Acid Suppression Research Articles

A prospective study of diagnostic testing and hospital charges after brief resolved unexplained event.

To evaluate diagnostic testing frequency/yield and determine drivers of hospital charges in a prospective cohort of infants with brief resolved unexplained event (BRUE) to test the hypothesis that length of stay (LOS), low-yield diagnostic testing, and repeat hospital visits increase costs. We conducted a prospective cohort study of infants admitted after BRUE to determine how clinical practice impacts the cost of care. Charge data from our institution's billing records database included room and board, diagnostics, medications, and professional fees for index hospitalizations and 6-month follow-ups. Charts were reviewed for clinical data, testing results, and repeat hospitalizations. Parent-reported symptoms and management changes were obtained by questionnaires. Multivariable analyses with linear regression were conducted to determine risk factors for hospitalization charges and total charges including hospitalization and 6-month follow-up. The cohort included 155 subjects with median index hospitalization charges of $11,256 and total charges of $15,675. Overall, 76% had persistent BRUE symptoms and 15% repeat hospitalization; 34% were treated with acid suppression. Only 9.7% of the tests performed provided a potential diagnosis, but the videofluoroscopic swallow study (VFSS) had the highest yield with 70% abnormal. On multivariable analysis, LOS, VFSS, flexible laryngoscopy, electroencephalogram, and repeat hospital visits were all associated with increased charges (fold change: 142%-354%). Hospitalization and follow-up care are costly after BRUE. Potentially modifiable drivers of charges include test number, LOS, and repeat hospital visits. Most testing is low-yield, but timely performance of VFSS may allow for cost-effective and appropriate treatment of oropharyngeal dysphagia and prevention of persistent symptoms. Gastroenterologists are frequently involved in caring for these children and are uniquely positioned to help guide testing and treatment related to gastroesophageal reflux disease and oropharyngeal dysphagia.

Restoring cefepime activity against multidrug-resistant KPC-producing Klebsiella pneumoniae by combination with boronic acid inhibitors, MB076 and S02030.

Foremost in the design of new β-lactamase inhibitors (BLIs) are the boronic acid transition state inhibitors (BATSIs). Two highly potent BATSIs being developed are S02030 and MB076 strategically designed to be active against cephalosporinases and carbapenemases, especially KPC. When combined with cefepime, S02030 and MB076 demonstrated potent antimicrobial activity against laboratory and clinical strains of Enterobacterales expressing a variety of class A and class C β-lactamases, including blaKPC-2 and blaKPC-3. Static time-kill assays revealed the bactericidal activity of cefepime in combination with S02030 and MB076 against a multidrug-resistant KPC-producing K. pneumoniae (KPC-Kpn-1), in which a ≥ 3-log10 decrease in the bacterial density was observed by 6 h. In vivo efficacy of MB076 in combination with cefepime was evaluated in a lung infection model where male C57BL/6 mice were infected intranasally with KPC-Kpn-1. Cefepime alone administered at 2 h post infection resulted in a 1.07 log10 CFU reduction at 24 h, while cefepime in combination with MB076 resulted in an enhanced reduction of 2.70 log10 CFU (P < 0.0001) compared to the no treatment control group. In a survival analysis where mice were infected via the tail vein with KPC-Kpn-1, all mice treated with placebo or cefepime alone (100 mg/kg) died, whereas those treated with a 1:4 molar ratio of cefepime-MB076 survived. Our data demonstrate bactericidal activity and in vivo efficacy of cefepime-MB076 comparable to ceftazidime-avibactam and support the continued development of this combination as a new treatment option for infections caused by class A carbapenemase producing Enterobacterales, particularly KPC-Kpn.

MFGE8 Acts as a Cell Adhesion Factor for Human-Induced Pluripotent Stem Cells in Embryology.

