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  1. Article ; Online: Esophageal stasis in achalasia patients without symptoms after treatment does not predict symptom recurrence.

    van Hoeij, F B / Smout, A J P M / Bredenoord, A J

    Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

    2017  Volume 29, Issue 8

    Abstract: Background: After achalasia treatment, a subset of patients has poor esophageal emptying without having symptoms. There is no consensus on whether to pre-emptively treat these patients. We hypothesized that, if left untreated, these patients will ... ...

    Abstract Background: After achalasia treatment, a subset of patients has poor esophageal emptying without having symptoms. There is no consensus on whether to pre-emptively treat these patients. We hypothesized that, if left untreated, these patients will experience earlier symptom recurrence than patients without stasis.
    Methods: 99 treated achalasia patients who were in clinical remission (Eckardt ≤3) at 3 months after treatment were divided into two groups, based on presence or absence of esophageal stasis on a timed barium esophagogram performed after 3 months.
    Key results: Two years after initial treatment, patients with stasis after treatment still had a wider esophagus (3 cm; IQR: 2.2-3.8) and more stasis (3.5 cm; IQR: 1.9-5.6) than patients without stasis (1.8 cm wide and 0 cm stasis; both P<.001). In patients with stasis, the esophageal diameter had increased from 2.5 to 3.0 cm within 2 years of follow-up. The symptoms, need for and time to retreatment were comparable between the two groups. Quality of life and reflux symptoms were also comparable between the two groups.
    Conclusions & inferences: Although patients with stasis initially had a wider esophagus and 2 years after treatment also had a higher degree of stasis and a more dilated esophagus, compared to patients without stasis, they did not have a higher chance of requiring retreatment. We conclude that stasis in symptom-free achalasia patients after treatment does not predict treatment failure within 2 years and can therefore not serve as a sole reason for retreatment.
    Language English
    Publishing date 2017-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 1186328-6
    ISSN 1365-2982 ; 1350-1925
    ISSN (online) 1365-2982
    ISSN 1350-1925
    DOI 10.1111/nmo.13059
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  2. Article ; Online: Review article: The measurement of non-acid gastro-oesophageal reflux.

    Smout, A J P M

    Alimentary pharmacology & therapeutics

    2007  Volume 26 Suppl 2, Page(s) 7–12

    Abstract: Background: Oesophageal pH monitoring has been used for three decades to study gastro-oesophageal reflux, but it does not allow detection of non-acid reflux episodes.: Aim: To discuss the techniques by which non-acid reflux can be measured and to ... ...

    Abstract Background: Oesophageal pH monitoring has been used for three decades to study gastro-oesophageal reflux, but it does not allow detection of non-acid reflux episodes.
    Aim: To discuss the techniques by which non-acid reflux can be measured and to evaluate the clinical relevance of such measurements.
    Methods: Review of the literature on non-acid reflux monitoring.
    Results: Ambulatory oesophageal impedance monitoring (using a catheter with ring electrodes) allows one to detect all types of gastro-oesophageal reflux, acid as well as non-acid. Measurement of intra-oesophageal bilirubin concentration also detects reflux irrespective of the pH, but only when there is bilirubin in the gastric juice and technical short-comings limit the applicability of this technique. In untreated subjects, about 50% of reflux episodes are non-acid (nadir pH > 4). In patients on acid inhibition, up to 95% of reflux episodes are non-acid. Treatment with an acid inhibitor leads to a significant decrease in the incidence of acid reflux episodes, but not to a reduction in the total number of reflux episodes. This shift is associated with a shift in symptoms from heartburn to regurgitation. With impedance monitoring, the temporal association between symptoms that persist during inhibition of acid secretion and non-acid reflux events can be demonstrated. In a proportion of patients with chronic cough, the coughing episodes are preceded by non-acid reflux.
    Conclusions: Intraluminal impedance monitoring of gastro-oesophageal reflux is a feasible technique, which provides clinically important information about the relationships between symptoms and non-acid reflux events.
    MeSH term(s) Bilirubin/metabolism ; Cough/etiology ; Esophageal pH Monitoring/instrumentation ; Gastroesophageal Reflux/complications ; Gastroesophageal Reflux/drug therapy ; Humans ; Monitoring, Ambulatory/methods
    Chemical Substances Bilirubin (RFM9X3LJ49)
    Language English
    Publishing date 2007-12
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 639012-2
    ISSN 1365-2036 ; 0269-2813 ; 0953-0673
    ISSN (online) 1365-2036
    ISSN 0269-2813 ; 0953-0673
    DOI 10.1111/j.1365-2036.2007.03527.x
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  3. Article ; Online: Evaluation of gastrointestinal motility with MRI: Advances, challenges and opportunities.

