1
|
Halland M, Prichard DO, Kahn A, Lavey CJ, Katzka DA, Alexander JA. Esophageal Self-Dilation in Benign Refractory Esophageal Strictures: Outcomes from a Randomized Controlled Trial and a Prospective Observational Study. Dig Dis Sci 2024:10.1007/s10620-024-08402-z. [PMID: 38811502 DOI: 10.1007/s10620-024-08402-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/20/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Patients with benign esophageal strictures may not maintain a response to endoscopic dilation, stenting, incisional or injectional therapies. For patients with these refractory esophageal strictures, esophageal self-dilation therapy (ESDT), performed to maintain luminal patency, may provide persistent symptomatic benefit while reducing patients' reliance on healthcare services and the risk associated with repeated endoscopic procedures. AIMS The aim of this study was to evaluate the efficacy and safety of EDST in a randomized controlled trial and prospective observational study. METHODS Twenty-five patients with refractory benign esophageal strictures were recruited at two esophageal clinics between November 2018 and June 2021. Twelve patients participated in the randomized trial and 13 in the prospective observational study. The number of endoscopic dilations, impact of therapy on dysphagia, adverse events, and complications were recorded. RESULTS In the randomized study, 50% of patients performing ESDT and 100% of controls required endoscopic dilation during follow-up (P = 0.02). In the observational study, the median (IQR) number of endoscopic dilations fell from 7 [7-10] in the 6 months prior to commencing ESDT to 1 [0-2] in the 6 months after (P < 0.0001). Most patients (22/25) were able to learn self-dilation. Few serious adverse events were noted. Dysphagia severity remained unchanged or improved. CONCLUSIONS ESDT appears to be a safe effective therapy for benign esophageal strictures refractory to endoscopic treatment. CLINICAL TRIAL NUMBER NCT03738566.
Collapse
Affiliation(s)
- Magnus Halland
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
- School of Medicine, University of Newcastle, Newcastle, NSW, 2300, Australia.
| | - David O Prichard
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
- St James' Hospital, University of Dublin, Dublin, Ireland
- Trinity College, Dublin, Ireland
| | - Allon Kahn
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA
| | - Crystal J Lavey
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - David A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey A Alexander
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
2
|
Elliott JA, Guinan E, Reynolds JV. Measurement and optimization of perioperative risk among patients undergoing surgery for esophageal cancer. Dis Esophagus 2024; 37:doad062. [PMID: 37899136 PMCID: PMC10906714 DOI: 10.1093/dote/doad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/28/2023] [Indexed: 10/31/2023]
Abstract
Esophagectomy is an exemplar of complex oncological surgery and is associated with a relatively high risk of major morbidity and mortality. In the modern era, where specific complications are targeted in prevention and treatment pathways, and where the principles of enhanced recovery after surgery are espoused, optimum outcomes are targeted via a number of approaches. These include comprehensive clinical and physiological risk assessment, specialist perioperative care by a high-volume team, and multimodal inputs throughout the patient journey that aim to preserve or restore nutritional deficits, muscle mass and function.
Collapse
Affiliation(s)
- Jessie A Elliott
- Trinity St. James’s Cancer Institute, Trinity College Dublin and St. James’s Hospital, Dublin, Ireland
| | - Emer Guinan
- Trinity St. James’s Cancer Institute, Trinity College Dublin and St. James’s Hospital, Dublin, Ireland
| | - John V Reynolds
- Trinity St. James’s Cancer Institute, Trinity College Dublin and St. James’s Hospital, Dublin, Ireland
| |
Collapse
|
3
|
Maslenkina K, Mikhaleva L, Mikhalev A, Kaibysheva V, Atiakshin D, Motilev E, Buchwalow I, Tiemann M. Assessment of the Severity and the Remission Criteria in Eosinophilic Esophagitis. Biomedicines 2023; 11:3204. [PMID: 38137426 PMCID: PMC10740698 DOI: 10.3390/biomedicines11123204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/19/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
Eosinophilic esophagitis (EoE) is an immune-mediated disease that manifests with dysphagia and is characterized by the predominantly eosinophilic infiltration of the esophageal mucosa. Several instruments have been developed to assess the symptoms of EoE: the Daily Symptom Questionnaire (DSQ), EoE Activity Index (EEsAI), Pediatric EoE Symptom Severity (PEESSv2), etc. The use of the EREFS is a gold standard for endoscopic diagnosis. The EoE histologic scoring system (EoEHSS) was elaborated for the assessment of histological features in EoE. However, the remission criteria are not clearly defined and vary greatly in different studies. Gastroenterologists establish the severity of EoE mainly based on endoscopic findings. At the same time, EoE requires a multidisciplinary approach. The recently developed Index of Severity of Eosinophilic Esophagitis (I-SEE) that is built on symptoms, endoscopic findings, and histological features is promising.
Collapse
Affiliation(s)
- Ksenia Maslenkina
- A.P. Avtsyn Research Institute of Human Morphology, Petrovsky National Research Center of Surgery, 119991 Moscow, Russia; (K.M.); (L.M.); (E.M.)
| | - Liudmila Mikhaleva
- A.P. Avtsyn Research Institute of Human Morphology, Petrovsky National Research Center of Surgery, 119991 Moscow, Russia; (K.M.); (L.M.); (E.M.)
| | - Alexander Mikhalev
- Laboratory of Surgical Gastroenterology and Endoscopy, Pirogov Russian National Research University, 117997 Moscow, Russia; (A.M.); (V.K.)
| | - Valeria Kaibysheva
- Laboratory of Surgical Gastroenterology and Endoscopy, Pirogov Russian National Research University, 117997 Moscow, Russia; (A.M.); (V.K.)
| | - Dmitri Atiakshin
- Research and Educational Resource Center for Immunophenotyping, Digital Spatial Profiling and Ultrastructural Analysis Innovative Technologies, RUDN University, 6 Miklukho-Maklaya St., 117198 Moscow, Russia;
| | - Eugeny Motilev
- A.P. Avtsyn Research Institute of Human Morphology, Petrovsky National Research Center of Surgery, 119991 Moscow, Russia; (K.M.); (L.M.); (E.M.)
| | - Igor Buchwalow
- Research and Educational Resource Center for Immunophenotyping, Digital Spatial Profiling and Ultrastructural Analysis Innovative Technologies, RUDN University, 6 Miklukho-Maklaya St., 117198 Moscow, Russia;
- Institute for Hematopathology, Fangdieckstr. 75a, 22547 Hamburg, Germany;
| | - Markus Tiemann
- Institute for Hematopathology, Fangdieckstr. 75a, 22547 Hamburg, Germany;
| |
Collapse
|
4
|
Mei X, Zhang Q, Zhang F, Jin J, Zeng Z, Kong D. Balloon-occluded Esophageal Varices Obliteration Versus Ligation for the Management of F2 Esophageal Varices: A Randomized Controlled Trial. Surg Laparosc Endosc Percutan Tech 2023; 33:456-462. [PMID: 37523518 DOI: 10.1097/sle.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/17/2023] [Indexed: 08/02/2023]
Abstract
AIM To compare balloon-occluded esophageal varices obliteration (BEVO) with esophageal variceal ligation (EVL) in the management of cirrhotic patients with type F2 esophageal varices (F2-EVs). MATERIALS AND METHODS A total of 157 patients with F2-EVs were randomly assigned to either BEVO (n=79) or EVL (n=78) group in the prospective study between July 2021 and December 2021. Primary outcomes included recurrence and eradication rates. Secondary outcomes included rebleeding rate, and procedural complications. RESULTS The recurrence rate of EVs was notably lower in the BEVO group than in the EVL group (3.80% vs. 21.79%; P =0.001). The rate of complete eradication in the BEVO group was significantly higher than that of the EVL group (96.20% vs. 74.36%; P <0.001). The incidence of rebleeding in the BEVO group was markedly lower than that of the EVL group (7.59% vs. 20.51%; P =0.02). There was a higher incidence of transient dysphagia in the EVL group than in the BEVO group (10.26% vs. 1.27%; P =0.015). CONCLUSIONS BEVO exerted an effective treatment option for F2-EVs.
Collapse
Affiliation(s)
- Xuecan Mei
- Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University, Key Laboratory of Digestive Diseases of Anhui Province, Hefei, Anhui, China
| | | | | | | | | | | |
Collapse
|
5
|
Le KHN, Low EE, Yadlapati R. Evaluation of Esophageal Dysphagia in Elderly Patients. Curr Gastroenterol Rep 2023; 25:146-159. [PMID: 37312002 PMCID: PMC10726678 DOI: 10.1007/s11894-023-00876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW While guidelines exist for the evaluation and management of esophageal dysphagia in the general population, dysphagia disproportionately affects the elderly. In this article, we reviewed the literature on evaluating esophageal dysphagia in elderly patients and proposed a diagnostic algorithm based on this evidence. RECENT FINDINGS In older patients, dysphagia is often well compensated for by altered eating habits and physiologic changes, underreported by patients, and missed by healthcare providers. Once identified, dysphagia should be differentiated into oropharyngeal and esophageal dysphagia to guide diagnostic workup. For esophageal dysphagia, this review proposes starting with endoscopy with biopsies, given its relative safety even in older patients and potential for interventional therapy. If endoscopy shows a structural or mechanical cause, then further cross-sectional imaging should be considered to assess for extrinsic compression, and same session endoscopic dilation should be considered for strictures. If biopsies and endoscopy are normal, then esophageal dysmotility is more likely, and high-resolution manometry and additional workup should be performed following the updated Chicago Classification. Even after diagnosis of the root cause, complications including malnutrition and aspiration pneumonia should also be assessed and monitored, as they both result from and can further contribute to dysphagia. The successful evaluation of esophageal dysphagia in elderly patients requires a thorough, standardized approach to collecting a history, selection of appropriate diagnostic workup, and assessment of risk of potential complications, including malnutrition and aspiration.
Collapse
Affiliation(s)
| | - Eric E Low
- Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA
| | - Rena Yadlapati
- Department of Gastroenterology and Hepatology, University of California, San Diego, CA, USA.
- , La Jolla, CA, USA.
| |
Collapse
|
6
|
Evaluation of Therapeutic Effect of Buspirone in Improving Dysphagia in Patients with GERD and Ineffective Esophageal Motility: A Randomized Clinical Trial. GASTROENTEROLOGY INSIGHTS 2022. [DOI: 10.3390/gastroent14010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Ineffective esophageal motility (IEM) is the most common esophageal motility disorder associated with low-to-moderate amplitude contractions in the distal esophagus in manometric evaluations. Despite recent new conceptions regarding the pathophysiology of esophageal motility and IEM, there are still no effective therapeutic interventions for the treatment of this disorder. This study aimed to investigate the effect of buspirone in the treatment of concomitant IEM and GERD. Methods and Materials: The present study was a randomized clinical trial conducted at the Imam Khomeini Hospital, Tehran. Patients with a history of gastroesophageal reflux disease and dysphagia underwent upper endoscopy to rule out any mechanical obstruction and were diagnosed with an ineffective esophageal motility disorder based on high-resolution manometry. They were given a package containing the desired medication(s); half of the packets contained 10 mg (for 30 days) of buspirone and 40 mg (for 30 days) of pantoprazole, and the other half contained only 40 mg (for 30 days) of pantoprazole. Dysphagia was scored based on the Mayo score, as well as a table of dysphagia severity. Manometric variables were recorded before and after the treatment. Results: Thirty patients (15 pantoprazole and 15 pantoprazole plus buspirone) were included. Females comprised 63.3% of the population, with a mean age of 46.33 ± 11.15. The MAYO score and resting LES pressure significantly changed after treatment. The MAYO and Swallowing Disorder Questionnaire scores significantly decreased after treatment in both groups of patients. Our results revealed that the post-intervention values of manometric variables differed significantly between the two groups after controlling for the baseline values of the variables. This analysis did not demonstrate the superiority of buspirone. Conclusion: Buspirone seems to have no superiority over PPI. Treatment with concomitant IEM and GERD using proton pump inhibitors improves the patient’s clinical condition and quality of life. However, adding buspirone to the treatment regimen did not appear to make a significant difference in patient treatment.
