10 results on '"Sweis, R."'
Search Results
2. Chicago classification version 4.0 © technical review: Update on standard high-resolution manometry protocol for the assessment of esophageal motility.
- Author
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Fox MR, Sweis R, Yadlapati R, Pandolfino J, Hani A, Defilippi C, Jan T, and Rommel N
- Subjects
- Deglutition physiology, Esophageal Motility Disorders physiopathology, Esophagus physiopathology, Humans, Manometry standards, Patient Positioning standards, Esophageal Motility Disorders classification, Esophageal Motility Disorders diagnosis, Esophagus physiology, Manometry classification, Patient Positioning classification
- Abstract
The Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high-resolution manometry (HRM). A key feature of CCv.4.0 is the more rigorous and expansive protocol that incorporates single wet swallows acquired in different positions (supine, upright) and provocative testing, including multiple rapid swallows and rapid drink challenge. Additionally, solid bolus swallows, solid test meal, and/or pharmacologic provocation can be used to identify clinically relevant motility disorders and other conditions (eg, rumination) that occur during and after meals. The acquisition and analysis for performing these tests and the evidence supporting their inclusion in the Chicago Classification protocol is detailed in this technical review. Provocative tests are designed to increase the diagnostic sensitivity and specificity of HRM studies for disorders of esophageal motility. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification, decrease the proportion of HRM studies that deliver inconclusive diagnoses and increase the number of patients with a clinically relevant diagnosis that can direct effective therapy. Another aim in establishing a standard manometry protocol for motility laboratories around the world is to facilitate procedural consistency, improve diagnostic reliability, and promote collaborative research., (© 2021 John Wiley & Sons Ltd.)
- Published
- 2021
- Full Text
- View/download PDF
3. Reply to Kristo et al.
- Author
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Haidry RJ, Lipman G, Banks MR, Butt MA, Sehgal V, Graham D, Dunn JM, Gupta A, Sweis R, Miah H, Morris D, Smart HL, Bhandari P, Willert R, Fullarton G, Morris J, Di Pietro M, Gordon C, Penman I, Barr H, Patel P, Boger P, Kapoor N, Mahon B, Hoare J, Narayanasamy R, O'Toole D, Cheong E, Direkze NC, Ang Y, Veitch A, Dhar A, Nyalender D, Ragunath K, Leahy A, Fullard M, Rodriguez-Justo M, Novelli M, and Lovat LB
- Subjects
- Female, Humans, Male, Adenocarcinoma surgery, Barrett Esophagus surgery, Catheter Ablation, Esophageal Neoplasms surgery, Esophagus surgery, Precancerous Conditions surgery
- Published
- 2016
- Full Text
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4. Comparing outcome of radiofrequency ablation in Barrett's with high grade dysplasia and intramucosal carcinoma: a prospective multicenter UK registry.