    de Jonge, C S / Smout, A J P M / Nederveen, A J / Stoker, J

    Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

    2018  Volume 30, Issue 1

    Abstract: Dynamic magnetic resonance imaging (MRI) of gastrointestinal motility has developed rapidly over the past few years. The non-invasive and non-ionizing character of MRI is an important advantage together with the fact that it is fast and can visualize the ...

    Abstract Dynamic magnetic resonance imaging (MRI) of gastrointestinal motility has developed rapidly over the past few years. The non-invasive and non-ionizing character of MRI is an important advantage together with the fact that it is fast and can visualize the entire gastrointestinal tract. Advances in imaging and quantification techniques have facilitated assessment of gastric, small intestinal, and colonic motility in a clinical setting. Automated quantitative motility assessment using dynamic MRI meets the need for non-invasive techniques. Recently, studies have begun to examine this technique in patients, including those with IBD, pseudo-obstruction and functional bowel disorders. Remaining challenges for clinical implementation are processing the large amount of data, standardization and validation of the numerous MRI metrics and subsequently assessment of the potential role of dynamic MRI. This review examines the methods, advances, and remaining challenges of evaluation of gastrointestinal motility with MRI. It accompanies an article by Khalaf et al. in this journal that describes a new protocol for assessment of pan-intestinal motility in fasted and fed state in a single MRI session.
    MeSH term(s) Crohn Disease/diagnostic imaging ; Gastrointestinal Diseases/diagnostic imaging ; Gastrointestinal Motility ; Gastrointestinal Tract/diagnostic imaging ; Humans ; Intestinal Pseudo-Obstruction/diagnostic imaging ; Irritable Bowel Syndrome/diagnostic imaging ; Magnetic Resonance Imaging, Cine/methods ; Magnetic Resonance Imaging, Cine/trends
    Language English
    Publishing date 2018-01
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1186328-6
    ISSN 1365-2982 ; 1350-1925
    ISSN (online) 1365-2982
    ISSN 1350-1925
    DOI 10.1111/nmo.13257
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  4. Article ; Online: Rapid drinking challenge during high-resolution manometry is complementary to timed barium esophagogram for diagnosis and follow-up of achalasia.

    Ponds, F A / Oors, J M / Smout, A J P M / Bredenoord, A J

    Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

    2018  Volume 30, Issue 11, Page(s) e13404

    Abstract: Background: Esophageal stasis is a hallmark of achalasia. Timed barium esophagogram (TBE) is used to measure stasis but exposes patients to ionizing radiation. It is suggested that esophageal stasis can be objectified on high-resolution manometry (HRM) ... ...

    Abstract Background: Esophageal stasis is a hallmark of achalasia. Timed barium esophagogram (TBE) is used to measure stasis but exposes patients to ionizing radiation. It is suggested that esophageal stasis can be objectified on high-resolution manometry (HRM) as well using a rapid drinking challenge test (RDC). We aimed to assess esophageal stasis in achalasia by a RDC during HRM and compare this to TBE.
    Methods: Thirty healthy subjects (15 male, age 40 [IQR 34-49]) and 90 achalasia patients (53 male, age 47 [36-59], 30 untreated/30 treated symptomatic/30 treated asymptomatic) were prospectively included to undergo HRM with RDC and TBE. RDC was performed by drinking 200 mL of water. Response to RDC was measured by basal and relaxation pressure in the esophagogastric junction (EGJ) and esophageal pressurization during the last 5 seconds.
    Key results: EGJ basal and relaxation pressure during RDC were higher in achalasia compared to healthy subjects (overall P < .01). Esophageal body pressurization was significantly higher in untreated (43 [33-35 mm Hg]) and symptomatic treated patients (25 [16-32] mm Hg) compared to healthy subjects (6 [3-7] mm Hg) and asymptomatic treated patients (11 [8-15] mm Hg, overall P < .01). A strong correlation was observed between esophageal pressurization during RDC and barium column height at 5 minutes on TBE (r = .75, P < .01), comparable to the standard predictor of esophageal stasis, IRP (r = .66, P < .01).
    Conclusions & inferences: The RDC can reliably predict esophageal stasis in achalasia and adequately measure treatment response to a degree comparable to TBE. We propose to add this simple test to each HRM study in achalasia patients.
    MeSH term(s) Adult ; Barium ; Diagnostic Techniques, Digestive System ; Drinking ; Esophageal Achalasia/diagnosis ; Female ; Follow-Up Studies ; Humans ; Male ; Manometry/methods ; Middle Aged
    Chemical Substances Barium (24GP945V5T)
    Language English
    Publishing date 2018-07-10
    Publishing country England
    Document type Clinical Trial ; Journal Article
    ZDB-ID 1186328-6
    ISSN 1365-2982 ; 1350-1925
    ISSN (online) 1365-2982
    ISSN 1350-1925
    DOI 10.1111/nmo.13404
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  5. Article ; Online: A pregnant patient with excessive belching.

