Monday, April 7, 7:30 - 9:50 a.m. - Room Camille Blanc

Inflammation in the esophagus

Q. Aziz (UK)  -  P. Biancani (USA)
Discussant: Ch. Knowles (UK)

Are the reflux patterns different in NERD and GERD? J. Behar (Providence)

Which GER episodes are associated with symptoms? R. Tutuian (Zürich)   

What happens to the permeability of esophageal mucosa in NERD & GERD and what are the mechanisms of reflux-induced increased permeability in esophageal epithelium? R.C. Orlando (Chapel Hill)

Besides acid, are there other stimuli that can cause increase in the permeability and dilated intracellular spaces in the esophageal mucosa? D. Sifrim (Leuven)

What are the sites of acid-induced upregulation of nociceptors? Q. Aziz (London)

Can one visualize nociceptor in the esophagus and what are their properties? M. Kollarik (Baltimore)  

What are the neuro-physiological techniques that allow understanding of the visceral sensitivity and hypersensitivity in GERD patients? A.M. Drews (Aalborg)

Are there specific receptors in the esophagus that induce heartburn and chest pain? A. Hobson (Harlow)

Is there a difference in nociceptors in the esophageal mucosa of normal controls and of GERD or NERD patients? M. Guarino (Rome)

Is there a CNS representation of gastro-esophageal reflux? Y. Taché ( Los Angeles)

What is the effect of Barrett’s metaplasia on the pain perception? L.L. Swanström (Portland)

Are there neural nociceptors in the esophageal mucosa? C.H. Knowles (London)

Are non neural as well as neural nociceptors present in the esophageal mucosa? How are they activated? Do they produce inflammatory mediators? K.M. Harnett (Providence)

Do vanilloid receptors contribute to acid-induced esophageal inflammation? K.S. Dua  (Milwaukee)

What are the immune cell-related inflammatory mediators? E.H. Metman  (Tours)

Can the involvement of the muscle layer in production of inflammatory mediators be specified? P. Biancani (Providence)

Does oxidative stress contribute to progression of Barrett's esophagus to adenocarcinoma? H. Piazuelo (Zaragoza)  

What is the role of Hydrogen peroxide produced by NADPH oxidase in the Barrett’s epithelial cells? W. Cao (Providence)

What is the significance of eosinophils and other immune cells in the esophageal mucosa? G. Falk (Cleveland)  

How much do we know today on the cellular and molecular mechanisms of healing esophageal injury? A.S. Tarnawski (Los Angeles)

     


Monday, April 7, 10:10 a.m. - 12:30 p.m. - Room Camille Blanc

Non-acid reflux, and the changing paradigm of GERD

D.O. Castell (USA)  -  D. Sifrim (Belgium)
Discussant:  W.M. Weinstein (USA)
What is the composition of the so-called "non-acid" reflux? F. Pace (Milan)
Is there a correlation between suppression of reflux symptoms and correction of acid reflux, as shown by pHmetry? M. Luostarinen (Tampere)
Should pH-only reflux episodes be considered as true reflux events? R. Tutuian (Zürich)
Is there still a role for pH only monitoring? Th. Piche (Nice)
What can be expected from MII/pH monitoring in the evaluation of non-acid reflux in GERD patients non responsive to antisecretory therapy? F. Zerbib (Bordeaux)
Should the description of the "acid pocket" lead to a change in the understanding of the pathogenesis of distal esophageal acid exposure? L.S. Miller (Philadelphia)
What is the correlation between cellular changes, as included in the histologic score, and acid exposure? M. Upton (Seattle)
Is squamous epithelium in erosive GERD different from Barrett's and NERD? A. Fiocca (Genoa)
What are the mediators of symptoms from non-acid reflux? R.K. Mittal (San Diego)
Does non-acid reflux cause extra-esophageal symptoms? P.C. Belafsky (Sacramento)
What is the correlation between the proximal extent of the refluxate and individual reflux symptoms? L.F. Johnson (Birmingham, AL)
What is the compared value of SAP (Symptom Association Probability) and SSI Symptom Sensitivity Index) in the quantification of the association between symptoms and reflux? I. Tack  (Leuwen)
How to differentiate patients with functional heartburn from NERD patients? Prakash Gyawali (St Louis)
What is the relation between the number of reflux episodes to a positive symptom association? D. Sifrim (Leuven)
What is the current evaluation of the relationship between H pylori and GERD? F. Di Mario (Parma)
In hypo-chlorhydric patients, are there other bacteria species that could account for false positive results in the diagnosis of HP infection? G. Brandi (Bologna)
What is the frequency of non-acid reflux in patients on high-dose PPIs? D.O. Castell (Charlestonl)
Should patients be taken off PPI therapy for evaluation of non-acid reflux? F. Zerbib (Bordeaux)
Does composition of non-acid reflux dictate therapy? Th. Piche (Nice)
What therapy is effective for symptomatic non-acid reflux? C. Rees (Winston Salem) 