- Author
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Haidry RJ, Lipman G, Banks MR, Butt MA, Sehgal V, Graham D, Dunn JM, Gupta A, Sweis R, Miah H, Morris D, Smart HL, Bhandari P, Willert R, Fullarton G, Morris J, Di Pietro M, Gordon C, Penman I, Barr H, Patel P, Boger P, Kapoor N, Mahon B, Hoare J, Narayanasamy R, O'Toole D, Cheong E, Direkze NC, Ang Y, Veitch A, Dhar A, Nyalender D, Ragunath K, Leahy A, Fullard M, Rodriguez-Justo M, Novelli M, and Lovat LB
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- Adenocarcinoma pathology, Adult, Aged, Aged, 80 and over, Barrett Esophagus pathology, Esophageal Neoplasms pathology, Esophagoscopy, Esophagus pathology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mucous Membrane pathology, Mucous Membrane surgery, Precancerous Conditions pathology, Registries, Treatment Outcome, United Kingdom, Adenocarcinoma surgery, Barrett Esophagus surgery, Catheter Ablation, Esophageal Neoplasms surgery, Esophagus surgery, Precancerous Conditions surgery
- Abstract
Background and Study Aim: Mucosal neoplasia arising in Barrett's esophagus can be successfully treated with endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA). The aim of the study was to compare clinical outcomes of patients with high grade dysplasia (HGD) or intramucosal cancer (IMC) at baseline from the United Kingdom RFA registry., Patients and Methods: Prior to RFA, visible lesions and nodularity were removed entirely by EMR. Thereafter, patients underwent RFA every 3 months until all visible Barrett's mucosa was ablated or cancer developed (end points). Biopsies were taken at 12 months or when end points were reached., Results: A total of 515 patients, 384 with HGD and 131 with IMC, completed treatment. Prior to RFA, EMR was performed for visible lesions more frequently in the IMC cohort than in HGD patients (77 % vs. 47 %; P < 0.0001). The 12-month complete response for dysplasia and intestinal metaplasia were almost identical in the two cohorts (HGD 88 % and 76 %, respectively; IMC 87 % and 75 %, respectively; P = 0.7). Progression to invasive cancer was not significantly different at 12 months (HGD 1.8 %, IMC 3.8 %; P = 0.19). A trend towards slightly worse medium-term durability may be emerging in IMC patients (P = 0.08). In IMC, EMR followed by RFA was definitely associated with superior durability compared with RFA alone (P = 0.01)., Conclusion: The Registry reports on endoscopic therapy for Barrett's neoplasia, representing real-life outcomes. Patients with IMC were more likely to have visible lesions requiring initial EMR than those with HGD, and may carry a higher risk of cancer progression in the medium term. The data consolidate the approach to ensuring that these patients undergo thorough endoscopic work-up, including EMR prior to RFA when necessary., (© Georg Thieme Verlag KG Stuttgart · New York.)
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- 2015
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5. Failure to respond to physiologic challenge characterizes esophageal motility in erosive gastro-esophageal reflux disease.
- Author
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Daum C, Sweis R, Kaufman E, Fuellemann A, Anggiansah A, Fried M, and Fox M
- Subjects
- Adult, Deglutition physiology, Esophagus pathology, Female, Humans, Male, Manometry methods, Middle Aged, Retrospective Studies, Young Adult, Esophageal Motility Disorders physiopathology, Esophagus physiology, Esophagus physiopathology, Gastroesophageal Reflux pathology, Gastroesophageal Reflux physiopathology, Peristalsis physiology
- Abstract
Background: Non-specific esophageal dysmotility with impaired clearance is often present in patients with gastro-esophageal reflux disease (GERD), especially those with erosive disease; however the physio-mechanic basis of esophageal dysfunction is not well defined., Methods: Retrospective assessment of patients with erosive reflux disease (ERD; n=20) and endoscopy negative reflux disease (ENRD; n=20) with pathologic acid exposure on pH studies (>4.2% time/24 h) and also healthy controls (n=20) studied by high resolution manometry. Esophageal motility in response to liquid and solid bolus swallows and multiple water swallows (MWS) was analyzed. Peristaltic dysfunction was defined as failed peristalsis, spasm, weak or poorly coordinated esophageal contraction (>3cm break in 30 mmHg isocontour)., Key Results: Peristaltic dysfunction was present in 33% of water swallows in controls, 56% ENRD and 76% ERD respectively (P<0.023 vs controls, P=0.185 vs ENRD). The proportion of effective peristaltic contractions improved with solid compared to liquid bolus in controls (18%vs 33%, P=0.082) and ENRD (22%vs 54%, P=0.046) but not ERD (62%vs 76%, P=0.438). Similarly, MWS was followed by effective peristalsis in 83% of controls and 70% ENRD but only 30% ERD patients (P<0.017 vs controls and P<0.031 vs ENRD). The association between acid exposure and dysmotility was closer for solid than liquid swallows (r=0.52 vs 0.27)., Conclusions & Inferences: Peristaltic dysfunction is common in GERD. ERD patients are characterized by a failure to respond to the physiologic challenge of solid bolus and MWS that is likely also to impair clearance following reflux events and increase exposure to gastric refluxate., (© 2011 Blackwell Publishing Ltd.)
