The Utility of Esophageal Motility Testing in Gastroesophageal Reflux Disease (GERD)
AbstractPurpose of ReviewHere, we discuss how esophageal motor testing plays important roles in patients with suspected gastroesophageal reflux disease (GERD). In addition to guiding appropriate placement of catheters for ambulatory reflux monitoring, esophageal high-resolution manometry (HRM) rules out confounding diagnoses, such as achalasia spectrum disorders, that can present with symptoms similar to that of GERD, but are managed very differently.Recent FindingsHRM performed with impedance in the post-prandial setting (PP-HRIM) can assess for rumination syndrome or supragastric belching, which should be directed towards behavioral interventions. The recent GERD Classification of Motor Function recommends a hierarchical approach, focusing on (1) the esophagogastric junction (EGJ), (2) the esophageal body, and (3) esophageal contraction reserve, which can be assessed with provocative maneuvers at HRM, such as multiple rapid swallows (MRS). This approach can inform the appropriate tailoring of antireflux surgery. Novel esophageal motility metrics, such as the EGJ-contractile integral from HRM, or post-reflux swallow-induced peristaltic wave indices from 24-h pH-impedance monitoring, may also assist with GERD diagnosis.SummaryAssessment of esophageal motor function can contribute in a significant manner to the care of patients with suspected GERD, particularly when esophageal symptoms do not improve with antisecretory therapy, and/or when surgical or endoscopic antireflux the...
An 82-year-old male, with a history of bowel cancer with partial colectomy, gastroesophageal reflux disease, remote partial gastrectomy for peptic ulcer disease, and no documented prior kidney disease, presents with several months of fatigue and subacute decline in kidney function. He had no history of diabetes, hypertension, kidney stones, or prior urinary tract infections. He denied use of nonsteroidal anti-inflammatory agents, herbal medications, and recent antibiotics. There was no family history of renal disease.
New international consensus guidelines offer recommendations for selecting adults with gastroesophageal reflux disorder (GERD) for antireflux surgery.Reuters Health Information
DiscussionWe suggest an open gastrectomy with roux-en-Y anastomosis as an alternative to the Nissen fundoplication for patients with connective tissue disease that develop terminal pulmonary consequences and require a lung transplant.
Conclusions: Fundoplication with GT is effective in reducing hospital admissions and emergency department visits from GER and seizures in NI children. Because of high mortality within a year of fundoplication and GT in DNR children, anti-reflux medications with GT might be an alternative. PMID: 31423518 [PubMed - in process]
We examined the relationships among symptom burden, EMD, acid exposure time (AET), symptom association probability, and body mass index (BMI).
ConclusionsPatient and physician ’s characteristics were related to high utilization of gastroenterology services among GERD patients. The associations with age and country of birth might reflect more severe disease. The regional differences warrant further research and interventions at the district level. Training in gastroenter ology of primary care physicians without a board certification is warranted.
MONDAY, Aug. 19, 2019 -- Symptomatic gastroesophageal reflux disease (GERD) is associated with chronic temporomandibular disorder (TMD), and the correlation is partially mediated by somatization, anxiety, and undermined sleep, according to a study...
CONCLUSIONS The study demonstrates that aspiration of gastric contents can cause pulmonary fibrosis, and mixed aspiration of pepsin and gastric fluid can accelerate this process. This study provides strong evidence in support of a potential association between human GERD and IPF. PMID: 31419218 [PubMed - in process]
The objective of this article is to provide a structured and applicable approach to managing ESRD that is up-to-date and evidence based. To achieve this objective, we created an alphabetized mnemonic and synthesized our discussion to address Anemia, Bone health, Cardiovascular issues, vitamin D deficiency, Electrolytes imbalances, Fluid overload, and Gastroesophageal reflux in patients with ESRD.