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Kishi Y, Nakawaga M, Inumaru A, Nambu M, Sakaguchi M, Murabata M, Matsuoka M, Kako J. Interventions for Hiccups in Adults: A Scoping Review of Western and Eastern Approaches. Palliat Med Rep 2025; 6:171-178. [PMID: 40308713 PMCID: PMC12040553 DOI: 10.1089/pmr.2024.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2025] [Indexed: 05/02/2025] Open
Abstract
Hiccups are caused by involuntary spasms of the diaphragm and external intercostal muscles. When persistent, they can significantly reduce the quality of life. However, comprehensive reviews of available treatments and their corresponding evaluation metrics remain scarce. This scoping review aimed to comprehensively map the interventions used to treat hiccups in adults and clarify the current state of outcome measures employed in existing research. We conducted a scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) -ScR guidelines and the framework of Arksey and O'Malley. Using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Ichushi-web databases, we identified studies published up to June 3, 2024. The search terms included "HICCUP," "HICCOUGH," and "SINGULTUS." A total of 3248 articles were identified, with 499 duplicates removed. After screening 2749 titles and abstracts, 2708 articles were excluded. Full-text reviews of 41 articles led to the exclusion of 18, resulting in 23 that met the inclusion criteria. Of these, 17 studies focused on pharmacological interventions, including baclofen, metoclopramide, methylprednisolone, and Shitei-to, while 6 studies examined nonpharmacological interventions, such as acupuncture, infrared therapy, rebreathing techniques, and cervical epidural block. Outcome measures were categorized into objective and subjective evaluations. Objective measures included complete cessation, partial cessation, frequency reduction, and time to complete cessation. Subjective measures assessed the distress caused by hiccups using patient-reported scales, such as the numerical rating scale. This scoping review identified 23 studies on hiccup interventions, including five randomized controlled trials on pharmacological agents and one study on a nonpharmacological approach. Studies included both Western and Eastern medicine, offering new perspectives on hiccup management. The outcome measures were primarily objective, with some patient-reported assessments. These findings provide a foundation for future research on hiccup treatment and evaluation methods.
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Affiliation(s)
- Yohei Kishi
- Graduate School of Medicine, Mie University, Tsu, Japan
| | - Moe Nakawaga
- Graduate School of Medicine, Mie University, Tsu, Japan
| | - Anri Inumaru
- Graduate School of Medicine, Mie University, Tsu, Japan
| | - Michiko Nambu
- Graduate School of Medicine, Mie University, Tsu, Japan
| | | | | | - Mari Matsuoka
- Graduate School of Medicine, Mie University, Tsu, Japan
| | - Jun Kako
- Graduate School of Medicine, Mie University, Tsu, Japan
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Simadibrata DM, Lesmana E, Lee YY. Experimental drugs for erosive esophagitis: what is in the clinical development pipeline? Expert Opin Investig Drugs 2024; 33:1009-1018. [PMID: 39152730 DOI: 10.1080/13543784.2024.2393868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 08/05/2024] [Accepted: 08/14/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Proton pump inhibitor (PPI) has revolutionized the treatment of erosive esophagitis (EE) in the past few decades. However, roughly 30-40% of the patients, especially those with severe EE (Los Angeles Grade C/D), remain poorly responsive to this medication. Novel drugs have been formulated and/or repurposed to address this problem. AREAS COVERED This review highlights novel drugs that have been investigated for use in EE, such as mucosal protectants, prokinetics, transient lower esophageal sphincter relaxation (TLESR) reducers, novel PPIs, and the new potassium-competitive acid blocker (PCAB). Studies have demonstrated that PCAB has promising results (efficacy and safety) compared to PPI for the healing of EE, especially in severe diseases. EXPERT OPINION PCAB has gained interest in recent years, with pharmacokinetics and pharmacodynamics properties surpassing PPI. Although recent data on PCABs, which comprised mainly of Vonoprazan, have shown promising results, more randomized controlled trials for other PCAB drugs are needed to elucidate and confirm the superiority of this drug class to PPI, the current first-line treatment of EE.