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- 2011
- Full Text
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6. Normative values and inter-observer agreement for liquid and solid bolus swallows in upright and supine positions as assessed by esophageal high-resolution manometry.
- Author
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Sweis R, Anggiansah A, Wong T, Kaufman E, Obrecht S, and Fox M
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- Adult, Esophagus anatomy & histology, Female, Humans, Male, Manometry instrumentation, Middle Aged, Muscle Contraction physiology, Observer Variation, Peristalsis physiology, Reference Values, Young Adult, Deglutition physiology, Esophagus physiology, Manometry methods, Manometry standards, Posture
- Abstract
Background: High-resolution manometry (HRM) with spatiotemporal representation of pressure data is a recent advance in esophageal measurement. At present, normal values are available for 5mL water swallows in the supine position. This study provides reference values for liquid and solid bolus swallows in the upright seated and supine positions., Methods: A total of 23 asymptomatic volunteers (11M:12F, age 20-56) underwent HRM (Manoscan 360; Sierra Scientific Instruments) with 5mL water and 1cm3 bread swallows in the upright and supine positions. Normal values for primary parameters associated with effective bolus transport [proximal transition zone length (PTZ, assesses peristaltic coordination], contraction front velocity (CFV), distal contractile index (DCI) and integrated relaxation pressure (IRP)] are presented. For each parameter, median values along with the 5-95th percentile range are reported. Inter-observer agreement between independent observers is reported using the intra-class correlation coefficient., Key Results: A higher proportion of swallows were peristaltic for liquids than solids in both the upright and supine positions (both P<0.05). As workload increases with solid bolus and on moving from the upright to the supine position the esophageal contractile response resulted in a shorter PTZ, a slower CFV, and a more vigorous DCI. Also IRP increased during solid bolus transit (all P<0.01). There was significant agreement between independent observers for HRM parameters., Conclusions & Inferences: Normative values for esophageal function for solids as well as liquids and in the 'physiologic', upright position will optimize the utility of HRM studies. The high level of inter-observer agreement indicates that these can be applied as reference values in clinical practice., (© 2011 Blackwell Publishing Ltd.)
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- 2011
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7. Inter-observer agreement for diagnostic classification of esophageal motility disorders defined in high-resolution manometry
- Author
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Fox, Mark, Pandolfino, J E, Sweis, R, Sauter, M, Abreu Y Abreu, A T, Anggiansah, A, Bogte, A, Bredenoord, A J, Dengler, W, Elvevi, A, Fruehauf, H, Gellersen, S, Ghosh, S, Gyawali, C P, Heinrich, H, Hemmink, M, Jafari, J, Kaufman, E, Kessing, K, Kwiatek, M, Lubomyr, B, Banasiuk, M, Mion, F, Pérez-de-la-Serna, J, Remes-Troche, J M, Rohof, W, Roman, S, Ruiz-de-León, A, Tutuian, R, Uscinowicz, M, Valdovinos, M A, Vardar, R, Velosa, M, Waśko-Czopnik, D, Weijenborg, P, Wilshire, C, Wright, J, Zerbib, F, Menne, D, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Gastroenterology and Hepatology, and University of Zurich
- Subjects
Adult ,Observer Variation ,Consensus ,Manometry ,610 Medicine & health ,Deglutition ,Esophageal Achalasia ,10219 Clinic for Gastroenterology and Hepatology ,Esophagus ,Image Interpretation, Computer-Assisted ,Humans ,2715 Gastroenterology ,Esophageal Motility Disorders ,Peristalsis ,Single-Blind Method ,Prospective Studies - Abstract
