226 results on '"Katz PO"'
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2. PGI24 RACIAL, SOCIAL, AND ECONOMIC DISPARITIES IN KNOWLEDGE AND CARE SEEKING BEHAVIORS FOR GASTRO-ESOPHAGEAL REFLUX DISEASE (GERD)
- Author
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Yuen, EJ, primary, Toner, R, additional, Cobb, N, additional, Katz, PO, additional, and Goldfarb, NI, additional
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- 2008
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3. PGI16 DISPARITIES IN MEDICATION UTILIZATION AND COMPLIANCE FOR GASTRO-ESOPHAGEAL REFLUX DISEASE: A POPULATION-BASED STUDY
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Yuen, EJ, primary, Toner, R, additional, Cobb, N, additional, Katz, PO, additional, and Goldfarb, NI, additional
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- 2008
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4. Prevention of relapse of healed reflux esophagitis is related to the duration of intragastric pH <GT> 4.
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Johnson DA, Katz PO, Levine D, Röhss K, Astrand M, Junghard O, and Nagy P
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- 2010
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5. Utility and standards in esophageal manometry.
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Katz PO, Menin RA, and Gideon RM
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- 2008
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6. Chest pain: it's not cardiac -- what next?
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Carter CS, Disla E, Katz PO, and Richter JE
- Abstract
Noncardiac chest pain poses a common diagnostic challenge that contributes substantially to morbidity and health care costs. A careful evaluation is required to make an accurate, cost-effective diagnosis. [ABSTRACT FROM AUTHOR]
- Published
- 1998
7. Nocturnal acid breakthrough: pH, drugs and bugs.
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Tutuian R, Katz PO, Castell DO, Tutuian, Radu, Katz, Philip O, and Castell, Donald O
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- 2004
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8. Celecoxib combined with esomeprazole prevented recurrent ulcer bleeding in patients with previous NSAID-induced ulcer bleeding.
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Katz PO
- Published
- 2007
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9. Virtual colonoscopy to screen for colorectal cancer.
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Rockey DC, Zarchy TM, Pais S, Uribe JR, Bongiorno C, Katz PO, Thomas GS, and Pickhardt PJ
- Published
- 2004
10. Upper Gastrointestinal Endoscopy off Proton Pump Inhibitor With Concurrent Telemetry Capsule pH Monitoring: Evidence Based and Cost Effective.
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Katz PO and Ghosh G
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- Humans, Proton Pump Inhibitors therapeutic use, Proton Pump Inhibitors economics, Proton Pump Inhibitors adverse effects, Proton Pump Inhibitors administration & dosage, Endoscopy, Gastrointestinal economics, Male, Middle Aged, Female, Esophageal pH Monitoring, Gastroesophageal Reflux diagnosis, Aged, Telemetry economics, Cost-Benefit Analysis
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- 2024
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11. Questionnaire for diagnosis and response to therapy in rumination syndrome.
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Pomenti SF, Tsang AJ, Khan AR, Katz PO, and Katzka DA
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- Humans, Surveys and Questionnaires, Female, Male, Adult, Treatment Outcome, Rumination Syndrome therapy, Rumination Syndrome diagnosis
- Abstract
Rumination is a behavioral disorder characterized by regurgitation of food without retching. It is diagnosed clinically by the Rome Criteria and treated primarily by diaphragmatic breathing. Despite diagnosis and follow-up being based on symptomatic responses to therapies, there are no published or validated questionnaires. To address this care-gap, a rumination questionnaire was developed and reviewed by two expert esophagologists and five patients diagnosed with rumination. Ultimately, an eight-point questionnaire with scoring ranging from -1 to 10 was finalized. This newly developed questionnaire was implemented on five additional patients diagnosed clinically with rumination syndrome with improvement after interventions noted., (© The Author(s) 2024. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2024
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12. Comparative Outcomes of Anti-Reflux Surgery in Obese Patients with Gastroesophageal Reflux Disease 1 .
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Greenberg JA, Palacardo F, Edelmuth RCL, Egan CE, Lee YJ, Schnoll-Sussman FH, Katz PO, Finnerty BM, Fahey TJ 3rd, and Zarnegar R
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- Humans, Fundoplication methods, Diaphragm surgery, Obesity complications, Obesity surgery, Retrospective Studies, Hernia, Hiatal complications, Hernia, Hiatal surgery, Gastroesophageal Reflux complications, Gastroesophageal Reflux surgery, Gastric Bypass methods, Obesity, Morbid surgery, Laparoscopy methods
- Abstract
Introduction: Roux-en-Y gastric bypass (RYGB) has been the preferred operation for obese patients with gastroesophageal reflux disease (GERD); however, some patients are hesitant to undergo bypass. Obese patients have a multifactorial predisposition to GERD, including lower esophageal sphincter (LES) dysfunction and aberrant pressure gradients across their diaphragmatic crura. Among non-obese patients, anti-reflux surgery (ARS) with hiatal hernia (HH) repair and LES augmentation has shown excellent long-term results. We aimed to determine whether patient satisfaction and GERD recurrence differed between obese and non-obese patients who underwent ARS., Methods: Review of patients who underwent ARS between January 2012 and June 2021 was performed. Perioperative and postoperative characteristics were compared across three BMI groups: BMI < 30 kg/m
2 , 30 kg/m2 ≤ BMI < 35 kg/m2 , and BMI ≥ 35 kg/m2 ., Results: Four-hundred thirteen patients were identified, of which 294 (71.1%) had BMI < 30 kg/m2 , 87 (21.1%) were 30 kg/m2 ≤ BMI < 35 kg/m2 , and 32 (7.7%) had a BMI ≥ 35 kg/m2 . Patients with BMI ≥ 35 kg/m2 had higher preoperative manometric and EndoFLIP™ intra-balloon pressure at the LES than those with lower BMIs. This value was increased to a similar level throughout ARS across the three cohorts. Post-operative GERD-specific satisfaction was similar across the three cohorts, as were rates of postoperative reflux and hiatal hernia recurrence on barium swallow; rates of reoperation were low., Conclusions: ARS with HH repair and LES augmentation may be appropriate for select patients across a range of BMIs, including those with a BMI ≥ 35 kg/m2 who are hesitant to undergo RYGB., (© 2022. The Society for Surgery of the Alimentary Tract.)- Published
- 2023
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13. Response to Haseeb et al.
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Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, and Spechler SJ
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- 2022
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14. Clinical role of ambulatory reflux monitoring in PPI non-responders: recommendation statements.
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Yadlapati R, Gawron AJ, Gyawali CP, Chen J, Clarke J, Fass R, Jain A, Lynch K, Khan A, Katz PO, Katzka DA, Richter J, Schnoll-Sussman F, Spechler SJ, Vaezi MF, Vela M, and Pandolfino JE
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- Humans, Esophageal pH Monitoring, Proton Pump Inhibitors therapeutic use, Esophagitis, Peptic drug therapy, Gastroesophageal Reflux diagnosis, Gastroesophageal Reflux drug therapy
- Abstract
Background: Optimal ambulatory reflux monitoring methodology in symptomatic reflux patients continues to be debated., Aims: To utilise published literature and expert opinion to develop recommendation statements addressing use of ambulatory reflux monitoring in clinical practice METHODS: The RAND Appropriateness Method (RAM) was utilised among 17 experts with discussion, revision and two rounds of ranking of recommendation statements. Ambulatory reflux monitoring protocol, methodology and thresholds ranked as appropriate by ≥80% of panellists met the criteria for appropriateness., Results: Prolonged (96-h recommended) wireless pH monitoring off proton pump inhibitor (PPI) was identified as the appropriate diagnostic tool to assess the need for acid suppression in patients with unproven gastro-oesophageal reflux disease (GERD) and persisting typical reflux symptoms despite once-daily PPI. Acid exposure time (AET) <4.0% on all days of monitoring with negative reflux-symptom association excludes GERD and does not support ongoing PPI treatment. Conversely, AET >6.0% across ≥2 days is conclusive evidence for GERD and supports treatment for GERD, while AET >10% across ≥2 days identifies severe acid burden that supports escalation of anti-reflux treatment. In previously proven GERD, impedance-pH monitoring on PPI is helpful in defining refractory GERD and mechanisms of continued symptoms; the presence of <40 reflux events, AET <2.0% and a negative reflux-symptom association does not support escalation of anti-reflux treatment. In contrast, AET > 4.0% and positive reflux-symptom association support escalation of anti-reflux treatment, including use of invasive therapeutics., Conclusions: Statements meeting appropriateness for average clinical care have been identified when utilising reflux monitoring in patients with typical reflux symptoms and PPI non-response., (© 2022 John Wiley & Sons Ltd.)
