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1. Updates to the modern diagnosis of GERD: Lyon consensus 2.0.

Author

Gyawali, C Prakash, Yadlapati, Rena, Fass, Ronnie, Katzka, David, Pandolfino, John, Savarino, Edoardo, Sifrim, Daniel, Spechler, Stuart, Zerbib, Frank, Fox, Mark R., Bhatia, Shobna, de Bortoli, Nicola, Yu Kyung Cho, Cisternas, Daniel, Chien-Lin Chen, Cock, Charles, Hani, Albis, Troche, Jose Maria Remes, Yinglian Xiao, and Vaezi, Michael F.

Subjects
HEARTBURN, MEDICAL terminology, BARRETT'S esophagus, DIAGNOSIS, SYMPTOMS, MEDICAL specialties & specialists
Published
2024
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4. Alteraciones de la motilidad esofágica en la manometría de alta resolución: Clasificación de Chicago versión 4.0©

Author

Yadlapati, Rena, primary, Kahrilas, Peter J., additional, Fox, Mark R., additional, Bredenoord, Albert J., additional, Gyawali, C. Prakash, additional, Roman, Sabine, additional, Babaei, Arash, additional, Mittal, Ravinder K., additional, Rommel, Nathalie, additional, Savarino, Edoardo, additional, Sifrim, Daniel, additional, Smout, André, additional, Vaezi, Michael F., additional, Zerbib, Frank, additional, Akiyama, Junichi, additional, Bhatia, Shobna, additional, Bor, Serhat, additional, Carlson, Dustin A., additional, Chen, Joan W., additional, Cisternas, Daniel, additional, Cock, Charles, additional, Coss-Adame, Enrique, additional, de Bortoli, Nicola, additional, Defilippi, Claudia, additional, Fass, Ronnie, additional, C. Ghoshal, Uday, additional, Gonlachanvit, Sutep, additional, Hani, Albis, additional, Hebbard, Geoffrey S., additional, Jung, Kee Wook, additional, Katz, Philip, additional, Katzka, David A., additional, Khan, Abraham, additional, Paul Kohn, Geoffrey, additional, Lazarescu, Adriana, additional, Lengliner, Johannes, additional, Mittal, Sumeet K., additional, Omari, Taher, additional, Park, Moo In, additional, Penagini, Roberto, additional, Pohl, Daniel, additional, Richter, Joel E., additional, Serra, Jordi, additional, Sweis, Rami, additional, Tack, Jan, additional, Tatum, Roger P., additional, Tutuian, Radu, additional, Vela, Marcelo F., additional, Wong, Reuben K., additional, Wu, Justin C., additional, Xiao, Yinglian, additional, and Pandolfino, John E., additional

Published
2022
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7. Effect of high altitude on human postprandial $^{13}$ C-octanoate metabolism, intermediary metabolites, gastrointestinal peptides, and visceral perception

Author

Strunz, Patrick-Pascal; https://orcid.org/0000-0002-3168-7074, Vuille-Dit-Bille, Raphael N, Fox, Mark R; https://orcid.org/0000-0003-4394-5584, Geier, Andreas, Maggiorini, Marco, Gassmann, Max; https://orcid.org/0000-0003-2750-8878, Fruehauf, Heiko, Lutz, Thomas A; https://orcid.org/0000-0002-5056-8548, Goetze, Oliver; https://orcid.org/0000-0003-2860-0270, Strunz, Patrick-Pascal; https://orcid.org/0000-0002-3168-7074, Vuille-Dit-Bille, Raphael N, Fox, Mark R; https://orcid.org/0000-0003-4394-5584, Geier, Andreas, Maggiorini, Marco, Gassmann, Max; https://orcid.org/0000-0003-2750-8878, Fruehauf, Heiko, Lutz, Thomas A; https://orcid.org/0000-0002-5056-8548, and Goetze, Oliver; https://orcid.org/0000-0003-2860-0270

