Gastroenterology - Science topic

Referee rewiever

I need to find a gastroenterology nursing professor to serve as my thesis examiner. Thank you for recommending the right person.

Dear Colleagues,

collaborative research has the capabilities for exchanging ideas, learning new skills, improve the quality of results, and personal factors such as fun and pleasure. In this context, i think that work for new and productive academic collaborations is essential. My reaseach are are gastroenterology and hepatology (see my profile). If your point of view is similar, please contact me to exchange ideas, opinions and to discuss possible common projects.

Keep in touch

Ludovico

we are two enthusiastic researcher looking for interesting proposal in field of gastroenterology and endoscopy for a research project so we can publish in a prestige journal regards

A clinical dilemma in day to day practice in India...

I was trying to find a trusted journal that accepts a clinical image with a description but it seems a bit hard since it is not a common type

So I would be really grateful if someone can recommend a journal with a reasonable publication fee and good indexing.

The clinical image fall underneath surgery and gastroenterology

Thanks

African journal of gastroenterology and hepatology is free (no any article publication charges), the submitted material is subjected to revision via a software program for plagiarism, an open access journal, an eminent group of editorial board members, a strong peer review process with at least 3 peer reviewers per article.

A case of three males who presented strong precordial pain, in supine and prone position during night, with GERD and hiatal hernia type I ascertained by gastroscopy, treated by single manoeuvre, is described.

Manoeuvre consist in laying down patient in supine position, legs straight down and hands by his sides, using a pillow to lift up the head. Done that, subject should actively arches spine (at least 7-8 cm from the couch at level T12-L2), taking hyperlodosis position, without lifting sacral region, upper thoracic sections or any other segments from the couch.

Three males complaining of stabbing precordial chest pain (mean ± standard deviation age, 24.6 ± 2.88 years; range, 20–28 years) have been treated between November 2016 and August 2017. Subjects have not suffered of any cardiac problem, normal EKG, pressure 80-120 mmhg, BMI 21.93 ± 2.49. While hiatal hernia type I and reflux disorders had been ascertained by gastroscopy in two of them, in the same year and three years before respectively. Patients, stated to have suffered in the previous two weeks of strong precordial pain, in supine and prone position during night, not accompanied by burning retrosternal discomfort. Subjects also declared have not taken medication for GERD, or any other type of drugs and were symptomatic during the visit.

They were instructed to holding aforesaid position for 10 seconds at least, performing 3 time or more (with pause of 30 seconds between each prove), until symptoms vanish. The manoeuvre was applied in each patients and complete precordial pain resolution was obtained in all attempts. Indeed, despite pain comes back after manoeuvre ends and patients laying down supine, three, four repetitions of aforesaid manoeuvre spaced with intervals of 30 seconds were able to lead a complete and sustained resolution of symptoms, all night long.

You may find out more, project and photo here https://www.researchgate.net/project/New-single-manoeuvre-leading-GERD-precordial-chest-pain-resolution-in-few-seconds-small-case-series

Dear community,

Can anyone inform if "advanced research in gastroenterology & hepatology" is considered as predatory journal ? according to our findings, the publisher "Juniper" is considered as such.

Please advice,

Thank you

I kindly need five peer reviewers to review my Gastroenterology article in Cureus in order to publish it. (Cureus is a journal that requires the corresponding author to contact five peer reviewers in order to review the article before publication)

If you're willing to help with your feedback, please send me your Email, Full name, and Affiliation

Thanks!

Which is the best free tool/software to make graphical abstracts for research papera related to Gastroenterology?

How common is the situation ?

We have known many a causes of splenic abscess. But how common is it in immunocompetent/immunocompromised children?

Hello everyone,

I am actively looking for a reviewer to submit my manuscript. American College of Gastroenterology requires one reviewer during submission.

Thank you in advance.