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Affiliation(s)
- Daniel Martin Simadibrata
- Department of Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
- Medicine, Universitas Indonesia, Jakarta, Indonesia
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Elvira Lesmana
- Medicine, Universitas Indonesia, Jakarta, Indonesia
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
- GI Function and Motility Unit, Hospital USM, Kota Bharu, Malaysia
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Moshiree B, Drossman D, Shaukat A. AGA Clinical Practice Update on Evaluation and Management of Belching, Abdominal Bloating, and Distention: Expert Review. Gastroenterology 2023; 165:791-800.e3. [PMID: 37452811 DOI: 10.1053/j.gastro.2023.04.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/22/2023] [Accepted: 04/17/2023] [Indexed: 07/18/2023]
Abstract
DESCRIPTION Belching, bloating, and abdominal distention are all highly prevalent gastrointestinal symptoms and account for some of the most common reasons for patient visits to outpatient gastroenterology practices. These symptoms are often debilitating, affecting patients' quality of life, and contributing to work absenteeism. Belching and bloating differ in their pathophysiology, diagnosis, and management, and there is limited evidence available for their various treatments. Therefore, the purpose of this American Gastroenterological Association (AGA) Clinical Practice Update is to provide best practice advice based on both controlled trials and observational data for clinicians covering clinical features, diagnostics, and management considerations that include dietary, gut-directed behavioral, and drug therapies. METHODS This Expert Review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology. These best practice advice statements were drawn from a review of the published literature based on clinical trials, the more robust observational studies, and from expert opinion. Because systematic reviews were not performed, these best practice advice statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. Best Practice Advice Statements BEST PRACTICE ADVICE 1: Clinical history and physical examination findings and impedance pH monitoring can help to differentiate between gastric and supragastric belching. BEST PRACTICE ADVICE 2: Treatment options for supragastric belching may include brain-gut behavioral therapies, either separately or in combination, such as cognitive behavioral therapy, diaphragmatic breathing, speech therapy, and central neuromodulators. BEST PRACTICE ADVICE 3: Rome IV criteria should be used to diagnose primary abdominal bloating and distention. BEST PRACTICE ADVICE 4: Carbohydrate enzyme deficiencies may be ruled out with dietary restriction and/or breath testing. In a small subset of at-risk patients, small bowel aspiration and glucose- or lactulose-based hydrogen breath testing may be used to evaluate for small intestinal bacterial overgrowth. BEST PRACTICE ADVICE 5: Serologic testing may rule out celiac disease in patients with bloating and, if serologies are positive, a small bowel biopsy should be done to confirm the diagnosis. A gastroenterology dietitian should be part of the multidisciplinary approach to care for patients with celiac disease and nonceliac gluten sensitivity. BEST PRACTICE ADVICE 6: Abdominal imaging and upper endoscopy should be ordered in patients with alarm features, recent worsening symptoms, or an abnormal physical examination only. BEST PRACTICE ADVICE 7: Gastric emptying studies should not be ordered routinely for bloating and distention, but may be considered if nausea and vomiting are present. Whole gut motility and radiopaque transit studies should not be ordered unless other additional and treatment-refractory lower gastrointestinal symptoms exist to warrant testing for neuromyopathic disorders. BEST PRACTICE ADVICE 8: In patients with abdominal bloating and distention thought to be related to constipation or difficult evacuation, anorectal physiology testing is suggested to rule out a pelvic floor disorder. BEST PRACTICE ADVICE 9: When dietary modifications are needed (eg, low-fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet), a gastroenterology dietitian should preferably monitor treatment. BEST PRACTICE ADVICE 10: Probiotics should not be used to treat abdominal bloating and distention. BEST PRACTICE ADVICE 11: Biofeedback therapy may be effective for bloating and distention when a pelvic floor disorder is identified. BEST PRACTICE ADVICE 12: Central neuromodulators (eg, antidepressants) are used to treat bloating and abdominal distention by reducing visceral hypersensitivity, raising sensation threshold, and improving psychological comorbidities. BEST PRACTICE ADVICE 13: Medications used to treat constipation should be considered for treating bloating if constipation symptoms are present. BEST PRACTICE ADVICE 14: Psychological therapies, such as hypnotherapy, cognitive behavioral therapy, and other brain-gut behavior therapies may be used to treat patients with bloating and distention. BEST PRACTICE 15: Diaphragmatic breathing and central neuromodulators are used to treat abdominophrenic dyssynergia.
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Affiliation(s)
- Baha Moshiree
- Atrium Health, Division of Gastroenterology, Hepatology and Nutrition, Wake Forest Medical University, Charlotte, North Carolina.
| | - Douglas Drossman
- University of North Carolina, Chapel Hill, North Carolina; Rome Foundation, Raleigh, North Carolina; Drossman Gastroenterology, Durham, North Carolina
| | - Aasma Shaukat
- Division of Gastroenterology, Hepatology and Nutrition, New York University Grossman School of Medicine, New York, New York
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Arabpour E, Khoshdel S, Akhgarzad A, Abdi M, Tabatabaie N, Alijanzadeh D, Abdehagh M. Baclofen as a therapeutic option for gastroesophageal reflux disease: A systematic review of clinical trials. Front Med (Lausanne) 2023; 10:997440. [PMID: 36873860 PMCID: PMC9981648 DOI: 10.3389/fmed.2023.997440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
Background The main components of gastroesophageal reflux disease (GERD) management include a combination of medications and lifestyle modifications; Nevertheless, based on the severity of symptoms and their response to medications, other treatments could be considered. Baclofen has been demonstrated in studies to relieve GERD symptoms. The current study aimed to precisely address the effects of baclofen on the treatment of GERD and its characteristics. Methods A systematic search was carried out in Pubmed/Medline, Cochrane CENTRAL, Scopus, Google Scholar, Web of Science, and clinicaltrials.gov up to December 10, 2021. The search terms included baclofen, GABA agonists, GERD, and reflux. Results We selected 26 papers that matched the inclusion criteria after examining 727 records. Studies were classified into four categories based on the study population and reported outcomes: (1) adults, (2) children, (3) patients with gastroesophageal reflux-induced chronic cough, (4) hiatal hernia patients. The results revealed that baclofen can significantly improve reflux symptoms and pH-monitoring and manometry findings to different degrees in all four mentioned categories; although its effect on pH-monitoring parameters seems less significant than the other parameters. Mild neurological and mental status deterioration were the most reported side effects. However, side effects occurred in a portion of less than 5% of short-term users and nearly 20% of long-term users. Conclusion In PPI-resistant patients, a trial of adding baclofen to the PPI may be helpful. Baclofen therapies may be more beneficial for symptomatic GERD patients who also report concurrent conditions including alcohol use disorder, non-acid reflux, or obesity. Systematic review registration https://clinicaltrials.gov/.
