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Publications (351)
Background
The term ‘laryngopharyngeal reflux’ (‘LPR’) is frequently applied to aerodigestive symptoms despite lack of objective reflux evidence. This initiative aimed to develop a modern care paradigm for LPR supported by otolaryngology and gastroenterology disciplines.
Methods
A 28-member international inter-disciplinary working group developed...
Background
Many patients diagnosed with gastro‐oesophageal reflux disease (GERD) have persistent symptoms despite proton pump inhibitor (PPI) therapy.
Aims
The aim of this consensus is to provide evidence‐based statements to guide clinicians caring for patients with refractory reflux‐like symptoms (rRLS) or refractory GERD.
Methods
This consensus...
Background
In the last two decades the development of high-resolution manometry (HRM) has changed and revolutionized the diagnostic assessment of patients complain foregut symptoms. The role of HRM before and after antireflux procedure remains unclear, especially in surgical practice, where a clear understanding of esophageal physiology and hiatus...
LINKED CONTENT
This article is linked to Calabrese et al papers. To view these articles, visit https://doi.org/10.1111/apt.17934 and https://doi.org/10.1111/apt.17960
Background
The Nine Item Avoidant/Restrictive Food Intake Disorder (ARFID) Screen (NIAS) questionnaire is originally available in English. Given the significant overlap of ARFID‐like symptoms in gastrointestinal (GI) diseases, ARFID screening becomes crucial in these patient populations. Consequently, the translation of the NIAS questionnaire into...
Goals
Develop quality indicators for ineffective esophageal motility (IEM).
Background
IEM is identified in up to 20% of patients undergoing esophageal high-resolution manometry (HRM) based on the Chicago Classification. The clinical significance of this pattern is not established and management remains challenging.
Study
Using RAND/University of...
The Lyon Consensus provides conclusive criteria for and against the diagnosis of gastro-oesophageal reflux disease (GERD), and adjunctive metrics that consolidate or refute GERD diagnosis when primary criteria are borderline or inconclusive. An international core and working group was assembled to evaluate research since publication of the original...
Background
Question prompt lists (QPLs) are structured sets of disease‐specific questions, intended to encourage question‐asking by patients and enhance patient‐physician communication. To date, a dysphagia‐specific QPL has not been developed for patients with esophageal dysphagia symptoms. We aim to develop a dysphagia‐specific QPL incorporating b...
Background
The Chicago Classification (CC) used to define esophageal motility disorders in high‐resolution manometry (HRM) has evolved over time. Our aim was to compare the frequency of motility disorders diagnosed with the last two versions (CCv3.0 and CCv4.0) and to evaluate symptoms severity according to the diagnoses.
Methods
From June to Dece...
Achalasia is a rare disorder of the oesophageal smooth muscle characterized by impaired relaxation of the lower oesophageal sphincter (LES) and absent or spastic contractions in the oesophageal body. The key pathophysiological mechanism is loss of inhibitory nerve function that probably results from an autoimmune attack targeting oesophageal myente...
A brief esophageal dysphagia questionnaire (BEDQ) was recently developed in English to evaluate frequency and intensity of dysphagia. Our aim was to validate this questionnaire in French in a cohort of patients referred for esophageal manometry. Patients referred for esophageal high resolution manometry were offered to fill out different questionna...
Background:
Question prompt lists (QPLs) are structured sets of disease-specific questions that enhance patient-physician communication by encouraging patients to ask questions during consultations.
Aim:
The aim of this study was to develop a preliminary achalasia-specific QPL created by esophageal experts.
Methods:
The QPL content was derived...
Introduction
Small percentage of patients with esophageal dysmotility disorders (EDD) fail to improve or relapse following management by laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM). In this study, we aimed to describe the role of functional luminal imaging probe (FLIP) in identifying the patients who might benefit from L...
Background and study aims The aim of this study was to assess long-term clinical outcomes beyond 6 years in patients who underwent per-oral endoscopic myotomy (POEM) for the treatment of achalasia.
Patients and methods Patients with achalasia who underwent POEM between 2010 and 2012 and had follow-up of at least 6 years were retrospectively identif...
