We analyze the impact of the rotation law on equilibrium sequences of relativistic differentially-rotating neutron stars in axisymmetry. The maximum allowed mass for each model is strongly affected ...by the distribution of the angular velocity in the radial direction and by the consequent degree of differential rotation. To study the wide parameter space implied by the choice of the rotation law, we introduce a functional form that generalizes the so-called “j-const. law” adopted in all previous work. We compute equilibrium sequences of differentially rotating stars with a polytropic equation of state starting from the spherically symmetric static case. By analyzing the sequences with decreasing degrees of differential rotation, we find that the maximum value of the ratio T/|W| of rotational kinetic energy to gravitational binding energy, is substantially limited in these cases to a value of 0.128.
Patients with irritable bowel syndrome (IBS) often associate their symptoms to certain foods. In congenital sucrase-isomaltase deficiency (CSID), recessive mutations in the SI gene (coding for the ...disaccharidase digesting sucrose and 60% of dietary starch)1 cause clinical features of IBS through colonic accumulation of undigested carbohydrates, triggering bowel symptoms.2 Hence, in a previous study,3 we hypothesized that CSID variants reducing SI enzymatic activity may contribute to development of IBS symptoms. We detected association with increased risk of IBS for 4 rare loss-of-function variants typically found in (homozygous) CSID patients, because carriers (heterozygous) of these rare variants were more common in patients than in controls.1,4 Through a 2-step computational and experimental strategy, the present study aimed to determine whether other (dys-)functional SI variants are associated with risk of IBS in addition to known CSID mutations. We first aimed to identify all SI rare pathogenic variants (SI-RPVs) on the basis of integrated Mendelian Clinically Applicable Pathogenicity (M-CAP) and Combined Annotation Dependent Depletion (CADD) predictive (clinically relevant) scores; next, we inspected genotype data currently available for 2207 IBS patients from a large ongoing project to compare SI-RPV case frequencies with ethnically matched population frequencies from the Exome Aggregation Consortium (ExAC).
Background
High‐resolution manometry (HRM) provides information on esophagogastric junction (EGJ) morphology, distinguishing three different subtypes. Data on the correlation between EGJ subtypes and ...impedance‐pH detected reflux patterns are lacking. We aimed to correlate the EGJ subtypes with impedance‐pH findings in patients with reflux symptoms.
Methods
Consecutive patients with suspected gastroesophageal reflux disease (GERD) were enrolled. All patients underwent HRM and impedance‐pH testing off‐therapy. EGJ was classified as: Type I, no separation between the lower esophageal sphincter (LES) and crural diaphragm (CD); Type II, minimal separation (>1 and <2 cm); Type III, ≥2 cm separation. We measured esophageal acid exposure time (AET), number of total reflux episodes and symptom association analysis.
Key Results
We enrolled 130 consecutive patients and identified 46.2% Type I EGJ, 38.5% Type II, and 15.4% Type III patients. Type III subjects had a higher number of reflux episodes (61 vs 45, p < 0.03, vs 25, p < 0.001), a greater mean AET (12.4 vs 4.2, p < 0.02, vs 1.5, p < 0.001) and a greater positive symptom association (75% vs 72%, p = 0.732 vs 43.3%, p < 0.02) compared with Type II and I patients, respectively. Furthermore, Type II subjects showed statistically significant (overall p < 0.01) increased reflux when compared with Type I patients. Type III and II EGJ morphologies had a more frequent probability to show a positive multichannel intraluminal impedance pH monitoring than Type I (95% vs 84% vs 50%, p < 0.001).
Conclusions & Inferences
Increasing separation between LES and CD can cause a gradual and significant increase in reflux. EGJ morphology may be useful to estimate an abnormal impedance‐pH testing in GERD patients.
Esophagogastric junction (EGJ) morphology can play an important role in defense mechanism against reflux. Defining EGJ morphology with high‐resolution manometry (HRM) may be useful to predict an abnormal impedance‐pH testing in GERD. This study aims to establish a correlation between EGJ subtypes and different reflux parameters, detected during impedance‐pH monitoring in GERD patients. EGJ morphology is depicted at HRM by evaluating the position of lower esophageal sphincter (LES) and crural diaphragm (CD). EGJ subtypes are classified as: Type I, no separation detectable between LES and CD; Type II, presence of minimal separation (>1 and <2 cm) between LES and CD; Type III, presence of separation ≥2 cm. Reflux parameters determined at impedance‐pH monitoring are total number of reflux, total esophageal acid exposure time (AET) and symptom‐reflux events association analysis. Our findings demonstrated that a gradual and significant increase in terms of esophageal AET, total number of reflux episodes and positive reflux‐symptom association are observed when the separation between LES and CD becomes wider (Type II and III EGJ morphology). EGJ morphology may be useful to estimate an abnormal impedance‐pH testing in patients with reflux symptoms. However, reflux monitoring remains mandatory to confirm the diagnosis of GERD.
Summary
Background
Little is known about the relationship between proton pump inhibitor‐responsive oesophageal eosinophilia (PPI‐REE), eosinophilic esophagitis (EoE) and gastro‐oesophageal reflux ...disease (GERD).
Aim
To compare high resolution manometry features and symptom profiles of patients with EoE, PPI‐REE and GERD.
Methods
Consecutive patients diagnosed with EoE or PPI‐REE according to international criteria (presence of at least one typical symptom of oesophageal dysfunction; at least 15 eosinophils per high‐power field at mid/proximal oesophagus, persistence or resolution of eosinophils after an 8‐week PPI trial), and a group of patients with proven GERD and oesophageal eosinophilia, prospectively completed the GerdQ questionnaire and underwent high resolution manometry.
Results
Thirty‐five patients with EoE, 17 with PPI‐REE and 27 with GERD were enrolled. When compared to GERD, both EoE and PPI‐REE had higher rates of dysphagia (15% vs. 94% vs. 88%, P < 0.0001), patients with EoE reported heartburn and regurgitation less frequently (26% vs. 85%, and 17% vs. 74%, respectively; P < 0.001 for each and had lower GerdQ score 1 (0–6) vs. 8 (6–12), P < 0.001 than GERD patients. There was no significant difference comparing PPI‐REE and GERD patients. Patients with PPI‐REE had a higher prevalence of erosive oesophagitis than patients with EoE (35% vs. 9%, P = 0.04), which was similar to that of GERD (48%, P = 0.54). Patients with EoE had a lower frequency of high resolution manometry features associated with GERD than patients with PPI‐REE. There was no significant difference between PPI‐REE and GERD patients.
Conclusion
GERD, as assessed by GerdQ and high resolution manometry is common in patients with PPI‐REE, which may share similar pathogenic mechanisms.
Pelvic floor rehabilitation is frequently recommended for defecation disorders, in both constipation and fecal incontinence. However, the lack of patient selection, together with the variety of ...rehabilitation methods and protocols, often jeopardize the results of this approach, causing difficulty in evaluating outcomes and addressing proper management, and above all, in obtaining scientific evidence for the efficacy of these methods for specific indications. The authors represent different gastroenterological and surgical scientific societies in Italy, and their aim was to identify the indications and agree on treatment protocols for pelvic floor rehabilitation of patients with defecation disorders. This was achieved by means of a modified Delphi method, utilizing a working team (10 members) which developed the statements and a consensus group (15 members, different from the previous ones) which voted twice also suggesting modifications of the statements.
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