A Research Agenda for Helminth Diseases of Humans: Basic Research and Enabling Technologies to Support Control and Elimination of Helminthiases

Successful and sustainable intervention against human helminthiases depends on optimal utilisation of available control measures and development of new tools and strategies, as well as an understanding of the evolutionary implications of prolonged intervention on parasite populations and those of their hosts and vectors. This will depend largely on updated knowledge of relevant and fundamental parasite biology. There is a need, therefore, to exploit and apply new knowledge and techniques in order to make significant and novel gains in combating helminthiases and supporting the sustainability of current and successful mass drug administration (MDA) programmes. Among the fields of basic research that are likely to yield improved control tools, the Disease Reference Group on Helminth Infections (DRG4) has identified four broad areas that stand out as central to the development of the next generation of helminth control measures: 1) parasite genetics, genomics, and functional genomics; 2) parasite immunology; 3) (vertebrate) host–parasite interactions and immunopathology; and 4) (invertebrate) host–parasite interactions and transmission biology. The DRG4 was established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR). The Group was given the mandate to undertake a comprehensive review of recent advances in helminthiases research in order to identify notable gaps and highlight priority areas. This paper summarises recent advances and discusses challenges in the investigation of the fundamental biology of those helminth parasites under the DRG4 Group's remit according to the identified priorities, and presents a research and development agenda for basic parasite research and enabling technologies that will help support control and elimination efforts against human helminthiases

Physiologic and pathologic belching

Accumulation of air in the stomach increases gastric volume, which activates receptors in the gastric wall. A reflex is initiated, leading to relaxation of the lower esophageal sphincter, upward movement of the air through the esophagus, and finally passage through the upper esophageal sphincter, during which an audible belch can sometimes be heard. Excessive belching is often reported in patients with gastroesophageal reflux disease and functional dyspepsia. Often other symptoms are predominant, and these should be treated first. Sometimes patients present with excessive belching as an isolated symptom. These patients belch in very high frequencies, up to 20 times per minute, and often during consultation. This condition is referred to as aerophagia. In these patients air is sucked into the esophagus or injected by pharyngeal contraction, after which it is expelled immediately. Aerophagia is a behavioral disorder, and behavioral therapy and/or speech therapy seems to be the therapy of choic

Advances in motility testing--current and novel approaches

Disorders of gastrointestinal motility are frequently seen in clinical practice. Apart from motility disorders, factors leading to lowered visceroperception thresholds are recognized as commonly involved in the pathogenesis of functional gastrointestinal disorders. The wide array of gastrointestinal motility and viscerosensitivity tests available is in contrast with the relatively limited number of tests used universally in clinical practice. The main reason for this discrepancy is that the outcome of a test only becomes truly important when it carries clinical consequences. The main goal of this Review is to assess the place of the presently available gastrointestinal motility and sensitivity tests in the clinical armamentarium of the gastroenterologis

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The rumination syndrome is a behavioral condition characterized by postprandial regurgitation. In contrast to what many think, the disorder does not exclusively occur in mentally disabled patients or children but also in otherwise healthy adults. As symptoms of postprandial regurgitation are often mistaken for gastroesophageal reflux disease or vomiting, the rumination syndrome is an underappreciated condition. Rumination episodes are caused by an intragastric pressure increases which forces the gastric content into the esophagus and mouth and occurs during 3 distinct mechanisms: primary rumination, secondary rumination, and supragastric belch-associated rumination. Combined manometry-impedance can distinguish rumination from gastroesophageal reflux disease. Treatment of the rumination syndrome consists of a thorough explanation of the mechanisms underlying the rumination episodes and behavioral therapy. As behavioral therapy is a time-consuming and often expensive treatment, we propose that a clinical suspicion of the disorder is always confirmed by a manometry-impedance measuremen

Gastro-oesophageal reflux disease

Gastro-oesophageal reflux disease is one of the most common disorders of the gastrointestinal tract. Over past decades, considerable shifts in thinking about the disease have taken place. At a time when radiology was the only diagnostic test available, reflux disease was regarded as synonymous with hiatus hernia. After the advent of the flexible endoscope, reflux disease was, for a period, equated to oesophagitis. The introduction of oesophageal pH monitoring made us believe that reflux disease could be defined by an abnormally high proportion of time with oesophageal pH less than 4. Moreover, the successive arrival of histamine-2-receptor antagonists and proton-pump inhibitors changed our idea of treatment for the disease, with swings from and towards surgery, endoscopic techniques, and alternative pharmaceutical option