Neurogastroenterology and motility disorders of the upper gastrointestinal (GI) tract represent a complex and heterogeneous group of conditions that involve the interaction between the GI tract and the central nervous system. They constitute a significant number of outpatient gastroenterology visits, resulting in a high healthcare burden. These disorders often occur in the absence of identifiable structural causes on routine endoscopy and radiological imaging. A more targeted approach in the assessment of functional GI disorders is increasingly being integrated into routine clinical practice, given the recent advancements in technology and physiologic testing. When used in the appropriate clinical context, these tests not only elucidate the physiological basis for the patient's symptoms, but also prevent inappropriate treatment and repeated investigations. This review aims to summarise the advances in clinically available diagnostic tools for the evaluation of upper GI functional disorders.
Humans ; Gastrointestinal Diseases/physiopathology* ; Upper Gastrointestinal Tract/physiopathology* ; Gastrointestinal Motility ; Endoscopy, Gastrointestinal

Humans ; Child ; Caustics/toxicity* ; Burns, Chemical/therapy* ; Consensus ; Upper Gastrointestinal Tract/injuries*

OBJECTIVE: To study the complications of upper gastrointestinal foreign body in children and related risk factors. METHODS: Clinical data were collected from 772 children with upper gastrointestinal foreign bodies who were treated at the outpatient service or were hospitalized from January 2014 to December 2018. A multivariate logistic regression analysis was used to investigate the risk factors for the development of complications in children with upper gastrointestinal foreign bodies. RESILTS: The upper gastrointestinal foreign bodies were taken out by electronic endoscopy for the 772 children. There were 414 boys and 358 girls, with a median age of 2.8 years. Children under 3 years old accounted for 59.5%. The foreign bodies were mainly observed in the esophagus (57.5%) and the stomach (28.9%), with a retention time of ≤24 hours in 465 children (60.2%) and >24 hours in 307 children (39.8%). The types of upper gastrointestinal foreign bodies mainly included round metal foreign bodies (37.2%), long foreign bodies (24.7%), sharp foreign bodies (16.2%), batteries (14.4%), corrosive substances (4.8%), and magnets (2.7%). As for the severity of complications, 47.7% (368 children) had mild complications, 12.7% (98 children) had serious complications, and 39.6% (306 children) had no complications. The logistic regression analysis showed that an age of <3 years, underlying diseases, location of foreign body, type of foreign body, and a retention time of >24 hours were risk factors for the development of complications in these children (OR=2.141, 7.373, 6.658, 8.892, and 6.376 respectively, P<0.05). CONCLUSIONS An understanding of the above high-risk factors for the complications of upper gastrointestinal foreign bodies is helpful to choose appropriate intervention methods and thus reduce the incidence of serious complications.
Child, Preschool ; Endoscopy, Gastrointestinal ; Esophagus ; Female ; Foreign Bodies ; Humans ; Male ; Retrospective Studies ; Risk Factors ; Upper Gastrointestinal Tract

Infectious diseases of the upper gastrointestinal tract are rare, but certain bacteria including Treponema pallidum and Mycobacterium tuberculosis may infect the esophagus, stomach, and duodenum even in an immunocompetent individual. Gastric syphilis is difficult to diagnose because it presents with non-specific symptoms and diverse endoscopic findings. Nevertheless, gastric syphilis should be considered in the differential diagnosis when a patient presents with chronic inflammatory gastric lesions such as multiple erosive/ulcerative lesions and stricture or with other evidence of syphilis. Histological evaluation and specific serological tests should be performed if syphilis is suspected. Esophageal and gastroduodenal tuberculosis also exhibits non-specific clinical manifestations. The diagnosis is confirmed by mucosal biopsy or aspiration cytology revealing the presence of caseating granulomata and/or acid-fast bacilli. Mycobacterial culture and polymerase chain reaction should be incorporated into routine diagnostic studies to improve the diagnostic sensitivity. The diagnosis of tuberculosis is occasionally confirmed indirectly by an excellent response of the patient to anti-tubercular therapy.
Bacteria ; Biopsy ; Communicable Diseases ; Constriction, Pathologic ; Diagnosis ; Diagnosis, Differential ; Duodenum ; Esophagus ; Humans ; Mycobacterium tuberculosis ; Polymerase Chain Reaction ; Serologic Tests ; Stomach ; Syphilis ; Treponema pallidum ; Tuberculosis ; Upper Gastrointestinal Tract

