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Rettura F, Bronzini F, Campigotto M, Lambiase C, Pancetti A, Berti G, Marchi S, de Bortoli N, Zerbib F, Savarino E, Bellini M. Refractory Gastroesophageal Reflux Disease: A Management Update. Front Med (Lausanne) 2021; 8:765061. [PMID: 34790683 PMCID: PMC8591082 DOI: 10.3389/fmed.2021.765061] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022] Open
Abstract
Gastroesophageal reflux disease (GERD) is one of the most frequent gastrointestinal disorders. Proton pump inhibitors (PPIs) are effective in healing lesions and improving symptoms in most cases, although up to 40% of GERD patients do not respond adequately to PPI therapy. Refractory GERD (rGERD) is one of the most challenging problems, given its impact on the quality of life and consumption of health care resources. The definition of rGERD is a controversial topic as it has not been unequivocally established. Indeed, some patients unresponsive to PPIs who experience symptoms potentially related to GERD may not have GERD; in this case the definition could be replaced with “reflux-like PPI-refractory symptoms.” Patients with persistent reflux-like symptoms should undergo a diagnostic workup aimed at finding objective evidence of GERD through endoscopic and pH-impedance investigations. The management strategies regarding rGERD, apart from a careful check of patient's compliance with PPIs, a possible change in the timing of their administration and the choice of a PPI with a different metabolic pathway, include other pharmacologic treatments. These include histamine-2 receptor antagonists (H2RAs), alginates, antacids and mucosal protective agents, potassium competitive acid blockers (PCABs), prokinetics, gamma aminobutyric acid-B (GABA-B) receptor agonists and metabotropic glutamate receptor-5 (mGluR5) antagonists, and pain modulators. If there is no benefit from medical therapy, but there is objective evidence of GERD, invasive antireflux options should be evaluated after having carefully explained the risks and benefits to the patient. The most widely performed invasive antireflux option remains laparoscopic antireflux surgery (LARS), even if other, less invasive, interventions have been suggested in the last few decades, including endoscopic transoral incisionless fundoplication (TIF), magnetic sphincter augmentation (LINX) or radiofrequency therapy (Stretta). Due to the different mechanisms underlying rGERD, the most effective strategy can vary, and it should be tailored to each patient. The aim of this paper is to review the different management options available to successfully deal with rGERD.
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Affiliation(s)
- Francesco Rettura
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesco Bronzini
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michele Campigotto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Christian Lambiase
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Andrea Pancetti
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Ginevra Berti
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Santino Marchi
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Nicola de Bortoli
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Frank Zerbib
- CHU de Bordeaux, Centre Medico-Chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Massimo Bellini
- Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Visaggi P, Savarino E, Sciume G, Chio TD, Bronzini F, Tolone S, Frazzoni M, Pugno C, Ghisa M, Bertani L, Bellini M, Savarino V, Peroni D, Marchi S, de Bortoli N. Eosinophilic esophagitis: clinical, endoscopic, histologic and therapeutic differences and similarities between children and adults. Therap Adv Gastroenterol 2021; 14:1756284820980860. [PMID: 33613690 PMCID: PMC7871287 DOI: 10.1177/1756284820980860] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/20/2020] [Indexed: 02/04/2023] Open
Abstract
In the absence of secondary causes, eosinophilic esophagitis (EoE) is a chronic, local, progressive, T-helper type 2 immune-mediated disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. In the last 20 years, the incidence and prevalence of EoE have risen sharply, and the chances of encountering affected patients in clinics and endoscopy rooms have increased. Nevertheless, it is estimated that the mean diagnostic delay of EoE is 4-6 years in both children and adults. Unfortunately, the longer the disease stays unrecognized, the likelier it is for the patient to have persistent or increased esophageal eosinophilic inflammation, to complain of non-resolving symptoms, and to develop fibrotic complications. Early detection depends on the recognition of initial clinical manifestations that vary from childhood to adulthood and even among patients of the same age. The disease phenotype also influences therapeutic approaches that include drugs, dietary interventions, and esophageal dilation. We have herein reviewed epidemiologic, clinical, endoscopic, and histologic features and therapeutic options of EoE focusing on differences and similarities between children and adults that may certainly serve in daily clinical practice.
