Marcelo F. Vela

Maximal acid reflux control for Barrett’s oesophagus: feasible and effective

The treatment of patients with Barrett’s oesophagus is controversial. Debate exists regarding the use and value of high dose acid suppression as the standard of practice. Despite prolonged use of high dose proton pump inhibitors (40 mg omeprazole, 60 mg lansoprazole), most studies have shown no convincing evidence of significant regression of Barrett’s length. These studies, however, have used fixed doses of proton pump inhibitors and did not regularly document control of oesophageal acid exposure.

Vigorous achalasia: original description requires minor change.

Vigorous achalasia was described in 1957 as a subset of achalasia with a higher contraction amplitude (>37 mm Hg), minimal esophageal dilatation, prominent tertiary contractions, and higher incidence of chest pain. Goals Ascertain the existence of a distinct achalasia group based on manometric, radiographic, and clinical grounds. Study The records of 209 idiopathic achalasia patients seen over a 9-year interval were reviewed for duration and frequency of dysphagia, chest pain, heartburn, weight loss, and nocturnal symptoms, as well as for treatment outcome. Manometric tracings were reanalyzed for lower esophageal sphincter pressure (LESP), LES residual pressure, distal esophageal contraction amplitude, and presence of repetitive waves. Patients were subsequently divided into classic (amplitude ≤37 mm Hg) and vigorous (amplitude >37 mm Hg) achalasia groups. Esophagrams were reassessed blindly for esophageal diameter both in the upright and recumbent positions and presence of lumen-occlusive tertiary contractions. Results One hundred forty-four classic and 65 vigorous achalasia patients were identified. These groups were similar in age and gender, as well as duration of symptoms. Chest pain was equally prevalent in both groups. Lower esophageal sphincter pressure was higher (p < 0.01) and repetitive waves more common (p < 0.0001) in the vigorous achalasia group. Upright esophageal diameter was smaller (p = 0.0003) and tertiary contractions more frequent (p = 0.0004) in this group. Conclusion The original manometric and radiographic description of vigorous achalasia is accurate. The incidence of chest pain is similar to that of patients with classic achalasia.

Prior botulinum toxin injection may compromise outcome of pneumatic dilatation in achalasia

Prior botulinum toxin injection may compromise outcome of pneumatic dilatation in achalasia

Esophageal function in normal subjects and patients with either scleroderma (SCL) or ineffective esophageal motility (IEM) assessed through multichannel intraluminal impedance (MII)

Esophageal function in normal subjects and patients with either scleroderma (SCL) or ineffective esophageal motility (IEM) assessed through multichannel intraluminal impedance (MII)

Delta pH (1 or 2 units) is not associated with symptoms in nonacid reflux: a study using combined multichannel intraluminal impedance and pH (MII/pH)

Delta pH (1 or 2 units) is not associated with symptoms in nonacid reflux: a study using combined multichannel intraluminal impedance and pH (MII/pH)