Expert review of gastroenterology & hepatology
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The practice of sedation for digestive endoscopy continues to evolve throughout the world. In many countries, there is a trend for increased utilization of sedation during routine endoscopic procedures. Sedation improves patient satisfaction with endoscopy and the willingness to comply with screening guidelines and it improves the quality of examination. ⋯ Controversy regarding the feasibility of endoscopist-directed propofol administration continues, in spite of overwhelming evidence supporting this practice. In the USA, recent revisions in policy by the Centers for Medicare and Medicaid Services may threaten the practice of endoscopist-directed propofol administration. In this article, future trends in sedation practice, including fospropofol and computer-assisted personalized sedation, are discussed.
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Expert Rev Gastroenterol Hepatol · Aug 2010
Multicenter StudyThe proton pump inhibitor test and the diagnosis of gastroesophageal reflux disease.
There continues to be significant controversy related to diagnostic testing for gastroesophageal reflux disease (GERD). Symptoms of GERD may be associated with physiologic esophageal acid exposure measured by intraesophageal pH monitoring or pH-impedance monitoring, and a significant percentage of patients with abnormal esophageal acid (or weak acid) exposure have no or minimal clinical symptoms of reflux. On the other hand, endoscopic lesions are only present in a minority of GERD patients. ⋯ In conclusion, the PPI test is a sensitive but less specific test. Its optimal duration is 1 week, and the optimal cutoff value is a decrease of heartburn score of more than 75%. NERD patients respond less satisfactorily to PPIs, even when functional heartburn patients are excluded and only 'true' NERD patients are considered.