Abstract

OBJECTIVE: At high altitude (HA), acute mountain sickness (AMS) is accompanied by neurologic and upper gastrointestinal symptoms (UGS). The primary aim of this study was to test the hypothesis that delayed gastric emptying (GE), assessed by $^{13}$ C-octanoate breath testing (OBT), causes UGS in AMS. The secondary aim was to assess post-gastric mechanisms of OBT, which could confound results under these conditions, by determination of intermediary metabolites, gastrointestinal peptides, and basal metabolic rate. METHODS: A prospective trial was performed in 25 healthy participants (15 male) at 4559 m (HA) and at 490 m (Zurich). GE was assessed by OBT (428 kcal solid meal) and UGS by visual analogue scales (VAS). Blood sampling of metabolites (glucose, free fatty acids (FFA), triglycerides (TG), beta-hydroxyl butyrate (BHB), L-lactate) and gastrointestinal peptides (insulin, amylin, PYY, etc.) was performed as well as blood gas analysis and spirometry. STATISTICAL ANALYSIS: variance analyses, bivariate correlation, and multilinear regression analysis. RESULTS: After 24 h under hypoxic conditions at HA, participants developed AMS (p < 0.001). $^{13}$ CO$_{2}$ exhalation kinetics increased (p < 0.05) resulting in reduced estimates of gastric half-emptying times (p < 0.01). However, median resting respiratory quotients and plasma profiles of TG indicated that augmented beta-oxidation was the main predictor of accelerated $^{13}$ CO$_{2}$ -generation under these conditions. CONCLUSION: Quantification of $^{13}$ C-octanoate oxidation by a breath test is sensitive to variation in metabolic (liver) function under hypoxic conditions. $^{13}$ C-breath testing using short-chain fatty acids is not reliable for measurement of gastric function at HA and should be considered critically in other severe hypoxic conditions, like sepsis or chronic lung disease.

Published
2022

8. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Motility, and European Society for Paediatric Gastroenterology Hepatology and Nutrition consensus

Author

Hammer, Heinz F; https://orcid.org/0000-0001-8683-4951, Fox, Mark R; https://orcid.org/0000-0003-4394-5584, Keller, Jutta; https://orcid.org/0000-0002-5884-1115, Salvatore, Silvia, Basilisco, Guido, Hammer, Johann; https://orcid.org/0000-0002-2452-1201, Lopetuso, Loris, Benninga, Marc, Borrelli, Osvaldo, Dumitrascu, Dan, Hauser, Bruno, Herszenyi, Laszlo, Nakov, Radislav, Pohl, Daniel, Thapar, Nikhil, Sonyi, Marc, Hammer, Heinz F; https://orcid.org/0000-0001-8683-4951, Fox, Mark R; https://orcid.org/0000-0003-4394-5584, Keller, Jutta; https://orcid.org/0000-0002-5884-1115, Salvatore, Silvia, Basilisco, Guido, Hammer, Johann; https://orcid.org/0000-0002-2452-1201, Lopetuso, Loris, Benninga, Marc, Borrelli, Osvaldo, Dumitrascu, Dan, Hauser, Bruno, Herszenyi, Laszlo, Nakov, Radislav, Pohl, Daniel, Thapar, Nikhil, and Sonyi, Marc

Abstract

Introduction: Measurement of breath hydrogen (H2 ) and methane (CH4 ) excretion after ingestion of test-carbohydrates is used for different diagnostic purposes. There is a lack of standardization among centers performing these tests and this, together with recent technical developments and evidence from clinical studies, highlight the need for a European guideline. Methods: This consensus-based clinical practice guideline defines the clinical indications, performance, and interpretation of H2 -CH4 -breath tests in adult and pediatric patients. A balance between scientific evidence and clinical experience was achieved by a Delphi consensus that involved 44 experts from 18 European countries. Eighty eight statements and recommendations were drafted based on a review of the literature. Consensus (≥80% agreement) was reached for 82. Quality of evidence was evaluated using validated criteria. Results: The guideline incorporates new insights into the role of symptom assessment to diagnose carbohydrate (e.g., lactose) intolerances and recommends that breath tests for carbohydrate malabsorption require additional validated concurrent symptom evaluation to establish carbohydrate intolerance. Regarding the use of breath tests for the evaluation of oro-cecal transit time and suspected small bowel bacterial overgrowth, this guideline highlights confounding factors associated with the interpretation of H2 -CH4 -breath tests in these indications and recommends approaches to mitigate these issues. Conclusion: This clinical practice guideline should facilitate pan-European harmonization of diagnostic approaches to symptoms and disorders, which are very common in specialist and primary care gastroenterology practice, both in adult and pediatric patients. In addition, it identifies areas of future research needs to clarify diagnostic and therapeutic approaches. Keywords: fructose; intolerance; lactose; malabsorption; oro-cecal transit time; small intestinal bacterial overgrowth.

