Ronnie Fass - Academia.edu (original) (raw)

Papers by Ronnie Fass

Research paper thumbnail of Die Montreal-Definition und -Klassifikation der gastroösophagealen Refluxkrankheit: Ein globales evidenzbasiertes Konsensus-Papier

Zeitschrift Fur Gastroenterologie, Nov 1, 2007

Research paper thumbnail of Maintenance of Heartburn Symptom Relief in Patients Stepped-Down from Twice-Daily Proton Pump Inhibitor to Once-Daily Dexlansoprazole MR

The American Journal of Gastroenterology, Oct 1, 2011

Research paper thumbnail of Effects of Dexlansoprazole MR on Sleep Quality and Health-Related Quality of Life (HRQOL) in Patients with Symptomatic Nonerosive GERD

The American Journal of Gastroenterology, Oct 1, 2009

Research paper thumbnail of Effect of Dexlansoprazole MR on Improving Work Productivity and Daily Activities in Patients with Symptomatic Nonerosive GERD

The American Journal of Gastroenterology, Oct 1, 2009

Research paper thumbnail of Dexlansoprazole MR for Treatment for Nocturnal Heartburn in Patients with Symptomatic Nonerosive GERD

The American Journal of Gastroenterology, Oct 1, 2009

Research paper thumbnail of Reduced Mental and Physical Functioning among Patients with Frequent Atypical GERD Symptoms

American Journal of Gastroenterology, 2006

Research paper thumbnail of Patients with Nocturnal Heartburn and Acid Regurgitation Report More Frequent Nighttime and Daytime Atypical GERD Symptoms

American Journal of Gastroenterology, 2006

Research paper thumbnail of Patients with Severe GERD Report More Frequent Nighttime and Daytime Atypical GERD Symptoms

American Journal of Gastroenterology, 2006

Research paper thumbnail of Changing epidemiology of gastroesophageal reflux disease in the Asian–Pacific region: An overview

Journal of Gastroenterology and Hepatology, 2004

Gastroesophageal reflux disease (GERD) is a common disease in the West, which now appears to be... more Gastroesophageal reflux disease (GERD) is a common disease in the West, which now appears to be also increasing in prevalence in the Asian Pacific region. The reasons for this changing epidemiology are two‐fold: an increased awareness among doctors and patients, and/or a true increase in the prevalence of the disease. Prevalence rates of reflux esophagitis (RE) of up to 16% and prevalence of GERD symptoms of up to 9% have been reported in the Asian population. However, the frequency of strictures and Barrett's esophagus remain very low. Non‐erosive reflux disease (NERD) appears to be the most common form of GERD among Asian patients accounting for 50–70% of cases with GERD. Among Asian patients differences can also be discerned among different ethnic groups. For example, in Malaysia where a multiracial society exists, RE is significantly more common among Indians compared to Chinese and Malays whereas NERD is more frequently seen in the Indian and Malays compared to the Chines...

Research paper thumbnail of The Impact of Chronic Cannabis Use on Esophageal Motility in Patients Referred for Esophageal Manometry

Journal of Clinical Gastroenterology

Background: Tetrahydrocannabinol, the main psychoactive compound in cannabis, binds with high aff... more Background: Tetrahydrocannabinol, the main psychoactive compound in cannabis, binds with high affinity to the cannabinoid 1 receptor. Small randomized controlled studies using conventional manometry have shown that the cannabinoid 1 receptor can modulate esophageal function, namely transient lower esophageal sphincter relaxation frequency and lower esophageal sphincter tone. The effect of cannabinoids on esophageal motility in patients referred for esophageal manometry has not been fully elucidated using high-resolution esophageal manometry (HREM). We aimed to characterize the clinical effect of chronic cannabis use on esophageal motility utilizing HREM. Methods: Patients who underwent HREM from 2009 to 2019 were identified at 4 academic medical centers. The study group consisted of patients with a noted history of chronic cannabis use, a diagnosis of cannabis-related disorder, or a positive urine toxicology screen. Age and gender-matched patients with no history of cannabis use wer...