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- 2022
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15. Quantifying physiologic parameters of the gastroesophageal junction during re-operative anti-reflux surgery.
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Greenberg JA, Stefanova DI, Reyes FV, Edelmuth RCL, Thiesmeyer JW, Egan CE, Liu M, Schnoll-Sussman FH, Katz PO, Christos P, Finnerty BM, Fahey TJ 3rd, and Zarnegar R
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- Endoscopy, Gastrointestinal, Esophageal Sphincter, Lower surgery, Esophagogastric Junction surgery, Humans, Manometry, Gastroesophageal Reflux etiology, Gastroesophageal Reflux surgery, Hernia, Hiatal surgery
- Abstract
Background: Hiatal hernia re-approximation during index anti-reflux surgery (ARS) contributes approximately 80% of overall change in distensibility index (DI) and, potentially, compliance of the gastroesophageal (GEJ), while sphincter augmentation contributes approximately 20%. Whether this is seen in re-operative ARS is unclear. We quantify the physiologic parameters of the GEJ at each step of robotic re-operative ARS and compare these to index ARS., Methods: Robotic ARS with hiatal hernia repair was performed on 195 consecutive patients with pathologic reflux utilizing EndoFLIP™, of which 26 previously had ARS. Intra-operative GEJ measurements, including cross-sectional area (CSA), pressure, DI, and high-pressure zone (HPZ) length were collected pre-repair, post-diaphragmatic re-approximation, post-mesh placement, and post-lower-esophageal sphincter (LES) augmentation., Results: Both cohorts were similar by sex and BMI and underwent similar procedures. The re-operative cohort was older (60.6 ± 15.3 vs. 52.7 ± 16.2 years, p = 0.03), had more frequent pre-operative dysphagia (69.2% vs. 42.6%, p = 0.01) and esophageal dysmotility on barium swallow (75.0% vs. 35.0%, p < 0.001) but lower rates of hiatal hernia on endoscopy (30.8% vs. 68.7%, p < 0.001) compared to index procedures. Among the re-operative cohort, the CSA decreased by 34 (IQR - 80, - 15) mm
2 and DI 1.1 (IQR - 2.4, - 0.6) mm2 /mmHg (both p < 0.001). Pressure increased by 11.2 (IQR 4.7, 14.9) mmHg and HPZ by 1.5 (1,2) cm (both p < 0.001). These changes were similar to those seen in index ARS. Diaphragmatic re-approximation contributed to a greater percentage of overall change to the GEJ than did the augmentation procedure, with 72% of the change in DI occurring during hiatal closure, similar to that seen during index ARS., Conclusions: During re-operative ARS, dynamic intra-operative monitoring can quantify the effects of each operative step on GEJ physiologic parameters. Diaphragmatic re-approximation appears to have a greater effect on GEJ physiology than does LES-sphincter augmentation during both index and re-operative ARS., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)- Published
- 2022
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16. Editorial: refractory reflux sensitivity - a place for baclofen?
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Katz PO
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- Baclofen therapeutic use, Humans, Esophagitis, Peptic, Gastroesophageal Reflux diagnosis, Gastroesophageal Reflux drug therapy, Muscle Relaxants, Central therapeutic use
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- 2022
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17. Evaluation of post-operative dysphagia following anti-reflux surgery.
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Greenberg JA, Stefanova DI, Reyes FV, Edelmuth RCL, Harik L, Thiesmeyer JW, Egan CE, Palacardo F, Liu M, Christos P, Schnoll-Sussman FH, Katz PO, Finnerty BM, Fahey TJ 3rd, and Zarnegar R
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- Esophagogastric Junction surgery, Fundoplication adverse effects, Fundoplication methods, Humans, Retrospective Studies, Deglutition Disorders epidemiology, Deglutition Disorders etiology, Gastroesophageal Reflux surgery, Laparoscopy methods
- Abstract
Background: Anti-reflux surgery (ARS) has known long-term complications, including dysphagia, bloat, and flatulence, among others. The factors affecting the development of post-operative dysphagia are poorly understood. We investigated the correlation of intra-operative esophagogastric junction (EGJ) characteristics and procedure type with post-operative dysphagia following ARS., Methods: Robotic ARS was performed on 197 consecutive patients with pathologic reflux utilizing EndoFLIP™ technology. Intraoperative EGJ measurements including distensibility index (DI), cross-sectional area (CSA), and high-pressure zone (HPZ) length were collected. Dysphagia was assessed pre-operatively and at 3 months post-operatively., Results: The median pre-operative DI for all procedures was 2.6 (IQR 1.6-4.5) mm
2 /mmHg. There was no difference in post-operative DI between procedures [Hill: 0.9 (IQR 0.7-1.1) mm2 /mmHg, Nissen: 1.0 (IQR 0.7-1.4) mm2 /mmHg, Toupet: 1.2 (IQR 0.8-1.5) mm2 /mmHg, Linx: 1.0 (IQR 0.7-1.2) mm2 /mmHg, p = 0.24], whereas post-operative HPZ length differed by augmentation type [Hill: 3 (IQR 2.8-3) cm, Nissen: 3.5 (IQR 3-3.5) cm, Toupet: 3 (IQR 2.5-3.5) cm, Linx: 2.5 (IQR 2.5-3) cm, p = 0.032]. Eighty-nine patients (45.2%) had pre-operative dysphagia. Thirty-two patients (27.6%) reported any dysphagia at their 3-month post-operative visit and 12 (10.3%) developed new or worsening post-operative dysphagia [Hill: 2/18 (11.1%), Nissen: 2/35 (5.7%), Toupet: 4/54 (7.4%), Linx: 4/9 (44.4%), p = 0.006]. The median pre-operative and post-operative DI of patients who developed new or worsening dysphagia was 2.0 (IQR 0.9-3.8) mm2 /mmHg and 1.2 (IQR 1.0-1.8) mm2 /mmHg, respectively, and that of those who did not was 2.5 (IQR 1.6-4.0) mm2 /mmHg and 1.0 (IQR 0.7-1.4) mm2 /mmHg (p = 0.21 and 0.16, respectively)., Conclusions: Post-operative DI was similar between procedures, and there was no correlation with new or worsening post-operative dysphagia. Linx placement was associated with higher rates of new or worsening post-operative dysphagia despite a shorter post-procedure HPZ length and similar post-operative DI when compared to other methods of LES augmentation., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)- Published
- 2022
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18. In the memory of our following colleagues, and friends.
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Rattan S, Cao W, Katz PO, and Goyal RK
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- 2022
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19. Reflux Monitoring in Lung Disease: Is There a Better Metric than Esophageal Acid Exposure Time?