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Affiliation(s)
- Erfan Arabpour
- Department of Gastroenterology and Hepatology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Khoshdel
- Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Akhgarzad
- Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadamin Abdi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negin Tabatabaie
- Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Dorsa Alijanzadeh
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdehagh
- Department of Gastroenterology and Hepatology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Konno D, Sugino S, Shibata TF, Misawa K, Imamura-Kawasawa Y, Suzuki J, Kido K, Nagasaki M, Yamauchi M. Antiemetic effects of baclofen in a shrew model of postoperative nausea and vomiting: Whole-transcriptome analysis in the nucleus of the solitary tract. CNS Neurosci Ther 2022; 28:922-931. [PMID: 35238164 PMCID: PMC9062569 DOI: 10.1111/cns.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/28/2022] Open
Abstract
Aims The molecular genetic mechanisms underlying postoperative nausea and vomiting (PONV) in the brain have not been fully elucidated. This study aimed to determine the changes in whole transcriptome in the nucleus of the solitary tract (NTS) in an animal model of PONV, to screen a drug candidate and to elucidate the molecular genetic mechanisms of PONV development. Methods Twenty‐one female musk shrews were assigned into three groups: the Surgery group (shrew PONV model, n = 9), the Sham group (n = 6), and the Naïve group (n = 6). In behavioral studies, the main outcome was the number of emetic episodes. In genetic experiments, changes in the transcriptome in the NTS were measured. In a separate study, 12 shrews were used to verify the candidate mechanism underlying PONV. Results A median of six emetic episodes occurred in both the Sham and Surgery groups. Whole‐transcriptome analysis indicated the inhibition of the GABAB receptor‐mediated signaling pathway in the PONV model. Baclofen (GABAB receptor agonist) administration eliminated emetic behaviors in the shrew PONV model. Conclusions Our findings suggest that the GABAB receptor‐mediated signaling pathway is involved in emesis and that baclofen may be a novel therapeutic or prophylactic agent for PONV.
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Affiliation(s)
- Daisuke Konno
- Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, Sendai, Japan.,Department of Integrative Genomics, Tohoku University Tohoku Medical Megabank Organization, Sendai, Japan
| | - Shigekazu Sugino
- Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Tomoko F Shibata
- Department of Integrative Genomics, Tohoku University Tohoku Medical Megabank Organization, Sendai, Japan
| | - Kazuharu Misawa
- Department of Integrative Genomics, Tohoku University Tohoku Medical Megabank Organization, Sendai, Japan.,Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuka Imamura-Kawasawa
- Department of Pharmacology, Biochemistry and Molecular Biology, Institute for Personalized Medicine, Pennsylvania State University College of Medicine, Hershey, USA
| | - Jun Suzuki
- Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Kanta Kido
- Department of Anesthesiology, Kanagawa Dental University Graduate School of Dentistry, Yokosuka, Japan
| | - Masao Nagasaki
- Department of Integrative Genomics, Tohoku University Tohoku Medical Megabank Organization, Sendai, Japan.,Center for the Promotion of Interdisciplinary Education and Research, Kyoto University, Kyoto, Japan
| | - Masanori Yamauchi
- Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Zhu Y, Xu X, Zhang M, Si F, Sun H, Yu L, Qiu Z. Pressure and length of the lower esophageal sphincter as predictive indicators of therapeutic efficacy of baclofen for refractory gastroesophageal reflux-induced chronic cough. Respir Med 2021; 183:106439. [PMID: 33962111 DOI: 10.1016/j.rmed.2021.106439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Therapeutic efficacy of baclofen is suboptimal in the treatment of refractory gastroesophageal reflux-induced chronic cough (GERC). The purpose of the study is to identify its therapeutic predictors in a prospective clinical study. METHODS 138 patients with suspected refractory GERC were treated with baclofen. Before the therapy, all the patients underwent esophageal manometry and multichannel intraluminal impedance-pH monitoring to establish the diagnosis. After the efficacy of baclofen was evaluated, a stepwise logistic regression analysis was performed to identify the therapeutic predictors of baclofen and to establish a regression prediction model. RESULTS The overall response rate of baclofen treatment was 52.2% (72/138). The lower esophageal sphincter pressure (LESP) (odds ratio (OR) = 0.592, P = 0.000) and lower esophageal sphincter length (LESL) (OR = 0.144, P = 0.008) were independent predictors of baclofen efficacy. The optimal cut-off point to predict baclofen efficacy for LESP was 11.00 mmHg, with a sensitivity of 83.7% and specificity of 79.1% while that for LESL was 2.35 cm, with a sensitivity of 81.6% and specificity of 72.1%. The highest predictive specificity (90.7%) was achieved when both LESP and LESL were jointly used. CONCLUSIONS LESP and LESL may be used to screen the patients with refractory GERC suitable for baclofen therapy and help improve the therapeutic precision. CLINICAL TRIAL REGISTRATION ChiCTR- ONC-13003123.
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Affiliation(s)
- Yiqing Zhu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Shanghai, 200065, China
| | - Xianghuai Xu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Shanghai, 200065, China
| | - Mengru Zhang
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Shanghai, 200065, China
| | - Fengli Si
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Shanghai, 200065, China
| | - Huihui Sun
- Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Shanghai, 200065, China
| | - Li Yu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Shanghai, 200065, China
| | - Zhongmin Qiu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Shanghai, 200065, China.
