Journal ArticleNeurogastroenterol Motil · April 2025
BACKGROUND: Refluxate volume and pH drop following gastroesophageal reflux are mostly cleared by peristalsis. We evaluated the roles of primary volume clearing peristaltic wave (VCPW), secondary VCPW, post-reflux swallow-induced peristaltic wave (PSPW), an ...
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Journal ArticleClin Gastroenterol Hepatol · February 2025
BACKGROUND AND AIMS: Heartburn symptoms contribute to healthcare-seeking among patients with gastroesophageal reflux disease (GERD). Despite clinical guidance, management is often dictated by insurance restrictions. Several potassium-competitive acid block ...
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Journal ArticleGastroenterology · November 2024
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DESCRIPTION: The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update (CPU) is to summarize the available evidence and offer expert Best Practice Advice on the integration of potassium-competitive acid blockers ...
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Journal ArticleClin Gastroenterol Hepatol · October 2024
BACKGROUND AND AIMS: Heartburn is the most common symptom seen in gastroenterology practice. We aimed to optimize cost-effective evaluation and management of heartburn. METHODS: We developed a decision analytic model from insurer and patient perspectives c ...
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Journal ArticleForegut · September 1, 2024
Symptoms suspicious for gastroesophageal reflux disease (GERD) represent frequent indications for medical presentation, as do symptoms potentially compatible with delayed gastric emptying. In this clinical setting, care must be taken to characterize patien ...
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Journal ArticleNeurogastroenterol Motil · September 2024
BACKGROUND: Mean nocturnal baseline impedance (MNBI) can improve diagnostic accuracy for gastroesophageal reflux disease (GERD), but must be manually calculated and is not routinely reported. We aimed to determine how automated software-derived mean supine ...
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Journal ArticleNeurogastroenterol Motil · August 2024
BACKGROUND: Diabetes Mellitus (DM) is known to induce a wide range of harmful effects on several organs, notably leading to ineffective esophageal motility (IEM). However, the relationship between DM and IEM is not fully elucidated. We aimed to determine t ...
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Journal ArticleAm J Gastroenterol · December 1, 2023
INTRODUCTION: Artificial intelligence chatbots could serve as an information resource for patients and a tool for clinicians. Their ability to respond appropriately to questions regarding gastroesophageal reflux disease is unknown. METHODS: Twenty-three pr ...
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Chapter · September 2023
Symptoms potentially attributable to gastroesophageal reflux disease are among those most commonly reported to primary care providers in the outpatient setting. In this review, we discuss clinical approaches to the evaluation and management of these sympto ...
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Journal ArticleDis Esophagus · June 15, 2023
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Magnetic sphincter augmentation (MSA) is a surgical intervention for well-characterized gastroesophageal reflux disease (GERD), where the esophagogastric junction barrier is augmented using a bracelet of magnetized titanium beads. MSA could be an attractiv ...
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Journal ArticleDig Dis Sci · June 2023
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In our present clinical paradigm, patient symptoms and presentation in the setting of traditional findings from endoscopy (erosive esophagitis, Barrett's esophagus, reflux-mediated stenosis), esophageal high-resolution manometry, and/or ambulatory reflux m ...
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Journal ArticleGastroenterology · June 2023
INTRODUCTION: Chronic idiopathic constipation (CIC) is a common disorder associated with significant impairment in quality of life. This clinical practice guideline, jointly developed by the American Gastroenterological Association and the American College ...
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Journal ArticleAm J Gastroenterol · June 1, 2023
INTRODUCTION: Chronic idiopathic constipation (CIC) is a common disorder associated with significant impairment in quality of life. This clinical practice guideline, jointly developed by the American Gastroenterological Association and the American College ...
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Chapter · April 21, 2023
The Chicago Classification (CC), now in its fourth iteration [CC Version 4.0 (CC v4.0)], represents the quintessential interpretation and classification scheme for the evaluation of motor function and the diagnosis of motility disorders with esophageal hig ...
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Chapter · April 21, 2023
Esophageal motility disorders present with symptoms that can include dysphagia, regurgitation, and/or retrosternal pain. After an initial upper endoscopy, choice of esophageal physiologic evaluation modality includes barium radiography, high-resolution man ...
