The Experts below are selected from a list of 3324 Experts worldwide ranked by ideXlab platform

Joel E. Richter - One of the best experts on this subject based on the ideXlab platform.

  • Chest Pain of EsopHageal Origin and Reflux Hypersensitivity
    Gastrointestinal Motility Disorders, 2018
    Co-Authors: Wojciech Blonski, Joel E. Richter
    Abstract:

    The prevalence of non-cardiac chest pain in general population has been estimated as 13%. Non-cardiac chest pain might be caused by either acid reflux, EsopHageal motility disorders, eosinopHilic esopHagitis or visceral hypersensitivity (functional chest pain). After a cardiac cause of chest pain has been excluded, a short-term trial with proton pomp inhibitor (PPI) is the most cost-effective method for assessing whether non-cardiac chest pain is due to acid reflux. Upper endoscopy with biopsies of the esopHagus are recommended to exclude erosive or eosinopHilic esopHagitis as possible causes of chest pain. In patients with persistent chest pain despite short-term PPIs trial the next step is to perform 24-h distal EsopHageal pH Monitoring or 48-h wireless distal EsopHageal pH Monitoring off PPI therapy to provide objective evidence whether acid reflux is present. After excluding acid reflux, the next step is to perform EsopHageal manometry to determine whether a major EsopHageal motility abnormality may be causing the chest pain such as achalasia, esopHagogastric junction outflow obstruction, jackhammer esopHagus, diffuse EsopHageal spasm, or absent peristalsis. After exclusion of acid reflux, eosinopHilic esopHagitis, or EsopHageal motility abnormality, the diagnosis of non-cardiac chest pain due to visceral hypersensitivity (functional chest pain) can be made. Treatment options of functional chest pain include theopHylline, low-dose antidepressants (imipramine, trazodone, sertraline, or venlafaxine), or psychological interventions such as cognitive behavioral therapy or hypnotherapy.This chapter discusses the epidemiology, pathopHysiology, diagnosis, and management of non-cardiac chest pain.

  • ambulatory EsopHageal pH Monitoring using a wireless system
    The American Journal of Gastroenterology, 2003
    Co-Authors: John E Pandolfino, Joel E. Richter, Tina M Ours, Jason M Guardino, Jennifer Chapman, Peter J Kahrilas
    Abstract:

    Abstract Objectives Limitations of catheter-based EsopHageal pH Monitoring are discomfort, inconvenience, and interference with normal activity. An alternative to conventional pH Monitoring is the wireless Medtronic Bravo pH System. The aim of this study was to evaluate the safety, performance, and tolerability of this system. Methods A total of 44 healthy subjects and 41 patients with gastroEsopHageal reflux disease (GERD) were studied for a 2-day period. The pH telemetry capsule was positioned transorally 6 cm above the squamocolumnar junction using endoscopic measurement. The signal transmitted from the capsule was received and recorded by a small, pager-sized receiver, and pH data were subsequently uploaded to a computer for analysis. Results Successful 24-h pH studies were completed in 82 subjects (96%). During the 24-h study period the median percentage of the time that pH was Conclusion The wireless Bravo pH System successfully recorded EsopHageal acid exposure in 96% of the patients during a 24-h period and in 89% of subjects for >36 h. The 95th percentile for the 2-day recordings in control subjects was 5.3%, slightly higher than observed with conventional systems.

  • ambulatory EsopHageal pH Monitoring
    The American Journal of Medicine, 1997
    Co-Authors: Joel E. Richter
    Abstract:

    ExtraEsopHageal manifestations of gastroEsopHageal reflux may be best diagnosed using ambulatory EsopHageal pH Monitoring. This test involves the placemenmt of a thin pH probe in the esopHagus, which is connected to a small box on a waistbelt. Studies are done in an ambulatory state in the patient's home and work environment. Data collected assesses acid exposure time over the circadian cycle and the relationship of symptoms to pH drops. Studies in adult asthmatics demonstrate abnormal amounts of acid reflux by 24-hour EsopHageal pH Monitoring in >50% of patients. Likewise, large studies in patients with chronic ENT complaints find abnormal acid reflux values in 50-80% of patients. Several problems and issues with ambulatory pH Monitoring still need addressing, including (1) the need for dual pH Monitoring, (2) artifact and reproducibility, (3) normal values, (4) role in the initial diagnosis, and (5) role in the follow-up of poorly responding patients.