Research paper thumbnail of Esophageal Hypocontractile Disorders and Hiatal Hernia Size Are Predictors for Long Segment Barrett’s Esophagus

Journal of Neurogastroenterology and Motility

Background/Aims Presently, there is paucity of information about clinical predictors, especially ... more Background/Aims Presently, there is paucity of information about clinical predictors, especially esophageal motor abnormalities, for long segment Barrett's esophagus (LSBE) as compared with short segment Barrett's esophagus (SSBE). The aims of this study are to compare the frequency of esophageal function abnormalities between patients with LSBE and those with SSBE and to determine their clinical predictors. Methods This was a multicenter cohort study that included all patients with a diagnosis of BE who underwent high-resolution esophageal manometry. Motility disorders were categorized as hypercontractile disorders or hypocontractile disorders and their frequency was compared between patients with LSBE and those with SSBE. Multivariable logistic regression modeling was used to calculate the odds of being diagnosed with LSBE relative to SSBE for demographics, comorbidities, medication use, endoscopic findings, and the type of motility disorders. Results A total of 148 patients with BE were identified, of which 89 (60.1%) had SSBE and 59 (39.9%) LSBE. Patients with LSBE had a significantly larger hiatal hernia and higher likelihood of erosive esophagitis than patients with SSBE (P = 0.002). Patients with LSBE had a significantly lower mean LES resting pressure, distal contractile integral, distal latency, and significantly higher failed swallows and hypocontractile motility disorders than those with SSBE (P < 0.05). Hiatal hernia and hypocontractile motility disorder increased the odds of LSBE by 38.0% and 242.0%, as opposed to SSBE. Conclusions The presence of a hypocontractile motility disorder increased the risk for LSBE. Furthermore, the risk for LSBE was directly associated with the length of the hiatal hernia.

Research paper thumbnail of Diagnostic Accuracy of the Proton Pump Inhibitor Test in Gastroesophageal Reflux Disease and Noncardiac Chest Pain

Journal of Clinical Gastroenterology

BACKGROUND Response to a trial of proton pump inhibitors (PPIs) is currently accepted as a first ... more BACKGROUND Response to a trial of proton pump inhibitors (PPIs) is currently accepted as a first step in the management of gastroesophageal reflux disease (GERD). However, information on the diagnostic performance of the PPI test is limited. AIM The aim of this study was to determine the diagnostic accuracy of the PPI test in GERD and noncardiac chest pain (NCCP) and to assess the test performance in erosive reflux disease (ERD) and nonerosive reflux disease (NERD). METHODS Web of Science, Cochrane Controlled Register of Trials (CENTRAL), and MEDLINE were searched for studies reporting the diagnostic accuracy of the PPI test in adult patients with typical GERD and NCCP who underwent evaluation using an accepted reference standard, from January 1, 1950, through February 1, 2021. Subgroup analyses were performed, and the risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS Nineteen studies (GERD=11, NCCP=8) involving 1691 patients were included. In GERD, the PPI test had 79% pooled sensitivity [95% confidence interval (CI), 72%-84%], and 45% pooled specificity (95% CI, 40%-49%). In NCCP, pooled sensitivity and specificity were 79% (95% CI, 69%-86%) and 79% (95% CI, 69%-86%), respectively. In ERD, the PPI test had 76% pooled sensitivity (95% CI, 66%-84%) and 30% pooled specificity (95% CI, 8%-67%). In NERD, the PPI test had 79% pooled sensitivity (95% CI, 70%-86%) and 50% pooled specificity (95% CI, 39%-61%). CONCLUSIONS The PPI test was sensitive in GERD but with suboptimal specificity. The test performed better in GERD-related NCCP. Diagnostic accuracy was comparable in ERD and NERD.

Research paper thumbnail of Alteration in Integrated Relaxation Pressure During Successive Swallows in Subjects With Normal Manometry Versus Those With Esophagogastric Junction Outflow Obstruction