Collapse
|
7
|
Chen K, Xing L, Xu B, Li Y, Liu T, Zhang T, Shi H, Lu H, Zhou W, Hou J, Shi H, Qin D. Research progress in the risk factors and screening assessment of dysphagia in the elderly. Front Med (Lausanne) 2022; 9:1021763. [PMID: 36419790 PMCID: PMC9676222 DOI: 10.3389/fmed.2022.1021763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/21/2022] [Indexed: 10/30/2023] Open
Abstract
With the aging of the population, the incidence of dysphagia has gradually increased and become a major clinical and public health issue. Early screening of dysphagia in high-risk populations is crucial to identify the risk factors of dysphagia and carry out effective interventions and health management in advance. In this study, the current epidemiology, hazards, risk factors, preventive, and therapeutic measures of dysphagia were comprehensively reviewed, and a literature review of screening instruments commonly used globally was conducted, focusing on their intended populations, main indicators, descriptions, and characteristics. According to analysis and research in the current study, previous studies of dysphagia were predominantly conducted in inpatients, and there are few investigations and screenings on the incidence and influencing factors of dysphagia in the community-dwelling elderly and of dysphagia developing in the natural aging process. Moreover, there are no unified, simple, economical, practical, safe, and easy-to-administer screening tools and evaluation standards for dysphagia in the elderly. It is imperative to focus on dysphagia in the community-dwelling elderly, develop unified screening and assessment tools, and establish an early warning model of risks and a dietary structure model for dysphagia in the community-dwelling elderly.
Collapse
Affiliation(s)
- Kerong Chen
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Liwei Xing
- The First School of Clinical Medicine, Yunnan University of Chinese Medicine, Kunming, China
| | - Bonan Xu
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Yi Li
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Tianyun Liu
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Tingjuan Zhang
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Hongping Shi
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Hanmei Lu
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Wengang Zhou
- Department of Medical, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Jianhong Hou
- Department of Orthopedics, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Hongling Shi
- Department of Rehabilitation Medicine, The Third People’s Hospital of Yunnan Province, Kunming, China
| | - Dongdong Qin
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| |
Collapse
|
8
|
Franciosi JP, Mougey EB, Dellon ES, Gutierrez-Junquera C, Fernandez-Fernandez S, Venkatesh RD, Gupta SK. Proton Pump Inhibitor Therapy for Eosinophilic Esophagitis: History, Mechanisms, Efficacy, and Future Directions. J Asthma Allergy 2022; 15:281-302. [PMID: 35250281 PMCID: PMC8892718 DOI: 10.2147/jaa.s274524] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/14/2022] [Indexed: 12/11/2022] Open
Abstract
Over the past decade, the role of proton pump inhibitor (PPI) medication has evolved from a diagnostic tool for Eosinophilic Esophagitis (EoE), by excluding patients with PPI responsive esophageal eosinophilia (PPI-REE), to a therapy for EoE. This transition resulted from the Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the Appraisal of Guidelines for Research and Evaluation II (AGREE) Conference to support PPI therapy for EoE in children and adults. Additional recent advances have suggested a role for genetic variations that might impact response to PPI therapy for EoE. This review article will explore a brief background of EoE, the evolution of PPI therapy for EoE and its proposed mechanisms, efficacy and safety in children and adults, and considerations for future PPI precision medicine in patients with EoE.
Collapse
Affiliation(s)
- James P Franciosi
- Division of Gastroenterology, Nemours Children’s Hospital, Orlando, FL, USA
- College of Medicine, University of Central Florida, Orlando, FL, USA
- Correspondence: James P Franciosi, Division of Gastroenterology, Nemours Children’s Hospital, 6535 Nemours Parkway, Orlando, FL, 32827, USA, Email
| | - Edward B Mougey
- Center for Pharmacogenomics and Translational Research, Nemours Children’s Health System, Jacksonville, FL, USA
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Carolina Gutierrez-Junquera
- Pediatric Gastroenterology Unit, Hospital Universitario Puerta de Hierro-Majadahonda, Autonomous University of Madrid, Madrid, Spain
| | | | - Rajitha D Venkatesh
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Sandeep K Gupta
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Riley Hospital for Children, Indiana University School of Medicine and Community Health Network, Indianapolis, IN, USA
| |
Collapse
|
9
|
Dorsey YC, Song EJ, Leiman DA. Beyond the Eckardt Score: Patient-Reported Outcomes Measures in Esophageal Disorders. Curr Gastroenterol Rep 2021; 23:29. [PMID: 34850300 DOI: 10.1007/s11894-021-00831-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of patient reported outcome measures (PROMs) and summarize their role in assessing undifferentiated dysphagia and common esophageal disorders, including achalasia, eosinophilic esophagitis (EoE), and gastroesophageal reflux disease (GERD). RECENT FINDINGS Given the subjective nature of swallowing disorders, accurate diagnoses often rely on capturing the patient experience. As a result, the number of PROMs used to characterize esophageal symptoms is increasing with a recent particular emphasis on EoE. Overall, esophageal-focused PROMs are used to interpret patient symptoms and quality of life, diagnosis, and symptom changes over time. There are limitations with each instrument, including factors affecting validity, reliability, accessibility, patient participation, and logistical implementation. PROM instruments can be helpful tools in the diagnosis and treatment of esophageal disorders. Instruments should be chosen based on factors such as target population and setting, including research, clinical, and quality improvement efforts. Future research should address how best to implement PROMs and integrate the obtained data with patient care.
Collapse
Affiliation(s)
- Y Claire Dorsey
- Division of Gastroenterology, Duke University School of Medicine, Duke Clinical Research Institute, 200 Morris Street, Durham, NC, 27701, USA
| | - Erin J Song
- Department of Medicine, Duke University, Durham, NC, USA
| | - David A Leiman
- Division of Gastroenterology, Duke University School of Medicine, Duke Clinical Research Institute, 200 Morris Street, Durham, NC, 27701, USA. .,Duke Clinical Research Institute, Durham, NC, USA.
| |
Collapse
|
10
|
Rao SJ, Nickel JC, Kiell EP, Madden LL. Readability of Commonly Used Patient-Reported Outcome Measures in Laryngology. Laryngoscope 2021; 132:1069-1074. [PMID: 34498753 DOI: 10.1002/lary.29849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) are used to evaluate patients' symptoms and clinical improvement after an intervention. Advocacy efforts and increased provider awareness regarding health literacy have helped to improve the readability of PROMs. Recent studies in otolaryngology in rhinology, pediatric otolaryngology, and head and neck reported PROM readability scores above the sixth-grade level. However, there is limited data regarding the readability of laryngology PROMs. Thus, this study aims to report the readability levels of PROMs in laryngology by assessing different readability indices and describing the relationship of readability levels to equitable healthcare. METHODS This is a bibliometric study that received approval from institutional review board (IRB) review as a nonhuman subject research study. Recent and widely utilized laryngology PROMs were selected from a publicly available literature search by reviewing laryngology systematic reviews, PubMed, and Google Scholar. Laryngology PROMs were selected from voice, dysphagia, airway, and other PROMs including voice questionnaires administered to patients seeking gender affirming voice care from systematic reviews and expert opinion. There were 37 PROMs included in this study. PROMs were analyzed via Gunning Fog, Simple Measure of Gobbledygook (SMOG), FORCAST, and Flesch Reading Ease Score. RESULTS All laryngology PROMs had readabilities above the recommended sixth-grade level. The mean and standard deviation (SD) of Gunning Fog was 7.30 (2.59), SMOG was 8.70 (1.51), FORCAST was 10.05 (1.51), and Flesch Reading Ease Score was 8.08 (2.76). CONCLUSION Laryngology PROMs are above the recommended middle school reading level. To further promote health equity, readability should be considered when developing future PROMs. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
Collapse
Affiliation(s)
- Shambavi J Rao
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Joseph C Nickel
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Eleanor P Kiell
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| |
Collapse
|
11
|
Effects of Diaphragmatic Breathing on the Pathophysiology and Treatment of Upright Gastroesophageal Reflux: A Randomized Controlled Trial. Am J Gastroenterol 2021; 116:86-94. [PMID: 33009052 DOI: 10.14309/ajg.0000000000000913] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Uncontrolled results suggest that diaphragmatic breathing (DB) is effective in gastroesophageal reflux disease (GERD) but the mechanism of action and rigor of proof is lacking. This study aimed to determine the effects of DB on reflux, lower esophageal sphincter (LES), and gastric pressures in patients with upright GERD and controls. METHODS Adult patients with pH proven upright GERD were studied. During a high-resolution impedance manometry, study patients received a standardized pH neutral refluxogenic meal followed by LES challenge maneuvers (Valsalva and abdominal hollowing) while randomized to DB or sham. After that, patients underwent 48 hours of pH-impedance monitoring, with 50% randomization to postprandial DB during the second day. RESULTS On examining 23 patients and 10 controls, postprandial gastric pressure was found to be significantly higher in patients compared with that in controls (12 vs 7 mm Hg, P = 0.018). Valsalva maneuver produced reflux in 65.2% of patients compared with 44.4% of controls (P = 0.035). LES increased during the inspiratory portion of DB (42.2 vs 23.1 mm Hg, P < 0.001) in patients and healthy persons. Postprandial DB reduced the number of postprandial reflux events in patients (0.36 vs 2.60, P < 0.001) and healthy subjects (0.00 vs 1.75, P < 0.001) compared with observation. During 48-hour ambulatory study, DB reduced the reflux episodes on day 2 compared with observation on day 1 in both the patient and control groups (P = 0.049). In patients, comparing DB with sham, total acid exposure on day 2 was not different (10.2 ± 7.9 vs 9.4 ± 6.2, P = 0.804). In patients randomized to DB, esophageal acid exposure in a 2-hour window after the standardized meal on day 1 vs day 2 reduced from 11.8% ±6.4 to 5.2% ± 5.1, P = 0.015. DISCUSSION In patients with upright GERD, DB reduces the number of postprandial reflux events pressure by increasing the difference between LES and gastric pressure. These data further encourage studying DB as therapy for GERD.
Collapse
|
12
|
Abstract
Esophageal symptoms are common and may indicate the presence of gastroesophageal reflux disease (GERD), structural processes, motor dysfunction, behavioral conditions, or functional disorders. Esophageal physiologic tests are often performed when initial endoscopic evaluation is unrevealing, especially when symptoms persist despite empiric management. Commonly used esophageal physiologic tests include esophageal manometry, ambulatory reflux monitoring, and barium esophagram. Functional lumen imaging probe (FLIP) has recently been approved for the evaluation of esophageal pressure and dimensions using volumetric distension of a catheter-mounted balloon and as an adjunctive test for the evaluation of symptoms suggestive of motor dysfunction. Targeted utilization of esophageal physiologic tests can lead to definitive diagnosis of esophageal disorders but can also help rule out organic disorders while making a diagnosis of functional esophageal disorders. Esophageal physiologic tests can evaluate obstructive symptoms (dysphagia and regurgitation), typical and atypical GERD symptoms, and behavioral symptoms (belching and rumination). Certain parameters from esophageal physiologic tests can help guide the management of GERD and predict outcomes. In this ACG clinical guideline, we used the Grading of Recommendations Assessment, Development and Evaluation process to describe performance characteristics and clinical value of esophageal physiologic tests and provide recommendations for their utilization in routine clinical practice.
