Radu Tutuian

..Combined MII-OM identifies and quantifies the effects of gravity on the dichotomy between specific pressures measured by OM and function assessed as transit measured by MII...

..The aim of our study is to evaluate esophageal bolus transit in patients with manometric patterns of ineffective esophageal motility (IEM)...

..The opportunity to review these documented changes visually helps to make the patient aware of the functional aspects of the condition, avoiding unwarranted therapies and providing the opportunity to reinforce behavioral modifications...

..pylori to 'assist'acid suppression obtained by PPI twice-daily, adding bedtime H2RAs after successful H. pylori eradication or other approaches to eliminate NAB results in better clinical outcomes...

..Careful selection of appropriate surgical candidates is important, and the risk of developing new or recurrent symptoms requiring medication should be disclosed to patients contemplating the surgical alternative...

..Laryngopharyngeal reflux is of great interest to otolaryngologists, speech and language therapists, and gastroenterologists. This is a brief review of recent publications in the diagnosis of laryngopharyngeal reflux...

..Recently developed single-use disposable catheters use small balloons prefilled with air that transmit the pressure of oesophageal contractions to external transducers...

..Combined MII-pH is a useful tool in evaluating patients with persistent symptoms on acid-suppressive therapy, patients with atypical symptoms, and infants...

....

..Normative data for this method have not been published. The aim of this study was to establish normative data for combined MII-EM and to correlate liquid and viscous bolus transit by impedance with esophageal contractions by manometry...

..This parameter is easy to calculate, but does not identify the actual pH level. Recent studies have recommended the use of the integrated intragastric acidity as a more refined method of assessing intragastric acid control...

..An unexplained genetic factor must be present, however, to explain the predominance of BE in white middle-aged men...

....

..MII-pH shows promise to become an important clinical tool, particularly to assess gastroesophageal reflux in the postprandial period and in patients with persistent symptoms on therapy and with atypical symptoms...

..Endoscopic antireflux procedures are recommended only in selected patients and given the relative short experience with these techniques, patients treated with endoscopic procedures should be enrolled in a rigorous follow-up program...

..Aim: To evaluate the frequency of chronic cough associated with nonacid reflux and the response of these patients to laparoscopic Nissen fundoplication...

..5-HT(4) receptor agonists are used as promotility agents of the stomach, small and large intestine. There is limited information on the influence of 5-HT(4) receptor agonists on oesophageal function and gastro-oesophageal reflux...

....

..This threshold has been selected as it exceeds the average DEA in healthy volunteers by 2 SDs. Since its introduction the clinical significance of this finding has been challenged, as many patients with NE are asymptomatic...

..0001). CONCLUSION: Since rapid food intake produces more GER in healthy volunteers, studies in GERD patients are warranted to evaluate if eating slowly may represent another "life-style modification" aimed at reducing GER...

..Outcomes data are warranted to evaluate whether stratifying DES patients based on pressure and bolus transit information may improve the clinical approach...

..Combined multichannel intraluminal impedance and esophageal manometry (MII-EM) allows both a functional and a manometric evaluation of esophageal motility and identifies chronic fluid retention...

..The addition of a bedtime H2 receptor antagonist (H2RA) to proton pump inhibitor (PPI) b.i.d. to inhibit nocturnal acid breakthrough (NAB) is controversial. H2RA tolerance has been documented suggesting limitations in its long-term effect...

..Distal oesophageal spasm is a rare and under-investigated motility abnormality. Recent studies indicate effective bolus transit in varying percentages of distal oesophageal spasm patients...

..Bethanechol, a direct-acting muscarinic receptor agonist, has been shown in healthy volunteers to produce a significant increase in peristaltic amplitude in the distal esophagus...

..Persistent symptoms on acid suppressive therapy are due to either acid or nonacid gastroesophageal reflux (GER) episodes or are not related to reflux...

..Combined multichannel intraluminal impedance and manometry (MII-EM) enables the simultaneous measurement of intraesophageal pressures and bolus transit at various levels within the esophagus...

..MII clarifies functional abnormalities in patients with abnormal manometric studies...

..Current findings support the recommendations to carefully instruct patients to record all oral intake and to exclude meal periods from the analysis...

..Combined analysis (CA) including the SI and percentage time pH<4 provides a more comprehensive interpretation of pH monitoring results...

