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Esophagic impedance

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https://www.readbyqxmd.com/read/29761528/nonerosive-reflux-disease-clinical-concepts
#1
REVIEW
C Prakash Gyawali, Dan E Azagury, Walter W Chan, Servarayan M Chandramohan, John O Clarke, Nicola de Bortoli, Edgar Figueredo, Mark Fox, Daniela Jodorkovsky, Adriana Lazarescu, Peter Malfertheiner, Jan Martinek, Kenric M Murayama, Roberto Penagini, Edoardo Savarino, Katerina P Shetler, Ellen Stein, Roger P Tatum, Justin Wu
Esophageal symptoms can arise from gastroesophageal reflux disease (GERD) as well as other mucosal and motor processes, structural disease, and functional esophageal syndromes. GERD is the most common esophageal disorder, but diagnosis may not be straightforward when symptoms persist despite empiric acid suppressive therapy and when mucosal erosions are not seen on endoscopy (as for nonerosive reflux disease, NERD). Esophageal physiological tests (ambulatory pH or pH-impedance monitoring and manometry) can be of value in defining abnormal reflux burden and reflux-symptom association...
May 15, 2018: Annals of the New York Academy of Sciences
https://www.readbyqxmd.com/read/29759494/impact-of-lowering-irrigation-flow-rate-on-atrial-lesion-formation-in-thin-atrial-tissue-preliminary-observations-from-experimental-and-clinical-studies
#2
Saurabh Kumar, Jorge Romero, William G Stevenson, Lori Foley, Ryan Caulfield, Akira Fujii, Shinichi Tanigawa, Laurence M Epstein, Bruce A Koplan, Usha B Tedrow, Roy M John, Gregory F Michaud
OBJECTIVES: The authors sought to investigate the effect of low irrigation flow rate on lesion characteristics and ablation outcomes in a clinicopathological study. BACKGROUND: Irrigated ablation produces deeper lesions compared with nonirrigated ablation, which may not be desirable in the thin-walled posterior left atrium (LA), where collateral esophageal injury is possible. METHODS: Lesions were placed on the smooth posterior right atrium in 20 swine and posterior LA in 60 patients at a maximum power of 20 to 25 W with either: 1) power-controlled ablation at an irrigation flow rate of 17 ml/min (high-flow group 10 swine; n = 40) or 2) temperature-controlled ablation at an irrigation flow rate of 2 ml/min (low-flow group 10 swine; n = 20)...
October 2017: JACC. Clinical Electrophysiology
https://www.readbyqxmd.com/read/29757356/developing-a-diagnostic-understanding-of-gerd-phenotypes-through-the-analysis-of-levels-of-mucosal-injury-immune-activation-and-psychological-comorbidity
#3
C Zhong, K Liu, K Wang, H Liu, H Su, J Wu, L Duan
Patients with gastroesophageal reflux disease (GERD) can present with typical or atypical symptoms. The aim of this study is to explore the underlying physiological and psychological mechanisms that lead to different symptomatic manifestations of GERD. A total of 238 patients diagnosed with GERD underwent gastroscopy, 24 h multichannel intraluminal impedance-pH (MII-pH) monitoring, and psychological assessment with questionnaires. Patient symptoms were used to classify GERD into phenotypes of typical reflux syndrome (TRS, n = 87), reflux chest pain syndrome (RCS, n = 98), and extraesophageal syndromes (EES, n = 53)...
May 10, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29754440/indications-and-interpretation-of-esophageal-function-testing
#4
REVIEW
C Prakash Gyawali, Nicola de Bortoli, John Clarke, Carla Marinelli, Salvatore Tolone, Sabine Roman, Edoardo Savarino
Esophageal symptoms are common, and can arise from mucosal, motor, functional, and neoplastic processes, among others. Judicious use of diagnostic testing can help define the etiology of symptoms and can direct management. Endoscopy, esophageal high-resolution manometry (HRM), ambulatory pH or pH-impedance manometry, and barium radiography are commonly used for esophageal function testing; functional lumen imaging probe is an emerging option. Recent consensus guidelines have provided direction in using test findings toward defining mechanisms of esophageal symptoms...
May 12, 2018: Annals of the New York Academy of Sciences
https://www.readbyqxmd.com/read/29733830/genesis-of-esophageal-pressurization-and-bolus-flow-patterns-in-patients-with-achalasia-esophagus
#5
Subum Park, Ali Zifan, Dushyant Kumar, Ravinder K Mittal
BACKGROUND & AIMS: In patients with achalasia esophagus, swallows induce simultaneous pressure waves known as esophageal pressurization. We studied the mechanism of esophageal pressurization and bolus flow patterns in patients with type 2 or type 3 achalasia. METHODS: We recorded high-resolution manometry with impedance and intraluminal ultrasound images concurrently in patients with type 2 achalasia (n=6) or type 3 achalasia (n=8) and in 10 healthy subjects (controls) during swallows of 5 ml, 0...