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Journal ArticleGastroenterol Hepatol (N Y) · December 2022
Potassium-competitive acid blockers (PCABs) such as vonoprazan represent a novel class of acid suppressants that show tremendous promise to enhance care of acid peptic disorders. PCAB characteristics distinct from those of proton pump inhibitors-such as ac ...
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Journal ArticleDis Esophagus · May 10, 2022
BACKGROUND: Upper endoscopy (EGD) is frequently performed in patients with esophageal complaints following anti-reflux surgery such as fundoplication. Endoscopic evaluation of fundoplication wrap integrity can be challenging. Our primary aim in this pilot ...
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Chapter · January 1, 2022
The burgeoning obesity epidemic has fostered increased innovation and utilization of bariatric surgical interventions. These include adjustable gastric banding, sleeve gastrectomy, Roux-en-Y gastric bypass, and biliopancreatic diversion-duodenal switch, as ...
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Chapter · January 1, 2022
The esophageal microbiome is an emerging field of investigation. Better understanding of the relationships between the esophageal microbiome and esophageal motility disorders may impact clinical management and facilitate further understanding of esophageal ...
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Journal ArticleGastroenterol Hepatol (N Y) · July 2021
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In up to half of patients with symptoms suspected to stem from gastroesophageal reflux disease (GERD), these symptoms persist despite treatment with daily proton pump inhibitor (PPI) therapy. The symptoms may be characterized as typical (eg, heartburn or r ...
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Journal ArticleJ Clin Gastroenterol · February 1, 2021
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Esophageal high-resolution manometry (HRM) assesses esophageal motor function and is indicated both for evaluation of esophageal symptoms and before antireflux interventions. HRM studies are interpreted and esophageal motor diagnoses made according to the ...
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Journal ArticleJ Gastroenterol · January 2021
BACKGROUND: Artificial intelligence (AI) has potential to streamline interpretation of pH-impedance studies. In this exploratory observational cohort study, we determined feasibility of automated AI extraction of baseline impedance (AIBI) and evaluated cli ...
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Journal ArticleDis Esophagus · December 7, 2020
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Esophageal baseline impedance (BI) acquired during esophageal contraction (contractile segment impedance [CSI]) is proposed to improve BI accuracy in gastroesophageal reflux disease (GERD). We evaluated associations between CSI and conventional and novel G ...
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Journal ArticleJ Neurogastroenterol Motil · September 30, 2020
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BACKGROUND/AIMS: Esophageal baseline impedance (BI) can be extracted from pH-impedance tracings as mean nocturnal baseline impedance (MNBI), and from high-resolution impedance manometry (HRIM), but it is unknown if values are similar between acquisition me ...
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Journal ArticleDig Dis Sci · September 2020
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Recent innovations in esophageal diagnostic testing have enhanced gastroenterology clinical practice by facilitating more nuanced and advanced evaluation of esophageal symptoms. Among these pivotal advances is the FDA-approved functional lumen imaging prob ...
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Journal ArticleAm J Gastroenterol · September 2020
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Esophageal symptoms are common and may indicate the presence of gastroesophageal reflux disease (GERD), structural processes, motor dysfunction, behavioral conditions, or functional disorders. Esophageal physiologic tests are often performed when initial e ...
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Journal ArticleClin Gastroenterol Hepatol · July 2020
BACKGROUND & AIMS: Esophageal motor disorders (EMD) and pathologic reflux are often identified in obese individuals, but it is not clear how obesity contributes to these symptoms. We examined the relationships among symptom burden, EMD, acid exposure time ...
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Journal ArticleClin Gastroenterol Hepatol · March 2020
BACKGROUND & AIMS: Abnormal acid exposure time (AET) is associated with good outcomes of symptoms from antireflux therapy. Low esophageal mean nocturnal baseline impedance (MNBI) is an additional marker of reflux disease. We aimed to evaluate the value of ...
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Journal ArticleCurr Gastroenterol Rep · July 10, 2019
PURPOSE OF REVIEW: Here, 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 ...
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Journal ArticleJ Neurogastroenterol Motil · April 30, 2019
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In predisposed individuals with long standing gastroesophageal reflux disease (GERD), esophageal squamous mucosa can transform into columnar mucosa with intestinal metaplasia, commonly called Barrett's esophagus (BE). Barrett's mucosa can develop dysplasia ...
