Functional Lumen Imaging Probe as Part of Multimodality Assessment of Esophagogastric Junction Opening Is Important in Longitudinal Follow-Up of Patients With Treated Achalasia.

Background: Functional lumen imaging probe (FLIP) utility is established in treatment-naïve achalasia but less clear following lower esophageal sphincter (LES) directed therapy.

Methods: Achalasia patients with LES directed therapy across three tertiary care centers between 2017 and 2024 with post-treatment FLIP and timed barium esophagram (TBE) were retrospectively identified. Reduced esophagogastric junction (EGJ) opening was defined by distensibility index (DI) < 2 mm/mmHg and diameter < 12 mm.

Gastroesophageal reflux disease is not associated with disease severity in patients with Mycobacterium avium complex lung infection.

Background: Mycobacterium avium complex (MAC) pulmonary infection was previously associated with gastroesophageal reflux disease (GERD), although the effects of GERD on MAC outcomes remains unclear. The goal of this study was to assess the prevalence of GERD in patients with MAC pulmonary infection and its association with clinical outcomes.

Methods: This was a retrospective study of adult patients with confirmed MAC pulmonary infection who underwent ambulatory pH monitoring.

Optimizing Assessment of Contraction Reserve in Ineffective Esophageal Motility: A Study of Upright Multiple Rapid Swallows.

Background/aims: Multiple rapid swallows (MRS) is a provocative test during high-resolution esophageal manometry (HRM) to evaluate contraction reserve (CR). This study aims to determine the prevalence of CR in patients with ineffective esophageal motility (IEM) and MRS performed in the upright position, and to assess the ideal number of MRS sequences.

Methods: We enrolled adult patients diagnosed with IEM according to the Chicago classification version 4.

Breakthrough Contractions During Multiple Rapid Swallows on High-Resolution Esophageal Manometry: A Marker of Esophageal Dysmotility in Post-Bariatric Surgery Patients.

Background: This study investigates multiple rapid swallows during high-resolution esophageal manometry (HREM) as an indicator of esophageal dysmotility following bariatric surgery. Gastrointestinal complications, including esophageal dysfunction, are common after bariatric surgery, and predictive markers are lacking.

Methods: Retrospective analysis of adult patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2013 and 2023 and were subsequently evaluated by HREM.

Diagnosis and Management of Noncardiac Chest Pain.

Noncardiac chest pain is a challenging condition often encountered by primary care providers, emergency medicine physicians, and gastroenterologists. It is frequently accompanied by persistent symptoms, diagnostic uncertainty, decreased quality of life, and high health care burden. Gastroesophageal reflux disease is the most common esophageal cause followed by functional chest pain, and at least half of patients with noncardiac chest pain have psychiatric comorbidities such as anxiety or depression.

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.

Successful treatment of severe passenger lymphocyte syndrome with efgartigimod synergy.

Introduction: This case describes passenger lymphocyte syndrome (PLS) generating human platelet antigen 1a (HPA-1a) alloantibodies against the recipient's platelets after liver transplant. Given the rarity of PLS, especially in liver transplant with HPA-1a alloantibodies, disease course and management options are poorly described.

Methods: The patient had cirrhosis secondary to nonalcoholic steatohepatitis complicated by hepatocellular carcinoma, encephalopathy, and severe ascites.

Presence of esophageal contractility after achalasia treatment is associated with improved esophageal emptying.

Background And Aims: Some achalasia patients exhibit esophageal contractile activity on follow-up after treatment, yet its importance remains unclear. We aimed to identify factors associated with presence of contractility after treatment and to assess its impact on timed barium esophagram (TBE) and clinical outcomes.

Methods: Patients with type I or II achalasia on baseline high-resolution manometry (HRM) who completed HRM, TBE, and functional lumen imaging probe (FLIP) after treatment were retrospectively identified.

Assessing mechanical function of peristalsis with functional lumen imaging probe panometry: Contraction power and displaced volume.

Background And Aims: The distal contractile integral (DCI) quantifies the contractile vigor of primary peristalsis on high-resolution manometry (HRM), whereas no such metric exists for secondary peristalsis on functional lumen imaging probe (FLIP) panometry. This study aimed to evaluate novel FLIP metrics of contraction power and displaced volume in asymptomatic controls and a patient cohort.

Methods: Thirty-five asymptomatic controls and adult patients (with normal esophagogastric junction outflow/opening and without spasm) who completed HRM and FLIP panometry were included.

The impact of primary peristalsis, contractile reserve, and secondary peristalsis on esophageal clearance measured by timed barium esophagogram.

Background: Primary and secondary peristalsis facilitate esophageal bolus transport; however, their relative impact for bolus clearance remains unclear. We aimed to compare primary peristalsis and contractile reserve on high-resolution manometry (HRM) and secondary peristalsis on functional lumen imaging probe (FLIP) Panometry with emptying on timed barium esophagogram (TBE) and incorporate findings into a comprehensive model of esophageal function.

Methods: Adult patients who completed HRM with multiple rapid swallows (MRS), FLIP, and TBE for esophageal motility evaluation and without abnormal esophagogastric junction outflow/opening or spasm were included.

Fidaxomicin treatment for Clostridioides difficile infection in patients with inflammatory bowel disease.

Background And Aim: Although fidaxomicin is an effective first-line treatment for Clostridioides difficile infection, it has not been well studied in patients with inflammatory bowel disease. We aimed to assess the effectiveness of fidaxomicin for the treatment of C. difficile infection in patients with inflammatory bowel disease.

Number of bottles of esophageal biopsies in the evaluation of eosinophilic esophagitis and clinical outcomes.

Background: The number of bottles of esophageal biopsies needed for the evaluation of eosinophilic esophagitis (EoE) is unclear, despite cost differences.

Aims: Assess the clinical outcomes between patients with one and two bottles of esophageal biopsies for the assessment of EoE.

Methods: Retrospective study of adults who underwent esophagogastroduodenoscopy (EGD) for esophageal symptoms between January 2015 and June 2021 and findings of ≥15 eosinophils per high power field (eos/hpf).

Development of Achalasia in a Patient With Chronic Intestinal Pseudo-Obstruction.

Development of concurrent achalasia and chronic intestinal pseudo-obstruction (CIPO) is rare, although esophageal dysmotility is common in patients with CIPO and may suggest worse clinical outcomes. We present a case of a 63-year-old man with a 15-year history of CIPO who developed postprandial regurgitation, vomiting, and dysphagia and was diagnosed with achalasia through radiographic and endoscopic findings. This is only the third case in the reported literature that involves both conditions.

An Unusual Cause of Large Bowel Obstruction in a Patient With Ulcerative Colitis.

Endometriosis is a rare cause of large bowel obstruction and has been infrequently reported in patients with inflammatory bowel disease. We present an unusual case of a young woman with ulcerative colitis, who presented with a large bowel obstruction with colonic stricture and peripancreatic mass concerning for malignancy. The evaluation revealed endometriosis, and her large bowel obstruction was successfully managed with leuprolide and colonic stenting.

A case series of eosinophilic esophagitis and primary adrenal insufficiency.

Although previously associated with secondary adrenal insufficiency and other autoimmune diseases, eosinophilic esophagitis has not been described in patients with primary adrenal insufficiency. In this case series, we describe three patients with eosinophilic esophagitis and primary adrenal insufficiency, including two patients with polyglandular autoimmune syndrome type 1. All patients experienced improvement in esophageal symptoms with treatment of eosinophilic esophagitis.