Esophagogastric junction morphology is associated with a positive impedance‐<scp>pH</scp> monitoring in patients with <scp>GERD</scp>

Tolone, Salvatore; Cassan, Chiara De; Bortoli, Nicola de; Roman, Sabine; Galeazzi, Francesca; Salvador, Renato; Marabotto, Elisa; Furnari, Manuele; Zentilin, Patrizia; Marchi, Santino; Bardini, Romeo; Sturniolo, G.C.; Savarino, Vincenzo; Savarino, Edoardo

doi:10.1111/nmo.12606

Cited by 100 publications

(80 citation statements)

References 30 publications

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“…The presence of hiatal hernia exposes patients to increased AET, TNR and to a more severe GERD pattern[43]. In literature in fact, is currently reported that at baseline hiatus hernia, LES resting pressure and length are significantly more compromised in patients with severe erosive reflux disease (ERD) and Barrett’s esophagus (BE) compared to those with mild erosions and non erosive reflux disease (NERD).…”

Section: Anatomical Factors: Hiatal Hernia Presencementioning

confidence: 99%

Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors

Tolone

Gualtieri

Savarino

et al. 2016

WJGS

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Gastroesophageal reflux disease (GERD) is nowadays a highly prevalent, chronic condition, with 10% to 30% of Western populations affected by weekly symptoms. Many patients with mild reflux symptoms are treated adequately with lifestyle modifications, dietary changes, and low-dose proton pump inhibitors (PPIs). For those with refractory GERD poorly controlled with daily PPIs, numerous treatment options exist. Fundoplication is currently the most commonly performed antireflux operation for management of GERD. Outcomes described in current literature following laparoscopic fundoplication indicate that it is highly effective for treatment of GERD; early clinical studies demonstrate relief of symptoms in approximately 85%-90% of patients. However it is still unclear which factors, clinical or instrumental, are able to predict a good outcome after surgery. Virtually all demographic, esophagogastric junction anatomic conditions, as well as instrumental (such as presence of esophagitis at endoscopy, or motility patterns determined by esophageal high resolution manometry or reflux patterns determined by means of pH/impedance-pH monitoring) and clinical features (such as typical or atypical symptoms presence) of patients undergoing laparoscopic fundoplication for GERD can be factors associated with symptomatic relief. With this in mind, we sought to review studies that identified the factors that predict outcome after laparoscopic total fundoplication.

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Section: Anatomical Factors: Hiatal Hernia Presencementioning

confidence: 99%

Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors

Tolone

Gualtieri

Savarino

et al. 2016

WJGS

View full text Add to dashboard Cite

show abstract

“…A new HRM metric evaluating EGJ barrier function, the EGJ contractile integral, incorporates EGJ length and pressure amplitudes during all phases of respiration . When abnormal, this metric identifies EGJ hypotension association with unequivocally abnormal reflux testing . Second, esophageal body motor function is characterized using software tools and defined according to Chicago Classification metrics into normal, fragmented peristalsis, ineffective esophageal motility, and absent contractility .…”

Section: Discussionmentioning

confidence: 99%

Nonerosive reflux disease: clinical concepts

Gyawali

Azagury

Chan

et al. 2018

Annals of the New York Academy of Sciences

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Esophageal symptoms can arise from gastroesophageal reflux disease (GERD) as well as other mucosal and motor processes, structural disease, and functional esophageal syndromes. GERD is the most common esophageal disorder, but diagnosis may not be straightforward when symptoms persist despite empiric acid suppressive therapy and when mucosal erosions are not seen on endoscopy (as for nonerosive reflux disease, NERD). Esophageal physiological tests (ambulatory pH or pH-impedance monitoring and manometry) can be of value in defining abnormal reflux burden and reflux-symptom association. NERD diagnosed on the basis of abnormal reflux burden on ambulatory reflux monitoring is associated with similar symptom response from antireflux therapy for erosive esophagitis. Acid suppression is the mainstay of therapy, and antireflux surgery has a definitive role in the management of persisting symptoms attributed to NERD, especially when the esophagogastric junction is compromised. Adjunctive approaches and complementary therapy may be of additional value in management. In this review, we describe the evaluation, diagnosis, differential diagnosis, and management of NERD.

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“…Optimizing the PPI dose or receiving fundoplication was correlated with a low rate of BE recurrence after RFA. Some studies suggest that fundoplication may result in improved control of gastroesophageal reflux (acid, weakly acid, and weakly alkaline) and is associated with fewer recurrences of intestinal metaplasia after RFA in selected patients with a coexisting hiatal hernia of > 3 cm 83 or more severe reflux exposure …”

Section: Treatmentmentioning

confidence: 99%

Recent advances in Barrett's esophagus

Inadomi

Alastal

Bonavina

et al. 2018

Annals of the New York Academy of Sciences

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Barrett's esophagus (BE) is the only known precursor of esophageal adenocarcinoma, one of the few cancers with increasing incidence in developed countries. The pathogenesis of BE is unclear with regard to either the cellular origin of this metaplastic epithelium or the manner in which malignant transformation occurs, although recent data indicate a possible junctional origin of stem cells for BE. Treatment of BE may be achieved using endoscopic eradication therapy; however, there is a lack of discriminatory tools to identify individuals at sufficient risk for cancer development in whom intervention is warranted. Reduction in gastroesophageal reflux of gastric contents including acid is mandatory to achieve remission from BE after endoscopic ablation, and can be achieved using medical or nonmedical interventions. Research topics of greatest interest include the mechanism of BE development and transformation to cancer, risk stratification methods to identify individuals who may benefit from ablation of BE, optimization of eradication therapy, and surveillance methods to ensure that remission is maintained after eradication is achieved.

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Esophagogastric junction morphology is associated with a positive impedance‐pH monitoring in patients with GERD

Abstract: Increasing separation between LES and CD can cause a gradual and significant increase in reflux. EGJ morphology may be useful to estimate an abnormal impedance-pH testing in GERD patients.

Cited by 100 publications

References 30 publications

Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors

Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors

Nonerosive reflux disease: clinical concepts

Recent advances in Barrett's esophagus

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