Automated software-derived supine baseline impedance is highly correlated with manual nocturnal baseline impedance for the diagnosis of GERD.

BACKGROUND: Mean nocturnal baseline impedance (MNBI) can improve diagnostic accuracy for gastroesophageal reflux disease (GERD), but must be manually calculated and is not routinely reported. We aimed to determine how automated software-derived mean supine baseline impedance (MSBI), a potential novel GERD metric, is related to MNBI. METHODS: Consecutively obtained pH-impedance studies were assessed. Manually extracted MNBI was compared to MSBI using paired t-test and Spearman's correlations. KEY RESULTS: The correlation between MNBI and MSBI was very high (ρ = 0.966, p < 0.01). CONCLUSIONS & INFERENCES: The ease of acquisition and correlation with MNBI warrant the routine clinical use and reporting of MSBI with pH-impedance studies.

Measuring and improving quality in esophageal care and swallowing disorders.

Evaluating clinical care through quality-related metrics is increasingly common. There are now numerous quality statements and indicators related to the medical management of benign and pre-malignant esophageal diseases. Expert consensus leveraging evidence-based recommendations from published society guidelines has been the most frequently used basis for developing esophageal quality statements. While surgical care of patients with esophageal malignancies, including squamous cell carcinoma, has also been developed, those related to benign esophageal disease now include domains of diagnosis, treatment, and monitoring for gastroesophageal reflux disease, eosinophilic esophagitis (EoE), achalasia, and Barrett's esophagus (BE). Several recent studies evaluating adherence to quality metrics affirm substantial variation in practice patterns with opportunities for improvement in care across esophageal diseases. In particular, patient education regarding treatment options in achalasia, frequency of esophageal biopsies among patients with dysphagia to evaluate for EoE, and endoscopic evaluation within a BE segment are areas identified to have need for improvement. As the management of esophageal diseases becomes more complex and interdisciplinary, adherence to quality metrics may be a source of standardization and improvement in delivery and ultimately patient outcomes. Indeed, the development of national quality databases has resulted in a significant growth in the use of these metrics for quality improvement activities and may form the basis for future inclusion in quality reporting and payment programs.

Potassium-Competitive Acid Blockers: Present and Potential Utility in the Armamentarium for Acid Peptic Disorders.

Potassium-competitive acid blockers (PCABs) such as vonoprazan represent a novel class of acid suppressants that show tremendous promise to enhance care of acid peptic disorders. PCAB characteristics distinct from those of proton pump inhibitors-such as acid stability with dosing independent of food consumption, rapid onset of action, less variability with CYP2C19 polymorphisms, and extended half-lives-may add value in clinical practice. With recently reported data beyond Asian populations and expanding regulatory approval of PCABs, clinicians should be aware of these medications and their potential roles in the management of acid peptic disorders. This article provides an up-to-date summary of the evidence around PCABs for the treatment of gastroesophageal reflux disease (especially erosive esophagitis healing and maintenance), eosinophilic esophagitis, Helicobacter pylori infection, and peptic ulcer healing and secondary prophylaxis.

Predictors of Abnormal Functional Luminal Impedance Planimetry Findings in Non-mechanical Esophagogastric Junction Outflow Obstruction.

BACKGROUND: Esophagogastric junction outflow obstruction (EGJOO) is a common but nonspecific motility pattern identified by esophageal high-resolution manometry (HRM). Functional luminal impedance planimetry (FLIP) provides information regarding lower esophageal sphincter (LES) mechanics, which can identify achalasia spectrum disorders and is useful in evaluating EGJOO. However, the relationship between HRM and FLIP parameters in EGJOO is not clearly defined. AIMS: To identify predictors of abnormal FLIP findings in patients with non-mechanical EGJOO. METHODS: This is a retrospective cohort study of patients with non-mechanical EGJOO who underwent FLIP between 10/1/16 and 7/1/19. Demographic data including age and gender, examination indication, concomitant medications, HRM parameters, symptom burden, and FLIP metrics of diameter and distensibility index (DI) were collected. DI was categorized as not low (DI > 2.8), borderline low (DI 1.1-2.8), and definitely low (DI ≤ 1). Kruskal-Wallis and Fisher's exact tests were used to assess the relationship between HRM and FLIP parameters and to identify predictors of abnormal FLIP. RESULTS: Among the 44 patients studied, most were female (n = 33, 75%) and the median age was 63. The median IRP was 18.2, and 10 (23%) patients used chronic narcotics. Lower total heartburn and regurgitation scores, and LES diameter by FLIP are associated with definitely low DI. CONCLUSIONS: In patients with non-mechanical EGJOO, reflux burden scores and FLIP diameters can aid in predicting DI. These results may provide useful adjunctive data to help in differentiating which patients have meaningful outflow obstruction.

Primary extradural paraganglioma of the thoracic spine: A case report.

Paragangliomas are rare, mostly benign neuroendocrine tumors arising from autonomic paraganglia. Spinal paragangliomas are uncommon, and among these, paragangliomas of the thoracic spine are distinctly unusual. We present the case of a primary paraganglioma of the extradural thoracic spine in a 34-year-old woman.