Best Regards,

Surya Suresh

Dear all,

I aim to do genome editing of mouse colon using an AAV mediated system. The best serotypes for intestine have already been described and also the mode of delivery which pinpoints SMA (superior mesenteric artery) as the mainstay. I was wondering if you have some experience with this and if yes, if you could indicate other ways of delivery that might serve the purpose just fine. I have seen not so good results for oral IP and enema. 

Thank you and best regards

Is there any score to predict massive transfusion i.e; >/=5 units RCC in case of GI bleed just like for trauma patients?

Could anyone help to find the method for stomach ulcer induction in rats according to Shay et al. or published work on it more in detail?

COVID-19 is spreading around the world, and faeces were popular and agreed for the presence of viral RNA with different studies reported. Its presence mean that the gastrointestinal (GI) tract is one of the hosting organ for such coronavirus.

How are other parts of the GI tract system affected by this virus?

Reference:

Clinical features of covid-19-related liver damage.

Clin Gastroenterol Hepatol. 2020 Apr 10.

Pancreatic injury patterns in patients with COVID-19 pneumonia.

Gastroenterology. 2020 Apr 01.

i have  patient 50-year-old post lap cholecystectomy2month complain from RUQ pain the ,cystic duct more than, 2/3 left in place and its tortuous and contain small 5-6mm stone so what is the best intervention for management of retained cystic duct stone with out merrizi  after lap cholecystectomy ?

Hypnotherapy in IBS

11 year old is admitted due to Toxic mega colon , colon diameter 7 cm . Started with i.v steroider , anti biotics , NPO and TPN . Due to insufficient response , is given Infliximab yesterday

1. How many days it takes before one can see response to Infliximab ?

2. After how many days , another medisine like Cyclosporin can be tried ?

Doing a thesis proposal on changing the gut microbiome associated with obesity using garlic and if garlic can act as a complement to healthy lifestyle

Usually，rats suffering from DSS-induced colitis died after 7days.Now if we treat them with butyrate(1mg/g weight),how about survival rate?

Does taking many medications make a load on the kidney, liver and stomach affecting them negatively?

Are there any specific recommendations for management of bisacodyl abuse? Is the approach of stopping bisacodyl immediately ( or tapering it down) + adding lactulose throughout ? Are there any guidelines regarding dosing/regimens/period of tapering bisacodyl and adding lactulose?

Over the past three decades, adenocarcinoma of the oesophagus has increased in incidence more than any other tumour. The cancer is thought to be the result of gastroesophageal reflux damaging and inflaming the distal oesophagus and causing its squamous mucosa to undergo columnar metaplasia . This Barrett’s mucosa has an increased risk of progressing to dysplasia and adenocarcinoma.

What factors are responsible for the rapid rise?

Excuse my naive experience in this area.

Lets assume we have a patient with 2nd degree hemorrhoids, and we want to apply topical product to reduce the swelling of hemorrhoids, do we apply the product on the hemorrhoids after it prolapse or we wait till it return to its position spontaneously then we apply using an applicator? I mean the proper timing for the application of the product.

Second scenario, we have a patient with third degree hemorrhoids, will we apply the product on the prolapsed hemorrhoids or we reduce it manually then we apply the product afterwards using the applicator?

PBC is a chronic liver condition resulting from progressive destruction of the intrahepatic bile duct and eventually leading to cirrhosis.

Knowing that PBC might have an autoimmune etiology, why isn't it treated with immunosuppressive therapy (like: corticosteroids, azathioprine.. etc)?

If so, is there any evidence for that?

I just collect materials of stent insertion for obstructive incurable esophageal cancer. It is retrospectively, so it is difficult to clarify if it's beneficial for relief of dysphagia and a better health-related quality of life. Do you have any good idea to make it useful?

Patient was diagnosed with acute refractory Ulcerative Colitis 4 years ago. Medications have not helped and thus patient is looking to alternative treatments. Patient reported, upon taking 3 grams of pharmaceutical grade Glycine supplement, number of daily bowel movements immediately reduced from 8 to 2 and bleeding reduced significantly. Has anyone else seen of or heard of such an impact with Glycine? What could be the therapeutic mechanism?

