Treatment Of GERD Research Articles

Pancreatic Acinar Metaplasia (PAM) in the Distal Esophagus - Is it a Variant of Pancreatic Heterotopia or an Under Reported Histological Finding?

Purpose: Introduction: PAM consists of nests or lobules of pancreatic acinar cells which are characterized by the presence of fine acidophilic granules in the apical cytoplasm and prominent basophilia of the basal portion of the cells. They contain exocrine pancreatic markers such as lipase, trypsinogen, and pancreatic alpha-amylase. Pancreatic heterotopia (PH) (pancreatic rest) is distinguished from PAM by the presence of ductal elements, pancreatic stroma or well defined islets. We report a case of PAM above the gastro esophageal junction (GEJ) and present a brief review of the literature. Case: A 77 year old woman with known GERD for more than 10 years underwent a follow up EGD for refractory symptoms. Patient had a known history of acoustic neuroma treated with resection and radiotherapy, and hyper plastic colon polyps. The current EGD showed a small hiatus hernia and irregular Z line, a fundic gland polyp, and erythematous gastropathy. Biopsies of the distal esophagus showed gastric mucosa with ectopic pancreatic tissue and adjacent inflammation. There was no evidence of BE or H. Pylori gastritis. Discussion: Out of 644 patients who underwent EGD Johansson et al identified PAM above GEJ in 40 (6%), below GEJ in 67 (10%) and both above and below GEJ in 14 (2%). Female gender, H. Pylori infection and GERD were associated with PAM above the GEJ. Focal PAM was found in 11 of 350 (3.14%) biopsies of Barrett's mucosa from 120 patients with BE enrolled in a clinical efficacy trial of omeprazole versus ranitidine for treatment of GERD. Another study by Popiolek et al examined GEJ specimens from 69 young adults and children and found that PAM was present in 16% of the study population and was not associated with BE. The data suggested that PAM at the GEJ develops independently of inflammation and was felt to be a congenital. In contrast, anecdotal reports of heterotopic pancreas (commonly recognized as pancreatic rest) causing abdominal pain, acute pancreatititis, GI bleeding, gastric perforation, gastric outlet obstruction, obstructive jaundice, intussuception, pseudocyst formation, and rarely adenocarcinoma have been described. The presence of PAM above GEJ is likely congenital and may have no clinical relevance or malignant potential. However it remains a distinct and common histological finding and may be underreported in clinical practice.

Gastroesophageal reflux disease

GERD is a common chronic gastrointestinal disorder, and its prevalence in Asia is increasing. Classical symptoms of heartburn and regurgitation are common presentations. There is no standard criterion for the diagnosis of GERD, and 24-h pH monitoring lacks sensitivity in NERD. Furthermore, diagnostic studies for gastroesophageal reflux disease have several limitations. A short course of PPI is often used in clinical practice as a diagnostic test for gastroesophageal reflux disease. Elderly patients with GERD usually present with atypical manifestations, and they tend to develop more severe disease. PPI remains the mainstay of treatment for GERD. In a subset of patients who wish to discontinue maintenance treatment, anti-reflux surgery is a therapeutic option.

Endoscopic lower esophageal sphincter bulking for the treatment of GERD: safety evaluation of injectable polymethylmethacrylate microspheres in miniature swine