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Katz PO
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- Benchmarking, Electric Impedance, Esophageal pH Monitoring, Humans, Hydrogen-Ion Concentration, Lung physiopathology, Proton Pump Inhibitors, Gastroesophageal Reflux physiopathology, Idiopathic Pulmonary Fibrosis complications
- Abstract
Abstract: Ambulatory reflux monitoring can be performed with either a telemetry capsule to monitor for esophageal acid exposure alone for a period of 48-96 hours, and a 24 hour catheter based impedance/pH study which is most valuable for evaluating patients with objective evidence of GERD who are incompletely relieved with proton pump inhibitors. Some would consider catheter-based impedance/pH as the "best" test to evaluate patients with extraesophageal symptoms including suspected pulmonary complications of GERD. This editorial provides comment on the use of novel advanced metrics, mean nocturnal baseline impedance and post-reflux induced-swallow peristaltic wave index in analysis of these studies., (Copyright © 2022 by The American College of Gastroenterology.)
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- 2022
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20. The impact of pneumoperitoneum on esophagogastric junction distensibility during anti-reflux surgery.
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Liu M, Stefanova DI, Finnerty BM, Schnoll-Sussman FH, Katz PO, Fahey TJ 3rd, and Zarnegar R
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- Esophagogastric Junction pathology, Esophagogastric Junction surgery, Fundoplication methods, Humans, Manometry, Gastroesophageal Reflux etiology, Gastroesophageal Reflux pathology, Gastroesophageal Reflux surgery, Insufflation, Pneumoperitoneum etiology
- Abstract
Objective: We aimed to quantify the contribution of pneumoperitoneum on compliance of the esophagogastric junction (EGJ) during anti-reflux surgery., Background: Compliance of the EGJ is reduced with anti-reflux surgery. EndoFLIP® planimetry can be used to assess dynamic changes of EGJ compliance intraoperatively. It is unclear how pneumoperitoneum impacts intraoperative measurements by EndoFLIP® and the implications thereof on validity of the results. Therefore, determining variability in EndoFLIP® measurements based on pneumoperitoneum is warranted to establish guidelines to interpret clinical outcomes., Methods: Primary anti-reflux surgery was performed on 39 consecutive patients with pathologic reflux. Intraoperative EGJ measurements including distensibility index (DI), cross-sectional area (CSA), and intrabag pressure were collected using EndoFLIP® at 0, 10, and 15 mmHg of intraperitoneal pressure. Data were acquired pre-procedure, post-hiatal hernia repair, and post-LES augmentation with fundoplications., Results: Patients underwent Nissen (13.2%), Toupet (68.4%), LINX (10.5%), or Hill-fundoplications (7.9%). There was no difference between 0 and 10 mmHg of pneumoperitoneum in CSA, pressure, or DI measurements pre-procedure; however, there was a difference between 0 and 15 mmHg in pressure (p = 0.016) and DI (p = 0.023) measurements. After LES augmentation, 10 mmHg intraperitoneal pressure reduced DI, though the absolute difference is small (2.0 vs. 1.5 mm
2 /mmHg, p = 0.002)., Conclusion: Pneumoperitoneum affected EGJ distensibility at 15 mmHg, but not 10 mmHg, of insufflation prior to anti-reflux procedures. After anti-reflux surgery, there was a significant variance between 0 and 10 mmHg of pneumoperitoneum in pressure and distensibility. The change in pressure appears linear and needs to be considered if procedural modifications are performed based on intraoperative findings and when evaluating clinical outcomes., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)- Published
- 2022
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21. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease.
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Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, and Spechler SJ
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- Gastroesophageal Reflux therapy, Humans, Disease Management, Endoscopy, Digestive System methods, Gastroesophageal Reflux diagnosis, Proton Pump Inhibitors therapeutic use
- Abstract
Gastroesophageal reflux disease (GERD) continues to be among the most common diseases seen by gastroenterologists, surgeons, and primary care physicians. Our understanding of the varied presentations of GERD, enhancements in diagnostic testing, and approach to patient management have evolved. During this time, scrutiny of proton pump inhibitors (PPIs) has increased considerably. Although PPIs remain the medical treatment of choice for GERD, multiple publications have raised questions about adverse events, raising doubts about the safety of long-term use and increasing concern about overprescribing of PPIs. New data regarding the potential for surgical and endoscopic interventions have emerged. In this new document, we provide updated, evidence-based recommendations and practical guidance for the evaluation and management of GERD, including pharmacologic, lifestyle, surgical, and endoscopic management. The Grading of Recommendations, Assessment, Development, and Evaluation system was used to evaluate the evidence and the strength of recommendations. Key concepts and suggestions that as of this writing do not have sufficient evidence to grade are also provided., (Copyright © 2021 by The American College of Gastroenterology.)
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- 2022
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22. Development of quality indicators for the diagnosis and management of achalasia.
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Kamal AN, Kathpalia P, Otaki F, Bredenoord AJ, Castell DO, Clarke JO, Falk GW, Fass R, Prakash Gyawali C, Kahrilas PJ, Katz PO, Katzka DA, Pandolfino JE, Penagini R, Richter JE, Roman S, Savarino E, Triadafilopoulos G, Vaezi MF, Vela MF, and Leiman DA
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- Consensus, Delivery of Health Care, Humans, Quality Indicators, Health Care, Esophageal Achalasia diagnosis, Esophageal Achalasia therapy, Gastroesophageal Reflux
- Abstract
Background: The management of achalasia has improved due to diagnostic and therapeutic innovations. However, variability in care delivery remains and no established measures defining quality of care for this population exist. We aimed to use formal methodology to establish quality indicators for achalasia patients., Methods: Quality indicator concepts were identified from the literature, consensus guidelines and clinical experts. Using RAND/University of California, Los Angeles (UCLA) Appropriateness Method, experts in achalasia independently ranked proposed concepts in a two-round modified Delphi process based on 1) importance, 2) scientific acceptability, 3) usability, and 4) feasibility. Highly valid measures required strict agreement (≧ 80% of panelists) in the range of 7-9 for across all four categories., Key Results: There were 17 experts who rated 26 proposed quality indicator topics. In round one, 2 (8%) quality measures were rated valid. In round two, 19 measures were modified based on panel suggestions, and experts rated 10 (53%) of these measures as valid, resulting in a total of 12 quality indicators. Two measures pertained to patient education and five to diagnosis, including discussing treatment options with risk and benefits and using the most recent version of the Chicago Classification to define achalasia phenotypes, respectively. Other indicators pertained to treatment options, such as the use of botulinum toxin for those not considered surgical candidates and management of reflux following achalasia treatment., Conclusions & Inferences: Using a robust methodology, achalasia quality indicators were identified, which can form the basis for establishing quality gaps and generating fully specified quality measures., (© 2021 John Wiley & Sons Ltd.)
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- 2021
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23. Common Gastroenterology Disorders in the Elderly.
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Soumekh AE and Katz PO
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- Aged, Humans, Gastrointestinal Diseases
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- 2021
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24. Nonsteroidal Antiinflammatory Drugs, Anticoagulation, and Upper Gastrointestinal Bleeding.