Is the number of neutrophils and monocytes in "normal" blood high enough to make the fecal calprotectin test become positive even in the case of a non-inflammatory source of bleeding (e.g., bleeding from hemorrhoids)?

We are currently working on the methodology of randomized control trials (RCTs) for fecal microbiota transplantation (FMT) treatment.

The objective of this study is to identify most relevant designs of RCTs in FMT treatment.

In order to do this, we created short-vignettes comparing different designs of trials.

If you are a specialist of FMT treatment, we would like to collect your opinion on this subject.

Please click on the following link to begin the survey: http://clinicalepidemio.fr/FMT-design/

Your participation in the survey is voluntary, anonymous and should take you about 10 minutes to complete .

Thank you for your time and cooperation.

A 14 year old girl with Crohn's disease A1L3P, earlier received prednisone, azatioprin, infliximab (clinical improvement with 1 in 4 weeks scheme), relapsed in October. Recently she was switched to adalimumab (humira, 3 inj) with no significant improvement (3-4 liquid stools a day, oral cavity ulcers, elevated ESR and CRP). What would be advisable tactic to treat this patient?

A recent meta-analysis has shown that pancreatic elastase test has a combined sensitivity of 0.77 in detecting exocrine pancreatic insufficiency (Vanga, Rohini R. et al. Clinical Gastroenterology and Hepatology, 2018). What's the impact of this reported sensitivity in current clinical practice? Would a test with higher sensitivity make a positive and significant impact on time-to-diagnosis?

what can be the best test to diagnose chronic pancreatitis ?

Mine is a small, moderate volume endoscopy-majorly centered Gastroenterology practice in Ikeja, Lagos State, Nigeria.

The price for this basic procedure for the screening for colorectal problems is prohibitive. Thus I have always been open to consider alternatives that would reduce the end-user costs to my patients presenting for the procedure.

The cost of procurement of PEG and other newer bowel prep solutions (which are not readily available in my environment) is high. So I have recently resorted to the use of Epsom salts based laxative for my bowel preps.

The results have been fantastic for bowel cleasing and identification of colonic anormalies. But I do have reservations as I encounter the various possible side effects of its use.

Presently, the salts are only not used for patients with overt kidney disease. All the other patients of mine- a total of about 30 per week, get the salts-based regimen.

I just want to know how to best combine use the drug going forwad.

Thank you.

Which agent is the best for occasional use for someone who has NAFLD ? and why ?

I have read studies that showed benefit for those who have NAFLD, and ingest Curcumin but Unfortunately the COMMUNITY HERBAL MONOGRAPH ON CURCUMA LONGA L., RHIZOMA which is adopted by the Committee on Herbal Medicinal Products lists Liver disease to be a contraindication for Turmeric consumption, and when I sent them, they said that NAFLD is included in the "liver disease" category? So is it contraindicated for NAFLD patients or not ?

a gentleman with isr has prolapse of colon after isr, while a feels a whitehead procedure in 2 phases may be good, has anyone any experience on this

There are some formula for estimating nares to lower esophageal sphincter distance in infants based on height. I'm looking for some data in adults to estimate such distance based on gender and height. What is important for me is the upper margin of the LES as we need to place a probe 5 cm above LES.

intestinal parasites may cause bloating 

With this test could be possible obtain a complete precordial pain resolution (GERD related) in a few seconds. Manoeuvre is completely painless. However how does it work is partially uncleared, and it can be applied only in symptomatic subjects.

Manoeuvre has been conceived, and tested on subject, 23 years old, BMI: 19,48, pressure: 80-120 mmhg, normal EKG, without any cardiac problem and with hiatal hernia type I ascertained by gastroscopy. Presenting, strong precordial pain in supine and prone position during night, not accompanied by burning retrosternal discomfort. The subject does not take medication for GERD, or any other type of drugs.

It was performed 3 time every session (with pause of 30'' between each prove) and for 5 consecutive days on symptomatic subject. 