 

     

Monday, April 7, 1:45 - 4:05 p.m. - Room Camille Blanc

Esophageal imaging: past, present, and future

C.L. Canon (USA)  -  F.I. Habib (Italy)
Discussant:  M.S. Levine (USA)
What imaging methods are available for evaluating the esophagus in 2008? F.I. Habib (Rome)
What is the value of esophagography in the evaluation of dysphagia? A. Wuttge-Hannig (Munich)
What is the radiographic approach for patients with GERD? C.D. Scheirey (Burlington)
Where is the GEJ? C.L. Canon (Birmingham, AL)

Can esophagography diagnose short esophagus? S. Mattioli (Bologna)

What is the sensitivity and specificity of fluoroscopy for identifying reflux? I. Laufer (Philadelphia)
Can esophagography differentiate GERD from infectious inflammation? M.S. Levine (Philadelphia)
What is the role of esophagography in Barrett's esophagus? P. Pokieser (Vienna)

What is the association between esophageal dysmotility and GERD with esophagography? Y. Ali (Cairo)

What can be expected from timed barium esophagogram in the assessment of patients with achalasia? L.S. Miller (Philadelphia)

How can achalasia and scleroderma be radiographic mimics? F.I. Habib (Rome)
What can be expected from esophagography for the indication of fundoplication in patients with esophageal dysmotility? H.W. Boyce (Tampa)
What can be expected from radio-isotopic esophageal transit in GERD patients with non-specific motor disorders? C. Iascone (Rome)
What is the role of esophagography in the diagnosis of esophageal cancer? P. Siersema (Utrecht)
What is the role of cross sectional imaging in the diagnosis of esophageal cancer? W.G. Lewis - C. Twine (Cardiff)
What is the compared value of endoscopic and radiographic evaluation of hiatal hernias? H.W. Boyce (Tampa)
Is EUS a useful tool in the evaluation of achalasia patients? E.H. Metman (Tours)
What are the optimal imaging studies for complications following fundoplication surgery? Ch. Hannig (Munich)
Is EUS a useful tool in following patients after fundoplication? B. Jobe (Pittsburgh)
Is there a role for impedance in the pre- and post-operative evaluation of achalasia? R.P. Tatum (Seattle)

     