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Affiliation(s)
- Pierfrancesco Visaggi
- Gastroenterology Unit, Department of
Translational Research and New Technologies in Medicine and Surgery,
University of Pisa, Pisa, Italy
| | - Edoardo Savarino
- Division of Gastroenterology, Department of
Surgery, Oncology and Gastroenterology, University of Padua, Padua,
Italy
| | - Giusi Sciume
- Gastroenterology Unit, Department of
Translational Research and New Technologies in Medicine and Surgery,
University of Pisa, Pisa, Italy
| | - Teresa Di Chio
- Pediatric Institute of Italian Switzerland,
Bellinzona, Switzerland
| | - Francesco Bronzini
- Gastroenterology Unit, Department of
Translational Research and New Technologies in Medicine and Surgery,
University of Pisa, Pisa, Italy
| | - Salvatore Tolone
- Division of Surgery, Department of Surgery,
University of Campania, Naples, Italy
| | - Marzio Frazzoni
- Gastroenterology Digestive Pathophysiology Unit,
Baggiovara Hospital, Modena, Italy
| | - Camilla Pugno
- Gastroenterology Unit, Department of
Translational Research and New Technologies in Medicine and Surgery,
University of Pisa, Pisa, Italy
| | - Matteo Ghisa
- Division of Gastroenterology, Department of
Surgery, Oncology and Gastroenterology, University of Padua, Padua,
Italy
| | - Lorenzo Bertani
- Gastroenterology Unit, Department of
Translational Research and New Technologies in Medicine and Surgery,
University of Pisa, Pisa, Italy
| | - Massimo Bellini
- Gastroenterology Unit, Department of
Translational Research and New Technologies in Medicine and Surgery,
University of Pisa, Pisa, Italy
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal
Medicine, University of Genoa, Genoa, Italy
| | - Diego Peroni
- Pediatric Unit, Department of Clinical and
Experimental Medicine, University of Pisa, Pisa, Italy
| | - Santino Marchi
- Gastroenterology Unit, Department of
Translational Research and New Technologies in Medicine and Surgery,
University of Pisa, Pisa, Italy
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Aubert B, Boutigny D, De Bonis I, Gaillard JM, Jeremie A, Karyotakis Y, Lees JP, Robbe P, Tisserand V, Palano A, Chen GP, Chen JC, Qi ND, Rong G, Wang P, Zhu YS, Eigen G, Reinertsen PL, Stugu B, Abbott B, Abrams GS, Borgland AW, Breon AB, Brown DN, Button-Shafer J, Cahn RN, Clark AR, Dardin S, Day C, Dow SF, Elioff T, Fan Q, Gaponenko I, Gill MS, Goozen FR, Gowdy SJ, Gritsan A, Groysman Y, Jacobsen RG, Jared RC, Kadel RW, Kadyk J, Karcher A, Kerth LT, Kipnis I, Kluth S, Kolomensky YG, Kral JF, Lafever R, LeClerc C, Levi ME, Lewis SA, Lionberger C, Liu T, Long M, Lynch G, Marino M, Marks K, Meyer AB, Mokhtarani A, Momayezi M, Nyman M, Oddone PJ, Ohnemus J, Oshatz D, Patton S, Perazzo A, Peters C, Pope W, Pripstein M, Quarrie DR, Rasson JE, Roe NA, Romosan A, Ronan