symptoms using dietary changes, lifestyle modifications, behavioural changes or fast-acting rescue therapies. One reason for this may be the lack of emphasis in management guidelines owing to 'low-quality' evidence and a paucity of interventional studies. Thus, a panel of 11 gastroenterologists and primary care doctors used the Delphi method to develop consolidated advice for patients based on expert consensus...
January 1, 2024: European Journal of Gastroenterology & Hepatology
#8
JOURNAL ARTICLE
Guy Elisha, Sourav Halder, Dustin A Carlson, Wenjun Kou, Peter J Kahrilas, John E Pandolfino, Neelesh A Patankar
Functional luminal imaging probe (FLIP) is used to measure cross-sectional area (CSA) and pressure at sphincters. It consists of a catheter surrounded by a fluid filled cylindrical bag, closed on both ends. Plotting the pressure-CSA hysteresis of a sphincter during a contraction cycle, which is available through FLIP testing, offers information on its functionality, and can provide diagnostic insights. However, limited work has been done to explain the mechanics of these pressure-CSA loops. This work presents a consolidated picture of pressure-CSA loops of different sphincters...
February 1, 2024: Journal of Biomechanical Engineering
#9
EDITORIAL
Peter J Kahrilas
No abstract text is available yet for this article.
December 2023: Alimentary Pharmacology & Therapeutics
#10
REVIEW
Daniela Schiller, Alessandra N C Yu, Nelly Alia-Klein, Susanne Becker, Howard C Cromwell, Florin Dolcos, Paul J Eslinger, Paul Frewen, Andrew H Kemp, Edward F Pace-Schott, Jacob Raber, Rebecca L Silton, Elka Stefanova, Justin H G Williams, Nobuhito Abe, Moji Aghajani, Franziska Albrecht, Rebecca Alexander, Silke Anders, Oriana R Aragón, Juan A Arias, Shahar Arzy, Tatjana Aue, Sandra Baez, Michela Balconi, Tommaso Ballarini, Scott Bannister, Marlissa C Banta, Karen Caplovitz Barrett, Catherine Belzung, Moustafa Bensafi, Linda Booij, Jamila Bookwala, Julie Boulanger-Bertolus, Sydney Weber Boutros, Anne-Kathrin Bräscher, Antonio Bruno, Geraldo Busatto, Lauren M Bylsma, Catherine Caldwell-Harris, Raymond C K Chan, Nicolas Cherbuin, Julian Chiarella, Pietro Cipresso, Hugo Critchley, Denise E Croote, Heath A Demaree, Thomas F Denson, Brendan Depue, Birgit Derntl, Joanne M Dickson, Sanda Dolcos, Anat Drach-Zahavy, Olga Dubljević, Tuomas Eerola, Dan-Mikael Ellingsen, Beth Fairfield, Camille Ferdenzi, Bruce H Friedman, Cynthia H Y Fu, Justine M Gatt, Beatrice de Gelder, Guido H E Gendolla, Gadi Gilam, Hadass Goldblatt, Anne Elizabeth Kotynski Gooding, Olivia Gosseries, Alfons O Hamm, Jamie L Hanson, Talma Hendler, Cornelia Herbert, Stefan G Hofmann, Agustin Ibanez, Mateus Joffily, Tanja Jovanovic, Ian J Kahrilas, Maria Kangas, Yuta Katsumi, Elizabeth Kensinger, Lauren A J Kirby, Rebecca Koncz, Ernst H W Koster, Kasia Kozlowska, Sören Krach, Mariska E Kret, Martin Krippl, Kwabena Kusi-Mensah, Cecile D Ladouceur, Steven Laureys, Alistair Lawrence, Chiang-Shan R Li, Belinda J Liddell, Navdeep K Lidhar, Christopher A Lowry, Kelsey Magee, Marie-France Marin, Veronica Mariotti, Loren J Martin, Hilary A Marusak, Annalina V Mayer, Amanda R Merner, Jessica Minnier, Jorge Moll, Robert G Morrison, Matthew Moore, Anne-Marie Mouly, Sven C Mueller, Andreas Mühlberger, Nora A Murphy, Maria Rosaria Anna Muscatello, Erica D Musser, Tamara L Newton, Michael Noll-Hussong, Seth Davin Norrholm, Georg Northoff, Robin Nusslock, Hadas Okon-Singer, Thomas M Olino, Catherine Ortner, Mayowa Owolabi, Caterina Padulo, Romina Palermo, Rocco Palumbo, Sara Palumbo, Christos Papadelis, Alan J Pegna, Silvia Pellegrini, Kirsi Peltonen, Brenda W J H Penninx, Pietro Pietrini, Graziano Pinna, Rosario Pintos