Mouse embryonic fibroblasts (MEFs) have been widely used as feeder cells in embryonic stem cell cultures because they can mimic the embryonic microenvironment. Milk fat globule-epidermal growth factor 8 (MFGE8) is expressed during mouse gonadal development, 10.5-13.5 embryonic, and is also found in MEF-conditioned medium (MEF-CM). Feeder-less culture of human-induced pluripotent stem cells (iPSCs) with MEF-CM significantly decreased the number of adherent cells when an inhibitory antibody against MFGE8 was used. The concentration of mouse MFGE8 in MEF-CM, as measured by an ELISA (Enzyme-Linked Immunosorbent Assay), was 0.16-1.24 μg/mL. Mouse MFGE8 and human MFGE8 have partially different molecular structures. Both the recombinant mouse MFGE8 and human MFGE8 significantly promoted cell adhesion of human iPSCs at medium-added concentrations of 2 μg/mL. This cell adhesion was also strongly inhibited by Arginylglycylaspartic acid (RGD) inhibitors, suggesting that it is dependent on the RGD sequence. The integrin αVβ5 expressed in iPSCs was thought to be involved in binding to the RGD sequence. MEF-CMs have long been an essential bio-derived material for the feeder culture method of iPSC culture. This study demonstrates that MFGE8 in MEF-CM is a functional factor in the promoting of cell adhesion of human iPSCs. Furthermore, the use of MFGE8-containing media demonstrates that iPSCs can be established and cultured while maintaining pluripotency and inducing three germ layer differentiation. The results of this study suggest the possibility of using MFGE8 as a scaffold material suitable for inducing differentiation when reproducing invivo maturation in vitro.

Development of Advanced Processing Techniques for Pigeon Pea Dal to Enhance In vitro Protein Digestibility

Pigeon pea (Cajanus cajan) is a nutritionally significant legume, rich in protein (18–25%), carbohydrates (57.6%), and essential micronutrients such as ascorbic acid, folic acid, niacin, and pantothenic acid. However, the presence of antinutritional factors such as polyphenols, phytic acid, and enzyme inhibitors adversely impacts protein digestibility and bioavailability. This study was conducted to develop advanced, energy-efficient thermal processing methods, including hydrothermal treatment, autoclaving, and infrared heating, to enhance the in vitro protein digestibility (IVPD) and reduce the polyphenol content of pigeon pea dals. Each treatment was applied at varying intensities, followed by different drying durations, and evaluated for moisture content, IVPD, and polyphenol levels. The moisture content across treatments ranged from 8.45% to 16.78%, with the lowest levels achieved under extended drying durations (5 hours for hydrothermal and infrared heating, and 8 hours for autoclaving). IVPD significantly increased with thermal exposure, reaching 82.81% in hydrothermal (HT30+DT5), 85.72% in autoclaving (AC60+DT8), and 85.12% in infrared heating (IRH30+DT5). Polyphenol content exhibited a decreasing trend with increasing duration of thermal treatment. This reduction is attributed to thermal degradation of polyphenols during treatment. Thermal processing disrupted protein matrices and degraded polyphenols, contributing to improved digestibility.

A Lipoxygenase Gene Modulates Jasmonate Biosynthesis to Enhance Blast Resistance in Rice.

Inhibition of jasmonic acid (JA) signaling renders plants more susceptible to biotic stresses. Pathogen infection can induce an increase in JA levels. However, our understanding of the mechanisms mediating pathogen-induced JA accumulation in rice (Oryza sativa) remains limited. We characterized OsLOX9, a lipoxygenase gene of the 13-LOX subfamily involved in JA biosynthesis, which is induced upon infection by the rice blast fungus Magnaporthe oryzae. Two independent lox9 mutants exhibited increased susceptibility to M. oryzae infection, a phenotype that was fully restored by methyl-JA (MeJA) treatment, and showed a reduced pathogen-induced accumulation of 12-oxo-phytodienoic acid, JA, and its bioactive form JA-Ile. RNA sequencing-based expression analysis in response to M. oryzae infection revealed an essential role of OsLOX9-produced JAs in upregulating terpenoid phytoalexin pathway genes. Furthermore, we found that the JA core transcription factor, OsMYC2, can bind to the promoter of OsLOX9 and activate its expression, creating a positive feedback loop during pathogenesis. This study reveals that OsLOX9 is a key blast fungus-induced JA biosynthetic gene and contributes to rice resistance to blast disease.

Periorificial dermatitis in infants and preschoolers - a narrative review.

