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Mean nocturnal baseline impedance in gastro-esophageal reflux disease diagnosis:Should we strictly follow the Lyon 2 Consensus?

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World Journal of Gastroenterology 2024年第26期30卷 3253-3256页

作者： theodoros a voulgaris Georgios P Karamanolis Department of Gastroenterology School of MedicineNational and Kapodistrian University of AthensAthens 11527Greece

Clinical practice guidelines drive clinical practice and clinicians rely to them when trying to answer their most common *** of the most important position papers in the field of gastro-esophageal reflux disease(GERD)is the one produced by the Lyon *** an updated second version has been *** nocturnal baseline impedance(MNBI)was proposed by the first Consensus to act as supportive evidence for GERD *** a cut-off of 2292 Ohms was proposed,a value revised in the second *** updated Consensus recommended that an MNBI2500 Ohms can be used to refute *** proposed cut-offs move in the correct direction by diminishing the original cut-off,nevertheless they arise from a study of normal subjects where cut-offs were provided by measuring the mean value±2SD and not in symptomatic ***,data exist that even symptomatic patients with inconclusive disease or reflux hypersensitivity(RH)show lower MNBI values in comparison to normal subjects or patients with functional heartburn(FH).Moreover,according to the data,MNBI,even among symptomatic patients,is affected by age and body mass ***,various studies have proposed different cut-offs by using receiver operating characteristic curve analysis even lower than the one ***,no information is given for patients submitted to on-proton pump inhibitors pH-impedance studies even if new and extremely important data now ***,even if MNBI is an extremely important tool when trying to approach patients with reflux symptoms and could distinguish conclusive GERD from RH or FH,its values should be interpreted with caution.

关键词： Mean nocturnal baseline impedance Gastro-esophageal reflux disease Lyon 2 Consensus pH-impedance Diagnosis

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Esophageal manifestation in patients with scleroderma

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World Journal of Clinical Cases 2021年第20期9卷 5408-5419页

作者： theodoros a voulgaris Georgios P Karamanolis Department of Gastroenterology and Hepatology Laiko General HospitalNational and Kapodistian University of AthensAthens 11527Greece

The esophagus is the most commonly affected part of the gastrointestinal system in patients with systemic sclerosis(SSc).Esophageal involvement may lead to a significant reduction in patient quality of *** exact pathophysiology is complex and not yet fully ***,esophageal smooth muscle becomes atrophied and replaced by fibrous tissue leading to severe motility disturbance of the distal *** are mainly attributed to gastroesophageal reflux disease and to esophageal *** evidence has correlated esophageal involvement to the severity of pulmonary *** formed guidelines exist about the diagnostic modalities used to assess esophageal disease in patients with SSc,though upper gastrointestinal endoscopy is the first and most important modality used as it can reveal alterations commonly observed in patients with *** exploration can be made by high resolution manometry and pH-impedance *** pump inhibitors remain the mainstay of treatment,while prokinetic agents are commonly used as add-on therapy in patients with symptoms attributed to gastroesophageal reflux disease not responding to standard therapy as well as to motility *** reflux disease symptoms in patients with SSc are frequently difficult to manage,and new therapeutic modalities are *** role of surgical treatment is restricted and should only be preserved for resistant cases.

关键词： Systemic sclerosis Esophagus Gastroesophageal reflux disease Esophageal dysmotility Proton pump inhibitors

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Serum zonulin levels in patients with liver cirrhosis:Prognostic implications

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World Journal of Hepatology 2021年第10期13卷 1394-1404页

作者： theodoros a voulgaris Dimitrios Karagiannakis E Hadziyannis Spilios Manolakopoulos Georgios P Karamanolis George Papatheodoridis John Vlachogiannakos Academic Department of Gastroenterology and Hepatology Medical School of National and Kapodistrian University of AthensGeneral Hospital of Athens“Laiko”Athens 11527Greece Academic Department of Medicine Hippokrat General HospitalNational and Kapodistrian University of AthensAthens 11527Greece

BACKGROUND Increased gut permeability and bacterial translocation play an important role in liver *** is a recently recognized protein involved in the disintegration of the intestinal *** To investigate possible differences in serum zonulin levels among patients with different cirrhosis stages and their potential prognostic *** Consecutive cirrhotic patients who attended our liver clinic were included in the *** zonulin levels,clinical,radiological and biochemical data were collected at *** who accepted participation in a regular surveillance program were followed-up for at least 12 *** We enrolled 116 cirrhotics[mean Child-Turcotte-Pugh(CTP)score:6.2±1.6;model for end-stage liver disease score:11±3.9].The causes of cirrhosis were viral hepatitis(39%),alcohol(30%),non-alcoholic fatty liver disease(17%),and other(14%).At baseline,53% had decompensated cirrhosis,48% had ascites,and 32% had history of hepatic *** zonulin levels were significantly higher in patients with CTP-B class than CTP-A class(4.2±2.4 ng/dL vs 3.5±0.9 ng/dL,P=0.038),with than without ascites(P=0.006),and with than without history of encephalopathy(P=0.011).Baseline serum zonulin levels were independently associated with the probability of decompensation at 1 year(P=0.039),with an area under the receiving operating characteristic of 0.723 for predicting hepatic *** CTP score(P=0.021)and portal vein diameter(P=0.022)were independent predictors of *** Serum zonulin levels are higher in patients with more advanced chronic liver disease and have significant prognostic value in identifying patients who will develop decompensation.

关键词： Zonulin Cirrhosis Intestinal barrier Bacterial translocation Decompensation Permeability

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