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The Causes of Gastroesophageal Reflux after Laparoscopic Sleeve Gastrectomy: Quantitative Assessment of the Structure and Function of the Esophagogastric Junction by Magnetic Resonance Imaging and High-Resolution Manometry. Obes Surg 2021; 30:2108-2117. [PMID: 32207049 DOI: 10.1007/s11695-020-04438-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The incidence of de novo gastroesophageal reflux disease (GERD) after LSG is substantial. However, an objective correlation with the structural gastric and EGJ changes has not been demonstrated yet. We aimed to prospectively evaluate the effects of laparoscopic sleeve gastrectomy (LSG) on the structure and function of the esophagogastric junction (EGJ) and stomach. METHODS Investigations were performed before and after > 50% reduction in excess body weight (6-12 months after LSG). Subjects with GERD at baseline were excluded. Magnetic Resonance Imaging (MRI), high-resolution manometry (HRM), and ambulatory pH-impedance measurements were used to assess the structure and function of the EGJ and stomach before and after LSG. RESULTS From 35 patients screened, 23 (66%) completed the study (age 36 ± 10 years, BMI 42 ± 5 kg/m2). Mean excess weight loss was 59 ± 18% after 7.1 ± 1.7-month follow-up. Esophageal acid exposure (2.4 (1.5-3.2) to 5.1 (2.8-7.3); p = 0.040 (normal < 4.0%)) and reflux events increased after surgery (57 ± 24 to 84 ± 38; p = 0.006 (normal < 80/day)). Esophageal motility was not altered by surgery; however, intrabdominal EGJ length and pressure were reduced (both p < 0.001); whereas the esophagogastric insertion angle (35° ± 11° to 51° ± 16°; p = 0.0004 (normal < 60°)) and esophageal opening diameter (16.9 ± 2.8 mm to 18.0 ± 3.7 mm; p = 0.029) were increased. The increase in reflux events correlated with changes in EGJ insertion angle (p = 0.010). Patients with > 80% reduction in gastric capacity (TGV) had the highest prevalence of symptomatic GERD. CONCLUSION LSG has multiple effects on the EGJ and stomach that facilitate reflux. In particular, EGJ disruption as indicated by increased (more obtuse) esophagogastric insertion angle and small gastric capacity were associated with the risk of GERD after LSG. clinicaltrials.gov: NCT01980420.
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Chahuan J, Rey P, Monrroy H. Rumination syndrome. A review article. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021. [DOI: 10.1016/j.rgmxen.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chahuan J, Rey P, Monrroy H. Rumination syndrome. A review article. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 86:163-171. [PMID: 33602544 DOI: 10.1016/j.rgmx.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 02/07/2023]
Abstract
Rumination syndrome is a functional gastrointestinal disorder characterized by effortless postprandial regurgitation of ingested food into the mouth. An unperceived postprandial contraction of the abdominal wall could be a key mechanism. In those patients, retrograde flow of the ingested gastric content into the mouth is produced due to a simultaneous combination of elevated intra-abdominal pressure and negative intrathoracic pressure. The estimated prevalence is around 2% in the general adult population. The main clinical characteristics include: a) early postprandial regurgitation, b) the effortlessly regurgitated material is similar to the ingested food, c) the regurgitated material is spit out or swallowed again. The clinical diagnosis of rumination syndrome relies on the clinical criteria. High resolution esophageal manometry, ideally including impedance monitoring, can be an important adjunct for making the clinical diagnosis. Its management is based on instruction as to the nature of the pathology, education in postprandial diaphragmatic breathing, and the assessment of possible psychiatric comorbidity. Baclofen use is reserved for second-line treatment in patients with refractory symptoms.
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Affiliation(s)
- J Chahuan
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Rey
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Laboratorio de Fisiología Digestiva, Red de Salud UC-Christus, Santiago, Chile
| | - H Monrroy
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Laboratorio de Fisiología Digestiva, Red de Salud UC-Christus, Santiago, Chile.
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Talley NJ, Zand Irani M. Optimal management of severe symptomatic gastroesophageal reflux disease. J Intern Med 2021; 289:162-178. [PMID: 32691466 DOI: 10.1111/joim.13148] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022]
Abstract
Gastroesophageal reflux disease (GERD) is a common disorder, and empirical proton pump inhibitor (PPI) treatment is often the first step of management; however, up to 40% of patients remain symptomatic despite PPI treatment. Refractory reflux refers to continued symptoms despite an adequate trial of PPI, and management remains challenging. The differential diagnosis is important; other oesophageal (e.g. eosinophilic oesophagitis) and gastroduodenal disorders (e.g. functional dyspepsia) should be ruled out, as this changes management. A combination of clinical assessment, endoscopic evaluation and in selected cases oesophageal function testing can help characterize patients with refractory reflux symptoms into oesophageal phenotypes so appropriate therapy can be more optimally targeted. Medical options then may include adding a H2 receptor antagonist, alginates, baclofen or antidepressant therapy, and there is emerging evidence for bile acid sequestrants and diaphragmatic breathing. The demonstration of a temporal association of symptoms with reflux events on pH-impedance testing (reflux hypersensitivity) serves to focus the management on modulating oesophageal perception and reducing the reflux burden, or identifies those with no obvious pathophysiologic abnormalities (functional heartburn). Anti-reflux surgery based on randomized controlled trial evidence has a role in reflux hypersensitivity or continued pathological acid reflux despite PPI in carefully considered, fully worked up cases that have failed medical therapy; approximately two of three cases will respond but there is a small risk of complications. In patients with persistent volume reflux despite medical therapy, given the lack of alternatives, anti-reflux surgery is a consideration. Promising newer approaches include endoscopic techniques. This review aims to summarize current diagnostic approaches and critically evaluates the evidence for the efficacy of available treatments.