Therefore, I'm looking for researches who have possibility to provide data, in order to verify this hypothesis.

Complications related to viral hepatitis, alcohol-related and non-alcoholic liver disease, are the main reason for seeking gastroenterologists and hepatologists advice. In addition, hepatocellular carcinoma often arise on the ground of hepatitis, representing the fifth most common cancer in men and the ninth in women. In 2015, the World Health Organization estimated that 325 million people were living with chronic hepatitis infections (hepatitis B or C) worldwide and that globally, 1.34 million people died of viral in 2015.

In front of this global health problem, gastroenterologists, hepatologists and hepato-biliary-pancreatic (HBP) surgeons, are daily involved in the clinical routine in taking difficult clinical decisions. As Sir William Osler quoted: “medicine is a science of uncertainty and an art of probability” and no doctor returns home from a busy day at the hospital without the nagging feeling that some of his/her diagnoses may turn out to be wrong, or some treatments may not lead to the expected cure. Probability is a recurring theme in medical practice and the ability of dealing with risk and uncertainty can be elicited through a special kind of intelligence. In 2012, The UK psychologist Dylan Evans defined it as “risk-intelligence” that is "a special kind of intelligence for thinking about risk and uncertainty", at the core of which is the ability to estimate probabilities accurately.  

Consequently, doctors are routinely asked to make predictions, and their predictions would lead to a consistent payoff when regarding a patient’s life. At the basis of “wise” medical decisions, physician’s experience surely plays a vital role. However, doctors can assume that their competency in a given area can be significantly higher than it really is. Such illusory superiority, is described as the Dunning – Kruger effect, a meta-cognitive bias leading to a discrepancy between the way people actually perform and the way they perceive their own performance level. The concept of “risk-intelligence” relies on the confidence that each subject has with their own knowledge, thus returning accurate probability estimates, and a “wise” doctor should be aware that he/she do not known, thus, returning high risk-intelligence.

To date, little is known about risk-intelligence and the Dunning – Kruger effect between doctors, and, especially, among hepatologists, a specialty strongly involved in important clinical decisions. With this aim we conducted a survey to test how risk-intelligence affects medical decision making in this particular clinical setting and whether the Dunning – Kruger bias can effectively affect these physicians.

If you are a gastroenterologist, hepatologist or HBP surgeon please help us in investigate this issue by completing the following survey:

I have an argument with QA during SOP writing, regarding nasogastric tubing covered under oral dosing title.

If it is correct kindly provide me a logic.

Thanking you.

pradeep patil 

52 year old woman with a BMI of 50,Known Hypertensive for over 10 years,dyslipedemia and joint pains underwent MGB/OAGB 7 months ago.she has been on the standard Diet schedule but no exercise at all.Yet she lost about 30 kgs and regained 5 kgs.Her present complaints are nausea and retching and weakness of legs.

Clinical exam is unremarkable.stopped BP medications ,continuing only Thyroid meidcation for Hypo thyroidism. on and off she required IV fluids for dehydration/weakness.

Blood chemistry including TSH were normal.Upper Gi endoscopy is N,contrast CT is N.cortisol was done 2months ago was N.

Some children with post corrosive esophageal stricture are refractory to esophageal dilatation, at which time esophageal stenting many be indicated. 

CT enteroclysis or capsule endoscopy 

Hi,

I'm looking for a relatively rapid viscero-somatic or viscero-visceral reflex responsive to esophageal pain that can be objectively measured?

28 year male with signet ring low rectal cancer , cancer is suitable for intersphincteric resection on  MRI should we do isr or recommend aper

A 21 year old had a strep throat infection 2 months ago. She took two courses of Amoxicillin and clavulanate potassium 875 mg / 125 mg. 2 weeks ago she went to an ENT specialist complaining that her voice has not returned to normal yet. She had a laryngoscopy that revealed the presence of esophageal candidal infection that has ascended to the larynx. She was prescribed Clarithromycin 500mg 1 pill/day for 7 days, Pantover 40mg 1pill/day for 20 days, Fexofenadine hydrochloride 120mg 1pill/day for 10 days.