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Journal ArticleDig Dis Sci · December 2018
Esophageal high-resolution manometry (HRM) has advanced the understanding of esophageal motor function and the ability to diagnose and manage disorders of esophageal motility. In this review, we describe the indications for and the technical performance of ...
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Journal ArticleNeurogastroenterol Motil · September 2018
Although neurogastroenterology and motility (NGM) disorders are some of the most frequent disorders encountered by practicing gastroenterologists, a structured competency-based training curriculum developed by NGM experts is lacking. The American Neurogast ...
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Journal ArticleDis Esophagus · August 1, 2018
Eosinophilic esophagitis (EoE) is a chronic disease that can be diagnosed at any age, but is not associated with malignancy and does not shorten lifespan. It remains unknown whether an EoE diagnosis affects insurability or insurance premium costs. We there ...
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Journal ArticleJ Neurogastroenterol Motil · July 30, 2018
BACKGROUND/AIMS: Breaks in the peristaltic contour on esophageal high-resolution manometry (HRM) may be associated with bolus retention in the esophagus. We evaluated the relationship between peristaltic breaks and esophageal symptoms, reflux exposure, and ...
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Journal ArticleAliment Pharmacol Ther · January 2018
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BACKGROUND: Genetic polymorphisms in G-protein beta-3 subunit (GNβ3) and beta-2 adrenergic receptor (ADRB2) are associated with pain and gut hypersensitivity, which can overlap with gastroesophageal reflux disease (GERD). AIM: To evaluate relationships bet ...
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Journal ArticleNeurogastroenterol Motil · December 2017
BACKGROUND: The upper esophageal sphincter (UES) reflexively responds to bolus presence within the esophageal lumen, therefore UES metrics can vary in achalasia. METHODS: Within consecutive patients undergoing esophageal high-resolution manometry (HRM), 30 ...
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Journal ArticleNeurogastroenterol Motil · July 2017
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BACKGROUND: The Chicago Classification (CC) uses high-resolution manometry (HRM) software tools to designate esophageal motor diagnoses. We evaluated changes in diagnostic designations between two CC versions, and determined motor patterns not identified b ...
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Journal ArticleNeurogastroenterol Motil · April 2017
BACKGROUND: High-resolution manometry (HRM) categorizes esophageal motor processes into specific Chicago Classification (CC) diagnoses, but the clinical impact of these motor diagnoses on symptom burden remain unclear. METHODS: Two hundred and eleven subje ...
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Journal ArticleAliment Pharmacol Ther · January 2017
BACKGROUND: High-resolution manometry has become the preferred choice of oesophagologists for oesophageal motor assessment, but the learning curve among trainees remains unclear. AIM: To determine the learning curve of high-resolution manometry interpretat ...
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Journal ArticleNeurogastroenterol Motil · December 2016
BACKGROUND: High-resolution manometry (HRM) utilizes software tools to diagnose esophageal motor disorders. Performance of these software metrics could be affected by averaging and by software characteristics of different manufacturers. METHODS: High-resol ...
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Journal ArticleCurr Gastroenterol Rep · November 2016
The utilization of impedance technology has enhanced our understanding and assessment of esophageal dysmotility. Esophageal high-resolution manometry (HRM) catheters incorporated with multiple impedance electrodes help assess esophageal bolus transit, and ...
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Journal ArticleClin Gastroenterol Hepatol · October 2016
We assessed peristaltic reserve using multiple rapid swallows (MRS) during esophageal high-resolution manometry (HRM) of 111 patients with systemic sclerosis (89 women; ages, 42-64 y). We performed a retrospective analysis of HRM studies that included MRS ...
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Journal ArticleDis Esophagus · October 2016
The esophagogastric junction contractile integral (EGJ-CI), designed similar to distal contractile integral (DCI), has been proposed as a metric to evaluate EGJ barrier function. We determined normative values and evaluated EGJ-CI in predicting esophageal ...
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Journal ArticleAliment Pharmacol Ther · October 2016
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BACKGROUND: Mean nocturnal baseline impedance (MNBI), a novel pH-impedance metric, may be a surrogate marker of reflux burden. AIM: To assess the predictive value of MNBI on symptomatic outcomes after anti-reflux therapy. METHODS: In this prospective obser ...
