Reaction to Articles on High Resolution Manometry, the Length of the Lower Esophageal Sphincter and the Diagnosis of Gastroesophageal Reflux Disease

Levin, Michael D

doi:10.1590/s0004-2803.201900000-39

Cited by 3 publications

(4 citation statements)

References 6 publications

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“…Furthermore, all these measurements in children based on manometry record the distance to the upper margin of the LES rather than the actual EGJ and do not acknowledge that the LES is a region and not a point. The LES is a high‐pressure zone that lengthens with age, measuring 1‐3 cm in children and 3–5 cm in adults (Levin, 2019).…”

Section: Discussionmentioning

confidence: 99%

Esophageal length in children: Reference data and a novel predictive equation

Tinawi

Stringer

2021

Clinical Anatomy

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Minimal information exists on the length of the child's esophagus, namely the distance from the cricopharyngeus to the esophagogastric junction (EGJ). We aimed to investigate the relationship between esophageal length (EL) and the age, height, and weight of the child. Children undergoing upper gastrointestinal endoscopy between February 2019 and May 2021 at our institution were prospectively audited. Children with anatomical esophageal disorders were excluded. Endoscopic distances from the incisors to the cricopharyngeus and EGJ were obtained, and novel predictive equations derived to predict EL. Intra‐observer agreement for endoscopic measurements showed an intra‐class correlation coefficient of 0.99. A total of 290 children aged 0.4–17.3 years were included in the analysis; they were divided into a model development cohort (n = 261) and a model validation cohort (n = 29). Measured EL correlated best with height (r = 0.92) as compared to age (r = 0.90) or weight (r = 0.83). The optimal equation for predicting EL was 0.156 × height (cm) – 1.336 (adjusted R2 = 0.841); this had a success rate of 76% in the validation cohort. The optimal equation for predicting distance from incisors to EGJ was 0.199 × height (cm) + 6.470 (adjusted R2 = 0.889); this had a success rate of 69% in the validation cohort. This is the first study to report a predictive equation for estimating esophageal length in children. Accurate prediction of esophageal length may assist with clinical esophageal procedures in children such as nasogastric and pH probe placement.

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Section: Discussionmentioning

confidence: 99%

Esophageal length in children: Reference data and a novel predictive equation

Tinawi

Stringer

2021

Clinical Anatomy

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“…e) In a vertical position during the intake of liquid barium, the LES (red arrow) opens under the influence of hydrostatic pressure and in this case, it remains open, despite the decrease in the length of the column, i.e., hydrostatic pressure. (f) In a horizontal position, with a sharp increase in pressure in the stomach, the LES remains open, but its length is 20% shorter than the minimum normal limit (3.2-4.2 (3.60±0.08 cm) [5]. Esophagus is not dilated, and the force of the peristaltic wave (white arrow) overcomes the high tone of the LES caused by high pressure in the stomach.…”

Section: Types Of Motor Function 1 Motor Function Of the Esophagus An...mentioning

confidence: 99%

“…A patient with gastroesophageal reflux disease was examined as healthy, based on the absence of typical complaints. The abdominal part of the LES opened, causing the LES to become almost 2 times shorter, which is typical for a damaged LES in ГЭРБ patients [5]. The authors regarded shortening of the "esophagus + LES" complex as shortening of the esophagus.…”

Section: Types Of Motor Function 1 Motor Function Of the Esophagus An...mentioning

confidence: 99%

“…Based on manometric [38], radiological [5] and histological studies [39], it has been established that the LES in GERD is shortened due to the opening of the abdominal part, which to varying degrees ceases to perform the antireflux function. As can be seen from Figure 8, shortening of the LES not only weakens its antireflux function, but also leads to an increase in the His angle.…”

Section: с)mentioning

confidence: 99%

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Gastrointestinal Motility and Law of the Intestine

Levin

2023

Preprint

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Modern gastroenterology, which occupies the pages of scientific journals without alternative, began as an initiative of manufacturers of diagnostic equipment. For widespread advertising, they selected practical doctors who were not familiar with the methodology of science and superficial knowledge of physiology. This is how a group led by DeMeester arose, which in 1976 published the DeMeester score, i.e., the normal limit for esophageal pH monitoring. pH <4, less than 4% of the time per day was considered normal, i.e., it was unreasonably claimed that such reflux is physiological. This article proves that this study was carried out with numerous methodological errors, which led to an erroneous conclusion. For a long time, pH monitoring was considered the gold standard and with its help hypotheses were proposed that form the basis of modern gastroenterology. The article proves the fallacy of 13 hypotheses, which are presented as theories. Numerous articles using pH monitoring have publicized this method. Practitioners became "great scientists", equipment manufacturers became successful businessmen. Over time, they found other groups of practitioners to promote devices for impedance ph monitoring, high-resolution manometry, and many others. At the same time, a network of reviewers who believe in the infallibility of the luminaries do not allow studies that contradict their faith to be published. Thus, fundamental science was destroyed, which alone could assess the harm of false research both for science and for patients. Conclusion This study provides a list of hypotheses, that were previously considered theories, but since scientific evidence has proven these assumptions to be false, they should be excluded from subsequent use and citation.

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Gastrointestinal motility and law of the intestine

Levin, MD, PhD, DSc

2024

GHOA

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Modern gastroenterology, which occupies the pages of scientific journals without an alternative, began as an initiative of manufacturers of equipment for pH monitoring. DeMeester et al, in contradiction to scientific research, suggested the possibility of gastroesophageal reflux, which does not damage the esophagus. Therefore, they began to perform pH research in the esophagus. This is how a group led by DeMeester arose, who in 1976 published the DeMeester score, i.e., the normal limit for esophageal pH monitoring. pH <4, less than 4% of the time per day was considered normal, i.e., it was unreasonably claimed that such reflux is physiological. However, this study was carried out with numerous methodological errors, which led to an erroneous conclusion. For a long time, pH monitoring was considered the gold standard and with its help hypotheses were proposed that form the basis of modern gastroenterology. Numerous articles using pH monitoring have publicized this method. When practice showed the low diagnostic efficiency of pH monitoring, devices for impedance pH monitoring were proposed, the principle of which was based on previous false ideas about the pathological physiology of reflux disease. As a control for determining the normal limits for high-resolution manometry (HRM), individuals were selected who claimed that they had no complaints. They did not undergo an objective study, including pH monitoring. Therefore, the results of HRM are not accurate and scientific. This article proves the fallacy of 13 hypotheses, which are presented as theories. Conclusion This study provides a list of hypotheses that were previously considered theories, but since scientific evidence has proven these assumptions to be false, they should be excluded from subsequent use and citation.

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Reaction to Articles on High Resolution Manometry, the Length of the Lower Esophageal Sphincter and the Diagnosis of Gastroesophageal Reflux Disease

Cited by 3 publications

References 6 publications

Esophageal length in children: Reference data and a novel predictive equation

Esophageal length in children: Reference data and a novel predictive equation

Gastrointestinal Motility and Law of the Intestine

Gastrointestinal motility and law of the intestine

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