Tuesday, April 8, 7:30 - 9:50 a.m. - Room Camille Blanc

Evaluation of GERD and NERD

G.W. Falk (USA)  -  J. Tack (Belgium)
Discussant:  M. Hongo (Japan)
What information can be given by computer based techniques of modelling the flow of bolus mass? A.W. Stier (Greifswald)
How to differentiate patients with NERD from those with functional heartburn or dyspepsia? V. Savarino (Genoa)
What is the role of saliva in NERD? J. Sarosiek (Kansas City)
What is the sensitivity and cost-effectiveness of endoscopy for the evaluation of GERD? J.F. Demarquay (Monaco)
What is the role of functional endoscopy for the diagnosis of NERD? I.F. Herrmann (Rome)
What is the value of magnifying endoscopy with local application of acetic acid for the detection of esophagitis? A. Hoffman (Mainz)
What is the accuracy of histology / electron microscopy for the diagnosis of NERD? S. Emerenziani (Rome)
- The value of endomicroscopy
Should pH monitoring over long periods of time (48h) help to detect the true variation of acid exposure? M. Fox (Zurich)
- What are the current indications of 16- and 12-hour pH studies?
What is the compared sensitivity of the Bravo technique and pH catheter in detecting reflux events? J.E. Pandolfino (Chicago)
- In evaluation of GERD, how to eliminate swallow-induced artefacts?
Is unsedated transnasal endoscopy the solution for mass screening in GERD patients? A. Chak (Cleveland)
What is the effect of the attachment of the wireless pH capsule on esophageal motility? C. Prakash Gyawali (St louis)
- Is endoscopy mandatory for the right placement of the wireless pH capsule?
Unsedated endoscopy: does sedation affect the result of tubeless pH monitoring? P.C. Belafsky (Los Angeles)
The mystery of overlap: can pH monitoring differentiate between various GERD groups? V. Savarino (Genoa)
- What is the rate of overlap of esophageal acid exposure in NERD and SSBE patients?
Should combined MII/pH esophageal monitoring be considered as the best way for the evaluation of patients with GERD symptoms? A. Taddei (Florence)
- Is there a role for Bilitec monitoring in NERD?
What are the indications of MII/pH monitoring in pediatric GERD? S.R. Jadcherla (Columbus)
What is the specific value of high resolution manometry to identify the functionally important aspects of esophageal motor activity in GERD patients? M. Fox (Zurich)
What can be expected from narrow-band imaging in the diagnosis of GERD and Barrett's esophagus? H.C. Wolfsen (Jacksonville)
Is there a proven relationship between HP and NERD? M. Cicala (Rome)
In patients with NERD, is there a risk of mis-classification due to healing of previously unknown esophagitis? V. Savarino (Genoa)
What is the rate of evolution of NERD to erosive esophagitis? F. Pace (Milan)

     


Tuesday, April 8, 10:10 a.m. - 12:30 p.m. - Room Camille Blanc

Defence mechanisms against supra-esophageal complications of reflux disease

R. Shaker (USA)  -  R.C. Orlando (USA)
Discussant:  N. Tobey (USA)
Are neural connections between the motor nucleus of the vagus and the crural diaphragm to play a role in the AR barrier? E. Bardan  (Hashomer)
- Do inhibitory reflexes of the aero-digestive tract and esophagus promote reflux?
Can interplay between physiology and mechanics in the function and dysfunction of the pharyngo-esophageal and gastro-esophageal segments be specified? J.G. Brasseur (University Park)
What information on acid contact during sleep can be given by studies on animal models? L.F. Johnson (Birmingham AL)
What is the importance of sleep-related GER in the pathogenesis of esophagitis? K.S. Dua (Milwaukee)
What is the effect of stimulation of "pharyngeal swallows" during sleep? B. Martin-Harris (Charleston)

What are the causes of the prolongation of acid clearance during sleep? L.F. Johnson (Birmingham, AL)
What is the role of impedance in determination of high reflux? Is it preferable to pharyngeal pH? D.O. Castell (Charleston)

How does sleep stage affect sphincter reflex and secondary peristalsis in reflux patients? A.M. Drewes (Aalborg)
What is the role of silent GERD in the explanation of sleep complaints? J. Galli (Rome)
Are the mechanisms preventing retrograde aspiration clearly identified in patients with supra-esophageal complications of GERD? K.S. Dua (Milwaukee)
What are the modifications of the UES function during GERD? R.K. Mittal (San Diego)
What are the glottal muscles involved in the esophago-glottal closure reflex? R.K. Mittal (San Diego)
 
What are the underlying causes (impaired protective reflexes, mucosal sensory deficits, reduced mucosal protection) of esophago-pharyngeal reflux? J.H. Blumin (Milwaukee)
What is the effect of phonation on upper GI tract and UES? B. Martin-Harris (Charleston)
What are the clinical implications of the pharyngo-UES contractile reflex in GERD patients? J.H. Blumin (Milwaukee)

