Consensus Guidelines: Best Practices for the Prevention, Detection and Management of Hepatitis B Virus Reactivation in Clinical Trials with Immunosuppressive/Immunomodulatory Therapy.

Hepatitis B virus reactivation (HBVr) during and after immunosuppressive/immunomodulatory (IS/IM) therapy is associated with significant morbidity and mortality, including hepatic decompensation and acute liver failure. The risk of HBVr with IS/IM has been heterogeneous and often unpredictable. As a result, patients with active or previous HBV infection are often excluded from clinical drug trials of such agents.

Gastroparesis and gastroparesis-like syndrome: response to therapy and its predictors.

Purpose: The natural history and outcome of patients with gastroparesis is not well known. The aim of this study was to identify the clinical or pathophysiological characteristics, if any, that may be helpful in predicting therapeutic response in this condition.

Methods: This is a retrospective study of a cohort of patients who presented to a tertiary referral center with symptoms suggestive of gastroparesis.

Interobserver variability in antroduodenal manometry.

Interobserver variability affects investigations involving assessment of complex visual data, such as histopathology, radiology and motility. This study assessed interobserver variation for interpretation of antroduodenal manometry (ADM), as this has not been previously investigated. Thirty-five ADM recordings from children aged 0.

Changes in the gastric enteric nervous system and muscle: a case report on two patients with diabetic gastroparesis.

Background: The pathophysiological basis of diabetic gastroparesis is poorly understood, in large part due to the almost complete lack of data on neuropathological and molecular changes in the stomachs of patients. Experimental models indicate various lesions affecting the vagus, muscle, enteric neurons, interstitial cells of Cajal (ICC) or other cellular components. The aim of this study was to use modern analytical methods to determine morphological and molecular changes in the gastric wall in patients with diabetic gastroparesis.

Postcholecystectomy sphincter of oddi dyskinesia--a diagnostic dilemma--role of noninvasive nuclear and invasive manometric and endoscopic aspects.

Background: Persistent abdominal pain after cholecystectomy is not uncommon. Sphincter of oddi dysfunction (SOD) is one of the causes for this entity. However, diagnosing SOD is often difficult.

Drug Insight: from disturbed motility to disordered movement--a review of the clinical benefits and medicolegal risks of metoclopramide.

Metoclopramide, the only drug approved by the FDA for treatment of diabetic gastroparesis, but used off-label for a variety of other gastrointestinal indications, has many potentially troublesome adverse neurologic effects, particularly movement disorders. In this article, we comprehensively review the indications and side effects of metoclopramide, and describe some common pitfalls and strategies to minimize the medicolegal risks to the prescribing physician. Metoclopramide accounts for nearly a third of all drug-induced movement disorders, a common reason for a malpractice suit.

An unusual electrocardiogram artifact: what is its source?

A diabetic female presented with nausea and vomiting. Her electrocardiogram showed sinus rhythm with two artifactual spikes, not synchronized with the cardiac rhythm. The patient had an implanted gastric electrical stimulation system for treating her diabetic gastroparesis.

Comorbidities associated with constipation in children referred for colon manometry may mask functional diagnoses.

Background: In children with prolonged constipation of unclear pathogenesis or unresponsive to treatment, colon manometry can discriminate between functional fecal retention (FFR) and colon neuromuscular diseases.

Aim: To identify the clinical features precipitating referral for colon manometry in children with functional constipation.

Method: Retrospective medical record review of 173 constipated children (116 male, mean age 6.

Comparison of morning and evening administration of rabeprazole for gastro-oesophageal reflux and nocturnal gastric acid breakthrough in patients with reflux disease: a double-blind, cross-over study.

Aim: To assess the effect of timing of rebeprazole (RB) 20 mg/d administration on oesophageal acid exposure and nocturnal gastric acid breakthrough (NGAB) in patients with GERD.

Methods: 20 GERD patients received two 7-day treatments of RB in the morning (a.m.

Baclofen blocks LES relaxation and crural diaphragm inhibition by esophageal and gastric distension in cats.

