20 // THE NEW GASTROENTEROLOGIST: INSIGHTS FOR FELLOWS & YOUNG GIS WINTER 2016
2015: A Year in Review in Esophagus,
Inflammatory Bowel Disease, and Motility
By Hassan Siddiki M.D., M.S.; Marcelo F. Vela, M.D., MSCR;
Amy Foxx-Orenstein, D.O., FACG, FACP; and Jonathan A. Leighton, M.D.
In this overview, we summarize the key original research pub- lished in 2015 on esophagus, inflammatory bowel disease, and motility. This research has influ- enced clinical practice and indicates the future of gastroenterology.
In 2015, endoscopic anti-reflux
therapy was shown to be a feasible
alternative treatment for a subset of
patients with proton-pump inhibitor
(PPI) refractory gastroesophageal
reflux disease (GERD) symptoms. The
RESPECT trial compared transoral
fundoplication with a sham procedure
plus PPI (n = 87 vs. 42); transoral fundoplication showed improvement in
regurgitation on 6-month follow-up.1
In addition, transoral fundoplication
Transoral fundoplication was also associated with a
was also associated with a reduc-
tion in esophageal acid exposure as
measured by pH-metry. The authors
attributed the success of the trial to
optimization of technique by deploy-
ing more fasteners compared to the
prior negative trials. Outcomes from
the National Registry data created for
this new device will help establish if
the trial findings are reproducible.
Another exciting development in the
area of GERD diagnostics is the use of
impedance measured with a through-
the-scope catheter that comes in
direct contact with mucosa; this tech-
nique was shown in a study to reliably
diagnose GERD – in the absence of
erosive esophagitis – from non-GERD
( 3,252 Ω vs. 4,806 Ω, P less than or
equal to .001), suggesting the greater
role that endoscopy may have in the
future management of this disorder.
A study published in PLoS One
created headlines when it reported
a “signal” linking PPIs with elevated
risk of myocardial infarction.
3 A com-
puter algorithm for data mining was
employed but there was no control
for biases originating from covariates
Dr. Siddiki is a clinical fellow in the department of gastroenterology and hepatology, Mayo Clinic; Dr. Vela
is the director of esophageal disorders in the division of gastroenterology and hepatology, Mayo Clinic; Dr.
Foxx-Orenstein is professor of medicine, co-director of motility, director of Mayo Clinic Weight And Well-
ness Solutions, department of gastroenterology and hepatology, Mayo Clinic; and Dr. Leighton is professor
of medicine, division of gastroenterology and hepatology, Mayo Clinic, Scottsdale, Ariz.
reduction in esophageal acid exposure as measured