Are there specific symptoms or physical findings allowing for the diagnosis of reflux to the laryngo-pharynx? P.C. Belafsky (Los Angeles)
What is the relationship of GERD to the development of Idiopathic Pulmonary Fibrosis? G. Raghu  (Seattle) 

What is the role of pharyngeal reflux in the pathogenesis of sinusitis/otitis in adults? I. Herrmann (Rome)
Should nocturnal acid breakthrough be considered as a substantial risk factor for night-time GER? R.H. Hunt (Hamilton)

Is bedtime dosing with immediate-release PPIs an effective strategy in patients with night-time heartburn? C. Scarpignato (Parma)

     


Tuesday, April 8, 1:45 - 4:05 p.m. - Room Camille Blanc

Extra-esophageal manifestations of GERD Clinical evaluation and diagnosis

I.F. Herrmann (Italy)  -  I.J.S. Cook (Australia)
Discussanst:  P.C. Belafsky (USA) – J. Allen (USA)
What is the functional relationship between upper GI and respiratory tracts? S. Harding (Birmingham AL)
What is the rate of chronic obstructive pulmonary disease in patients with GERD?
A.H. Morice (Cottingham)
Zhong Gao Wang (Beijing)
What is the frequency of chronic laryngitis and globus sensation associated with acid reflux? C.J. Rees (Winston Salem)
What is the role of gas reflux in ENT manifestations of GERD? A.J.P.M. Smout (Utrecht)
What is the correlation between reflux suppression and improvement of symptoms of laryngo-pharyngeal reflux? J.H. Blumin (Milwaukee)
What is the respective role of micro-aspirations and vagally mediated events in atypical symptoms of GERD? Susan Meltzer (Baltimore)

How to ascertain the relationship between chronic cough and reflux? A.H. Morice (Cottingham)
Can the etiologic relationship between GERD and cough in children be assessed? B. Bizzari (Rome)
What is the rate of esophagitis in children with cough and symptoms of GER? D. Thompson (Cincinnati)      
        
What is the rate of esophagitis in adult patients with atypical GERD? C.J. Rees (Winston Salem)
What is the compared threshold of culture on broncho-alveolar lavage for bronchitis and pneumonia in children with cough? M. Fayon (Bordeaux)
How can a cause-effect relationship between GER and asthma be shown? J.L. Mathew  (New Delhi)

Can true incidence of GER in asthmatic adults be evaluated? Susan Meltzer (Baltimore)
Is there a relationship between aspiration of gastric contents and airway neutrophilia? S. Harding (Birmingham)
Can asthma medications promote GER? S. Harding (Birmingham, AL)
What are the means of selection of patients with atypical GERD to diagnostic or empiric therapy? S. Achem (Jacksonville)
- How should empiric therapy be conducted?
Are there indications for surgery in patients with atypical GERD unresponsive to PPI therapy? R. Tutuian (Zurich)
What is the role of non-acid reflux in patients with atypical symptoms non responsive to acid suppression? J.E. Richter (Philadelphia)
Is impedance-pH monitoring the best way to exclude GERD as a cause in patients with atypical symptoms? S Emerenziani (Rome)
Can over-diagnosis of GERD be avoided in patients with atypical symptoms? R. Dantas (Sao Paulo)

     


Wednesday, April 9, 7:30 - 9:50 a.m. - Room Camille Blanc

Surgical treatment of GERD

B. Gayet (France)  -  L.L. Swanström (USA)
Discussant:  R.P. Tatum (USA)
How should selection of patients for anti-reflux surgery be made after failure of PPIs? W. N. Felix (Sao Paulo)
- Is response to fundoplication dependent on medical response to PPIs?
Should the indications for ARS be based on a positive SAP (Symptom Association Probability) and impedance documented GER? A.P.J.M. Smout (Utrecht)
How should the importance of impaired esophageal motility be considered for the choice of the anti-reflux procedure? H. Van der Walt (Pretoria)
- What is the outcome of ARS with aperistaltic esophagus?
Is delayed gastric emptying a contra-indication for ARS? R.W. McCallum (Kansas City)

