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Esophagogastric junction outflow obstruction: Where are we now in diagnosis and management?

World Journal of Gastroenterology 2019年第4期25卷 411-416页

作者： salih samo Emad Qayed Department of Medicine Division of Digestive Diseases Emory University School of Medicine

Esophagogastric junction outflow obstruction(EGJOO) is a major motility disorder based on the Chicago Classification of esophageal motility disorders.This entity involves a heterogenous group of underlying etiologies. The diagnosis is reached by performing high-resolution manometry. This reveals evidence of obstruction at the esophagogastric junction, manifested by an elevated integrated relaxation pressure(IRP) above a cutoff value(IRP threshold varies by the manometric technology and catheter used), with preserved peristalsis. Further tests like endoscopy, timed barium esophagram, and cross-sectional imaging can help further elucidate the underlying etiology and rule out mechanical causes.Treatment is tailored to the underlying cause. Similar to achalasia, treatment targeting lower esophageal sphincter disruption like pneumatic dilation, peroral endoscopic myotomy, and botulinum injection are used in patients with functional EGJOO and persistent symptoms.

关键词： Esophagogastric junction outflow obstruction High-resolution manometry

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Distal esophageal spasm:Update on diagnosis and management in the era of high-resolution manometry

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World Journal of Clinical Cases 2020年第6期8卷 1026-1032页

作者： Harika Gorti salih samo Nikrad Shahnavaz Emad Qayed Department of Medicine Atlanta Veteran Affairs Medical Center and Emory University School of MedicineAtlantaGA 30322United States Department of Medicine Division of Digestive DiseasesEmory University School of MedicineAtlantaGA 30303United States

Distal esophageal spasm(DES)is a rare major motility disorder in the Chicago classification of esophageal motility disorders(CC).DES is diagnosed by finding of≥20%premature contractions,with normal lower esophageal sphincter(LES)relaxation on high-resolution manometry(HRM)in the latest version of CCv3.0.This feature differentiates it from achalasia type 3,which has an elevated LES relaxation pressure.Like other spastic esophageal disorders,DES has been linked to conditions such as gastroesophageal reflux disease,psychiatric conditions,and narcotic use.In addition to HRM,ancillary tests such as endoscopy and barium esophagram can provide supplemental information to differentiate DES from other conditions.Functional lumen imaging probe(FLIP),a new cutting-edge diagnostic tool,is able to recognize abnormal LES dysfunction that can be missed by HRM and can further guide LES targeted treatment when esophagogastric junction outflow obstruction is diagnosed on FLIP.Medical treatment in DES mostly targets symptomatic relief and often fails.Botulinum toxin injection during endoscopy may provide a temporary therapy that wears off over time.Myotomy through peroral endoscopic myotomy or via surgical Heller myotomy can provide long term relief in cases with persistent symptoms.

关键词： Distal esophageal spasm High-resolution manometry Esophagus Functional lumenal imaging probe Spastic achalasia Esophageal motility

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Lubiprostone induced ischemic colitis

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World Journal of Gastroenterology 2013年第2期19卷 299-303页

作者： Muhammed Sherid Humberto Sifuentes salih samo Parakkal Deepak Subbaramiah Sridhar Department of Internal Medicine Division of GastroenterologySaint Francis HospitalEvanstonIL 60202United States Section of Gastroenterology and Hepatology Medical College of GeorgiaGeorgia Health Sciences UniversityAugustaGA 30912United States Department of Internal Medicine Division of GastroenterologyNorthShore University HealthSystemHighland ParkIL 60035United States

Ischemic colitis accounts for 6%-18% of the causes of acute lower gastrointestinal bleeding.It is often multifactorial and more commonly encountered in the elderly.Several medications have been implicated in the development of colonic ischemia.We report a case of a 54-year old woman who presented with a two-hour history of nausea,vomiting,abdominal pain,and bloody stool.The patient had recently used lubiprostone with close temporal relationship between the increase in the dose and her symptoms of rectal bleeding.The radiologic,colonoscopic and histopathologic findings were all consistent with ischemic colitis.Her condition improved without any serious complications after the cessation of lubiprostone.This is the first reported case of ischemic colitis with a clear relationship with lubiprostone(Naranjo score of 10).Clinical vigilance for ischemic colitis is recommended for patients receiving lubiprostone who are presenting with abdominal pain and rectal bleeding.

关键词： Lubiprostone Ischemic colitis Gastrointestinal bleeding Rectal bleeding Colonoscopy

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Ischemic colitis induced by the newly reformulated multicomponent weight-loss supplement Hydroxycut~

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World Journal of Gastrointestinal Endoscopy 2013年第4期5卷 180-185页

作者： Muhammed Sherid salih samo Samian Sulaiman Joseph H Gaziano Department of Internal Medicine Division of Gastroenterology CGH Medical Center Department of Internal Medicine Division of Gastroenterology Saint Francis Hospital

Ischemic colitis accounts for 6%-18% of causes of acute lower gastrointestinal bleeding. It is more often multifactorial and more common in elderly. Drugs are considered important causative agents of this disease with different mechanisms. In this paper, we describe a 37-year-old otherwise healthy female presented with sudden onset diffuse abdominal pain and bloody stool. Radiologic, colonoscopic and histopathologic findings were all consistent with ischemic colitis. Her only suspected factor was hydroxycut which she had been taking for a period of 1 mo prior to her presentation. Her condition improved uneventfully after cessation of hydroxycut, bowel rest, intravenous hydration, and antibiotics. This is a first case of ischemic colitis with clear relationship with hydroxycut use (Naranjo score of 7). Our case demonstrates the importance of questioning patients regarding the usage of dietary supplements; especially since many patients consider them safe anddo not disclose their use voluntarily to their physicians. Hydroxycut has to be considered as a potential trigger for otherwise unexplained ischemic colitis.

关键词： Hydroxycut Weight-loss supplement Herbal Ischemic colitis Gastrointestinal bleeding Colonoscopy

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