Collapse
|
13
|
Hirano I, Safroneeva E, Roumet MC, Comer GM, Eagle G, Schoepfer A, Falk GW. Randomised clinical trial: the safety and tolerability of fluticasone propionate orally disintegrating tablets versus placebo for eosinophilic oesophagitis. Aliment Pharmacol Ther 2020; 51:750-759. [PMID: 32149424 DOI: 10.1111/apt.15670] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/21/2019] [Accepted: 02/03/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND APT-1011, a fluticasone propionate orally disintegrating tablet formulation, is under investigation for the treatment of eosinophilic oesophagitis (EoE). AIMS To evaluate the safety and tolerability of APT-1011 administered to patients with EoE and to assess the effect on clinical symptoms of EoE, endoscopic appearance and oesophageal eosinophilia. METHODS A randomised, double-blind, placebo-controlled, multicentre, phase 1b/2a study was conducted at seven medical centres in the US to evaluate the safety and tolerability of APT-1011 over 8 weeks in adults and adolescents with EoE. Participants were randomised to placebo (n = 8), 1.5 mg APT-1011 BID (n = 8) or 3.0 mg APT-1011 QD (n = 8). Safety and tolerability were assessed as the primary outcome; histologic and endoscopic measures were assessed as exploratory outcomes. RESULTS There were no deaths, serious treatment-emergent adverse events (TEAEs), severe TEAEs or discontinuations from the study related to a TEAE. In one participant randomised to 1.5 mg APT-1011 BID, a reduction in cortisol was observed, but without evidence of adrenal insufficiency. Compared with placebo, treatment with APT-1011 resulted in greater reductions in oesophageal eosinophil counts, EoE Endoscopic Reference Score, patient global assessment and symptom-based EoE activity index from baseline to end of treatment (Week 8). CONCLUSIONS APT-1011 was safe and well tolerated in adolescents and adults with EoE. Exploratory efficacy outcomes demonstrated improvement in histologic and endoscopic findings as well evidence of symptom improvement. The results of this study support the continued development of APT-1011 for the treatment of EoE (NCT-01386112).
Collapse
Affiliation(s)
- Ikuo Hirano
- Department of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ekaterina Safroneeva
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Marie C Roumet
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | | | - Gina Eagle
- Adare Pharmaceuticals, Lawrenceville, NJ, USA
| | - Alain Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Gary W Falk
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
14
|
Dellon ES, Gupta SK. A Conceptual Approach to Understanding Treatment Response in Eosinophilic Esophagitis. Clin Gastroenterol Hepatol 2019; 17:2149-2160. [PMID: 30710696 PMCID: PMC6667323 DOI: 10.1016/j.cgh.2019.01.030] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/15/2019] [Accepted: 01/20/2019] [Indexed: 02/07/2023]
Abstract
While the diagnosis and initial treatment of eosinophilic esophagitis are becoming more standardized, there are still major gaps in knowledge related to measuring treatment response. One such question centers on how to measure treatment response and what treatment endpoints should be. This impacts not only patient care and engagement in decision-making, but also the field of drug development. In addition, studies so far have use a myriad of treatment endpoints including over a dozen histologic endpoint criteria. This review will discuss the various stakeholders involved in assessment of treatment endpoints of a complex condition, including patients, practitioners and regulatory agencies, and the care settings in which treatment response is assessed, including routine clinical care, clinical trials, and observational studies. Potential parameters or treatment endpoints such as histology, symptoms, patient-reported outcomes, endoscopy, and biomarkers are discussed along with associated challenges and opportunities. A framework on how to define treatment outcomes is discussed and a conceptual approach treatment response is proposed. This takes into account histology, symptoms, and endoscopic findings and harnesses existing, validated tools. It includes definitions of nonresponse, complete normalization, and a graded response category between these 2 extremes, and also permits flexibility and latitude for modifications as newer knowledge emerges. In addition, ways to position the pediatric population in these endeavors are discussed as are future research directions.
Collapse
Affiliation(s)
- Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Sandeep K Gupta
- Division of Pediatric Gastroenterology, University of Illinois College of Medicine, Peoria, IL
| |
Collapse
|
15
|
Arasu S, Liaquat H, Suri J, Ehrlich AC, Friedenberg FK. Incidence and risk factors of dysphagia after variceal band ligation. Clin Mol Hepatol 2019; 25:374-380. [PMID: 31315388 PMCID: PMC6933116 DOI: 10.3350/cmh.2019.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/12/2019] [Indexed: 01/08/2023] Open
Abstract
Background/Aims There is a lack of data on long-term morbidity, particularly dysphagia, following endoscopic variceal band ligation (EVL). The aim of this study are to assess the incidence of dysphagia and variables associated with this complication after EVL. Methods We identified individuals who completed at least one session of EVL as their sole treatment for varices from August 2012 to December 2017. Included patients achieved “complete eradication” of varices not requiring further therapy. Patients ≥90 days from their last EVL session completed a modified version of the Mayo Clinic Dysphagia Questionnaire. Individuals with dysphagia were invited to undergo a barium esophagram. Patients with pre-EVL dysphagia were excluded. Results Of the patients, 68 possessed inclusion criteria, nine (13.2%) died and 20 (29.4%) were lost to follow up. For the remaining 39 (57.4%) patients, 23 were males, mean age of 61.7±8.6 years. The most common etiology of liver disease was hepatitis C virus (n=18; 46.2%). The median number of banding sessions was 2.0 (interquartile range [IQR], 1.0–4.0) with a median of 9.0 bands placed (IQR, 3.0–14.0). Twelve patients (30.8%) developed new-onset dysphagia post-EVL. In univariate analysis, pre-EVL MELD score and non-emergent initial banding were associated with long-term dysphagia. In a regression model adjusted for age, sex, number of bands, and use of acid suppression after EVL, no factor was independently associated with dysphagia (all p>0.05). No strictures were identified on subsequent esophageal evaluation. Conclusions Approximately 30% of patients developed new-onset, chronic dysphagia post-EVL. Incident dysphagia was associated with a non-emergent initial banding session. The mechanism for dysphagia remains unknown.
Collapse
Affiliation(s)
- Saraswathi Arasu
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Hammad Liaquat
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Jaspreet Suri
- Internal Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Adam C Ehrlich
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| | - Frank K Friedenberg
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
16
|
Taft TH, Kern E, Starkey K, Craft J, Craven M, Doerfler B, Keefer L, Kahrilas P, Pandolfino J. The dysphagia stress test for rapid assessment of swallowing difficulties in esophageal conditions. Neurogastroenterol Motil 2019; 31:e13512. [PMID: 30474165 PMCID: PMC6386586 DOI: 10.1111/nmo.13512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/09/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Esophageal dysphagia is a common symptom in gastroenterology practice. Current rapid assessment tools are limited to oropharyngeal dysphagia and do not translate well to esophageal conditions. We aim to create a novel tool, the dysphagia stress test (DST), to evaluate swallowing in patients with esophageal disease characterized by dysphagia. METHODS Adults with eosinophilic esophagitis (EoE), gastroesophageal reflux disease (GERD), achalasia, and dysphagia not otherwise specified (NOS) participated. Patient controls with non-esophageal diagnoses and healthy controls were also recruited. Participants completed the DST with five bolus challenges: water, applesauce, rice, bread, barium tablet and rated their swallowing difficulty and pain. A study clinician observed and documented water use and refusal of any challenges. Participants also completed measures of esophageal symptoms, hypersensitivity, and symptom anxiety to evaluate the DST validity. Collinearity of bolus challenges guided item reduction. KEY RESULTS A total of 132 subjects participated. Both control groups and GERD patients had the best swallowing ability, while achalasia, EOE, and dysphagia NOS scored poorer. About 90% of patients were able to attempt or pass each of the bolus challenges, suggesting high acceptability. Construct validity of the DST is evidenced by modest negative correlations with symptom severity, hypersensitivity, and anxiety. The DST does not appear to be influenced by brain-gut processes. Applesauce, rice, and bread demonstrated collinearity; thus, the DST was reduced to three challenges. CONCLUSIONS & INFERENCES The DST is the first rapid assessment tool designed for gastroenterology clinics with direct observation of swallowing ability across several conditions to mitigate issues related to patient self-report of esophageal symptoms.
Collapse
Affiliation(s)
- Tiffany H Taft
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| | - Emily Kern
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| | - Kristen Starkey
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| | - Jenna Craft
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| | - Meredith Craven
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| | - Bethany Doerfler
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| | - Laurie Keefer
- Icahn School of Medicine, Mount Sinai Medical Center, Susan and Leonard Feinstein IBD Center
| | - Peter Kahrilas
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| | - John Pandolfino
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology
| |
Collapse
|
17
|
Qin Y, Sunjaya DB, Myburgh S, Sawas T, Katzka DA, Alexander JA, Halland M. Outcomes of oesophageal self-dilation for patients with refractory benign oesophageal strictures. Aliment Pharmacol Ther 2018; 48:87-94. [PMID: 29785713 DOI: 10.1111/apt.14807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/04/2018] [Accepted: 04/24/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Current management of refractory benign oesophageal strictures with endoscopic dilations and stenting leads to resolution of dysphagia in only 30% of patients. Oesophageal self-dilation may be an alternative. AIM To evaluate the efficacy and safety of oesophageal self-dilation at a tertiary referral centre. METHODS We conducted a retrospective review of patients with refractory benign oesophageal strictures who participated in oesophageal self-dilation at Mayo Clinic (Rochester, MN, USA) between 2003 and 2017. Clinical data including stricture characteristics, Dakkak and Bennett Dysphagia Score, number and dates of endoscopies, and complications were collected. A two-tailed paired Student's t test was used to compare the measures of efficacy, with differences considered significant at a 5% probability level. RESULTS We identified 52 patients with refractory strictures treated with self-dilation. The median number of endoscopic interventions was reduced from 9.5 (range 5-30) to 0 (range 0-3) within 12 months before and after self-dilation, respectively (P < 0.0001). A median intervention-free interval of 417 days (IQR 256-756 days) was observed. The mean dysphagia score at baseline was 2.5 (95% CI 2.2-2.8) and 0.33 (95% CI 0.11-0.53) after self-dilation. 23 of 27 (85%) patients who received enteral nutrition prior to self-dilation had their feeding tubes removed. CONCLUSIONS Oesophageal self-dilation is an effective way of maintaining oesophageal patency in refractory benign oesophageal strictures, with safety comparable to current standard of care. Prospective studies are needed to further validate the role of self-dilation in treatment of refractory benign oesophageal strictures.
Collapse
Affiliation(s)
- Y Qin
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - D B Sunjaya
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - S Myburgh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - T Sawas
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - D A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - J A Alexander
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - M Halland
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
18
|
Kanotra SP, Vaitaitis V, Hopkins H, Fletcher M, Gonsoulin CK, Keith B. Impact of supraglottoplasty on parental preception of swallowing using a 10 question swallowing index. Int J Pediatr Otorhinolaryngol 2018; 109:122-126. [PMID: 29728164 DOI: 10.1016/j.ijporl.2018.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/28/2018] [Accepted: 03/28/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Laryngomalacia can have a significant impact on swallowing function. Most of the studies in literature have focused on evaluating swallowing dysfunction in children with Laryngomalacia using clinical assessment and swallowing studies i.e. functional endoscopic evaluation of swallowing or videofluroscopic evaluation of swallowing. OBJECTIVE The objective of the current study was to evaluate the parental perception of swallowing using a newly devised 10-point swallowing index before and after supraglottoplasty. MATERIAL AND METHODS This was a prospective study performed at a tertiary care Aerodigestive center over a period of 18 months. A total of 51 supraglottoplasties were performed by a single surgeon over an 18-month period. Parents were asked to fill a non validated 10-point questionnaire before and after supraglottoplasty. Of the 51 surgeries, 34 surveys were completed, and 28 surveys were included in the study. All the patients were classified in to mild, moderate and severe laryngomalacia based on the established criterion. Each point in the index was graded on the Likert scale. RESULTS A total of 28 patients who underwent supraglottoplasty were included in the study. There was a significant improvement in the overall parental perception in the swallowing of children with laryngomalacia following supraglottoplasty. There was statistically significant improvement in 9 out of 10 indices on the questionnaire. CONCLUSION Supraglottoplasty has an overall positive impact on parental perception of swallowing in children with Laryngomalacia. Caregivers had fewer concerns postoperatively, with fewer choking spells and breathing issues during feeds, and a greater satisfaction with the amount consumed at each feed. This Index adds a valuable subjective component to pediatric swallowing assessments pre and post supraglottoplasty. This tool could be used in conjunction with MBSS and FEES measures to provide a more comprehensive assessment.