She had a stool analysis done on the same day same day because she also complained of mucous in her stool. It revealed the presence of yeast. No ova, or cysts were seen. Pus Cells were 0-1/HPF. Erythrocytes were 1-2/HPF. No occult blood was seen. 

However, within the large intestine microflora Clostridium spp. Is an essential and important anaerobic bacterium, within all possible associations, it would be possible that the true etiologic agent was Clostridium and not Blastocystis spp.?

A 7 years old girl

with Henoch Schonlein Purpura (HSP) : diagnosed by typical rash over both legs, skin biopsy - leucocytoclastic vasculitis, arthropathy, abdominal pain.

One episode of hematemesis. Urine within normal limit.

UGI endoscopy revealed two duodenal ulcers.

Should Intravenous Methylprednisolone be given under PPI coverage in case of severe flare up/recurrence?

Or

Are there other options of immunosuppressant i.e azathioprine, cyclophosphamide etc. as used in HSP nephritis?

1.     32 y.o pregnant female presented to the ER complaining of headache, fever and vomiting. LP was done. CSF was cloudy and CSF analysis showed: low glucose, elevated protein, and high WBCs with the presence of neutrophils. Patient was started on Vancomycin, Ceftriaxone, and Acyclovir as empiric therapy. CSF culture showed gram positive diplococcus bacteria so Acyclovir was discontinued. Ceftriaxone and Vancomycin were continued.

·      Was anything missing in the empiric therapy?

·      What is wrong in the management?

·      What is your choice of antibiotics to treat her?

I had two patients with anal pain, probably proctalgia or anodynie with reporting of a burning or painfull sensation in the foot, mostly the sole.

68 yr-old man

Rheumatic athritis. No renal lithiasis.

TURP in 2010 (adenoma, 55 grams)

And relapse of dysuria because of giant stone in prostatic bed...

Lithotripsy, urinalysis (once he had corynebacterium glucuronolyticum in 2013)

TURP again and again under antibiotics...

In 2016 Holep (complete), ,no bacteriuria, carboapatite and brushite stones...

Recurrence in 2017...

Any idea ?

Thank you.

A 15 year old female child with

1. Beta thalassemia major (on regular transfusion, HLA matched donor unavailable)

2. Splenomegaly with multiple splenic infarcts

3. Acute Pancreatitis (Amylase- 345, Lipase- 420) (non necrotising)

4. HCV infection with mild cholestasis

5. Severe autoimmune hemolytic anemia (DCT negative): Hb - 2.8 gm%

6. Widal Test 1:160 positivity with Blood culture negative  

Following sequencing of 16S rRNA gene positive gastric samples, one of the bacteria matched was Hydrogenobaculum ! .I realized it lives in very low pH and thermogenic and lives outside human and animals in the environment.What could be the significance of our Could it be a contaminant during endoscopy or tissue processing?

one of the my friend suffer from pyogenic liver abscess. Doctors prescribed  piperacillin and tazobactam for five days then ciprofloxacine and metronidazole tablets for last 15 days. After the USG and contrast CT scan report shown, there is no changes in lives abscess. Is there any alternative treatment to completely cure pyogenic liver abscess without Drainage method?.

Preoperative,Intraoperative and Postoperative factors that can influence the outcome in peptic ulcer perforation.

 A man now 80 years old presents progressive ataxia amb pendular nystagmus wich began at age 75. A extensive study was negative. He doesn't present malabsorption and diarrhea, Two month ago vomited freqüently  and ataxia got worse . Transglutaminase and endomisium antibodies were negative, Recent duodenal biopsy is compatible with celiac disease (MARSH 3), amb HLA-DQ2 is positive. Slight improvement with gluten free diet. 

This case, a silent seronegative celiac disease with clinical neuroloy over age 75,is a exception, or is not a true celiac disease, or instead, may be a possible cause of some idiophatic ataxias ?, 

I'm looking for causes of varices in upper third of orsophagus.

