European Society for Neurogastroenterology and Motility Consensus on Gastroparesis: What Issues Remain Unresolved?

Aim: to analyse the document of the European Society for Neurogastroenterology and Motility consensus on gastroparesis, held in 2020.Key findings. The evaluation of the voting results on the submitted statements of the consensus meeting shows that there is a high level of agreement among the experts regarding the definition of gastroparesis, the main diseases in which it occurs, and the existing diagnostic methods. At the same time, there is a divergence of views regarding the role of individual pathogenetic factors of gastroparesis and their relationship with clinical symptoms, as well as the effectiveness of drugs of various groups and other treatment methods.Conclusion. The pathophysiological mechanisms of gastroparesis and the effectiveness of various treatment methods need further research

Efficacy of Topical Corticosteroid Monotherapy in Inducing and Maintaining Clinical and Histologic Remission in Adolescent and Adult Patients with Eosinophilic Esophagitis: a Systematic Review and Meta-Analysis

Background: Eosinophilic esophagitis (EoE) is the second most common cause of esophagitis. Topical steroids represent a promising group of drugs for inducing and maintaining clinical and histological remission in these patients.Objective. To evaluate the effectiveness of topical steroids in inducing and maintaining clinical and histological remission in adolescent and adult patients with EoE.Methods. A systematic literature search using defined keywords was performed up to March 20, 2021 in the MEDLINE / PubMed, EMBASE (Excerpta Medica), and Cochrane Central Register of Controlled Trials, ClinicalTrial.gov databases.Results. 390 patients from 5 studies were included in this systematic review with meta-analysis. The meta-analysis showed that topical steroids, compared with placebo, was more effective in inducing (odds ratio (OR) 75.77; 95 % confidence interval (CI): (21.8; 263.41), p < 0.001) and maintaining complete histological remission (OR 103.65; 95 % CI: (36.05; 298.01), p < 0.001) in patients with EoE. Also, topical steroids significantly relieved disease symptoms compared with placebo in inducing and maintaining clinical remission (OR 4.86; 95 % CI: (1.4; 16.86), p = 0.01) and (OR 11.06; 95 % CI: (4.62; 26.45), p < 0.001) respectively.Conclusions. Topical steroids represent an effective group of drugs for inducing and maintaining histologic and clinical remission in adolescent and adult patients with EoE

High resolution manometry and new classification of esophageal motility disorders

Purpose of the review. To present application of Chicago classification criteria of esophageal motility disorders defined in high resolution manometry in clinical practice. Basic provisions. High-resolution manometry is the most exact hi-tech diagnostic method for esophageal motor function disorders according to Chicago classification v3.0. Uniqueness of the method consists in capacity to define integrated quantitative and qualitative metrics of esophageal contractile function and to establish their specific disorders e.g.: change of intrabolus pressure at disorders of esophagogastric junction (EGj) outflow, hypercontractile esophagus, fragmented contractions and weak or failed peristalsis, distal esophageal spasm. Assessment of the type of achalasia subtypes has significant impact on the patients’ treatment choice. According to anatomical location of the lower esophageal sphincter and crural diaphragm several morphological types of gastro-esophageal junction are defined that determine severity of gastroesophageal reflux disease. Multiple rapid swallow responses during esophageal high-resolution manometry reflect esophageal body peristaltic reserve and is a predictor of postoperative complications. Differential diagnosis of belching type became possible at combined application of high-resolution manometry and impedance measurement. Conclusion. High-resolution manometry is a fundamental diagnostic test of esophageal motor function disorders. Clinical application of this method significantly expands diagnostic potential and allows to carry out personalized treatment that increases treatment quality

Macrophage phenotype after human refluxate exposure, esophageal dysmotility and their correlation with gastroesophageal reflux disease

