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J Gastrointest Surg 2022 May 18. Epub 2022 May 18.

Department of Gastro-Intestine Surgery, Shanghai Changzheng Hospital, Naval Medical University, 415 FengYang Road, Shanghai, 200003, People's Republic of China.

Introduction: The incidence of adenocarcinoma of esophageal-gastric junction (AEJ) has been increasing in recent years. Esophagogastrostomy after proximal gastrectomy (PG-EG) is the most commonly used surgical method for this disease which causes a constant spasm of the pyloric sphincter by cutting the vagus nerve around the esophagus, so H-M pyloroplasty (Heineke-Mikulicz pyloroplasty) is often operated after PG-EG to prevent delayed gastric emptying. However, H-M pyloroplasty destroys anti-reflux structure of pylorus and leads to serious bile reflux. Read More

Gastroenterology 2022 May 7. Epub 2022 May 7.

Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN.

Background And Aims: Studies with limited sample sizes have investigated association of chronic opioid use with motility disorders of esophagogastric junction and esophageal body peristalsis. Our aims were to use a large cohort of patients to assess: 1) the impact of opioid exposure on clinical and manometric characteristics and 2) the association of opioid exposure with higher long-term symptom burden.

Methods: Patients recruited from a tertiary medical center who underwent high-resolution manometry (HRM) between 2007 and 2018 were included. Read More

J Gastrointest Surg 2022 Apr 26. Epub 2022 Apr 26.

Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India.

Background: There is limited data on long-term outcomes of per-oral endoscopic myotomy (POEM). In this study, we aim to evaluate the efficacy of POEM in patients who completed a minimum follow-up of 5 years.

Methods: Data of patients who underwent POEM and completed ≥ 5-year follow-up were analyzed, retrospectively. Read More

Dis Esophagus 2022 Apr 25. Epub 2022 Apr 25.

Department of Surgery, Federal University of Sao Paulo, Escola Paulista de Medicina, Sao Paulo, Brazil.

Esophageal motility disorders (EMD) may be considered primary disorders only in the absence of gastroesophageal reflux disease (GERD). If GERD is present, treatment should be directed toward correction of the abnormal reflux. The actual prevalence of GERD in manometric dysmotility patterns according to the new Chicago Classification 4. Read More

Gastroenterol Hepatol (N Y) 2021 Oct;17(10):468-475

University of South Florida Morsani College of Medicine, Tampa, Florida.

High-resolution manometry (HRM) has revolutionized esophageal motility testing, and the evolving Chicago Classification has been critical in codifying HRM metrics and definitions of old and new motility disorders. The latest Chicago Classification (version 4.0) is the result of a working group of 52 members (10 women) from 20 countries. Read More

Ther Umsch 2022 Apr;79(3-4):133-140

Klinik für Allgemeinchirurgie, Viszeral-, Thorax-, Kinder- und Endokrine Chirurgie, Johannes Wesling Klinikum, Universitätsklinikum der Ruhr Universität Bochum, Minden, Deutschland.

Achalasia Update The neurodegenerative disease achalasia (obsolete: "cardiac spasm") is the second most common functional disease of the esophagus after reflux disease. It is associated with an extremely high level of suffering for the patient. Pathophysiologically, it is a combination of a lack of swallowing-reflex relaxation at the gastric entrance and disturbed peristalsis of the tubular esophagus. Read More

J Voice 2022 Apr 10. Epub 2022 Apr 10.

Department of Otolaryngology, Nepean Hospital, Kingswood, New South Wales, Australia; Department of Otolaryngology, Westmead Hospital, Westmead, New South Wales, Australia.

Background: Tracheoesophageal puncture (TEP) with voice prosthesis (VP) insertion is the gold standard of surgical voice restoration in postlaryngectomy patients. The conventional technique involves rigid esophagoscopes and trocar performed by ENT surgeons alone, with technical limitations encountered in patients with cervical abnormalities - in particular those with free or rotational flap reconstructions and postradiotherapy strictures. We report our technique using flexible endoscopy which we show to be feasible and without major safety events, as a possible consideration in the anticipated difficult TEP. Read More

Korean J Gastroenterol 2022 Feb;79(2):66-71

Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

The Chicago Classification is being revised continuously for the accurate diagnosis of esophageal peristaltic disorders in which the etiology is unclear, and the disease behavior is heterogeneous. The ver. 4. Read More

Gastroenterology 2022 05 25;162(6):1617-1634. Epub 2022 Feb 25.

Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center and Division of Gastroenterology, Nashville, Tennessee.

Dysphagia is a common symptom with significant impact on quality of life. Our diagnostic armamentarium was primarily limited to endoscopy and barium esophagram until the advent of manometric techniques in the 1970s, which provided the first reliable tool for assessment of esophageal motor function. Since that time, significant advances have been made over the last 3 decades in our understanding of various esophageal motility disorders due to improvement in diagnostics with high-resolution esophageal manometry. Read More

Expert Rev Gastroenterol Hepatol 2022 Mar 2;16(3):205-216. Epub 2022 Mar 2.

Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy.

Introduction: Investigations conducted using conventional manometry and, recently, using high-resolution manometry (HRM), allowed us to explore the field of esophageal motility and understand the potential link between motor features and gastroesophageal reflux disease (GERD) pathogenesis. The management of patients with nonachalasic esophageal motor disorders is often challenging, due to the clinical heterogeneous presentation and the multifactorial nature of the mechanisms underlying symptoms.

Areas Covered: Several studies, carried out using HRM, have better interpreted the esophageal motor function in patients with esophagogastric junction outflow obstruction (EGJOO), distal esophageal spasm (DES), hypertensive esophagus, and hypomotility disorders. Read More

Am J Physiol Gastrointest Liver Physiol 2022 May 16;322(5):G500-G512. Epub 2022 Feb 16.

Theoretical and Applied Mechanics Program, McCormick School of Engineering, Northwestern University, Evanston, Illinois.

We used in silico models to investigate the impact of the dimensions of myotomy, contraction pattern, the tone of the esophagogastric junction (EGJ), and musculature at the myotomy site on esophageal wall stresses potentially leading to the formation of a blown-out myotomy (BOM). We performed three sets of simulations with an in silico esophagus model, wherein the myotomy-influenced region was modeled as an elliptical section devoid of muscle fibers. These sets investigated the effects of the dimensions of myotomy, differing esophageal contraction types, and differing esophagogastric junction (EGJ) tone and wall stiffness at the myotomy affected region on esophageal wall stresses potentially leading to BOM. Read More

Esophagus 2022 Feb 8. Epub 2022 Feb 8.

Division of Gastroenterology-Hepatology, Department of Medicine, Albany Medical College, 1769 Union Street, 2nd Floor, Niskayuna, Albany, NY, 12309, USA.

Background: High-Resolution Manometry (HRM) with provocative maneuvers, such as Multiple Rapid Swallows (MRS) and Apple Viscous Swallows (AVS), is commonly utilized to diagnose esophageal disorders. Increasing standardization in HRM protocol can help save time and reduce patient discomfort. This study assesses AVS and MRS to determine their respective benefits and limitations. Read More

Curr Gastroenterol Rep 2022 Jan;24(1):10-17

Division of Gastroenterology, University of California, San Diego, ACTRI, Building 1W517, 9500 Gilman Drive MC 0956, La Jolla, CA, 92093, USA.

Purpose Of Review: Chicago Classification has standardized clinical approach to primary esophageal motility disorders. With new clinical data and advancing treatments, Chicago Classification has undergone multiple revisions to reflect updated findings and enhance diagnostic accuracy. This review will describe the recently published Chicago Classification version 4. Read More

Foregut (Thousand Oaks) 2021 Sep 20;1(3):207-215. Epub 2021 Aug 20.

Northwestern University, Feinberg School of Medicine, Department of Medicine, 676 St Clair Street, 14th floor, Chicago, Illinois 60611-2951, USA.

Chicago Classification version 4.0 (CC v4.0), published in 2021, presents several modifications largely aimed at minimizing over-diagnosis of inconclusive patterns on high-resolution manometry (HRM). Read More

Neurogastroenterol Motil 2022 Jan 24:e14321. Epub 2022 Jan 24.

Department of Medicine, Center for Esophageal Diseases, Baylor University Medical Center and Center for Esophageal Research, Baylor Scott & White Research Institute, Dallas, Texas, USA.