  • reproducibility of proximal probe pH parameters in 24 hour ambulatory EsopHageal pH Monitoring
    The American Journal of Gastroenterology, 1997
    Co-Authors: Michael F Vaezi, P L Schroeder, Joel E. Richter
    Abstract:

    OBJECTIVES To assess the reproducibility and reliability of the proximal pH probe in detecting acid reflux into the proximal esopHagus. METHODS Using dual probe ambulatory EsopHageal pH Monitoring, we studied 32 subjects (11 healthy control subjects, 10 patients with distal EsopHageal acid reflux, and 11 patients with both distal and proximal EsopHageal acid exposure) on two separate days within a 20-day period. The distal pH probe was placed 5 cm above the manometrically determined lower EsopHageal spHincter, and the proximal probe was positioned immediately distal to the upper EsopHageal spHincter. Patients were categorized on the basis of the EsopHageal pH data obtained during the first study. Reflux parameters assessed were the percentages of time in which pH was <4 in the total, upright, and supine positions. To be considered reproducible, all three of the above parameters had to remain in the same category as the first day's results. RESULTS Intrasubject reproducibility of the proximal probe was 91-100% in healthy subjects, 70-90% in patients with distal EsopHageal acid reflux, and 45-73% in patients with proximal EsopHageal acid reflux. The proximal probe reproducibility for the overall diagnosis of gastroEsopHageal reflux disease was 91% in healthy subjects, 70% in patients with distal EsopHageal acid reflux, and only 55% in those with proximal EsopHageal acid reflux. Statistical analysis demonstrated only a fair index of concordance (kappa = 0.40) for the proximal probe. CONCLUSIONS The proximal pH probe has excellent specificity (91%) but poorer sensitivity and reproducibility (55%) for identifying abnormal amounts of proximal EsopHageal acid reflux. Therefore, a negative test result does not exclude proximal reflux with microaspiration as a cause of atypical reflux symptoms.

  • twenty four hour ambulatory EsopHageal pH Monitoring in the diagnosis of acid reflux related chronic cough
    Southern Medical Journal, 1997
    Co-Authors: Michael F Vaezi, Joel E. Richter
    Abstract:

    ABSTRACT:To define the role of ambulatory pH Monitoring in evaluating chronic cough, we studied EsopHageal pH values of patients referred to a gastroenterology laboratory. Chronic cough was evaluated in 31 patients, who were grouped based on response to treatments; 11 patients (35.5%) had gastroesop

Stefan Oberg - One of the best experts on this subject based on the ideXlab platform.

Tom R. Demeester - One of the best experts on this subject based on the ideXlab platform.

  • proximal EsopHageal pH Monitoring improved definition of normal values and determination of a composite pH score
    Journal of The American College of Surgeons, 2010
    Co-Authors: Shahin Ayazi, Arzu Oezcelik, Emmanuele Abate, Jeffrey A. Hagen, Steven R. Demeester, John C. Lipham, Joerg Zehetner, Geoffrey P Kohn, Helen J Sohn, Tom R. Demeester
    Abstract:

    Background Patients with respiratory and laryngeal symptoms are commonly referred for evaluation of reflux disease as a potential cause. Dual-probe pH Monitoring is often performed, although data on normal acid exposure in the proximal esopHagus are limited because of the small number of normal subjects and inconsistent placement of the proximal pH sensor in relation to the upper EsopHageal spHincter. We measured proximal EsopHageal acid exposure using dual-probe pH and calculated a composite pH score in a large number of asymptomatic volunteers to better define normal values. Study Design Eighty-one normal subjects free of reflux, laryngeal, or respiratory symptoms were recruited. All had video esopHagrapHy to exclude hiatal hernia. EsopHageal pH Monitoring was performed using 1 of 3 different dual-probe catheters with sensors spaced 10, 15, or 18 cm apart. The standard components of EsopHageal acid exposure were measured, excluding meal periods. A composite pH score for the proximal esopHagus was calculated using these components. Results The final study population consisted of 59 (49% male) subjects, with a median age of 27 years. All had normal distal EsopHageal acid exposure and no hiatal hernia. The 95 th percentile values for the percent time the pH was th percentile for the number of reflux episodes was 24 and for the calculated proximal EsopHageal composite pH score was 16.4. Conclusions In a large population of normal subjects, we have defined the normal values and calculated a composite pH score for proximal EsopHageal acid exposure. The total percent time pH

  • Hiatal Hernia, Lower EsopHageal SpHincter Incompetence, and Effectiveness of Nissen Fundoplication in the Spectrum of GastroEsopHageal Reflux Disease
    Journal of Gastrointestinal Surgery, 2009
    Co-Authors: Reginald V. N. Lord, Jeffrey A. Hagen, Steven R. Demeester, Jeffrey H. Peters, Dino Elyssnia, Corinne T. Sheth, Tom R. Demeester
    Abstract:

    Background and Aims GastroEsopHageal reflux disease (GERD) is a spectrum of disease that includes nonerosive reflux disease (NERD), erosive reflux disease (ERD), and Barrett’s esopHagus (BE). Treatment outcomes for patients with different stages have differed in many studies. In particular, acid suppressant medication therapy is reported to be less effective for treating patients with NERD and Barrett’s esopHagus. The aims of this study were to investigate (1) the role of mechanical factors including hiatal hernia and lower EsopHageal spHincter (LES) competence in the spectrum of GERD and (2) outcomes of Nissen fundoplication. Methods From the records of patients who had undergone laparoscopic Nissen fundoplication after an abnormal pH study, we identified 50 symptomatic consecutive patients with each of the GERD stages: (1) NERD, (2) mild ERD, defined as esopHagitis that was healed with acid suppression therapy, (3) severe ERD, defined as esopHagitis that persisted despite medical therapy, and (4) BE. Exclusion criteria were normal distal EsopHageal acid exposure, EsopHageal pH Monitoring performed elsewhere, antireflux surgery less than 1 year previously or previous fundoplication, and a named EsopHageal motility disorder or distal EsopHageal low amplitude hypomotility. Patients who could not be contacted for the study were also excluded. All patients completed a detailed preoperative questionnaire; underwent preoperative upper gastrointestinal endoscopy, stationary manometry, and distal EsopHageal pH Monitoring; and were interviewed at least 1 year after operation. Results One hundred sixty patients meeting the entry criteria were studied. The mean follow-up period was 36.7 months. The only significant preoperative symptom difference was that patients with BE had more moderately severe or severe dyspHagia compared to patients with NERD. Patients with severe ERD or BE had a significantly higher prevalence of hiatal hernia, lower LES pressures, and more EsopHageal acid exposure. Hiatal hernia and hypotensive LES were present in most patients with severe ERD or BE but in only a minority of patients with NERD or mild ERD. Surgical therapy resulted in similarly excellent symptom outcomes for patients in all GERD categories. Conclusions Compared to mild ERD and NERD, severe ERD and BE are associated with significantly greater loss of the mechanical antireflux barrier as reflected in the presence of hiatal hernia and LES measurements. Restoration of the antireflux barrier and hernia reduction by laparoscopic Nissen fundoplication provides similarly excellent symptom control in all patients.

  • Measurement of gastric pH in ambulatory EsopHageal pH Monitoring
    Surgical Endoscopy and Other Interventional Techniques, 2008
    Co-Authors: Shahin Ayazi, Jessica M. Leers, Arzu Oezcelik, Emmanuele Abate, Christian G. Peyre, Jeffrey A. Hagen, Steven R. Demeester, Farzaneh Banki, John C. Lipham, Tom R. Demeester
    Abstract:

    Background Ambulatory EsopHageal pH Monitoring is the method used most widely to quantify gastroEsopHageal reflux. The degree of gastroEsopHageal reflux may potentially be underestimated if the resting gastric pH is high. Normal subjects and symptomatic patients undergoing 24-h pH Monitoring were studied to determine whether a relationship exists between resting gastric pH and the degree of EsopHageal acid exposure.

  • ambulatory 24 hour EsopHageal pH Monitoring why when and what to do
    Journal of Clinical Gastroenterology, 2003
    Co-Authors: Christopher G Streets, Tom R. Demeester
    Abstract:

    The incidence of gastroEsopHageal reflux disease (GERD) is increasing and if left untreated can lead to significant patient morbidity and even death. The disease results from the abnormal reflux of gastric contents into the distal esopHagus causing symptoms in most and subsequent mucosal damage in some. Several investigations can be used to confirm the diagnosis, but most are dependent on the presence of sequelae and complications of the disease. The pHysiologic test of ambulatory 24-hour EsopHageal pH Monitoring has proved to be the most sensitive and specific diagnostic investigation. It measures increased EsopHageal exposure to gastric juice by detecting the concentration of hydrogen ions (pH <4) in the distal esopHagus. The technique measures gastric juice exposure at a point 5 cm above the manometrically determined upper border of the lower EsopHageal spHincter. The exposure is measured in components of frequency of reflux episodes, duration of reflux episodes, and accumulated exposure time. The components are integrated into a composite score, which is reproducible, gender and race independent, and correlates with the degree of EsopHageal epithelial damage determined histologically. The composite score has been shown to be the most reliable measurement of a therapeutic acid suppression regimen or an effective antireflux operation.