May 4, 2018: Gastroenterology
https://www.readbyqxmd.com/read/29708892/continuous-negative-abdominal-pressure-reduces-ventilator-induced-lung-injury-in-a-porcine-model
#6
Takeshi Yoshida, Doreen Engelberts, Gail Otulakowski, Bhushan Katira, Martin Post, Niall D Ferguson, Laurent Brochard, Marcelo B P Amato, Brian P Kavanagh
BACKGROUND: In supine patients with acute respiratory distress syndrome, the lung typically partitions into regions of dorsal atelectasis and ventral aeration ("baby lung"). Positive airway pressure is often used to recruit atelectasis, but often overinflates ventral (already aerated) regions. A novel approach to selective recruitment of dorsal atelectasis is by "continuous negative abdominal pressure." METHODS: A randomized laboratory study was performed in anesthetized pigs...
April 27, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29686276/management-options-for-patients-with-gerd-and-persistent-symptoms-on-proton-pump-inhibitors-recommendations-from-an-expert-panel
#7
Rena Yadlapati, Michael F Vaezi, Marcelo F Vela, Stuart J Spechler, Nicholas J Shaheen, Joel Richter, Brian E Lacy, David Katzka, Philip O Katz, Peter J Kahrilas, C Prakash Gyawali, Lauren Gerson, Ronnie Fass, Donald O Castell, Jenna Craft, Luke Hillman, John E Pandolfino
BACKGROUND: The aim of this study was to assess expert gastroenterologists' opinion on treatment for distinct gastroesophageal reflux disease (GERD) profiles characterized by proton pump inhibitor (PPI) unresponsive symptoms. METHODS: Fourteen esophagologists applied the RAND/UCLA Appropriateness Method to hypothetical scenarios with previously demonstrated GERD (positive pH-metry or endoscopy) and persistent symptoms despite double-dose PPI therapy undergoing pH-impedance monitoring on therapy...
April 24, 2018: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/29681623/lack-of-improvement-of-impaired-chemical-clearance-characterizes-ppi-refractory-reflux-related-heartburn
#8
Marzio Frazzoni, Leonardo Frazzoni, Salvatore Tolone, Nicola De Bortoli, Vincenzo Savarino, Edoardo Savarino
OBJECTIVE: Heartburn is the most specific symptom of reflux disease and is highly responsive to proton pump inhibitor (PPI) therapy. Some patients do not respond to PPIs, but mechanisms of refractoriness have not yet been fully elucidated. Impedance-pH monitoring, allowing comprehensive on-therapy assessment of reflux, represents a valuable test to investigate PPI refractoriness. METHODS: Prospective multicenter study comparing endoscopy-negative patients with PPI-refractory and PPI-responsive heartburn...
April 23, 2018: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/29643293/-a-case-of-non-cardiac-chest-pain-caused-by-esophageal-motility-disorder-observed-on-esophageal-high-resolution-manometry
#9
Kazumasa Muta, Eikichi Ihara, Yusuke Kitagawa, Shohei Hamada, Keita Fukaura, Tsutomu Iwasa, Akira Aso, Haruei Ogino, Kazuhiko Nakamura, Yoshihiro Ogawa
A 20-year-old man was referred to our hospital with dysphagia and chest pain. Heart disease was denied. No abnormality was observed in upper esophagogastroduodenoscopy and fluoroscopy;furthermore, no gastric acid-related symptoms were observed on combined esophageal multichannel intraluminal impedance and pH monitoring. Esophageal high-resolution manometry (HRM) performed by liquid swallow revealed normal peristalsis;however, HRM performed while the patient was taking solid meals showed abnormal contraction, and the patient simultaneously complained of chest pain...
2018: Nihon Shokakibyo Gakkai Zasshi, the Japanese Journal of Gastro-enterology
https://www.readbyqxmd.com/read/29642692/noncardiac-chest-pain-a-2018-update
#10
Marilena Durazzo, Giuseppe Gargiulo, Rinaldo Pellicano
Noncardiac chest pain (NCCP) is defined as recurring, angina-like, chest pain of noncardiac origin. Studies have estimated that gastroesophageal reflux disease (GERD) is the most common contributing factor for NCCP. In patients with non-GERD related NCCP, esophageal motility disorders, and functional chest pain (FCP) of presumed esophageal origin are the main underlying mechanisms for symptoms. Epidemiologic studies show a high prevalence of panic disorder, anxiety and major depression in NCCP patients. The diagnostic esophageal workup starts only after that cardiac and pulmonary diseases have been ruled out...