    Kessing, B F / Bredenoord, A J / Smout, A J P M

    Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus

    2016  Volume 29, Issue 6, Page(s) 688–689

    Abstract: We present a patient that developed severe belching during pregnancy. Esophageal pH-impedance monitoring revealed frequent supragastric belching, but not gastroesophageal reflux disease (GERD). Thus, severe belching during pregnancy can be due to a ... ...

    Abstract We present a patient that developed severe belching during pregnancy. Esophageal pH-impedance monitoring revealed frequent supragastric belching, but not gastroesophageal reflux disease (GERD). Thus, severe belching during pregnancy can be due to a behavioral disorder in the absence of GERD. Belching complaints during pregnancy should therefore not always be treated as GERD.
    MeSH term(s) Adult ; Diagnosis, Differential ; Electric Impedance ; Eructation/diagnosis ; Esophageal pH Monitoring ; Female ; Gastroesophageal Reflux/diagnosis ; Humans ; Pregnancy ; Pregnancy Complications/diagnosis
    Language English
    Publishing date 2016-08
    Publishing country United States
    Document type Case Reports
    ZDB-ID 639470-x
    ISSN 1442-2050 ; 1120-8694
    ISSN (online) 1442-2050
    ISSN 1120-8694
    DOI 10.1111/dote.12076
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    Zs.A 2378: Show issues Location:
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  6. Article ; Online: Esophageal acid sensitivity and mucosal integrity in patients with functional heartburn.

    Weijenborg, P W / Smout, A J P M / Bredenoord, A J

    Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

    2016  Volume 28, Issue 11, Page(s) 1649–1654

    Abstract: Background: Patients with functional heartburn (FH) experience troublesome heartburn that is not related to gastroesophageal reflux. The etiology of the heartburn sensation in FH patients is unknown. In patients with reflux disease, esophageal ... ...

    Abstract Background: Patients with functional heartburn (FH) experience troublesome heartburn that is not related to gastroesophageal reflux. The etiology of the heartburn sensation in FH patients is unknown. In patients with reflux disease, esophageal hypersensitivity seems associated with impaired mucosal integrity. We aimed to determine esophageal sensitivity and mucosal integrity in FH and non-erosive reflux disease (NERD) patients.
    Methods: In this prospective experimental study, we performed an acid perfusion test and upper endoscopy with biopsies in 12 patients with NERD and nine patients with FH. Mucosal integrity was measured during endoscopy using electrical tissue impedance spectroscopy and biopsy specimens were analyzed in Ussing chambers for transepithelial electrical resistance and transepithelial permeability.
    Key results: Lag time to heartburn perception was significantly longer in FH patients (median 12 min) than in NERD patients (median 3 min). Once perceived, intensity of heartburn was scored equal with median visual analog scale 6.5 and 7.1 respectively. Esophageal mucosal integrity was also comparable between FH and NERD patients, both in vivo extracellular impedance and ex vivo transepithelial resistance and permeability were similar.
    Conclusions & inferences: Patients with FH did not show acid hypersensitivity as seen in patients with NERD. However, once perceived, intensity of heartburn is similar. Esophageal mucosal integrity is similar between NERD and FH patients, and is therefore unlikely to be the underlying cause of the observed difference in esophageal acid perception.
    Language English
    Publishing date 2016-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 1186328-6
    ISSN 1365-2982 ; 1350-1925
    ISSN (online) 1365-2982
    ISSN 1350-1925
    DOI 10.1111/nmo.12864
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  7. Book: A guide to gastrointestinal motility disorders