Journal of Neurogastroenterology and Motility, 2021

Background/Aims Integrated relaxation pressure (IRP) is defined as the average minimum esophagoga... more Background/Aims Integrated relaxation pressure (IRP) is defined as the average minimum esophagogastric junction pressure for 4 seconds of relaxation (contiguous or noncontiguous) within 10 seconds of swallowing. The durability of IRP values during successive swallows in the supine position remains to be elucidated. The aim is to determine alteration in IRP values during successive swallows among subjects with normal esophageal manometry versus those with esophagogastric junction outflow obstruction (EGJOO). Methods Consecutive subjects, who underwent high-resolution esophageal manometry (HREM) were included in the study. Individuals had to have either normal manometry or EGJOO. A total of 10 wet swallows of 5 mL water were performed after an adaptation period of a minimum of 3 minutes. Mean IRP was analyzed for both subject groups for each individual swallow. Results Thirty-one patients with EGJOO and seventy patients with normal manometry were included. As expected, the median IRP was higher in EGJOO patients compared to those with normal HREM (mean: 23.92 vs 5.34, P < 0.001). The mean IRP of the last swallow was 40% lower than the mean IRP of the first swallow in the normal subjects (P = 0.015). In contrast, the difference in the mean IRP value in the EGJOO group between the first and the last swallow was 19% (P = 0.018). Conclusions This study demonstrated that there is a significant decline in the mean IRP during successive swallows in subjects with normal esophageal manometry and those with EGJOO, despite adequate adaptation periods. This decline in IRP was less pronounced in EGJOO.

Research paper thumbnail of Publication data

Clinical trial: the effects of the proton pump inhibitor dexlansoprazole MR on daytime and nightt... more Clinical trial: the effects of the proton pump inhibitor dexlansoprazole MR on daytime and nighttime heartburn in patients with non-erosive reflux disease

Research paper thumbnail of No association between chronic use of ranitidine, compared with omeprazole or famotidine, and gastrointestinal malignancies

Alimentary Pharmacology & Therapeutics, 2021

In 2019, the United States Food and Drug Administration detected above‐regulation levels of the h... more In 2019, the United States Food and Drug Administration detected above‐regulation levels of the human carcinogen N‐nitrosodimethylamine (NDMA) in ranitidine, resulting in a complete removal of the medication from the market. NDMA is known to cause gastrointestinal malignancies in animal models.

Research paper thumbnail of Durability of Esophageal Motor Disorders Identified on High-Resolution Esophageal Manometry: A Case Series

Advances in Therapy, 2020

Background/Aim: Diagnosis of esophageal motor disorders using high-resolution esophageal manometr... more Background/Aim: Diagnosis of esophageal motor disorders using high-resolution esophageal manometry (HREM) may result in medical, endoscopic or surgical intervention. However, prior to any intervention, durability of the HREM findings should be established. The aim of this case series was to assess 25 patients who had undergone HREM twice, at least 6 months apart, and to determine the durability of the initial manometric diagnosis. Methods and Patients: This is a case series of 25 patients who underwent HREM at least twice, 6 months apart, at a large safety net hospital. All patients were evaluated in between the tests for any clinical intervention. Demographics, patients' indication for HREM and clinical presentation were documented as well. Results: Of the 25 patients, HREM results improved in 32%, worsened in 20% and were unchanged in 48%. Some interventions were employed between the first and second HREM diagnosis. Those associated with an improved diagnosis included doubling the proton pump inhibitor (PPI) dose, restarting a PPI, adding a histamine 2 blocker (H2 blocker) and use of empiric dilation. Conclusions: In this case series, about half of the patients undergoing two esophageal manometries, at least 6 months apart, demonstrated lack of durability of their initially diagnosed esophageal motor disorder.

Research paper thumbnail of Diagnosis and Management of Functional Chest Pain in the Rome IV Era

Journal of Neurogastroenterology and Motility, 2019

Functional chest pain accounts for about a third of the patients with noncardiac chest pain. It i... more Functional chest pain accounts for about a third of the patients with noncardiac chest pain. It is a very common functional esophageal disorder that remains even today a management challenge to the practicing physician. Based on the definition offered by the Rome IV criteria, diagnosis of functional chest pain requires a negative workup of noncardiac chest pain patients that includes, proton pump inhibitor test or empirical proton pump inhibitor trial, endoscopy with esophageal mucosal biopsies, reflux testing, and esophageal manometry. The mainstay of treatment are neuromodulators that are primarily composed of anti-depressants. Alternative medicine and psychological interventions may be provided alone or in combination with other therapeutic modalities.