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Lee MW and Katz PO
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- Aged, Anti-Inflammatory Agents, Non-Steroidal administration & dosage, Anticoagulants administration & dosage, Gastrointestinal Hemorrhage therapy, Humans, Peptic Ulcer chemically induced, Peptic Ulcer Hemorrhage chemically induced, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Anticoagulants adverse effects, Gastrointestinal Hemorrhage chemically induced, Peptic Ulcer complications, Platelet Aggregation Inhibitors adverse effects, Proton Pump Inhibitors therapeutic use
- Abstract
Advanced age, history of peptic ulcer disease, Helicobacter pylori, coadministration of nonsteroidal antiinflammatory drugs (NSAIDs), corticosteroids, anticoagulation, and antiplatelets are risk factors for gastrointestinal bleeding in the elderly. Awareness of these risks and appropriate use of NSAIDs, particularly in those needing antiplatelet or anticoagulant therapy, is critical to optimal management. Careful selection of elderly patients requiring antiplatelet, anticoagulation, or chronic NSAID therapy for cotherapy with proton pump inhibitors can significantly reduce morbidity and mortality from gastrointestinal bleeding., Competing Interests: Disclosure Dr Katz is a Consultant for Phathom Pharma., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2021
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25. The Proton Pump Inhibitor Is Not Working: Assess Don't Guess.
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Katz PO
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- Humans, Proton Pump Inhibitors adverse effects, Esophagitis, Peptic, Gastroesophageal Reflux drug therapy
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- 2021
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26. Regarding "Increased Risk of COVID-19 in Patients Taking Proton Pump Inhibitors".
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Hajifathalian K and Katz PO
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- COVID-19, Humans, SARS-CoV-2, Betacoronavirus, Coronavirus Infections, Pandemics, Pneumonia, Viral, Proton Pump Inhibitors adverse effects
- Published
- 2020
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27. Proton pump inhibitors do not increase the risk of dementia: a systematic review and meta-analysis of prospective studies.
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Desai M, Nutalapati V, Srinivasan S, Fathallah J, Dasari C, Chandrasekhar VT, Mohammad B, Kohli D, Vaezi M, Katz PO, and Sharma P
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- Child, Child, Preschool, Cross-Sectional Studies, Humans, Infant, Prospective Studies, Retrospective Studies, Dementia chemically induced, Dementia epidemiology, Proton Pump Inhibitors adverse effects
- Abstract
Published studies have reported variable results on the association between duration of proton pump inhibitor (PPI) use and the risk of dementia. An extensive literature search was performed in PubMed, Embase, Google Scholar, and Cochrane for studies examining the risk of cognitive decline and dementia among PPI users versus non-PPI users in prospective studies. Retrospective database linkage studies, case reports, case series, editorials, uncontrolled cohort studies, cross-sectional studies, and review articles were excluded. Primary outcome was pooled hazard rate (HR) of any dementia among PPI users compared with non-PPI users. Secondary outcomes were pooled HR of Alzheimer's dementia (AD) and risk with long-term PPI follow-up (more than 5 years) studies. Meta-analysis outcomes, heterogeneity (I2), and meta-regression (for the effect of covariates) were derived by statistical software R and Open meta-analyst. A total of six studies (one RCT and five prospective) with 308249 subjects, average age of 75.8 ± 5.2 years, and follow-up of 5 (range 1.5-11) years were included in the analysis. Pooled HR of any dementia was 1.16 (n = 6, 95% confidence interval (CI) = 0.86-1.47). Results remained unchanged when only studies with long-term PPI use (more than 5 years) were analyzed (n = 4, pooled HR 1.10, 95% CI 0.66-1.53). Finally, the pooled HR for AD was 1.06 (n = 3, 95% CI 0.70-1.41). There was substantial heterogeneity among inclusion studies (I2 = 93%). Meta-regression did not demonstrate a significant role of age at study start (P = 0.1) or duration of PPI use (P = 0.62) to incident dementia. The results of this systematic review and meta-analysis do not show a significant relationship between PPI use and dementia in prospective studies with at least a 5-year follow-up., (© The Author(s) 2020. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2020
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28. Quantifying Factors Essential to the Integrity of the Esophagogastric Junction During Antireflux Procedures.
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Stefanova DI, Limberg JN, Ullmann TM, Liu M, Thiesmeyer JW, Beninato T, Finnerty BM, Schnoll-Sussman FH, Katz PO, Fahey TJ 3rd, and Zarnegar R
- Subjects
- Adult, Esophageal Sphincter, Lower surgery, Esophagogastric Junction physiopathology, Female, Follow-Up Studies, Gastroesophageal Reflux physiopathology, Humans, Male, Manometry methods, Middle Aged, Pressure, Retrospective Studies, Esophageal Sphincter, Lower physiopathology, Esophagogastric Junction surgery, Esophagoplasty methods, Gastroesophageal Reflux surgery, Monitoring, Intraoperative methods
- Abstract
Objective: To quantify the contribution of key steps in antireflux surgery on compliance of the EGJ., Background: The lower esophageal sphincter and crural diaphragm constitute the intrinsic and extrinsic sphincters of the EGJ, respectively. Interventions to treat reflux attempt to restore the integrity of the EGJ. However, there are limited data on the relative contribution of critical steps during antireflux procedures to the functional integrity of the EGJ., Methods: Primary antireflux surgery was performed on 100 consecutive patients with pathologic reflux. Intraoperative EGJ measurements including distensibility index (DI), cross-sectional area (CSA), and HPZ length were collected using EndoFLIP. Data was acquired pre-repair, post-diaphragmatic re-approximation with sub-diaphragmatic EGJ relocation, and post-sphincter augmentation., Results: Patients underwent Nissen (45%), Toupet (44%), or LINX (11%). After diaphragmatic re-approximation, DI decreased by a median 0.77 mm2/mm Hg [95%-confidence interval (CI): -0.99, -0.58; P < 0.0001], CSA decreased 16.0 mm2 (95%-CI: -20.0, -8.0; P < 0.0001), whereas HPZ length increased 0.5 cm (95%-CI: 0.5, 1.0; P < 0.0001). After sphincter augmentation, DI decreased 0.14 mm2/mm Hg (95%-CI: -0.30, -0.04; P = 0.0005) and CSA decreased 5.0 mm2 (95%-CI: -10.0, 1.0; P = 0.0.0015), whereas HPZ length increased 0.5 cm (95%-CI: 0.50, 0.54; P < 0.0001). Diaphragmatic re-approximation had a higher percent contribution to distensibility (79% vs 21%), CSA (82% vs 18%), and HPZ (60% vs 40%) than sphincter augmentation., Conclusion: Dynamic intraoperative monitoring demonstrates that diaphragmatic re-approximation and sub-diaphragmatic relocation has a greater effect on EGJ compliance than sphincter augmentation. As such, antireflux procedures should address both for optimal improvement of EGJ physiology., Competing Interests: Dr. Zarnegar and Dr. Katz work as consultants for companies as disclosed in their conflict of interest form, however, there are no conflicts with this manuscript. The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2020
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29. Vitamin C Deficiency: An Under-Recognized Condition in Crohn's Disease.
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Gordon BL, Galati J, Yang S, Katz PO, and Scherl EJ
- Abstract
Although many nutritional deficiencies are associated with Crohn's disease (CD), vitamin C deficiency is less frequently diagnosed and reported despite its prevalence. Vitamin C deficiency may be more difficult to diagnose in patients with CD because symptoms from active CD may overlap with scurvy. Identification of the deficiency is vital, however, because treatment can lead to swift, marked resolution of symptoms. We present a patient with long-standing CD who presented with gum bleeding and was found to have scurvy., (© 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)
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- 2020
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30. Is it time to revisit surgery and endoscopic therapy for refractory GERD?