April 11, 2018: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/29606884/proton-pump-inhibitor-refractory-gastroesophageal-reflux-disease-challenges-and-solutions
#11
REVIEW
Joseph Mermelstein, Alanna Chait Mermelstein, Maxwell M Chait
A significant percentage of patients with gastroesophageal reflux disease (GERD) will not respond to proton pump inhibitor (PPI) therapy. The causes of PPI-refractory GERD are numerous and diverse, and include adherence, persistent acid, functional disorders, nonacid reflux, and PPI bioavailability. The evaluation should start with a symptom assessment and may progress to imaging, endoscopy, and monitoring of esophageal pH, impedance, and bilirubin. There are a variety of pharmacologic and procedural interventions that should be selected based on the underlying mechanism of PPI failure...
2018: Clinical and Experimental Gastroenterology
https://www.readbyqxmd.com/read/29602998/clinical-feasibility-of-a-new-full-thickness-endoscopic-plication-device-gerdx%C3%A2-for-patients-with-gerd-results-of-a-prospective-trial
#12
Michael Weitzendorfer, Georg O Spaun, Stavros A Antoniou, Kai Witzel, Klaus Emmanuel, Oliver O Koch
BACKGROUND: Previous studies suggest clinical effectiveness of endoscopic full-thickness plication in selected patients with gastroesophageal reflux disease (GERD). The aim of this study was to assess the clinical safety and efficiency of the GERDx™ device by evaluating clinical parameters, reflux symptom scores, and quality of life (QoL). METHODS: Prospective one-arm trial evaluating the outcome of forty patients with GERD subjected to endoscopic plication with the GERDx™ device...
March 30, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29597090/lobaplatin-promotes-radiosensitivity-induces-apoptosis-attenuates-cancer-stemness-and-inhibits-proliferation-through-pi3k-akt-pathway-in-esophageal-squamous-cell-carcinoma
#13
Shupei Pan, Yuchen Sun, Donghu Sui, Tian Yang, Shenbo Fu, Jizhao Wang, Beina Hui, Ruxing Xi, Chenchen He, Xiaozhi Zhang
Radiotherapy is one of the common treatments for esophageal squamous cell carcinoma (ESCC). Yet, local recurrence led by radioresistance is still not solved. Lobaplatin (LBP) is known to have powerful clinical anti-tumor activities in various tumors, but its effect in radiotherapy is rarely studied. Here we report that LBP is a promising radiosensitizer for ESCC. We treated ESCC cells with LBP and radiation, both separately and in combination. Untreated cells were set as control groups. We found that LBP inhibited ESCC cell growth and enhanced their radiosensitivity...
March 26, 2018: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/29574541/speech-therapy-as-treatment-for-supragastric-belching
#14
Liesbeth Ten Cate, Thomas V K Herregods, Philippe H Dejonckere, Gerrit J M Hemmink, André J P M Smout, Albert J Bredenoord
The purpose of this study was to describe a newly developed speech therapy program as an innovating therapeutic approach and to assess the results of this intervention in patients with supragastric belching. This is a retrospective analysis of prospectively gathered data from 73 patients with supragastric belching who were treated with speech therapy between 2007 and 2017. Of these, 48 were included for evaluation of therapy. Thirty patients had supragastric belching proven by 24-h impedance measurements. Eighteen patients were diagnosed by an experienced speech language pathologist as having supragastric belching according to precise criteria...
March 24, 2018: Dysphagia
https://www.readbyqxmd.com/read/29549453/a-modified-nissen-fundoplication-subjective-and-objective-midterm-results
#15
Sabrina Rampado, Edoardo Savarino, Angelica Ganss, Giulia Pozza, Romeo Bardini
PURPOSE: The failure rate of laparoscopic anti-reflux surgery is approximately 10-20%. The aim of our prospective study was to investigate whether a modified Nissen fundoplication (MNF) can improve reflux symptoms and prevent surgical treatment failure in the midterm. METHODS: The MNF consisted of (1) suturing the esophagus to the diaphragmatic crura on each side using four non-absorbable stitches, (2) reinforcing clearly weak crura with a tailored Ultrapro mesh, and (3) fixing the upper stitch of the valve to the diaphragm...
