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Devault K.,Mayo Clinic Florida | Mcmahon B.P.,Trinity Academic Gastroenterology Group | Celebi A.,Kocaeli University | Costamagna G.,Catholic University of Rome | And 12 more authors.
Annals of the New York Academy of Sciences | Year: 2013

The following paper on gastroesophageal reflux disease (GERD) and Barrett's esophagus (BE) includes commentaries on defining esophageal landmarks; new techniques for evaluating upper esophageal sphincter (UES) tone; differential diagnosis of GERD, BE, and hiatal hernia (HH); the use of high-resolution manometry for evaluation of reflux; the role of fundic relaxation in reflux; the use of 24-h esophageal pH-impedance testing in differentiating acid from nonacid reflux and its potential inclusion in future Rome criteria; classification of endoscopic findings in GERD; the search for the cell origin that generates BE; and the relationship between BE, Barrett's carcinoma, and obesity. © 2013 New York Academy of Sciences.

Lottrup C.,University of Aalborg | Gregersen H.,Chongqing University | Liao D.,University of Aarhus | Fynne L.,Aarhus University Hospital | And 6 more authors.
Journal of Gastroenterology | Year: 2015

This nonsystematic review aims to describe recent developments in the use of functional lumen imaging in the gastrointestinal tract stimulated by the introduction of the functional lumen imaging probe. When ingested food in liquid and solid form is transported along the gastrointestinal tract, sphincters provide an important role in the flow and control of these contents. Inadequate function of sphincters is the basis of many gastrointestinal diseases. Despite this, traditional methods of sphincter diagnosis and measurement such as fluoroscopy, manometry, and the barostat are limited in what they can tell us. It has long been thought that measurement of sphincter function through resistance to distension is a better approach, now more commonly known as distensibility testing. The functional lumen imaging probe is the first medical measurement device that purports in a practical way to provide geometric profiling and measurement of distensibility in sphincters. With use of impedance planimetry, an axial series of cross-sectional areas and pressure in a catheter-mounted allantoid bag are used for the calculation of distensibility parameters. The technique has been trialed in many valvular areas of the gastrointestinal tract, including the upper esophageal sphincter, the esophagogastric junction, and the anorectal region. It has shown potential in the biomechanical assessment of sphincter function and characterization of swallowing disorders, gastroesophageal reflux disease, eosinophilic esophagitis, achalasia, and fecal incontinence. From this early work, the functional lumen imaging technique has the potential to contribute to a better and more physiological understanding of narrowing regions in the gastrointestinal tract in general and sphincters in particular. © 2015, Springer Japan.

Neumann H.,Friedrich - Alexander - University, Erlangen - Nuremberg | Neurath M.F.,Friedrich - Alexander - University, Erlangen - Nuremberg | Vieth M.,Institute of Pathology | Lever F.M.,UMC Utrecht | And 14 more authors.
Annals of the New York Academy of Sciences | Year: 2013

This paper reporting on techniques for esophageal evaluation and imaging and drugs for esophageal disease includes commentaries on endoscopy techniques including dye-based high-resolution and dye-less high-definition endoscopy; the shift from CT to MRI guidance in tumor delineation for radiation therapy; the role of functional lumen imaging in measuring esophageal distensibility; electrical stimulation of the lower esophageal sphincter (LES) as an alternative to fundoduplication for treatment of gastroesophageal reflux disease (GERD); the morphological findings of reflux esophagitis and esophageal dysmotility on double-contrast esophagography; the value of videofluoroscopy in assessing protecting mechanisms in patients with chronic reflux or swallowing disorders; targeting visceral hypersensitivity in the treatment of refractory GERD; and the symptoms and treatments of nighttime reflux and nocturnal acid breakthrough (NAB). © 2013 New York Academy of Sciences.