- Author
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Katz PO and Schnoll-Sussman F
- Subjects
- Endoscopy, Fundoplication, Humans, Gastroesophageal Reflux surgery, Proton Pump Inhibitors
- Published
- 2020
- Full Text
- View/download PDF
31. Letter: bone fracture risk among older long-term users of proton pump inhibitors. Authors' reply.
- Author
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Schnoll-Sussman F and Katz PO
- Subjects
- Humans, Proton Pump Inhibitors, Fractures, Bone, Physicians
- Published
- 2020
- Full Text
- View/download PDF
32. Editorial: simultaneous prolonged monitoring of the acid pocket and oesophageal reflux.
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Katz PO and Castell DO
- Subjects
- Alginates, Aluminum Hydroxide, Antacids, Drug Combinations, Humans, Obesity, Silicic Acid, Sodium Bicarbonate, Esophagitis, Peptic, Gastroesophageal Reflux
- Published
- 2020
- Full Text
- View/download PDF
33. Proton Pump Inhibitors: The Good, Bad, and Ugly.
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Schnoll-Sussman F, Niec R, and Katz PO
- Subjects
- Contraindications, Drug, Humans, Gastroesophageal Reflux drug therapy, Proton Pump Inhibitors adverse effects
- Abstract
Proton pump inhibitors (PPIs) continue to be the medication of choice for treatment of acid-related disease, with few if any overt side effects seen with daily use. They are often prescribed empirically, often in high doses and with many patients being treated with multiple PPIs without an objective diagnosis. Therefore, they are believed to be overprescribed and used without indication. In this article we discuss the appropriate clinical indications for PPIs, review in detail the major associated adverse events, and put in perspective key issues in balancing benefits and risk of this exceptional (and safe) class of drug., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
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34. Lymphocyte-predominant Esophagitis: A Distinct and Likely Immune-mediated Disorder Encompassing Lymphocytic and Lichenoid Esophagitis.
- Author
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Pittman ME, Hissong E, Katz PO, and Yantiss RK
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Databases, Factual, Diagnosis, Differential, Esophagitis immunology, Esophagitis pathology, Esophagoscopy, Female, Humans, Immune System Diseases complications, Immune System Diseases immunology, Immune System Diseases pathology, Lymphocytosis immunology, Lymphocytosis pathology, Male, Middle Aged, Young Adult, Esophagitis diagnosis, Lymphocytosis diagnosis
- Abstract
Lymphocytic esophagitis is a well-known manifestation of Crohn disease among children but is not considered to be an immune-mediated mucositis in adults. We hypothesize that adult-onset lymphocyte-predominant esophagitis is also an immune-mediated inflammatory pattern, the nature of which has been masked by other conditions that feature esophageal lymphocytosis and occur in older patients. We performed this study to consolidate diagnostic criteria for lymphocyte-predominant esophagitis and determine its clinical significance. We identified 61 patients with lymphocyte-rich inflammation in the mid or proximal esophagus, none of whom had another explanation for esophageal lymphocytosis. Affected patients were usually older adults and 72% were women. Most (56%) presented with dysphagia and 34% had eosinophilic esophagitis-like changes with rings, exudates, and/or edematous mucosa and linear furrows. Intraepithelial lymphocytosis was accompanied by mucosal injury featuring edema, basal zone hyperplasia, and scattered dyskeratotic cells. Some cases displayed occasional neutrophils or even superficial microabscesses; eosinophils were consistently infrequent. Most (67%) patients had at least 1 systemic immune-mediated disorder, particularly Crohn disease (30%) and connective tissue diseases (23%); only 1 had mucocutaneous lichen planus. We conclude that mild mucosal lymphocytosis (ie, ≥20 lymphocytes/HPF) alone is a frequent and nonspecific finding; criteria for lymphocyte-predominant esophagitis should include evidence of mucosal injury and allow for more than the occasional neutrophil. When this diagnosis is limited to cases that feature lymphocytosis unattributed to acid reflux, motility disorders, or infection, lymphocyte-predominant esophagitis may represent an immune-mediated disorder with characteristic clinical manifestations and a predilection for middle-aged women.
- Published
- 2020
- Full Text
- View/download PDF
35. Editorial: moving towards appropriate use of proton pump inhibitors. Authors' reply.
- Author
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Schnoll-Sussman F and Katz PO
- Subjects
- Humans, Proton Pump Inhibitors, Eosinophilic Esophagitis, Gastroesophageal Reflux, Physicians
- Published
- 2020
- Full Text
- View/download PDF
36. Reported proton pump inhibitor side effects: what are physician and patient perspectives and behaviour patterns?
- Author
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Ghosh G, Schnoll-Sussman F, Mathews S, and Katz PO
- Subjects
- Adult, Attitude of Health Personnel, Attitude to Health, Female, Fractures, Bone chemically induced, Fractures, Bone epidemiology, Humans, Male, Middle Aged, Physicians psychology, Physicians statistics & numerical data, Self Report statistics & numerical data, Surveys and Questionnaires, Drug-Related Side Effects and Adverse Reactions epidemiology, Drug-Related Side Effects and Adverse Reactions psychology, Health Knowledge, Attitudes, Practice, Perception, Proton Pump Inhibitors adverse effects
- Abstract
Background: Proton pump inhibitors (PPI) are among the most commonly prescribed medications and studies are reporting potentially harmful PPI-related adverse events. While these studies' findings are controversial, their impact on patients and physicians remains unknown., Aim: To determine patient and physician awareness of PPI-related adverse events, source of information, and subsequent effect on patient behaviour and physician practice., Methods: A 20-item questionnaire was administered to English speaking adult patients and physicians in primary care and specialty clinics about topics including knowledge of PPI-related adverse events, change in behaviour of patients on PPIs and physician management of patients on PPIs., Results: Of 277 patients surveyed, 45% reported knowledge of side effects related to PPIs. Patients were more likely to hear about PPI side effects from non-physician sources (66%) than physicians (38%). Of patients who had heard about PPI side effects, bone fractures and osteoporosis were the most common concerns, 42% and 44% respectively. Of PPI users, 38% changed their behaviour based upon concerns about PPI-related adverse events. Change in patient behaviour due to concern about PPI side effects was associated with age ≥ 65 years (odds ratio [OR] 4.07 [1.19-13.94]; P = 0.03) and concern about long-term side effects (OR 2.31 [1.03-5.17]; P = 0.04). Of 83 physicians surveyed, 60% reported concern about PPI-related adverse events, with bone fractures (46%) and osteoporosis (49%) being the most frequently reported. Overall, 37% of physicians reported changing their practice based upon their concerns., Conclusions: Nearly half of patients reported knowledge of PPI-related adverse events, most often from non-physician sources, and general concern regarding their impact. PPI users are changing their behaviour based upon these concerns, without physician input, and care providers are changing behaviour based on relatively weak evidence., (© 2019 John Wiley & Sons Ltd.)
- Published
- 2020
- Full Text
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37. Tips for the Budding Esophagologist.
- Author
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Schnoll-Sussman F and Katz PO
- Subjects
- Career Choice, Clinical Competence, Education, Medical, Continuing, Fellowships and Scholarships, Gastroenterology trends, Humans, Medicine standards, Societies, Medical, Esophageal Diseases diagnosis, Esophageal Diseases therapy, Gastroenterology standards, Medicine trends
- Abstract
Purpose of Review: The specialty of gastroenterology has evolved such that there are now multiple areas of "superspecialty" within the field. Interest in "esophagology" has expanded as options for medical therapy, advanced optics, motility testing and reflux monitoring, and minimally invasive and endoscopic therapeutics have grown. For a multitude of reasons, academic and private practices alike are looking to expand in this growing superspecialty., Recent Findings: Several articles offer criteria for competency in manometry. This article discusses in detail multiple options for developing skills in diagnosis and treatment of esophageal disease with "tips for the budding esophagologist."