Published
2022

10. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Motility, and European Society for Paediatric Gastroenterology Hepatology and Nutrition consensus

Author

Hammer, Heinz F, Fox, Mark R, Keller, Jutta, Salvatore, Silvia, Basilisco, Guido, Hammer, Johann, Lopetuso, Loris, Benninga, Marc, Borrelli, Osvaldo, Dumitrascu, Dan, Hauser, Bruno, Herszenyi, Laszlo, Nakov, Radislav, Pohl, Daniel, Thapar, Nikhil, Sonyi, Marc, University of Zurich, and Hammer, Heinz F

Subjects
10219 Clinic for Gastroenterology and Hepatology, 610 Medicine & health, 2730 Oncology, 2715 Gastroenterology
Published
2022

11. Chicago classification version 4.0 © technical review: Update on standard high-resolution manometry protocol for the assessment of esophageal motility

Author

Fox, Mark R, Sweis, Rami, Yadlapati, Rena, Pandolfino, John, Hani, Albis, Defilippi, Claudia, Jan, Tack, Rommel, Nathalie, University of Zurich, and Fox, Mark R

Subjects
2807 Endocrine and Autonomic Systems, 10219 Clinic for Gastroenterology and Hepatology, 610 Medicine & health, 2715 Gastroenterology, 1314 Physiology
Published
2021
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13. Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0©

Author

Yadlapati, Rena; https://orcid.org/0000-0002-7872-2033, Kahrilas, Peter J, Fox, Mark R; https://orcid.org/0000-0003-4394-5584, et al, Pohl, Daniel; https://orcid.org/0000-0002-0855-1152, Yadlapati, Rena; https://orcid.org/0000-0002-7872-2033, Kahrilas, Peter J, Fox, Mark R; https://orcid.org/0000-0003-4394-5584, et al, and Pohl, Daniel; https://orcid.org/0000-0002-0855-1152

Abstract

Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high-resolution manometry (HRM). Fifty-two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two-years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of esophagogastric junction (EGJ) outflow obstruction (EGJOO), more stringent diagnostic criteria for ineffective esophageal motility and description of baseline EGJ metrics. Further, the CCv4.0 sought to define motility disorder diagnoses as conclusive and inconclusive based on associated symptoms, and findings on provocative testing as well as supportive testing with barium esophagram with tablet and/or functional lumen imaging probe. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification and provide more standardized and rigorous criteria for patterns of disorders of peristalsis and obstruction at the EGJ.

Published
2021

14. European guideline on indications, performance and clinical impact of $^{13}$ C-breath tests in adult and pediatric patients: An EAGEN, ESNM, and ESPGHAN consensus, supported by EPC

Author

Keller, Jutta; https://orcid.org/0000-0002-5884-1115, Hammer, Heinz F; https://orcid.org/0000-0001-8683-4951, Afolabi, Paul R, Benninga, Marc, Borrelli, Osvaldo, Dominguez-Munoz, Enrique, Dumitrascu, Dan, Goetze, Oliver, Haas, Stephan L, Hauser, Bruno, Pohl, Daniel, Salvatore, Silvia, Sonyi, Marc, Thapar, Nikhil, Verbeke, Kristin, Fox, Mark R; https://orcid.org/0000-0003-4394-5584, European 13C-breath test group, Keller, Jutta; https://orcid.org/0000-0002-5884-1115, Hammer, Heinz F; https://orcid.org/0000-0001-8683-4951, Afolabi, Paul R, Benninga, Marc, Borrelli, Osvaldo, Dominguez-Munoz, Enrique, Dumitrascu, Dan, Goetze, Oliver, Haas, Stephan L, Hauser, Bruno, Pohl, Daniel, Salvatore, Silvia, Sonyi, Marc, Thapar, Nikhil, Verbeke, Kristin, Fox, Mark R; https://orcid.org/0000-0003-4394-5584, and European 13C-breath test group

Abstract

INTRODUCTION $^{13}$ C-breath tests are valuable, noninvasive diagnostic tests that can be widely applied for the assessment of gastroenterological symptoms and diseases. Currently, the potential of these tests is compromised by a lack of standardization regarding performance and interpretation among expert centers. METHODS This consensus-based clinical practice guideline defines the clinical indications, performance, and interpretation of $^{13}$ C-breath tests in adult and pediatric patients. A balance between scientific evidence and clinical experience was achieved by a Delphi consensus that involved 43 experts from 18 European countries. Consensus on individual statements and recommendations was established if ≥ 80% of reviewers agreed and <10% disagreed. RESULTS The guideline gives an overview over general methodology of $^{13}$ C-breath testing and provides recommendations for the use of $^{13}$ C-breath tests to diagnose Helicobacter pylori infection, measure gastric emptying time, and monitor pancreatic exocrine and liver function in adult and pediatric patients. Other potential applications of $^{13}$ C-breath testing are summarized briefly. The recommendations specifically detail when and how individual $^{13}$ C-breath tests should be performed including examples for well-established test protocols, patient preparation, and reporting of test results. CONCLUSION This clinical practice guideline should improve pan-European harmonization of diagnostic approaches to symptoms and disorders, which are very common in specialist and primary care gastroenterology practice, both in adult and pediatric patients. In addition, this guideline identifies areas of future clinical research involving the use of $^{13}$ C-breath tests.