Background: Functional lumen imaging probe (FLIP) panometry can show spastic secondary contractile patterns of unclear significance in symptomatic patients who have no esophageal obstructive disorders, and no motility disorders on high-resolution manometry (HRM).

Methods: We retrospectively analyzed non-obstructed, symptomatic patients with HRM findings of no motility disorder or ineffective esophageal motility (IEM) for whom spastic secondary contractile patterns identified by FLIP panometry were used to guide treatment. Symptoms were scored using the Brief Esophageal Dysphagia Questionnaire (BEDQ). Read More

Dis Esophagus 2021 Dec 23. Epub 2021 Dec 23.

Digestive Diseases Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.

Geriatric patients with existing studies on the safety and efficacy of peroral endoscopic myotomy (POEM) for achalasia involve small sample sizes and single institutions. However, multi-center, large-scale data analyses are lacking. The study aimed to clarify the characteristics of geriatric patients with esophageal motility disorders (EMDs) and determine the procedure-related outcomes and clinical course following POEM. Read More

Clin Gastroenterol Hepatol 2021 Nov 9. Epub 2021 Nov 9.

Division of Gastroenterology and Hepatology, Department of Medicine, Chicago, Illinois.

Background & Aims: An association of eosinophilic esophagitis (EoE) with esophageal dysmotility has been described, however, the related mechanism remains unclear. We aimed to evaluate clinical and physiologic characteristics, including esophageal distensibility, associated with secondary peristalsis in patients with EoE.

Methods: A total of 199 consecutive adult patients with EoE (age, 18-78 y; 32% female) who completed a 16-cm functional luminal imaging probe (FLIP) during endoscopy were evaluated in a cross-sectional study. Read More

Gastroenterol Clin North Am 2021 12 6;50(4):885-903. Epub 2021 Oct 6.

Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8124, St Louis, MO 63110, USA. Electronic address:

Achalasia is the prototypical obstructive motor disorder diagnosed using HRM, but non-achalasia motor disorders are often identified in symptomatic patients. The clinical relevance of these disorders are assessed using ancillary HRM maneuvers (multiple rapid swallows, rapid drink challenge, solid swallows) that augment the standard supine HRM evaluation by challenging peristaltic function. Finding obstructive motor physiology in non-achalasia motor disorders may raise the option of invasive management akin to achalasia. Read More

J Clin Gastroenterol 2022 01;56(1):16-22

Department of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.

For more than a decade, per-oral endoscopic myotomy (POEM) has been performed for the treatment of achalasia and other dysmotilities of the esophagus. POEM has become an accepted alternative to Heller myotomy, a salvation technique for patients not responding to Heller myotomy and the favorite intervention for diffuse esophageal spasm and jackhammer esophagus. POEM paved the way for endoscopic pyloromyotomy, Zenker's diverticulum myotomy, and submucosal tunneling with endoscopic resection. Read More

J Neurogastroenterol Motil 2021 Oct;27(4):513-517

Department of Medicine and Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

High-resolution manometry permitted the creation of the Chicago classification, that is the categorization for esophageal motility disorders most currently used. Despite its wide acceptance, there are few pitfalls for the correct interpretation of the tests. This technique review illustrates some difficult cases that may lead to misinterpretation of the results. Read More

Neurogastroenterol Motil 2022 03 16;34(3):e14233. Epub 2021 Sep 16.

Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA.

Background And Aims: Chronic opioid effects on the esophagus are poorly understood. We investigated whether opioids were associated with increased prevalence of esophageal motility disorders.

Methods: A retrospective study of all patients undergoing high-resolution manometry (HREM) at the Yale Gastrointestinal Motility Lab between January 2014 and August 2019. Read More

Esophagus 2022 01 3;19(1):182-188. Epub 2021 Sep 3.

Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.

Background: With the development of high-resolution manometry (HRM) and peroral endoscopy, more patients with esophageal motility disorders (EMDs) including achalasia are diagnosed and treated. The characteristics of Japanese patients with EMDs are unknown and should be elucidated.

Methods: A large-scale database analysis was performed at seven high-volume centers in Japan. Read More

Surg Obes Relat Dis 2021 11 31;17(11):1884-1889. Epub 2021 Jul 31.

Harvard Medical School, Department of Surgery, Mount Auburn Hospital, Waltham, Massachusetts.