Aim of the study. To investigate the esophageal dysmotility, changes in the esophageal mucosa and the immune response depending on the type of refluxate in gastroesophageal reflux disease (GERD) patients.Material and methods. 68 patients with GERD were recruited: 28 (14 men; mean age, 45.74 ± 2.23 years) nonerosive reflux disease (NERD), 22 (15 men; mean age, 45.0 ± 3.24 years) erosive reflux disease (EE), 18 (13 men; mean age, 47.22 ± 2.95) Barrett’s Esophagus (BE). GERD patients underwent esophageal high-resolution manometry (HRM) with a 22-channel water-perfused catheter and Solar GI system (Medical Measurements Systems, Enschede, the Netherlands), 24-hour impedance and pH monitoring using the Ohmega Ambulatory Impedance pH Recorder (Medical Measurements Systems). We analyzed receptor characteristics of monocyte-derived macrophages in all groups of patients.Results. On HRM examination, we showed that DCI (distal contractile integral) in NERD patients was higher than in EE (p = 0.088) and BE (p = 0.076), also LES RP (lower esophageal sphincter resting pressure) in NERD patients was higher than in EE (p = 0.039) and BE (p = 0.012). The analysis of reflux characteristics showed that the total reflux time with pH < 4 for BE patients was longer than that for NERD and EE patients. An analysis of receptor characteristics of monocyte-derived macrophages showed the prevalence of CD25 and CD80 expression in all groups of patients.Conclusion. An analysis of the phenotype of macrophages derived from blood monocytes of GERD patients revealed a prevalence of М1 macrophages that was typical for the Th1 type of immune response. The degree of esophageal dysmotility was correlated with GERD severity and type

Excessive Belching: a Separate Syndrome or Another Symptom of Functional Dyspepsia?

Aim of review. Interpretation of published evidence on the relationship between the excessive belching syndrome and functional dyspepsia (FD) and their management in patient care.Key points. According to the Rome IV criteria of functional gastrointestinal disorders (FGID), excessive belching in the absence of other dyspeptic symptoms is to be considered a manifestation of the excessive belching syndrome, which can be of gastric or supragastric nature. Combination of high-resolution manometry and impedancemetry allows an accurate diagnosis of belching and selection of optimal treatment strategy. Belching complicated by other symptoms of dyspepsia is to be considered yet another FD symptom according to the Rome IV criteria of FGID. Prokinetics are recommended to relieve belching in such cases.Conclusion. Understanding the relationship between the excessive belching syndrome and FD requires further research

High-resolution manometry in clinical practice: analysis of esophageal motor function according to Chicago classification

Aim of review. To analyze the basic esophageal pressure metrics according to Chicago classification v3.0, received at high-resolution manometry and to present the results of clinical application. Summary. Nowadays high-resolution manometry is the most exact hi-tech diagnostic method for esophageal motor function disorders. The changes identified during the investigation are systematized in the Chicago classification v3.0. This relatively new diagnostic method was introduced to clinical application in Russian Federation for the first time in 2011. Vasilenko clinic of internal diseases propedeutics, gastroenterology and hepatology (Sechenov University) accumulated significant experience of high-resolution esophageal manometry of overall 1150 studies. Uniqueness of the method consists in capacity to define integrated quantitative and qualitative metrics of esophageal contractile function and to establish their specific disorders e.g.: change of intrabolus pressure at disorders of esophagogastric junction (EGj) outflow, hypercontractile esophagus, fragmented contractions and weak or failed peristalsis, distal esophageal spasm. Assessment of the type of achalasia subtypes has significant impact on the patients’ treatment choice. Differential diagnosis of belching type, rumination, aerophagy became possible at combined application of high-resolution manometry and impedance measurement. According to anatomical location of the lower esophageal sphincter and crural diaphragm several morphological types of gastro-esophageal junction are defined that determine severity of gastroesophageal reflux disease. Additional provocative tests can be recommended prior to considering anti-reflux surgical treatment that will help to forecast the risk of complications. High-resolution manometry is indicated for patients presenting with dysphagia symptoms, noncoronary chest pain, gastroesophageal reflux disease and other disorders. Conclusion. High-resolution manometry is a fundamental diagnostic test of esophageal motor function disorders. Clinical application of this method significantly expands diagnostic potential and allows to carry out personalized treatment that increases treatment quality

Efficacy of Alginate-Antacid Medication in the Treatment of Patients with Gastroesophageal Reflux Disease