Published
2021

15. Effect of meal volume and calorie load on postprandial gastric function and emptying: studies under physiological conditions by combined fiber-optic pressure measurement and MRI

Author

Kwiatek, Monika A., Menne, Dieter, Steingoetter, Andreas, Goetze, Oliver, Forras-Kaufman, Zsofia, Kaufman, Elad, Fruehauf, Heiko, Boesiger, Peter, Fried, Michael, Schwizer, Werner, and Fox, Mark R.

Subjects
Magnetic resonance imaging -- Methods, Pressure -- Measurement, Pressure -- Methods, Gastrointestinal system -- Motility, Gastrointestinal system -- Research, Fiber optics -- Equipment and supplies, Fiber optics -- Usage, Biological sciences
Abstract

This study assessed the effects of meal volume (MV) and calorie load (CL) on gastric function. MRI and a minimally invasive fiber-optic recording system (FORS) provided simultaneous measurement of gastric volume and pressure changes during gastric tilting and emptying of a liquid nutrient meal in physiological conditions. The gastric response to 12 iso-osmolar MV-CL combinations of a multinutrient drink (MV: 200, 400, 600, 800 ml; CL: 200, 300, 400 kcal) was tested in 16 healthy subjects according to a factorial design. Total gastric volume (TGV) and gastric content volume (GCV = MV + secretion) were measured by MRI during nasogastric meal infusion and gastric emptying over 60 min. Intragastric pressure was assessed at 1 Hz by FORS. The dynamic change in postprandial gastric volumes was described by a validated three-component linear exponential model. The stomach expanded with MV, but the ratio of GCV:MV at [t.sub.0] diminished with increasing MV (P < 0.01). Postprandial changes in TGV followed those of GCV. Intragastric pressure increased with MV, and this effect was augmented further by CL (P = 0.02); however, the absolute pressure rise was gastric accommodation; gastric emptying; intragastric pressure doi: 10.1152/ajpgi.00117.2009.

Published
2009

18. Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0 ©

Author

Yadlapati, Rena, primary, Kahrilas, Peter J., additional, Fox, Mark R., additional, Bredenoord, Albert J., additional, Prakash Gyawali, C., additional, Roman, Sabine, additional, Babaei, Arash, additional, Mittal, Ravinder K., additional, Rommel, Nathalie, additional, Savarino, Edoardo, additional, Sifrim, Daniel, additional, Smout, André, additional, Vaezi, Michael F., additional, Zerbib, Frank, additional, Akiyama, Junichi, additional, Bhatia, Shobna, additional, Bor, Serhat, additional, Carlson, Dustin A., additional, Chen, Joan W., additional, Cisternas, Daniel, additional, Cock, Charles, additional, Coss‐Adame, Enrique, additional, de Bortoli, Nicola, additional, Defilippi, Claudia, additional, Fass, Ronnie, additional, Ghoshal, Uday C., additional, Gonlachanvit, Sutep, additional, Hani, Albis, additional, Hebbard, Geoffrey S., additional, Wook Jung, Kee, additional, Katz, Philip, additional, Katzka, David A., additional, Khan, Abraham, additional, Kohn, Geoffrey Paul, additional, Lazarescu, Adriana, additional, Lengliner, Johannes, additional, Mittal, Sumeet K., additional, Omari, Taher, additional, Park, Moo In, additional, Penagini, Roberto, additional, Pohl, Daniel, additional, Richter, Joel E., additional, Serra, Jordi, additional, Sweis, Rami, additional, Tack, Jan, additional, Tatum, Roger P., additional, Tutuian, Radu, additional, Vela, Marcelo F., additional, Wong, Reuben K., additional, Wu, Justin C., additional, Xiao, Yinglian, additional, and Pandolfino, John E., additional

Published
2020
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21. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management.

Author

Misselwitz, Benjamin; https://orcid.org/0000-0002-8719-5175, Butter, Matthias, Verbeke, Kristin, Fox, Mark R; https://orcid.org/0000-0003-4394-5584, Misselwitz, Benjamin; https://orcid.org/0000-0002-8719-5175, Butter, Matthias, Verbeke, Kristin, and Fox, Mark R; https://orcid.org/0000-0003-4394-5584