MT, Shelkov VG, Stone R, Telnov AV, von der Lippe H, Weber T, Wenzel WA, Zisman MS, Bright-Thomas PG, Harrison TJ, Hawkes CM, Kirk A, Knowles DJ, O'Neale SW, Watson AT, Watson NK, Deppermann T, Koch H, Krug J, Kunze M, Lewandowski B, Peters K, Schmuecker H, Steinke M, Andress JC, Barlow NR, Bhimji W, Chevalier N, Clark PJ, Cottingham WN, De Groot N, Dyce N, Foster B, Mass A, McFall JD, Wallom D, Wilson FF, Abe K, Hearty C, Mattison TS, McKenna JA, Thiessen D, Camanzi B, Jolly S, McKemey AK, Tinslay J, Blinov VE, Bukin AD, Bukin DA, Buzykaev AR, Dubrovin MS, Golubev VB, Ivanchenko VN, Kolachev GM, Korol AA, Kravchenko EA, Onuchin AP, Salnikov AA, Serednyakov SI, Skovpen YI, Telnov VI, Yushkov AN, Lankford AJ, Mandelkern M, McMahon S, Stoker DP, Ahsan A, Buchanan C, Chun S, MacFarlane DB, Prell S, Rahatlou S, Raven G, Sharma V, Burke S, Campagnari C, Dahmes B, Hale D, Hart PA, Kuznetsova N, Kyre S, Levy SL, Long O, Lu A, Richman JD, Verkerke W, Witherell M, Yellin S, Beringer J, Dorfan DE, Eisner AM, Frey A, Grillo AA, Grothe M, Heusch CA, Johnson RP, Kroeger W, Lockman WS, Pulliam T, Sadrozinski H, Schalk T, Schmitz RE, Schumm BA, Seiden A, Spencer EN, Turri M, Walkowiak W, Williams DC, Chen E, Dubois-Felsmann GP, Dvoretskii A, Hanson JE, Hitlin DG, Metzler S, Oyang J, Porter FC, Ryd A, Samuel A, Weaver M, Yang S, Zhu RY, Devmal S, Geld TL, Jayatilleke S, Jayatilleke SM, Mancinelli G, Meadows BT, Sokoloff MD, Bloom P, Fahey S, Ford WT, Gaede F, van Hoek WC, Johnson DR, Michael AK, Nauenberg U, Olivas A, Park H, Rankin P, Roy J, Sen S, Smith JG, Wagner DL, Blouw J, Harton JL, Krishnamurthy M, Soffer A, Toki WH, Warner DW, Wilson RJ, Zhang J, Brandt T, Brose J, Colberg T, Dahlinger G, Dickopp M, Dubitzky RS, Eckstein P, Futterschneider H, Krause R, Maly E, Müller-Pfefferkorn R, Otto S, Schubert KR, Schwierz R, Spaan B, Wilden L, Behr L, Bernard D, Bonneaud GR, Brochard F, Cohen-Tanugi J, Ferrag S, Fouque G, Gastaldi F, Matricon P, Mora de Freitas P, Renard C, Roussot E, T'Jampens S, Thiebaux C, Vasileiadis G, Verderi M, Anjomshoaa A, Bernet R, Di Lodovico F, Khan A, Muheim F, Playfer S, Swain JE, Falbo M, Bozzi C, Dittongo S, Folegani M, Piemontese L, Treadwell E, Anulli F, Baldini-Ferroli R, Calcaterra A, de Sangro R, Falciai D, Finocchiaro G, Patteri P, Peruzzi IM, Piccolo M, Xie Y, Zallo A, Bagnasco S, Buzzo A, Contri R, Crosetti G, Lo Vetere M, Macri M, Monge MR, Pallavicini M, Passaggio S, Pastore FC, Patrignani C, Pia MG, Robutti E, Santroni A, Morii M, Bartoldus R, Dignan T, Hamilton R, Mallik U, Cochran J, Crawley HB, Fischer PA, Lamsa J, McKay R, Meyer WT, Rosenberg EI, Albert JN, Beigbeder C, Benkebil M, Breton D, Cizeron R, Du S, Grosdidier G, Hast C, Höcker A, LePeltier V, Lutz AM, Plaszczynski S, Schune MH, Trincaz-Duvoid S, Truong K, Valassi A, Wormser G, Bionta RM, Brigljević V, Brooks