Endoscopic therapy for GERD is an appealing, minimally invasive alternative to medical treatment and surgery. Various materials have been tested to augment the lower esophageal sphincter (LES), with limited success. To our knowledge, safety and migration of polymethylmethacrylate (PMMA) microspheres has never been evaluated. To assess the safety, migration, inflammatory reaction, and durability of PMMA injected into the LES of miniature swine to create a reflux barrier. Animal study. Approved animal research facilities. Injection of the LES of miniature swine with PMMA. Histopathology of the injected site at certain intervals and postnecropsy microsphere counts of various organs. Minimal inflammatory reaction at the injection site, persistent bulking effect of the material, and no migration of microspheres. Injection of LES with PMMA caused a mild inflammatory reaction. The bulking effect of the injected material was persistent. Migration of microspheres was eliminated with the use of larger-sized microspheres. Animal model. Our phase I study documented that 40-microm polymethylmethacrylate microspheres are biocompatible and that PMMA microspheres are resistant to degradation when injected submucosally into the wall of the esophagus. The detection of 40-microm PMMA microspheres in local lymph nodes, liver, and lungs of some animals in the phase I study clearly documented transport of PMMA away from the injection site. This finding was eliminated by increasing the size of microspheres to 125 microm. The potential therapeutic effects of these larger microspheres for humans with GERD remains to be evaluated.

Symptomatic outcome following laparoscopic anterior 180° partial fundoplication: Our initial experience

Gastroesophageal reflux disease is increasing in frequency in the Asia Pacific region, which can be attributed to increase in awareness among doctors and patients and/or true increase in the prevalence of this disease. Surgical treatment of GERD is well established in the West and in selected clinical situations, provides well recognized benefits over non-surgical treatment. In contrast, there are only a few published studies in Asia especially on the outcome of the laparoscopic anterior fundoplication within the Asian community. Our aim is to evaluate symptomatic outcome of laparoscopic anterior 180° fundoplication in our community. Prospective analyses of 25 consecutive patients were done using a standardized questionnaire post-operatively. Overall satisfaction and the symptoms of heartburn and dysphagia were assessed together with other adverse effects of the surgery. Follow up was carried at a median of 9 months after surgery. Symptoms of heartburn assessed using the VAS showed significant drop from mean 7.4 pre-operatively to mean 1.75 postoperatively. De Meester symptom score indicated that a majority (56%) of patients reported none/minimal GERD symptoms, the other 44% reported mild GERD symptoms. This showed a vast improvement compared to pre-operative scoring where 80% of the patients reported moderate to severe GERD symptoms. This directly correlates with the estimation of patient satisfaction using Visick grading system with 24 (96%) patients reported none or mild symptoms post operatively. Overall, it is reasonable to conclude that laparoscopic anterior partial fundoplication achieved a satisfactory rate of overall success in our centre at short term follow up. Key words: Laparoscopic anterior fundoplication, GERD, symptomatic outcome.

T1134 Clinical Predictive Symptoms of Sliding Hiatus Hernia in Gastro-Esophageal Reflux Disease (GERD) Patients

outcome of a cohort of patients with symptoms suggestive for GERD after traditional or wireless pH monitoring. Material and methods: Fifty one consecutive patients (20 M, 22-78 years), 35 with typical and 16 with atypical symptoms, who underwent 96h wireless pH monitoring and 51 patients, matched for age, sex and symptom of referral (principal symptom), who underwent 24h traditional pH monitoring entered the study. All patients were contacted with a structured telephone interview regarding GERD treatment after pH monitoring, concordance between GERD treatment and results of pH monitoring, improvement of the principal symptom and satisfaction (1-10 visual analogue scale, VAS). pH monitoring was classified as positive (time at pH 4.7% and/or SAP>95%), negative (time at pH<4 <4.7% and SAP<95%) or indeterminate (time at pH<4 <4.7% and SAP not measurable). Results: Proton pump inhibitors were used in 86% and 76% of patients before wireless and traditional pH monitoring (p=NS). In the wireless group prolonging recording period from 24 to 48 and 96h decreased indeterminate tests from 16 to 11 and 5 respectively (p<0.01). After pH monitoring, treatment was modified in 57% and 51% of the patients in the wireless and traditional group respectively, concordance between results of the test and treatment for GERD being higher in the wireless compared to the traditional group, 78% vs 58% of the patients (p<0.05). A positive and an indeterminate test similarly increased the likelihood of GERD treatment compared to a negative test, RR 1.91 (1.32.8) and RR 1.83 (1.2-2.9) respectively. Both improvement/disappearance of the principal symptom and satisfaction at time of the telephone interview were similar in the two groups, 73% vs 65% and 69% vs 62%. Conclusions: 96h wireless pH monitoring increased the likelihood to exclude/confirm GERD as the cause of the patients’ symptoms; treatment was concordant with the test’s result more frequently than after traditional pH monitoring. Outcome, although favorable in more than two thirds of the patients, was similar to the one of traditional pH monitoring. # A. Oesophagus 1. GERD