La Clasificación de Chicago v4.0 (CCv4.0) es el esquema actualizado para clasificar las alteraciones de la motilidad esofágica utilizando la métrica de la manometría de alta resolución (HRM). Para desarrollar la CCv4.0, 52 expertos internacionales diversos separados en siete subgrupos de trabajo utilizaron una metodología formalmente validada, en u...
Background:
Question prompt lists (QPLs) are structured sets of disease-specific questions intended for patient use, enhancing the patient-physician communication by encouraging patients to ask relevant questions during a consultation. Recently, a preliminary 78 question gastroesophageal reflux disease (GERD) specific QPL was created by 12 esophag...
Background and aims:
Acid exposure time (AET) and reflux episode thresholds from the Lyon Consensus may not apply for pH-impedance studies performed on proton pump inhibitor (PPI) therapy. We aimed to determine metrics from 'on PPI' pH-impedance studies predicting need for escalation of therapy.
Methods:
De-identified pH-impedance studies perfor...
Background
The low FODMAPs (fermentable oligo‐, di‐, monosaccharides, and polyols) diet improves lower gastrointestinal symptoms. Patients suffering from proton pump inhibitor (PPI) refractory gastroesophageal reflux disease (GERD) have limited treatment options. We investigated the efficacy of a low FODMAPs diet in patients with PPI refractory GER...
Background
Accurate reflux episode identification is crucial for pH‐impedance interpretation. Individual reflux episode characteristics associated with inter‐reviewer concordance are incompletely understood.
Methods
Ambulatory pH‐impedance studies from 19 GERD patients (median age 52 years, 78.9% F) were analyzed by 5 reviewers. Metadata from pH‐i...
Background
The management of achalasia has improved due to diagnostic and therapeutic innovations. However, variability in care delivery remains and no established measures defining quality of care for this population exist. We aimed to use formal methodology to establish quality indicators for achalasia patients.
Methods
Quality indicator concept...
Introduction:
An esophageal hypervigilance and anxiety scale (EHAS) was developed in English to assess the psychological process in patients with esophageal disorders. The aim of the current study was to validate this scale in French.
Patients and methods:
Patients referred for esophageal high resolution manometry (HRM) were offered to fill out...
Background
Supragastric belching (SGB) and rumination are behavioral disorders associated with proton pump inhibitor (PPI) non‐response and can be diagnosed using multichannel intraluminal impedance‐pH (MII‐pH) and post‐prandial high‐resolution impedance manometry (PPHRIM). This pilot study compared diagnostic yield and inter‐rater agreement for SG...
Distal esophageal spasm (DES) is defined as a manometric pattern of at least 20% of premature contractions in a context of normal esophago‐gastric junction relaxation in a patient with dysphagia or non‐cardiac chest pain. The definition of premature contraction requires the measurement of the distal latency and identification of the contractile dec...
Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high‐resolution manometry (HRM). Fifty‐two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two‐years to develop CCv4.0. Key updates in CCv.4.0 consist of a m...
Up to 40% of patients with symptoms suspicious of gastroesophageal reflux disease (GERD) do not respond completely to proton pump inhibitor (PPI) therapy. The term “refractory GERD” has been used loosely in the literature. A distinction should be made between refractory symptoms (ie, symptoms may or may not be GERD‐related), refractory GERD symptom...
Background
Several patients in gastroenterology practice present with esophageal symptoms, and in case of normal endoscopy with biopsies, high‐resolution manometry (HRM) is often the next step. Our aim was to develop a European consensus on the clinical application of esophageal HRM, to offer the clinician guidance in selecting patients for HRM and...
Hypercontractile esophagus (HE) is a heterogeneous major motility disorder diagnosed when ≥20% hypercontractile peristaltic sequences (distal contractile integral >8,000 mm Hg*s*cm) are present within the context of normal lower esophageal sphincter (LES) relaxation (integrated relaxation pressure < upper limit of normal) on esophageal high-resolut...
Introduction
Per-oral endoscopic myotomy (POEM) is effective in achalasia. The objective of this study was to evaluate the short-term clinical efficacy of POEM in non-achalasia esophageal motility disorders (NAEMD).
