Azpiroz, Fernando

Abstract The sections in this article are: Functional Division of Stomach Methodological Aspects: Interrelationships Among Parietal Force and Manometric and Electrical Measurements of Gastric Motility Gastrointestinal Motility During Interdigestive Period Interdigestive Motor Pattern of Stomach Interrelationships Between Gastric Motility, Secretion, and Clearance of Duodenogastric Reflux During Interdigestive Period Gastrointestinal Response to A Meal Swallowing Early Postcibal Period Plateau Phase Declining Phase and Transition to Interdigestive Activity Gastric Emptying Profile Relationships among Gastric Emptying, Motility, and Structure: Mechanics of Gastric Emptying Preliminary Processing: Antropyloric Grinder Emptying Function Effects of Gravity and Body Position on Gastric Emptying Regulation of Gastric Emptying Physical and Chemical Characteristics of Meals That Influence their Emptying From Stomach Interactions Between Gastric Emptying and Gastric Secretion Intestinal Motility and its Relationship to Luminal Flow and Absorption Physiological Measurement of Transit In Small Bowel Effect of Opiates and Sex Hormones on Intestinal Motility and Transit Control of Gastrointestinal Motility: Physiological and Pathophysiological Implications for Gastric Motility and Intestinal Transit Control at Level of Gut Smooth Muscle Control at Level of Gut Intrinsic and Extrinsic Nervous Systems Hormonal Control Control at Cerebral Level

AbstractBackgroundAn international group of experts evaluated and revised recommendations for ambulatory reflux monitoring for the diagnosis of gastro‐esophageal reflux disease (GERD).MethodsLiterature search was focused on indications and technical recommendations for GERD testing and phenotypes definitions. Statements were proposed and discussed during several structured meetings.Key ResultsReflux testing should be performed after cessation of acid suppressive medication in patients with a low likelihood of GERD. In this setting, testing can be either catheter‐based or wireless pH‐monitoring or pH‐impedance monitoring. In patients with a high probability of GERD (esophagitis grade C and D, histology proven Barrett's mucosa >1 cm, peptic stricture, previous positive pH monitoring) and persistent symptoms, pH‐impedance monitoring should be performed on treatment. Recommendations are provided for data acquisition and analysis. Esophageal acid exposure is considered as pathological if acid exposure time (AET) is greater than 6% on pH testing. Number of reflux episodes and baseline impedance are exploratory metrics that may complement AET. Positive symptom reflux association is defined as symptom index (SI) >50% or symptom association probability (SAP) >95%. A positive symptom‐reflux association in the absence of pathological AET defines hypersensitivity to reflux.Conclusions and InferencesThe consensus group determined that grade C or D esophagitis, peptic stricture, histology proven Barrett's mucosa >1 cm, and esophageal acid exposure greater >6% are sufficient to define pathological GERD. Further testing should be considered when none of these criteria are fulfilled.