Periorifical dermatitis (POD) is a papular, chronic inflammatory skin disease commonly seen in women in their 2nd to 4th decade of life. The major differential diagnosis is persistent acne. In children, POD is less common than in adults. In infants and preschoolers POD is rare. We performed a narrative review for POD in children ≤6years of age. Diagnosis is clinical. The disease presents with monomorphic erythematous papules that usually leave a 1-2mm Grenz zone around the red lips unaffected. Perinasal skin, nostrils and eyelids can be involved, while extrafacial manifestations are rare. The granulomatous subtype of POD is more common in small children that in adults. The most important differential diagnoses in children include atopic and seborrheic dermatosis, pediatric rosacea, juvenile acne, and cutaneous sarcoidosis. While topical macrolides, azelaic acid, and calcineurin inhibitors are often used in mild cases of adult POD, oral tetracyclines are the treatment of choice in more advanced cases. In infants and preschoolers, tetracycline should be avoided since they can affect the calcification (hardening) of the bones and teeth and lead to permanent discoloration of teeth. There are no randomized controlled trials for POD in this age group available. Topical metronidazole or erythromycin and oral erythromycin are most used. New drugs like JAK inhibitors are on the horizon.

Outcomes for infants with BRUE diagnosed with oropharyngeal dysphagia or gastroesophageal reflux disease: a multicenter study from the Pediatric Health Information System Database.

We aimed to determine the prevalence of gastroesophageal reflux disease (GERD) and oropharyngeal dysphagia as explanatory diagnoses, risk factors for acid suppression treatment, and risk factors for repeat hospital visit in infants hospitalized after brief resolved unexplained event (BRUE) using a multicenter pediatric database. We performed a multicenter retrospective database study of infants admitted with BRUE in the Pediatric Health Information System between 2016 and 2021. Data included diagnostic testing, explanatory diagnoses, treatment with acid suppression, and related repeat hospital visits within 6months. Multivariable logistic regression models were used to determine risk factors for treatment with acid suppression and repeat hospital visit. Of 17,558 subjects admitted to 47 hospitals, 34% were given an explanatory diagnosis of GERD and 1.4% oropharyngeal dysphagia. Twelve percent were treated with acid suppression, with some centers having rates as high as 26%. Multiple factors, including most notably the GERD diagnosis, were associated with increased prescribing risk. Ten percent of subjects had repeat hospital visits. Subjects given an explanatory diagnosis of GERD (OR 1.66, 95% CI 1.48-1.86, p < 0.001) or oropharyngeal dysphagia (OR 2.13, 95% CI 1.55-2.91, p < 0.001) had increased risk for repeat hospital visit as did those treated with acid suppression. CONCLUSION: GERD as an explanatory diagnosis was associated with increased risk of repeat hospital visit, despite its conception as a benign, treatable condition. Treatment with acid suppression was common but did not prevent repeat hospitalization. Oropharyngeal dysphagia as an explanatory diagnosis was also associated with increased risk of repeat hospital visit.

Angelica gigas Nakai (Korean Dang-gui) Root Alcoholic Extracts in Health Promotion and Disease Therapy - active Phytochemicals and In Vivo Molecular Targets.

Angelica gigas Nakai (AGN) root is a medicinal herbal widely used in traditional medicine in Korea. AGN root ethanolic extracts have been marketed as dietary supplements in the United States for memory health and pain management. We have recently reviewed the pharmacokinetics (PK) and first-pass hepatic metabolism of ingested AGN supplements in humans for the signature pyranocoumarins decursin (D, Cmax 1x), decursinol angelate (DA, Cmax ~ 10x) and their common botanical precursor and hepatic metabolite decursinol (DOH, Cmax ~ 1000x). Here we update in vivo medicinal activities of AGN and/or its pyranocoumarins and furanocoumarin nodakenin in cancer, pain, memory loss, cerebral ischemia reperfusion stroke, metabolic syndrome and vascular endothelial dysfunctions, anxiety, sleep disorder, epilepsy, inflammatory bowel disease, osteoporosis and osteoarthritis. Given their polypharmacology nature, the pertinent mechanisms of action are likely misrepresented by many cell culture studies that did not consider the drug metabolism knowledge. We report here Rho-associated protein kinases (ROCK1/2) as novel targets for DA and DOH. Combining with published inhibitory activity of DOH on acetylcholinesterase, agonist activity of DOH and antagonist/degrader activity of DA/D on androgen and estrogen receptors, D/DA promoting activity for glutamic acid decarboxylase (GAD)- gamma-aminobutyric acid (GABA) inhibitory axis and inhibition of glutamate dehydrogenase (GDH), monoamine oxidase-A (MAO-A) and transient receptor potential vanilloid 1 (TRPV1), we postulate their contributions to neuro-cognitive, metabolic, oncologic, vascular and other beneficial bioactivities of AGN extracts. A clinical trial is being planned for an AGN extract to manage side effects of androgen deprivation therapy in prostate cancer patients.