284 Laparoscopic Antireflux Surgery vs Long-Term Esomeprazole Treatment for Chronic GERD. Final Results After 5 Yrs of Follow up in the Lotus Study

Introduction A once-only flexible sigmoidoscopy (FS) screening at age around 60 has been proposed as a cost-effective and acceptable method of reducing colorectal cancer (CRC) incidence and mortality. We undertook a large randomised controlled trial in a general population sample to compare CRC incidence and mortality rates following a single FS screen. Methods and baseline results Between 1994 and 1999, we sent a questionnaire to 375 744 men and women, aged 55 to 64 years, in 14 UK centres, asking whether they would have the FS screening if invited. Those who responded ‘yes definitely' or ‘yes probably' and were found to be eligible (n = 170 432) were randomised to the control or intervention arms of the trial in a 2:1 ratio. Of 57 254 people invited, 40 674 (71%) were screened. Following screening, 38 525 (95%) had either no pathology or only low-risk adenomas and were discharged and 2051 had high risk adenomas detected and underwent colonoscopy. Biannual updates on status (emigration, cancer diagnoses or deaths) were obtained by matching with the National Health Service Central Register, Office of National Statistics, UK cancer registries, and Hospitals Episodes Statistics records. Results of follow-up The median follow-up time to death, emigration or 31st December 2008 is currently 11 years. A total of 2491 participants developed CRC during 1.85 million person years of follow-up: 1523 developed a distal cancer (rectum or sigmoid colon), 894 developed cancer in the proximal colon, 34 developed cancer in both sites, and in 40 cases the site was not known. On an intent-to-treat analysis, a significant reduction in incidence of total and distal CRC was observed among those invited for screening. A greater reduction was seen among those who attended for screening. Colorectal cancer mortality rates were also reduced significantly. Adjustment for self-selection bias in attenders using Cuzick et al's method (Stat Med 1997;16:1017-29) made little difference to the rate ratios or significance. Conclusion By 11 years, total and distal colorectal cancer incidence rates were reduced significantly among people offered a single flexible sigmoidoscopy screen between ages 55 and 64 years, and so far no attenuation of effect has been observed. Detailed results will be presented.

Beyond Acid Suppression: New Pharmacologic Approaches for Treatment of GERD

Proton pump inhibitors are highly successful in treating gastroesophageal reflux disease, but a significant proportion of patients have persistent symptoms from weakly or nonacidic reflux. Transient lower esophageal sphincter relaxation (TLESR) represents the dominant mechanism of gastroesophageal reflux and has therefore become the most intensely investigated therapeutic target. The triggering of TLESR involve the vagal pathways and the gamma-aminobutyric type B (GABA(B)) and metabotropic glutamate type 5 (mGluR5) receptors. Baclofen is a GABA(B) receptor agonist that is effective in inhibiting TLESR and reducing the number of reflux episodes, but is associated with significant central nervous system (CNS) side effects. The newer GABA(B) agonists, such as AZD9343 and AZD3355, and mGluR5 antagonists, such as 2-methyl-6-(phenylethynyl)-pyridine (MPEP), have been shown in small, randomized, controlled trials to have comparable efficacy to baclofen, but possibly a more favorable CNS side effect profile. Cannibinoid agonists, such as Delta(9)-THC, have also been demonstrated to reduce TLESRs and reflux events respectively. Macrolide antibiotics (eg, erythromycin) show early promise in a select group of patients with possible reflux associated post-lung transplant problems.