What is the influence of pre-operative esophagitis on the outcome of ARS?
P. Omelanczuk (Mendoza)
- What are the predictive factors of the surgical outcome of ARS in NERD?
Nissen + hyper-selective vagotomy: a new ARS to overcome concerns about long term outcome of Nissen? R.W. McCallum (Kansas City)

What is the best attitude to adopt when a shortened esophagus is recognized during surgery? J. Salo (Helsinki)
What are the long-term results of the partial anterior fundoplication? S. Contini (Parma)

What is the effect of pre-operative existence of diffuse non-GERD symptoms (bloating, abdominal crampy pain, IBS) on the results of surgery? B.K. Oelschlager (Seattle)
Can a permanent anti-reflux barrier be expected after classic ARS, and what are the indications of duodenal diversion? I. Braghetto (Santiago)
Is there a place for robotic fundoplication in ARS? K. Kernstine (Duarte)
What is the relationship between the effect of the various AR procedures on the triggering of TLESRs and the clinical efficacy of the procedure? R.P. Tatum (Seattle)
Does fundoplication affect esophageal motor function? T.C.B. Dehn (Reading)

What can be expected from gastric electrical stimulation in the treatment of post-vagotomy gastroparesis occurring after Nissen fundoplication? R.W. McCallum (Kansas City)
What is the proportion of NERD patients experiencing reflux symptoms after ARS? L. Bonavina (Milan)
- What is the origin of these symptoms (hyper-sensitivity?)
What is the rate of drug consumption after ARS? C. Scarpignato (Parme)
What are the results of ARS on the evolution of Barrett's esophagus? Why does Barrett's esophagus progress after  surgery in some patients? (persistent reflux? genetic issues?) A.H. Hölscher (Cologne)
When is esophageal resection mandatory in benign GERD? E. Sihvo (Helsinki)
How should the non-correlation between ARS in children and histological improvement be interpreted? R.D. Odze (Boston)   
        

What is the balance between surgery and medical therapy in young patients with chronic GERD? H.L. Waldum (Trondheim)

     


Wednesday, April 9, 10:10 a.m. - 12:30 p.m. - Room Camille Blanc

GERD, Adenocarcinoma, and Genetics

S.J. Meltzer (USA)  -  P. Hainaut (France)
Discussant:  Y. Romero (USA)
Can GERD be considered as inherited? G. Singh (Stanford)
Is there evidence of implication of genetic factors in the etiology of GERD? M. Imtiyaz (West Bromwich)
What is currently known about a gene for pediatric reflux existing on chromosome 13? B. Asling (Gothenburg)
May genetic differences explain the geographical variations observed in the frequency of GERD, and its lower prevalence in Asia? M. Kusano (Maebashi)
What is the role of genetic predisposition in the development of Barrett's esophagus? A. Chak (Cleveland)
Can genetic markers help in the identification of Barrett patients at risk for cancer, and likely to respond best to mucosal resection? K.K. Krishnadath (Amsterdam)
Is there a difference between medical and surgical therapy in terms of progression of Barrett's esophagus to dysplasia and adeno-carcinoma? A. Lanas (Zaragoza)
What is the link between acid exposure, cellular proliferation, and columnar differentiation?  G. Triadafilopoulos (Stanford)
What is the efficacy of new Cox2 inhibitors for the regression of Barrett's dysplasia? S.J. Meltzer (Baltimore)
- Can the protective effect of NSAIDS on the development of adenocarcinomas in Barrett's esophagus be ascertained?
Can genetic examination of neoplastic lesions on Barrett's esophagus support the dysplasia-carcinoma sequence? R. Fiocca (Genoa)