March 2018: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/29543695/mucosal-impedance-measurements-differentiate-pediatric-patients-with-active-vs-inactive-eosinophilic-esophagitis
#16
Mary Allyson Lowry, Michael F Vaezi, Hernan Correa, Tina Higginbotham, James C Slaughter, Sari Acra
BACKGROUND & AIMS: Eosinophilic esophagitis (EoE) is a chronic disorder in children that requires continued assessment of disease activity, involving repeated sedation, endoscopy, and biopsy analysis. We investigated whether mucosal impedance measurements can be used to monitor disease activity in pediatric patients with EoE. METHODS: We measured mucosal impedance at 3 locations in the esophagus in pediatric patients (1-18 years old; 32 with active EoE, 10 with inactive EoE, 32 with non-erosive reflux disease [NERD]) and 53 children with symptoms but normal findings from histologic analyses (controls) undergoing routine esophagogastroduodenoscopy at the Vanderbilt Pediatric Gastroenterology Clinic...
March 14, 2018: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/29542847/impaired-motility-in-barrett-s-esophagus-a-study-using-high-resolution-manometry-with-physiologic-challenge
#17
S Sanagapalli, A Emmanuel, R Leong, S Kerr, L Lovat, R Haidry, M Banks, D Graham, A Raeburn, N Zarate-Lopez, R Sweis
BACKGROUND: Esophageal dysmotility may predispose to Barrett's esophagus (BE). We hypothesized that high-resolution manometry (HRM) performed with additional physiologic challenge would better delineate dysmotility in BE. METHODS: Included patients had typical reflux symptoms and underwent endoscopy, HRM with single water swallows and adjunctive testing with solids and rapid drink challenge (RDC) before ambulatory pH-impedance monitoring. BE and endoscopy-negative reflux disease (ENRD) subjects were compared against functional heartburn patient-controls (FHC)...
March 15, 2018: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/29541393/effective-screening-of-t-cells-recognizing-neoantigens-and-construction-of-t-cell-receptor-engineered-t-cells
#18
Taigo Kato, Tatsuo Matsuda, Yuji Ikeda, Jae-Hyun Park, Matthias Leisegang, Sachiko Yoshimura, Tetsuro Hikichi, Makiko Harada, Makda Zewde, Sho Sato, Kosei Hasegawa, Kazuma Kiyotani, Yusuke Nakamura
Neoantigens are the main targets of tumor-specific T cells reactivated by immune checkpoint-blocking antibodies or when using tumor-infiltrating T cells for adoptive therapy. While cancers often accumulate hundreds of mutations and harbor several immunogenic neoantigens, the repertoire of mutation-specific T cells in patients might be restricted. To bypass suboptimal conditions, which impede the reactivation of existing T cells or the priming of neoantigen-specific T cells in a patient, we employ T cells of healthy donors with an overlapping HLA repertoire to target cancer neoantigens...
February 16, 2018: Oncotarget
https://www.readbyqxmd.com/read/29505550/unilateral-versus-bilateral-lung-transplantation-do-different-esophageal-risk-factors-predict-chronic-allograft-failure
#19
Anupong Tangaroonsanti, Augustine S Lee, Marcelo F Vela, Michael D Crowell, David Erasmus, Cesar Keller, Jorge Mallea, Francisco Alvarez, Cristina Almansa, Kenneth R DeVault, Lesley A Houghton
GOALS: To assess the effect of unilateral versus bilateral lung transplantation (LTx) on esophageal motility and gastroesophageal reflux, and the association with the development of obstructive chronic lung allograft dysfunction (o-CLAD). BACKGROUND: We have shown that esophagogastric junction outflow obstruction, incomplete bolus transit, and proximal reflux are all independent risk factors for the development of chronic allograft failure. However, it remains unclear whether these factors are influenced by the type of surgery and how this relates to allograft failure...
March 2, 2018: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/29444224/a-systematic-review-with-meta-analysis-of-the-prevalence-of-gastroesophageal-reflux-in-congenital-diaphragmatic-hernia-pediatric-survivors
#20
J V Arcos-Machancoses, C Ruiz Hernández, J Martin de Carpi, S Pinillos Pisón
Congenital diaphragmatic hernia survivors are a well-known group at risk for developing gastroesophageal reflux disease that may be particularly long-term severe. The aim of this study is to provide a systematic review of the prevalence of gastroesophageal reflux in infant and children survivors treated for congenital diaphragmatic hernia.Electronic and manual searches were performed with keywords related to congenital diaphragmatic hernia, gastroesophageal reflux disease, and epidemiology terms. Summary estimates of the prevalence were calculated...
February 9, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
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