Background: Studies of patients who have undergone surgery while infected with COVID-19 have shown increased risks for adverse outcomes in both pulmonary complications and mortality. It has become clear that the risk of complications from perioperative COVID-19 infection must be weighed against the risk from delayed surgical treatment. Studies have also shown that prior bariatric surgery conveys protection against mortality from COVID-19 and that obesity is the biggest risk factor for mortality from COVID-19 infection in adults under 45 years of age. Read More

Neurogastroenterol Motil 2022 01 13;34(1):e14192. Epub 2021 Jun 13.

Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

Background And Aims: This study aimed to systematically evaluate a classification scheme of secondary peristalsis using functional luminal imaging probe (FLIP) panometry through comparison with primary peristalsis on high-resolution manometry (HRM).

Methods: 706 adult patients that completed FLIP and HRM for primary esophageal motility evaluation and 35 asymptomatic volunteers ("controls") were included. Secondary peristalsis, that is, contractile responses (CRs), was classified on FLIP panometry by the presence and pattern of contractility as normal (NCR), borderline (BCR), impaired/disordered (IDCR), absent (ACR), or spastic-reactive (SRCR). Read More

BMC Gastroenterol 2021 May 17;21(1):222. Epub 2021 May 17.

Division of Gastroenterology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, 2, Phayathai Road, Rajathewi, Bangkok, 10400, Thailand.

Background: Jackhammer esophagus is a rare esophageal motility disorder that can result in dysphagia, chest pain, and gastro-esophageal reflux symptoms. High-resolution manometry is the gold standard for diagnosis, while corkscrew esophagus on upper gastrointestinal endoscopy is an uncommon manifestation.

Case Presentation: 72-year-old man who presented with progressive dysphagia for three months without symptoms of chest pain or heartburn. Read More

ORL J Otorhinolaryngol Relat Spec 2021 5;83(5):304-309. Epub 2021 May 5.

ENT Section, Department of Medical, Surgical and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy.

Secondary aphonia significantly affects the quality of life of the laryngectomy patient despite the excellent success of the operation. Vocal rehabilitation often does not achieve the desired results, given the innumerable prognostic variables. Tracheo-oesophageal speech is considered the standard gold method of voice restoration, but a possible spasm of pharyngo-oesophageal segment is the prominent cause of rehabilitation failure. Read More

Exp Ther Med 2021 Jun 14;21(6):604. Epub 2021 Apr 14.

5th Clinical Department, Gastroenterology and Internal Medicine Discipline, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.

This prospective study aimed to determine the manometric pattern and the prevalence of esophageal dysmotility in 79 morbidly obese patients selected for laparoscopic sleeve gastrectomy. After clinical evaluation and upper gastrointestinal endoscopy, high-resolution esophageal manometry was performed. The esophageal peristalsis, lower esophageal sphincter (LES) basal pressure, and LES relaxation were evaluated. Read More

JSLS 2021 Jan-Mar;25(1)

Department of Surgery, University of Szeged, Albert Szent-Györgyi Health Center, Szeged, Hungary.

Introduction: We have analyzed the short- and long-term results of various surgical therapies for achalasia, especially changes in postoperative esophageal function.

Patients And Methods: Between January 1, 2008 and December 31, 2017, 54 patients with esophageal achalasia were treated in our institution. Patients scheduled for surgery underwent a comprehensive gastroenterological assessment pre- and post-surgery. Read More

Adv Ther 2021 05 27;38(5):2017-2026. Epub 2021 Mar 27.

Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Diogo de Faria 1087 cj 301, Sao Paulo, SP, 04037-003, Brazil.

The Chicago Classification is the most used classification for primary esophageal motility disorders (PEMD). This classification was recently updated to the 4.0 version. Read More

Surg Endosc 2022 02 17;36(2):1619-1626. Epub 2021 Mar 17.

Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Health Sciences Center, T19-053, Stony Brook Medicine, Stony Brook, NY, 11794-8191, USA.

Introduction: Achalasia is a debilitating primary esophageal motility disorder. Heller myotomy (HM) is a first-line therapy for the treatment of achalasia patients who have failed other modalities. Other indications for HM include diverticulum, diffuse esophageal spasm, and esophageal strictures. Read More