Research paper thumbnail of Stress and Gastroesophageal Reflux Disease

Proceedings of the Shevchenko Scientific Society Medical sciences, 2018

Gastroesophageal refl ux disease (GERD) is one of the commonest conditions managed by clinicians.... more Gastroesophageal refl ux disease (GERD) is one of the commonest conditions managed by clinicians. Regurgitation and heartburn are considered the cardinal symptoms of GERD. In recent decades, an increasing association has been noted between stress and GERD and our knowledge about the pathophysiology of this relationship is constantly evolving. Both acute and chronic stress can accentuate GERD related symptoms. Subjects exposed to chronic life stressors are more likely to complaint of GERD symptoms. Current data suggests that acute stress exacerbates GERD symptoms by enhancing the perceptual responses to intra-esophageal acid stimulivia central mechanisms without increasing the amount of acid refl ux. This process is likely mediated by an increase in esophageal mucosal permeability. Treatment with proton pump inhibitors attenuates the effect of acute stress on esophageal perception thresholds for pain. However, the effect of anti-refl ux therapy in patients experiencing chronic stress remains to be elucidated. Disclosures. No confl icts of interest, fi nancial or otherwise, are declared by the authors.

Research paper thumbnail of Reflux hypersensitivity - what is in the name?

NeuroGastroLATAM Reviews, 2018

Research paper thumbnail of Most Patients With Gastroesophageal Reflux Disease Who Failed Proton Pump Inhibitor Therapy Also Have Functional Esophageal Disorders

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, Jan 18, 2018

As many as 45% of patients with gastroesophageal reflux disease (GERD) still have symptoms after ... more As many as 45% of patients with gastroesophageal reflux disease (GERD) still have symptoms after receiving once-daily proton pump inhibitor (PPI) therapy. We aimed to compare reflux characteristics and patterns between responders and non-responders to once-daily PPI therapy using combined impedance-pH monitoring. Patients who reported heartburn and/or regurgitation at least twice per week for 3 months while receiving standard-dose PPI therapy were assigned to the PPI failure group (n = 16). Patients who reported a complete resolution of symptoms on once-daily PPIs for at least 4 weeks were assigned to the PPI success group (n = 13). We collected demographic data and subjects completed the short-form 36 and the GERD health-related quality of life questionnaires. Patients then underwent upper endoscopy and combined esophageal impedance-pH monitoring while on PPI therapy. Four patients in the PPI success group (31%) and 4 patients in the PPI failure group (25%) had abnormal results fro...

Research paper thumbnail of Die Montreal-Definition und -Klassifikation der gastroösophagealen Refluxkrankheit: Ein globales evidenzbasiertes Konsensus-Papier

Zeitschrift Fur Gastroenterologie, Nov 1, 2007

Research paper thumbnail of Maintenance of Heartburn Symptom Relief in Patients Stepped-Down from Twice-Daily Proton Pump Inhibitor to Once-Daily Dexlansoprazole MR

The American Journal of Gastroenterology, Oct 1, 2011

Research paper thumbnail of Effects of Dexlansoprazole MR on Sleep Quality and Health-Related Quality of Life (HRQOL) in Patients with Symptomatic Nonerosive GERD

The American Journal of Gastroenterology, Oct 1, 2009

Research paper thumbnail of Effect of Dexlansoprazole MR on Improving Work Productivity and Daily Activities in Patients with Symptomatic Nonerosive GERD

The American Journal of Gastroenterology, Oct 1, 2009

Research paper thumbnail of Dexlansoprazole MR for Treatment for Nocturnal Heartburn in Patients with Symptomatic Nonerosive GERD

The American Journal of Gastroenterology, Oct 1, 2009

Research paper thumbnail of Reduced Mental and Physical Functioning among Patients with Frequent Atypical GERD Symptoms

American Journal of Gastroenterology, 2006

Research paper thumbnail of Patients with Nocturnal Heartburn and Acid Regurgitation Report More Frequent Nighttime and Daytime Atypical GERD Symptoms

American Journal of Gastroenterology, 2006

Research paper thumbnail of Patients with Severe GERD Report More Frequent Nighttime and Daytime Atypical GERD Symptoms

American Journal of Gastroenterology, 2006

Research paper thumbnail of Changing epidemiology of gastroesophageal reflux disease in the Asian–Pacific region: An overview

