A. Grigolon

A pneumatic dilation strategy in achalasia: prospective outcome and effects on oesophageal motor function in the long term

Aliment Pharmacol Ther 31, 658–665

Subcardial 24-h Wireless pH Monitoring in Gastroesophageal Reflux Disease Patients With and Without Hiatal Hernia Compared With Healthy Subjects

OBJECTIVES:After meals, highly acidic gastric juice is present in the subcardial region, the so-called acid pocket. Patients with gastroesophageal reflux disease (GERD) have a higher frequency of acidic reflux. Our aim was to investigate the possible differences in subcardial pH in GERD over 24 h and the role of hiatal hernia (HH), using a wireless capsule.METHODS:A total of 14 healthy volunteers (4 men, 24–60 years), 10 GERD patients without HH (4 men, 25–68 years), and 11 GERD patients with HH ≥3 cm (2 men, 46–74 years) underwent 24-h wireless pH monitoring 2 cm below the squamocolumnar junction. All patients had increased 24-h acid reflux. A standardized lunch was given to all study subjects.RESULTS:No capsule detached during the 24-h recording. Median 24-h pH was similar in healthy subjects, and in patients without and with HH, median: 1.4 (interquartile range: 1.2 –1.9), 1.5 (1.3 –1.7), and 1.4 (1.3 –1.7), respectively. Similar results were seen in the supine period. Median pH after the standardized meal was often highly acidic, 2.7 (1.5 – 3.2), 1.9 (1.6 – 2.3), and 2.5 (1.6 – 3.2), respectively. The first minute with a median pH <2 occurred 14 min (4 – 49), 14 min (6 – 25), and 20 min (4 – 43), respectively, P=NS, after the end of the meal. Similar data were observed on pooling all meals together.CONCLUSIONS:Subcardial pH is confirmed to be highly acidic early after meals, but it is similar over 24 h in healthy subjects and GERD patients independent of the presence of HH.

Esophageal Acid Exposure on Proton Pump Inhibitors in Unselected Asymptomatic Gastroesophageal Reflux Disease Patients

Background and Aim Efficacy of proton pump inhibitors (PPIs) on symptoms of gastroesophageal reflux (GER) is supposed to result from normalization of esophageal acid exposure; however, recent data in selected severe patients have challenged this concept. The aim of the study was to investigate 24-hour esophagogastric pH in unselected patients with GER disease in symptomatic remission during PPIs. Methods Thirty of the 31 consecutive patients with heartburn enrolled achieved adequate symptom control (≤1 heartburn episode/wk) on PPIs o.d. (n=22) or b.d. (n=8); 3 refused pH monitoring, thus 27 tracings were analyzed. Results Medians (Interquartile Range); Intragastric tracings showed a wide range of inhibition of acid secretion, 61.2% (49.7% to 80.2%) time at pH>4, nocturnal acid breakthrough being shorter (P=0.03) on PPIs b.d. compared with PPIs o.d., 125 minutes (90 to 247) versus 253 minutes (210 to 340). Esophageal acid exposure was 3.3% (1.4% to 7.9%) time at pH<4, 9 patients having increased exposure (ie, >5.5%), 7 of whom on PPIs o.d. Patients with increased acid GER on PPIs had a higher prevalence of esophagitis (67% vs. 22%, P<0.05) and hiatus hernia (78% vs. 39%, P<0.1) at endoscopy off PPIs. Conclusions One third of unselected patients with GER disease asymptomatic on PPIs have an increased esophageal acid exposure, especially if their PPI is administered o.d.

Computer simulator among experts involved in screening colonoscopy

Background In the era of screening colonoscopy, assessment of operator competence is warranted. Aim To evaluate feasibility of a computer simulator (CS) use for assessment of competence in colonoscopy by investigating performance of expert endoscopists at CS. Subjects Twenty expert endoscopists involved in screening colonoscopy. Methods Experts returned a questionnaire regarding personal practice (duration of activity, number of colonoscopies in the last year and assistance by a nurse) and performances (percentage of caecal intubation and polyp detection rate). One easy and one difficult colonoscopy were proposed at CS in randomized order. Results Participation rate was 75%. Caecal intubation rate in clinical practice was more than 90% for all experts. At CS, time to caecal intubation and number of attempts for ileal intubation were significantly lower during easy versus difficult colonoscopy (P<0.01 for both items); interestingly, percentage of mucosa explored was higher (P<0.05) during the difficult simulation. Withdrawal time ≥6 min was achieved by 40 and 33% of experts during the easy and difficult simulation, respectively. Independent of simulation difficulty, time with loop was lower (P<0.05) for experts using hands-free insertion (n = 8) compared with those using nurse assistance in their clinical practice (n = 7). No correlation was found between scores at CS and performance in clinical practice. Conclusion Scores at CS are sensitive to the rate of technical difficulty and nurse assistance during daily practice. Withdrawal time is often shorter than required for high accuracy in polyp detection. CS could be a well-accepted tool for assessment of competence.

Traditional vs wireless intragastric pH monitoring: are the two techniques comparable?

Background  Few data are available comparing intragastric pH measured with the traditional catheter‐based and the more recent wireless system (Bravo), and also comparing intraesophageal and intragastric pH during reflux events. Aims of our study were to elucidate these points.

Prolonged wireless pH monitoring: importance of how to analyse oesophageal acid exposure

To The Editor: Prolonged wireless pH monitoring is gaining acceptance as a reliable and well tolerated technique for detection of gastro-oesophageal reflux disease (GORD) [1,2]. It is presently unk...

Chest trauma and aetiology of achalasia

Achalasia is a motility disorder caused by neural dysfunction which may involve both the myenteric plexus of the oesophagus, the vagal nerves, and the dorsal motor nucleus.1,2 The aetiology of the disorder is still obscure, viral infection and autoimmunity having been suggested. Recently, Park and Vaezi1 proposed that different environmental factors in patients with genetic predisposition could lead to the same clinical picture and manometric findings. As part of an ongoing prospective study in patients with achalasia,3 we have investigated if chest trauma could be involved in the development of achalasia. Twenty consecutive achalasia patients (eight men), …