Combination of Symptom Profile, Endoscopic Findings, and Esophageal Mucosal Histopathology Helps to Differentiate Achalasia from Refractory Gastroesophageal Reflux Disease

: Achalasia, a rare primary esophageal motility disorder, is often misdiagnosed as refractory gastroesophageal reflux disease (GERD). This study is aimed to identify the clinical and histopathologic features that may help to differentiate these two entities. Patients with untreated achalasia and those with refractory reflux symptoms despite ≥8 weeks of proton-pump inhibitor treatment were enrolled prospectively. All patients underwent validated symptom questionnaires, esophagogastroduodenoscopy with biopsy, and high-resolution impedance manometry (HRIM). Histopathology of esophageal mucosa was compared based on four pre-determined histological criteria: basal cell hyperplasia or papillae elongation, eosinophilic infiltration, petechiae formation, and hypertrophy of the muscularis mucosae (MM). Compared with the GERD patients, patients with achalasia had similar reflux symptoms, but higher Eckardt scores, fewer erosive esophagitis and hiatal hernia, more esophageal food retention on endoscopy, and higher prevalence of hypertrophy of the MM and petechiae formation on histopathology. Multivariate logistic regression based on Eckardt score ≥4, normal esophagogastric junction morphology or esophageal food retention, and coexistence of petechiae formation and hypertrophy of the MM, established the best prediction model for achalasia. Therefore, combination of routinely accessible variables, including Eckardt score, endoscopic features, and histopathology obtained via esophageal mucosal biopsy, may provide an earlier identification of achalasia.

Impact of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RA) on Food Content During Esophagogastroduodenoscopy (EGD)

Background Glucagon-like peptide-1 receptor agonists (GLP-1RA) have delayed gastric emptying properties; however, the impact on esophagogastroduodenoscopy (EGD) visualization is unknown. Objective: This study examines the impact of GLP-1RA use on EGD visualization and gastric content retention. Methods: This was a retrospective cohort study with matched controls. The primary endpoint was the odds of retained food documented during EGD. Secondary endpoints included incidence of lavage and need for repeat EGD due to poor visualization and were compared using Fisher exact test. Analyses were performed in R Studio. Results: There were 59 patients in the cohort prescribed a GLP-1RA with 118 matched controls. Food retention was documented with 4 patients (6.8%) in the GLP-1RA cohort versus 2 patients (1.7%) in the control group (odds ratio [OR] 4.22 [95% CI 0.87-20.34]). No difference was observed in the need for lavage during EGD or in the need for repeat EGD attributed to poor visualization. Conclusion and Relevance: This study addresses a previously uninvestigated question in clinical practice. GLP-1RA did not significantly increase odds of retained food on EGD. Although a numerical difference was observed, it did not reach statistical difference. No cases required repeat EGD due to poor visualization, and no change to EGD pre-procedure instructions were warranted at the study facility.

Feeding performance of the larval stag beetle Aegus chelifer (Coleoptera: Lucanidae) explains adult body size variation and sexual dimorphism

In stag beetle larvae, food availability is considered a major cause of body size variation in adults, but this has not been explicitly tested. To evaluate wood use and the effects of food quantity on growth and adult body size, the feeding performance of the tropical stag beetle Aegus chelifer MacLeay (Coleoptera: Lucanidae), which is widely distributed in Southeast Asia, was investigated by rearing larvae with different food quantities. Apparent digestibility was approximately 9%, and the efficiency of conversion of ingested food ranged from 0.7% to 1.7%. Feeding period, total food consumption, and adult body size significantly increased alongside food quantity. Males had higher consumption rates than females did at the same larval weight due to shorter food retention time. Males showed greater variation in feeding, growth performance, and adult body size than females. Differences in feeding performance that depend on food availability may enhance their fitness and may further result in sexual differences and adult body size variation.

Sea-Surface Slicks and Their Effect on the Concentration of Plastics and Zooplankton in the Coastal Waters of Rapa Nui (Easter Island)

The abundance and distribution of plastic debris at the sea surface shows considerable variability over different spatial scales. Some of the oceanographic processes at small (<1 km) and submeso (1–10 km) scales manifest themselves as slicks at the sea surface, which might have the potential to concentrate organisms and particles (such as positively buoyant plastics), putting species that feed in these areas at risk of ingesting plastics. Slicks can be filaments, lines, meanders, or patches, which are lighter in color and smoother in surface roughness compared to the surrounding area. Here we tested the hypothesis that passive particles (including plastics) and organisms are aggregated in the surface waters within these slicks. According to their main features (orientation to coast and/or wind), the studied slicks were most likely generated by oceanographic processes such as topographically controlled fronts, other types of fronts and internal waves. Neuston samples were collected from the sea surface inside and outside of slicks (n = 11 sites with slicks) in the coastal waters of Rapa Nui (Easter Island) during two campaigns in austral summer (January 2018) and autumn (April 2019). In general, passive particles, including plastics, exuviae, eggs and foraminiferans, were found more frequently inside than outside the slicks. In some cases, motile zooplankton organisms such as chaetognaths, vertically migrating crustaceans and early developmental stages (EDS) of fish were also more common within the slicks. In addition, a positive relationship was found between plastics and planktonic organisms such as foraminiferans, snails and jellyfish (e.g., Velella velella), although a strong correlation was also found with fish EDS and chaetognaths. These results suggest that surface slicks are areas of aggregation for both passive particles and active organisms, thus playing an important ecological role in food retention and particle concentration where the risk of plastic ingestion by fish and seabirds is enhanced.