Journal of Gastroenterology and Hepatology, 2004

Gastroesophageal reflux disease (GERD) is a common disease in the West, which now appears to be... more Gastroesophageal reflux disease (GERD) is a common disease in the West, which now appears to be also increasing in prevalence in the Asian Pacific region. The reasons for this changing epidemiology are two‐fold: an increased awareness among doctors and patients, and/or a true increase in the prevalence of the disease. Prevalence rates of reflux esophagitis (RE) of up to 16% and prevalence of GERD symptoms of up to 9% have been reported in the Asian population. However, the frequency of strictures and Barrett's esophagus remain very low. Non‐erosive reflux disease (NERD) appears to be the most common form of GERD among Asian patients accounting for 50–70% of cases with GERD. Among Asian patients differences can also be discerned among different ethnic groups. For example, in Malaysia where a multiracial society exists, RE is significantly more common among Indians compared to Chinese and Malays whereas NERD is more frequently seen in the Indian and Malays compared to the Chines...

Research paper thumbnail of The Impact of Chronic Cannabis Use on Esophageal Motility in Patients Referred for Esophageal Manometry

Journal of Clinical Gastroenterology

Background: Tetrahydrocannabinol, the main psychoactive compound in cannabis, binds with high aff... more Background: Tetrahydrocannabinol, the main psychoactive compound in cannabis, binds with high affinity to the cannabinoid 1 receptor. Small randomized controlled studies using conventional manometry have shown that the cannabinoid 1 receptor can modulate esophageal function, namely transient lower esophageal sphincter relaxation frequency and lower esophageal sphincter tone. The effect of cannabinoids on esophageal motility in patients referred for esophageal manometry has not been fully elucidated using high-resolution esophageal manometry (HREM). We aimed to characterize the clinical effect of chronic cannabis use on esophageal motility utilizing HREM. Methods: Patients who underwent HREM from 2009 to 2019 were identified at 4 academic medical centers. The study group consisted of patients with a noted history of chronic cannabis use, a diagnosis of cannabis-related disorder, or a positive urine toxicology screen. Age and gender-matched patients with no history of cannabis use wer...

Research paper thumbnail of Esophageal Hypocontractile Disorders and Hiatal Hernia Size Are Predictors for Long Segment Barrett’s Esophagus

Journal of Neurogastroenterology and Motility

Background/Aims Presently, there is paucity of information about clinical predictors, especially ... more Background/Aims Presently, there is paucity of information about clinical predictors, especially esophageal motor abnormalities, for long segment Barrett's esophagus (LSBE) as compared with short segment Barrett's esophagus (SSBE). The aims of this study are to compare the frequency of esophageal function abnormalities between patients with LSBE and those with SSBE and to determine their clinical predictors. Methods This was a multicenter cohort study that included all patients with a diagnosis of BE who underwent high-resolution esophageal manometry. Motility disorders were categorized as hypercontractile disorders or hypocontractile disorders and their frequency was compared between patients with LSBE and those with SSBE. Multivariable logistic regression modeling was used to calculate the odds of being diagnosed with LSBE relative to SSBE for demographics, comorbidities, medication use, endoscopic findings, and the type of motility disorders. Results A total of 148 patients with BE were identified, of which 89 (60.1%) had SSBE and 59 (39.9%) LSBE. Patients with LSBE had a significantly larger hiatal hernia and higher likelihood of erosive esophagitis than patients with SSBE (P = 0.002). Patients with LSBE had a significantly lower mean LES resting pressure, distal contractile integral, distal latency, and significantly higher failed swallows and hypocontractile motility disorders than those with SSBE (P < 0.05). Hiatal hernia and hypocontractile motility disorder increased the odds of LSBE by 38.0% and 242.0%, as opposed to SSBE. Conclusions The presence of a hypocontractile motility disorder increased the risk for LSBE. Furthermore, the risk for LSBE was directly associated with the length of the hiatal hernia.

