Detailed program











Attenzione: apre in una nuova finestra.

This program will evolve every day. It will be regularly completed as speaker and topic confirmations come in.

SPAZIO COMO (Grand Forum and Plenary Sessions)

VILLA MONASTERO (Symposia)

VILLA CARLOTTA (Topic Fora)

VILLA BALBIANELLO (Special Sessions)

VILLA PLINIANA (Round Tables)

See below, and program at a glance.


SPAZIO COMO  (Grand Fora and Plenary Sessions)

Plenary Session 1 Sunday, September 2, 8:00 – 9:45 am
Physiology UES – Body – LES

Chairs:
L.S. Miller (Philadelphia) – K.R. DeVault (Jacksonville)
Discussant:
B.P. McMahon (Dublin)
Secretary: A. Vegesna (Philadelphia)

  • Is there a neurophysiological relationship between the proximal and distal esophagus? D. Sifrim (London)
  • What are the differences in esophageal muscle "in vitro" properties between the lower esophageal circular muscle, the clasp muscle, and the sling fibers? M.R. Ruggieri (Philadelphia) 
  • What new modalities (in vivo & in vitro) can be used to evaluate the HPZ of the proximal and distal esophagus (FLIP, MicroCT, EUS)? A. Vegesna (Philadelphia)
  • What is the effect of laryngeal stimulation on the UESP? Is this effect reproducible? R.K. Mittal (San Diego)
  • To what extent can fluoroscopy and manometry with biomechanics define the various stages of UES opening? B.P. McMahon (Dublin)
  • Is there a mechanical relationship between anterior hyoid movement, extent of UES opening and aspiration? A. Ouyang (Hershey)
  • What is the relationship between pharyngeal contraction, relaxation of upper esophageal sphincter muscle and function in the normal swallow and with dysphagia? A. Ouyang (Hershey)
  • What is the function of the muscularis mucosa in the esophagus? L.S. Miller (Philadelphia)
  • What are the differences in esophageal muscle between the striated, transition zone, proximal smooth muscle, distal smooth muscle and LES muscle? How do they affect the "in vivo" compliance and contractility of the esophagus? J.G. Brasseur (University Park)
  • What is the current understanding of the coordination of contraction passage from proximal to transition to smooth muscle esophageal segments? J.G. Brasseur (University Park)
  • Which are the most important excitatory and inhibitory neurotransmitters regulating the esophageal striated and smooth muscle esophagus? P. Clavé (Mataro)
  • What non-pharmacological approaches are available that can alter the gastro-esophageal sphincter function? A. Ouyang (Hershey)
  • What is the evidence for a physiological sphincter without an anatomical counterpart within the gastro-esophageal segment? L.S. Miller (Philadelphia)
  • Understanding the sphincteric components of the gastro-esophageal segment that are responsible for the generation of the high-pressure zone at the esophago-gastric junction. R.K. Mittal (San Diego)
  • Do longitudinal muscles of the esophagus contract during various types of LES relaxation and what is its role in LES function? R.K. Mittal (San Diego)
  • What physiologic abnormalities are present in the muscles of the HPZ in GERD subjects vs normal control subjects (in vitro & in vivo). M.R. Ruggieri (Philadelphia)

Plenary Session 2 Sunday, September 2, 10:15 am - 12:00 pm
UES dysfunction
Diverticula – Globus pharyngeus

Chairs: R.K. Mittal (San Diego) – D. Sifrim (London)
Discussant: E. Rieder (Portland)                 

  • What are the respective advantages of VFSS (video-fluoroscopic swallowing study) and FEES (fiberoptic endoscopic evaluation of swallowing) in the evaluation of UES dysfunction? B. Martin-Harris (Charleston)
  • What is the etiology of Zenker diverticulum? A. Schindler (Milan)
  • Spectrum dysfunction – From CPM bars to Zenker diverticulum. R. Dantas (Riberao Preto)
  • What is the proper diagnostic algorithm for patients with presumed CP dysfunction? P.C. Belafsky (Los Angeles)
  • What are the indications of endoscopic methods of treatment? J.M. Collard (Brussels)       
  • Is myotomy alone reasonable for small diverticula? J.M. Collard (Brussels) 
  • How should we treat a diverticulum associated with reflux? E. Rieder (Portland)              
  • What is the role of CPM dysfunction in globus sensation? A. Schindler (Milan)
  • What is the mechanism by which reflux contributes to globus pharyngeus? J. Del Gaudio (Atlanta)
  • What is the role of reflux in patients with isolated globus? A. Babaei (Milwaukee)
  • Do we need videofluoroscopy in patients with dysphagia, suspicion of aspiration, or globus? P. Pokieser (Vienna)
  • What is the role of endoscopy in the evaluation of globus? J. Del Gaudio (Atlanta)
  • What is the role of impedance-manometry and pH testing in globus evaluation? S. Kuribayashi (Gumna)
  • What is the best treatment for globus related to reflux? K. Zelenik (Ostrava)
  • Of those with impaired UES opening, who are better candidates for surgical intervention? A. Ouyang (Hershey)
  • What is the role of psychologic treatment in the globus patient? I. Sarosiek (El Paso)