Vonoprazan Fumarate: A Promising Therapeutic Option for the Rapid Relief of Laryngopharyngeal Reflux Disease.

The aim is to examine the Reflux Symptom Score-12 (RSS-12) and assess the effectiveness of vonoprazan fumarate in managing laryngopharyngeal reflux disease (LPRD) among the Chinese population. A total of 140 patients with LPRD who were treated at our otorhinolaryngology outpatient clinic were included. The patients were randomly divided into the vonoprazan treatment group and the esomeprazole treatment group. The outcome indicators were the pretreatment and post treatment values of the Reflux Symptom Index (RSI), RSS-12, and reflux finding score. The mean pretreatment RSS-12 and RSI values were 55.79±11.94 and 18.67±3.60 in the vonoprazan treatment group and 54.91±11.95 and 18.44±3.66 in the esomeprazole treatment group, respectively. Furthermore, both groups showed a significant decrease in the RSI and RSS-12 values after 4, 8, and 12weeks of acid suppression therapy. In particular, 12weeks of treatment led to a good treatment response in 91.4% and 87.1% of the patients in the vonoprazan treatment and esomeprazole treatment groups, respectively, based on their RSI values, and a favorable treatment response in 82.9% and 77.1% of those in the vonoprazan treatment and esomeprazole treatment groups, respectively, according to their RSS-12 values. More importantly, after 4 and 8weeks of acid-suppressive therapy, the relative baseline change in RSS-12 scores in the vonoprazan treatment group was considerably larger than that in the omeprazole treatment group. Compared to proton pump inhibitors (PPIs), vonoprazan fumarate has demonstrated superior early therapeutic efficacy, resulting in a notable improvement in laryngopharyngeal reflux symptoms at the start of treatment. When we extended acid-suppressive medication for 12weeks, we saw a treatment effect comparable to that ofPPIs.

A Pharmacokinetic/Pharmacodynamic Study of Esomeprazole Comparing a Dual Delayed-Release Formulation (YYD601) to a Conventional Formulation Following Multiple Administrations in Healthy Adult Subjects.

YYD601 is a new dual delayed-release formulation of esomeprazole, developed to enhance plasma exposure and prolong the duration of acid suppression. This study aimed to evaluate the safety, pharmacokinetic (PK), and pharmacodynamic (PD) profiles of YYD601 20 mg following single and multiple oral administrations in healthy, fasting adult Koreans, and to compare these outcomes to those of the conventional esomeprazole 20 mg capsule. A randomized, open-label, two-period crossover study was conducted in 28 participants, who were divided into two treatment groups: one group received YYD601 20 mg, and the other received conventional esomeprazole 20 mg, once daily for five consecutive days. Blood samples for PK analysis were collected pre-dose and up to 24hours post-dose. The primary PK parameters (AUClast and AUCτ) were evaluated. PD endpoints included integrated gastric acidity, percentage of time with intragastric pH > 4 over 24-hour and nighttime intervals, and percent change in serum gastrin levels after multiple dosing. A total of 22 participants completed the study. YYD601 displayed more prolonged plasma concentration-time profiles than the conventional formulation, although the extent of the systemic exposure (AUC values) showed no statistically significant difference between the two formulations. With regard to the 24-hour gastric acid inhibition, YYD601 was comparable to the conventional formulation. The YYD601 showed a greater tendency for acid inhibition at night, as indicated by the percentage change of time with nocturnal acid breakthrough and other PD parameters. Both treatments were well tolerated, with no serious adverse events reported. Through extended systemic exposure of esomeprazole, YYD601 produces gastric acid suppression that is comparable to that of the conventional esomeprazole formulation, with a greater tendency to suppress acid at night. YYD601 20 mg was safe and well tolerated following single and multiple oral administrations, supporting its use as an effective alternative to conventional esomeprazole therapy. http://clinicaltrials.gov, NCT03985319 (Date of registration: May 29, 2019; Study period: between July 2019 and March 2020).

