Background and Aims: Optimal bowel preparation before capsule endoscopy (CE) is currently unknown. In this multicenter, blinded, randomized controlled trial, we assessed clinical effectiveness of 2 types of purgative regimen and a control arm of clear fluid only. Methods: Patients with suspected small intestinal bleeding were randomized into 3 arms: arm A, clear fluids only for 18 hours before CE and simethicone 200 mg in 150 mL water immediately before CE; arm B, same as A + 2 L of polyethylene glycol (PEG) 12 hours before CE; and arm C, same as A + 1 L PEG + sodium ascorbate 3 hours before CE. To assess diagnostic yield, lesions were classified either as highly relevant (P2) or less relevant (P0 or P1) lesions. Small-bowel visualization quality (SBVQ) was assessed using the Brotz score. Patient tolerability was assessed using the visual analog scale (0-10, with lower scores indicating better tolerability). Results: Two hundred twenty-nine patients completed the study. The mean age was 58.7 years (95% confidence interval, 29.3-87.9), and 47.2% were men. There was no significant difference in diagnosis of P2 lesions in arms A, B, and C (48.7%, 48.0%, and 45.9%, respectively; P=.94). Overall SBVQ and distal SBVQ were similar across the 3 arms (P =.94 and P =.68, respectively). Patients reported better tolerability in arm A (mean score, 1.5) compared with arms B and C (mean score, 3.5 and 2.6, respectively; P <.001). Conclusions: The use of a purgative bowel preparation before CE does not improve diagnostic yield or smallbowel visualization and is associated with lower patient tolerance.

Background Thickening of the esophageal wall in patients with eosinophilic esophagitis (EoE) and gastro-esophageal reflux disease (GERD) has been shown in studies using endoscopic ultrasound (EUS). We hypothesise that transmural inflammation in EoE results in prominent esophageal wall thickening compared with the mucosal inflammation in GERD. The aim of this study was to compare the relationship among dysphagia, endoscopic appearance, wall thickness, histology, and motility in EoE and GORD. Methods EoE and GERD patients were prospectively studied between February 2012 and April 2021. Patients were studied on 2 separate occasions with endoscopy, EUS and mucosal biopsies, followed by high-resolution manometry. Epidemiology and dysphagia data were obtained. Results A total of 45 patients (31 EoE, 14 GERD) were included. There were no significant differences in age, sex, duration of disease and presence of esophageal motility disorders. EoE patients had a higher dysphagia score (P < 0.001), EREFS score (P < 0.001) and peak eosinophil count (P < 0.001) compared with GERD patients. Thickness of the submucosa in the distal esophagus in EoE was significantly higher than GERD (P = 0.003) and positively correlated with duration of disease (P = 0.01, R = 0.67). Positive correlation was also found between dysphagia score and distal total esophageal wall thickness (P = 0.03, R = 0.39) in EoE patients. No correlation was found between these variables in GERD patients. Conclusion Distal esophageal wall thickness positively correlates with dysphagia score in EoE but not GERD. This appears to be related to the composition of the submucosa which can be identified using EUS.

Mehul Lamba: NO financial relationship with a commercial interest | Kimberley Ryan: NO financial relationship with a commercial interest | Jason Hwang: NO financial relationship with a commercial interest | Florian Grimpen: NO financial relationship with a commercial interest | Gary Lim: NO financial relationship with a commercial interest | Dale Cornelius: NO financial relationship with a commercial interest | Alan Moss: YES financial relationship with a commercial interest;Janssen:Consulting;Pfizer:Consulting | Eu Jin Lim: NO financial relationship with a commercial interest | Gregor Brown: NO financial relationship with a commercial interest | Nam Nguyen: NO financial relationship with a commercial interest | Marcus Tippett: NO financial relationship with a commercial interest | Andrew Taylor: NO financial relationship with a commercial interest | Mark Appleyard: NO financial relationship with a commercial interest