- Published
- 2019
- Full Text
- View/download PDF
38. Jackhammer Esophagus: Symptom Presentation, Associated Distal Contractile Integral, and Assessment of Bolus Transit.
- Author
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Sloan JA, Mulki R, Sandhu N, Samuel S, and Katz PO
- Subjects
- Adult, Aged, Chest Pain etiology, Deglutition Disorders etiology, Esophageal Motility Disorders diagnosis, Female, Humans, Male, Middle Aged, Muscle Contraction physiology, Retrospective Studies, Esophageal Motility Disorders physiopathology, Esophagus physiopathology, Gastrointestinal Transit physiology
- Abstract
Goals: The aim of our study was to characterize jackhammer esophagus symptoms and their relationship with the distal contractile integral (DCI) and bolus transit., Background: Jackhammer esophagus is defined by the Chicago Classification version 3.0. This diagnosis is relatively new, with the most current definition being established in 2014. The forerunners of this diagnosis, nutcracker (or hypercontractile) esophagus, have been associated with noncardiac chest pain (NCCP)., Study: A retrospective chart review was performed of motility studies from 2011 to 2016. Studies with a diagnosis of jackhammer esophagus, hypercontractile esophagus, nutcracker, esophagogastric junction outflow obstruction, or hypertensive lower esophageal sphincter were reread using Chicago Classification version 3.0, and were included if they met criteria for jackhammer esophagus. Unpaired t-tests were used for analysis (P≤0.05)., Results: In total, 142 studies were identified with the above diagnoses. After excluding 84 studies, 58 remained for analysis and 17 were found to have jackhammer esophagus (29%). The mean age was 54 (28 to 75), 5 (29%) were males and 12 (71%) were females. The primary indications were NCCP (5), dysphagia (8), and other causes (4) (cough, heartburn, or regurgitation). The mean DCIs were 17,245 mm Hg×s×cm (NCCP), 14,669 mm Hg×s×cm (dysphagia), and 11,264 mm Hg×s×cm (other causes). The mean DCIs were compared: NCCP versus dysphagia (P=0.41), and NCCP versus other causes (P=0.05). Fifteen (88%) had normal bolus transit for both liquid and viscous swallows., Conclusions: In our small sample size, dysphagia was frequently the presenting symptom followed by NCCP. Those with NCCP have a trend toward a higher DCI. Bolus transit appeared to be normal in this patient population. More data are needed to further elucidate the genesis of symptoms and how they relate to the degree of contractility.
- Published
- 2019
- Full Text
- View/download PDF
39. Pilot, Randomized, Blinded, Placebo-Controlled Trial Investigating the Correlation Between Acid Control and Heartburn Relief with 14 Days of Esomeprazole Treatment.
- Author
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Miner PB, Johnson DA, Katz PO, Li J, Gatoulis SC, and Pollack C
- Subjects
- Adult, Double-Blind Method, Drug Administration Schedule, Drug Monitoring methods, Female, Humans, Male, Middle Aged, Nonprescription Drugs administration & dosage, Proton Pump Inhibitors administration & dosage, Treatment Outcome, Esomeprazole administration & dosage, Gastric Acidity Determination, Gastroesophageal Reflux diagnosis, Gastroesophageal Reflux drug therapy, Gastroesophageal Reflux physiopathology, Heartburn drug therapy, Heartburn etiology
- Abstract
Introduction: Reflux symptoms are frequently associated with esophageal acid exposure. However, other potential causes unrelated to acid secretion are possible, and the relationship between acid control and symptomatic improvement remains unclear. This study investigated the correlation between individual intragastric pH control and heartburn relief among subjects with frequent heartburn who are likely to self-treat with over-the-counter (OTC) medications. We hypothesized that improved acid control would provide greater symptomatic improvement among individuals representative of an OTC population., Methods: This phase 4, single-center, randomized, double-blind, placebo-controlled study was conducted in subjects without diagnosed gastroesophageal reflux disease or other gastrointestinal conditions who were experiencing frequent heartburn (≥ 3 episodes/week; ≥ 2 nighttime episodes/week over past 30 days) that was responsive to treatment. Subjects entered a 7-day run-in phase, received placebo BID (before breakfast and dinner), and completed symptom diaries. During the treatment phase, subjects received esomeprazole 20 mg BID, esomeprazole 20 mg then placebo, or placebo BID. Subjects underwent 24-h intragastric pH monitoring at baseline and day 14 and completed daily symptom diaries., Results: In the per-protocol population (n = 39), mean (SD) change from baseline in percentage of time with intragastric pH > 4 was 58.7% (± 26.4%) versus 41.0% (± 30.4%) for those who did and did not achieve 24-h heartburn relief. Significant correlations were observed between change in percentage of time with intragastric pH > 4 and 24-h heartburn relief (OR 1.028; 95% CI 1.001, 1.055; P = 0.0442) and complete resolution (OR 1.034; 95% CI 1.003, 1.065; P = 0.0301)., Conclusions: Individuals with greater improvements in duration of intragastric acid suppression had an increased likelihood of achieving heartburn relief and resolution. These results indicate that individuals not adequately controlling their intragastric pH may require an escalation in dose of their acid-suppressive therapy, assessment with 24-h pH monitoring, or a change in treatment regimen to address non-reflux-related etiologies of their heartburn., Trial Registration: ClinicalTrials.gov identifier: NCT02708355., Funding: Pfizer Consumer Healthcare, Madison, NJ, USA. Plain language summary available for this article.
- Published
- 2018
- Full Text
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40. The Advantages and Adverse Events Associated With Long-Term Use of Proton Pump Inhibitors.
- Author
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Katz PO
- Abstract
Competing Interests: Dr Katz has no relevant conflicts of interest to disclose.
- Published
- 2018
41. Management options for patients with GERD and persistent symptoms on proton pump inhibitors: recommendations from an expert panel.
- Author
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Yadlapati R, Vaezi MF, Vela MF, Spechler SJ, Shaheen NJ, Richter J, Lacy BE, Katzka D, Katz PO, Kahrilas PJ, Gyawali PC, Gerson L, Fass R, Castell DO, Craft J, Hillman L, and Pandolfino JE
- Subjects
- Behavior Therapy, California, Decision Trees, Drug Administration Schedule, Esophagoscopy, Female, Fundoplication, Gastroesophageal Reflux therapy, Humans, Male, Middle Aged, Prospective Studies, Proton Pump Inhibitors administration & dosage, Gastroesophageal Reflux drug therapy, Practice Patterns, Physicians', Proton Pump Inhibitors therapeutic use
- Abstract
Background: The aim of this study was to assess expert gastroenterologists' opinion on treatment for distinct gastroesophageal reflux disease (GERD) profiles characterized by proton pump inhibitor (PPI) unresponsive symptoms., Methods: Fourteen esophagologists applied the RAND/UCLA Appropriateness Method to hypothetical scenarios with previously demonstrated GERD (positive pH-metry or endoscopy) and persistent symptoms despite double-dose PPI therapy undergoing pH-impedance monitoring on therapy. A priori thresholds included: esophageal acid exposure (EAE) time >6.0%; symptom-reflux association: symptom index >50% and symptom association probability >95%; >80 reflux events; large hiatal hernia: >3 cm. Primary outcomes were appropriateness of four invasive procedures (laparoscopic fundoplication, magnetic sphincter augmentation, transoral incisionless fundoplication, radiofrequency energy delivery) and preference for pharmacologic/behavioral therapy., Results: Laparoscopic fundoplication was deemed appropriate for elevated EAE, and moderately appropriate for positive symptom-reflux association for regurgitation and a large hiatal hernia with normal EAE. Magnetic sphincter augmentation was deemed moderately appropriate for elevated EAE without a large hiatal hernia. Transoral incisionless fundoplication and radiofrequency energy delivery were not judged appropriate in any scenario. Preference for non-invasive options was as follows: H2RA for elevated EAE, transient lower esophageal sphincter relaxation inhibitors for elevated reflux episodes, and neuromodulation/behavioral therapy for positive symptom-reflux association., Conclusion: For treatment of PPI unresponsive symptoms in proven GERD, expert esophagologists recommend invasive therapy only in the presence of abnormal reflux burden, with or without hiatal hernia, or regurgitation with positive symptom-reflux association and a large hiatus hernia. Non-invasive pharmacologic or behavioral therapies are preferred for all other scenarios.
