1,721,016 research outputs found
Systematic Review: esophageal motility patterns in patients with eosinophilic esophagitis
No full textEosinophilic esophagitis (EoE) is a chronic disorder of the esophagus characterized by an eosinophil-predominant inflammation and symptoms of esophageal dysfunction. Eosinophils can influence esophageal motility, leading to dysphagia worsening. The spectrum of esophageal motility in EoE is uncertain
Advancements in the use of 24-hour impedance-pH monitoring for GERD diagnosis
No full textGastro-esophageal reflux disease (GERD) occurs in about 25% of the general population. The complexity of the disease and the multiplicity of its clinical manifestations impair the availability of a singular diagnostic test. The majority of GERD patients do not have any endoscopically visible lesions, the so-called non erosive reflux disease (NERD). This latter population consists of several subgroups characterized by: 1. excess of acid; 2. normal acid, but hypersensitivity to acid or weakly acidic reflux; 3. normal acid, but lack of any relationship between symptoms and reflux episodes. At present, 24-h impedance-pH monitoring represents the best diagnostic tool to detect abnormal reflux and to correlate symptoms to reflux episodes. Moreover, the recent adoption of novel impedance metrics, such as mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index, seem to be able to improve the diagnostic yield of 24-h impedance-pH monitoring, making this test the most accurate in diagnosis of GERD
Pathophysiology of GERD
No full textBackground: Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal disorder caused by the retrograde flow of gastric contents into the esophagus, leading to bothersome symptoms and complications. Its pathophysiology is complex and multifactorial, and recent research has aimed to explain the heterogeneity of GERD phenotypes, each influenced by different underlying mechanisms that contribute to symptom presentation and disease progression. Summary: GERD arises from an imbalance between defensive mechanisms and disruptive factors. Key pathophysiological contributors include esophageal gastric junction dysfunction, transient lower esophageal sphincter relaxations, esophageal motility abnormalities, delayed gastric emptying, and thoracoabdominal pressure gradients. Mucosal damage is exacerbated by prolonged exposure to acid and bile, pepsin activity, and impaired esophageal volume and chemical clearance. Additionally, central and peripheral neural modulation influences symptom perception, with heightened visceral sensitivity and esophageal hypervigilance playing significant roles in symptom severity and treatment response. Emerging diagnostic techniques such as high-resolution manometry, impedance-pH monitoring, and EndoFLIP® are improving our ability to identify specific pathophysiological abnormalities, leading to more personalized approaches to GERD management. Key Messages: (i) GERD results from a multifactorial interplay between anatomical, functional, and neurophysiological mechanisms. (ii) Esophageal clearance, EGJ structure and function, acid exposure, mucosal resistance, and neural modulation are crucial determinants of symptom severity and disease progression. (iii) The presence of different phenotypes of the reflux disease (e.g., GERD, functional heartburn, and reflux hypersensitivity) underscores the need for individualized diagnostic and therapeutic strategies. (iv) Advances in diagnostic technologies enhance our understanding of GERD pathophysiology, facilitating tailored management approaches beyond acid suppression therapies. Future research should focus on refining GERD phenotyping and integrating mechanistic insights into personalized treatment paradigms
A tricky case of pancreatic arteriovenous malformation: the role of endoscopic ultrasound in the diagnosis of this rare condition
No full textREAL LIFE COMPARISON OF DIFFERENT ANTI-TNF BIOLOGIC THERAPIES FOR ULCERATIVE COLITIS TREATMENT: A RETROSPECTIVE COHORT STUDY