Miller L.,North Shore Long Island Jewish Medical Center | Clave P.,CIBER ISCIII | Clave P.,Laboratori Of Fisiologia Digestiva | Farre R.,Catholic University of Leuven | And 5 more authors.
Annals of the New York Academy of Sciences | Year: 2013

The following discussion on the physiology of the esophagus includes commentaries on the function of the muscularis mucosa and submucosa as a mechanical antireflux barrier in the esophagus; the different mechanisms of neurological control in the esophageal striated and smooth muscle; new insights from animal models into the neurotransmitters mediating lower esophageal sphincter (LES) relaxation, peristalsis in the esophageal body (EB), and motility of esophageal smooth muscle; differentiation between in vitro properties of the lower esophageal circular muscle, clasp muscle, and sling fibers; alterations in the relationship between pharyngeal contraction and relaxation of the upper esophageal sphincter (UES) in patients with dysphagia; the mechanical relationships between anterior hyoid movement, the extent of upper esophageal opening, and aspiration; the application of fluoroscopy and manometry with biomechanics to define the stages of UES opening; and nonpharmacological approaches to alter the gastroesophageal junction (GEJ). © 2013 New York Academy of Sciences.

Hussey M.,Adelaide and Meath Hospital | Hussey M.,Trinity Academic Gastroenterology Group | Garrigle R.M.,Trinity College Dublin | Kennedy U.,Trinity College Dublin | And 10 more authors.
European Journal of Gastroenterology and Hepatology | Year: 2016

Introduction The role of antitumour necrosis factor agents, in particular infliximab in ulcerative colitis (UC) has been well established. More recently adalimumab, a fully humanized antitumour necrosis factor α monoclonal antibody, was licensed for refractory moderately active UC in 2012. Available outcome data for adalimumab from routine clinical practice is limited. Aims To evaluate the clinical response and remission to adalimumab in a cohort of UC patients. Methods Patients with UC treated with adalimumab were identified from our inflammatory bowel disease database from 2007. A retrospective chart review was undertaken. Demographic and clinical data were recorded including a Mayo score and C-reactive protein (CRP) where available. All patients received standard induction subcutaneous therapy (160/80/40 mg) followed by a maintenance dose of 40 mg fortnightly. Clinical and biochemical response was assessed at 6 and 12 months. Clinical response was defined by a reduction in Mayo score more than or equal to 3, whereas clinical remission was defined by a total score of 2 or less. Dose adjustments and adverse events were also noted. Results In all, 52 patients were identified. Of these, 65% (n=34) were male and the mean age was 45 years (range 23'72 years). A total of 65% (n =34) had left sided disease, 31% (n=16) pancolitis and 4% (n =2) proctitis. The majority commenced adalimumab due to a loss of response to immunomodulator therapy (n=45, 87%), whereas the remaining 13% (n =7) had loss of response or been intolerant to infliximab. The mean disease duration was 8 years (1'29 years). At baseline 85% (n =44) had moderate disease and 15% (n= 8) had mild disease. The baseline mean CRP was 13.5 mg/l (range 1'82 mg/l) and the mean Mayo score was 6 (range 4'10). The mean duration of treatment was 18.5 months (range 4'95 months). Follow-up data was available in 46 (88%) and 37 (71%) patients at 6 and 12 months. Overall there was a statistically significant improvement in mean partial Mayo score on follow-up; 6 months =2 [P =0.0001, 95% confidence interval (CI) 2.99'4.55], 12 months= 2 (P =0.0001, 95% CI 2.74'4.46). While 65% (n =34) and 52% (n=27) had a clinical response at 6 and 12 months, respectively, 52% (n =27) and 42% (n =22) were in remission. Overall mean CRP normalized at 6 months (P= 0.002, 95% CI 3.31'15.1). Of note 25% (n =13) required dose escalation during follow-up, while treatment was discontinued by seven patients, five (71%) due to a loss of response, the remaining two (29%) due to an adverse event. Conclusion Our study shows adalimumab is an effective and safe long-term therapy for moderately active UC refractory to other treatments. While this data is encouraging, further work is required on patient selection and to determine the impact of treatment on both natural history and quality of life. © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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