A, Fackler O, Fujino D, Lange DJ, Mugge M, O'Connor TG, Pedrotti B, Shi X, van Bibber K, Wenaus TJ, Wright DM, Wuest CR, Yamamoto B, Carroll M, Fry JR, Gabathuler E, Gamet R, George M, Kay M, Payne DJ, Sloane RJ, Touramanis C, Aspinwall ML, Bowerman DA, Dauncey PD, Egede U, Eschrich I, Gunawardane NJ, Martin R, Nash JA, Price DR, Sanders P, Smith D, Azzopardi DE, Back JJ, Dixon P, Harrison PF, Newman-Coburn D, Potter RJ, Shorthouse HW, Strother P, Vidal PB, Williams MI, Cowan G, George S, Green MG, Kurup A, Marker CE, McGrath P, McMahon TR, Salvatore F, Scott I, Vaitsas G, Brown D, Davis CL, Ford K, Li Y, Pavlovich J, Allison J, Barlow RJ, Boyd JT, Fullwood J, Jackson F, Lafferty GD, Savvas N, Simopoulos ET, Thompson RJ, Weatherall JH, Bard R, Farbin A, Jawahery A, Lillard V, Olsen J, Roberts DA, Schieck JR, Blaylock G, Dallapiccola C, Flood KT, Hertzbach SS, Kofler R, Lin CS, Staengle H, Willocq S, Wittlin J, Brau B, Cowan R, Sciolla G, Taylor F, Yamamoto RK, Britton DI, Milek M, Patel PM, Trischuk J, Lanni F, Palombo F, Bauer JM, Booke M, Cremaldi L, Eschenberg V, Kroeger R, Reep M, Reidy J, Sanders DA, Summers DJ, Beaulieu M, Martin JP, Nief JY, Seitz R, Taras P, Zacek V, Nicholson H, Sutton CS, Cavallo N, Cartaro C, De Nardo G, Fabozzi F, Gatto C, Lista L, Paolucci P, Piccolo D, Sciacca C, LoSecco JM, Alsmiller JR, Gabriel TA, Handler T, Heck J, Brau JE, Frey R, Iwasaki M, Sinev NB, Strom D, Borsato E, Colecchia F, Dal Corso F, Galeazzi F, Margoni M, Marzolla M, Michelon G, Morandin M, Posocco M, Rotondo M, Simonetto F, Stroili R, Torassa E, Voci C, Bailly P, Benayoun M, Briand H, Chauveau J, David P, De La Vaissière C, Del Buono L, Genat JF, Hamon O, Le Diberder F, Lebbolo H, Leruste P, Lory J, Martin L, Roos L, Stark J, Versillé S, Zhang B, Manfredi PF, Ratti L, Re V, Speziali V, Frank ED, Gladney L, Guo QH, Panetta JH, Angelini C, Batignani G, Bettarini S, Bondioli M, Bosi F, Carpinelli M, Forti F, Giorgi MA, Lusiani A, Martinez-Vidal F, Morganti M, Neri N, Paoloni E, Rama M, Rizzo G, Sandrelli F, Simi G, Triggiani G, Walsh J, Hairre M, Judd D, Paick K, Turnbull L, Wagoner DE, Albert J, Bula C, Fernholz R, Lu C, McDonald KT, Miftakov V, Sands B, Schaffner SF, Smith AJ, Tumanov A, Varnes EW, Bronzini F, Buccheri A, Bulfon C, Cavoto G, del Re D, Faccini R, Ferrarotto F, Ferroni F, Fratini K, Lamanna E, Leonardi E, Mazzoni MA, Morganti S, Piredda G, Safai Tehrani F, Serra M, Voena C, Waldi R, Jacques PF, Kalelkar M, Plano RJ, Adye T, Claxton B, Franek B, Galagedera S, Geddes NI, Gopal GP, Lidbury J, Xella SM, Aleksan R, Besson P, Bourgeois P, De Domenico G, Emery S, Gaidot A, Ganzhur SF, Gosset L, Hamel de Monchenault G, Kozanecki W, Langer M, London GW, Mayer B, Serfass B, Vasseur G, Yeche C, Zito M, Copty N, Purohit MV, Singh H, Yumiceva FX, Adam I, Anthony PL, Aston D, Baird K, Bartelt