Evaluation of gastroesophageal reflux disease using the bravo capsule ph system

© 2016 The Korean Society of Neurogastroenterology and Motility. Gastroesophageal reflux disease (GERD) is a disease predominantly seen in the West but there is a rising trend in Asia. Ambulatory 24-hour catheter-based pH monitoring has been the de facto gold standard test for GERD that correlates symptoms with acid reflux episodes. However, drawbacks such as patients\u27 discomfort, and catheter displacement render the test as cumbersome and errorprone. The Bravo pH wireless system is designed to be user-friendly and has an added advantage of prolonged pH monitoring. The system is comparable to the catheter-based pH monitoring system in terms of diagnostic yield and symptom-reflux association. Indications include evaluation of patients with refractory GERD symptoms and prior to anti-reflux surgery. Bravo utilizes a wireless pH-sensing capsule with a complete prepackaged system, and a data processing software. The capsule may be positioned indirectly using endoscopic or manometric landmarks or under direct endoscopic guidance. Optimal threshold cut-offvalues are yet to be standardized but based on available studies, for the Asian population, it may be recommended for total % time pH \u3c 4 of 5.8 over 48 hours. Cost is a limitation but capsule placement is relatively safe although technical failures may be seen in small percentage of cases

Large Balloon Dilation versus Mechanical Lithotripsy for Large Bile Duct Stones: A Systematic Review & Meta-Analysis

Introduction: Common bile duct stone (CBDS) is a common disorder of the biliary tract and often necessitates intervention to prevent biliary complications. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and balloon stone extraction remain to be the standard treatment for CBDS. For large stones (\u3e12mm), removal may be challenging. After sphincterotomy, use of mechanical lithotripsy (ML) has been widely used for clearance of large stone in the last 3 decades. Large balloon dilatation (LBD) is also established as a highly successful method of removing CBDS. This present study aims to determine which procedure is more effective and safer in clearing common bile duct stones. Methodology: A literature search of randomized controlled trials (RCTs) comparing balloon dilatation and mechanical lithotripsy up to April 2020 in electronic databases including Cochrane Library, MEDLINE (PubMed), Google Scholar, Herdin.ph and Clinicaltrials.gov as well as hand-search of publications was done. Primary outcome was stone clearance rate. Secondary outcomes include overall complication rate and specific rates for pancreatitis, cholangitis, perforation and bleeding. Results: Three RCTs (enrolling 273 patients) met our inclusion criteria. No significant difference observed in stone clearance rate between the two groups (OR 1.44, 95% CI 0.68 to 3.87, P=0.34, moderate certainty). The overall complication rate was significantly higher in the ML group (RR 0.45, 95% CI 0.24 to 0.82, P=0.01, high certainty). Post-ERCP cholangitis did not occur in the LBD group. Six percent of the patients in the ML group developed cholangitis and was statistically significant (RR 0.11, 95% CI 0.01 to 0.86, P=0.04, high certainty). No difference in post-ERCP pancreatitis, perforation and bleeding observed. No significant heterogeneity was seen in the studies included. Conclusion: Balloon dilatation is a safer and effective alternative to mechanical lithotripsy in the removal of large common bile duct stones in terms of developing cholangitis. There was no difference in rate of pancreatitis, perforation and bleeding observed in both interventions. A higher risk of cholangitis is observed with the use of mechanical lithotripsy

Large balloon dilation vs. mechanical lithotripsy for the management of large bile duct stones: a prospective randomized study

Common bile duct stone (CBDS) is a common disorder of the biliary tract and often necessitates intervention to prevent biliary complications. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and balloon stone extraction remain to be the standard treatment for CBDS. For large stones (\u3e12mm), removal may be challenging. After sphincterotomy, use of mechanical lithotripsy (ML) has been widely used for clearance of large stone in the last 3 decades. Large balloon dilatation (LBD) is also established as a highly successful method of removing CBDS. This present study aims to determine which procedure is more effective and safer in clearing common bile duct stones

Randomised clinical trial: the effectiveness of Gaviscon Advance vs non-alginate antacid in suppression of acid pocket and post-prandial reflux in obese individuals after late-night supper

©2020 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd Background: Late-night supper increases the risk of postprandial reflux from the acid pocket especially in obesity. An alginate-based, raft-forming medication may be useful for obese patients with GERD. Aims: To compare the efficacy of Gaviscon Advance (Reckitt Benckiser, UK) and a non-alginate antacid in post-supper suppression of the acid pocket and post-prandial reflux among obese participants. Methods: Participants underwent 48 h wireless and probe-based pH-metry recording of the acid pocket and lower oesophagus, respectively, and were randomised to single post-supper (10 pm) dose of either Gaviscon Advance or a non-alginate antacid on the second night. Primary outcomes were suppression of median pH of acid pocket and lower oesophagus, measured every 10-minutes post-supper for 1 h. Secondary outcomes were suppression of % time pH \u3c 4 at lower oesophagus and improvement in frequency and visual analogue score (VAS) of regurgitation. Results: Of the 81 screened participants, 55 were excluded and 26 (mean age 33.5 years, males 77.8% and BMI 32.8 kg/m2) were randomised to Gaviscon Advance (n = 13) or antacid (n = 13). Median pH of the acid pocket but not the lower oesophagus was suppressed with Gaviscon Advance vs antacid (all P \u3c 0.04) Gaviscon Advance but not antacid significantly reduced in % time pH \u3c 4, symptom frequency and VAS on day 2 vs day 1 (all P \u3c 0.05). Conclusions: Among obese individuals, Gaviscon Advance was superior to a non-alginate antacid in post-supper suppression of the acid pocket. (Clinical trial registration unique identifier: NCT03516188)

Exposure to environmental microbiota explains persistent abdominal pain and irritable bowel syndrome after a major flood

Abstract Background After an environmental disaster, the affected community is at increased risk for persistent abdominal pain but mechanisms are unclear. Therefore, our study aimed to determine association between abdominal pain and poor water, sanitation and hygiene (WaSH) practices, and if small intestinal bacterial overgrowth (SIBO) and/or gut dysbiosis explain IBS, impaired quality of life (QOL), anxiety and/or depression after a major flood. Results New onset abdominal pain, IBS based on the Rome III criteria, WaSH practices, QOL, anxiety and/or depression, SIBO (hydrogen breath testing) and stools for metagenomic sequencing were assessed in flood victims. Of 211 participants, 37.9% (n = 80) had abdominal pain and 17% (n = 36) with IBS subtyped diarrhea and/or mixed type (n = 27 or 12.8%) being the most common. Poor WaSH practices and impaired quality of life during flood were significantly associated with IBS. Using linear discriminant analysis effect size method, gut dysbiosis was observed in those with anxiety (Bacteroidetes and Proteobacteria, effect size 4.8), abdominal pain (Fusobacteria, Staphylococcus, Megamonas and Plesiomonas, effect size 4.0) and IBS (Plesiomonas and Trabulsiella, effect size 3.0). Conclusion Disturbed gut microbiota because of environmentally-derived organisms may explain persistent abdominal pain and IBS after a major environmental disaster in the presence of poor WaSH practices