Citations 12
Ambulatory reflux monitoring for diagnosis of gastro‐esophageal reflux disease: Update of the Porto consensus and recommendations from an international consensus group
Roman, Sabine , Gyawali, C. Prakash , Savarino, Edoardo , Wu, Justin C. Y. , Vela, Marcelo F. , Tatum, Roger P. , Fox, Mark , Pandolfino, John E. , Bredenoord, Albert J. , group, the GERD consensus, Tack, Jan , Penagini, Roberto , Mion, François , Bor, Serhat , Patel, Amit , Cicala, Michele , Bortoli, Nicola de , Azpiroz, Fernando , Roman, S , Gyawali, C P , Yadlapati, Rena , Zerbib, Frank , Tutuian, Radu I. , Sifrim, Daniel , Keller, Jutta , group, the GERD consensus, Patel, A , Penagini, Roberto , Tack, Jan , Bor, Serhat , de Bortoli, Nicola , Savarino, Edoardo
Neurogastroenterology & Motility | March 31, 2017 | Volume: 29 | Issue: 10 | Pages: 1-15
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.
Causes and treatments of achalasia, and primary disorders of the esophageal body
Félix, V. , DeVault, Kenneth R. , Penagini, Roberto , Elvevi, Alessandra, Swanström, Lee L. , Wassenaar, Eelco B., Crespin, Oscar M. , Pellegrini, Carlos A. , Wong, Roy K.H., DeVault, Kenneth, Penagini, Roberto
Annals of the New York Academy of Sciences | June 6, 2014 | Volume: 1300 | Issue: 1 | Pages: 236-249
The following on achalasia and disorders of the esophageal body includes commentaries on controversies regarding whether patients with complete lower esophageal sphincter (LES) relaxation can be considered to exhibit early achalasia; the roles of different mucle components of the LES in achalasia; sensory neural pathways impaired in achalasia; indications for peroral endoscopic myotomy and advantages of the technique over laparoscopic and thorascopic myotomy; factors contributing to the success of surgical therapy for achalasia; modifications to the classification of esophageal body primary motility disorders in the advent of high‐resolution manometry (HRM); analysis of the LES in differentiating between achalasia and diffuse esophageal spasm (DES); and appropriate treatment for DES, nutcracker esophagus (NE), and hypertensive LES (HTLES).