Surgical extraction of the impacted mandibular third molar: Vestibular bone window technique

Introduction. Surgical extraction of impacted mandibular third molar can lead to the periodontal defect on distal aspect of the mandibular second molar causing pocket formation, tooth sensitivity, food retention, postoperative infections. Different surgical techniques have been proposed to reduce periodontal complications. Case Outline. We presented five cases treated with Vestibular Bone Window Technique. Considering data from the literature review, benefits and limitations of the technique are discussed and compared to the Standard Surgical Technique. Conclusion. Vestibular Bone Window Technique might be recommended surgical procedure for the extraction of impacted mandibular third molar when bucco-distal bone wall is present preoperatively. Taking into account only five cases, future work should consider a randomized clinical trial with the larger stratified samples.

The Historical Views on the Disease Name, Etiology and Pathogenesis for Gastroesophageal Reflux Disease in Traditional Chinese Medicine with Combined Knowledge Graph and Qualitative analysis

Background To clarify the historical views on disease name, etiology and pathogenesis for Gastroesophageal reflux disease (GERD) in ancient Traditional Chinese Medicine (TCM). Methods A comprehensive literature search was performed in < Zhong Hua Yi Dian > database with keywords ‘Acid regurgitation’, ‘Epigastric upset’ and ‘Bilious vomiting’. All the information about disease names, etiology and pathogenesis were included and extracted by two independent reviewers. The Citespace software was used for data analysis. After data importing and purging, the analysis was performed in two steps with 1000 years interval. This study mainly used descriptive statistics, co-occurrence analysis, and cluster analysis, accompanied with qualitative analysis. Results A total of 187 disease name, 286 etiology and 429 pathogenesis records related to GERD were final identified. The authors and bibliographies co-occurrence analysis showed there were 13 main nodes and 6 lines before 1000 A.D., 151 nodes and 65 lines after 1000 A.D.. As for disease name, ‘Ou Ku’ and ‘Ou Dan’, the earliest names related to GERD in TCM appeared in the Han and Jin dynasties. In disease etiology analysis, 8 nodes appeared during 1-1000 A.D. and increased rapidly until 1900 A.D.; the cluster analysis identified 9 research hotspots which contains Internal injury diet, Pathogenic factor of gallbladder, Internal injury due to emotional disorder, Food retention, Heat stagnation of body fluid, Incoordination between the spleen and stomach, Damp-heat syndrome of stomach, Phlegm-fire, Cold evil invading the stomach. As for disease pathogenesis, the earliest explanation ‘the evil in gallbladder and ascendant rising of stomach qi’ was appeared in the 3rd century; the cluster analysis identified 8 research hotspots which contains Spleen qi deficiency and adverse rising of phlegm and fluid retention, Pathogenic factor invading upper-jiao, Heat stagnation of body fluid at lung and stomach, Insufficiency-cold of middle qi, Phlegm moving due to fire, Phlegm and fluid retention in upper-jiao and cold food retention of stomach, Sufficient wood and insufficient soil, Food retention of middle-jiao. Conclusions There are many treatises focused on GERD related symptoms and signs in TCM. This study clarified its name, etiology and pathogenesis, which provides a good reference for further theoretical and clinical research.

Dietary modifications achieved successful resolution of symptoms of gastroparesis diagnosed by demonstrating gastric food retention after overnight fasting in diabetic dialysis patients: two case reports with literature review

Background Gastroparesis is frequently overlooked and difficult to treat. The diagnosis of gastroparesis requires standard upper gastrointestinal endoscopy to exclude gastric outlet obstruction and objective evidence demonstrating delayed gastric emptying. However, none of the internationally recommended methods for measuring gastric emptying including scintigraphy are covered by the Japanese health insurance system. Limitations in the diagnosis might be related to the disease being overlooked in Japan. Meanwhile, presence of retained food in the stomach after overnight fasting without obstruction is classically known to be suggestive of gastroparesis. Some recent reports have considered gastric food retention after an overnight fasting equivalent to delayed gastric emptying. Case presentation Two diabetic dialysis patients presented with nausea, vomiting, and oral feeding intolerance in the absence of mechanical obstruction. Abdominal computed tomography, upper gastrointestinal endoscopy, and ultrasonography demonstrated gastric food retention after overnight fasting. The findings led to the diagnosis of gastroparesis. Appropriate dietary modifications alone successfully relieved the symptoms despite persistent delayed gastric emptying. Conclusions Demonstrating retained food residue after fasting for sufficient duration might be a diagnostic alternative. Dietary modifications alone provided significant clinical benefits. Possible approaches for the diagnosis and treatment of gastroparesis in Japan should be investigated.

Molecular Functionality of Plant Proteins from Low- to High-Solid Systems with Ligand and Co-Solute

In the food industry, proteins are regarded as multifunctional systems whose bioactive hetero-polymeric properties are affected by physicochemical interactions with the surrounding components in formulations. Due to their nutritional value, plant proteins are increasingly considered by the new product developer to provide three-dimensional assemblies of required structure, texture, solubility and interfacial/bulk stability with physical, chemical or enzymatic treatment. This molecular flexibility allows them to form systems for the preservation of fresh food, retention of good nutrition and interaction with a range of microconstituents. While, animal- and milk-based proteins have been widely discussed in the literature, the role of plant proteins in the development of functional foods with enhanced nutritional profile and targeted physiological effects can be further explored. This review aims to look into the molecular functionality of plant proteins in relation to the transport of bioactive ingredients and interaction with other ligands and proteins. In doing so, it will consider preparations from low- to high-solids and the effect of structural transformation via gelation, phase separation and vitrification on protein functionality as a delivery vehicle or heterologous complex. Applications for the design of novel functional foods and nutraceuticals will also be discussed.