Patients and methods
Patients with NAEMD diagnosed by high-resolution manometry were included in a retrospective multicentric study....
Background:
Artificial intelligence (AI) has potential to streamline interpretation of pH-impedance studies. In this exploratory observational cohort study, we determined feasibility of automated AI extraction of baseline impedance (AIBI) and evaluated clinical value of novel AI metrics.
Methods:
pH-impedance data from a convenience sample of sy...
Objective: High-resolution manometry (HRM) is the current standard for characterization of esophageal body and esophagogastric junction (EGJ) function. We aimed to examine the prevalence of abnormal esophageal motor patterns in health, and to determine optimal thresholds for software metrics across HRM systems.
Design: Manometry studies from asymp...
Background
Esophagogastric junction contractile integral (EGJ‐CI) and EGJ morphology are high‐resolution manometry (HRM) metrics that assess EGJ barrier function. Normative data standardized across world regions and HRM manufacturers are limited.
Methods
Our aim was to determine normative EGJ metrics in a large international cohort of healthy volu...
Objective: Limitations of existing impedance-pH thresholds include small sample size of normative studies, inclusion of artefactual pH drops and incorrect identification of impedance reflux events. We aimed to obtain new impedance-pH thresholds from expert consensus analysis of tracings from a large number of healthy subjects.
Design: Of 541 studi...
Background/aim
Increased intra‐abdominal pressure from abdominal compression augments esophageal peristalsis during high‐resolution manometry (HRM), and straight leg raise (SLR) while supine increases intra‐abdominal pressure. We determined if water swallows performed during SLR can mimic contraction reserve seen with multiple rapid swallows (MRS)....
Ambulatory pH-impedance monitoring evaluates gastroesophageal reflux disease (GERD) symptoms that persist despite empiric treatment trials.1 Although automated analysis of pH-impedance monitoring is known to overestimate non-acid reflux episodes,2 even experts may disagree on individual reflux episodes,3,4 and accurate identification of postreflux...
Background and aims:
The underlying physiology of post-reflux swallow-induced peristaltic wave (PSPW) is unclear. We aimed to: 1) calculate the probability of a random association between reflux and PSPW; 2) characterize factors that could underlie triggering of PSPW and 3) assess the chemical clearance effect of PSPW in healthy asymptomatic subje...
The functional lumen imaging probe (FLIP) measures luminal dimensions using impedance planimetry, performed most often during sedated upper endoscopy. Mechanical properties of the esophageal wall and opening dynamics of the esophagogastric junction (EGJ) can be objectively evaluated in esophageal motor disorders, eosinophilic esophagitis, esophagea...
Aim: Irritable bowel syndrome (IBS) is a frequent disease, associating chronic abdominal pain and abnormal bowel habits. The sympatho-vagal balance may be altered in IBS. We tested the effect of transcutaneous auricular stimulation of the left vagus nerve (taVNS) on symptoms and physiological and biological variables. Patients & methods: Twelve IBS...
Background/aims
Jackhammer esophagus (JE) is a hypercontractile esophageal motor disorder defined by at least two swallows with a distal contractile integral (DCI) >8000 mm Hg.s.cm during high‐resolution manometry (HRM). The relationship between symptoms and hypercontractility and the response to therapies have been poorly evaluated. The aim of thi...
Background: The first step in the Chicago Classification v3.0 of esophageal dysmotility disorders (EDD) is to determine if the integrated relaxation pressure (IRP) decreases appropriately signifying appropriate LES relaxation. Although the diagnosis is based on HRM, impedance planimetry may be a useful tool to guide management in challenging cases....
Background and study aims Per-oral endoscopic myotomy (POEM) is associated with a short-term clinical response of 82 % to 100 % in treatment of patients with achalasia. Data are limited on the long-term durability of the clinical response in these patients. The aim of this study was to determine the long-term outcomes of patients undergoing POEM fo...
Background/aims:
Peroral endoscopy myotomy (POEM) is effective to treat achalasia. We aim to determine POEM effect on esophageal function and search for predictive factors of response to POEM and co-occurrence of gastroesophageal reflux disease (GERD).