High-resolution esophageal manometry (HRM) is a recent development used in the evaluation of esophageal function. Our aim was to assess the inter-observer agreement for diagnosis of esophageal motility disorders using this technology. Practitioners registered on the HRM Working Group website were invited to review and classify (i) 147 individual water swallows and (ii) 40 diagnostic studies comprising 10 swallows using a drop-down menu that followed the Chicago Classification system. Data were presented using a standardized format with pressure contours without a summary of HRM metrics. The sequence of swallows was fixed for each user but randomized between users to avoid sequence bias. Participants were blinded to other entries. (i) Individual swallows were assessed by 18 practitioners (13 institutions). Consensus agreement (≤2/18 dissenters) was present for most cases of normal peristalsis and achalasia but not for cases of peristaltic dysmotility. (ii) Diagnostic studies were assessed by 36 practitioners (28 institutions). Overall inter-observer agreement was 'moderate' (kappa 0.51) being 'substantial' (kappa > 0.7) for achalasia type I/II and no lower than 'fair-moderate' (kappa >0.34) for any diagnosis. Overall agreement was somewhat higher among those that had performed >400 studies (n = 9; kappa 0.55) and 'substantial' among experts involved in development of the Chicago Classification system (n = 4; kappa 0.66). This prospective, randomized, and blinded study reports an acceptable level of inter-observer agreement for HRM diagnoses across the full spectrum of esophageal motility disorders for a large group of clinicians working in a range of medical institutions. Suboptimal agreement for diagnosis of peristaltic motility disorders highlights contribution of objective HRM metrics.
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- 2014
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8. Variation in esophageal physiology testing in clinical practice: Results from an international survey.
- Author
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the International Working Group for GI Motility and Function, Sweis, R., Heinrich, H., and Fox, M.
- Subjects
- *
ESOPHAGEAL motility , *ESOPHAGEAL achalasia , *DATA acquisition systems , *GASTROESOPHAGEAL reflux , *VENTRICULAR outflow obstruction - Abstract
Abstract: Background: Advances in clinical measurement of esophageal motility and function have improved the assessment of swallowing disorders and reflux symptoms. Variation in data acquisition, analysis, and reporting exists and impacts on diagnosis and management. Aims and Methods: This study examined variation in esophageal manometry methodology between institutions to establish the status in current practice. A structured survey was distributed through international NGM societies using an Internet‐based platform. Questions explored infrastructure, technology, analysis, and reporting. Key Results: Responses were received from 91 centers from 29 countries. Eighteen (20%) centers used “conventional” manometry, 75 (82%) high‐resolution manometry, and 53 (58%) HR impedance manometry. All centers documented motility for single water swallows. The Chicago Classification was applied by 65 (71.4%) centers. In contrast, analysis of EGJ morphology varied widely. Adjunctive testing was often applied: multiple rapid swallows (77%), rapid drink challenge (77%), single solid swallows (63%), and a standard test meal (18%). Of 86 (94.5%) units that offered pH impedance (pH‐Z) studies, approximately half (53.5%) performed tests on acid‐suppressant medication in patients with a high pretest probability (eg, erosive esophagitis). Most (75.6%) centers manually reviewed every reflux event. Others examined pH‐Z data only prior to symptoms. To assess symptom association with reflux events, 73.6% centers analyzed each symptom separately, whereas 29.7% centers pooled symptoms. Conclusions and Inferences: There is marked variation in the data acquisition, analysis, and reporting of esophageal manometry studies. Further efforts to improve quality and uniformity in testing and reporting are required. This survey provides information upon which best‐practice guidelines can be developed. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
9. Sildenafil relieves symptoms and normalizes motility in patients with oesophageal spasm: a report of two cases.
- Author
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Fox, M., Sweis, R., Wong, T., and Anggiansah, A.