Aim. In this work, we aim to analyze the efficacy of treatment for heartburn and pathological gastroesophageal refluxes (GERs) using alginate-antacid medication. We assess the dynamics of inflammatory process in patients with gastroesophageal reflux disease (GERD) treated with alginate-antacid medication used at conventional dosage, both as a monotherapy and as part of a GERD combination therapy. To this end, we set out to confirm the formation of the layer of unbuffered acidic gastric juice over the gastric chyme after eating, as well as to determine the acidneutralizing effect of alginate-antacid medication upon its interaction with the acidic contents of the stomach.Materials and methods. 36 case records of GERD patients were analyzed (20 women and 16 men, mean age 47.03 years old). All patients were asked to report the heartburn intensity (according to a Likert scale) prior and during the treatment. They were subjected to esophagogastroduodenoscopy (EGD) and 24-hour pH impedance monitoring prior and on the 14th day of treatment. Before treatment, high-resolution esophageal manometry was performed to exclude the esophageal hiatal hernia (EHH) and to determine the upper and lower boundaries of the lower esophageal sphincter (LES). Group 1 included patients with non-erosive reflux disease (NERD), who were receiving monotherapy with alginate-antacid. Patients with the I-II degree of erosive esophagitis (EE) comprised groups 2 and 3, respectively, and were receiving proton pump inhibitor (PPI) monotherapy and PPI and alginate-antacid medication combination therapy, respectively. In group 1, 10 patients were examined using a probe pull-through technique with the purpose of determining pH levels in the cardiac stomach, in the area of the gastro-esophageal junction and in the esophagus at a level of 5 cm above the LES, both in the fasting state and after eating, as well as prior and after using alginate-antacid preparations. Results. On the third day of treatment, a complete heartburn relief was observed in 5 (41.6 %) patients of the NERD patient group (group 1), who were receiving a monotherapy with alginate-antacid medication. Heartburn relief was achieved in 3 EE (25 %) and 6 EE patients (50 %) following a PPI treatment course and a PPI and alginate-antacid medication treatment course, respectively. On the 5th day of treatment, heartburn was neutralized in 8 (66.7 %), 7 (58.3 %) and 9 (75 %) patients, with these numbers having risen to 10 (83.3 %), 9 (75 %) and 10 (83.3 %) patients (in the respective groups) on the 14th day. Before treatment, no significant differences in the heartburn intensity were identified between the groups. On the 3rd day of treatment, a significant difference was observed in the dynamics of heartburn intensity between groups 1 – 2 and 2 – 3 (p < 0.05), with this difference having disappeared by the 5th day. According to EGD in the NERD group, inflammation were eliminated in 10 (83.3 %) patients. In EE patients of the 2nd and 3rd groups, the healing of erosions was confirmed in 8 (66.7 %) and 10 (83.3 %) patients, respectively. In general, during the 24-hour pH impedance monitoring, pathological acid, weakly acid and non acid GERs were diagnosed in 28 (77.8 %), 15 (41.7 %) and 9 (25 %) patients, respectively. Under a course of alginate-antacid medication monotherapy, acid reflux was eliminated in 100 % of NERD patients. Among ERD patients undergoing PPI monotherapy, acidic GERs were eliminated in 9 (75 %) patients; however, the addition of alginate-antacid medication to a PPI treatment regimen allowed this result to be increased to 91.7 %. Weakly acid GERs were eliminated in 70 % and 33.3 % of patients in groups 1 and 2, respectively. In group 3, where patients were receiving a PPI and alginate-antacid medication combination treatment, weakly acid GERs were eliminated in 75 % of cases. Non acid refluxes were eliminated in groups 1 and 3 in 50 %, and in 2 – in 33.3 % of cases. When pulling the probe in the fasting state, a sharp change in pH values from acid (0.9–2 units) to weakly acid, and then non acid (5.5–7.6 units), was observed in 100 % of cases. After a meal and before the administration of alginate-antacid medication, the layer of unbuffered acidic gastric juice (pH < 2) was detected in the proximal stomach of 9 patients (90 %). After administration of alginate-antacid medication, the pH ranged from 6.1 to 7.7 units in 7 (70 %) patients, and increased to 4.2 units in 3 people (30 %).Conclusions. The inclusion of alginate-antacid medication into treatment schemes for managing ERD patients significantly increases its effectiveness, reliably increasing the rate of the onset of the clinical effect. alginate-antacid medication is shown to be an effective monotherapy for NERD. An important advantage of alginate-antacid medication in the treatment of GERD postprandial symptoms consists in its ability to neutralize and displace distally the layer of unbuffered acidic gastric juice, which forms above the chyme surface

Efficacy of Alginate-Antacid Medication in the Treatment of Patients with Gastroesophageal Reflux Disease