Collapse
Affiliation(s)
- Sohit Paul Kanotra
- Department of Pediatric Otolaryngology, Louisiana State University, USA; Department of Pediatric Otolaryngology, Children's Hospital New Orleans, USA.
| | - Vil Vaitaitis
- Department of Pediatric Otolaryngology, Louisiana State University, USA
| | - Hunter Hopkins
- Department of Pediatric Otolaryngology, Louisiana State University, USA
| | - Meghan Fletcher
- Department of Speech Language Pathology, Children's Hospital New Orleans, USA
| | | | - Brent Keith
- Department of Pediatric Gastroenterology, Louisiana State University, USA
| |
Collapse
|
19
|
Jaffar S, Devadas M. Characterization of Self-Reported Dysphagia and Impact on Weight Outcomes After Laparoscopic Sleeve Gastrectomy. Obes Surg 2018; 28:3177-3185. [PMID: 29799107 DOI: 10.1007/s11695-018-3293-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION/AIMS There is paucity of literature examining dysphagia after laparoscopic sleeve gastrectomy (LSG). Moreover, there are few validated scoring systems for dysphagia that adequately assess its psychosocial impact. We aim to investigate dysphagia after LSG using a multidimensional scale that examines its functional and emotional impact. As secondary aims, we evaluated the impact of dysphagia on weight outcomes and its relationship with pre-operative gastro-esophageal reflux disease (GERD) and proton pump inhibitor (PPI) use. METHODS One hundred twenty-four patients 1 year or more post-LSG were administered the validated Dysphagia Handicap Index (DHI) questionnaire. To further delineate esophageal dysphagia, three additional questions were added. One hundred one patients (81.5%) responded. Physical, Emotional, Functional, and Esophageal scales were analyzed combined and individually using a multivariate model. RESULTS No patients reported dysphagia pre-operatively. The median DHI scale scores are the following: Physical-2 (0-20); Functional-4 (0-22); Emotional-2 (0-14); and Esophageal-2 (0-8). On multivariate analysis, DHI Emotional scores significantly correlated with reduced total weight loss (%TWL) (p = 0.001) and excess weight loss (%EWL) (p = 0.023). The physical symptoms of dysphagia did not affect weight outcomes. Post-operatively, PPI usage increased significantly (15.8 vs 19.8%, p = 0.01) and correlated with higher dysphagia scores. CONCLUSION A statistically validated dysphagia-specific questionnaire was utilized to evaluate the impact of LSG on dysphagia including its functional and emotional influences. The psychosocial handicap of dysphagia significantly reduced weight loss outcomes. A correlation between PPI use and dysphagia after LSG was found. The prevalence of dysphagia after LSG and the factors that contribute to its symptoms need to be further studied.
Collapse
Affiliation(s)
- Sukaina Jaffar
- Department of Upper Gastrointestinal Surgery and General Surgery, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, NSW, Australia.
| | - Michael Devadas
- Department of Upper Gastrointestinal Surgery and General Surgery, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, NSW, Australia.,Department of Bariatric Surgery and Upper Gastrointestinal Surgery, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia.,Centre for Bariatric and Metabolic Surgery, Circle of Care - Institute of Weight Control, Hospital for Specialist Surgery, Sydney, NSW, Australia.,Department of Upper Gastrointestinal Surgery and General Surgery, Nepean Private Hospital, Sydney, NSW, Australia.,Department of Upper Gastrointestinal Surgery and General Surgery, Norwest Private Hospital, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
20
|
Hudgens S, Evans C, Phillips E, Hill M. Psychometric validation of the Dysphagia Symptom Questionnaire in patients with eosinophilic esophagitis treated with budesonide oral suspension. J Patient Rep Outcomes 2017; 1:3. [PMID: 29757322 PMCID: PMC5934937 DOI: 10.1186/s41687-017-0006-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/27/2017] [Indexed: 02/07/2023] Open
Abstract
Background Eosinophilic esophagitis (EoE) is characterized by high levels of eosinophils in the esophageal mucosa. Patients with the disease present with a range of symptoms, including dysphagia (difficulty swallowing). The aim of this analysis was to assess the psychometric properties of the Dysphagia Symptom Questionnaire (DSQ), a patient-reported outcome (PRO) measure of dysphagia associated with EoE. Psychometric properties of the DSQ were assessed using data collected from a 12-week, phase 2, multicenter, randomized, double-blind, placebo-controlled trial of budesonide oral suspension in adolescents and adults (11–40 years old) with EoE. Results The study population comprised 93 patients with EoE; 94.6% of whom were white, 68.8% were male and the mean age (standard deviation) was 21.6 (7.7) years. Patients had been diagnosed with EoE for a mean of 37.6 months before study initiation. The DSQ was feasible to implement with few item-level data missing at baseline. Item discrimination was high, with floor and ceiling effects below the predefined threshold (≤9%). Higher DSQ scores corresponded with presence and increased severity of dysphagia, indicative of strong item discrimination among patients at baseline (threshold >50%). The DSQ was able to detect changes in symptoms over time and produced similar outcomes to those from physician- and other patient-rated measures, supportive of construct validity. The DSQ had strong test–retest reliability (intraclass correlation coefficient, r = 0.82); and was also responsive to disease-level changes, with higher DSQ scores corresponding to increased esophageal eosinophilic burden. Lastly, the percentage changes in the minimal clinically important difference and clinically important difference in DSQ score were estimated at −27.4% and −55.4%, respectively. Conclusions These analyses support the DSQ as a valid and reliable measure of dysphagia in patients with EoE. Changes in DSQ scores suggest a level of agreement between clinician, patient and histologic response. The DSQ should therefore be considered a viable PRO measure of dysphagia for use in future therapeutic studies of EoE.
Collapse
Affiliation(s)
- Stacie Hudgens
- Clinical Outcome Solutions, 3709 North Campbell, Tucson, AZ 85719 USA
| | - Christopher Evans
- Endpoint Outcomes, 11 Beacon Street, Suite 910, Boston, MA 02108 USA
| | - Elaine Phillips
- Formerly at Meritage Pharma, Inc., 12555 High Bluff Drive #385, San Diego, CA 92130 USA
| | - Malcolm Hill
- Formerly at Meritage Pharma, Inc., 12555 High Bluff Drive #385, San Diego, CA 92130 USA
| |
Collapse
|
21
|
Quader F, Reddy C, Patel A, Gyawali CP. Elevated intrabolus pressure identifies obstructive processes when integrated relaxation pressure is normal on esophageal high-resolution manometry. Am J Physiol Gastrointest Liver Physiol 2017; 313:G73-G79. [PMID: 28408642 PMCID: PMC5538833 DOI: 10.1152/ajpgi.00091.2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/05/2017] [Accepted: 04/10/2017] [Indexed: 01/31/2023]
Abstract
Elevated integrated relaxation pressure (IRP) on esophageal high-resolution manometry (HRM) identifies obstructive processes at the esophagogastric junction (EGJ). Our aim was to determine whether intrabolus pressure (IBP) can identify structural EGJ processes when IRP is normal. In this observational cohort study, adult patients with dysphagia and undergoing HRM were evaluated for endoscopic evidence of structural EGJ processes (strictures, rings, hiatus hernia) in the setting of normal IRP. HRM metrics [IRP, distal contractile integral (DCI), distal latency (DL), IBP, and EGJ contractile integral (EGJ-CI)] were compared among 74 patients with structural EGJ findings (62.8 ± 1.6 yr, 67.6% women), 27 patients with normal EGD (52.9 ± 3.2 yr, 70.3% women), and 21 healthy controls (27.6 ± 0.6 yr, 52.4% women). Findings were validated in 85 consecutive symptomatic patients to address clinical utility. In the primary cohort, mean IBP (18.4 ± 0.9 mmHg) was higher with structural EGJ findings compared with dysphagia with normal EGD (13.5 ± 1.1 mmHg, P = 0.002) and healthy controls (10.9 ± 0.9 mmHg, P < 0.001). However, mean IRP, DCI, DL, and EGJ-CI were similar across groups (P > 0.05 for each comparison). During multiple rapid swallows, IBP remained higher in the structural findings group compared with controls (P = 0.02). Similar analysis of the prospective validation cohort confirmed IBP elevation in structural EGJ processes, but correlation with dysphagia could not be demonstrated. We conclude that elevated IBP predicts the presence of structural EGJ processes even when IRP is normal, but correlation with dysphagia is suboptimal.NEW & NOTEWORTHY Integrated relaxation pressure (IRP) above the upper limit of normal defines esophageal outflow obstruction using high-resolution manometry. In patients with normal IRP, elevated intrabolus pressure (IBP) can be a surrogate marker for a structural restrictive or obstructive process at the esophagogastric junction (EGJ). This has the potential to augment the clinical value of esophageal HRM by raising suspicion for a structural EGJ process when IBP is elevated.
Collapse
Affiliation(s)
- Farhan Quader
- 1Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri;
| | - Chanakyaram Reddy
- 1Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri; ,2Division of Gastroenterology University of Michigan School of Medicine, Ann Arbor, Michigan; and
| | - Amit Patel
- 1Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri; ,3Division of Gastroenterology, Duke University School of Medicine and Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - C. Prakash Gyawali
- 1Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri;
| |
Collapse
|
22
|
Reed CC, Wolf WA, Cotton CC, Dellon ES. A visual analogue scale and a Likert scale are simple and responsive tools for assessing dysphagia in eosinophilic oesophagitis. Aliment Pharmacol Ther 2017; 45:1443-1448. [PMID: 28370355 PMCID: PMC5419874 DOI: 10.1111/apt.14061] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 02/10/2017] [Accepted: 03/05/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND While symptom scores have been developed to evaluate dysphagia in eosinophilic oesophagitis (EoE), their complexity may limit clinical use. AIM To evaluate a visual analogue scale (VAS) and a 10-point Likert scale (LS) for assessment of dysphagia severity before and after EoE treatment. METHODS We conducted a prospective cohort study enrolling consecutive adults undergoing out-patient endoscopy. Incident cases of EoE were diagnosed per consensus guidelines. At diagnosis and after 8 weeks of treatment, symptoms were measured using the VAS, LS and the Mayo Dysphagia Questionnaire (MDQ). The percentage change in scores before and after treatment were compared overall, in treatment responders (<15 eos/hpf) and non-responders, and in patients without baseline dilation. RESULTS In 51 EoE cases, the median VAS decreased from 3.6 at baseline to 1.4 post-treatment (71% decrease), the LS decreased from 6 to 2 (67%) and the MDQ decreased from 20 to 10 (49%). The VAS correlated with both the LS (R = 0.77; P < 0.0001) and MDQ (R = 0.46, P = 0.001). After stratification by histological response, the LS decreased 70% in responders vs. 13% in non-responders (P = 0.02). In patients who did not receive baseline dilation, both the VAS and LS decreased significantly more in the histological responders. CONCLUSIONS Both the VAS and LS were responsive to successful treatment as measured by histologic improvement. Because the VAS and LS are simple to administer and are responsive to treatment, they can provide an efficient and objective method for assessing dysphagia severity in EoE in clinical practice.
