Philip B. Miner

Antisense inhibition of ICAM-1 expression as therapy provides insight into basic inflammatory pathways through early experiences in IBD

Background: Alicaforsen (ISIS 2302), an antisense to intercellular adhesion molecule-1 (ICAM-1) (CD54), was designed to inhibit ICAM-1 expression. ICAM-1 seems to play a role in cell-mediated inflammation, specifically cell trafficking. For this reason, it may be useful in a variety of immune-mediated diseases, including inflammatory bowel disease. Objective: To evaluate the use of alicaforsen in clinical trials to understand its efficacy and side effects, as well as assess for evidence that may offer insight into disease pathways. Methods: We evaluate all of the available, published trials, with a focus on the prospective, randomized trials. Results/conclusions: Systemic treatment for Crohns disease has not revealed significant effect. Topical enemas for ulcerative colitis have demonstrated some effect in secondary outcomes, and initial studies in pouchitis are promising. In general, the compound has been well tolerated and safe.

Evaluation of Esophageal Sensation

Dramatic progress has been made over the past decade in the sophistication and availability of equipment to test esophageal motility and sensation. High-resolution esophageal manometry and impedance have moved from the research clinic into clinical practice. Some of the testing is costly and time consuming, and requires extensive experience to perform the testing and properly interpret the results. These sensory studies are valuable in the interpretation of clinical problems, and provide important research information. Clinicians should evaluate the research studies to advance their understanding of the pathophysiology of the esophagus.

Direct neutralization of esophageal acid by antacid in meal-induced heartburn

Background: Antacids are thought to relieve heartburn by neutralizing gastric acid. Previously, we described antacid efficacy in heartburn as due to direct reduction of intraluminal esophageal acid (Gastroenterology 1999;116:A292).

Esophageal acid perfusion in conditioned athletes while running decreases performance in subjects without a history of heartburn, but not in runners with heartburn history

Purpose: We have recently demonstrated increased acid reflux into the esophagus of conditioned athletes during exercise. Extraintestinal manifestations of GERD include asthma and laryngitis suggesting acid reflux into the esophagus may alter athletic performance. The aims of this study were 1) to compare exercise to exhaustion in conditioned athletes with and without a history or heartburn while the esophagus is perfused with saline (sham) or 0.1 N HCl (Bernstein) and 2) to assess the effect of acid perfusion on pulmonary function after exercise.

Integrated acidity: a novel technique demonstrating synergy between low dose ranitidine and antacid for acid reduction and relief of meal-induced heartburn

Integrated acidity: a novel technique demonstrating synergy between low dose ranitidine and antacid for acid reduction and relief of meal-induced heartburn

Integrated acidity and heartburn severity determine timing of self-medication in postprandial heartburn

Integrated acidity and heartburn severity determine timing of self-medication in postprandial heartburn

7144 “the bone in my throat belongs to me” : pharnygeal dysphagia from anterior cervical osteophytes.

69 yo male with a long-standing history of gastroesophageal reflux disease presented with a pressure sensation in his posterior pharynx. Dysphagia associated with this sensation resulted in a 20 lb weight loss and the inability to swallow his medications. Evaluation with a video endoscope revealed several large osteophytes in the midline of the posterior pharynx with an osteophyte from C-5 covering the proximal part of the upper esophageal sphincter. The obstruction of the upper esophageal sphincter was confirmed by a barium swallow and a MRI documented the location and benign nature of these phenomenally large anterior osteophytes. Anterior cervical osteophytectomy by our neurosurgeon (CFE) resulted in prompt, complete resolution of the globus sensation, the feeling of a bone in the posterior pharynx and the dysphagia. Conclusion: Anterior cervical osteophytes can cause pharyngeal dysphagia by physical obstruction of the proximal upper esophageal sphincter. Endoscopy, lateral neck films, barium swallow and MRI demonstrated the pathology which was readily reversed by surgery.