- Subjects
- *
SILDENAFIL , *ESOPHAGUS , *GASTROINTESTINAL motility , *DEGLUTITION disorders , *SPASMS - Abstract
Oesophageal spasm presents with dysphagia and chest pain. Current treatments are limited by poor efficacy and side effects. Studies in health and oesophageal dysmotility show that sildenafil reduces peristaltic pressure and velocity; however the clinical efficacy and tolerability in symptomatic oesophageal spasm remains uncertain. We provided open-label sildenafil treatment to two patients with severe, treatment resistant symptoms associated with oesophageal spasm. The effects of sildenafil on oesophageal function and symptoms were documented by high resolution manometry (HRM). Patients were followed up to assess the efficacy of maintenance treatment with sildenafil b.i.d. HRM revealed focal and diffuse spasm in the smooth muscle oesophagus that were associated with symptoms in both cases, especially on swallowing solids. Lower oesophageal sphincter function was normal. A therapeutic trial of 25–50 mg sildenafil suppressed oesophageal contraction almost completely for water swallows; however effective, coordinated peristalsis returned with reduced frequency of spasm for solid swallows. Dysphagia and chest pain resolved during the therapeutic trial and efficacy was maintained on maintenance treatment with 25–50 mg sildenafil b.i.d. without troublesome side effects. This report shows that sildenafil can improve oesophageal function and relieve dysphagia and chest pain in patients with oesophageal spasm in whom other treatments have failed. [ABSTRACT FROM AUTHOR]
- Published
- 2007
- Full Text
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10. Variation in esophageal physiology testing in clinical practice: Results from an international survey
- Author
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Henriette Heinrich, Rami Sweis, Mark A. Fox, University of Zurich, and Sweis, R
- Subjects
medicine.medical_specialty ,Esophageal pH Monitoring ,Manometry ,Physiology ,Monitoring, Ambulatory ,Achalasia ,610 Medicine & health ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Internal medicine ,Humans ,Medicine ,Esophageal Motility Disorders ,2715 Gastroenterology ,Esophagus ,Esophageal physiology ,Endocrine and Autonomic Systems ,business.industry ,Reflux ,International survey ,Reproducibility of Results ,1314 Physiology ,medicine.disease ,Dysphagia ,Pre- and post-test probability ,Clinical Practice ,2807 Endocrine and Autonomic Systems ,medicine.anatomical_structure ,10219 Clinic for Gastroenterology and Hepatology ,030220 oncology & carcinogenesis ,Emergency medicine ,030211 gastroenterology & hepatology ,medicine.symptom ,business - Abstract
Background Advances in clinical measurement of esophageal motility and function have improved the assessment of swallowing disorders and reflux symptoms. Variation in data acquisition, analysis, and reporting exists and impacts on diagnosis and management. Aims and Methods This study examined variation in esophageal manometry methodology between institutions to establish the status in current practice. A structured survey was distributed through international NGM societies using an Internet-based platform. Questions explored infrastructure, technology, analysis, and reporting. Key Results Responses were received from 91 centers from 29 countries. Eighteen (20%) centers used “conventional” manometry, 75 (82%) high-resolution manometry, and 53 (58%) HR impedance manometry. All centers documented motility for single water swallows. The Chicago Classification was applied by 65 (71.4%) centers. In contrast, analysis of EGJ morphology varied widely. Adjunctive testing was often applied: multiple rapid swallows (77%), rapid drink challenge (77%), single solid swallows (63%), and a standard test meal (18%). Of 86 (94.5%) units that offered pH impedance (pH-Z) studies, approximately half (53.5%) performed tests on acid-suppressant medication in patients with a high pretest probability (eg, erosive esophagitis). Most (75.6%) centers manually reviewed every reflux event. Others examined pH-Z data only prior to symptoms. To assess symptom association with reflux events, 73.6% centers analyzed each symptom separately, whereas 29.7% centers pooled symptoms. Conclusions and Inferences There is marked variation in the data acquisition, analysis, and reporting of esophageal manometry studies. Further efforts to improve quality and uniformity in testing and reporting are required. This survey provides information upon which best-practice guidelines can be developed.
- Published
- 2018
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