Radiofrequency ablation in patients with large cervical heterotopic gastric mucosa and globus sensation: Closing the treatment gap

Kristo, Ivan; Rieder, Erwin; Paireder, Matthias; Schwameis, Katrin; Jomrich, Gerd; Dolak, Werner; Parzefall, Thomas; Riegler, Martin; Asari, Reza; Schoppmann, Sebastian F.

doi:10.1111/den.12959

Cited by 19 publications

(14 citation statements)

References 28 publications

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“…The efficacy of PPIs for LPR should be better for acid than non‐acid and mixed reflux, as PPIs do not limit refluxate mechanically but seek only to change its acid content . It has even been suggested that a PPI prescription (as single medication) in non‐acid and mixed LPR could exacerbate laryngopharyngeal mucosa injury from non‐conjugated bile salts, trypsin, etc by providing the required alkaline pH for optimal activity of non‐conjugated bile salts . Thus, it is likely that many LPR patients with non‐acid or mixed LPR did not receive adequate treatment during their initial therapeutic trial.…”

Section: Discussionmentioning

confidence: 99%

The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: A contemporary review

Lechien

Muls

Dapri

et al. 2019

Clinical Otolaryngology

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Objective: To summarise current knowledge about the prevalence, aetiology and management of recalcitrant laryngopharyngeal reflux (LPR) patients-those who do not respond to anti-reflux medical treatment. Methods:A literature search was conducted following the PRISMA guidelines to identify studies that reported success of anti-reflux medical treatment with emphasis on studies that attempted to be rigorous in defining a population of LPR patients and which subsequently explored the characteristics of non-responder patients (ie aetiology of resistance; differential diagnoses; management and treatment). Three investigators screened publications for eligibility from PubMED, Cochrane Library and Scopus and excluded studies based on predetermined criteria. Design, diagnostic method, exclusion criteria, treatment characteristics, follow-up and quality of outcome assessment were evaluated.Results: Of the 139 articles screened, 45 met the inclusion criteria. The definition of non-responder patients varied substantially from one study to another and often did | 785 LECHIEN Et aL

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Section: Discussionmentioning

confidence: 99%

The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: A contemporary review

Lechien

Muls

Dapri

et al. 2019

Clinical Otolaryngology

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“…In contrast, Kristo et al[78] recently reported an 80% rate of complete macroscopic and histologic eradication after 2 sessions of radiofrequency ablation with im-provements in globus sensation and quality of life without any major adverse events or stricture formation after an approximate 2-year follow-up. The involvement of the esophageal heterotopic mucosa in esophageal pathology may eventually become as popular as BE, which will promote novel technologies such as hybrid-APC that could improve the therapeutic intervention for selected cases of large IPs in the future[83,84].…”

Section: Management and Surveillance Considerationsmentioning

confidence: 98%

“…Other issues such as elevated surfaces[78] or the size of the IP should be taken into consideration before deciding which strategy is most appropriate. For instance, experts generally did not include patients with large IPs in the previously conducted interventional APC trials to exclude the possibility of stricture formation[18,79-81].…”

Section: Management and Surveillance Considerationsmentioning

confidence: 99%

Issues and controversies in esophageal inlet patch

Ciocalteu

Popa

Ionescu

et al. 2019

WJG

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The proximal esophagus is rarely examined, and its inspection is often inadequate. Optical chromoendoscopy techniques such as narrow band imaging improve the detection rate of inlet patches in the proximal esophagus, a region in which their prevalence is likely underestimated. Various studies have reported correlations between these esophageal marks with different issues such as Barrett’s esophagus, but these findings remain controversial. Conflicting reports complicate the process of interpreting the clinical features of esophageal inlet patches and underestimate their importance. Unfortunately, the limited clinical data and statistical analyses make reaching any conclusions difficult. It is hypothesized that inlet patches are correlated with various esophageal and extraesophageal symptoms, diagnoses and the personalized therapeutic management of patients with inlet patches as well as the differential diagnosis for premalignant lesions or early cancers. Due to its potential underdiagnosis, there are no consensus guidelines for the management and follow up of inlet patches. This review focuses on questions that were raised from published literature on esophageal inlet patches in adults.

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“…Indeed, up to 23% of patients with gastric inlet patch complain of globus symptom 2 and a controlled study reported a significant and sustained symptomatic improvement after argon plasma coagulation of the heterotopic mucosa 17 . Efficacy of radiofrequency ablation in improving globus symptoms has been reported in a small uncontrolled series 18 . Adenocarcinoma, Barrett's esophagus, and Helicobacter pylori are reported as rare consequences of inlet patches 48‐50 .…”

Section: Diagnosis Of Globusmentioning

confidence: 99%

ESNM/ANMS Review. Diagnosis and management of globus sensation: A clinical challenge

Zerbib

Rommel

Pandolfino

et al. 2020

Neurogastroenterology Motil

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Globus is a non‐painful sensation of a tightness or a lump/foreign body in the throat that is not associated with dysphagia and may actually improve during meals. While several otorhinolaryngologic, thyroid, and esophageal disorders have been linked to globus, cause‐and‐effect relationships are difficult to establish. Consequently, though part of the evaluation, objective otorhinolaryngologic and esophageal testing is often negative. The presence of alarm symptoms, particularly pain, weight loss, dysphagia, or odynophagia is indications for objective testing. A diagnosis of idiopathic globus requires exclusion of pharyngeal, laryngeal, and esophageal disorders with laryngoscopy, endoscopy, high‐resolution manometry, barium radiography, and/or ambulatory reflux monitoring. A trial of acid‐suppressive therapy may be reasonable in the absence of alarm symptoms, especially if concurrent reflux symptoms are identified. Ablation of heterotopic gastric mucosa in the proximal esophagus has been reported to improve globus symptoms. Beyond these specific approaches, further management of idiopathic globus consists of reassurance, neuromodulators, and complementary approaches. Globus has a benign course with no long‐term consequences, and the overall prognosis is good as the magnitude of symptoms may decline over time.

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Radiofrequency ablation in patients with large cervical heterotopic gastric mucosa and globus sensation: Closing the treatment gap

Abstract: This is the first study on RFA focusing on therapy of large symptomatic heterotopic gastric mucosa. Hereby, we demonstrate that this new technique can be successfully implemented in patients where treatment was limited so far (NCT03023280).

Cited by 19 publications

References 28 publications

The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: A contemporary review

The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: A contemporary review

Issues and controversies in esophageal inlet patch

ESNM/ANMS Review. Diagnosis and management of globus sensation: A clinical challenge

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