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Affiliation(s)
- N J Talley
- From the, NHMRC Centre of Research Excellence of Digestive Health, Faculty of Health and Medicine, University of Newcastle, New Lambton Heights, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - M Zand Irani
- From the, NHMRC Centre of Research Excellence of Digestive Health, Faculty of Health and Medicine, University of Newcastle, New Lambton Heights, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Katzka DA, Fox M. Achalasia: When a Simple Disease Becomes Complex. Gastroenterology 2020; 159:821-824. [PMID: 32693186 DOI: 10.1053/j.gastro.2020.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/16/2020] [Indexed: 12/02/2022]
Affiliation(s)
- David A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Mark Fox
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland; and Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Gastrointestinal Diseases, Centre for integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland.
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12
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Abdou MM. Synopsis of recent synthetic methods and biological applications of phosphinic acid derivatives. Tetrahedron 2020. [DOI: 10.1016/j.tet.2020.131251] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Leandri C, Soyer P, Oudjit A, Guillaumot MA, Chaussade S, Dohan A, Barret M. Contribution of magnetic resonance imaging to the management of esophageal diseases: A systematic review. Eur J Radiol 2019; 120:108684. [PMID: 31563109 DOI: 10.1016/j.ejrad.2019.108684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/11/2019] [Accepted: 09/18/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE Currently available imaging modalities used to investigate the esophagus are irradiating or limited to the analysis of the esophageal lumen. Magnetic resonance imaging (MRI) is a non-invasive and non-radiating imaging technique that provides high degrees of soft tissue contrast. Newly developed fast MRI sequences allow for both morphological and functional assessment of the esophageal body and esophagogastric junction. The purpose of this systematic review was to identify the contribution of MRI to the diagnosis and management of esophageal diseases, such as gastroesophageal reflux, esophageal motility disorders, esophageal neoplasms, and portal hypertension. METHODS We performed a systematic search of the Medline (via Ovid), EMBASE (via Ovid), PubMed and Cochrane Library databases from inception to December 2018 inclusively, using the MESH major terms "magnetic resonance imaging" AND "esophagus". RESULTS The initial search retrieved 310 references, of which 56 were found to be relevant for the study. References were analysed and classified in different subheadings: MRI protocols for the esophagus, gastroesophageal reflux disease, achalasia and other esophageal motility disorders, esophageal cancer, portal hypertension and other esophageal conditions. CONCLUSION MR Esophagography might become a non-invasive, non-irradiating technique of choice following diagnostic esophagogastroduodenoscopy for the assessment of esophageal diseases.
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Affiliation(s)
- Chloé Leandri
- Gastroenterology Department, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, France; Paris Descartes University, Paris, France.
| | - Philippe Soyer
- Paris Descartes University, Paris, France; Department of Radiology, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, France.
| | - Ammar Oudjit
- Department of Radiology, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, France.
| | - Marie-Anne Guillaumot
- Gastroenterology Department, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, France.
| | - Stanislas Chaussade
- Gastroenterology Department, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, France; Paris Descartes University, Paris, France.
| | - Anthony Dohan
- Paris Descartes University, Paris, France; Department of Radiology, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, France.
| | - Maximilien Barret
- Gastroenterology Department, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, France; Paris Descartes University, Paris, France.
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15
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Liu Z, Lu D, Guo J, Liu Y, Shi Z, Xu F, Lin L, Chen JD. Elevation of Lower Esophageal Sphincter Pressure With Acute Transcutaneous Electrical Acustimulation Synchronized With Inspiration. Neuromodulation 2019; 22:586-592. [DOI: 10.1111/ner.12967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 04/13/2019] [Indexed: 08/30/2023]
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Abdou MM, O'Neill PM, Amigues E, Matziari M. Phosphinic acids: current status and potential for drug discovery. Drug Discov Today 2019; 24:916-929. [PMID: 30481556 DOI: 10.1016/j.drudis.2018.11.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/05/2018] [Accepted: 11/20/2018] [Indexed: 01/17/2023]
Abstract
Phosphinic acid derivatives exhibit diverse biological activities and a high degree of structural diversity, rendering them a versatile tool in the development of new medicinal agents. Pronounced recent progress, coupled with previous research findings, highlights the impact of this moiety in medicinal chemistry. Here, we highlight the most important breakthroughs made with phosphinates with a range of pharmacological activities against many diseases, including anti-inflammatory, anti-Alzheimer, antiparasitic, antihepatitis, antiproliferative, anti-influenza, anti-HIV, antimalarial, and antimicrobial agents. We also provide the current status of the corresponding prodrugs, drug-delivery systems, and drug applications of phosphinic acids in the clinical stage.
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Affiliation(s)
- Moaz M Abdou
- Egyptian Petroleum Research Institute, Nasr City, PO 11727, Cairo, Egypt; Department of Chemistry, Xi'an Jiaotong Liverpool University, Suzhou, Jiangsu 215123, PR China; Department of Chemistry, University of Liverpool, Liverpool, L69 7ZD, UK
| | - Paul M O'Neill
- Department of Chemistry, University of Liverpool, Liverpool, L69 7ZD, UK; Department of Pharmacology, School of Biomedical Sciences, MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, L69 3GE, UK
| | - Eric Amigues
- Department of Chemistry, Xi'an Jiaotong Liverpool University, Suzhou, Jiangsu 215123, PR China
| | - Magdalini Matziari
- Department of Chemistry, Xi'an Jiaotong Liverpool University, Suzhou, Jiangsu 215123, PR China.