  • ambulatory 24 hour EsopHageal pH Monitoring
    2003
    Co-Authors: Christopher G Streets, Tom R. Demeester
    Abstract:

    The incidence of gastroEsopHageal reflux disease (GERD) is increasing and if left untreated can lead to significant patient morbidity and even death. The disease results from the abnormal reflux of gastric contents into the distal esopHagus causing symptoms in most and subsequent mucosal damage in some. Several investigations can be used to confirm the diagnosis, but most are dependent on the presence of sequelae and complications of the disease. The pHysiologic test of ambulatory 24-hour EsopHageal pH Monitoring has proved to be the most sensitive and specific diagnostic investigation. It measures increased EsopHageal exposure to gastric juice by detecting the concentration of hydrogen ions (pH <4) in the distal esopHagus. The technique measures gastric juice exposure at a point 5 cm above the manometrically determined upper border of the lower EsopHageal spHincter. The exposure is measured in components of frequency of reflux episodes, duration of reflux episodes, and accumulated exposure time. The components are integrated into a composite score, which is reproducible, gender and race independent, and correlates with the degree of EsopHageal epithelial damage determined histologically. The composite score has been shown to be the most reliable measurement of a therapeutic acid suppression regimen or an effective antireflux operation.

Rasa Zarnegar - One of the best experts on this subject based on the ideXlab platform.

  • bravo EsopHageal pH Monitoring more cost effective than empiric medical therapy for suspected gastroEsopHageal reflux
    Surgical Endoscopy and Other Interventional Techniques, 2016
    Co-Authors: Cheguevara Afaneh, David A Kleiman, Carl V Crawford, Thomas J Fahey, Veronica Zoghbi, Brendan M Finnerty, Anna Aronova, Thomas Ciecierega, Rasa Zarnegar
    Abstract:

    Introduction Early referral for catheter-based EsopHageal pH Monitoring is more cost-effective than empiric proton-pump inhibitor (PPI) therapy to diagnose gastroEsopHageal reflux disease (GERD). We hypothesize that BRAVO wireless pH Monitoring will also demonstrate substantial cost-savings compared to empiric PPI therapy, given its superior sensitivity and comfort.

  • early referral for EsopHageal pH Monitoring is more cost effective than prolonged empiric trials of proton pump inhibitors for suspected gastroEsopHageal reflux disease
    Journal of Gastrointestinal Surgery, 2014
    Co-Authors: David A Kleiman, Toni Beninato, Carl V Crawford, Thomas J Fahey, Rasa Zarnegar, Thomas Ciecierega, Brian P Bosworth, Laurent Brunaud, Brian G Turner
    Abstract:

    Introduction The most cost-effective diagnostic algorithm for gastroEsopHageal reflux disease (GERD) remains controversial. We hypothesized that prompt referral for EsopHageal pH Monitoring is more cost-effective than prolonged empiric courses of proton-pump inhibitors (PPIs).

  • Early Referral for EsopHageal pH Monitoring Is More Cost-Effective Than Prolonged Empiric Trials of Proton-Pump Inhibitors for Suspected GastroEsopHageal Reflux Disease
    Journal of Gastrointestinal Surgery, 2014
    Co-Authors: David Kleiman, Toni Beninato, Thomas Ciecierega, Laurent Brunaud, Brian Bosworth, Carl Crawford, Brian Turner, Thomas Fahey, Rasa Zarnegar
    Abstract:

    INTRODUCTION: The most cost-effective diagnostic algorithm for gastroEsopHageal reflux disease (GERD) remains controversial. We hypothesized that prompt referral for EsopHageal pH Monitoring is more cost-effective than prolonged empiric courses of proton-pump inhibitors (PPIs). DISCUSSION: A cost model was created based on a cohort of 100 patients with possible GERD who underwent pH Monitoring. The additional costs incurred from pH Monitoring were compared to the potential savings from avoiding unnecessary PPI usage in patients with a negative pH study. The costs of PPI therapy reach equivalence with pH Monitoring after 6.4 to 23.7 weeks, depending on the PPI regimen. A total of 21,411 weeks of PPIs were prescribed beyond the recommended 8-week trial, of which 32 % were for patients who had a negative 24-h pH Monitoring study. If the sensitivity of pH Monitoring was 96 %, early referral for pH Monitoring would have saved between $1,197 and $6,303 per patient over 10 years. This strategy remains cost-effective as long as the sensitivity of pH Monitoring is above 35 %. Prompt referral for pH Monitoring after a brief empiric PPI trial is a more cost-effective strategy than prolonged empiric PPI trials for patients with both EsopHageal and extraEsopHageal GERD symptoms.

  • early referral for 24 h EsopHageal pH Monitoring may prevent unnecessary treatment with acid reducing medications
    Surgical Endoscopy and Other Interventional Techniques, 2013
    Co-Authors: David A Kleiman, Matthew J Sporn, Toni Beninato, Yasmin Metz, Carl V Crawford, Thomas J Fahey, Rasa Zarnegar
    Abstract:

    Background GastroEsopHageal reflux disease (GERD) affects nearly 25 % of adults; however, an objective diagnosis is rarely established. We hypothesized that patients’ symptoms and response to acid-reducing therapy are poor predictors of the outcome of 24-h EsopHageal pH Monitoring.

Jorgen Wenner - One of the best experts on this subject based on the ideXlab platform.