Aim. In this work, we aim to analyze the efficacy of treatment for heartburn and pathological gastroesophageal refluxes (GERs) using alginate-antacid medication. We assess the dynamics of inflammatory process in patients with gastroesophageal reflux disease (GERD) treated with alginate-antacid medication used at conventional dosage, both as a monotherapy and as part of a GERD combination therapy. To this end, we set out to confirm the formation of the layer of unbuffered acidic gastric juice over the gastric chyme after eating, as well as to determine the acidneutralizing effect of alginate-antacid medication upon its interaction with the acidic contents of the stomach.Materials and methods. 36 case records of GERD patients were analyzed (20 women and 16 men, mean age 47.03 years old). All patients were asked to report the heartburn intensity (according to a Likert scale) prior and during the treatment. They were subjected to esophagogastroduodenoscopy (EGD) and 24-hour pH impedance monitoring prior and on the 14th day of treatment. Before treatment, high-resolution esophageal manometry was performed to exclude the esophageal hiatal hernia (EHH) and to determine the upper and lower boundaries of the lower esophageal sphincter (LES). Group 1 included patients with non-erosive reflux disease (NERD), who were receiving monotherapy with alginate-antacid. Patients with the I-II degree of erosive esophagitis (EE) comprised groups 2 and 3, respectively, and were receiving proton pump inhibitor (PPI) monotherapy and PPI and alginate-antacid medication combination therapy, respectively. In group 1, 10 patients were examined using a probe pull-through technique with the purpose of determining pH levels in the cardiac stomach, in the area of the gastro-esophageal junction and in the esophagus at a level of 5 cm above the LES, both in the fasting state and after eating, as well as prior and after using alginate-antacid preparations. Results. On the third day of treatment, a complete heartburn relief was observed in 5 (41.6 %) patients of the NERD patient group (group 1), who were receiving a monotherapy with alginate-antacid medication. Heartburn relief was achieved in 3 EE (25 %) and 6 EE patients (50 %) following a PPI treatment course and a PPI and alginate-antacid medication treatment course, respectively. On the 5th day of treatment, heartburn was neutralized in 8 (66.7 %), 7 (58.3 %) and 9 (75 %) patients, with these numbers having risen to 10 (83.3 %), 9 (75 %) and 10 (83.3 %) patients (in the respective groups) on the 14th day. Before treatment, no significant differences in the heartburn intensity were identified between the groups. On the 3rd day of treatment, a significant difference was observed in the dynamics of heartburn intensity between groups 1 – 2 and 2 – 3 (p < 0.05), with this difference having disappeared by the 5th day. According to EGD in the NERD group, inflammation were eliminated in 10 (83.3 %) patients. In EE patients of the 2nd and 3rd groups, the healing of erosions was confirmed in 8 (66.7 %) and 10 (83.3 %) patients, respectively. In general, during the 24-hour pH impedance monitoring, pathological acid, weakly acid and non acid GERs were diagnosed in 28 (77.8 %), 15 (41.7 %) and 9 (25 %) patients, respectively. Under a course of alginate-antacid medication monotherapy, acid reflux was eliminated in 100 % of NERD patients. Among ERD patients undergoing PPI monotherapy, acidic GERs were eliminated in 9 (75 %) patients; however, the addition of alginate-antacid medication to a PPI treatment regimen allowed this result to be increased to 91.7 %. Weakly acid GERs were eliminated in 70 % and 33.3 % of patients in groups 1 and 2, respectively. In group 3, where patients were receiving a PPI and alginate-antacid medication combination treatment, weakly acid GERs were eliminated in 75 % of cases. Non acid refluxes were eliminated in groups 1 and 3 in 50 %, and in 2 – in 33.3 % of cases. When pulling the probe in the fasting state, a sharp change in pH values from acid (0.9–2 units) to weakly acid, and then non acid (5.5–7.6 units), was observed in 100 % of cases. After a meal and before the administration of alginate-antacid medication, the layer of unbuffered acidic gastric juice (pH < 2) was detected in the proximal stomach of 9 patients (90 %). After administration of alginate-antacid medication, the pH ranged from 6.1 to 7.7 units in 7 (70 %) patients, and increased to 4.2 units in 3 people (30 %).Conclusions. The inclusion of alginate-antacid medication into treatment schemes for managing ERD patients significantly increases its effectiveness, reliably increasing the rate of the onset of the clinical effect. alginate-antacid medication is shown to be an effective monotherapy for NERD. An important advantage of alginate-antacid medication in the treatment of GERD postprandial symptoms consists in its ability to neutralize and displace distally the layer of unbuffered acidic gastric juice, which forms above the chyme surface

Consensus Meeting of European Society of Neurogastroenterology and Motility on Functional Dyspepsia (2020): Have We Dotted All the I’s?

Aim. A review of the agreement issued by the European Society of Neurogastroenterology and Motility consensus meeting on functional dyspepsia in 2020.Key points. Expert votes at the consensus meeting generally confirmed the main statements of the Rome Criteria Revision IV on the definition of functional dyspepsia, its aetiology and pathogenesis, diagnosis and treatment, as well as those of the Kyoto Consensus covering the possible association of dyspeptic complaints with H. pylori infection. An absent consensus on certain statements, especially in drug efficacy evaluation, demonstrates insufficient knowledge of many issues in disease.Conclusion. Functional dyspepsia demands further investigation