Research paper thumbnail of Diagnostic Accuracy of the Proton Pump Inhibitor Test in Gastroesophageal Reflux Disease and Noncardiac Chest Pain

Journal of Clinical Gastroenterology

BACKGROUND Response to a trial of proton pump inhibitors (PPIs) is currently accepted as a first ... more BACKGROUND Response to a trial of proton pump inhibitors (PPIs) is currently accepted as a first step in the management of gastroesophageal reflux disease (GERD). However, information on the diagnostic performance of the PPI test is limited. AIM The aim of this study was to determine the diagnostic accuracy of the PPI test in GERD and noncardiac chest pain (NCCP) and to assess the test performance in erosive reflux disease (ERD) and nonerosive reflux disease (NERD). METHODS Web of Science, Cochrane Controlled Register of Trials (CENTRAL), and MEDLINE were searched for studies reporting the diagnostic accuracy of the PPI test in adult patients with typical GERD and NCCP who underwent evaluation using an accepted reference standard, from January 1, 1950, through February 1, 2021. Subgroup analyses were performed, and the risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS Nineteen studies (GERD=11, NCCP=8) involving 1691 patients were included. In GERD, the PPI test had 79% pooled sensitivity [95% confidence interval (CI), 72%-84%], and 45% pooled specificity (95% CI, 40%-49%). In NCCP, pooled sensitivity and specificity were 79% (95% CI, 69%-86%) and 79% (95% CI, 69%-86%), respectively. In ERD, the PPI test had 76% pooled sensitivity (95% CI, 66%-84%) and 30% pooled specificity (95% CI, 8%-67%). In NERD, the PPI test had 79% pooled sensitivity (95% CI, 70%-86%) and 50% pooled specificity (95% CI, 39%-61%). CONCLUSIONS The PPI test was sensitive in GERD but with suboptimal specificity. The test performed better in GERD-related NCCP. Diagnostic accuracy was comparable in ERD and NERD.

Research paper thumbnail of Alteration in Integrated Relaxation Pressure During Successive Swallows in Subjects With Normal Manometry Versus Those With Esophagogastric Junction Outflow Obstruction

Journal of Neurogastroenterology and Motility, 2021

Background/Aims Integrated relaxation pressure (IRP) is defined as the average minimum esophagoga... more Background/Aims Integrated relaxation pressure (IRP) is defined as the average minimum esophagogastric junction pressure for 4 seconds of relaxation (contiguous or noncontiguous) within 10 seconds of swallowing. The durability of IRP values during successive swallows in the supine position remains to be elucidated. The aim is to determine alteration in IRP values during successive swallows among subjects with normal esophageal manometry versus those with esophagogastric junction outflow obstruction (EGJOO). Methods Consecutive subjects, who underwent high-resolution esophageal manometry (HREM) were included in the study. Individuals had to have either normal manometry or EGJOO. A total of 10 wet swallows of 5 mL water were performed after an adaptation period of a minimum of 3 minutes. Mean IRP was analyzed for both subject groups for each individual swallow. Results Thirty-one patients with EGJOO and seventy patients with normal manometry were included. As expected, the median IRP was higher in EGJOO patients compared to those with normal HREM (mean: 23.92 vs 5.34, P < 0.001). The mean IRP of the last swallow was 40% lower than the mean IRP of the first swallow in the normal subjects (P = 0.015). In contrast, the difference in the mean IRP value in the EGJOO group between the first and the last swallow was 19% (P = 0.018). Conclusions This study demonstrated that there is a significant decline in the mean IRP during successive swallows in subjects with normal esophageal manometry and those with EGJOO, despite adequate adaptation periods. This decline in IRP was less pronounced in EGJOO.

Research paper thumbnail of Publication data

Clinical trial: the effects of the proton pump inhibitor dexlansoprazole MR on daytime and nightt... more Clinical trial: the effects of the proton pump inhibitor dexlansoprazole MR on daytime and nighttime heartburn in patients with non-erosive reflux disease

Research paper thumbnail of No association between chronic use of ranitidine, compared with omeprazole or famotidine, and gastrointestinal malignancies

Alimentary Pharmacology & Therapeutics, 2021

In 2019, the United States Food and Drug Administration detected above‐regulation levels of the h... more In 2019, the United States Food and Drug Administration detected above‐regulation levels of the human carcinogen N‐nitrosodimethylamine (NDMA) in ranitidine, resulting in a complete removal of the medication from the market. NDMA is known to cause gastrointestinal malignancies in animal models.