Evaluating the efficacy of chemically modified pinacol as an acidic corrosion inhibitor for mild steel: A comparative study

Evaluating the efficacy of chemically modified pinacol as an acidic corrosion inhibitor for mild steel: A comparative study

Pig urine-induced ternary buffering complex and microbial community for mitigating acid inhibition in high-solid anaerobic digestion of rice straw

Pig urine-induced ternary buffering complex and microbial community for mitigating acid inhibition in high-solid anaerobic digestion of rice straw

Enhancing low-temperature anaerobic digestion of nitrogen-rich feedstocks: Mitigating free ammonia and short-chain fatty acid inhibitions

Enhancing low-temperature anaerobic digestion of nitrogen-rich feedstocks: Mitigating free ammonia and short-chain fatty acid inhibitions

Deposition selectivity on oxide versus metal surfaces via catalyzed atomic layer deposition of SiO2 and vapor-dosed phosphonic acid inhibitors

Deposition selectivity on oxide versus metal surfaces via catalyzed atomic layer deposition of SiO2 and vapor-dosed phosphonic acid inhibitors

GATA3-COMT1-Melatonin as Upstream Signaling of ABA Participated in Se-Enhanced Cold Tolerance by Regulate Iron Uptake and Distribution in Cucumis sativus L.

Selenium has the function of bio-stimulating hormone. However, the underlying physiological and molecular mechanisms of melatonin and abscisic acid as secondary messengers in improving cold tolerance by selenium are limited. This study investigated the effects of selenite on the cold stress of cucumber seedlings. The results showed that the content of endogenesis abscisic acid significantly changed with exogenous application of selenite under cold stress. Interestingly, we found that the content of iron significantly changed in this process. Iron uptake and distribution may be the important reason of selenium alleviates cold injury of cucumber seedlings. Whole genes transcriptome was used for screening key genes on leaf and root of cucumber seedlings. To determine the interrelation between abscisic acid and melatonin in selenite alleviating cold stress, abscisic acid inhibitor fluridone and melatonin synthesis inhibitor p-chlorophenylalanine were used for in-depth study. The results indicate that melatonin as upstream signal of ABA involved in selenium enhanced cucumber cold tolerance. The results of yeast single hybridization, EMSA, LUC, and overexpression transgenic showed that the transcription factor CsGATA3 regulates the expression of CsCOMT1 in vitro and in vivo and affects melatonin content. This study provides a theoretical basis for cucumber cultivation and breeding.

Utilization of Acid Suppressants After Withdrawal of Ranitidine in Korea: An Interrupted Time Series Analysis.

This study was performed to evaluate the utilization patterns of acid suppressants following the withdrawal of ranitidine in Korea. Health Insurance Review & Assessment Service (HIRA) data from January 2016 to May 2023 were utilized to assess the usage of histamine H2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) for acid-related diseases. Drug utilization was calculated for each agent based on the defined daily dose (DDD). To evaluate changes in utilization following the ranitidine recall, an interrupted time series analysis was conducted using segmented linear regression and an autoregressive integrated moving average model. Before the withdrawal of ranitidine, the DDD per 100,000 inhabitants per day was increasing by 6.9 (95% confidence interval [CI], 4.7 to 9.0) for H2RAs and by 19.3 (95% CI, 16.9 to 21.8) for PPIs each month. After the recall, H2RA utilization immediately declined by -1041.7 (95% CI, -1,115.8 to -967.7), followed by a monthly increase of 6.6 (95% CI, 3.7 to 9.6) above the previous trend. PPI utilization temporarily surged by 235.2 (95% CI, 149.1 to 321.3), then displayed a monthly increase of 4.1 (95% CI, 0.7 to 7.6) on top of the pre-recall trend. Among PPIs, esomeprazole and rabeprazole demonstrated notable increases, representing the most commonly used acid suppressants in 2023. PPI usage rose prominently following the withdrawal of ranitidine from the market. Considering the potential adverse effects of PPIs, further research is necessary to evaluate the public health implications of shifts in the utilization of acid suppressants.

