Clarifying misunderstandings and misinterpretations about proton pump inhibitor-responsive oesophageal eosinophilia

We appreciate the interest of Muir et al1 in our Position Paper on proton pump inhibitor-responsive oesophageal eosinophilia (PPI-REE).2 Their letter highlights the ongoing controversies related to PPI-REE, particularly regarding practical diagnostic concerns in paediatric patients. We would like to address several issues raised by the authors:When the clinical presentation is consistent with gastro-oesophageal reflux disease (GORD), an empiric trial of PPI therapy is always appropriate. Teenagers and adults with dysphagia, however, should undergo an endoscopic procedure, because dysphagia is a red-flag symptom. In adult patients with dysphagia and suspected eosinophilic oesophagitis (EoE), a baseline endoscopy off PPI therapy has diagnostic value. This approach has not led to unnecessary endoscopies or diagnostic confusion, as suggested by Muir et al.1 Instead, it has elucidated the existence and improved our understanding of PPI-REE in adult patients.2 The different and more non-specific clinical...
Source: Gut - Category: Gastroenterology Authors: Tags: PostScript Source Type: research

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CONCLUSION: Based on the results of studies of low-to-moderate quality, antireflux surgery improved QoL and reduced oesophageal acid exposure in NN and NI children in the short and medium term. Although antireflux surgery is a common elective operation, the lack of rigorous preoperative and postoperative evaluation(s) in the majority of patient-reported studies is striking. PMID: 32083325 [PubMed - as supplied by publisher]
Source: The British Journal of Surgery - Category: Surgery Authors: Tags: Br J Surg Source Type: research
ConclusionOur systematic review and meta-analysis showed consistent association between abnormal GEFV indicated by Hill ’s classification III/IV and symptomatic GERD and erosive esophagitis. Our recommendation is to include Hill’s classification in routine endoscopy reports and workup for GERD.
Source: Digestive Diseases and Sciences - Category: Gastroenterology Source Type: research
Every once in a while, a field that has felt static for decades begins to move. Gastroesophageal reflux disease (GERD) is in one of those times. GERD is a big modern problem with estimates of significant GERD in some 30 million in the United States. For a long while, treatment has boiled down to 2 options: the pill (proton pump inhibitors, PPIs) or the knife (laparoscopic fundoplication). There is no doubt that these treatments benefit a majority of patients suffering from GERD but have also left many dissatisfied.
Source: Gastrointestinal Endoscopy Clinics of North America - Category: Gastroenterology Authors: Tags: Foreword Source Type: research
The landscape of gastroesophageal reflux disease (GERD) management is changing, in a good way. Several key forces have converged (Box  1), propelling us to see GERD with a new perspective. One of these forces is the expanding role of the interventional gastrointestinal endoscopist in foregut diseases, including GERD, Barrett’s and early esophageal cancer, achalasia, Zenker diverticulum, early gastric cancer, gastric outlet obst ruction, and obesity. Accordingly, when tapped by Dr Lightdale to be the editor of this issue devoted to GERD management, I had the privilege of assembling some of the top GERD authoritie...
Source: Gastrointestinal Endoscopy Clinics of North America - Category: Gastroenterology Authors: Tags: Preface Source Type: research
Magnetic sphincter augmentation is an effective and safe surgical method for the treatment of gastroesophageal reflux disease (GERD). The device has been compared with twice-daily proton pump inhibitor therapy and laparoscopic fundoplication (in randomized trials and prospective cohort studies, respectively). Magnetic sphincter augmentation was superior to medical therapy and equivalent to surgery for the relief of GERD symptoms. Recent research focuses on implanting the device into more complex patients, such as those with larger hiatal hernias or those with Barrett ’s esophagus. Additional novel research topics inc...
Source: Gastrointestinal Endoscopy Clinics of North America - Category: Gastroenterology Authors: Source Type: research
Minimally invasive endoscopic antireflux therapies are critical for bridging the gap between medical and surgical treatments for gastroesophageal reflux disease (GERD). Although multiple endoscopic devices have been developed, perhaps some of the most exciting options that are currently evolving are the full-thickness suturing techniques using widely available and low-cost platforms. Full-thickness endoscopic suturing can allow for a highly durable recreation of the anatomic and functional components of a lower esophageal sphincter, which are deficient in patients with GERD. Proper patient selection, endoscopic hiatal hern...
Source: Gastrointestinal Endoscopy Clinics of North America - Category: Gastroenterology Authors: Source Type: research
Endoscopy DOI: 10.1055/a-1104-5245In Europe at present, but also in 2040, 1 in 3 cancer-related deaths are expected to be caused by digestive cancers. Endoscopic technologies enable diagnosis, with relatively low invasiveness, of precancerous conditions and early cancers, thereby improving patient survival. Overall, endoscopy capacity must be adjusted to facilitate both effective screening programs and rigorous control of the quality assurance and surveillance systems required. 1 For average-risk populations, ESGE recommends the implementation of organized population-based screening programs for colorectal cancer, based...
Source: Endoscopy - Category: Gastroenterology Authors: Tags: Position Statement Source Type: research
This study aimed to in vestigate the short-term outcomes of ARMS-C in GERD patients.MethodsFrom December 2016 to February 2018, we performed ARMS-C in 33 patients with pathologic reflux disease and esophageal hypersensitivity. ARMS-C involved endoscopic mucosal resection at the circumference of the esophagogastric junction (EGJ), resulting in narrowing of the hiatal opening after healing. The GERD symptoms, 24-h pH monitoring results, manometry, endoscopy, and EGJ distensibility were compared before and after the procedure.ResultsSix months after ARMS-C, 63% of patients discontinued the use of pump inhibitors (PPIs), while...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
AbstractPurpose of ReviewThe functional luminal imaging probe (FLIP) uses high-resolution planimetry to provide a three-dimensional image of the esophageal lumen by measuring diameter, volume, and pressure changes. The goal of this review is to summarize the most recent advances in applying the (FLIP) to esophageal disorders.Recent FindingsThe FLIP has been studied in esophageal disease states including gastroesophageal reflux disease (GERD), achalasia, and eosinophilic esophagitis. It has also been used in the investigation of dysphagia.SummaryThe FLIP is a valuable tool for the diagnosis of esophageal diseases as well as...
Source: Current Gastroenterology Reports - Category: Gastroenterology Source Type: research
Authors: Foisy H, Pioche M, Chabrun E, Ponchon T, Zerbib F, Rivory J, Mion F, Roman S Abstract Background/Aims: Peroral endoscopy myotomy (POEM) is effective to treat achalasia. We aim to determine POEM effect on esophageal function and search for predictive factors of response to POEM and co-occurrence of gastroesophageal reflux disease (GERD). Methods: A total of 64 untreated achalasia patients who underwent high-resolution manometry (HRM) before and 3 months after POEM were retrospectively included. Response to treatment was defined as an Eckardt score
Source: Journal of Neurogastroenterology and Motility - Category: Gastroenterology Tags: J Neurogastroenterol Motil Source Type: research
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