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Journal ArticleNeurogastroenterol Motil · September 2016
BACKGROUND: Positive symptom association probability (SAP) with physiologic esophageal acid exposure time (AET) on pH-impedance monitoring defines reflux hypersensitivity (RH), a correlate of acid sensitivity on pH monitoring. We evaluated prevalence, clin ...
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Journal ArticleNeurogastroenterol Motil · May 2016
BACKGROUND: Esophagogastric junction contractile integral (EGJ-CI) assesses EGJ barrier function on esophageal high resolution manometry (HRM). We assessed EGJ-CI values in achalasia and gastroesophageal reflux disease (GERD) to determine if postoperative ...
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Journal ArticleNeurogastroenterol Motil · April 2016
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BACKGROUND: Combinations of reflux parameters (acid exposure time, AET; symptom association probability, SAP) on pH-impedance monitoring describe varying confidence in reflux evidence. We compared outcomes between phenotypes with distinct pre-identified re ...
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Journal ArticleNeurogastroenterol Motil · February 2016
BACKGROUND: Ineffective esophageal motility (IEM) is associated with reflux disease, but its natural history is unclear. We evaluated patients undergoing repeat esophageal high resolution manometry (HRM) for symptomatic presentations after antireflux surge ...
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Journal ArticleJ Gastroenterol · February 2016
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BACKGROUND: Achalasia is classified into three HRM subtypes that predict outcomes from diverse management strategies. We assessed if symptomatic response varied when a single management strategy-Heller myotomy (HM)-is employed. METHODS: Treatment-naive sub ...
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Journal ArticleDis Esophagus · July 2015
Cameron lesions, as defined by erosions and ulcerations at the diaphragmatic hiatus, are found in the setting of gastrointestinal (GI) bleeding in patients with a hiatus hernia (HH). The study aim was to determine the epidemiology and clinical manifestatio ...
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Journal ArticleClin Gastroenterol Hepatol · May 2015
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BACKGROUND & AIMS: pH-impedance monitoring detects acid and nonacid reflux events, but little is known about which parameters predict outcomes of different management strategies. We evaluated a cohort of medically and surgically managed patients after pH-i ...
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Journal ArticleJ Clin Gastroenterol · February 2015
BACKGROUND: Globus is commonly encountered in clinical practice, but high-resolution manometry (HRM) characteristics are incompletely characterized. We evaluated HRM metrics in globus subjects, compared with age-matched and sex-matched dysphagia subjects a ...
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Journal ArticleNeurogastroenterol Motil · February 2015
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BACKGROUND: Intolerance of the esophageal manometry catheter may prolong high-resolution manometry (HRM) studies and increase patient distress. We assessed the impact of obtaining the landmark phase at the end of the study when the patient has acclimatized ...
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Journal ArticleGastrointest Endosc Clin N Am · October 2014
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High-resolution manometry (HRM) has advanced the understanding of esophageal peristaltic mechanisms and has simplified esophageal motor testing. In this article the technical aspects of HRM are addressed, focusing on test protocols, in addition to concerns ...
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Journal ArticleAm J Gastroenterol · June 2014
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OBJECTIVES: pH-impedance testing detects reflux events irrespective of pH, but its value in predicting treatment outcome is unclear. We prospectively evaluated subjects treated medically after pH-impedance testing to determine predictors of symptom improve ...
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Journal ArticleNeurogastroenterol Motil · May 2014
BACKGROUND: Multiple rapid swallows (MRS) during esophageal high resolution manometry (HRM) assess esophageal neuromuscular integrity by evaluating postdeglutitive inhibition and rebound contraction, but most reports performed only a single MRS sequence. W ...
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Journal ArticlePostgrad Med J · March 2013
BACKGROUND: Tricyclic antidepressants (TCAs) are known to benefit subjects with functional nausea and vomiting (FNV), but it is not known if alternate neuromodulators are also beneficial. We retrospectively evaluated outcomes and clinical predictors of res ...
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Journal ArticleEcohealth · March 1, 2006
Population declines of amphibian species in many parts of the world are associated with a lethal fungal pathogen, Batrachochytrium dendrobatidis. Using laboratory challenge assays, we describe the inhibition of B. dendrobatidis by members of eight genera o ...
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