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Zhao J, McMahon B, Fox M, Gregersen H. The esophagiome: integrated anatomical, mechanical, and physiological analysis of the esophago-gastric segment. Ann N Y Acad Sci 2018; 1434:5-20. [DOI: 10.1111/nyas.13869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/27/2018] [Accepted: 05/04/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Jingbo Zhao
- GIOME Academy, Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - Barry McMahon
- Trinity Academic Gastroenterology Group; Tallaght Hospital and Trinity College; Dublin Ireland
| | - Mark Fox
- Abdominal Center: Gastroenterology; St. Claraspital Basel Switzerland
- Neurogastroenterology and Motility Research Group; University Hospital Zürich; Zürich Switzerland
| | - Hans Gregersen
- GIOME, Department of Surgery; Prince of Wales Hospital and Chinese University of Hong Kong; Shatin Hong Kong SAR
- California Medical Innovations Institute; San Diego California
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18
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Gyawali CP, Azagury DE, Chan WW, Chandramohan SM, Clarke JO, Bortoli N, Figueredo E, Fox M, Jodorkovsky D, Lazarescu A, Malfertheiner P, Martinek J, Murayama KM, Penagini R, Savarino E, Shetler KP, Stein E, Tatum RP, Wu J. Nonerosive reflux disease: clinical concepts. Ann N Y Acad Sci 2018; 1434:290-303. [DOI: 10.1111/nyas.13845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/17/2018] [Accepted: 04/11/2018] [Indexed: 02/06/2023]
Affiliation(s)
- C. Prakash Gyawali
- Division of GastroenterologyWashington University School of Medicine St. Louis Missouri
| | - Dan E. Azagury
- Department of SurgeryStanford University Stanford California
| | - Walter W. Chan
- Division of Gastroenterology, Hepatology and EndoscopyBrigham and Women's Hospital Boston Massachusetts
| | | | - John O. Clarke
- Division of GastroenterologyStanford University Stanford California
| | - Nicola Bortoli
- Department of Translational ResearchUniversity of Pisa Pisa Italy
| | - Edgar Figueredo
- Department of SurgeryUniversity of Washington Seattle Washington
| | - Mark Fox
- Department of GastroenterologySt. Claraspital Basel Switzerland
| | - Daniela Jodorkovsky
- Division of Digestive and Liver DiseasesColumbia University Medical Center New York New York
| | - Adriana Lazarescu
- Division of GastroenterologyUniversity of Alberta Edmonton Alberta Canada
| | - Peter Malfertheiner
- Department of GastroenterologyOtto‐von‐Guericke Universität Magdeburg Germany
| | - Jan Martinek
- Department of HepatoGastroenterologyIKEM Prague Czech Republic
| | | | - Roberto Penagini
- Università degli Studi and Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Edoardo Savarino
- Department of SurgicalOncological and Gastroenterological Sciences, University of Padua Padua Italy
| | - Katerina P. Shetler
- Gastroenterology DivisionPalo Alto Medical Foundation Mountain View California
| | - Ellen Stein
- Division of GastroenterologyJohns Hopkins University Baltimore Maryland
| | - Roger P. Tatum
- Department of SurgeryUniversity of Washington Seattle Washington
| | - Justin Wu
- Department of Medicine and TherapeuticsChinese University of Hong Kong Sha Tin Hong Kong
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Corrigendum. Aliment Pharmacol Ther 2018; 47:1233. [PMID: 29574868 DOI: 10.1111/apt.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Scarpellini E, Boecxstaens V, Broers C, Vos R, Pauwels A, Tack J. Effect of baclofen on gastric acid pocket in subjects with gastroesophageal reflux disease symptoms. Dis Esophagus 2016; 29:1054-1063. [PMID: 26541138 DOI: 10.1111/dote.12443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Postprandial gastroesophageal reflux (PGER) in the distal esophagus (DE) is associated with a gastric juice 'acid pocket' (AP). Baclofen reduces AP extension into the DE in healthy volunteers, in part through increased lower esophageal sphincter (LES) pressure. We aimed to verify whether baclofen also affects postprandial AP location and extent in gastroesophageal reflux disease (GERD) patients. Thirteen treatment-naive heartburn-prevalent GERD patients underwent two AP studies, after pretreatment with baclofen 40 mg or placebo 30 minutes preprandially. We performed pH-probe stepwise pull-throughs (PT) (1 cm/min, LES -10 to +5 cm) before and every 30 minutes from 30 minutes before up to 150 minutes after a test meal. After the meal, both after placebo and baclofen, gastric pH significantly dropped at 30, 60, 90 minutes postprandially (P: nadir pHs of 3.9 ± 0.6, 2.3 ± 0.6, 2.1 ± 0.4; B: nadir pHs of 2.5 ± 0.4, 2.8 ± 0.4, 2.5 ± 0.3; all P < 0.05). After placebo, LES pressure decreased at 60, 90 and 120 minutes postprandially (32.7 ± 6.1 vs. 24.5 ± 3.1, 27.3 ± 5.9, 27.3 ± 6.0 mmHg; analysis of variance [ANOVA], P = 0.037), but this was prevented by baclofen (25.4 ± 3.4 vs. 29.4 ± 2, 32.2 ± 1.4, 35.5 ± 1.7 mmHg, ANOVA, P = not significant (NS)). Baclofen did not significantly decrease the postprandial AP extent above the LES but prevented the postprandial increase in transient lower esophageal sphincter relaxations (TLESRs) (preprandial vs. postprandial, placebo: 1.1 ± 0.3 vs. 3.7 ± 0.7, P < 0.05; baclofen: 1.4 ± 0.4 vs. 2 ± 0.5, P = NS). In GERD patients, baclofen significantly increases postprandial LES pressure, prevents the increase TLESRs but, unlike in healthy volunteers, does not affect AP extension into the DE.
