Esophageal epithelial Ikkβ deletion promotes eosinophilic esophagitis in experimental allergy mouse model.

Background: Eosinophilic esophagitis (EoE) is a chronic T helper type 2 (Th2)-associated inflammatory disorder triggered by food allergens, resulting in esophageal dysfunction through edema, fibrosis, and tissue remodeling. The role of epithelial remodeling in EoE pathogenesis is critical but not fully understood.

Objective: To investigate the role of epithelial IKKβ/NFκB signaling in EoE pathogenesis using a mouse model with conditional Ikkβ knockout in esophageal epithelial cells (Ikkβ).

A Software Framework for the Functional Lumen Imaging Probe-Mechanics (MechView).

Background: The functional lumen imaging probe (FLIP) has proven to be a versatile device for diagnosing esophageal motility disorders and estimating esophageal wall compliance, but there is a lack of viable software for quantitative assessment of FLIP measurements.

Methods: A Python-based web framework was developed for a unified assessment of FLIP measurements including clinical metrics such as esophagogastric junction (EGJ) distensibility index (DI), maximum EGJ opening diameter, mechanics-based metrics for estimating strength, and effectiveness of contractions, such as contraction power and displaced volume, and machine learning-based clustering and predictive algorithms such as the virtual disease landscape (VDL) and EGJ obstruction probability. The clinical and VDL probability metrics were then validated using FLIP data from 121 subjects constituting different categories of EGJ opening which were diagnosed by expert clinicians.

Validation of the Japanese version of the Esophageal Hypervigilance and Anxiety Scale for esophageal symptoms.

Background: The Esophageal Hypervigilance and Anxiety Scale (EHAS) is an English questionnaire created in the USA to assess these factors in all patients with esophageal diseases. The aim of this study was to develop and validate the Japanese version of EHAS and investigate the relationship between EHAS scores and symptoms in untreated disorders of esophagogastric junction (EGJ) outflow.

Methods: This prospective study recruited patients who underwent high-resolution manometry (HRM) at six tertiary centers in Japan.

Validation of the Laryngeal Cognitive-affective Tool in a Taiwanese Population.

Background And Aim: The laryngeal cognitive-affective tool (LCAT) was recently validated in the US to assess laryngeal-specific hypervigilance and anxiety. The aim of this study was to examine LCAT validity in the Taiwanese population.

Methods: This prospective single-center study enrolled adults from Hualien Tzu Chi Hospital with laryngeal symptoms for >6 months.

Endoscopic Sedation Type During FLIP Panometry Does Not Significantly Impact FLIP Motility Classification Relative to Manometry.

Background & Aims: Functional lumen imaging probe (FLIP) panometry evaluates esophageal motility at the time of sedated endoscopy and often parallels high-resolution manometry (HRM) performed in awake patients. This study aimed to assess the impact of endoscopic sedation on FLIP evaluation of esophageal motility.

Methods: Adult patients who completed FLIP panometry during sedated endoscopy and had a conclusive Chicago Classification version 4.

Four-Dimensional Impedance Manometry in Esophageal Motility Disorders.

Introduction: Four-dimensional high-resolution impedance manometry (4D HRM) uses impedance to estimate esophageal luminal cross-sectional area and track nadir impedance to measure intrabolus pressure (IBP). We aimed to determine whether 4D HRM metrics could define abnormal esophagogastric junction (EGJ) opening between Chicago Classification version 4.0 motility disorders and compare 4D HRM with functional lumen imaging probe (FLIP) metrics.

Defining lower esophageal sphincter physiomechanical states among esophageal motility disorders using functional lumen imaging probe panometry.

Background: Functional lumen imaging probe (FLIP) panometry assesses esophageal motility in response to controlled volumetric distension. This study aimed to describe the physiomechanical states of the lower esophageal sphincter (LES) in response to serial filling/emptying regimes for esophageal motility disorders.

Methods: Fourty-five patients with absent contractile response on FLIP and diagnoses of normal motility (n = 6), ineffective esophageal motility (IEM; n = 8), scleroderma (SSc; n = 10), or nonspastic achalasia (n = 21) were included, as were 20 patient controls with normal motility on FLIP and manometry.

North American Expert Consensus on the Post-procedural Care of Patients After Per-oral Endoscopic Myotomy Using a Delphi Process.

Background & Aims: There is significant variability in the immediate post-operative and long-term management of patients undergoing per-oral endoscopic myotomy (POEM), largely stemming from the lack of high-quality evidence. We aimed to establish a consensus on several important questions on the after care of post-POEM patients through a modified Delphi process.

Methods: A steering committee developed an initial questionnaire consisting of 5 domains (33 statements): post-POEM admission/discharge, indication for immediate post-POEM esophagram, peri-procedural medications and diet resumption, clinic follow-up recommendations, and post-POEM reflux surveillance and management.

Gastrointestinal disease in systemic sclerosis: the neglected organ system?

Purpose Of Review: Identifying outcomes and clinical trial endpoints enabled the discovery of new inflammatory bowel disease (IBD) treatments. Herein, we describe efforts to advance the study of gastrointestinal (GI) manifestations in systemic sclerosis (SSc).

Recent Findings: Insights into the scope of the problem, as well as advancements in the measurement and treatment of SSc-GI, are underway.

Acceptance and commitment therapy for the treatment of irritable bowel syndrome and inflammatory bowel disease: a narrative review.

Background And Objective: Cognitive behavioral therapy (CBT) is a common treatment modality for patients with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). CBT may not be a good fit for all patients and some may instead benefit from an acceptance and commitment therapy (ACT) approach. This narrative review presents evidence for the use of ACT in adult patients with IBS or IBD.