Purpose: To compare GI symptoms, measures of generic and disease specific health related quality of life (HRQoL), anorectal and pudendal nerve function and anal sphincter morphology between (i) patients 2 years after 3D conformal radiotherapy (3D-CRT)high dose rate (HDR) brachytherapy for carcinoma of the prostate and aged matched patients before radiotherapy and (ii) symptomatic and asymptomatic patients 2 years after 3D-CRTHDR brachytherapy.Material and methods: Methodology included: (i) modified LENT-SOMA scales for GI symptoms, (ii) EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires for generic and disease specific HRQoL, (iii) anorectal manometry and terminal motor latency for anorectal and pudendal nerve function and (iv) endorectal ultrasound for anal sphincter morphology. GI symptoms, parameters of HRQoL, anorectal and pudendal nerve function and anal sphincter morphology were compared using Mann-Whitney's U, unpaired t and (2) tests.Results: Impairment of HRQoL bowel symptoms in the patients 2 years after 3D-CRT +/- HDR brachytherapy was associated with worse anorectal motor and sensory function, internal and external anal sphincter morphology and 5x greater prevalence of pudendal nerve dysfunction compared with age matched patients before radiotherapy. Symptomatic patients had worse (i) HRQoL measures including global quality of life and bowel and urinary symptom scores, (ii) rectal bleeding, fecal urgency and incontinence scores and (iii) a 2x higher prevalence of pudendal nerve dysfunction compared with asymptomatic patients.Rectal and anal (i) V 40Gy >65%, (ii) Dmax >60Gy, (iii) pudendal nerve Dmax >60Gy and (iv) Anal V 60Gy >40% were associated with a greater prevalence of pudendal nerve dysfunction.Conclusions: 3D-CRT +/- HDR brachytherapy for prostate carcinoma, impairs late functional measures including HRQoL, anorectal and pudendal nerve function. Rectal, anal and pudendal nerve radiation dose constraints are proposed for reducing the prevalence of pudendal nerve dysfunction.

Although capsule endoscopy (CE) has proven to be superior to all of the diagnostic modalities in the evaluation of obscure gastrointestinal (GI) bleeding, it has no ability to obtain histology or to perform endoscopic interventions. Single balloon enteroscopy (SBE), on the other hand, has excellent therapeutic capacity but lower diagnostic yield given the success rate for retrograde approach is between 20-30%. Data on the outcomes of combined use of ante-grade SBE and CE for obscure GI bleeding in a single session are lacking.

with refractory non-erosive gastroesophageal reflux disease were assessed by multichannel intraluminal impedance and pH monitoring, with mucosal integrity assessed by measuring basal esophageal mucosal impedance at channel 3. Biopsy samples were taken from esophageal mucosae covering the esophageal body and lower esophageal sphincter.Real-time RT-PCR was performed to assess the expression of PARs 1, 2, 3 and 4. Results: For esophageal motility function, DCI was 2991.0±711.5 mmHg (n=13), and BLESP was 30.6±2.8 mmHg (n=21).DCI was not measured in eight patients because of achalasia and absent peristalsis.By multivariate regression analysis, both PAR1 and PAR2 were negatively associated with DCI (P=0.0030 and P=0.0038, respectively), while no PARs were associated with BLESP.In contrast, for esophageal mucosal integrity, the base line impedance was 2250±203.5V (n=19).Multivariate regression analysis revealed that PAR1 was negatively associated with basal mucosal impedance (P=0.0012).Conclusions: Esophageal-expressed PARs are significantly associated with esophageal function.PARs 1 and 2 possibly play a role in reduced esophageal body contractility, affecting esophageal clearance.PAR1 may be involved in impaired mucosal integrity, which affects the mucosal barrier function.PARs could be a therapeutic target for esophageal motility disorders and GERD.

OBJECTIVES:Esophageal wave amplitude is an important determinant of esophageal clearance. A threshold of 30 mmHg is widely accepted as the threshold for effective clearance in the distal esophagus. However, the precise relationship between wave amplitude and clearance has received relatively little attention. The aim of this study was to assess the impact of peristaltic wave amplitude on esophageal volume clearance using multiple intraluminal impedance (MII) measurement. METHODS:Concurrent manometry and MII were performed on 42 healthy asymptomatic volunteers and 13 patients with ineffective esophageal motility. Esophageal motility was measured at four sites 5-cm apart, starting 2 cm above the lower esophageal sphincter. MII was measured at corresponding sites with electrodes incorporated into the manometric assembly. Ten 5-mL liquid (saline) boluses and ten 5-mL low impedance viscous boluses were tested in each subject. Pressure wave amplitude was determined at each site as well as peristaltic success of the responses. Bolus clearance was measured from individual recording segment and from the esophagus as a whole. RESULTS:The proportion of liquid boluses cleared at each site was directly related to wave amplitude and did not increase significantly above a threshold of 25 mmHg in the proximal esophagus, 22 mmHg in the mid-esophagus, and 30 mmHg in the distal esophagus. Corresponding wave amplitudes for total esophageal clearance were 35-40 mmHg. There was a good correlation between the wave amplitude at one site of the esophagus and those of the rest of the esophagus. For both liquid and viscous boluses, the likelihood of impaired clearance was directly related to the number of segments with hypotensive pressure waves. CONCLUSION:The findings confirm the validity of the wave amplitude threshold required for effective liquid bolus clearance and have established the amplitude threshold for clearance of viscous boluses. However, the number of hypotensive pressure waves required for the definition of ineffective motility may be too low.