GERD-related Chronic Cough

GERD-related Chronic Cough

Insights Gained From the Symptomatic Evaluation of Classification of Esophageal Motility Disorders: A Review of 4215 Patients

Purpose: Achalasia (Ach), diffuse esophageal spasm (DES), nutcracker esophagus (NC), and non specific motility disorder (NSMD), are described primary esophageal body motility disorders. The relationship between manometric diagnosis and clinical symptoms is poorly understood. The aim of this study is to examine the correlation between patient's presenting symptoms and manometric findings. Methods: Manometric findings and reported symptoms of all patients undergoing esophageal manometry and pH studies at the Creighton University Medical Center were prospectively entered in a database. Twenty-four year data was accessed and analyzed to understand symptom correlation. Results: Of the 4215 patients, 130(3.1%) had Ach, 192 (4.6%) had DES, 290 (6.9%) had NC, 508 (12.1%) had NSMD and 3095 (73.4%) had normal esophageal body motility. There is significant symptom overlap between the groups. The pattern of symptom distribution is similar in patients with Ach and DES with dysphagia correlating with increasing simultaneous waves. Patients with NC, normal body motility and NSMD predominantly presented with reflux symptoms. Twenty-four hour pH score and reflux associated symptoms are inversely related to the LES competence. Conclusion: Symptoms and manometric diagnosis do not correlate well on an individual basis. Achalasia- DES seem to be part of the same clinical spectrum. Lower esophageal sphincter competence plays an important role in preventing gastro-esophageal reflux. Treatment of GERD and its related esophageal body motility disturbances should be directed at restoring LES competence.

Will skepticism stop the evolution of endoscopic GERD treatment?

Will skepticism stop the evolution of endoscopic GERD treatment?

Can we get the necessary clinical trials in children and avoid the unnecessary ones?

Clinical trials are necessary to provide data on the safety, efficacy and optimal use of medicines. In children, data are needed to cover all ages, from newborns to adolescents. Getting the necessary clinical trials performed is required to achieve the goals of the U.S., EU and WHO paediatric medicines initiatives [1]. However, as stated in the EU Paediatric Regulation [2], unnecessary trials should be avoided for obvious ethical reasons. For new medicinal products of therapeutic interest for children, the EU requirement of early submission of a Paediatric Investigation Plan (PIP) for approval by the Paediatric Committee (PDCO), and compliance with the PIP to get the substantial reward/incentive are likely to capture most of the necessary trials being [2] performed. So far the majority of the 122 PIPs approved by the PDCO [3] include a deferral for the studies to be performed after more data become available in adults. However, it is already evident that clinical trials of off-patent products will not be performed in children to the same extent as they will be for the new products. Only 13 (4%) of the 313 PIPs submitted were for off-patent products [3]. When we consider that 70–80% of approved medicines are not labelled for children, and about half of the medicines used for children are off-label, the work ahead is substantial before the necessary clinical trials are performed and paediatric data have been appropriately assessed. Prioritising the medicines to be studied on the basis of children’s needs has proven difficult. It is also uncertain whether the way the EU is funding the study of the prioritised medicines will result in necessary or ‘scientifically interesting’ trials. Much paediatric data on medicines used off-label in children exist but have never been submitted for regulatory assessment and are not included in the product information. The recently published paper of Tafuri et al. in this journal [4] demonstrated that for two of the five proton pump inhibitors (PPI) used in the treatment of GERD in children, much of the necessary clinical evidence already exists and is publicly available. Existing data may also fill at least a significant part of the regulatory requirements for paediatric labelling, which is not necessarily surprising as three of the five products studied are already labelled for children in the U.S. Studying the other two PPIs is hardly necessary. However, as the example of SSRI studies in adolescents’ showed [5], important existing data are not always available, particularly not data from industry-sponsored trials that show negative results for safety or efficacy [5]. The provisions of the EU Paediatric Regulation [2] for making information on all paediatric clinical trials, including results, publicly available and the requirement for the marketing authorisation holders to submit all paediatric studies, including those not in the public domain, for assessment to the competent authority should further help reduce unnecessary duplication of trials. Available data are not always as good as for the PPIs but may still contain important information that should be considered before new clinical trials are planned. Old data, modern understandings of developmental pharmacology and modelling methods combined with clinical experience may be substituted for the learning phase of the learningconfirming cycle of trials to attain the necessary data for safety and efficacy. This approach is currently being tested Eur J Clin Pharmacol (2009) 65:747–748 DOI 10.1007/s00228-009-0675-y