Esophageal epithelial deletion promotes eosinophilic esophagitis in experimental allergy mouse model.

Background: Eosinophilic esophagitis (EoE) is a chronic T helper type 2 (Th2)-associated inflammatory disorder triggered by food allergens, resulting in esophageal dysfunction through edema, fibrosis, and tissue remodeling. The role of epithelial remodeling in EoE pathogenesis is critical but not fully understood.

Objective: To investigate the role of epithelial IKKβ/NFκB signaling in EoE pathogenesis using a mouse model with conditional β knockout in esophageal epithelial cells ( β ).

Effects of Cholecystokinin on Esophageal Motor Response to Distension in Asymptomatic Volunteers.

Background/aims: Cholecystokinin (CCK) administration has been shown to reduce lower esophageal sphincter (LES) pressure in normal subjects in manometric studies. Functional luminal imaging probe (FLIP) panometry offers a method to assess esophageal motility in response to sustained distension though mechanisms related to this response remain unexplored. The aim of this study is to evaluate the effect of CCK-8 on the esophageal response to distension in asymptomatic volunteers using FLIP.

Assessment of colonoscopy skill using machine learning to measure quality: Proof-of-concept and initial validation.

Low-quality colonoscopy increases cancer risk but measuring quality remains challenging. We developed an automated, interactive assessment of colonoscopy quality (AI-CQ) using machine learning (ML). Based on quality guidelines, metrics selected for AI development included insertion time (IT), withdrawal time (WT), polyp detection rate (PDR), and polyps per colonoscopy (PPC).

Peroral endoscopic myotomy for hypercontractile (Jackhammer) esophagus: A retrospective multicenter series with long-term follow-up.

Introduction: Long-term outcome data are limited for non-achalasia esophageal motility disorders treated by peroral endoscopy myotomy (POEM) as a separate group. We investigated a subset of symptomatic patients with hypercontractile esophagus (Jackhammer esophagus).

Methods: Forty two patients (mean age 60.

Age Affects Esophageal Secondary Peristalsis More Than Primary as Assessed by FLIP Panometry and High-resolution Manometry.

Age-related changes in esophageal function involve increased rates of dysmotility with advancing age (sometimes described as presbyesophagus). Specifically, advanced age has been associated with increased lower esophageal sphincter (LES) pressure and decreased peristaltic vigor. However, the mechanisms underlying these changes, including the relative relationship of primary peristalsis and secondary peristalsis over the lifespan, remain incompletely understood.

Enhancing Chicago Classification diagnoses with functional lumen imaging probe-mechanics (FLIP-MECH).

Background: Esophageal motility disorders can be diagnosed by either high-resolution manometry (HRM) or the functional lumen imaging probe (FLIP) but there is no systematic approach to synergize the measurements of these modalities or to improve the diagnostic metrics that have been developed to analyze them. This work aimed to devise a formal approach to bridge the gap between diagnoses inferred from HRM and FLIP measurements using deep learning and mechanics.

Methods: The "mechanical health" of the esophagus was analyzed in 740 subjects including a spectrum of motility disorder patients and normal subjects.

Discriminating "impaired" from "disordered" contractile response on FLIP panometry by utilizing pressure measurement.

Background: Functional lumen imaging probe (FLIP) panometry evaluates esophageal motility, including the contractile response to distension, that is, secondary peristalsis. Impaired/disordered contractile response (IDCR) is an abnormal, but nonspecific contractile response that can represent either hypomotility or spastic motor disorders on high-resolution manometry (HRM). We hypothesized that FLIP pressure could be incorporated to clarify IDCR and aimed to determine its utility in a cohort of symptomatic esophageal motility patients.

Four-dimensional impedance manometry volume metrics for predicting abnormal bolus retention.

Background: The objective measurement for esophageal bolus volume and bolus clearance could classify abnormal high-resolution manometry (HRM) beyond the current Chicago classification. We aimed to compare the novel four-dimensional impedance manometry (4D HRM) volume metrics with timed barium esophagram (TBE).

Methods: Adults with esophageal symptoms undergoing HRM and TBE were included.

Focal Distal Esophageal Dilation (Blown-Out Myotomy) After Achalasia Treatment: Prevalence and Associated Symptoms.

Introduction: Peroral endoscopic myotomy (POEM) may result in a distended distal esophagus, referred to as a blown-out myotomy (BOM), the relevance of which is uncertain. The aim of this study was to investigate the prevalence, risk factors, and associated symptoms of BOM after achalasia treatment.

Methods: A data set of the locally treated patients in a randomized controlled trial comparing POEM with pneumatic dilation (PD) was analyzed.

Effect of esophageal body recoil on clinical outcomes in non-spastic achalasia.

Background: Despite the established efficacy of achalasia treatments on symptomatic outcomes, there are limited data evaluating the treatment effect on esophageal dilatation. This study aimed to assess the effect achalasia treatment on esophageal dilatation and the effect of esophageal width reduction ("recoil") on clinical outcomes.

Methods: Patients with type I or type II achalasia that completed high-resolution manometry (HRM), functional lumen imaging probe (FLIP), and timed barium esophagram (TBE) pre and post treatment were included.

Behavioral Therapy for Functional Heartburn: Recommendation Statements.

Background & Aims: Brain-gut behavior therapies (BGBT) are increasingly recognized as effective therapeutic interventions for functional heartburn. However, recommendations regarding candidacy for treatment, initial treatment selection, and navigating treatment non-response have not been established for functional heartburn specifically. The aim of this study was to establish expert-based recommendations for behavioral treatment in patients with functional heartburn.