Lobo, Kelly L Polnaszek, Maryna Polyakova, Christine Rabinak, S Helene Richter, Thalia Richter, Giuseppe Riva, Amelia Rizzo, Jennifer L Robinson, Pedro Rosa, Perminder S Sachdev, Wataru Sato, Matthias L Schroeter, Susanne Schweizer, Youssef Shiban, Advaith Siddharthan, Ewa Siedlecka, Robert C Smith, Hermona Soreq, Derek P Spangler, Emily R Stern, Charis Styliadis, Gavin B Sullivan, James E Swain, Sébastien Urben, Jan Van den Stock, Michael A Vander Kooij, Mark van Overveld, Tamsyn E Van Rheenen, Michael B VanElzakker, Carlos Ventura-Bort, Edelyn Verona, Tyler Volk, Yi Wang, Leah T Weingast, Mathias Weymar, Claire Williams, Megan L Willis, Paula Yamashita, Roland Zahn, Barbra Zupan, Leroy Lowe
Over the last decades, theoretical perspectives in the interdisciplinary field of the affective sciences have proliferated rather than converged due to differing assumptions about what human affective phenomena are and how they work. These metaphysical and mechanistic assumptions, shaped by academic context and values, have dictated affective constructs and operationalizations. However, an assumption about the purpose of affective phenomena can guide us to a common set of metaphysical and mechanistic assumptions...
March 2024: Neuroscience and Biobehavioral Reviews
#11
JOURNAL ARTICLE
Dustin A Carlson, Ikuo Hirano, Nirmala Gonsalves, Peter J Kahrilas, Isis K Araujo, Mira Yang, Marie-Pier Tetreault, John E Pandolfino
BACKGROUND AND AIMS: The evaluation provided by functional lumen imaging probe (FLIP) Panometry includes esophageal distensibility/compliance (mechanics) of the esophageal body and esophagogastric junction (EGJ) and esophageal motility (secondary peristalsis). We aimed to develop a composite score using these parameters to characterize physiomechanical function in patients with eosinophilic esophagitis (EoE). METHODS: 215 adult patients with EoE that completed FLIP Panometry during sedated endoscopy with esophageal biopsies were included...
October 25, 2023: Gastrointestinal Endoscopy
#12
JOURNAL ARTICLE
Sourav Halder, John E Pandolfino, Peter J Kahrilas, Andree Koop, Jacob Schauer, Isis K Araujo, Guy Elisha, Wenjun Kou, Neelesh A Patankar, Dustin A Carlson
BACKGROUND AND AIMS: The distal contractile integral (DCI) quantifies the contractile vigor of primary peristalsis on high-resolution manometry (HRM), whereas no such metric exists for secondary peristalsis on functional lumen imaging probe (FLIP) panometry. This study aimed to evaluate novel FLIP metrics of contraction power and displaced volume in asymptomatic controls and a patient cohort. METHODS: Thirty-five asymptomatic controls and adult patients (with normal esophagogastric junction outflow/opening and without spasm) who completed HRM and FLIP panometry were included...
October 16, 2023: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
#13
EDITORIAL
John Lipham, Peter J Kahrilas
No abstract text is available yet for this article.
January 2024: Gastroenterology
#14
JOURNAL ARTICLE
Jeanine Wakim El-Khoury, John E Pandolfino, Peter J Kahrilas, Bidemi Godo, Domenico A Farina, Wenjun Kou, Dustin A Carlson
BACKGROUND: The esophageal response to stepwise distension during the functional lumen imaging probe (FLIP) Panometry study often parallels high-resolution manometry (HRM) motility diagnoses. This study aimed to describe the changes in FLIP metrics during FLIP emptying, that is, reduced volume distension. METHODS: Adult patients who completed FLIP and HRM for esophageal motility evaluation were included. Esophagogastric junction (EGJ) opening parameters were assessed during stepwise FLIP filling to volumes of 60 mL ("filling 60 mL"), then 70 mL, and then back to 60 mL ("emptying 60 mL")...