Patient factors predictive of 24-h pH normalization following endoluminal gastroplication for GERD

Endoluminal full-thickness gastroplication has been documented to provide significant and long-lasting improvement of GERD symptoms and health-related quality of life (HRQL) with very little patient morbidity. These treatments, however, are criticized for normalizing esophageal acid exposure in only 30-40% of patients treated. We hypothesize that there are objective criteria that will identify those patients who will have a normal DeMeester score (DMS) following endoluminal treatment. Data from a prospective multicenter trial using the NDO Plicator device to treat GERD were available for statistical analysis. All patients were treated with endoluminal full-thickness gastroplication. All patients had GERD symptoms and abnormal 24-h pH exposure preoperatively. Postoperative objective outcome was assessed by performing 24-h pH studies at 6 months. Univariate and multivariate regression analyses were performed to determine factors predictive of successful treatment (normalized 24-h pH). A total of 266 patients were included in the study. Mean preoperative DMS was 47.91 (+/-31.34). Postoperatively, mean DMS decreased significantly (37.11 +/- 24.63, p < 0.001), and 31.67% of patients had a DMS within normal range (DMS < 22). Results of multivariate regression analysis demonstrated that the following preoperative patient characteristics were predictive of postoperative success (normal DMS): DMS < 30 (odds ratio [OR] = 4.24, 95% confidence interval [CI] = 1.73, 10.36, p < 0.001), heartburn score < 2 (OR = 3.37, CI = 1.44, 7.89, p = 0.005), and BMI < 30 (OR = 4.93, CI = 1.55, 15.61, p = 0.007). Data analysis from this prospective study indicates that the odds of objective success would be significantly greater if the treatment was restricted to thinner patients with mild reflux disease. This may help define the optimal place for endoluminal therapy in a comprehensive GERD treatment algorithm.

T1061 Do Gastroenterologists Evaluate Patient GERD Symptom Severity and Treatment Outcome More Accurately Than Other Medical Specialists? Usefulness of a Combined Patient Self-Assessment Questionnaire (ReQuest®) and a Physician Symptom Likert Scale

T1061 Do Gastroenterologists Evaluate Patient GERD Symptom Severity and Treatment Outcome More Accurately Than Other Medical Specialists? Usefulness of a Combined Patient Self-Assessment Questionnaire (ReQuest®) and a Physician Symptom Likert Scale

W1849 Clinical Course of Extra-Esophageal Disorders in Gastroesophageal Reflux Disease During Routine Care: A 5-Year Follow-Up Study

P>0.05).All 5 GERD bleeders required endoscopy treatment had multiple esophageal ulcers(LA class C or D).The majority of the GERD bleeders 63/84 had multiple esophageal ulcers. Other risk factors for patients with bleeding GERD were identified. Barrett's esophagus was found in 11/58 (19%) of GERD bleeders (26/84 had LA class D were unable to diagnose Barrett's) comparing to 10% in general GERD patients, odd ratio was 1.9 (P<0.05). NSAID use found in 13/84 (15%), odd ratio was 2.5 (P<0.05). 18/84 of the GERD bleeders were taking maintenance treatment for GERD at the time of the bleeding. Only 6/84 GERD bleeder had abdominal pain or reflux symptomes on admission. CONCLUSIONS:AUGIB is a serious complication of GERD.It required admission to hospital, blood transfusion and endoscopic treatment.Barrett's esophagus,NSAID use, and multiple esophageal ulcers were significant risk factors for GERD bleeding.REFERENCES:(1)PJKahrilas, NEnglJMed 2008;359:1700-7. (2)Boonpongmanee et al Gastrointestinal Endosc 2004;59:788-94