Grand Forum 1 Sunday, September 2, 1:15 - 2:15 pm

Defining esophageal landmarks
Chair: L.F. Miller (Philadelphia) – K.R. DeVault (Jacksonville)
Key note: What is biomechanics and what role does it play in diagnostics, surgical and non surgical 
treatments of GI disorders? J.G. Brasseur (University Park)

  • How to define and locate the GEJ? H. Inoue (Yokohama)                                                                                      

  • What technology is used to define esophageal landmarks and how is it used ((EGD, ultrasound, 
radiology, manometry)? K.R. DeVault (Jacksonville)
  • What anatomic and/or physiologic markers are used to define esophageal landmarks at the high pressure zone of the distal esophagus? L.F. Miller (Philadelphia)                         
  • What anatomic and/or physiologic markers are used to define esophageal landmarks within the
 esophageal body? J.G. Brasseur (University Park)                                     
                   
  • What anatomic and/or physiologic markers are used to define esophageal landmarks at the upper 
esophageal sphincter? B.P. McMahon (Dublin)
  • What anatomic and/or physiologic markers are used to define esophageal landmarks in a hiatal hernia and how do we define a hiatal hernia? A. Celebi (Kocaeli)

Plenary Session 3 Sunday, September 2, 2:30 – 4:15 pm
Achalasia

Chairs:
C.A. Pellegrini (Seattle) – R. Dantas (Ribeirao Preto)
Discussant: R. Penagini (Milan)
Secretary: E.B. Wassenaar (Seattle)

  • Should achalasia be considered as a strictly Primary myopathy? P.O. Katz (Philadelphia)
  • How has HRM (and stationary impedance) redefined the diagnosis of non-achalasia spastic disorders of the esophagus? R.P. Tatum (Seattle)
  • Can cases where relaxation is preserved considered as initial stages? V.N. Felix (Sao Paulo)
  • How is the LESP function in Chagas’ disease? R. Dantas (Ribeirao Preto)
  • Is the mega-esophagus of Chagas’ disease physiologically comparable to that of idiopathic achalasia? R.V. Soares (Chicago)
  • Does failure of balloon dilation foretell a poor result from surgery? S. Szachnowicz (Sao Paulo)
  • In what circumstances should surgical treatment be considered from the outset? J.E.Richter (Tampa)
  • Are sensory neural pathways impaired in achalasia? R. Penagini (Milan)
  • Based on manometry, what are different subtypes of achalasia, and how does longitudinal muscle contraction pattern differ among them? R.K. Mittal (San Diego)
  • When should esophagectomy be considered for the treatment of achalasia? M. Loviscek (Buenos Aires)
  • What are the technical components of surgery for achalasia that are important to success? C. Pellegrini (Seattle)
  • When esophagectomy is required, what is the best substitute? J.M. Collard (Brussels)
  • How do you approach someone with recurrent dysphagia after Heller myotomy? S.A.Wright (Seattle)
  • Which components of the lower esophageal high pressure zone are abnormal in achalasia?
    (lower esophageal circular muscle, clasp muscle, sling muscle, or a combination of these muscles) K.R. DeVault (Jacksonville)
  • Is a totally endoscopic approach to esophageal myotomy a better option? H. Inoue (Yokohama)

Plenary Session 4 Sunday, September 2, 4:30 - 6:15 pm
Primary disorders / Esophageal body
Diffuse Esophageal Spasms – Nutcracker esophagus – Intermediate forms

Chairs: D.O. Castell (Charleston) – P.O. Katz (Philadelphia)
Discussant: R. Tutuian (Bern)

General Concepts

  • How does circular and longitudinal muscle contraction coordinate during normal peristalsis and discoordinate in spastic   
    motor disorders? R.K. Mittal (San Diego)                                                                                                  
  • How and why is the latency of distal esophageal contraction affected in diffuse esophageal spasm? R.K. Mittal (San Diego)            
  • How has HRM (and stationary impedance?) redefined the diagnosis of disorders with impaired peristalsis in the esophagus? What is the value of the latency point? K.R. DeVault (Jacksonville)                   
  • Is there a relationship among physiology/pathophysiology, function/dysfunction and biomechanics of longitudinal muscle in the esophagus? J.G. Brasseur (University Park)
  • What is the evidence that DES, nutcracker esophagus, and achalasia represent a spectrum of diseases?