What is the potential value of direct analysis of epithelial proteins with mass spectrometry to identify Barrett patients with high risk of developing malignancy? J.M. Streitz (Duluth)
What are the recognized potential biomarkers for early diagnosis of esophageal adenocarcinoma? P. Bechi  (Florence)
Is the level of sensitivity of TP 53 expression high enough to allow for its consideration as a putative biomarker for endoscopic detection of adenocarcinoma? L. Hardie  (Leeds)
What can be expected from mutations of p53 gene and overexpression of p53 protein in the development of adenocarcinomas? P. Hainaut (Lyons)
What is the role of folate metabolism and associated enzymes in the development of adenocarcinomas? D. Vallboehmer (Cologne)
What is the relationship between tumor progression, telomerase activity, and gene expression? Y. Romero (Rochester)   
 
What is the prognostic significance of p53 mutations for the survival of patients with adenocarcinoma?P. Schneider (Zurich)
Can expression of nuclear factors for the regulation of genes involved in inflammation predict response or resistance to neoadjuvant regimens? R.D. Odze (Boston)
What is the difference in expression levels, as shown by genetic testing, correlated with a differential sensitivity of primary, nodal, and metastatic tissue to chemotherapeutic agents? P. Schneider (Zurich)
How to speculate on the H-pylori induced apoptosis in Barrett derived adenocarcinoma cells? K. Dvorakova (Tucson)


     


Wednesday, April 9, 1:45 - 4:05 p.m. - Room Camille Blanc

Surgical treatment of esophageal adenocarcinoma

T. Aikou (Japan)  -  A.H. Hölscher (Germany)
Discussant:  B.A. Jobe (USA)
What is the result of the prospective evaluation of the progression of HGD to adenocarcinoma? H.D. Appelman (Ann Arbor)
What is the rate of multi-focality of superficial lesions? G. Chejfec (Chicago)
Can the frequency of occult adenocarcinoma developing in patients with HGD be assessed? S.J. Sontag (Chicago)
- Can the true incidence be determined?
What are the contra-indications for endoscopic treatment in operable patients? P.D. Siersema (Utrecht)
What is the rate of secondary esophageal resection following mucosectomy? R. Dumas (Monaco)
Is use of robot likely to alleviate some difficulties of thoracoscopy? R. van Hillegersberg (Utrecht)
Can laparoscopic esophagectomy be considered as an oncologically acceptable approach for treatment of esophageal adenocarcinomas? T.C.B. Dehn (Reading)

What are the advantages and indications of prone position for thoracic esophagectomy? C. Palanivelu (Coimbatore)
What are the indications of trans-hiatal esophagectomy for adenocarcinomas invading the sub-mucosa? E.T. Sihvo (Helsinki)
- What is the compared value of this technique vs trans-thoracic approach?
What is the definition of the best candidate for sentinel node navigation? T. Aikou (Kagoshima)
What can be expected from the combination of sentinel node navigation and radio-immuno guided surgery in evaluation of the extent of surgical resections? H.J. Stein (Salzburg)
What are the current indications of 3-field node dissection for adenocarcinomas of the EG junction? J. Räsänen (Helsinki)
- Should 2-step approach be preferred for 3-field lymph node dissection?
What are the factors predictive of complete resection of an esophageal adenocarcinoma? Ch. Mariette (Lille)
Are post-esophagectomy complications linked to pre-operative high levels of specific cellular proteins and post-operative production of cytokines? B. Brücher (Tübingen)

What is the place of prokinetics for improvement of post-operative feeding after esophageal replacement? J.M. Collard (Brussels)
Is post-chemoradiation biopsy a reliable prognostic indicator of residual post-resection cancer and lymphnode metastasis? R.H. Riddell  (Toronto)

What are the results of esophagectomy for malignant lesions discovered during endoscopic surveillance for Barrett's esophagus? P. Schneider  (Zurich)
Is evaluation of the long-term results of mini-invasive esophagectomyy, compared to standard techniques, currently possible? B.A. Jobe (Pittsburgh)
What is the long-term survival following limited resection of early adenocarcinomas in Barrett's esophagus? W.K. Kauer (Salzburg)
- What are the indications of the Merendino operation?
- Is there a justification for prophylactic esophagectomy?
What are the long-term results of total esophagectomy for adenocarcinomas of the cardia? L. Bonavina (Milan)