Clinical and Histopathologic Response to Various Treatment Interventions in Patients with EE

RATIONALE: To define the clinical and laboratory characteristics and response to therapy in a population of patients with eosinophilic esophagitis (EE).METHODS: A retrospective analysis of 32 pediatric patients with EE.RESULTS: The majority of patients were male (83%) with a median age of onset of 3y (range 4 m-16y). Other atopic diseases included acute food reactions (6%), asthma (41%), allergic rhinitis (53%), and atopic dermatitis (28%), with evidence of aeroallergen sensitization in 59%. Food allergy was diagnosed in 88% to milk (n = 19), peanut (n = 19), tree nut (n = 16), soy (n = 13), egg (n = 12), and meats [beef, pork, chicken (n = 13)]. EE symptoms (with % of patients and median age of onset) included: GERD (53%, 6 m); diarrhea (25%, 1y); poor growth (28%, 2y); vomiting (50%, 3y); abdominal pain (50%, 6y); and dysphagia (28%, 9y). 25% reported at least one episode of food impaction. Patients underwent one or more of three interventions: GERD treatment (n = 22), food elimination (n = 28), or medication [swallowed fluticasone (n = 21), prednisone (n = 1)]. Symptomatic improvement occurred in 24% with GERD treatment, 46% with food elimination, and 40% with medication. When specific eosinophil counts were provided, histopathology improved in 6/10 with food elimination alone, 3/3 with medication alone, and 7/7 with medication plus food elimination.CONCLUSIONS: EE presents with a variety of symptoms that vary according to age. Response to treatment was generally good but often required a combination of food elimination and medication. RATIONALE: To define the clinical and laboratory characteristics and response to therapy in a population of patients with eosinophilic esophagitis (EE). METHODS: A retrospective analysis of 32 pediatric patients with EE. RESULTS: The majority of patients were male (83%) with a median age of onset of 3y (range 4 m-16y). Other atopic diseases included acute food reactions (6%), asthma (41%), allergic rhinitis (53%), and atopic dermatitis (28%), with evidence of aeroallergen sensitization in 59%. Food allergy was diagnosed in 88% to milk (n = 19), peanut (n = 19), tree nut (n = 16), soy (n = 13), egg (n = 12), and meats [beef, pork, chicken (n = 13)]. EE symptoms (with % of patients and median age of onset) included: GERD (53%, 6 m); diarrhea (25%, 1y); poor growth (28%, 2y); vomiting (50%, 3y); abdominal pain (50%, 6y); and dysphagia (28%, 9y). 25% reported at least one episode of food impaction. Patients underwent one or more of three interventions: GERD treatment (n = 22), food elimination (n = 28), or medication [swallowed fluticasone (n = 21), prednisone (n = 1)]. Symptomatic improvement occurred in 24% with GERD treatment, 46% with food elimination, and 40% with medication. When specific eosinophil counts were provided, histopathology improved in 6/10 with food elimination alone, 3/3 with medication alone, and 7/7 with medication plus food elimination. CONCLUSIONS: EE presents with a variety of symptoms that vary according to age. Response to treatment was generally good but often required a combination of food elimination and medication.

Pharmacological treatment of GERD – a look beyond PPIs?