A 54-year old man had an episode of acute pancreatitis 4 years ago (drug related). He developed an obstruction of main pancreatic duct about 3 cm from the ampula of Vater. Since then the Wirsung is increasing. Now is 11 mm. He developed a type 2 diabetes and mild atrophy of the pancreas. He is not alcoholic. Should we leave this obstruction till develop pain or other symptoms or should we operate and perform a Roux-en-Y lateral pancreato-jejunostomy?

We need pre-malignant colorectal adenoma cell lines to study the effect of mutation in malignant transformation(tubular adenoma, villous adenoma and tubuvillous adenoma cell lines). I have been looking for them from ATCC but I did not find premalignant adenoma ones. what I find is colorectal adenocarcinoma, which is absolutely malignant. Any suggestions please? 

71 yo pacient with liver cirrhosis, admited for variceal bleeding, afebrile, torpor, with grade 1 ascites (negative exam for SBP),negative infectious workup with high level of procalcitonin ( >10ng/ml), CRP=1.34, normal leukocytes. We've been given Ciprofloxacin but  Any ideas?

Functional dyspepsia is classified in the group of functional gastrointestinal (GI) disorders and has its own criteria for the diagnosis in Rome criteria (just like IBS).

Helicobacter pylori (Hp) is a common micro-organism worldwide infecting about 50% of world’s population. It has been shown to be involved in the pathogenesis of many upper GI disorders like peptic ulcer disease and gastric cancer.

In the latest guidelines it has been recommended to eradicate Hp in the setting of functional dyspepsia. This recommendation is based on the fact that meta-analysis have shown that about 10% improvement in symptom score is seen in these patients after Hp eradication (NNT = 14).

Do you think that is there enough reason to conclude for Hp eradication in the setting of FD?

Is it true that the use of H2 blocker, proton pump inhibitors and other antacids can lead to the progression of recurring heartburn? The effect of reducing stomach acid can also make gastrin to be over expressed due to the reduction of stomach acid and make the pH of stomach up to neutral. The over growth of H. pylori without control can also lead to the associated risk of colorectal cancer. So, heartburn is not a simple problem and also can be a sign of the serious problem in our GI tract. The probable cancers may occur if heartburn is not treated properly such as esophageal cancer, stomach cancer and colorectal cancer as well. Is it useful for patients to take over-the-counter prescription drug like what I mentioned above.

high acidity in stomach is due vaguse nerve stimulation

18 months old with Crohn disease, steroid dependent and with allergic reaction to Infliximab.

Guidance from experts in Molecular biology technique will be highly appreciated.

Papers are showing mostly co-culture of human fibroblasts and murine gall bladder epithelial primary cell culture .But reasons or explanations are not there .

TNO TIM-2 system is a simulator of the human colon. Inside the flexible tube there is a hollow fiber dialysis system in order to remove the fermentation metabolites or the released drug from a formulation. I would like to know the absorptive surface area of this dialysis system.

Laser ablation (LA) is is a less known and few employed procedure to accomplish hypertermic necrosis of liver tumors. LA was described for the first time by Bown in 1983. A main advantage of LA is that laser light can be delivered precisely and predictably into any location of the liver without affecting surrounding tissue. The light is transmitted from the source to the patient through flexible optic fibres. In the technique used by us, very thin bare optical fibers, measuring 300 mµ in diameter and with flat tips are inserted through a 21-gauge needle.

-       adjacent large vessels: vena cava, first or second branch of the portal vein, the base of hepatic vein

-       adjacent to extrahepatic organs: gallbladder, gastrointestinal tract

-       I segment or liver dome

-       behind large vessels

-       behind TIPS

According to Teratani, nodules located less than 5mm from large vessels or extrahepatic organs were classified as high-risk location nodules. (Teratani T, Yoshida H, Shiina S, Obi S, Sato S, Tateishi R, Mine N, Kondo Y, Kawabe T, Omata M. Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations. Hepatology. 2006 May;43(5):1101-8.) Therefore nodules adjacent to a first or second branch of the portal vein, the base of hepatic veins, or the inferior vena cava, while nodules adjacent to extrahepatic organs were defined as those located less than 5 mm from the heart, lung, gallbladder,right kidney, or gastrointestinal tract.