No full textBACKGROUND: Head-to-head comparison studies evaluating the effectiveness and tolerability of anti-TNF drugs in IBD patients are lacking.AIMS: to compare the effectiveness and tolerability of anti-TNF-alpha drugs used in clinical practice in a cohort of patients with moderate to severe UC.METHODS: Retrospectively, 122 UC patients treated with Infliximab (IFX) Originator and Biosimilar, Adalimumab (ADA) and Golimumab (GOL) were included. We performed an ITT analysis to evaluate clinical response and remission, steroid-free clinical remission and endoscopy response according to the different time-points of the follow-up. Baseline and post-induction predictor factors of these outcomes were evaluated using multivariate logistic regressions models. Moreover, a propensity score-based weighting analysis was performed. Data were analyzed using R and STATA11 software.RESULTS: Overall clinical response was 77% after induction, 81.4% at 30 weeks, 76.9% at 52 weeks, while the steroid-free clinical remission was 39.7%, 46%, 54.6%, respectively. After induction, a higher rate of treatment failure was observed in GOL group. At the end of follow-up, lower rates of steroid-free clinical remission and clinical response were obtained by GOL. At week 52, endoscopic response was achieved by 46.5% of the population.CONCLUSIONS: Among the different anti-TNF treatment, moderate-to-severe UC seems to respond better to IFX and ADA, whereas GOL seems to be less effective, despite a similar good safety profile
Research gap in esophageal achalasia: a narrative review
No full text: In recent years, new translational evidence, diagnostic techniques, and innovative therapies have shed new light on esophageal achalasia and revamped the attention on this relatively rare motility disorder. This narrative review aims to highlight the most recent progress and the areas where further research is needed. The four senior authors identified five topics commonly discussed in achalasia management: i.e. pathogenesis, role of functional lumen imaging probe in the diagnostic flow chart of achalasia, how to define the outcome of achalasia treatments, how to manage persistent chest pain after the treatment, and if achalasia patients' may benefit from a regular follow-up. We searched the bibliographic databases to identify systematic reviews, meta-analyses, randomized control trials, and original research articles in English up to December 2023. We provide a summary with the most recent findings in each of the five topics and the critical points where to address future research, such as the immune-genetic patterns of achalasia that might explain the transition among the different phenotypes, the need for a validated clinical definition of treatment success, the use of neuromodulators to manage chest pain, and the need for identifying achalasia patients at risk for cancer and who may benefit of long-term follow-up. Although undoubtedly, progress has been made on the definition and management of achalasia, unmet needs remain. Debated aspects range from mechanistic insights, symptoms, objective measure relationships, and accurate clinical responses to therapeutic interventions. Translational research is eagerly awaited to answer these unresolved questions
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Research gaps in eosinophilic esophagitis: unanswered questions and future directions
No full textEosinophilic esophagitis (EoE) has emerged as a leading cause of dysphagia worldwide, yet significant knowledge gaps persist across fundamental aspects of disease management. This comprehensive narrative review examines critical research opportunities spanning five interconnected domains that collectively hamper optimal patient care. Despite advances in understanding type 2 inflammation, EoE pathogenesis remains incompletely characterized, particularly regarding gene-environment interactions, epithelial barrier dysfunction mechanisms, and tissue remodeling pathways. The diagnosis currently relies on endoscopy with biopsies with an arbitrary eosinophil threshold of 15 eosinophils/high-power field, while molecular endotypes and non-invasive biomarkers lack validation. Treatment strategies remain largely empirical without strong evidence-based therapeutic hierarchies, comparative effectiveness data, or reliable response predictors. The lack of head-to-head comparison trials of different interventions limits evidence-based treatment selection, while combination therapy approaches remain mostly underexplored. Challenges in defining optimal treatment targets persist, as recent eosinophil-depleting biologics achieved histologic responses without symptomatic improvement, highlighting the limitations of eosinophil-centric disease models. Disease trajectory prediction and long-term outcome monitoring lack systematic approaches, while primary prevention strategies remain undefined despite escalating global incidence. Addressing these research gaps through coordinated multidisciplinary efforts has the potential to transform EoE management from empirical to personalized, evidence-based approaches, ultimately improving patient outcomes and potentially enabling disease prevention
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