..MII-pH shows promise to become an important clinical tool, particularly to assess GER in the postprandial period and in patients with persistent symptoms on acid suppression therapy...

..Given this relative small number of swallows concerns have been raised whether the abnormal findings based on 10 wet swallows would persist with another set of 10 wet swallows...

..The present review summarises the technical aspects in performing and interpreting esophageal reflux monitoring procedures...

..The ability to associate symptoms with nonacid reflux events will help guide therapy in select groups of patients, such as patients with ongoing symptoms on acid-suppressive therapy as well as in the pediatric population...

..MII-EM can be used to collect data with minimal variability in healthy subjects during unrestricted upright meal consumption. This technique may be used to identify abnormal motility patterns during physiologic swallowing...

..Patients with acid reflux are likely to perceive symptoms earlier, and symptoms with acid and nonacid reflux may be produced by different mechanisms...

..Manometric identification of an hiatal hernia is an infrequent finding with low sensitivity but high specificity compared to endoscopy...

..Using this technique, we aimed to characterise the frequency of acid and non-acid reflux (NAR) and their relationship to typical and atypical GOR symptoms in patients on PPI therapy...

..CONCLUSION: Patients with a positive symptom index resistant to PPIs with non-acid or acid reflux demonstrated by MII-pH monitoring can be treated successfully by laparoscopic Nissen fundoplication...

..Further prospective, placebo-controlled studies may help confirm that there is a role for night-time H2RAs in GERD symptom control...

..In sum, GERD is a complex problem caused by many factors that are exacerbated when the patient is in the supine position...

..We report the case of a 45 year old woman with a history of a chronic cough referred for fundoplication after documenting her symptoms were associated with non-acid reflux using multichannel intraluminal impedance and pH (MII-pH)...

..In our experience, the addition of bedtime H2RAs is clinically effective in controlling nocturnal acid breakthrough and GERD symptoms...

..Liver surveillance during EUS is worthwhile for patients in whom there is another indication for the procedure; but, at present, EUS should not replace traditional imaging modalities...

..Conventional esophageal manometry evaluating liquid swallows in the recumbent position measures pressure changes at a limited number of sites and does not assess motility during solid swallows in the physiologic upright position...

..In conclusion, these findings suggest that the term diffuse esophageal spasm is a misnomer and the DES is more appropriately described as "distal" esophageal spasm...

..In summary, diagnosis achalasia requires shrewd history taking and dedicated esophageal testing. In experienced hands, treatment of achalasia can provide long-term sustained clinical improvement...

..While preliminary studies indicate that a bolus might be retained in this area, the clinical relevance of the LPZ remains unclear...

..The prevalence of those lesions in GERD patients is not well established. The aim of this study was to evaluate the prevalence of GERD signs in the laryngopharyngeal area during routine upper gastrointestinal endoscopy...

..This study characterizes the frequency, duration, and extent of reflux in health and provides normal values for 24-h Imp-pH for future comparison with GERD patients...

..Oral esomeprazole might control intragastric acidity more effectively compared with other acid-suppressive agents after IV therapy...

..The results of several studies suggest that impedance-pH monitoring is useful in the evaluation of patients with PPI-resistant typical reflux symptoms, chronic unexplained cough, excessive belching, and rumination...

..Outcome data are needed to evaluate the prognostic value of combined manometry-impedance in patients with GORD undergoing anti-reflux surgery...

..Laparoscopic mesh-augmented hiatoplasty (LMAH) might be an alternative operation aimed at restoring the intra-abdominal part of the esophagus and reducing the size of the diaphragmatic hiatus...

..In the recent years combined multichannel intraluminal impedance and pH (MII-pH) monitoring has become a clinical tool that permits the clarification of the mechanisms underlying the persistent symptoms on acid suppressive therapy...

..Combined impedance-pH monitoring offers the ability to identify reflux episodes independently of their acid content, an important advantage when evaluating patients with symptoms persisting during acid-suppressive therapy...

..The aim of this study was to assess the frequency of acid and nonacid refluxes after Merendino procedure using multichannel intraluminal impedance-pH (MII-pH) monitoring...

..2%) and cancer (31.7%) to be complications of GERD. CONCLUSIONS: Frequency of GERD symptoms in the United States is unaffected by gender or race but is lower in the elderly...