The Experts below are selected from a list of 411 Experts worldwide ranked by ideXlab platform
Daniel Sifrim - One of the best experts on this subject based on the ideXlab platform.
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esnm anms consensus paper diagnosis and management of refractory gastro esophageal reflux disease
Neurogastroenterology and Motility, 2021Co-Authors: Frank Zerbib, Albert J Bredenoord, Daniel Sifrim, Ronnie Fass, Peter J Kahrilas, Sabine Roman, Edoardo Savarino, Michael F Vaezi, Rena Yadlapati, Prakash C GyawaliAbstract:Up to 40% of patients with symptoms suspicious of gastroesophageal reflux disease (GERD) do not respond completely to proton pump inhibitor (PPI) therapy. The term "refractory GERD" has been used loosely in the literature. A distinction should be made between refractory symptoms (ie, symptoms may or may not be GERD-related), refractory GERD symptoms (ie, persisting symptoms in patients with proven GERD, regardless of relationship to ongoing reflux), and refractory GERD (ie, objective evidence of GERD despite adequate medical management). The present ESNM/ANMS consensus paper proposes use the term "refractory GERD symptoms" only in patients with persisting symptoms and previously proven GERD by either endoscopy or esophageal pH monitoring. Even in this context, symptoms may or may not be reflux related. Objective evaluation, including endoscopy and esophageal physiologic testing, is requisite to provide insights into mechanisms of symptom generation and evidence of true refractory GERD. Some patients may have true ongoing refractory acid or weakly acidic reflux despite PPIs, while others have no evidence of ongoing reflux, and yet others have functional esophageal disorders (overlapping with proven GERD confirmed off therapy). In this context, attention should also be paid to supragastric belching and Rumination Syndrome, which may be important contributors to refractory symptoms.
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High-resolution Manometry: Esophageal Disorders Not Addressed by the “Chicago Classification”
2016Co-Authors: Yu Tien Wang, Etsuro Yazaki, Daniel SifrimAbstract:The development of the high-resolution esophageal manometry (HRM) and the Chicago classification have improved the diag-nosis and management of esophageal motility disorders. However, some conditions have yet to be addressed by this classi-fication. This review describes findings in HRM which are not included in the current Chicago classification based on the expe-rience in our center. This includes the analysis of the upper esophageal sphincter, proximal esophagus, longitudinal muscle contraction, disorders related to gastroesophageal reflux disease and respiratory symptoms. The utility of provocative tests and the use of HRM in the evaluation of Rumination Syndrome and post-surgical patients will also be discussed. We believe that characterization of the manometric findings in these areas will eventually lead to incorporation of new criteria into the existing classification. (J Neurogastroenterol Motil 2012;18:365-372
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high resolution manometry esophageal disorders not addressed by the chicago classification
Journal of Neurogastroenterology and Motility, 2012Co-Authors: Yu Tien Wang, Etsuro Yazaki, Daniel SifrimAbstract:The development of the high-resolution esophageal manometry (HRM) and the Chicago classification have improved the diagnosis and management of esophageal motility disorders. However, some conditions have yet to be addressed by this classification. This review describes findings in HRM which are not included in the current Chicago classification based on the experience in our center. This includes the analysis of the upper esophageal sphincter, proximal esophagus, longitudinal muscle contraction, disorders related to gastroesophageal reflux disease and respiratory symptoms. The utility of provocative tests and the use of HRM in the evaluation of Rumination Syndrome and post-surgical patients will also be discussed. We believe that characterization of the manometric findings in these areas will eventually lead to incorporation of new criteria into the existing classification.
Magnus Halland - One of the best experts on this subject based on the ideXlab platform.