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Affiliation(s)
- E Scarpellini
- TARGID (Translational Research Centre for Gastrointestinal Disorders), University of Leuven, Leuven, Belgium
| | - V Boecxstaens
- TARGID (Translational Research Centre for Gastrointestinal Disorders), University of Leuven, Leuven, Belgium
| | - C Broers
- TARGID (Translational Research Centre for Gastrointestinal Disorders), University of Leuven, Leuven, Belgium
| | - R Vos
- TARGID (Translational Research Centre for Gastrointestinal Disorders), University of Leuven, Leuven, Belgium
| | - A Pauwels
- TARGID (Translational Research Centre for Gastrointestinal Disorders), University of Leuven, Leuven, Belgium
| | - J Tack
- TARGID (Translational Research Centre for Gastrointestinal Disorders), University of Leuven, Leuven, Belgium
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Abstract
Gastroesophageal reflux disease is one of the commonest chronic conditions in the western world and its prevalence is increasing worldwide. The discovery of the acid pocket explained the paradox of acid reflux occurring more frequently in the postprandial period despite intragastric acidity being low due to the buffering effect of the meal. The acid pocket was first described in 2001 when it was detected as an area of low pH immediately distal to the cardia using dual pH electrode pull-through studies 15 minutes after a meal. It was hypothesized that there was a local pocket of acid close to the gastroesophageal junction that escapes the buffering effect of the meal, and that this is the source of postprandial acidic reflux. The presence of the acid pocket has been confirmed in other studies using different techniques including high-resolution pHmetry, Bravo capsule, magnetic resonance imaging, and scintigraphy. This review aims to describe what we know about the acid pocket including its length, volume, fluid constituents, and its relationship to the lower esophageal sphincter and squamocolumnar junction. We will discuss the possible mechanisms that lead to the formation of the acid pocket and examine what differences exist in patients who suffer from acid reflux. Treatments for reflux disease that affect the acid pocket will also be discussed.
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22
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Khalaf A, Hoad CL, Spiller RC, Gowland PA, Moran GW, Marciani L. Magnetic resonance imaging biomarkers of gastrointestinal motor function and fluid distribution. World J Gastrointest Pathophysiol 2015; 6:140-149. [PMID: 26600972 PMCID: PMC4644878 DOI: 10.4291/wjgp.v6.i4.140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/28/2015] [Accepted: 10/27/2015] [Indexed: 02/07/2023] Open
Abstract
Magnetic resonance imaging (MRI) is a well established technique that has revolutionized diagnostic radiology. Until recently, the impact that MRI has had in the assessment of gastrointestinal motor function and bowel fluid distribution in health and in disease has been more limited, despite the novel insights that MRI can provide along the entire gastrointestinal tract. MRI biomarkers include intestinal motility indices, small bowel water content and whole gut transit time. The present review discusses new developments and applications of MRI in the upper gastrointestinal tract, the small bowel and the colon reported in the literature in the last 5 years.
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23
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Steger M, Schneemann M, Fox M. Systemic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther 2015; 42:1037-50. [PMID: 26307025 DOI: 10.1111/apt.13374] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/26/2015] [Accepted: 07/28/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hiccups are familiar to everyone, but remain poorly understood. Acute hiccups can often be terminated by physical manoeuvres. In contrast, persistent and intractable hiccups that continue for days or months are rare, but can be distressing and difficult to treat. AIM To review the management of hiccups, including a systematic review of reported efficacy and safety of pharmacological treatments. METHODS Available articles were identified using three electronic databases in addition to hand searching of published articles. Inclusion criteria were any reports of pharmaceutical therapy of 'hiccup(s)', 'hiccough(s)' or 'singultus' in English or German. RESULTS Treatment of 341 patients with persistent or intractable hiccups was reported in 15 published studies. Management was most effective when directed at the underlying condition. An empirical trial of anti-reflux therapy may be appropriate. If the underlying cause is not known or not treatable, then a range of pharmacological agents may provide benefit; however, systematic review revealed no adequately powered, well-designed trials of treatment. The use of baclofen and metoclopramide are supported by small randomised, placebo-controlled trials. Observational data suggest that gabapentin and chlorpromazine are also effective. Baclofen and gabapentin are less likely than standard neuroleptic agents to cause side effects during long-term therapy. CONCLUSIONS This systematic review revealed no high quality data on which to base treatment recommendations. Based on limited efficacy and safety data, baclofen and gabapentin may be considered as first line therapy for persistent and intractable hiccups, with metoclopramide and chlorpromazine in reserve.