Gut microbiota have been known to play an essential role in host immunity and metabolism. Dysbiosis is associated with various gastrointestinal (GI) and other diseases such as cancers, metabolic diseases, allergies, and immunological disorders. So far, the role of gut microbiota has been studied mainly in lower GI disease but has recently been reported in upper GI diseases other than Helicobacter pylori infection, including Barrett's esophagus, esophageal carcinoma, gastric cancer, functional dyspepsia, and non-steroidal anti-inflammatory drug-induced small intestinal mucosal injury. Probiotics have some beneficial effect on these diseases, but the effects are strain specific.
Anti-Inflammatory Agents, Non-Steroidal ; Barrett Esophagus ; Dysbiosis ; Dyspepsia ; Gastrointestinal Diseases ; Gastrointestinal Microbiome ; Helicobacter Infections ; Helicobacter pylori ; Hypersensitivity ; Metabolic Diseases ; Metabolism ; Microbiota ; Probiotics ; Stomach Neoplasms ; Upper Gastrointestinal Tract

Fecal microbiota transplantation (FMT) is an infusion in the colon, or the delivery through the upper gastrointestinal tract, of stool from a healthy donor to a recipient with a disease believed to be related to an unhealthy gut microbiome. FMT has been successfully used to treat recurrent Clostridium difficile infection (rCDI). The short-term success of FMT in rCDI has led to investigations of its application to other gastrointestinal disorders and extra-intestinal diseases with presumed gut dysbiosis. Despite the promising results of FMT in these conditions, several barriers remain, including determining the characteristics of a healthy microbiome, ensuring the safety of the recipient with respect to long-term outcomes, adequate monitoring of the recipient of fecal material, achieving high-quality control, and maintaining reasonable costs. For these reasons, establishing uniform protocols for stool preparation, finding the best modes of FMT administration, maintaining large databases of donors and recipients, and assuring that oral ingestion is equivalent to the more widely accepted colonoscopic infusion are issues that need to be addressed.
Clostridium difficile ; Clothing ; Colon ; Colonoscopy ; Dysbiosis ; Eating ; Fecal Microbiota Transplantation ; Gastrointestinal Microbiome ; Humans ; Microbiota ; Tissue Donors ; Upper Gastrointestinal Tract

Although ulcerative colitis (UC) is confined to colonic and rectal mucosa in a continuous fashion, recent studies have also demonstrated the involvement of upper gastrointestinal tract as diagnostic endoscopy becomes more available and technically advanced. The pathogenesis of UC is not well established yet. It might be associated with an inappropriate response of host mucosal immune system to gut microflora. Although continuous and symmetric distribution of mucosal inflammation from rectum to colon is a typical pattern of UC, clinical feature and course of atypically distributed lesions in UC might also help us understand the pathogenesis of UC. Herein, we report a case of duodenal involvement of UC which successfully remitted after infliximab therapy. Endoscopic and pathologic findings before and after administration of anti-tumor necrosis factor suggest that the pathogenesis of upper gastrointestinal involvement of UC may be similar to that of colon involvement.
Colitis, Ulcerative ; Colon ; Duodenitis ; Endoscopy ; Gastrointestinal Microbiome ; Humans ; Immune System ; Inflammation ; Infliximab ; Mucous Membrane ; Necrosis ; Rectum ; Ulcer ; Upper Gastrointestinal Tract

Foreign body (FB) ingestion of children is a common pediatric emergency requiring medical attention. Pediatric emergency physicians and gastroenterologists often encounter nervous and distressed situations, because of children presenting with this condition in the common clinical practice. When determining the appropriate timing and indications for intervention, physicians should consider multiple patient- and FB-related factors. The utilization of a flexible endoscopy is considered safe and effective to use in these cases, with a high success rate, for the effective extraction of FBs from the gastrointestinal tract of a child. Additionally, a Foley catheter and a magnet-attached Levin tube have been used for decades in the case of FB removal. Although their use has decreased significantly in recent times, these instruments continue to be used for several indications. Using a Foley catheter for this purpose does not require special training and does not necessarily require sedation of the patient or fluoroscopy, which serve as advantages of utilizing this method for foreign object retrieval. An ingested magnet or iron-containing FB can be retrieved using a magnet-attached tube, and can be effective to retrieve an object from any section of the upper gastrointestinal tract that can be reached. Simple and inexpensive devices such as Foley catheters and magnet-attached tubes can be used in emergencies such as with the esophageal impaction of disk batteries if endoscopy cannot be performed immediately (e.g., in rural areas and/or in patients presenting at midnight in a facility, especially in those without access to endoscopes or emergency services, or in any situation that warrants urgent removal of a foreign object).
Catheters ; Child ; Eating ; Emergencies ; Endoscopes ; Endoscopy ; Esophagus ; Fluoroscopy ; Foreign Bodies ; Gastrointestinal Tract ; Humans ; Methods ; Upper Gastrointestinal Tract ; Urinary Catheterization