Research paper thumbnail of Durability of Esophageal Motor Disorders Identified on High-Resolution Esophageal Manometry: A Case Series

Advances in Therapy, 2020

Background/Aim: Diagnosis of esophageal motor disorders using high-resolution esophageal manometr... more Background/Aim: Diagnosis of esophageal motor disorders using high-resolution esophageal manometry (HREM) may result in medical, endoscopic or surgical intervention. However, prior to any intervention, durability of the HREM findings should be established. The aim of this case series was to assess 25 patients who had undergone HREM twice, at least 6 months apart, and to determine the durability of the initial manometric diagnosis. Methods and Patients: This is a case series of 25 patients who underwent HREM at least twice, 6 months apart, at a large safety net hospital. All patients were evaluated in between the tests for any clinical intervention. Demographics, patients' indication for HREM and clinical presentation were documented as well. Results: Of the 25 patients, HREM results improved in 32%, worsened in 20% and were unchanged in 48%. Some interventions were employed between the first and second HREM diagnosis. Those associated with an improved diagnosis included doubling the proton pump inhibitor (PPI) dose, restarting a PPI, adding a histamine 2 blocker (H2 blocker) and use of empiric dilation. Conclusions: In this case series, about half of the patients undergoing two esophageal manometries, at least 6 months apart, demonstrated lack of durability of their initially diagnosed esophageal motor disorder.

Research paper thumbnail of Diagnosis and Management of Functional Chest Pain in the Rome IV Era

Journal of Neurogastroenterology and Motility, 2019

Functional chest pain accounts for about a third of the patients with noncardiac chest pain. It i... more Functional chest pain accounts for about a third of the patients with noncardiac chest pain. It is a very common functional esophageal disorder that remains even today a management challenge to the practicing physician. Based on the definition offered by the Rome IV criteria, diagnosis of functional chest pain requires a negative workup of noncardiac chest pain patients that includes, proton pump inhibitor test or empirical proton pump inhibitor trial, endoscopy with esophageal mucosal biopsies, reflux testing, and esophageal manometry. The mainstay of treatment are neuromodulators that are primarily composed of anti-depressants. Alternative medicine and psychological interventions may be provided alone or in combination with other therapeutic modalities.

Research paper thumbnail of Stress and Gastroesophageal Reflux Disease

Proceedings of the Shevchenko Scientific Society Medical sciences, 2018

Gastroesophageal refl ux disease (GERD) is one of the commonest conditions managed by clinicians.... more Gastroesophageal refl ux disease (GERD) is one of the commonest conditions managed by clinicians. Regurgitation and heartburn are considered the cardinal symptoms of GERD. In recent decades, an increasing association has been noted between stress and GERD and our knowledge about the pathophysiology of this relationship is constantly evolving. Both acute and chronic stress can accentuate GERD related symptoms. Subjects exposed to chronic life stressors are more likely to complaint of GERD symptoms. Current data suggests that acute stress exacerbates GERD symptoms by enhancing the perceptual responses to intra-esophageal acid stimulivia central mechanisms without increasing the amount of acid refl ux. This process is likely mediated by an increase in esophageal mucosal permeability. Treatment with proton pump inhibitors attenuates the effect of acute stress on esophageal perception thresholds for pain. However, the effect of anti-refl ux therapy in patients experiencing chronic stress remains to be elucidated. Disclosures. No confl icts of interest, fi nancial or otherwise, are declared by the authors.

Research paper thumbnail of Reflux hypersensitivity - what is in the name?

NeuroGastroLATAM Reviews, 2018

Research paper thumbnail of Most Patients With Gastroesophageal Reflux Disease Who Failed Proton Pump Inhibitor Therapy Also Have Functional Esophageal Disorders

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, Jan 18, 2018

As many as 45% of patients with gastroesophageal reflux disease (GERD) still have symptoms after ... more As many as 45% of patients with gastroesophageal reflux disease (GERD) still have symptoms after receiving once-daily proton pump inhibitor (PPI) therapy. We aimed to compare reflux characteristics and patterns between responders and non-responders to once-daily PPI therapy using combined impedance-pH monitoring. Patients who reported heartburn and/or regurgitation at least twice per week for 3 months while receiving standard-dose PPI therapy were assigned to the PPI failure group (n = 16). Patients who reported a complete resolution of symptoms on once-daily PPIs for at least 4 weeks were assigned to the PPI success group (n = 13). We collected demographic data and subjects completed the short-form 36 and the GERD health-related quality of life questionnaires. Patients then underwent upper endoscopy and combined esophageal impedance-pH monitoring while on PPI therapy. Four patients in the PPI success group (31%) and 4 patients in the PPI failure group (25%) had abnormal results fro...