P J Kahrilas

..Finally, current concepts of the pathophysiology and therapy of gastroesophageal reflux disease. Emphasis is placed on the dual sphincter theory of gastroesophageal junction competence and the need for maintenance anti-secretory therapy...

..Tegaserod (HTF 919), a 5-HT4 receptor partial agonist, has prokinetic effects that might be useful in decreasing acid reflux in gastro-oesophageal reflux disease (GERD)...

..These findings suggest that measurement of acid exposure 1 cm above the SCJ may improve accuracy of pH monitoring by detecting acid reflux events confined to the distal esophagus...

..This study aimed to determine if hiatal hernia influences vulnerability to reflux and transient lower esophageal sphincter relaxation (tLESR) during gastric distention in patients with gastroesophageal reflux disease (GERD)...

..The aims of this study were to evaluate the esophageal pressure topography (EPT) findings in EoE and to compare them with controls and patients with gastro-esophageal disease (GERD)...

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..This study aimed to correlate oesophageal bolus transit with features of oesophageal pressure topography (OPT) plots and establish OPT metrics for accurately measuring peristaltic velocity...

..97, p = 0.0146) as significant predictors of erosive esophagitis. CONCLUSION: Esophagitis severity is best predicted by hiatal hernia size and lower esophageal sphincter pressure. Of these, hiatal hernia size is the strongest predictor...

..Volume modulation of deglutitive UES relaxation is demonstrable with a microsleeve, albeit with less precision than with a solid-state transducer...

..Ambulatory pH monitoring is considered the gold standard for measuring oesophageal acid exposure, however, data comparing antimony and glass electrodes are limited...

..However, because the IRP value is also influenced by distal esophageal contractility, we hypothesized that its normal limits should vary with different patterns of contractility...

..Furthermore, such variants provide important clues into the pathophysiology of this rare disorder...

..By creating a low density gel 'raft' that floats on top of gastric contents, alginate-antacid formulations may neutralise the 'acid pocket'...

..This study aimed to define EGJ pressure morphology relative to the squamocolumnar junction (SCJ) during respiration with 3D-high resolution manometry (3D-HRM)...

..The aim of this study was to develop an automated algorithm calculating DCI...

..As a tool measuring more than one esophageal symptom, ESQ could guide patient management by indicating which of the coexisting symptoms needs to be addressed first...

..However, capsule presence was associated with a locus of augmented peristalsis and this phenomenon was most evident in subjects who perceived the presence of the Bravo capsule...

..This study analysed the relative accuracy of the Bravo wireless and the Slimline catheter-Mark III Digitrapper pH systems in the detection of acid reflux events...

..8%). Although far less common than distal peristaltic or OGJ abnormailites, TZ defects may be related to dysphagia in a minority of patients (<4% in this series) and should be considered a distinct oesophageal motility disorder...

..Whether or not GORD patients with extra-oesophageal symptoms exhibit an exaggeration of the UOS relaxation response during reflux is yet to be determined...

..This clarity diminishes progressively for DES and nonspecific esophageal motility disorders...

..Thus, although hiatus hernia may or may not be an initiating factor at the inception of reflux disease, it clearly can act as a sustaining factor accounting for the frequently observed chronicity of the disease...

..However, regardless of the motivation for pursuing surgical management, patients must be advised of potential suboptimal results and the irreversibility of the procedure...

..Our aims were to establish normative esophageal pressure topography data for the sitting position and to determine the effect of applying those norms to Chicago Classification diagnoses...

..The aim of the study was to assess whether upright and provocative swallows (PS) provided important information beyond that obtained from the standard supine manometric protocol...

..It is our expectation that modification of this classification scheme will continue to occur and this should further clarify the utility of pressure topography plotting in assessing oesophageal motility disorders...

..The pharmacologic profile of the new proton pump inhibitor esomeprazole has demonstrated advantages over omeprazole that suggest clinical benefits for patients with acid-related disease...

..These results support that impedance monitoring can be adapted to identify sphincter opening, to distinguish sphincter opening from sphincter relaxation, and to determine luminal contents during the opening period...

..This study aimed to test the tML method for localizing CDP in patients with abnormal motility...

..The purpose of this review is to consider the neuromuscular mechanism of LES contractility both by itself and in relation to the esophagogastric junction (EGJ) complex in order to appreciate the intricacies of EGJ valvular function...

..More research is needed to determine whether the detection of reflux events with Bravo will provide a good correlation with symptom episodes...

..Despite causing substantial proximal stomach relaxation, glucagon did not increase TLOSR frequency. This suggests that the relevant gastric mechanoreceptors responsible for triggering TLOSRs do not respond to passive elongation...

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..UES function was unaffected. We suggest that HAR therapy is an acceptable and useful intervention for patients with globus sensation...

..The dynamic anatomy of the EGJ highlights the difficulty of defining hiatal hernia and of elucidating the relation between hiatal hernia, the diaphragmatic hiatus, the LES, and GERD, including supraesophageal reflux...

..Finally, although the accomplishments summarized above are substantial, much work remains to fully exploit the potential of EPT in the clinical characterization of the EGJ...

..This review highlights recent insights into EoE in adults although, clearly, much of the available data overlap with pediatrics and, occasionally, with eosinophilic gastroenteritis...

..Increased oesophageal acid exposure in oesophagitis is attributable to impaired acid clearance and the greatest impairments in refluxate clearance occur in patients with large hiatal hernias...

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..This suggests that the receptive field for triggering tLESRs is contained within a wider field for elicitation of gastric receptive relaxation and that only the first is affected by fundoplication...

..Here, a summary of their conclusions and recommendations of how to achieve the best results from the various techniques now available for reflux measurement is presented...

..During TLOSR, significant elevation of the SCJ occurred only after LOS opening, suggesting that this was a consequence of oesophageal distension induced by gas reflux rather than a component of the opening mechanism...

..CONCLUSIONS: The esophageal symptoms of patients with abnormal esophageal motility may relate to the underlying psychological abnormalities, independent of manometric abnormalities...

..Both treatments were safe and well tolerated. CONCLUSIONS: Over 8 wk, lansoprazole 30 mg once daily relieved heartburn symptoms faster and more effectively than omeprazole 20 mg once daily in patients with erosive esophagitis...

..CONCLUSIONS: Esomeprazole demonstrates significantly greater efficacy than omeprazole in the treatment of GERD patients with erosive esophagitis. The tolerability and safety of esomeprazole are comparable to that of omeprazole. (Am..

..Specific therapy can then be addressed toward correcting dysfunctional elements...