    Bredenoord, Albert J / Smout, A. J. P. M / Tack, Jan

    2016  

    Author's details Albert J. Bredenoord, André Smout, Jan Tack
    MeSH term(s) Gastrointestinal Diseases ; Gastrointestinal Motility
    Language English
    Size viii, 112 pages :, illustrations (mostly color)
    Document type Book
    ISBN 9783319269368 ; 9783319269382 ; 3319269364 ; 3319269380
    Database Catalogue of the US National Library of Medicine (NLM)

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  8. Article ; Online: Jackhammer esophagus: Observations on a European cohort.

    Herregods, T V K / Smout, A J P M / Ooi, J L S / Sifrim, D / Bredenoord, A J

    Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

    2017  Volume 29, Issue 4

    Abstract: Background: With the advent of high-resolution manometry (HRM), a new diagnosis, jackhammer esophagus, was introduced. Little is known about this rare condition, and the relationship between symptoms and hypercontractility is not always straightforward. ...

    Abstract Background: With the advent of high-resolution manometry (HRM), a new diagnosis, jackhammer esophagus, was introduced. Little is known about this rare condition, and the relationship between symptoms and hypercontractility is not always straightforward. The aim of our study was to describe a large cohort of patients with jackhammer esophagus and to investigate whether manometric findings are associated with the presence of symptoms.
    Methods: All patients from 06, 2014 until 12, 2015 seen at two tertiary centers with at least one hypercontractile swallow (distal contractile integral [DCI] >8000 mm Hg/s/cm) on HRM were analyzed. Patients with ≥20% premature swallows, or patients with another diagnosis explaining their symptoms were excluded.
    Key results: Of the 34 patients identified with jackhammer esophagus, most suffered from dysphagia (67.6%) and/or chest pain (47.1%). The symptom chest pain was not associated with any of the manometric findings, whereas dysphagia was associated with the DCI of the hypercontractile swallows and with intrabolus pressure. In addition, all patients who had an isolated DCI of the lower esophageal sphincter (LES) zone >2000 mm Hg/s/cm had dysphagia. The differences in HRM and clinical characteristics between subgroups based on the contraction type (single- or multi-peaked) or based on meeting criteria of the Chicago Classification v3.0 and v2.0 were limited.
    Conclusions & inferences: The symptom dysphagia is accompanied with strong contractions of the LES, signs of a possible outflow obstruction, and a very high DCI. The presence of a multipeaked contraction seems to be of limited relevance, and caution is warranted in labeling patients with one hypercontractile swallow as normal.
    Language English
    Publishing date 2017-04
    Publishing country England
    Document type Journal Article
    ZDB-ID 1186328-6
    ISSN 1365-2982 ; 1350-1925
    ISSN (online) 1365-2982
    ISSN 1350-1925
    DOI 10.1111/nmo.12975
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  9. Article ; Online: Subtle lower esophageal sphincter relaxation abnormalities in patients with unexplained esophageal dysphagia.

    Herregods, T V K / van Hoeij, F B / Bredenoord, A J / Smout, A J P M

    Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

    2017  Volume 30, Issue 2

    Abstract: Background: Esophageal dysphagia is a relatively common symptom. We aimed to evaluate whether subtle, presently not acknowledged forms of dysfunction of the lower esophageal sphincter (LES) could explain dysphagia in a subset of patients with normal ... ...