Characteristics of laser ablation that favours this technique to treat HCC nodule located in difficult sites are:

-       the use of thin needles;

-       very precise deliver of energy;

-       greatest flexibility;

-       no heat sink effect.

Opioid-induced bowel dysfunction (OIBD) is an increasing problem due to the common use of opioids for chronic pain worldwide. It manifests with different symptoms, such as dry mouth, gastro-oesophageal reflux, vomiting, bloating, abdominal pain, anorexia, hard stools, constipation and incomplete evacuation. Opioid-induced constipation (OIC) is one of its many symptoms and probably the most prevalent.

There are no available tools to assess OIBD, but many rating scales have been developed to assess constipation, and a few specifically address OIC. A clinical treatment strategy for OIBD/OIC was proposed and presented in a flowchart. First-line treatment of OIC is conventional laxatives, lifestyle changes, tapering the opioid dosage and alternative analgesics. While opioid rotation may also improve symptoms, these remain unalleviated in a substantial proportion of patients. Should conventional treatment fail, mechanism-based treatment with opioid antagonists should be considered, and they show advantages over laxatives. It should not be overlooked that many reasons for constipation other than OIBD exist, which should be taken into consideration in the individual patient.

 In patients with cancer of the esophagus treated by external beam Radiotherapy (EBRT), there is fibrosis and at times, even stenosis. And in some patients, recurrences occur within 6 months following the completion of EBRT. In such patients, palliative chemotherapy is advised considering general health of the patient. However, due to fibrosis in sub-mucosal and even mucosal layers, the reach of chemotherapy drugs will be limited to the site in concern.  

To study visceral pain modulation we are working on appropriate models of esophageal pain to be used in experimental studies with healthy volunteers and then in patients.

For mechanical stimulation we use rapid balloon distension method at distal esophagus. Compared to rapid balloon distension method, the electrical stimulation is less technically demanding and more programmable and controllable. But, is the mechanical stimulation more ecologically valid than the electrical stimulation as a visceral pain method?

after 10-12 years after the neck operation for a cervical disc replacement, the spine is clear on scans and problem now is esophageal dysmotility. the patient takes 30 min to swallow half a cup of soup.

most articles like this review which has a follow-up of up to 3 years post-op

https://www.ncbi.nlm.nih.gov/pubmed/24662213 

and most long-term follow-up articles mainly focus on relief of the primary symptoms...

Q again: 

what is the TREATMENT of LATE esophageal dysmotility (i.e. no mechanical problem on endoscopy) post anterior cervical operation ?

some web 'update' on this topic is here: 

some practical experience in this scenario much appreciated.

best regards,

thanks for your attention

Within the last few years, I experienced three cases of pneumoperitoneum with and without pneumomediastinum developed immediately after the colonic stent implantation in patients with severe malignant colonic stenosis. Despite the presence of pneumoperitoneum, no patients complained about abdominal pain and presented peritoneal irritation. Moreover, there was no evidence of panperitonitis and elevated inflammatory reactions. Oral intake became possible after the deployment of colonic stents. All these patients underwent surgical resection of colon cancers. Operative findings revealed no evidence of colonic perforation. Postoperative course was uneventful. Does anybody have concerns about pneumoperitoneum that develops after the colonic stent implantation in patients with severe malignant colonic stenosis?

researches on bile acid receptors 

stapler hemorroidopexy for 3 and 4 degree Haemorroids is an interesting innovation.Easy to learn and practice with with similar results.pain is one of the important symptom all patients are scarred with ligation and excision which is the time tested procedure.Ofcourse cost is another factor.