Collapse
Affiliation(s)
- C C Reed
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - W A Wolf
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - C C Cotton
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - E S Dellon
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| |
Collapse
|
23
|
Patel DA, Sharda R, Hovis KL, Nichols EE, Sathe N, Penson DF, Feurer ID, McPheeters ML, Vaezi MF, Francis DO. Patient-reported outcome measures in dysphagia: a systematic review of instrument development and validation. Dis Esophagus 2017; 30:1-23. [PMID: 28375450 PMCID: PMC5675017 DOI: 10.1093/dote/dow028] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/25/2016] [Accepted: 11/29/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Patient-reported outcome (PRO) measures are commonly used to capture patient experience with dysphagia and to evaluate treatment effectiveness. Inappropriate application can lead to distorted results in clinical studies. A systematic review of the literature on dysphagia-related PRO measures was performed to (1) identify all currently available measures and (2) to evaluate each for the presence of important measurement properties that would affect their applicability. DESIGN MEDLINE via the PubMed interface, the Cumulative Index of Nursing and Allied Health Literature, and the Health and Psychosocial Instrument database were searched using relevant vocabulary terms and key terms related to PRO measures and dysphagia. Three independent investigators performed abstract and full text reviews. Each study meeting criteria was evaluated using an 18-item checklist developed a priori that assessed multiple domains: (1) conceptual model, (2) content validity, (3) reliability, (4) construct validity, (6) scoring and interpretation, and (7) burden and presentation. RESULTS Of 4950 abstracts reviewed, a total of 34 dysphagia-related PRO measures (publication year 1987-2014) met criteria for extraction and analysis. Several PRO measures were of high quality (MADS for achalasia, SWAL-QOL and SSQ for oropharyngeal dysphagia, PROMIS-GI for general dysphagia, EORTC-QLQ-OG25 for esophageal cancer, ROMP-swallowing for Parkinson's Disease, DSQ-EoE for eosinophilic esophagitis, and SOAL for total laryngectomy-related dysphagia). In all, 17 met at least one criterion per domain. Thematic deficiencies in current measures were evident including: (1) direct patient involvement in content development, (2) empirically justified dimensionality, (3) demonstrable responsiveness to change, (4) plan for interpreting missing responses, and (5) literacy level assessment. CONCLUSION This is the first comprehensive systematic review assessing developmental properties of all available dysphagia-related PRO measures. We identified several instruments with robust measurement properties in multiple diseases including achalasia, oropharyngeal dysphagia, post-surgical dysphagia, esophageal cancer, and dysphagia related to neurological diseases. Findings herein can assist clinicians and researchers in making more informed decisions in selecting the most fundamentally sound PRO measure for a given clinical, research, or quality initiative.
Collapse
Affiliation(s)
- D. A. Patel
- Division of Gastroenterology, Hepatology and Nutrition
| | - R. Sharda
- Division of Gastroenterology, Hepatology and Nutrition
| | | | | | - N. Sathe
- Department of Health Policy and the Evidence-Based Practice Center
| | - D. F. Penson
- Departments of Urological Surgery, Health Policy, and Medicine and the Center for Surgical Quality and Outcomes Research
| | - I. D. Feurer
- Departments of Biostatistics and Surgery and the Center for Surgical Quality and Outcomes Research
| | - M. L. McPheeters
- Department of Health Policy and the Evidence-Based Practice Center
| | - M. F. Vaezi
- Division of Gastroenterology, Hepatology and Nutrition
| | - David O. Francis
- Department of Otolaryngology and the Evidence-Based Practice Center and the Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
24
|
Reddy CA, Patel A, Gyawali CP. Impact of symptom burden and health-related quality of life (HRQOL) on esophageal motor diagnoses. Neurogastroenterol Motil 2017; 29:10.1111/nmo.12970. [PMID: 27723241 PMCID: PMC5367979 DOI: 10.1111/nmo.12970] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/12/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND High-resolution manometry (HRM) categorizes esophageal motor processes into specific Chicago Classification (CC) diagnoses, but the clinical impact of these motor diagnoses on symptom burden remain unclear. METHODS Two hundred and eleven subjects (56.8±1.0 years, 66.8% F) completed symptom questionnaires (GERDQ, Mayo dysphagia questionnaire [MDQ], visceral sensitivity index, short-form 36, dominant symptom index, and global symptom severity [GSS] on a 100-mm visual analog scale) prior to HRM. Subjects were stratified according to CC v3.0 and by dominant presenting symptom; contraction wave abnormalities (CWA) were evaluated within "normal" CC. Symptom burden, impact of diagnoses, and HRQOL were compared within and between cohorts. KEY RESULTS Major motor disorders had highest global symptom burden (P=.02), "normal" had lowest (P<.01). Dysphagia (MDQ) was highest with esophageal outflow obstruction (P=.02), but reflux symptoms (GERDQ) were similar in CC cohorts (P=ns). Absent contractility aligned best with minor motor disorders. Consequently, pathophysiologic categorization into outflow obstruction, hypermotility, and hypomotility resulted in a gradient of decreasing dysphagia and increasing reflux burden (P<.05 across groups); GSS (P=.05) was highest with hypomotility and lowest with "normal" (P=.002). Within the "normal" cohort, 33.3% had CWA; this subgroup had symptom burden similar to hypermotility. Upon stratification by symptoms, symptom burden (GSS, MDQ, HRQOL) was most profound with dysphagia. CONCLUSIONS AND INFERENCES Chicago Classification v3.0 diagnoses identify subjects with highest symptom burden, but pathophysiologic categorization may allow better stratification by symptom type and burden. Contraction wave abnormalities are clinically relevant and different from true normal motor function. Transit symptoms have highest yield for a motor diagnosis.
Collapse
Affiliation(s)
- Chanakyaram A. Reddy
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO
- Division of Gastroenterology, University of Michigan, St. Louis, MO
| | - Amit Patel
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO
- Division of Gastroenterology, Duke University School of Medicine and Durham VA Medical Center, St. Louis, MO
| | - C. Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
25
|
Cowan T, Foster R, Isbister GK. Acute esophageal injury and strictures following corrosive ingestions in a 27 year cohort. Am J Emerg Med 2017; 35:488-492. [DOI: 10.1016/j.ajem.2016.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/30/2016] [Accepted: 12/04/2016] [Indexed: 01/21/2023] Open
|
26
|
Sawas T, Ravi K, Geno DM, Enders F, Pierce K, Wigle D, Katzka DA. The course of achalasia one to four decades after initial treatment. Aliment Pharmacol Ther 2017; 45:553-560. [PMID: 27925255 DOI: 10.1111/apt.13888] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 10/16/2016] [Accepted: 11/15/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Most follow-up studies of achalasia are limited to <5 years. AIM To study the long-term efficacy of pneumatic dilation (PD) and myotomy in achalasia at least 10 years after treatment. METHODS We performed a retrospective cohort study of achalasia patients with >10 years follow-up after initial myotomy or pneumatic dilation. Symptom recurrence which required repeat dilation or surgery was compared between pneumatic dilation and myotomy. RESULTS One hundred and fifty patients (112 myotomy, 38 pneumatic dilation) of similar characteristics were studied. The mean duration of follow-up after initial treatment was 17.5 ± 7.2 years (10-40 years). Symptoms recurrence rate was 60.7% (100% pneumatic dilation patients vs. 47.3% myotomy), hazard ratio 0.24 demonstrating a lower need for repeat dilation or surgery with myotomy than pneumatic dilation (P = 0.008). All pneumatic dilation patients underwent myotomy in 4 ± 4 (0-16 years). Forty of 53 myotomy patients had symptom recurrence prompting further treatment: 16 pneumatic dilation, 11 myotomy and 13 both. The mean time to repeat procedure was 6.9 years (0-40). The myotomy group required fewer dilations and/or surgeries than the pneumatic dilation group (1.6 vs. 3.6, P < 0.001). 13 patients (10.1%) progressed to end-stage achalasia (five myotomy, eight pneumatic dilation) over 40 years. At last follow-up, 57/62 (92%) patients had absent or mild dysphagia, 53/62 (85%) patients had regurgitation less than once per week and 37 (60.7%) had heartburn episodes <1/week similar for pneumatic dilation and myotomy (P = 0.27). CONCLUSION Although the majority of patients treated for achalasia do well after decades of treatment, most patients may need a series of endoscopic and/or surgical procedures to maintain effective symptom control.
Collapse
Affiliation(s)
- T Sawas
- Division of Gastroenterology and Hepatology, Department of Surgery and Department of Population Studies and Biostatistics, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - K Ravi
- Division of Gastroenterology and Hepatology, Department of Surgery and Department of Population Studies and Biostatistics, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D M Geno
- Division of Gastroenterology and Hepatology, Department of Surgery and Department of Population Studies and Biostatistics, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - F Enders
- Division of Gastroenterology and Hepatology, Department of Surgery and Department of Population Studies and Biostatistics, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - K Pierce
- Division of Gastroenterology and Hepatology, Department of Surgery and Department of Population Studies and Biostatistics, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D Wigle
- Division of Gastroenterology and Hepatology, Department of Surgery and Department of Population Studies and Biostatistics, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D A Katzka
- Division of Gastroenterology and Hepatology, Department of Surgery and Department of Population Studies and Biostatistics, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
27
|
Bohm M, Jacobs JW, Gupta A, Gupta S, Wo JM. Most children with eosinophilic esophagitis have a favorable outcome as young adults. Dis Esophagus 2017; 30:1-6. [PMID: 26822685 DOI: 10.1111/dote.12454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The disease progression of eosinophilic esophagitis (EoE) from childhood into adulthood is unclear. To determine the clinical outcome of patients who were diagnosed with EoE as children, and who now are young adults. Children (<18 years old) diagnosed with EoE were enrolled in a prospective registry on demographics, presenting symptoms, and endoscopic/histologic findings. Subjects who now are adults (≥18 years old) were identified, and a structured telephone interview was conducted to obtain follow-up data on symptom prevalence (dysphagia to solids and liquids, nausea/vomiting, abdominal pain, and heartburn/regurgitation), food impaction, medication usage, health-care utilization, and resolution of atopy/food allergies. A favorable outcome was defined if EoE symptoms were resolved or improved by subjects' assessment. Unfavorable outcomes was defined as symptoms same or worse. Clinical variables that predicted a favorable outcome as an adult were examined. Mayo Dysphagia Scale (MDQ-30: scored 0-100) was administered to validate the outcome assessment. Mantel-Haenszel odds ratio and unpaired t-test were used. Fifty-eight subjects (64% male) who met study criteria were enrolled. Mean age at diagnosis was 12 years (range 4-17) and mean duration of follow-up was 8.3 years (2-16). As children, the most common presenting symptoms were abdominal pain (54%), dysphagia (33%), and vomiting (24%). As young adults, 47 subjects (81%) had a favorable outcome. Total MDQ-30 scores were 4.6 (0-30) and 14.1 (0-50) in subjects with favorable outcome and unfavorable outcome, respectively (P = 0.015). Two-thirds of subjects did not use steroids or proton pump inhibitors in the preceeding 12 months. Male children with EoE were four times more likely to have a favorable outcome as young adults compared with female children. Females were more likely to report nausea/vomiting as young adults (odds ratio 3.23, CI 0.97-10.60). Of all presenting symptoms in EoE children, dysphagia was the most likely to persist into adulthood (odds ratio 6.29, CI 1.85-21.38). Eighty one percent of EoE children had a favorable outcome as young adults. Most patients with symptom resolution did not require any form of steroid therapy or seek healthcare.
Collapse
Affiliation(s)
- M Bohm
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana, USA
| | - J W Jacobs
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana, USA
| | - A Gupta
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana, USA
| | - S Gupta
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana, USA
| | - J M Wo
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana, USA
| |
Collapse
|
28
|
Abstract
Activity of Eosinophilic Esophagitis (EoE) can be measured by patient reported outcomes (symptoms and quality of life) and clinician-reported outcomes (endoscopic, histologic, or biochemical alterations). Over the last years efforts have been underway to develop and validate instruments to assess EoE activity in the different domains. Such instruments are urgently needed to standardize the language of EoE activity assessment and, in so doing, to facilitate communication among various stakeholders. Such standardization will ultimately allow EoE researchers to define meaningful endpoints for use in clinical trials and observational studies, to compare the efficacy of different therapeutic modalities, and to develop algorithms in order to provide patients with the appropriate therapy. This review provides an overview of the current status of instruments that assess EoE activity in the different domains.