    Abstract Background: Esophageal dysphagia is a relatively common symptom. We aimed to evaluate whether subtle, presently not acknowledged forms of dysfunction of the lower esophageal sphincter (LES) could explain dysphagia in a subset of patients with normal findings at high-resolution manometry (HRM) according to the Chicago classification v3.0.
    Methods: We used HRM to compare LES relaxation characteristics in 97 patients with unexplained dysphagia with those in 44 healthy subjects. In addition, normative values for time to LES relaxation and completeness of LES relaxation were calculated. Patients with delayed or incomplete LES relaxation were compared with patients with normal relaxation.
    Key results: Dysphagia patients had a higher nadir LES pressure (P=.001) and a longer time to LES relaxation (P=.012) than healthy subjects. Based on the findings in healthy subjects, normal values of LES relaxation were defined as: ≥50% of swallows with normal LES relaxation time (<5 seconds) and ≤20% of swallows with incomplete LES relaxation (not reaching a value below 10 mm Hg). Dysphagia patients had significantly more often >50% swallows with delayed and/or incomplete LES relaxation than healthy controls (25% vs 4.5%; P=.004). Dysphagia patients with >50% delayed and/or incomplete LES relaxation had a significantly higher LES resting pressure (P<.001) and a significantly higher intrabolus pressure (P<.001) than dysphagia patients who did not fulfill the criteria.
    Conclusions and inferences: Subtle LES relaxation abnormalities, such as a delayed relaxation of the LES and/or incomplete LES relaxation, could be a cause of dysphagia in approximately one quarter of the patients with otherwise unexplained esophageal dysphagia.
    MeSH term(s) Adolescent ; Adult ; Aged ; Deglutition Disorders/etiology ; Deglutition Disorders/physiopathology ; Esophageal Sphincter, Lower/physiopathology ; Female ; Humans ; Male ; Manometry ; Middle Aged ; Young Adult
    Language English
    Publishing date 2017-08-14
    Publishing country England
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 1186328-6
    ISSN 1365-2982 ; 1350-1925
    ISSN (online) 1365-2982
    ISSN 1350-1925
    DOI 10.1111/nmo.13188
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  10. Article ; Online: Characterization of idiopathic esophagogastric junction outflow obstruction.

    van Hoeij, F B / Smout, A J P M / Bredenoord, A J

    Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society

    2015  Volume 27, Issue 9, Page(s) 1310–1316

    Abstract: Background: Esophagogastric junction (EGJ) outflow obstruction is a manometric diagnosis, characterized by an elevated relaxation pressure (IRP4) of the lower esophageal sphincter (LES) and intact or weak peristalsis. The etiology and preferred ... ...

    Abstract Background: Esophagogastric junction (EGJ) outflow obstruction is a manometric diagnosis, characterized by an elevated relaxation pressure (IRP4) of the lower esophageal sphincter (LES) and intact or weak peristalsis. The etiology and preferred treatment remain unknown. We describe a large patient cohort in detail, for a better understanding of this rare disorder.
    Methods: We included 47 patients, diagnosed with EGJ outflow obstruction on high-resolution manometry (HRM) between 2012 and December 2014.
    Key results: Idiopathic EGJ outflow obstruction was diagnosed in 34 patients. The majority (91%) of patients presented with retrosternal pain or dysphagia. The median (IQR) for various HRM parameters was IRP4, 18.9 mmHg (18-23); intrabolus pressure (IBP), 8.3 mmHg (5-12) and basal LES pressure, 27.5 mmHg (22-33). Peristaltic breaks were seen in 88% and elevated IBPmax in 74% of patients. No patients had stasis, difficult LES passage or esophageal dilation on endoscopy. Only 7/25 patients (28%) had stasis on barium esophagography. In 26 patients (82%), no treatment was required: 18 had symptoms judged unrelated to outflow obstruction, 5 had spontaneous symptom relief, and 3 declined therapy. Eight patients were treated: five received botox injections with a good but short-lived effect, three received pneumatic dilatation, of which one was successful. Three patients were diagnosed with achalasia on a subsequent manometry.
    Conclusions & inferences: Primary EGJ outflow obstruction has an unclear clinical significance. A substantial part of patients has unrelated symptoms, spontaneous symptom relief, or no stasis. Treated patients showed a beneficial response to botox injections. A small proportion develops achalasia at follow-up.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Esophageal Diseases/diagnosis ; Esophageal Diseases/physiopathology ; Esophagogastric Junction/physiopathology ; Female ; Humans ; Male ; Manometry ; Middle Aged ; Young Adult
    Language English
    Publishing date 2015-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 1186328-6
    ISSN 1365-2982 ; 1350-1925
    ISSN (online) 1365-2982
    ISSN 1350-1925
    DOI 10.1111/nmo.12625
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