Esophageal distension and transient lower esophageal sphincter (LES) relaxation (TLESR) are accompanied by simultaneous relaxation of the LES and inhibition of crural diaphragm. Recent studies indicate that baclofen decreases the frequency of TLESR; however, its effect on the crural diaphragm is not known. We evaluated the effects of baclofen on LES relaxation and crural diaphragm inhibition induced by gastric distension and esophageal distension in cats.

Relationship between esophageal muscle thickness and intraluminal pressure in patients with esophageal spasm.

We previously showed, in normal subjects, a positive correlation between the esophageal contraction amplitude and peak muscle thickness. The goal of this study was to determine the relationship between esophageal muscle thickness and contraction amplitude in patients with high-amplitude peristaltic and simultaneous contractions. Eleven patients with high-amplitude peristaltic contractions, 8 with diffuse esophageal spasm (DES), 7 with nonspecific (NS) motor disorder of the esophagus, and 10 normal subjects were studied using simultaneous pressure and ultrasound imaging.

Effect of cisapride on nocturnal transient lower oesophageal sphincter relaxations and nocturnal gastro-oesophageal reflux in patients with oesophagitis: a double-blind, placebo-controlled study.

Aim: To investigate the effect of cisapride, a selective 5-hydroxytryptamine-4 receptor agonist, on the frequency of nocturnal transient lower oesophageal sphincter relaxations and oesophageal acid exposure in patients with gastro-oesophageal reflux disease.

Methods: In a double-blind, placebo-controlled study, 10 patients with gastro-oesophageal reflux disease (six male and four female; mean age, 54 +/- 10.4 years) were randomly assigned to 5-day treatments with cisapride, 10 mg q.

Sustained esophageal contraction: a motor correlate of heartburn symptom.

Heartburn occurs in the presence as well as the absence of acid reflux. We searched for a motor correlate of heartburn. Twelve subjects with heartburn were studied with 24-h synchronized pressure, pH, and high-frequency intraluminal ultrasound (HFIUS) imaging of the esophagus.

Relationship between esophageal muscle thickness and intraluminal pressure: an ultrasonographic study.

A number of studies show a close temporal relationship between the rate of change in muscle thickness as detected by high-frequency intraluminal ultrasonography (HFIUS) and intraluminal pressure measured by manometry. There is a marked variability in esophageal contraction amplitude from one swallow to another at a given level in the esophagus and along the length of the esophagus. Furthermore, peristaltic pressures are higher in the distal compared with the proximal esophagus.

The effect of mechanoreceptor stimulation of the laryngopharynx on the oesophago-gastric junction.

Stimulation of the pharynx by injection of minute amounts of water induces prolonged period of lower oesophageal sphincter (LOS) relaxation and augmentation of the crural diaphragm (CD) contraction. The purpose of this study was to determine the effects of stimulating mechano-receptors at the laryngopharynx on the LOS and CD by using an air pulse stimulation device. Air pulses were delivered via the internal channel of a flexible endoscope.

Lower esophageal sphincter monitoring with sphinctometer: in vitro and in vivo studies.

The sphinctometer is a solid-state device system for prolonged ambulatory recordings of the lower esophageal sphincter (LES) pressure. The aims of this study were to determine 1) the pressure sensitivity and the latency of sphinctometer responses in vitro, 2) if the sphinctometer can record transient LES relaxations (TLESR) in vivo, and 3) if the currently accepted criteria for TLESR are applicable to sphinctometer recordings. Different segments of the sphinctometer were positioned in a chamber at known pressures to assess the sphinctometer readings as well as the latency of the response.

Sustained esophageal contraction: a marker of esophageal chest pain identified by intraluminal ultrasonography.

Background & Aims: Intraluminal pressure recording systems have not demonstrated predictable esophageal motor correlates of unexplained chest pain. This study used continuous high-frequency intraluminal ultrasonography to characterize esophageal contraction at the time of spontaneous and provoked chest pain.

Methods: Intraluminal pressure, pH, and ultrasound images of the esophagus were recorded for a maximum of 24 hours in 10 subjects with unexplained chest pain.

Comparison of three urease tests for detection of Helicobacter pylori in gastric biopsy specimens.

Objective: To propose two modified urease tests for the detection of Helicobacter pylori in gastric biopsy specimens.

Patients And Methods: The presence of H. pylori infection was determined in 237 patients undergoing upper gastrointestinal endoscopy.