J, Becla J, Bell R, Bloom E, Boeheim CT, Boyarski AM, Boyce RF, Bulos F, Burgess W, Byers B, Calderini G, Claus R, Convery MR, Coombes R, Cottrell L, Coupal DP, Coward DH, Craddock WW, DeStaebler H, Dorfan J, Doser M, Dunwoodie W, Ecklund S, Fieguth TH, Field RC, Freytag DR, Glanzman T, Godfrey GL, Grosso P, Haller G, Hanushevsky A, Harris J, Hasan A, Hewett JL, Himel T, Huffer ME, Innes WR, Jessop CP, Kawahara H, Keller L, Kelsey MH, Kim P, Klaisner LA, Kocian ML, Krebs HJ, Kunz PF, Langenegger U, Langeveld W, Leith DW, Louie SK, Luitz S, Luth V, Lynch HL, MacDonald J, Manzin G, Mariske H, McCulloch M, McShurley D, Menke S, Messner R, Metcalfe S, Moffeit KC, Mount R, Muller DR, Nelson D, Nordby M, O'Grady CP, O'Neill FG, Oxoby G, Pavel T, Perl J, Petrak S, Putallaz G, Quinn H, Raines PE, Ratcliff BN, Reif R, Robertson SH, Rochester LS, Roodman A, Russell JJ, Sapozhnikov L, Saxton OH, Schietinger T, Schindler RH, Schwiening J, Seeman JT, Serbo VV, Skarpass K, Snyder A, Soha A, Spanier SM, Stahl A, Stelzer J, Su D, Sullivan MK, Talby M, Tanaka HA, Va'vra J, Wagner SR, Weinstein AJ, White JL, Wienands U, Wisniewski WJ, Young CC, Zioulas G, Burchat PR, Cheng CH, Kirkby D, Meyer TI, Roat C, De Silva A, Henderson R, Berridge S, Bugg W, Cohn H, Hart E, Weidemann AW, Benninger T, Izen JM, Kitayama I, Lou XC, Turcotte M, Bianchi F, Bona M, Di Girolamo B, Gamba D, Smol A, Zanin D, Bosisio L, Della Ricca G, Lanceri L, Pompili A, Poropat P, Vuagnin G, Panvini RS, Brown CM, Kowalewski R, Roney JM, Band HR, Charles E, Dasu S, Elmer P, Hu H, Johnson JR, Nielsen J, Orejudos W, Pan Y, Prepost R, Scott IJ, von Wimmersperg-Toeller JH, Wu SL, Yu Z, Zobernig H, Kordich TM, Moore TB, Neal H. Measurement of CP-violating asymmetries in B0 decays to CP eigenstates. Phys Rev Lett 2001; 86:2515-2522. [PMID: 11289970 DOI: 10.1103/physrevlett.86.2515] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2001] [Indexed: 05/23/2023]
Abstract
We present measurements of time-dependent CP-violating asymmetries in neutral B decays to several CP eigenstates. The measurement uses a data sample of 23x10(6) Upsilon(4S)-->BbarB decays collected by the BABAR detector at the PEP-II asymmetric B Factory at SLAC. In this sample, we find events in which one neutral B meson is fully reconstructed in a CP eigenstate containing charmonium and the flavor of the other neutral B meson is determined from its decay products. The amplitude of the CP-violating asymmetry, which in the standard model is proportional to sin2beta, is derived from the decay time distributions in such events. The result is sin2beta = 0.34+/-0.20 (stat)+/-0.05 (syst).
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Affiliation(s)
- B Aubert
- Laboratoire de Physique des Particules, Annecy-le-Vieux, France
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