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baseline impedance measured during high resolution esophageal impedance manometry in patients with Rumination Syndrome is as abnormal as in patients with gerd
Journal of Clinical Gastroenterology, 2020Co-Authors: Magnus Halland, Nicholas J. Talley, David A Katzka, Karthik Ravi, Holly A Nelson, Michael D CrowellAbstract:Goals and Background:Baseline impedance measured during high-resolution impedance manometry (HRIM) can distinguish patients with gastroesophageal reflux disease (GERD) from controls, presumably due to differences in esophageal acid exposure. The characteristics of regurgitation and reflux in ruminat
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Rumination Syndrome pathophysiology diagnosis and treatment
Neurogastroenterology and Motility, 2017Co-Authors: Imad Absah, Nicholas J. Talley, David A Katzka, Abdul Rishi, Magnus HallandAbstract:Background Rumination Syndrome is a functional gastrointestinal disorder characterized by effortless and repetitive regurgitation of recently ingested food from the stomach to the oral cavity followed by either re-swallowing or spitting. Rumination is thought to occur due to a reversal of the esophagogastric pressure gradient. This is achieved by a coordinated abdominothoracic maneuver consisting of a thoracic suction, crural diaphragm relaxation and an increase in intragastric pressure. Careful history is important in the diagnosis of Rumination Syndrome; patients often report “vomiting” or “reflux” and the diagnosis can therefore be missed. Objective testing is available with high resolution manometry or gastroduodenal manometry. Increase in intra-gastric pressure followed by regurgitation is the most important characteristic to distinguish Rumination from other disorders such as gastroesophageal reflux. The mainstay of the treatment of Rumination Syndrome is behavioral therapy via diaphragmatic breathing in addition to patient education and reassurance. Purpose The purpose of this review was to critically appraise recent key developments in the pathophysiology, diagnosis and therapy for Rumination Syndrome. A literature search using OVID (Wolters Kluwer Health, New York, NY, USA) to examine the MEDLINE database its inception until May 2016 was performed using the search terms “Rumination Syndrome,” “biofeedback therapy,” and “regurgitation.” References lists and personal libraries of the authors were used to identify supplemental information. Articles published in English were reviewed in full text. English abstracts were reviewed for all other languages. Priority was given to evidence obtained from randomized controlled trials when possible.
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diaphragmatic breathing for Rumination Syndrome efficacy and mechanisms of action
Neurogastroenterology and Motility, 2016Co-Authors: Magnus Halland, Gopanandan Parthasarathy, Adil E Bharucha, David A KatzkaAbstract:Background While high resolution esophageal manometry combined with impedancometry has demonstrated that gastric pressurizations lead to Rumination, the contribution of upper esophageal sphincter (UES) and esophagogastric junction (EGJ) function to Rumination is unclear. Behavioral therapy with diaphragmatic breathing (DB) can reduce Rumination. We aimed to evaluate the pressures in the stomach, EGJ and UES during Rumination and the effects of DB augmented with biofeedback therapy. Methods Sixteen patients with Rumination were studied with manometry and impedancometry before and after a meal. The postprandial assessment comprised three periods: before, during, and after DB augmented with biofeedback therapy. Key results All patients had postprandial Rumination, which was associated (p Conclusions & inferences Diaphragmatic breathing aided with high resolution esophageal manometry is well-tolerated, effective and averts the gastroesophageal pressure disturbance that leads to Rumination.
Etsuro Yazaki - One of the best experts on this subject based on the ideXlab platform.
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Rumination Syndrome assessment of vagal tone during and after meals and during diaphragmatic breathing
Neurogastroenterology and Motility, 2020Co-Authors: Yoshimasa Hoshikawa, H Fitzke, Rami Sweis, Asma Fikree, Seth Saverymuttu, Sritharan S Kadirkamanathan, Katsuhiko Iwakiri, Etsuro YazakiAbstract:BACKGROUND: Pathophysiology of Rumination Syndrome (RS) is not well understood. Treatment with diaphragmatic breathing improves Rumination Syndrome. The aim of the study was to characterize vagal tone in patients with Rumination Syndrome during and after meals and during diaphragmatic breathing. METHODS: We prospectively recruited 10 healthy volunteers (HV) and 10 patients with RS. Subjects underwent measurement of vagal tone using heart rate variability. Vagal tone was measured during baseline, test meal and intervention (diaphragmatic (DiaB), slow deep (SlowDB), and normal breathing). Vagal tone was assessed using mean values of root mean square of successive differences (RMSSD), and area under curves (AUC) were calculated for each period. We compared baseline RMSSD, the AUC and meal-induced discomfort scores between HV and RS. Furthermore, we assessed the effect of respiratory exercises on symptom scores, and number of Rumination episodes. KEY RESULTS: There was no significant difference in baseline vagal tone between HV and RS. During the postprandial period, there was a trend to higher vagal tone in RS, but not significantly (P > .2 for all). RS had the higher total symptom scores than HV (P < .011). In RS, only DiaB decreased the number of Rumination episodes during the intervention period (P = .028), while both DiaB and SlowDB increased vagal tone (P < .05 for both). The symptom scores with the 3 breathing exercises showed very similar trends. CONCLUSIONS AND INFERENCES: Patients with RS do not have decreased vagal tone related to meals. DiaB reduced number of Rumination events by a mechanism not related to changes in vagal tone.