Abstract

Lactose is the main source of calories in milk, an essential nutriedigestion, patients with visceral hypersensitivity nt in infancy and a key part of the diet in populations that maintain the ability to digest this disaccharide in adulthood. Lactase deficiency (LD) is the failure to express the enzyme that hydrolyses lactose into galactose and glucose in the small intestine. The genetic mechanism of lactase persistence in adult Caucasians is mediated by a single C→T nucleotide polymorphism at the LCTbo -13'910 locus on chromosome-2. Lactose malabsorption (LM) refers to any cause of failure to digest and/or absorb lactose in the small intestine. This includes primary genetic and also secondary LD due to infection or other conditions that affect the mucosal integrity of the small bowel. Lactose intolerance (LI) is defined as the onset of abdominal symptoms such as abdominal pain, bloating and diarrhoea after lactose ingestion by an individual with LM. The likelihood of LI depends on the lactose dose, lactase expression and the intestinal microbiome. Independent of lactose digestion, patients with visceral hypersensitivity associated with anxiety or the Irritable Bowel Syndrome (IBS) are at increased risk of the condition. Diagnostic investigations available to diagnose LM and LI include genetic, endoscopic and physiological tests. The association between self-reported LI, objective findings and clinical outcome of dietary intervention is variable. Treatment of LI can include low-lactose diet, lactase supplementation and, potentially, colonic adaptation by prebiotics. The clinical outcome of these treatments is modest, because lactose is just one of a number of poorly absorbed carbohydrates which can cause symptoms by similar mechanisms.

Published
2019

23. European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients: European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Neurogastroenterology and Motility, and European Society for Paediatric Gastroenterology Hepatology and Nutrition consensus

Author

Hammer, Heinz F., Fox, Mark R., Keller, Jutta, Salvatore, Silvia, Basilisco, Guido, Hammer, Johann, Lopetuso, Loris, Benninga, Marc, Borrelli, Osvaldo, Dumitrascu, Dan, Hauser, Bruno, Herszenyi, Laszlo, Nakov, Radislav, Pohl, Daniel, Thapar, Nikhil, and Sonyi, Marc

Abstract

Measurement of breath hydrogen (H2) and methane (CH4) excretion after ingestion of test‐carbohydrates is used for different diagnostic purposes. There is a lack of standardization among centers performing these tests and this, together with recent technical developments and evidence from clinical studies, highlight the need for a European guideline. This consensus‐based clinical practice guideline defines the clinical indications, performance, and interpretation of H2‐CH4‐breath tests in adult and pediatric patients. A balance between scientific evidence and clinical experience was achieved by a Delphi consensus that involved 44 experts from 18 European countries. Eighty eight statements and recommendations were drafted based on a review of the literature. Consensus (≥80% agreement) was reached for 82. Quality of evidence was evaluated using validated criteria. The guideline incorporates new insights into the role of symptom assessment to diagnose carbohydrate (e.g., lactose) intolerances and recommends that breath tests for carbohydrate malabsorption require additional validated concurrent symptom evaluation to establish carbohydrate intolerance. Regarding the use of breath tests for the evaluation of oro‐cecal transit time and suspected small bowel bacterial overgrowth, this guideline highlights confounding factors associated with the interpretation of H2‐CH4‐breath tests in these indications and recommends approaches to mitigate these issues. This clinical practice guideline should facilitate pan‐European harmonization of diagnostic approaches to symptoms and disorders, which are very common in specialist and primary care gastroenterology practice, both in adult and pediatric patients. In addition, it identifies areas of future research needs to clarify diagnostic and therapeutic approaches.

Published
2022
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24. Chicago classification version 4.0© technical review: Update on standard high‐resolution manometry protocol for the assessment of esophageal motility.

Author

Fox, Mark R., Sweis, Rami, Yadlapati, Rena, Pandolfino, John, Hani, Albis, Defilippi, Claudia, Jan, Tack, and Rommel, Nathalie

Subjects
*ESOPHAGEAL motility disorders, *ESOPHAGEAL motility, *DIAGNOSIS
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. [ABSTRACT FROM AUTHOR]

Published
2021
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25. Clinical measurement of gastrointestinal motility and function: who, when and which test?

Author

Fox, Mark R; https://orcid.org/0000-0003-4394-5584, Kahrilas, Peter J, Roman, Sabine, Gyawali, C Prakash; https://orcid.org/0000-0002-3388-0660, Scott, S Mark, Rao, Satish S, Keller, Jutta, Camilleri, Michael, Fox, Mark R; https://orcid.org/0000-0003-4394-5584, Kahrilas, Peter J, Roman, Sabine, Gyawali, C Prakash; https://orcid.org/0000-0002-3388-0660, Scott, S Mark, Rao, Satish S, Keller, Jutta, and Camilleri, Michael

Abstract

Symptoms related to abnormal gastrointestinal motility and function are common. Oropharyngeal and oesophageal dysphagia, heartburn, bloating, abdominal pain and alterations in bowel habits are among the most frequent reasons for seeking medical attention from internists or general practitioners and are also common reasons for referral to gastroenterologists and colorectal surgeons. However, the nonspecific nature of gastrointestinal symptoms, the absence of a definitive diagnosis on routine investigations (such as endoscopy, radiology or blood tests) and the lack of specific treatments make disease management challenging. Advances in technology have driven progress in the understanding of many of these conditions. This Review serves as an introduction to a series of Consensus Statements on the clinical measurements of gastrointestinal motility, function and sensitivity. A structured, evidence-based approach to the initial assessment and empirical treatment of patients presenting with gastrointestinal symptoms is discussed, followed by an outline of the contribution of modern physiological measurement on the management of patients in whom the cause of symptoms has not been identified with other tests. Discussions include the indications for and utility of high-resolution manometry, ambulatory pH-impedance monitoring, gastric emptying studies, breath tests and investigations of anorectal structure and function in day-to-day practice and clinical management.