Collapse
Affiliation(s)
- A Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois (University Hospital Lausanne), Lausanne, Switzerland
| | - E Safroneeva
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - A Straumann
- Praxis Römerhof, Swiss EoE Clinic, Olten, Switzerland
| |
Collapse
|
29
|
|
30
|
Papadopoulou SL, Exarchakos G, Christodoulou D, Theodorou S, Beris A, Ploumis A. Adaptation and Assessment of Reliability and Validity of the Greek Version of the Ohkuma Questionnaire for Dysphagia Screening. Int Arch Otorhinolaryngol 2016; 21:58-65. [PMID: 28050209 PMCID: PMC5205524 DOI: 10.1055/s-0036-1580613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 02/01/2016] [Indexed: 11/04/2022] Open
Abstract
Introduction The Ohkuma questionnaire is a validated screening tool originally used to detect dysphagia among patients hospitalized in Japanese nursing facilities. Objective The purpose of this study is to evaluate the reliability and validity of the adapted Greek version of the Ohkuma questionnaire. Methods Following the steps for cross-cultural adaptation, we delivered the validated Ohkuma questionnaire to 70 patients (53 men, 17 women) who were either suffering from dysphagia or not. All of them completed the questionnaire a second time within a month. For all of them, we performed a bedside and VFSS study of dysphagia and asked participants to undergo a second VFSS screening, with the exception of nine individuals. Statistical analysis included measurement of internal consistency with Cronbach's α coefficient, reliability with Cohen's Kappa, Pearson's correlation coefficient and construct validity with categorical components, and One-Way Anova test. Results According to Cronbach's α coefficient (0.976) for total score, there was high internal consistency for the Ohkuma Dysphagia questionnaire. Test-retest reliability (Cohen's Kappa) ranged from 0.586 to 1.00, exhibiting acceptable stability. We also estimated the Pearson's correlation coefficient for the test-retest total score, which reached high levels (0.952; p = 0.000). The One-Way Anova test in the two measurement times showed statistically significant correlation in both measurements (p = 0.02 and p = 0.016). Conclusion The adapted Greek version of the questionnaire is valid and reliable and can be used for the screening of dysphagia in the Greek-speaking patients.
Collapse
Affiliation(s)
- Soultana L Papadopoulou
- Departments of Orthopedic Surgery & Physical Medicine and Rehabilitation Clinic, University of Ioannina Medical School, Ioannina, Greece
| | | | - Dimitrios Christodoulou
- Division of Internal Medicine, Hepato-Gastroenterology Unit, University of Ioannina, Ioannina, Greece
| | | | - Alexandre Beris
- Departments of Orthopedic Surgery & Physical Medicine and Rehabilitation Clinic, University of Ioannina Medical School, Ioannina, Greece
| | - Avraam Ploumis
- Departments of Orthopedic Surgery & Physical Medicine and Rehabilitation Clinic, University of Ioannina Medical School, Ioannina, Greece
| |
Collapse
|
31
|
Myer CM, Howell RJ, Cohen AP, Willging JP, Ishman SL. A Systematic Review of Patient- or Proxy-Reported Validated Instruments Assessing Pediatric Dysphagia. Otolaryngol Head Neck Surg 2016; 154:817-23. [DOI: 10.1177/0194599816630531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/13/2016] [Indexed: 12/31/2022]
Abstract
Objective Pediatric dysphagia occurs in 500,000 children each year; however, there is not a common tool to assess these children. Our aim was to identify validated patient- or parent-reported outcome assessment tools evaluating pediatric dysphagia. Data Sources Scopus, EMBASE, PubMed, Cochrane Library, and CINAHL electronic databases (all indexed years through August 2014). Review Methods Inclusion criteria included English-language articles containing instruments evaluated in children. Two investigators independently reviewed all articles, and the review was performed according to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Results The initial search yielded 1697 abstracts; 158 studies were assessed further. Four symptom questionnaires, validated in adults, were used to report pediatric dysphagia outcomes. Four outcomes tools assessing dysphagia were validated in pediatrics in selected populations. The Dysphagia in Multiple Sclerosis questionnaire and the Dysphagia Symptom Questionnaire for eosinophilic esophagitis were validated in adolescents and adults. The Symptom Questionnaire for Eosinophilic Esophagitis was validated in children with eosinophilic esophagitis. The Pediatric Quality of Life Inventory Gastrointestinal Symptoms Module, validated in children with gastrointestinal disorders, includes 2 domains that assess swallowing function. Conclusion We did not identify any validated patient- or parent-reported outcome assessment tools examining dysphagia symptoms in a general pediatric population. However, we identified 4 questionnaires that have been validated in specific pediatric disease cohorts. Having a standardized assessment instrument validated in all children would allow clinicians to systematically report symptoms and compare results of pediatric clinical trials. With this in mind, we recommend establishing a standard questionnaire for the broader pediatric population.
Collapse
Affiliation(s)
- Charles M. Myer
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Rebecca J. Howell
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Aliza P. Cohen
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - J. Paul Willging
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Stacey L. Ishman
- Division of Pediatric Otolaryngology–Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
32
|
Abstract
OPINION STATEMENT The activity of a particular esophageal disease, such as eosinophilic esophagitis (EoE) or achalasia, can be evaluated using clinician-reported outcome (ClinRO) measures assessing various endoscopic, histologic, functional, and laboratory findings, and patient-reported outcome (PRO) measures. The patient-reported outcome (PRO) measures are those that are designed to be self-reported by patients. Commonly used PRO instruments include those that assess symptom severity, health-related quality of life, "general" quality of life, or health status. Regulatory authorities increasingly rely on PRO measures to support labeling claims for drug development. Validated PRO measures for various esophageal diseases are needed in order to unify and standardize the way disease activity is assessed, define clinically meaningful endpoints for use in interventional and observational studies, compare the efficacy/effectiveness of various therapies, and optimize therapeutic algorithms for management of these diseases. This article reviews commonly used PRO instruments designed to assess symptom severity and quality of life in adult patients with EoE and achalasia.
Collapse
|
33
|
Abdel Jalil AA, Katzka DA, Castell DO. Approach to the patient with dysphagia. Am J Med 2015; 128:1138.e17-23. [PMID: 26007674 DOI: 10.1016/j.amjmed.2015.04.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 04/15/2015] [Accepted: 04/16/2015] [Indexed: 12/17/2022]
Abstract
Dysphagia is a fascinating symptom. It is ostensibly simple when defined by trouble swallowing, yet its subtleties in deciphering and its variations in pathophysiology almost mandate a thorough knowledge of medicine itself. With patience and careful questioning, a multitude of various disorders may be suggested before an objective test is performed. Indeed, the ability to diligently and comprehensively explore the symptom of dysphagia is not only rewarding but also a real test for a physician who prides himself or herself on good history taking.
Collapse
Affiliation(s)
- Ala' A Abdel Jalil
- Esophageal Disorders Program, Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston.
| | - David A Katzka
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn
| | - Donald O Castell
- Esophageal Disorders Program, Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston
| |
Collapse
|
34
|
Crowell MD, Umar SB, Lacy BE, Jones MP, DiBaise JK, Talley NJ. Multi-Dimensional Gastrointestinal Symptom Severity Index: Validation of a Brief GI Symptom Assessment Tool. Dig Dis Sci 2015; 60:2270-9. [PMID: 25842355 DOI: 10.1007/s10620-015-3647-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/26/2015] [Indexed: 12/30/2022]
Abstract
UNLABELLED Few instruments have been developed and validated for the evaluation of multi-dimensional GI symptoms. The Gastrointestinal Symptoms Severity Index (GISSI), a multi-dimensional, self-report instrument, was designed as a brief measure of the frequency, severity, and bothersomeness of individual GI and pelvic floor/urogynecologic symptoms. AIM To report the psychometric properties of the GISSI subscales, including factorial structure, validity, and internal consistency. METHODS The GISSI included 32 items that assessed upper and lower GI symptoms and seven items related to pelvic floor/urogynecologic symptoms. A total of 934 patients presenting for upper and lower GI complaints completed the questionnaire between January 2013 and December 2013. The sample was randomly split into derivation (n = 466) and validation datasets (n = 468). A non-patient sample of 200 was collected separately. RESULTS Exploratory factor analysis supported a six-factor model for the derivation sample that accounted for 69.3 % of the total variance. The six GI symptom clusters were labeled as constipation/difficult defecation (five items), abdominal pain/discomfort (four items), dyspepsia (four items), diarrhea/anal incontinence (four items), GERD/chest symptoms (four items), and nausea/vomiting (two items). Inclusion of additional items related to female pelvic floor/urogynecologic symptoms resulted in a separate factor. Confirmatory factor analysis of the validation dataset supported the a priori hypothesized six-factor measurement model (Χ (2)(428) = 1462.98; P < 0.001; GFI = .88; RMSEA = .051). CONCLUSION The GISSI demonstrated good to excellent psychometric properties and provided multi-dimensional scaling of prominent GI symptom clusters. Further validation may provide an efficient, valid, and reliable measure of patient-reported clinical outcomes.
Collapse
Affiliation(s)
- Michael D Crowell
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA,
| | | | | | | | | | | |
Collapse
|
35
|
Stephens EH, Gaur P, Hotze KO, Correa AM, Kim MP, Blackmon SH. Super-Charged Pedicled Jejunal Interposition Performance Compares Favorably With a Gastric Conduit After Esophagectomy. Ann Thorac Surg 2015; 100:407-13. [PMID: 26101096 DOI: 10.1016/j.athoracsur.2015.03.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND A variety of conduits can be utilized for esophageal reconstruction, but their postoperative function remains unknown. The objective of our study was to compare functional performance of super-charged pedicled jejunal (SPJ) to gastric conduits using a novel conduit assessment tool. METHODS Patients who underwent esophageal reconstruction between January 1, 2009 and December 31, 2013 were asked to complete questionnaires measuring postoperative functional outcomes. Conduit emptying and postoperative variables were recorded. Statistical analysis was performed using the Mann-Whitney U test and Fisher exact test for crosstabs. RESULTS Forty-five of the 94 esophageal reconstruction patients (48%) were alive, had either a gastric conduit or SPJ reconstruction, and completed the questionnaire. The mean age was 60.6 ± 12.5 years, 69% were male, and the majority of patients had cancer (87%). While the majority of the gastric patients underwent an oncologic resection for adenocarcinoma (65%), 50% of SPJ patients had undergone a previous resection (p = 0.008). The average time after surgery for last conduit assessment was 15 ± 13 months for the gastric conduit group and 17 ± 12 months for the SPJ group (p = 0.315). The average reflux, dumping, dysphagia, stricture, conduit emptying, and Zubrod scores were low and similar between groups: reflux 1.7 ± 1.9 for gastric conduit and 0.7 ± 1.3 for SPJ; dumping 0.97 ± 1.2 and 0.93 ± 1.1; dysphagia 0.60 ± 0.72 and 0.79 ± 0.89; stricture 0.7 ± 1.4 and 0.38 ± 0.96; conduit emptying 0.46 ± 0.93 and 0.33 ± 0.88; and Zubrod 0.84 ± 0.64 and 1.21 ± 0.8, respectively. The SPJ patients had a higher pain score (7.0 ± 3.2 vs 2.4 ± 2.4, p = 0.043). CONCLUSIONS Super-charged pedicled jejunal interposition performance is comparable with a gastric conduit after esophagectomy according to a novel, comprehensive conduit assessment tool.
