World Gastroenterology Organisation Global Guidelines

Malagelada, Juan–R.; Bazzoli, Franco; Boeckxstaens, Guy E.; Looze, Danny De; Fried, Michael; Kahrilas, Peter J.; Lindberg, Greger; Malfertheiner, Peter; Salis, Graciela; Sharma, Prateek; Sifrim, Daniel; Vakil, Nimish B.; Mair, Anton Le

doi:10.1097/mcg.0000000000000307

Cited by 167 publications

(54 citation statements)

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“…It is important to emphasize that esophageal eosinophilia is a histological finding that requires interpretation in the clinical context and that esophageal eosinophilia alone does not define EoE; indeed, many other diseases have been associated with this histologic finding [114]. Although the presence of esophageal eosinophilia was first described in a subset of patients with GERD, it usually locates in the distal esophagus and never reaches the high density commonly observed in EoE, where it is associated with esophageal motor dysfunction, particularly dysphagia and food impaction [110, 111].…”

Section: Resultsmentioning

confidence: 99%

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Scarpignato

Gatta

Zullo³

et al. 2016

BMC Med

359

288

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BackgroundThe introduction of proton pump inhibitors (PPIs) into clinical practice has revolutionized the management of acid-related diseases. Studies in primary care and emergency settings suggest that PPIs are frequently prescribed for inappropriate indications or for indications where their use offers little benefit. Inappropriate PPI use is a matter of great concern, especially in the elderly, who are often affected by multiple comorbidities and are taking multiple medications, and are thus at an increased risk of long-term PPI-related adverse outcomes as well as drug-to-drug interactions. Herein, we aim to review the current literature on PPI use and develop a position paper addressing the benefits and potential harms of acid suppression with the purpose of providing evidence-based guidelines on the appropriate use of these medications.MethodsThe topics, identified by a Scientific Committee, were assigned to experts selected by three Italian Scientific Societies, who independently performed a systematic search of the relevant literature using Medline/PubMed, Embase, and the Cochrane databases. Search outputs were distilled, paying more attention to systematic reviews and meta-analyses (where available) representing the best evidence. The draft prepared on each topic was circulated amongst all the members of the Scientific Committee. Each expert then provided her/his input to the writing, suggesting changes and the inclusion of new material and/or additional relevant references. The global recommendations were then thoroughly discussed in a specific meeting, refined with regard to both content and wording, and approved to obtain a summary of current evidence.ResultsTwenty-five years after their introduction into clinical practice, PPIs remain the mainstay of the treatment of acid-related diseases, where their use in gastroesophageal reflux disease, eosinophilic esophagitis, Helicobacter pylori infection, peptic ulcer disease and bleeding as well as, and Zollinger–Ellison syndrome is appropriate. Prevention of gastroduodenal mucosal lesions (and symptoms) in patients taking non-steroidal anti-inflammatory drugs (NSAIDs) or antiplatelet therapies and carrying gastrointestinal risk factors also represents an appropriate indication. On the contrary, steroid use does not need any gastroprotection, unless combined with NSAID therapy. In dyspeptic patients with persisting symptoms, despite successful H. pylori eradication, short-term PPI treatment could be attempted. Finally, addition of PPIs to pancreatic enzyme replacement therapy in patients with refractory steatorrhea may be worthwhile.ConclusionsOverall, PPIs are irreplaceable drugs in the management of acid-related diseases. However, PPI treatment, as any kind of drug therapy, is not without risk of adverse effects. The overall benefits of therapy and improvement in quality of life significantly outweigh potential harms in most patients, but those without clear clinical indication are only exposed to the risks of PPI prescription. Adhering with evidence-based ...