Published
2018

26. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition

Author

Arasaradnam, Ramesh P, Brown, Steven, Forbes, Alastair, Fox, Mark R, Hungin, Pali, Kelman, Lawrence, Major, Giles, O'Connor, Michelle, Sanders, Dave S, Sinha, Rakesh, Smith, Stephen Charles, Thomas, Paul, Walters, Julian R F, Arasaradnam, Ramesh P, Brown, Steven, Forbes, Alastair, Fox, Mark R, Hungin, Pali, Kelman, Lawrence, Major, Giles, O'Connor, Michelle, Sanders, Dave S, Sinha, Rakesh, Smith, Stephen Charles, Thomas, Paul, and Walters, Julian R F

Abstract

Chronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). This document has undergone significant revision in content through input by 13 members of the Guideline Development Group (GDG) representing various institutions. The GRADE system was used to appraise the quality of evidence and grading of recommendations.

Published
2018

27. Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0©.

Author

Yadlapati, Rena, Kahrilas, Peter J., Fox, Mark R., Bredenoord, Albert J., Prakash Gyawali, C., Roman, Sabine, Babaei, Arash, Mittal, Ravinder K., Rommel, Nathalie, Savarino, Edoardo, Sifrim, Daniel, Smout, André, Vaezi, Michael F., Zerbib, Frank, Akiyama, Junichi, Bhatia, Shobna, Bor, Serhat, Carlson, Dustin A., Chen, Joan W., and Cisternas, Daniel

Subjects
ESOPHAGEAL motility disorders, ESOPHAGOGASTRIC junction, ESOPHAGEAL motility, DIAGNOSIS
Abstract

Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from high‐resolution manometry (HRM). Fifty‐two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two‐years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of esophagogastric junction (EGJ) outflow obstruction (EGJOO), more stringent diagnostic criteria for ineffective esophageal motility and description of baseline EGJ metrics. Further, the CCv4.0 sought to define motility disorder diagnoses as conclusive and inconclusive based on associated symptoms, and findings on provocative testing as well as supportive testing with barium esophagram with tablet and/or functional lumen imaging probe. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification and provide more standardized and rigorous criteria for patterns of disorders of peristalsis and obstruction at the EGJ. [ABSTRACT FROM AUTHOR]

Published
2021
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28. What is new in Chicago Classification version 4.0?

Author

Yadlapati, Rena, Pandolfino, John E., Fox, Mark R., Bredenoord, Albert J., and Kahrilas, Peter J.

Subjects
ESOPHAGEAL motility, ESOPHAGEAL motility disorders, ESOPHAGOGASTRIC junction, CLASSIFICATION, DIAGNOSIS, SUPINE position
Abstract

Since publication of Chicago Classification version 3.0 in 2015, the clinical and research applications of high‐resolution manometry (HRM) have expanded. In order to update the Chicago Classification, an International HRM Working Group consisting of 52 diverse experts worked for two years and utilized formally validated methodologies. Compared with the prior iteration, there are four key modifications in Chicago Classification version 4.0 (CCv4.0). First, further manometric and non‐manometric evaluation is required to arrive at a conclusive, actionable diagnosis of esophagogastric junction (EGJ) outflow obstruction (EGJOO). Second, EGJOO, distal esophageal spasm, and hypercontractile esophagus are three manometric patterns that must be accompanied by obstructive esophageal symptoms of dysphagia and/or non‐cardiac chest pain to be considered clinically relevant. Third, the standardized manometric protocol should ideally include supine and upright positions as well as additional manometric maneuvers such as the multiple rapid swallows and rapid drink challenge. Solid test swallows, postprandial testing, and pharmacologic provocation can also be considered for particular conditions. Finally, the definition of ineffective esophageal motility is more stringent and now encompasses fragmented peristalsis. Hence, CCv4.0 no longer distinguishes between major versus minor motility disorders but simply separates disorders of EGJ outflow from disorders of peristalsis. [ABSTRACT FROM AUTHOR]

Published
2021
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29. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition

Author

Arasaradnam, Ramesh P, primary, Brown, Steven, additional, Forbes, Alastair, additional, Fox, Mark R, additional, Hungin, Pali, additional, Kelman, Lawrence, additional, Major, Giles, additional, O’Connor, Michelle, additional, Sanders, Dave S, additional, Sinha, Rakesh, additional, Smith, Stephen Charles, additional, Thomas, Paul, additional, and Walters, Julian R F, additional

Published
2018
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30. Modern diagnosis of GERD: the Lyon Consensus

Author

Gyawali, C Prakash, primary, Kahrilas, Peter J, additional, Savarino, Edoardo, additional, Zerbib, Frank, additional, Mion, Francois, additional, Smout, André J P M, additional, Vaezi, Michael, additional, Sifrim, Daniel, additional, Fox, Mark R, additional, Vela, Marcelo F, additional, Tutuian, Radu, additional, Tack, Jan, additional, Bredenoord, Albert J, additional, Pandolfino, John, additional, and Roman, Sabine, additional

Published
2018
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31. European guideline on indications, performance and clinical impact of 13C‐breath tests in adult and pediatric patients: An EAGEN, ESNM, and ESPGHAN consensus, supported by EPC

Author

Keller, Jutta, Hammer, Heinz F., Afolabi, Paul R., Benninga, Marc, Borrelli, Osvaldo, Dominguez‐Munoz, Enrique, Dumitrascu, Dan, Goetze, Oliver, Haas, Stephan L., Hauser, Bruno, Pohl, Daniel, Salvatore, Silvia, Sonyi, Marc, Thapar, Nikhil, Verbeke, Kristin, and Fox, Mark R.

Abstract

13C‐breath tests are valuable, noninvasive diagnostic tests that can be widely applied for the assessment of gastroenterological symptoms and diseases. Currently, the potential of these tests is compromised by a lack of standardization regarding performance and interpretation among expert centers. This consensus‐based clinical practice guideline defines the clinical indications, performance, and interpretation of 13C‐breath tests in adult and pediatric patients. A balance between scientific evidence and clinical experience was achieved by a Delphi consensus that involved 43 experts from 18 European countries. Consensus on individual statements and recommendations was established if ≥ 80% of reviewers agreed and <10% disagreed. The guideline gives an overview over general methodology of 13C‐breath testing and provides recommendations for the use of 13C‐breath tests to diagnose Helicobacter pyloriinfection, measure gastric emptying time, and monitor pancreatic exocrine and liver function in adult and pediatric patients. Other potential applications of 13C‐breath testing are summarized briefly. The recommendations specifically detail when and how individual 13C‐breath tests should be performed including examples for well‐established test protocols, patient preparation, and reporting of test results. This clinical practice guideline should improve pan‐European harmonization of diagnostic approaches to symptoms and disorders, which are very common in specialist and primary care gastroenterology practice, both in adult and pediatric patients. In addition, this guideline identifies areas of future clinical research involving the use of 13C‐breath tests.

Published
2021
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33. Diagnosis of Esophageal Motility Disorders: Esophageal Pressure Topography vs. Conventional Line Tracing

Author

Carlson, Dustin A, primary, Ravi, Karthik, additional, Kahrilas, Peter J, additional, Gyawali, Prakash C, additional, Bredenoord, Arjan J, additional, Castell, Donald O, additional, Spechler, Stuart J, additional, Halland, Magnus, additional, Kanuri, Navya, additional, Katzka, David A, additional, Leggett, Cadman L, additional, Roman, Sabine, additional, Saenz, Jose B, additional, Sayuk, Gregory S, additional, Wong, Alan C, additional, Yadlapati, Rena, additional, Ciolino, Jody D, additional, Fox, Mark R, additional, and Pandolfino, John E, additional

Published
2015
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34. Tu1143 Diagnosis of Esophageal Motility Disorders: Esophageal Pressure Topography Versus Conventional Line Tracings

Author

Carlson, Dustin A., primary, Ravi, Karthik, additional, Kahrilas, Peter J., additional, Gyawali, C. Prakash, additional, Bredenoord, Albert J., additional, Castell, Donald O., additional, Spechler, Stuart J., additional, Halland, Magnus, additional, Kanuri, Navya D., additional, Katzka, David A., additional, Leggett, Cadman L., additional, Roman, Sabine, additional, Saenz, Jose, additional, Sayuk, Gregory S., additional, Wong, Alan C., additional, Yadlapati, Rena, additional, Ciolino, Jody D., additional, Fox, Mark R., additional, and Pandolfino, John E., additional

Published
2015
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38. 14 Identification of Transient Lower Esophageal Sphincter Relaxation (TLESR) in High Resolution Manometry Combined With Impedance (HRM-Z): Toward a Consensus Definition