- Published
- 2018
- Full Text
- View/download PDF
42. Getting into a TIF(F) Over Fundoplication.
- Author
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Katz PO and Katzka DA
- Subjects
- Stomach, Treatment Outcome, Fundoplication, Gastroesophageal Reflux
- Published
- 2018
- Full Text
- View/download PDF
43. A System to Assess the Competency for Interpretation of Esophageal Manometry Identifies Variation in Learning Curves.
- Author
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Yadlapati R, Keswani RN, Ciolino JD, Grande DP, Listernick ZI, Carlson DA, Castell DO, Dunbar KB, Gawron AJ, Gyawali CP, Katz PO, Katzka D, Lacy BE, Spechler SJ, Tatum R, Vela MF, and Pandolfino JE
- Subjects
- Adult, Female, Humans, Male, Prospective Studies, Clinical Competence, Gastroenterology education, Gastroesophageal Reflux diagnosis, Health Personnel, Learning Curve, Manometry methods
- Abstract
Background & Aims: Quality esophageal high-resolution manometry (HRM) studies require competent interpretation of data. However, there is little understanding of learning curves, training requirements, or measures of competency for HRM. We aimed to develop and use a competency assessment system to examine learning curves for interpretation of HRM data., Methods: We conducted a prospective multicenter study of 20 gastroenterology trainees with no experience in HRM, from 8 centers, over an 8-month period (May through December 2015). We designed a web-based HRM training and competency assessment system. After reviewing the training module, participants interpreted 50 HRM studies and received answer keys at the fifth and then at every second interpretation. A cumulative sum procedure produced individual learning curves with preset acceptable failure rates of 10%; we classified competency status as competency not achieved, competency achieved, or competency likely achieved., Results: Five (25%) participants achieved competence, 4 (20%) likely achieved competence, and 11 (55%) failed to achieve competence. A minimum case volume to achieve competency was not identified. There was no significant agreement between diagnostic accuracy and accuracy for individual HRM skills., Conclusions: We developed a competency assessment system for HRM interpretation; using this system, we found significant variation in learning curves for HRM diagnosis and individual skills. Our system effectively distinguished trainee competency levels for HRM interpretation and contrary to current recommendations, found that competency for HRM is not case-volume specific., (Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
44. Esophagogastric junction outflow obstruction is often associated with coexistent abnormal esophageal body motility and abnormal bolus transit.
- Author
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Zheng E, Gideon RM, Sloan J, and Katz PO
- Subjects
- Deglutition Disorders etiology, Electric Impedance, Esophageal Motility Disorders complications, Female, Heartburn etiology, Humans, Male, Manometry, Middle Aged, Retrospective Studies, Esophageal Motility Disorders diagnosis, Esophageal Motility Disorders physiopathology, Esophagogastric Junction physiopathology, Gastrointestinal Transit, Pressure
- Abstract
Currently, the diagnosis of esophageal motility disorders is in part based upon a hierarchical algorithm in which abnormalities of the esophagogastric junction (EGJ) is prioritized. An important metric in evaluating the EGJ is the integrated relaxation pressure (IRP). Patients who do not have achalasia but are found to have an elevated IRP are diagnosed with EGJ outflow obstruction. It has been our observation that a subset of these patients also has a second named motility disorder and may also have abnormal bolus transit. The aim of this study is to determine the frequency of abnormal body motility and or abnormal bolus movement in patients with EGJ outflow obstruction. Further, in an effort to evaluate the potential clinical value in measuring bolus transit as a complement to esophageal manometry, specifically in patients with EGJ outflow obstruction, we analyzed the presenting symptoms of these patients. A total of 807 patients with a mean age of 53 years completed esophageal function testing with impedance monitoring and high-resolution manometry between January 2012 and October 2016. There were 74 patients with achalasia who were excluded from the study. Of the remaining 733 patients, 138 (19%) had an elevated IRP and were given a diagnosis of EGJ outflow obstruction. Among these patients, 56 (40%) were diagnosed with an abnormal motility pattern to liquids (ineffective esophageal motility = 28, distal esophageal spasm = 19, Jackhammer = 6), of which 44 (76%) had abnormal bolus transit to liquids, viscous, or both. In contrast, there were 82 patients with EGJ outflow obstruction and normal esophageal motility, of which 33 (40%) had abnormal bolus transit. Patients with preserved esophageal motility and EGJ outflow obstruction were then evaluated. Of the 733 patients, 299 (40%) had intact esophageal motility. Of the 299 patients with normal esophageal motility, 56 patients had an elevated IRP, of which 16 (28%) had abnormal bolus transit. There were 243 (33%) patients with intact esophageal motility and normal IRP. Of these, 56 (23%) patients had abnormal bolus transit. Among patients with abnormal bolus transit, the two most commonly presenting symptoms were dysphagia and heartburn. A substantial percentage of patients with EGJ outflow obstruction have abnormal esophageal body motility and or abnormal bolus transit. The clinical implications of EGJ outflow obstruction need to be further elucidated as current criteria do not allow for the description of other abnormalities in esophageal motility and bolus transit among patients who are given the diagnosis of EGJ outflow obstruction., (© The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2017
- Full Text
- View/download PDF
45. Oesophageal manometry with a solid test meal: ready for prime time?
- Author
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Katz PO and Schnoll-Sussman F
- Subjects
- Humans, Meals, Esophagus, Manometry
- Published
- 2017
- Full Text
- View/download PDF
46. Editorial: refractory GERD-good drug, wrong patients?
- Author
-
Katz PO
- Subjects
- Humans, Gastroesophageal Reflux, Proton Pump Inhibitors
- Published
- 2017
- Full Text
- View/download PDF
47. Analysis of 2-Week Data from Two Randomized, Controlled Trials Conducted in Subjects with Frequent Heartburn Treated with Esomeprazole 20 mg.