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Section: Resultsmentioning

confidence: 99%

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Scarpignato

Gatta

Zullo³

et al. 2016

BMC Med

359

288

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“…Neurologic causes are presumed to be of peripheral neuromuscular or central origins, and suspicion may warrant further testing. These guidelines are largely consistent across different clinical fields, like family medicine and gastroenterology . However, while sensation is an essential component of swallowing, sensory loss is not considered as comprehensively in the dysphagia evaluation as the standard classifications of structure and motility.…”

Section: Introductionmentioning

confidence: 99%

“…These guidelines are largely consistent across different clinical fields, like family medicine and gastroenterology. [3][4][5] However, while sensation is an essential component of swallowing, 6,7 sensory loss is not considered as comprehensively in the dysphagia evaluation as the standard classifications of structure and motility. Including sensory loss in the diagnostic framework may help clinicians clarify obscure cases.…”

Section: Introductionmentioning

confidence: 99%

Sensory dysphagia: A case series and proposed classification of an under recognized swallowing disorder

Santoso

Paydarfar

2019

Head & Neck

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Background Although sensory feedback is a vital regulator of deglutition, it is not comprehensively considered in the standard dysphagia evaluation. Difficulty swallowing secondary to sensory loss may be termed “sensory dysphagia” and may account for cases receiving diagnoses of exclusion, like functional or idiopathic dysphagia. Methods and Results Three cases of idiopathic dysphagia were suspected to have sensory dysphagia. The patients had (1) effortful swallowing, (2) globus sensation, and (3) aspiration. Endoscopic sensory mapping revealed laryngopharyngeal sensory loss. Despite normal laryngeal motor function during voluntary maneuvers, laryngeal closure was incomplete during swallowing. The causes of sensory loss were identified: cranial neuropathy from Chiari malformation, immune‐mediated neuronopathy, and nerve damage from prior traumatic intubation. Conclusions Sensory loss may cause dysphagia without primary motor dysfunction. Sensory dysphagia should be classified as a distinct form of swallowing motility disorder to improve diagnosis. Increasing awareness and developing appropriate assessment tools may advance dysphagia care.

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“…In the United States, benign oesophageal stricture has become less common, whilst EoE is increasing, along with oesophageal adenocarcinoma[ 8 ]. This pattern is mirrored in other Western nations[ 18 ]. Oesophageal squamous cell cancer remains a common condition in Asia, whilst Chagas disease still is prevalent is some regions of South America[ 18 ].…”

Section: Aetiology and Pathogenesismentioning

confidence: 73%

“…This pattern is mirrored in other Western nations[ 18 ]. Oesophageal squamous cell cancer remains a common condition in Asia, whilst Chagas disease still is prevalent is some regions of South America[ 18 ].…”

Section: Aetiology and Pathogenesismentioning

confidence: 73%

Dysphagia: Thinking outside the box

Philpott

Garg

Tomic

et al. 2017

WJG

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Dysphagia is a common symptom that is important to recognise and appropriately manage, given that causes include life threatening oesophageal neoplasia, oropharyngeal dysfunction, the risk of aspiration, as well as chronic disabling gastroesophageal reflux (GORD). The predominant causes of dysphagia varies between cohorts depending on the interplay between genetic predisposition and environmental risk factors, and is changing with time. Currently in white Caucasian societies adopting a western lifestyle, obesity is common and thus associated gastroesophageal reflux disease is increasingly diagnosed. Similarly, food allergies are increasing in the west, and eosinophilic oesophagitis is increasingly found as a cause. Other regions where cigarette smoking is still prevalent, or where access to medical care and antisecretory agents such as proton pump inhibitors are less available, benign oesophageal peptic strictures, Barrett’s oesophagus, adeno- as well as squamous cell carcinoma are endemic. The evaluation should consider the severity of symptoms, as well as the pre-test probability of a given condition. In young white Caucasian males who are atopic or describe heartburn, eosinophilic esophagitis and gastroesophageal reflux disease will predominate and a proton pump inhibitor could be commenced prior to further investigation. Upper gastrointestinal endoscopy remains a valid first line investigation for patients with suspected oesophageal dysphagia. Barium swallow is particularly useful for oropharyngeal dysphagia, and oesophageal manometry mandatory to diagnose motility disorders.

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World Gastroenterology Organisation Global Guidelines

Cited by 167 publications

References 0 publications

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Sensory dysphagia: A case series and proposed classification of an under recognized swallowing disorder

Dysphagia: Thinking outside the box

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