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Sleeve Gastrectomy, GERD, and Barrett’s Esophagus: It Is Time for Objective Testing
No full textDear Editor,
We have read with great interest the article published by Sebastianelli et al. [1] who reported the rate of Barrett’s esophagus (BE) 5 years after sleeve gastrectomy (SG). In this multicenter study, the authors followed-up 90 consecutive obese patients who underwent SG. All of them underwent upper endoscopy, clinical assessment for the presence of gastroesophageal reflux disease (GERD) symptoms, and recording of proton pump inhibitors (PPI) use before and after surgery. At baseline, BE was present in none of the obese patients, whereas 9 of them had esophagitis; 20 subjects, all assuming PPI before intervention, were classified as affected by GERD. After 5 years of follow-up, endoscopic examination showed newly diagnosed short BE, without evidence of dysplasia, in 18.8% of the cases. Interestingly, at univariate analysis, BE presence was linked to a failure of weight loss. Finally, the prevalence of GERD symptoms increased from 21 to 76%, with a consequent increase of PPI usage (52%), and esophagitis rate increased from 10 to 41% (with 19% of them being asymptomatic). Authors concluded that in SG patients, a systematic endoscopy should be performed in order to identify the pre-neoplastic lesion and preventing future complications.
This study provides very interesting data on a controversial issue, related to that is the prevalence of GERD and its complications after SG. Although some studies account for a reduction of GERD symptoms after SG, which could probably be related to the weight loss, other studies found a worsening of such symptoms or “de novo” development of this condition [2, 3]. The authors of the present study deserve commendation for exploring the incidence of GERD symptoms and related complications in patients with and without pre-operative symptoms and signs of pathological reflux. On the other hand, we believe that the interpretation of their findings would have greatly improved if the results of objective testing (high-resolution manometry, HRM, and impedance-pH monitoring) before and after SG were also reported. In fact, even if patients complaining of GERD symptoms and those with pre-operative esophagitis were included, no data on their real reflux burden can be extrapolated. Indeed, previous studies demonstrated that obese patients were hyposensitive to reflux occurrence [4]. In particular, two recent studies [5, 6] have showed that obese patients may have pathological exposure to reflux even in absence of symptoms and signs. Moreover, some Authors [7] showed that in obese subjects without pre-operative objective pathological reflux, SG increased the total number of reflux events, the esophageal pH < 4 exposure and the esophageal clearance time. A subsequent multicenter study [8] found that the most common mechanism of reflux genesis after SG is the increased intragastric pressure in the reduced stomach, because the lacking of fundus that in normal subject can maintain the stomach in an isobaric condition. Actually, GERD pathophysiology is complex and we should no more discuss about this phenomenon only considering symptoms or signs. The recent guidelines on GERD diagnosis and management [9, 10] clearly state that clinical features and mild esophagitis alone (grades A and B) are not sufficient to estimate the reflux burden. Furthermore, because of a high prevalence of non-erosive reflux disease [11] in the GERD spectrum, sometimes also with normal acid exposure but abnormal number of reflux events and positive reflux-related symptoms, impedance-pH monitoring is mandatory. This technique, in fact, allows to measure all kinds of reflux events, thus increasing the diagnostic yield of traditional reflux monitoring (pH-metry) [12]. Moreover, recent data suggests a further promising role of HRM in GERD pathophysiology; this technique allows to establish not only the motility of esophageal body, but actually can provide important data about esophagogastric junction morphology [13] and on the esophagogastric junction barrier effect [14]; the impairment of these two parameters is strongly linked to GERD presence.
Thus, providing objective testing with HRM and MII-pH before and after SG may be useful to understand whether a particular group of patients should be treated with alternative bariatric procedure in which there is a sure reduction of GERD, e.g., gastric bypass. So far, data obtained by HRM and MII-pH, together with those obtained by endoscopy, should be collected and reported before and after surgery in all studies evaluating the effect of any bariatric procedure in obese patients. This would allow to a better pre-operative selection for the best “tailored” bariatric surgery
ATLAS
No full textThe book provides a comprehensive overview of high-resolution and high-definition
anorectal manometry (HRAM/HDAM), showing the possible benefits of a wider
use of these techniques in clinical practice, as well as their limitations. Although
these techniques provide fresh insights into anorectal function and offer a new perspective on the pathophysiologic mechanisms of many defecation disturbances,
there is a need to clarify whether their use has beneficial effects on clinical management compared to conventional manometry. There is still a considerable way to go
to gain the clinical diffusion of esophageal HRM, which has become the gold standard in studying esophageal motility. Indeed, many gastroenterologists and surgeons are convinced that further studies are necessary in order to be able to
recommend HRAM and HDAM over and above conventional anorectal manometry.
The first part of the book presents anorectal anatomy and pathophysiology, highlighting the indications and limitations of conventional anorectal manometry. The
second part then focuses on the general concepts of high-resolution manometry and
the difference between conventional anorectal manometry and HRAM/HDAM,
including technical aspects and different equipment. The third part explains how to
perform, analyze, and interpret HRAM and HDAM recordings and describes the
parameters study protocol, normal values, and how to formulate a particular diagnosis. Lastly, the fourth part includes a collection of normal and pathological images
with a glossary of the most frequently used terms. Written by experts in the field of
anorectal manometry and defecation disorders, this book is of interest to specialists
and residents dealing with these conditions.
The editor is grateful to all the authors of the different chapters who with passion,
intelligence, and patience shared their knowledge and their experience to produce a
text that could be useful to all those who want to approach this new technology or
improve their own knowledge
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
Correction to: Does antrum size matter in sleeve gastrectomy? A prospective randomized study (Surgical Endoscopy, (2020), 10.1007/s00464-020-07811-1)
No full textThis article was updated to correct Juan Antonio Carbonell Asíns’ name in the author listing: Juan Antonio (given name) Carbonell Asíns (family name)
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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