September 11, 2023: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
#15
JOURNAL ARTICLE
Margarette H Clevenger, Adam L Karami, Dustin A Carlson, Peter J Kahrilas, Nirmala Gonsalves, John E Pandolfino, Deborah R Winter, Kelly A Whelan, Marie-Pier Tétreault
Eosinophilic esophagitis (EoE) is an esophageal immune-mediated disease characterized by eosinophilic inflammation and epithelial remodeling, including basal cell hyperplasia (BCH). Although BCH is known to correlate with disease severity and with persistent symptoms in patients in histological remission, the molecular processes driving BCH remain poorly defined. Here, we demonstrated that BCH is predominantly characterized by an expansion of non-proliferative suprabasal cells that are still committed to early differentiation...
September 5, 2023: JCI Insight
#16
JOURNAL ARTICLE
Peter J Kahrilas, Dustin A Carlson, John E Pandolfino
High-resolution manometry, Chicago Classification v4.0, the functional lumen imaging probe, Panometry, and peroral endoscopic myotomy (POEM) are all now integral parts of the landscape for managing achalasia or, more precisely, achalasia-like syndromes. This narrative review examines the impact of these innovations on the management of achalasia-like syndromes. High-resolution manometry was the disruptive technology that prompted the paradigm shift to thinking of motility disorders as patterns of obstructive physiology involving the esophagogastric junction and/or the distal esophagus rather than as siloed entities...
2023: Gastro Hep Adv
#17
JOURNAL ARTICLE
Andree H Koop, Peter J Kahrilas, Jacob Schauer, John E Pandolfino, Dustin A Carlson
BACKGROUND: Primary and secondary peristalsis facilitate esophageal bolus transport; however, their relative impact for bolus clearance remains unclear. We aimed to compare primary peristalsis and contractile reserve on high-resolution manometry (HRM) and secondary peristalsis on functional lumen imaging probe (FLIP) Panometry with emptying on timed barium esophagogram (TBE) and incorporate findings into a comprehensive model of esophageal function. METHODS: Adult patients who completed HRM with multiple rapid swallows (MRS), FLIP, and TBE for esophageal motility evaluation and without abnormal esophagogastric junction outflow/opening or spasm were included...
October 2023: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
#18
JOURNAL ARTICLE
Sourav Halder, Ethan M Johnson, Jun Yamasaki, Peter J Kahrilas, Michael Markl, John E Pandolfino, Neelesh A Patankar
Dynamic magnetic resonance imaging (MRI) is a popular medical imaging technique that generates image sequences of the flow of a contrast material inside tissues and organs. However, its application to imaging bolus movement through the esophagus has only been demonstrated in few feasibility studies and is relatively unexplored. In this work, we present a computational framework called mechanics-informed MRI (MRI-MECH) that enhances that capability, thereby increasing the applicability of dynamic MRI for diagnosing esophageal disorders...
2023: Frontiers in Physiology
#19
JOURNAL ARTICLE
Dustin A Carlson, I Hirano, N Gonsalves, P J Kahrilas, I K Araujo, M Yang, M P Tetreault, J E Pandolfino
BACKGROUND AND AIMS: Eosinophilic esophagitis (EoE) is characterized by eosinophilic inflammation, but also heterogeneous presentations involving fibrostenotic esophageal remodeling and esophageal dysmotility. We aimed to define and evaluate phenotypes of EoE using functional lumen imaging probe (FLIP) panometry (ie, a physiomechanical classification of EoE). METHODS: Patients with EoE who completed FLIP during endoscopy were included in a cross-sectional study...
May 30, 2023: Gastroenterology
#20
JOURNAL ARTICLE
Isis K Araujo, Cristina Shehata, Ikuo Hirano, Nimala Gonsalves, Peter J Kahrilas, Jacob M Schauer, Domenico Farina, Stephanie Peterson, W Kou, John E Pandolfino, Dustin A Carlson
BACKGROUND & AIMS: Chronic inflammation of eosinophilic esophagitis (EoE) results in progressive, fibrostenotic remodeling of the esophageal wall. This study aimed to demonstrate objective changes in esophageal distensibility relative to duration of EoE disease using a functional lumen imaging probe (FLIP). METHODS: Adult patients with EoE who completed a 16-cm FLIP protocol during endoscopy were evaluated in a cross-sectional study. FLIP analysis focused on distensibility plateau (DP) of the esophageal body...
May 8, 2023: Clinical Gastroenterology and Hepatology
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