- Author
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Katz PO, Le Moigne A, and Pollack C
- Subjects
- Adult, Double-Blind Method, Drug Administration Schedule, Esomeprazole administration & dosage, Esophagitis, Peptic drug therapy, Female, Humans, Male, Middle Aged, Proton Pump Inhibitors administration & dosage, Treatment Outcome, Esomeprazole therapeutic use, Heartburn drug therapy, Proton Pump Inhibitors therapeutic use
- Abstract
Purpose: These secondary analyses used data from 2 similarly designed studies in subjects experiencing frequent heartburn to evaluate the efficacy of esomeprazole 20 mg once daily for 2 weeks, which reflects the approved over-the-counter dosage and duration., Methods: Subjects without endoscopically identified erosive esophagitis who were experiencing heartburn for ≥6 months and ≥4 of 7 days prior to baseline (study 1, N = 368; study 2, N = 349) were randomly assigned to receive double-blind treatment with esomeprazole 40 or 20 mg (administered as esomeprazole magnesium trihydrate 44.5 and 22.3 mg, respectively) or placebo once daily for 4 weeks. Subjects recorded the severity of heartburn in a daily diary, and investigators assessed subjects at each study visit. Two-week assessments were the primary end points of interest in these analyses and included the percentage of subjects with complete heartburn resolution (no episodes during 7 consecutive days), time to sustained complete heartburn resolution (the first of 7 consecutive episode-free days), and heartburn relief (no episodes other than ≤1 mild episode during 7 consecutive days)., Findings: At week 2, the percentages of subjects who experienced complete heartburn resolution were significantly greater with esomeprazole 40 mg (study 1, 26.1%; study 2, 35.3%) and 20 mg (study 1, 25.2%; study 2, 35.7%) compared with placebo (study 1, 9.0%; study 2, 3.4%) (all, P ≤ 0.001). Beginning on day 1, the percentages of subjects who experienced sustained heartburn resolution was significantly greater in the groups treated with esomeprazole 40 mg (study 1, 19%; study 2, 19%; P < 0.0001) and 20 mg (study 1, 10%; study 2, 15%; P < 0.05) compared with the group that received placebo (study 1, 2%; study 2, 1%). Additionally, at week 2, the percentages of subjects experiencing heartburn relief were significantly greater with esomeprazole 40 mg (study 1, 35.3%; study 2, 40.5%) and 20 mg (study 1, 34.5%; study 2, 46.4%) compared with placebo (study 1, 16.5%; study 2, 8.6%) (all, P ≤ 0.001)., Implications: The results of this study demonstrate that once-daily treatment with esomeprazole 20 mg for 2 weeks effectively resolved subjects׳ heartburn compared with placebo, beginning on day 1. Studies precede FDA Act 801 clinical trial registration and results submission requirements., (Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
48. Benchmarks for the interpretation of esophageal high-resolution manometry.
- Author
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Yadlapati R, Keswani RN, Dunbar KB, Gawron AJ, Gyawali CP, Kahrilas PJ, Katz PO, Katzka D, Spechler SJ, Tatum R, and Pandolfino JE
- Subjects
- Benchmarking methods, Esophagus physiopathology, Humans, Manometry methods, Surveys and Questionnaires, Benchmarking standards, Clinical Competence standards, Esophageal Motility Disorders diagnosis, Esophageal Motility Disorders physiopathology, Manometry standards, Physician's Role
- Abstract
Background: Competent interpretation of esophageal high-resolution manometry (HRM) is integral to a quality study. Currently, methods to assess physician competency for the interpretation of esophageal HRM do not exist. The aim of this study was to use formal techniques to (i) develop an HRM interpretation exam, and (ii) establish minimum competence benchmarks for HRM interpretation skills at the trainee, physician interpreter, and master level., Methods: A total of 29 physicians from 8 academic centers participated in the study: 9 content experts separated into 2 study groups-expert test-takers (n=7) and judges (n=2), and 20 HRM inexperienced trainees ("trainee test-taker"; n=20). We designed the HRM interpretation exam based on expert consensus. Expert and trainee test-takers (n=27) completed the exam. According to the modified Angoff method, the judges reviewed the test-taker performance and established minimum competency cut scores for HRM interpretation skills., Key Results: The HRM interpretation exam consists of 22 HRM cases with 8 HRM interpretation skills per case: identification of pressure inversion point, hiatal hernia >3 cm, integrated relaxation pressure, distal contractile integral, distal latency, peristaltic integrity, pressurization pattern, and diagnosis. Based on the modified Angoff method, minimum cut scores for HRM interpretation skills at the trainee, physician interpreter, and master level ranged from 65-80%, 85-90% (with the exception of peristaltic integrity), and 90-95%, respectively., Conclusions & Inferences: Using a formal standard setting technique, we established minimum cut scores for eight HRM interpretation skills across interpreter levels. This examination and associated cut scores can be applied in clinical practice to judge competency., (© 2016 John Wiley & Sons Ltd.)
- Published
- 2017
- Full Text
- View/download PDF
49. The Safety of Appropriate Use of Over-the-Counter Proton Pump Inhibitors: An Evidence-Based Review and Delphi Consensus.
- Author
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Johnson DA, Katz PO, Armstrong D, Cohen H, Delaney BC, Howden CW, Katelaris P, Tutuian RI, and Castell DO
- Subjects
- Humans, Nonprescription Drugs therapeutic use, Proton Pump Inhibitors therapeutic use, Risk Assessment, Delphi Technique, Evidence-Based Medicine, Gastroesophageal Reflux drug therapy, Nonprescription Drugs administration & dosage, Nonprescription Drugs adverse effects, Proton Pump Inhibitors administration & dosage, Proton Pump Inhibitors adverse effects
- Abstract
The availability of over-the-counter (OTC) proton pump inhibitors (PPIs) for the short-term (2 weeks) management of frequent heartburn (≥2 days/week) has increased markedly, yet evidence-based recommendations have not been developed. A panel of nine international experts in gastroesophageal reflux disease developed consensus statements regarding the risks and benefits of OTC PPIs using a modified Delphi process. Consensus (based on ≥80% approval) was reached through multiple rounds of remote voting and a final round of live voting. To identify relevant data, the available literature was searched and summarized. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system terminology was used to rate the quality of evidence and strength of recommendations; consensus was based on ≥2/3 agreement. After 4 rounds of review, consensus was achieved for 18 statements. Notably, the available data did not directly reflect OTC use, but instead, prescription use; therefore, extrapolations to the OTC setting were often necessary. This limitation is regrettable, but it justifies performing this exercise to provide evidence-based expert opinion on a widely used class of drugs. The panel determined that using OTC PPIs according to label instructions is unlikely to mask the symptoms of esophageal or gastric cancer or adversely impact the natural history of related precursor conditions. OTC PPIs are not expected to substantially affect micronutrient absorption or bone mineral density or cause community-acquired pneumonia, Clostridium difficile infection, or cardiovascular adverse events. However, OTC PPI use may be associated with slightly increased risks for infectious diarrhea, certain idiosyncratic reactions, and cirrhosis-related spontaneous bacterial peritonitis. The available evidence does not suggest that OTC PPI use consistent with label instructions is associated with substantial health risks. To minimize potential risks, healthcare professionals and consumers must actively participate in decision making when managing reflux-related symptoms in the self-care setting.
- Published
- 2017
- Full Text
- View/download PDF
50. Clinical Implications of Emerging Data on the Safety of Proton Pump Inhibitors.
- Author
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Schnoll-Sussman F and Katz PO
- Abstract
Opinion Statement: Proton pump inhibitors (PPI) are among the safest class of drugs used by all care providers, including gastroenterologists. They are the mainstay in treatment of acid-related disease, in particular, gastroesophageal reflux disease. Without them, many patients would experience a major decrement in their quality of life. However, no drug is without side effects or adverse events. In the past decade, numerous reports, principally case control studies and meta-analyses, have raised questions about important adverse events related to the use of PPIs. This has affected not only physicians' prescribing habits but patients' concerns about using these medications, particularly long term. Several FDA warnings are listed including those related to long bone fractures, interaction with clopidogrel, enteric infections, and hypomagnesaemia. More recently, concerns regarding PPIs and cardiovascular events have resurfaced as have issues related to kidney disease and dementia. The methodology of these studies allows us to find an association with these events but does not provide us with sufficient evidence to determine causality. In general, the findings of the available studies do not fit with our clinical experience nor is the magnitude of the association sufficient to result in a major change in our practice. Nevertheless, the recent literature has resulted in our careful reevaluation of PPI use across both FDA indications and in general. This article will critically review the literature regarding potential PPI adverse events and attempt to place them in perspective for the practicing physician.
- Published
- 2017
- Full Text
- View/download PDF
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