BACKGROUND/AIMS: Appropriate interval for performing follow-up endoscopy among dyspeptic patients without abnormal findings on previous endoscopy is unclear. We analyzed the multicenter-collected data from the Korean Society of Neurogastroenterology and Motility. METHODS: We collected clinical data of the patients who visited the gastroenterology department and underwent 2 or more sessions of upper endoscopy during 2012–2017 at 6 university hospitals in Korea. Patients with endoscopic interval between 90 days and 760 days were included. For those with multiple endoscopic sessions, only the first 2 were analyzed. Positive outcome was defined as adenoma or cancer in the upper gastrointestinal tract. To identify the point of change and estimate the properties of the stochastic process before and after the change, we used Bayesian regression with Metropolis-Hastings algorithm. RESULTS: There were 1595 patients. Mean age was 58.8 years (standard deviation, 12.8). Median interval of endoscopy was 437 days (standard deviation, 153). On follow-up endoscopy, there were 12 patients (0.75%) who had neoplasia (4 with gastric cancer and 8 with gastric adnoma). As with the prior hypothesis, we presumed the change point (CP) of increase in frequency of organic lesion as 360 days. After random-walk Metropolis-Hastings sampling with Markov-Chain Monte Carlo iterations of 5000, the CP was 560 days (95% credible interval, 139–724). Estimated average of frequency of dysplastic lesions increased by a factor of 4.4 after the estimated CP. CONCLUSION: To rule out dysplastic lesions among dyspeptic patients who had previously normal endoscopy, a 2-year interval could be offered as follow-up interval for repeat upper endoscopy.
Adenoma ; Bayes Theorem ; Dyspepsia ; Endoscopy ; Follow-Up Studies ; Gastroenterology ; Gastroscopy ; Hospitals, University ; Humans ; Korea ; Stomach Neoplasms ; Upper Gastrointestinal Tract

Gastroesophageal reflux disease (GERD) is a very common disease, and the prevalence in the general population has recently increased. GERD is a chronic relapsing disease associated with motility disorders of the upper gastrointestinal tract. Several factors are implicated in GERD, including hypotensive lower esophageal sphincter, frequent transient lower esophageal sphincter relaxation, esophageal hypersensitivity, reduced resistance of the esophageal mucosa against the refluxed contents, ineffective esophageal motility, abnormal bolus transport, deficits initiating secondary peristalsis, abnormal response to multiple rapid swallowing, and hiatal hernia. One or more of these mechanisms result in the reflux of stomach contents into the esophagus, delayed clearance of the refluxate, and the development of symptoms and/or complications. New techniques, such as 24-hour pH and multichannel intraluminal impedance monitoring, multichannel intraluminal impedance and esophageal manometry, high-resolution manometry, 3-dimensional high-resolution manometry, enoscopic functional luminal imaging probe, and 24-hour dynamic esophageal manometry, provide more information on esophageal motility and have clarified the pathophysiology of GERD. Proton pump inhibitors remain the preferred pharmaceutical option to treat GERD. The ideal target of GERD treatment is to restore esophageal motility and reconstruct the anti-reflux mechanism. This review focuses on current advances in esophageal motor dysfunction in patients with GERD and the influence of these developments on GERD treatment.
Deglutition ; Electric Impedance ; Esophageal Motility Disorders ; Esophageal Sphincter, Lower ; Esophagogastric Junction ; Esophagus ; Gastroesophageal Reflux ; Gastrointestinal Contents ; Hernia, Hiatal ; Humans ; Hydrogen-Ion Concentration ; Hypersensitivity ; Manometry ; Mucous Membrane ; Peristalsis ; Pharmaceutical Preparations ; Phenobarbital ; Prevalence ; Proton Pump Inhibitors ; Relaxation ; Upper Gastrointestinal Tract