Kinetics and mechanism of gallic acid as an ecofriendly corrosion inhibitor for steel rebars in mortar

Chloride-induced corrosion of steel rebars embedded in mortar was effectively controlled by blending of gallic acid in wet mixture. Mixing of optimized concentration of gallic acid (GA) inhibitor (0.125%) in mortars considerably increased the charge transfer resistance of embedded rebars (80.11 Ω cm2) in comparison to that noted for the control mortars (3.36 Ω cm2) after 37 cycles of wet/dry treatments. The corrosion inhibition efficiency after this cycle of exposure was of the order of 95%. The studied inhibitor also improved the workability (% flow of wet mix) from 25% for control to 43% at its optimum dosing. It is suggested that GA transforms into negatively charged gallate anions in an alkaline-pore solution of concrete and electrostatically attracted to the positively charged calcium ions, forming a complex with a partial positive charge. This complex interacts with the negatively charged maghemite film formed on rebar surface and forms a protective film of FeO− Ca++– GA anion, isolating it from the aggressive electrolyte. The experimental results showed that Ca++ ion of the concrete had a strong synergistic effect in boosting the inhibitive performance of the GA. The inhibition efficiency increased from 84.1% in the presence of GA only to 97.9% for the mixture of GA and calcium ions.

Efficacy and safety of rebamipide/nizatidine in patients with erosive gastritis: A randomized, multicenter, phase 4 study.

For the treatment of gastritis, rebamipide, a mucoprotective agent, and nizatidine, a gastric acid suppressant, are commonly employed individually. To compare the efficacy of Mucotra® SR (rebamipide 150 mg) and Axid® (nizatidine 150 mg) combination therapy with the sole administration of Axid® in managing erosive gastritis. A total of 260 patients diagnosed with endoscopically confirmed erosive gastritis were enrolled in this open-label, multicenter, randomized, phase 4 clinical trial, allocating them into two groups: Rebamipide/nizatidine combination twice daily vs nizatidine twice daily for 2 weeks. The full-analysis set analysis encompassed 239 patients (rebamipide/nizatidine, n = 121; nizatidine, n = 118), while the per-protocol analysis included 218 patients (n = 110 vs 108). Post-treatment assessments comprised primary (erosion improvement rate) and secondary (erosion and edema cure rates, erythema improvement rates, hemorrhage, and gastrointestinal symptoms) endpoints. Furthermore, drug-related adverse effects were evaluated. Primary efficacy assessment showed a statistically significant improvement rate in mucosal erosions in the combination group compared to the control group in the full-analysis set (rebamipide/nizatidine 62.0%, nizatidine 49.2%, P = 0.046), with a similar trend noted in the per-protocol analysis (62.7% vs 50.0%, P = 0.058). Both groups were effective in curing erosion and edema and improvement of bleeding, erythema, and gastrointestinal symptoms, whereas no inter-group differences were noted. When confined to the participants with gastritis symptoms, improvement of erosion was more optimal in the combination group (63.0% vs 49.5%, P = 0.046). No adverse events related to the drugs were observed. Rebamipide/nizatidine combination is effective in treatment of erosive gastritis.

Clinical Research Progress of Treatment of Reflux Esophagitis by Integrated Traditional Chinese and Western Medicine

In recent years, the incidence of reflux esophagitis has been increasing year by year. This article aims to summarize the literature on RE inrecent years and elaborate on the etiology and treatment of RE from the perspective of integrated Chinese and Western medicine, and holds its pathogenesis of reflux esophagitis is still unclear. while utilizing targeted treatment with Western medicine, individualized treatment with traditional Chinese medicine can often be combined to reduce the recurrence rate of RE, reduce dependence on acid suppressants, and improve clinical efficacy and patient quality of life.

Upper gastrointestinal triple stenosis in a patient with trisomy 17p syndrome: Case report and literature review

AbstractUpper gastrointestinal stenosis, which can be congenital or acquired, can lead to dysphagia. The association between trisomy 17p syndrome, a rare chromosomal abnormality, and upper gastrointestinal stenosis is unclear. A 20‐year‐old man diagnosed with trisomy 17p syndrome was referred to our department due to recurrent vomiting. Esophagogastroduodenoscopy revealed stenotic areas in the esophagus, stomach, and duodenum. The congenital gastrointestinal stenosis present in both the duodenum and esophagus suggested that the stasis and reflux of digestive fluids exacerbated stenosis in the stomach and esophagus. Gastric acid suppression therapy and endoscopic dilation of the esophagus and duodenum effectively resolved the patient's vomiting symptoms.