Methods:
A total of 64 untreated achalasia patients who underwent high-resolution manometry (H...
Objectives:
Symptoms are inconsistently associated with esophageal motor findings on high-resolution manometry (HRM). We aimed to evaluate predictors of dysphagia severity, including esophageal hypervigilance and visceral anxiety, among patients evaluated with HRM.
Methods:
Adult patients undergoing HRM at 4 academic medical centers (United Stat...
Background:
Question prompt lists (QPLs) are structured sets of disease-specific questions intended for patient use, encouraging patients to ask questions to facilitate their consultation with their physician.
Aim:
The aim of this study was to develop a QPL specific to adults with gastroesophageal reflux disease (GERD), created by esophageal exp...
Objectives:
Per-Oral Endoscopic Myotomy (POEM) is a recommended treatment modality for achalasia, but there is little published data for its use in children. The objective of the present study was to evaluate whether POEM is clinically effective and safe for children.
Methods:
International multicenter retrospective study conducted in 14 tertiar...
Introduction
Botulinum toxin injection is known to be efficient to treat achalasia. We conducted a randomized trial in order to evaluate its efficacy to treat symptomatic hypercontractile esophageal disorders as characterized by esophageal high‐resolution manometry.
Methods
Patients with significant dysphagia and/or thoracic pain related to an hyp...
Background
Ineffective esophageal motility (IEM) is a heterogenous minor motility disorder diagnosed when ≥50% ineffective peristaltic sequences (distal contractile integral <450 mm Hg cm s) coexist with normal lower esophageal sphincter relaxation (integrated relaxation pressure < upper limit of normal) on esophageal high‐resolution manometry (HRM...
Background
Achalasia diagnosis requires elevated integrated relaxation pressure (IRP; manometric marker of lower esophageal sphincter [LES] relaxation). Yet, some patients exhibit clinical features of achalasia despite normal IRP and have LES dysfunction demonstrable by other means. We hypothesized these patients to exhibit equivalent therapeutic r...
Background:
Treatment options for achalasia include endoscopic and surgical techniques that carry the risk of esophageal bleeding and perforation. The rare coexistence of esophageal varices has only been anecdotally described and treatment is presumed to carry additional risk.
Methods:
Experience from physicians/surgeons treating this rare combi...
Acid exposure time commonly varies from day-to-day in prolonged wireless pH monitoring. Thus, diagnosis based on the number of days with abnormal acid burden may be misleading or inconclusive. We hypothesize that assessing longitudinal patterns of acid exposure may be diagnostically useful. Therefore, this study aims to describe acid exposure traje...
Background:
Esophageal shortening (ES) might be observed during high-resolution manometry (HRM), in particular after the rapid drink test (RDT). We aimed to assess its diagnostic value in patients referred for HRM.
Methods:
HRM of patients without previous esophagogastric surgery or endoscopic treatment was retrospectively reviewed using the Chi...
Symptoms related to abnormal gastrointestinal motility and function are common. Oropharyngeal and oesophageal dysphagia, heartburn, bloating, abdominal pain and alterations in bowel habits are among the most frequent reasons for seeking medical attention from internists or general practitioners and are also common reasons for referral to gastroente...
This corrects the article DOI: 10.1038/nrgastro.2017.130.
This corrects the article DOI: 10.1038/nrgastro.2017.132.
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal).
This article has been retracted due to overlapping/duplicate material.
Data from some patients from this study have previously been published in other journals without cross-referencing. Twenty...
Although neurogastroenterology and motility (NGM) disorders are some of the most frequent disorders encountered by practicing gastroenterologists, a structured competency‐based training curriculum developed by NGM experts is lacking. The American Neurogastroenterology and Motility Society (ANMS) and the European Society of Neurogastroenterology and...
Purpose:
High resolution anorectal manometry has been developed over the past years, as well as 3D high definition manometry (HDARM). However, the clinical impact of the results obtained with these new technologies remains to be determined. We thus analyzed various HDARM parameters of anal sphincter function and tested their capacity to discrimina...