Collapse
Affiliation(s)
| | - Puja Gaur
- The Methodist Hospital and Weill Cornell College of Medicine, Houston, Texas
| | - Kathleen O Hotze
- The Methodist Hospital and Weill Cornell College of Medicine, Houston, Texas
| | - Arlene M Correa
- The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Min P Kim
- The Methodist Hospital and Weill Cornell College of Medicine, Houston, Texas; The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | |
Collapse
|
36
|
Abstract
Oesophageal dysphagia is a common symptom, which might be related to severe oesophageal diseases such as carcinomas. Therefore, an organic process must be ruled out in the first instance by endoscopy in all patients presenting with dysphagia symptoms. The most prevalent obstructive aetiologies are oesophageal cancer, peptic strictures and eosinophilic oesophagitis. Eosinophilic oesophagitis is one of the most common causes of dysphagia in adults and children, thus justifying the need to obtain oesophageal biopsy samples from all patients presenting with unexplained dysphagia. With the advent of standardized high-resolution manometry and specific metrics to characterize oesophageal motility, the Chicago classification has become a gold-standard algorithm for manometric diagnosis of oesophageal motor disorders. In addition, sophisticated investigations and analysis methods that combine pressure and impedance measurement are currently in development. In the future, these techniques might be able to detect subtle pressure abnormalities during bolus transport, which could further explain pathophysiology and symptoms. The degree to which novel approaches will help distinguish dysphagia caused by motor abnormalities from functional dysphagia still needs to be determined.
Collapse
|
37
|
Sawas T, Dhalla S, Sayyar M, Pasricha PJ, Hernaez R. Systematic review with meta-analysis: pharmacological interventions for eosinophilic oesophagitis. Aliment Pharmacol Ther 2015; 41:797-806. [PMID: 25728929 DOI: 10.1111/apt.13147] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 01/06/2015] [Accepted: 02/11/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Eosinophilic oesophagitis (EoE) is a growing cause of dysphagia. Current therapies include dietary manipulation, steroids and biological drugs. AIM To perform a systematic review and summarise the effect of different medical interventions on EoE. METHODS Two reviewers searched Pubmed and Embase for studies on treatment for EoE. We included randomised controlled trials (RCT) limited to pharmacological interventions. Two reviewers selected studies. Meta-analysis was done using random effects model to estimate odds ratio (OR). Heterogeneity was determined by Cochran's Q statistic and I(2) . RESULTS Seventeen references met our inclusion criteria. Eleven RCTs involving 455 participants were included in the meta-analysis. 325 participants were evaluated for symptomatic improvement and 330 were evaluated for histological remission. Symptomatic improvement with topical steroids (7 studies, 250 participants) compared to the control group (placebo or PPI) was noted (OR: 3.03, 95% confidence interval, CI: 1.57-5.87). Histological remission was also noted in nine studies involving 330 participants (OR: 13.66, 95% CI: 2.65-70.34) comparing topical steroids to a control (placebo or PPI). There was no difference between anti-IL-5 drugs and placebo in terms of symptomatic improvement (OR: 0.69, 95% CI: 0.34-1.42). CONCLUSIONS Topical steroids induce significant symptomatic and histological remission, and should be considered as a first line treatment. Anti-IL-5 therapy has a minor effect on eosinophilic oesophagitis. Future research in eosinophilic oesophagitis should standardise methodology according to published guidelines to improve quality and allow direct comparison between therapies.
Collapse
Affiliation(s)
- T Sawas
- Department of Gastroenterology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | | | | |
Collapse
|
38
|
Once-daily omeprazole/sodium bicarbonate heals severe refractory reflux esophagitis with morning or nighttime dosing. Dig Dis Sci 2015; 60:146-62. [PMID: 24448652 DOI: 10.1007/s10620-013-3017-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 12/27/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Morning dose or twice-daily proton pump inhibitor (PPI) use is often prescribed to heal severe reflux esophagitis. AIM Compare the effect of single dose morning (control arm) versus nighttime (experimental arm) omeprazole/sodium bicarbonate (Zegerid(®)) (IR-OME) on esophagitis and gastroesophageal reflux symptoms. METHODS Adult outpatients with Los Angeles grade C or D esophagitis were allocated to open-label 40 mg IR-OME once a day for 8 weeks in a prospective, randomized, parallel design, single center study. Esophagogastroduodenoscopy (EGD) and validated self-report symptom questionnaires were completed at baseline and follow-up. Intention-to-treat and per-protocol analyses were performed. RESULTS Ninety-two of 128 (72 %) eligible subjects participated [64 (70 %) male, mean age 58 (range 19-86), median BMI 29 (range 21-51), 58 C:34 D]. Overall, 81 (88 %) subjects healed [n = 70 (76 %)] or improved [n = 11 (12 %)] erosions. There was no significant difference (morning vs. night) in mucosal healing [81 vs. 71 %, (p = 0.44)] or symptom resolution [heartburn (77 vs. 65 %, p = 0.12), acid regurgitation (82 vs. 73 %, p = 0.28)]. Prevalence of newly identified Barrett's esophagus was 14 % with half diagnosed only after treatment. CONCLUSIONS Once-daily IR-OME (taken morning or night) effectively heals severe reflux esophagitis and improves GERD symptoms. Results support the clinical practice recommendation to repeat EGD after 8 weeks PPI therapy in severe esophagitis patients to assure healing and exclude Barrett's esophagus.
Collapse
|
39
|
Long-term outcome after laparoscopic myotomy for achalasia. J Thorac Cardiovasc Surg 2014; 147:730-6; Discussion 736-7. [DOI: 10.1016/j.jtcvs.2013.09.063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 09/10/2013] [Accepted: 09/30/2013] [Indexed: 11/18/2022]
|
40
|
Bolier EA, Kessing BF, Smout AJ, Bredenoord AJ. Systematic review: questionnaires for assessment of gastroesophageal reflux disease. Dis Esophagus 2013; 28:105-20. [PMID: 24344627 DOI: 10.1111/dote.12163] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Numerous questionnaires with a wide variety of characteristics have been developed for the assessment of gastroesophageal reflux disease (GERD). Four well-defined dimensions are noticeable in these GERD questionnaires, which are symptoms, response to treatment, diagnosis, and burden on the quality of life of GERD patients. The aim of this review is to develop a complete overview of all available questionnaires, categorized per dimension of the assessment of GERD. A systematic search of the literature up to January 2013 using the Pubmed database and the Embase database, and search of references and conference abstract books were conducted. A total number of 65 questionnaires were extracted and evaluated. Thirty-nine questionnaires were found applicable for the assessment of GERD symptoms, three of which are generic gastrointestinal questionnaires. For the assessment of response to treatment, 14 questionnaires were considered applicable. Seven questionnaires with diagnostic purposes were found. In the assessment of quality of life in GERD patients, 18 questionnaires were found and evaluated. Twenty questionnaires were found to be used for more than one assessment dimension, and eight questionnaires were found for GERD assessment in infants and/or children. A wide variety of GERD questionnaires is available, of which the majority is used for assessment of GERD symptoms. Questionnaires differ in aspects such as design, validation and translations. Also, numerous multidimensional questionnaires are available, of which the Reflux Disease Questionnaire is widely applicable. We provided an overview of GERD questionnaires to aid investigators and clinicians in their search for the most appropriate questionnaire for their specific purposes.
Collapse
Affiliation(s)
- E A Bolier
- Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
41
|
Dellon ES, Irani AM, Hill MR, Hirano I. Development and field testing of a novel patient-reported outcome measure of dysphagia in patients with eosinophilic esophagitis. Aliment Pharmacol Ther 2013; 38:634-42. [PMID: 23837796 DOI: 10.1111/apt.12413] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/12/2013] [Accepted: 06/23/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dysphagia is the hallmark of eosinophilic esophagitis (EoE), but no validated dysphagia instruments in this population exist. AIM To develop and field test a patient-reported outcome (PRO) for dysphagia in subjects with EoE. METHODS This was a multi-centre/multi-phase prospective study. The first phase developed a dysphagia questionnaire using qualitative methods. The second phase was a 30-day field trial to test the instrument and assess content validity. Adolescents and adults with EoE, active symptoms of dysphagia and oesophageal eosinophilia (≥15 eosinophils per high-power field) were enrolled. Solid-food-avoidance days, dysphagia days and actions taken to get relief were recorded. A dysphagia score was calculated and compared to the Straumann Dysphagia Instrument (SDI). RESULTS Ten adolescents and 10 adults were included in the first phase and the Dysphagia Symptom Questionnaire (DSQ), a three-item daily electronic diary, was developed. In the second phase, 35 subjects finished the field trial (18 adults, 17 adolescents, mean age 24, 54% male, 95% white, 54% currently on topical corticosteroids). The median number of dysphagia days per week was 2 for adolescents vs. 4 for adults (P < 0.001), and 2 for those on topical steroids vs. 4 for those not on topical steroids (P < 0.001). The DSQ score strongly correlated with the number of dysphagia days (R = 0.96; P < 0.001) and the SDI (R = 0.77; P < 0.001). CONCLUSIONS The DSQ, a three-question patient-reported outcome, was successfully developed and field tested. The DSQ had content validity and the score accurately measured dysphagia frequency and intensity. The Dysphagia Symptom Questionnaire is suitable for use in clinical trials of EoE patients with dysphagia.
Collapse
Affiliation(s)
- E S Dellon
- Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7080, USA.
| | | | | | | |
Collapse
|
42
|
Franciosi JP, Hommel KA, Bendo CB, King EC, Collins MH, Eby MD, Marsolo K, Abonia JP, von Tiehl KF, Putnam PE, Greenler AJ, Greenberg AB, Bryson RA, Davis CM, Olive AP, Gupta SK, Erwin EA, Klinnert MD, Spergel JM, Denham JM, Furuta GT, Rothenberg ME, Varni JW. PedsQL eosinophilic esophagitis module: feasibility, reliability, and validity. J Pediatr Gastroenterol Nutr 2013; 57:57-66. [PMID: 23478422 PMCID: PMC4115583 DOI: 10.1097/mpg.0b013e31828f1fd2] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Eosinophilic esophagitis (EoE) is a chronic esophageal inflammatory condition with a paucity of information on health-related quality of life (HRQOL). The objective of the study was to report on the measurement properties of the PedsQL EoE Module. METHODS The PedsQL EoE Module was completed in a multisite study by 196 pediatric patients with EoE and 262 parents of patients with EoE. RESULTS The PedsQL EoE Module scales evidenced excellent feasibility (0.6%-3.1% missing), excellent group comparison reliability across total scale scores (patient α 0.93; parent proxy α 0.94), good reliability for the 7 individual scales (patient α 0.75-0.87; parent proxy α 0.81-0.92), excellent test-retest reliability (patient intraclass correlation coefficient 0.88; parent intraclass correlation coefficient 0.82), demonstrated no floor effects and low ceiling effects, and demonstrated a high percentage of scaling success for most scales. Intercorrelations with the PedsQL Generic Core Scales were in the medium (0.30) to large (0.50) range. PedsQL EoE Module scores were worse among patients with active histologic disease (≥ 5 eos/hpf) compared with those in remission (patient self-report: 63.3 vs 69.9 [P < 0.05]; parent proxy report: 65.1 vs 72.3 [P < 0.01]), and those treated with dietary restrictions compared with those with no restrictions (patient self-report: 61.6 vs 74.3 [P < 0.01]; parent proxy report: 65.5 vs 74.7 [P < 0.01]). CONCLUSIONS The results demonstrate excellent measurement properties of the PedsQL EoE Module. Patients with active histologic disease and those treated with dietary restrictions demonstrated worse PedsQL scores. The PedsQL EoE Module may be used in the evaluation of pediatric EoE disease-specific HRQOL in clinical research and practice.