Author

Roman, Sabine, primary, Xiao, Yinglian, additional, Zerbib, Frank, additional, Pandolfino, John E., additional, Holloway, Richard H., additional, Bredenoord, Albert J., additional, des Varannes, Stanislas Bruley, additional, Chen, Minhu, additional, Fox, Mark R., additional, Herbella, Fernando A., additional, Keller, Jutta, additional, Mion, Francois, additional, Mittal, Ravinder K., additional, Penagini, Roberto, additional, Savarino, Edoardo, additional, Sifrim, Daniel, additional, Wu, Justin C., additional, and Kahrilas, Peter J., additional

Published
2014
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39. The effect of Helicobacter pylori infection and eradication in patients with gastro‐oesophageal reflux disease: A parallel‐group, double‐blind, placebo‐controlled multicentre study

Author

Schwizer, Werner, primary, Menne, Dieter, additional, Schütze, Kurt, additional, Vieth, Michael, additional, Goergens, Reiner, additional, Malfertheiner, Peter, additional, Leodolter, Andreas, additional, Fried, Michael, additional, and Fox, Mark R, additional

Published
2013
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41. Su2034 Diagnosis of Small Intestinal Bacterial Overgrowth by Lactulose Hydrogen Breath Test With Scintigraphic Oro-Caecal Transit Test: Methodological Validation of Diagnostic Criteria in Healthy Controls and Patients With Diarrhea Predominant Irritable Bowel Syndrome

Author

Zhao, Jianmin, primary, Zheng, Xia, additional, Chu, Hua, additional, Zhao, Jianjun, additional, Cong, Yanqun, additional, Fried, Michael, additional, Fox, Mark R., additional, and Dai, Ning, additional

Published
2013
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44. Tu1803 Dysphagia Post-Fundoplication Evaluated With High-Resolution Manometry (HRM). The Relevance of a Dual High-Pressure Zone

Author

Yazaki, Etsuro, primary, Wang, Yu Tien, additional, Jafari, Jafar, additional, Fikree, Asma, additional, Schaub, Nora, additional, Sweis, Rami, additional, Tucker, Emily, additional, Knowles, Kevin R., additional, Wright, Jeff, additional, Hamlett, Katharine, additional, Beckingham, Ian, additional, Fox, Mark R., additional, and Sifrim, Daniel, additional

Published
2013
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45. Tu1788 Comparison of Post-Operative Physiology Parameters Between Asymptomatic and Symptomatic Patients After Anti-Reflux Surgery

Author

Wang, Yu Tien, primary, Yazaki, Etsuro, additional, Jafari, Jafar, additional, Fikree, Asma, additional, Schaub, Nora, additional, Sweis, Rami, additional, Tucker, Emily, additional, Knowles, Kevin R., additional, Wright, Jeff, additional, Hamlett, Katharine, additional, Beckingham, Ian, additional, Fox, Mark R., additional, and Sifrim, Daniel, additional

Published
2013
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46. Mo2099 Weight Gain in Anorexia Nervosa Patients Is Associated With Normalization of Gastric Contractile Activity and Visceral Sensation but Does Not Impact on Emptying Rate and Dyspeptic Symptoms

Author

Kuyumcu, Sena, primary, Goetze, Oliver, additional, Fox, Mark R., additional, Menne, Dieter, additional, Boesiger, Peter, additional, Milos, Gabriella, additional, Fried, Michael, additional, Schwizer, Werner, additional, and Steingoetter, Andreas, additional

Published
2013
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47. Sa1397 The Prevalence, Clinical Relevance and Impact on Diet of Lactose Intolerance in a Population With Lactase Deficiency: A Randomized, Double-Blind, Dose Response Study in Healthy Subjects and Patients With Diarrhea Predominant Irritable Bowel Syndrome

Author

Yang, Jianfeng, primary, Deng, Yanyong, additional, Chu, Hua, additional, Cong, Yanqun, additional, Zhao, Jianmin, additional, Pohl, Daniel, additional, Misselwitz, Benjamin, additional, Fried, Michael, additional, Dai, Ning, additional, and Fox, Mark R., additional

Published
2012
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48. Su1076 Measurement of Esophago-Gastric Junction Cross-Sectional Area and Distensibility by Endoflip® (Endolumenal Functional Lumen Imaging Probe) for the Diagnosis of Patients With Gastro-Esophageal Reflux Disease (GERD)

Author

Tucker, Emily, primary, Sweis, Rami, additional, Anggiansah, Angela, additional, Telakis, Emmanouil, additional, Wright, Jeff, additional, Knowles, Kevin R., additional, Wong, Terry, additional, and Fox, Mark R., additional

Published
2012
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