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Affiliation(s)
- M Steger
- Division of Internal Medicine, University Hospital Zürich, Zürich, Switzerland
| | - M Schneemann
- Division of Internal Medicine, University Hospital Zürich, Zürich, Switzerland
| | - M Fox
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Zürich Center for Integrated Human Physiology, Zürich, Switzerland
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24
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Steingoetter A, Sauter M, Curcic J, Liu D, Menne D, Fried M, Fox M, Schwizer W. Volume, distribution and acidity of gastric secretion on and off proton pump inhibitor treatment: a randomized double-blind controlled study in patients with gastro-esophageal reflux disease (GERD) and healthy subjects. BMC Gastroenterol 2015; 15:111. [PMID: 26328588 PMCID: PMC4557316 DOI: 10.1186/s12876-015-0343-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/27/2015] [Indexed: 12/15/2022] Open
Abstract
Background Postprandial accumulation of gastric secretions in the proximal stomach above the meal adjacent to the esophagogastric junction (EGJ), referred to as the ‘acid pocket’, has been proposed as a pathophysiological factor in gastro-esophageal reflux disease (GERD) and as a target for GERD treatment. This study assessed the effect of proton pump inhibitor (PPI) therapy on the volume, distribution and acidity of gastric secretions in GERD and healthy subjects (HS). Methods A randomized, double blind, cross-over study in 12 HS and 12 GERD patients pre-treated with 40 mg pantoprazole (PPI) or placebo b.i.d. was performed. Postprandial secretion volume (SV), formation of a secretion layer and contact between the layer and the EGJ were quantified by Magnetic Resonance Imaging (MRI). Multi-channel pH-monitoring assessed intragastric pH. Results A distinct layer of undiluted acid secretion was present on top of gastric contents in almost all participants on and off high-dose acid suppression. PPI reduced SV (193 ml to 100 ml, in HS, 227 ml to 94 ml in GERD; p < 0.01) and thickness of the acid layer (26 mm to 7 mm, 36 mm to 9 mm respectively, p < 0.01). No differences in secretion volume or layer thickness were observed between groups; however, off treatment, contact time between the secretion layer and EGJ was 2.6 times longer in GERD compared to HS (p = 0.012). This was not the case on PPI. Conclusions MRI can visualize and quantify the volume and distribution dynamics of gastric secretions that form a layer in the proximal stomach after ingestion of a liquid meal. The secretion volume and the secretion layer on top of gastric contents is similar in GERD patients and HS; however contact between the layer of undiluted secretion and the EGJ is prolonged in patients. High dose PPI reduced secretion volume by about 50 % and reduced contact time between secretion and EGJ towards normal levels. Trial registration NCT01212614. Electronic supplementary material The online version of this article (doi:10.1186/s12876-015-0343-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andreas Steingoetter
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland. .,Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, CH-8092, Zurich, Switzerland.
| | - Matthias Sauter
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Jelena Curcic
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Dian Liu
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland. .,Institute for Biomedical Engineering, University and ETH Zurich, Gloriastrasse 35, CH-8092, Zurich, Switzerland.
| | - Dieter Menne
- Menne Biomed Consulting, Olgastr. 7, D-72074, Tübingen, Germany.
| | - Michael Fried
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Mark Fox
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Werner Schwizer
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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Nagaraja V, McMahan ZH, Getzug T, Khanna D. Management of gastrointestinal involvement in scleroderma. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2015; 1:82-105. [PMID: 26005632 DOI: 10.1007/s40674-014-0005-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastrointestinal tract (GIT) commonly affects patients with systemic sclerosis (SSc). The GI involvement is quite heterogeneous varying from asymptomatic disease to significant dysmotility causing complications like malabsorption, weight loss and severe malnutrition. This review focuses on the management of GI involvement in SSc and has been categorized based on the segment of GIT involved. A brief discussion on the role of patient reported outcome measures in SSc-GI involvement has also been incorporated.
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Affiliation(s)
- Vivek Nagaraja
- Division of Rheumatology, University of Toledo, Toledo, Ohio
| | | | - Terri Getzug
- Division of Rheumatology, University of Toledo, Toledo, Ohio
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan
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Avdeev VG. [Some issues of the diagnosis and treatment of gastroesophageal reflux disease]. TERAPEVT ARKH 2015. [PMID: 28635804 DOI: 10.17116/terarkh20158710120-124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The clinical inefficacy of proton pump inhibitors (PPIs) is very frequently encountered in nonerosive gastroesophageal reflux disease (NERD) in particular. Postprandial acid pocket, weak-acid or alkaline reflux, etc. are one of the causes of resistance to antisecretory drugs. Alginates serve as a good alternative to PPIs in treating NERD and gastroesophageal reflux in children and pregnant women. The alginate test may help diagnose NERD.
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Affiliation(s)
- V G Avdeev
- Department of Internal Medicine, Faculty of Fundamental Medicine, M.V. Lomonosov Moscow State University, Moscow, Russia
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Vakil N. Baclofen and transient lower oesophageal sphincter relaxations - the band plays on. Aliment Pharmacol Ther 2014; 40:1360-1. [PMID: 25376198 DOI: 10.1111/apt.12987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 09/22/2014] [Indexed: 12/24/2022]
Affiliation(s)
- N Vakil
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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28
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Fox M, Curcic J. Editorial: baclofen and transient lower oesophageal sphincter relaxations - the band plays on - authors' reply. Aliment Pharmacol Ther 2014; 40:1361-2. [PMID: 25376199 DOI: 10.1111/apt.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 09/30/2014] [Indexed: 12/08/2022]
Affiliation(s)
- M Fox
- iDigest Clinic and Laboratory for Disorders of GI Motility and Function, Division of Gastroenterology, University Hospital Zurich, Zurich, Switzerland.
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