BACKGROUND: Approximately 20–30% of patients with gastro-esophageal reflux symptoms report inadequate symptom relief while on PPI therapy. Persisting acid or nonacid reflux can be demonstrated in 40–50% of them suggesting that there is room for anti-reflux therapy in these patients. Transient lower esophageal sphincter relaxations (TLESRs) are the main mechanism of all type of reflux, i.e. both acid and weakly acidic reflux episodes. Therefore, controlling the occurrence of TLESRs appears to be a relevant therapeutic objective in GERD. METHODS: Review on the pharmacological therapy of TLESRs for GERD management. RESULTS: Many compounds have been shown to decrease the number of TLESRs, but the most promising classes are GABAB agonists and mGluR5 antagonists both of which have orally formulations available for human use. The GABAB agonist baclofen, prescribed for the treatment of spasticity for many years, has been shown to decrease the number of TLESRs, esophageal acid exposure, and reflux symptoms. Considering the poor tolerability of this compound, more selective GABAB agonists are currently in development. ADX10059, a mGluR5 negative allosteric modulator, has been shown to decrease GER in both healthy subjects and GERD patients and has entered in phase IIb studies. CONCLUSIONS: Compounds that target TLESR activity represent a promising new therapeutic option for patients who suffer from GERD symptoms. These drugs will probably be developed as add-on therapy in combination with PPIs provided the tolerability and safety issues are resolved.

A new injectable agent for the treatment of GERD: results of the Durasphere pilot trial

A variety of endoscopic modalities have been introduced to treat GERD, including radiofrequency energy, suturing, plication, and injection therapy. Our purpose was to assess the long-term safety and effectiveness of Durasphere (Carbon Medical Technologies, St Paul, Minn), a new injectable bulking agent, in the treatment of mild-moderate GERD. Initial human pilot study. Single endoscopy center; study period from January 2005 to August 2006. Ten GERD subjects, confirmed by pH monitoring, on daily proton pump inhibitor (PPI) therapy, hiatal hernia <3 cm, and no or mild erosive esophagitis. Endoscopic injection with Durasphere, a new submucosal bulking agent, at the gastroesophageal junction. Change in symptom scores, PPI use, pH scores, and endoscopic findings; monitoring of safety profile. Nine of 10 patients completed the 12-month trial. There were no adverse events. The procedure was well tolerated with minimal patient discomfort and no dysphagia. At 12 months 70% of patients discontinued all antacid medication completely; 90% of patients reduced PPI use by greater than 50%. DeMeester scores improved from a mean of 44.5 at baseline to 26.5 at 12 months; 4 patients achieved normal pH scores. There was no esophagitis at 12 months, and no erosion, ulceration or sloughing of material was noted at any injection site. The Durasphere material did not appear to migrate. Nonrandomized study design without a control group; small number of subjects. Durasphere appears to be a promising new injectable bulking agent for the treatment of mild-moderate GERD, with demonstrable efficacy and no significant adverse events in a small cohort.

Endoluminal Full-Thickness Plication and Radiofrequency Treatments for GERD—Invited Critique

Endoluminal Full-Thickness Plication and Radiofrequency Treatments for GERD—Invited Critique

Tailored antireflux surgery.

With increasing age, the functional condition of the lower esophageal sphincter is getting weaker. Recent progress in peri-operative intensive care and the development of laparoscopic technique makes antireflux surgery a safe choice of GERD treatment in the elderly. This work evaluated the long-term results of tailored antireflux surgery in a group of elderly (more than 60 years old) patients. Five hundred and eighty one patients underwent antireflux surgery in our department from 1999 to 2005. Seventy of them (12.0%) were older than 60 years. Exclusion criteria of surgery were ASA IV classification and high grade esophageal dysmotility. Toupet's wrap was offered to patients with esophageal dysmotility or esophageal sphincter pressure higher than 15 mm Hg (16 cases). The rest were offered Nissen-Rossetti's complete wrap (54 cases). There was zero mortality and no further significant dysphagia. Pathological gastro-esophageal reflux after the surgery was detected in 6 patients (8.6%), which was a higher proportion than in the group of patients under 60 years. Good results of antireflux surgery with zero mortality and low morbidity can be achieved even in the elderly (more frequent use of incomplete Toupet's wrap).

Clinical Evaluation of Xp19986 as a Potential Treatment for GERD

Clinical Evaluation of Xp19986 as a Potential Treatment for GERD