Collapse
Affiliation(s)
- James P Franciosi
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Peroral endoscopic myotomy periprocedural evaluation: Predicting and measuring outcomes. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2013. [DOI: 10.1016/j.tgie.2013.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
44
|
Peterson KA, Byrne KR, Vinson LA, Ying J, Boynton KK, Fang JC, Gleich GJ, Adler DG, Clayton F. Elemental diet induces histologic response in adult eosinophilic esophagitis. Am J Gastroenterol 2013; 108:759-66. [PMID: 23381017 DOI: 10.1038/ajg.2012.468] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Elemental diets have not been studied in adults with eosinophilic esophagitis (EoE). The goal of this trial was to assess the efficacy of an elemental diet in adults with EoE. METHODS A total of 18 adults with EoE were given an elemental diet for 4 weeks, or just 2 weeks if their response was complete. Symptoms and histologic findings, based on biweekly biopsies, were monitored. Six subjects were rebiopsied 2-7 days after resuming a normal diet. RESULTS After therapy, esophageal tissue eosinophil content decreased from 54 to 10 per maximal high power field (P=0.0006). There was complete or nearly complete response (≤10 eosinophils) in 72% of subjects. Mast cell content, parabasal layer thickness, and endoscopic furrows and exudates also significantly decreased. Of the 29 qualified subjects, 11 (38%) failed to adhere to the diet. Several subjects had significant weight loss. Symptoms and endoscopic fixed strictures did not improve. After the subjects resumed a normal diet, the eosinophil content increased substantially in 3-7 days. CONCLUSIONS While symptoms did not improve and dietary compliance was problematic, there was substantial histologic improvement after 4 weeks on the elemental diet. EoE in adults is substantially triggered by foods.
Collapse
Affiliation(s)
- Kathryn A Peterson
- Department of Gastroenterology, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Menard-Katcher P, Marks KL, Liacouras CA, Spergel JM, Yang YX, Falk GW. The natural history of eosinophilic oesophagitis in the transition from childhood to adulthood. Aliment Pharmacol Ther 2013; 37:114-21. [PMID: 23121227 DOI: 10.1111/apt.12119] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 07/27/2012] [Accepted: 10/10/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Eosinophilic oesophagitis (EoE) is a chronic inflammatory condition affecting both children and adults. Little is known about the natural history of EoE in the transition from childhood into adulthood. AIM To determine the prevalence of EoE symptoms and impact of EoE on quality of life among adults diagnosed with EoE during childhood. METHODS This is a cross-sectional study of EoE patients from the Children's Hospital of Philadelphia EoE registry. Patients ≥18 years diagnosed with EoE during childhood were administered validated dysphagia [Mayo Dysphagia Questionnaire (MDQ)-30] and Quality of Life (PAGI-QOL) questionnaires. Ongoing EoE treatments were ascertained. RESULTS A total of 140 EoE patients ≥18 years were identified; 53 completed all questions. Only 6 (11%) subjects had positive (n = 2) or indeterminate (n = 4) dysphagia scores. However, of 47 patients with negative scores, 18 (37%) reported ongoing difficulty swallowing. The mean PAGI-QOL score was 4.58/5. The dietary dimension score was 3.73/5. Current pharmacological EoE treatments were topical steroids (3/53) and interleukin-5 antagonists (3/53). Additionally, 26/53 (49%) were on PPI therapy and 40/53 (76%) were following allergy directed diets. CONCLUSIONS The majority of young adults diagnosed with EoE during childhood continue to require pharmacological treatment and/or dietary modification for EoE. A substantial proportion of this population experiences ongoing swallowing difficulties that a standard dysphagia questionnaire fails to capture. Dietary quality of life, but not total quality of life, appears to be adversely affected. These data suggest that EoE diagnosed during childhood remains a significant medical issue during early adulthood, and that better EoE symptom measurement instruments are needed.
Collapse
Affiliation(s)
- P Menard-Katcher
- Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | | | | | | | | | | |
Collapse
|
46
|
Dellon ES, Sheikh A, Speck O, Woodward K, Whitlow AB, Hores JM, Ivanovic M, Chau A, Woosley JT, Madanick RD, Orlando RC, Shaheen NJ. Viscous topical is more effective than nebulized steroid therapy for patients with eosinophilic esophagitis. Gastroenterology 2012; 143:321-4.e1. [PMID: 22561055 PMCID: PMC3404241 DOI: 10.1053/j.gastro.2012.04.049] [Citation(s) in RCA: 230] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/09/2012] [Accepted: 04/24/2012] [Indexed: 02/07/2023]
Abstract
We performed a randomized trial to compare nebulized and viscous topical corticosteroid treatments for eosinophilic esophagitis (EoE). Subjects with incident EoE (n = 25) received budesonide 1 mg twice daily, either nebulized and then swallowed (NEB) or as an oral viscous slurry (OVB), for 8 weeks. Baseline eosinophil counts for the NEB and OVB groups were 101 and 83 (P = .62). Posttreatment counts were 89 and 11 (P = .02). The mucosal medication contact time, measured by scintigraphy, was higher for the OVB group than the NEB group (P < .005) and was inversely correlated with eosinophil count (R = -0.67; P = .001). OVB was more effective than NEB in reducing numbers of esophageal eosinophils in patients with EoE. OVB provided a significantly higher level of esophageal exposure to the therapeutic agent, which correlated with lower eosinophil counts.
Collapse
Affiliation(s)
- Evan S. Dellon
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC
| | - Arif Sheikh
- Division of Nuclear Medicine, Department of Radiology; University of North Carolina School of Medicine, Chapel Hill, NC
| | - Olga Speck
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Kimberly Woodward
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Ann B. Whitlow
- Division of Nuclear Medicine, Department of Radiology; University of North Carolina School of Medicine, Chapel Hill, NC
| | - Jessica M. Hores
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Marija Ivanovic
- Division of Nuclear Medicine, Department of Radiology; University of North Carolina School of Medicine, Chapel Hill, NC
| | - Allen Chau
- Division of Nuclear Medicine, Department of Radiology; University of North Carolina School of Medicine, Chapel Hill, NC
| | - John T. Woosley
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Ryan D. Madanick
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC
| | - Roy C. Orlando
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC
| | - Nicholas J. Shaheen
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC,Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC
| |
Collapse
|
47
|
Alexander JA, Jung KW, Arora AS, Enders F, Katzka DA, Kephardt GM, Kita H, Kryzer LA, Romero Y, Smyrk TC, Talley NJ. Swallowed fluticasone improves histologic but not symptomatic response of adults with eosinophilic esophagitis. Clin Gastroenterol Hepatol 2012; 10:742-749.e1. [PMID: 22475741 DOI: 10.1016/j.cgh.2012.03.018] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 03/13/2012] [Accepted: 03/15/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS We evaluated the effect of aerosolized fluticasone therapy on symptomatic dysphagia and histologic eosinophilia in adults with eosinophilic esophagitis (EoE). METHODS We performed a double-blind, randomized, placebo-controlled trial of fluticasone in 42 adult patients with a new diagnosis of EoE (30 men; mean age, 37.5 y). Participants were assigned randomly to groups that swallowed 880 μg of aerosolized fluticasone twice daily (n = 21), or took a placebo inhaler twice daily (n = 15) for 6 weeks. End points of the study were symptomatic and histologic response. RESULTS A complete histologic response (>90% decrease in mean eosinophil count) was observed in 11 of 15 subjects who received 6 weeks of fluticasone (62%), compared with none of the 15 subjects who received placebo (P < .001), based on intention-to-treat analysis; histologic responses were observed in 68% of subjects who received fluticasone (13 of 19) compared with none of those who received placebo (0 of 15) by per-protocol analysis (P < .001). Intracellular staining for eosinophil-derived neurotoxin was reduced in 81% of subjects who received fluticasone (13 of 16) compared with 8% who received placebo (1 of 13) (P < .001). Dysphagia was reduced in 57% of subjects who received fluticasone (12 of 21) compared with 33% who received placebo (7 of 21) (P = .22) by intention-to-treat analysis; dysphagia was reduced in 63% of patients who received fluticasone (12 of 19) and 47% of those who received placebo (7 of 15) (P = .49) based on per-protocol analysis. Esophageal candidiasis developed in 26% of subjects who received fluticasone (5 of 19), but in none of the subjects in the placebo group (P = .05). CONCLUSIONS Aerosolized, swallowed fluticasone leads to a histologic but not a symptomatic response in adults with EoE.
Collapse
Affiliation(s)
- Jeffrey A Alexander
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Jung KW. The necessity of validated questionnaires: determining accurate responses to proton pump inhibitor use. J Neurogastroenterol Motil 2012; 18:113. [PMID: 22324000 PMCID: PMC3271247 DOI: 10.5056/jnm.2012.18.1.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Kee Wook Jung
- Asan Digestive Disease Research Institute, Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
49
|
Francis DL, Foxx-Orenstein A, Arora AS, Smyrk TC, Jensen K, Nord SL, Alexander JA, Romero Y, Katzka DA. Results of ambulatory pH monitoring do not reliably predict response to therapy in patients with eosinophilic oesophagitis. Aliment Pharmacol Ther 2012; 35:300-7. [PMID: 22111863 DOI: 10.1111/j.1365-2036.2011.04922.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The consensus statements for eosinophilic oesophagitis recommend that ambulatory pH monitoring is one means of determining if gastro-oesophageal reflux is the cause of oesophageal eosinophilia and should guide pharmacological therapy. AIM To evaluate prospectively the accuracy of pH monitoring as a predictor of endoscopic, histological and symptomatic response in patients with oesophageal eosinophilia. METHODS We conducted a prospective trial in which patients with oesophageal eosinophilic infiltration with ≥15 eos/hpf underwent a 24-h pH study and were placed in one of two treatment arms for 6 weeks based on positive or negative results. Patients with abnormal acid exposure were treated with esomeprazole 40 mg twice daily and others were treated with oral viscous budesonide 1 g twice daily. Response to treatment was assessed by oesophageal histology (<5 eos/hpf) and symptoms. RESULTS A total of 51 patients were enrolled in the study. The average patient age was 39 years and 31 patients (61%) were male. The average number of eosinophils per hpf, prior to study enrolment was 41.2 (range 15-140, s.d. 27.7). Nineteen (37%) had positive pH studies and 32 (63%) had negative pH studies. Eighteen patients completed treatment with esomeprazole. Only eleven (61%) had histological response and, of these eleven, five (46%) had symptomatic improvement. A total of 28 patients with normal acid exposure completed treatment with budesonide. Only 16 (57%) had histological and 11 (69%) had symptomatic improvement. CONCLUSION In this prospective trial of pH-guided treatment, neither positive nor negative results of initial pH monitoring accurately predicted response to therapy.
Collapse
Affiliation(s)
- D L Francis
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Franciosi JP, Hommel KA, DeBrosse CW, Greenberg AB, Greenler AJ, Abonia JP, Rothenberg ME, Varni JW. Development of a validated patient-reported symptom metric for pediatric eosinophilic esophagitis: qualitative methods. BMC Gastroenterol 2011; 11:126. [PMID: 22099448 PMCID: PMC3228698 DOI: 10.1186/1471-230x-11-126] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 11/18/2011] [Indexed: 11/10/2022] Open
Abstract
Background Previous attempts to measure symptoms in pediatric Eosinophilic Esophagitis (EoE) have not fully included patients and parents in the item development process. We sought to identify and validate key patient self-reported and parent proxy-reported outcomes (PROs) specific to EoE. Methods We developed methodology for focus and cognitive interviews based on the Food and Drug Administration (FDA) guidelines for PROs, the validated generic PedsQL™ guidelines, and the consolidated criteria for reporting qualitative research (COREQ). Both child (ages 8-12 and 13-18) and parent-proxy (ages 2-4, 5-7, 8-12, and 13-18) interviews were conducted. Results We conducted 75 interviews to construct the new instrument. Items were identified and developed from individual focus interviews, followed by cognitive interviews for face and content validation. Initial domains of symptom frequency and severity were developed, and open-ended questions were used to generate specific items during the focus interviews. Once developed, the instrument construct, instructions, timeframe, scoring, and specific items were systematically reviewed with a separate group of patients and their parents during the cognitive interviews. Conclusions To capture the full impact of pediatric EoE, both histologic findings and PROs need to be included as equally important outcome measures. We have developed the face and content validated Pediatric Eosinophilic Esophagitis Symptom Score (PEESS™ v2.0). The PEESS™ v2.0 metric is now undergoing multisite national field testing as the next iterative instrument development phase.
Collapse
Affiliation(s)
- James P Franciosi
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | | | | | | | | | | | | | | |
Collapse
|