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High-resolution Manometry: Esophageal Disorders Not Addressed by the “Chicago Classification”
2016Co-Authors: Yu Tien Wang, Etsuro Yazaki, Daniel SifrimAbstract:The development of the high-resolution esophageal manometry (HRM) and the Chicago classification have improved the diag-nosis and management of esophageal motility disorders. However, some conditions have yet to be addressed by this classi-fication. This review describes findings in HRM which are not included in the current Chicago classification based on the expe-rience in our center. This includes the analysis of the upper esophageal sphincter, proximal esophagus, longitudinal muscle contraction, disorders related to gastroesophageal reflux disease and respiratory symptoms. The utility of provocative tests and the use of HRM in the evaluation of Rumination Syndrome and post-surgical patients will also be discussed. We believe that characterization of the manometric findings in these areas will eventually lead to incorporation of new criteria into the existing classification. (J Neurogastroenterol Motil 2012;18:365-372
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high resolution manometry esophageal disorders not addressed by the chicago classification
Journal of Neurogastroenterology and Motility, 2012Co-Authors: Yu Tien Wang, Etsuro Yazaki, Daniel SifrimAbstract:The development of the high-resolution esophageal manometry (HRM) and the Chicago classification have improved the diagnosis and management of esophageal motility disorders. However, some conditions have yet to be addressed by this classification. This review describes findings in HRM which are not included in the current Chicago classification based on the experience in our center. This includes the analysis of the upper esophageal sphincter, proximal esophagus, longitudinal muscle contraction, disorders related to gastroesophageal reflux disease and respiratory symptoms. The utility of provocative tests and the use of HRM in the evaluation of Rumination Syndrome and post-surgical patients will also be discussed. We believe that characterization of the manometric findings in these areas will eventually lead to incorporation of new criteria into the existing classification.
J Taminiau - One of the best experts on this subject based on the ideXlab platform.
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Childhood functional gastrointestinal disorders: Neonate/toddler
Gastroenterology, 2006Co-Authors: J TaminiauAbstract:Recognizing the importance of childhood functional gastrointestinal disorders in understanding adult functional gastrointestinal disorders, and encouraging clinical and research interest, the Rome Coordinating Committee added a pediatric working team to Rome II in 1999. For Rome III, there was an increase from 1 to 2 pediatric working teams. This report summarizes the current consensus concerning functional disorders in infants and toddlers. Another report covers disorders diagnosed more often in school-aged children and adolescents. The symptoms from functional gastrointestinal disorders in children younger than 5 years depend on maturational factors in anatomy, gastrointestinal physiology, and intellectual and affective functioning. There has been little or no change for infant regurgitation, infant Rumination Syndrome, or infant dyschezia. Cyclic vomiting Syndrome may be diagnosed after 2 rather than 3 episodes. The description of infant colic has been expanded, although there was consensus that infant colic does not reflect gastrointestinal malfunction. The greatest change was in functional constipation. Functional constipation and functional fecal retention in the 1999 report were merged into a single entity: functional constipation. Datadriven changes in diagnostic criteria for functional constipation appear to be less rigid and more inclusive than previous criteria
J A J M Taminiau - One of the best experts on this subject based on the ideXlab platform.
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childhood functional gastrointestinal disorders neonate toddler
Gastroenterology, 2006Co-Authors: Paul E Hyman, P J Milla, Marc A Benninga, Geoff Davidson, David F Fleisher, J A J M TaminiauAbstract:Recognizing the importance of childhood functional gastrointestinal disorders in understanding adult functional gastrointestinal disorders, and encouraging clinical and research interest, the Rome Coordinating Committee added a pediatric working team to Rome II in 1999. For Rome III, there was an increase from 1 to 2 pediatric working teams. This report summarizes the current consensus concerning functional disorders in infants and toddlers. Another report covers disorders diagnosed more often in school-aged children and adolescents. The symptoms from functional gastrointestinal disorders in children younger than 5 years depend on maturational factors in anatomy, gastrointestinal physiology, and intellectual and affective functioning. There has been little or no change for infant regurgitation, infant Rumination Syndrome, or infant dyschezia. Cyclic vomiting Syndrome may be diagnosed after 2 rather than 3 episodes. The description of infant colic has been expanded, although there was consensus that infant colic does not reflect gastrointestinal malfunction. The greatest change was in functional constipation. Functional constipation and functional fecal retention in the 1999 report were merged into a single entity: functional constipation. Data-driven changes in diagnostic criteria for functional constipation appear to be less rigid and more inclusive than previous criteria.
