Assessing Treatment Outcomes in Achalasia Using 4-Dimensional High-resolution Impedance Manometry.

Background/aims: Assessment of treatment response of achalasia often involves multiple procedures. We aim to investigate innovative metrics based on 4-dimensional high-resolution impedance manometry (4D HRM) to assess treatment response in achalasia patients.

Methods: Patients with achalasia treated by pneumatic dilation or myotomy who underwent follow-up evaluations were included.

Approach to Esophageal Symptoms: Optimizing Index Endoscopy.

We propose a novel algorithm integrating Clinical Achalasia Risk Score (CARS) scoring, functional lumen imaging probe (FLIP) panometry, and wireless pH monitoring to streamline esophageal symptom evaluation during index endoscopy. This approach reduces diagnostic delays and reliance on manometry, diagnosing 50% to 70% of patients without overt findings. CARS scoring assesses achalasia likelihood, guiding and informing FLIP panometry to evaluate esophagogastric junction opening and motility, yielding more accurate classifications, and wireless pH monitoring enhances gastroesophageal reflux disease diagnosis by measuring acid exposure over 48 to 96 hours.

When Manometry and Functional Lumen Imaging Probe Disagree: The Current Limitations of the Chicago Classification Version 4.0 and Probable Extended Indications of Functional Lumen Imaging Probe.

High-resolution manometry (HRM) has revolutionized evaluation of esophageal motility disorders, offering detailed pressure topography and refined diagnostic criteria codified through the Chicago classification (CC). However, patients with dysphagia may present with borderline or near-normal HRM findings, exhibiting clinically significant symptoms. CC version 4.

A combined endoscopy and functional lumen imaging probe panometry approach can expedite diagnosis of esophageal motility disorders.

Background And Aims: Upper endoscopy and functional lumen imaging probe (FLIP) panometry offer a complementary approach to diagnose esophageal motility disorders during the sedated endoscopy encounter. This study aimed to evaluate an approach combining an endoscopic motility score (CARS) and FLIP panometry to diagnosis esophageal motility disorders.

Methods: Adult patients who completed upper endoscopy with FLIP and high-resolution manometry (HRM) were included.

The San Diego Consensus for Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease.

Introduction: The term laryngopharyngeal reflux (LPR) is frequently applied to aerodigestive symptoms despite lack of objective reflux evidence. The aim of this initiative was to develop a modern care paradigm for LPR supported by otolaryngology and gastroenterology disciplines.

Methods: A 28-member international interdisciplinary working group developed practical statements within the following domains: definition/terminology, initial diagnostic evaluation, reflux monitoring, therapeutic trials, behavioral factors and therapy, and risk stratification.

Patient-Reported Outcome Measures in Benign Esophageal Disorders.

Patient-reported outcome (PRO) measures are essential tools for assessing a patient's subjective experience related to disease and health. PROs measure symptom severity and evaluate treatment efficacy across a range of conditions at a particular point in time. Although PROs focusing on esophageal symptoms and esophageal hypervigilance exist, disease-specific PROs for commonly encountered benign esophageal disorders such as gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), and achalasia are limited.

Endoscopic Prediction of Achalasia: Putting the CART Before the CARS.

Background And Aims: Endoscopy can detect features indicative of esophageal dysmotility, but standardized approaches for diagnosing achalasia based on these findings remain limited. Recently, the CARS score was developed to address this gap. This study aimed to evaluate the diagnostic utility of endoscopy in identifying achalasia, using the STARD framework and current reference standards.

Ex-vivo mechano-structural characterization of fresh diseased human esophagus.

The esophagus, the tube-like organ responsible for transporting food from the pharynx to the stomach, operates as a highly mechanical structure, exhibiting complex contraction and distension patterns triggered by neurological impulses. Despite the critical role of mechanics in its function and the need for high-fidelity models of esophageal transport, mechanical characterization studies of human esophagus remain relatively scarce. In addition to the paucity of studies in human specimens, the available results are often scattered in terms of methodology and scope, making it difficult to compare findings across studies and thereby limiting their use in computational models.

Diagnostic Accuracy of Timed Barium Esophagram for Achalasia.

Background & Aims: Timed barium esophagram (TBE) is commonly used to evaluate esophageal motor disorders, though its accuracy is limited. The lack of standardized criteria for TBE interpretation, coupled with reliance on single measurements and outdated reference standards, limits its effectiveness. This study aimed to reexamine the accuracy of TBE interpretation using the Standards for Reporting of Diagnostic Accuracy Studies (STARD) approach and updated reference standards.

Direct and Retrograde Wave Propagation in Unidirectionally Coupled Wilson-Cowan Oscillators.

Some biological systems exhibit both direct and retrograde propagating signal waves despite unidirectional coupling. To explain this phenomenon, we study a chain of unidirectionally coupled Wilson-Cowan oscillators. Surprisingly, we find that changes in the homogeneous global input to the chain suffice to reverse the wave propagation direction.

A Standardized Approach to Performing and Interpreting Functional Lumen Imaging Probe Panometry for Esophageal Motility Disorders: The Dallas Consensus.

Background & Aims: Functional lumen imaging probe (FLIP) panometry provides assessment of the esophagogastric junction opening and esophageal body contractile activity during an endoscopic procedure and is increasingly being incorporated into comprehensive esophageal motility assessments. The aim of this study was to provide a standardized approach and vocabulary to the procedure and interpretation and update the motility classification scheme.

Methods: A working group of 19 FLIP panometry experts convened in a modified Delphi consensus process to produce and assess statements on the FLIP panometry procedure and interpretation.

The Esophageal Response to Distension on Functional Lumen Imaging Probe Panometry Is Minimally Changed by Conscious Sedation in Healthy Asymptomatic Subjects.

Background/aims: Functional lumen imaging probe (FLIP) Panometry has demonstrated utility in the assessment of esophageal motility as a complement to existing methodologies like high-resolution manometry. However, as FLIP is typically performed with sedation during routine endoscopy, there is potential for impact of sedation agents on esophageal motility. We aim to examine the effects of conscious sedation with midazolam and fentanyl on FLIP Panometry metrics and classification.

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

Background: Eosinophilic esophagitis (EoE) is a chronic T2-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: We investigated the role of epithelial IKKβ/NF-κB 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.