DES

  • What is the role of nitric oxide in pathophysiology of DES? D.Sifrim (London)                                                         
  • Does the absence of neural abnormalities in DES exclude a neurogenic origin? R.K. Mittal (San Diego)                                          
  • What is the importance of associated hiatal hernia or GER in DES?                                                                                                 
  • Is the LES always normal in DES?  Is it easy to differentiate from achalasia?  R.K.Wong (Bethesda)                                            
  • Is there an effective therapy for DES? D.O. Castell (Chatleston)                       
  • What is the success rate of surgical treatment? C.A.Pellegrini (Seattle)

Nutcraker Esophagus

  • Is the natural history of nutcracker esophagus known? J.E.Richter (Tampa)                                                      
  • What criteria allow for differentiation of this syndrome from that of DES? K.R. DeVault (Jacksonville)                                              
  • Is esophageal clearance always normal? R.Tutuian (Bern)


Grand Forum 2 Monday, September 3, 7:00 - 8:00 am
Defining GERD: the burning issue

Chairs:
R.W. McCallum (El Paso) – F. Pace (Milan)
Key note: What is the importance of the Montreal classification? F. Pace (Milan)

  • Is there ever a neuro-physiological interaction between the gastro-esophageal sphincter and the pharyngo-esophageal sphincter? R.K. Mittal (San Diego)
  • Does endoscopic classification of GERD matter? R.W. McCallum (El Paso)
  • Do we need Rome IV criteria to classify heartburn? V. Savarino (Genoa)
  • Transient LES relaxations: how to improve its detection? A. Blackshaw (London)


Plenary Session 5 Monday, September 3, 8:15 - 10:00 am
LES dysfunction
Chairs: J.E. Richter (Tampa) – P. Bechi (Florence)
Discussant: K.K. Wang (Rochester, MN)

  • What is the value of the meticulous endoscopic and histological assessment of the gastric cardia? G. Costamagna (Rome)
  • Is functional heartburn different from NERD?
    – Which are the mechanisms of symptoms in functional heartburn? V. Savarino (Genoa)
  • What are the phreno-esophageal ligaments and what role do they play in the pathogenesis of 
hiatus hernia? R.K. Mittal (San Diego)
  • Which pharmacologic agents can alter the frequency of transient LES relaxation and why are they still not in clinical practice? R.K. Mittal (San Diego)
  • Is reflux possible in the presence of tone in the muscles within the gastro-esophageal sphincter? J.G. Brasseur (University Park)
  • Is the definition of TLESR mechanical or physiological, and what is the evidence that TLESR is the cause 
  of GERD? J.G. Brasseur (University Park)           
  • Can distensibility testing help identify EGJ sub-components and their function in health and disease? B.P. McMahon (Dublin)
  • Is the relationship between hiatal hernia and reflux mechanical or physiological? P. Bechi (Florence)
  • What is the status of fundic relaxation and accommodation in GE Reflux? R.W. McCallum (El Paso)
  • What is the role of the acid pocket in clinical reflux disease? C.P. Gyawali (St Louis)
  • What is the role of the crico-pharyngeus muscle in reflux disease? A. Schindler (Milan)
  • How does anti-reflux surgery correct LES dysfunction? S. Siboni (Milan)

Plenary Session 6 Monday, September 3, 10:15 am - 12:00 pm
Functional testing

Chairs:
R. Penagini (Milan) – C.P. Gyawali (St Louis)
Discussant: B.P. McMahon (Dublin)
Secretary: I. Bravi (Milan)

  • What are the current irrefutable indications for pH monitoring? P. Belafsky (Los Angeles)
  • What criteria define abnormal pH measurements above the UES? R. Shaker (Milwaukee)
  • Is there a role for single site pharyngeal pH monitoring using the ResTech device? E.S. Yuksel (Izmir)
  • When does wireless pH monitoring need to be extended beyond 48 hours? A. Shaker (St Louis)
  • Should gastric pH be recorded as part of ambulatory pH monitoring? D. Armstrong (Hamilton)
  • What has combined pH-impedance monitoring contributed to the understanding of GERD pathophysiology? A.M. Altomare (Rome)          
  • Is pH-impedance monitoring useful in differentiating NERD from functional heartburn? E. Savarino (Genoa)
  • Are inter- and intra-observer agreement acceptable in pH and Impedance analysis? R. Penagini (Milan)                                
  • What does Endoflip add to assessment of reflux disease? J. Lenglinger (Vienna)
  • Does ambulatory high-resolution manometry (HRM) with or without impedance have a role in clinical esophagology? J.O. Clarke (Baltimore)
  • Is HRIM the new gold standard in evaluating esophageal motility? R. Tutuian (Bern)
  • What is the current value of 3D HRM? C.P. Gyawali (St Louis)
  • Will HRM replace sleeve measurements in evaluating tLESRs? F. Zerbib (Bordeaux)
  • Do bread swallows improve the diagnostic yield of routine clinical HRM/HRIM studies? I. Bravi (Milan)


Grand Forum 3 Monday, September 3, 1:15 – 2:15 pm
Defining Barrett's esophagus

Chairs:
R.E. Sampliner (Tucson) – M. Upton (Seattle)
Key note: H.D. Appelman (Ann Arbor)

  • What is the origin of the BE cell? R.F.  Souza (Tucson)
  • How does obesity contribute to activation of pro-inflammatory pathways in Barrett's esophagus?

    Are BE and Barrett carcinoma diseases of obesity and high caloric concentration? J. Reynolds (Dublin)
  • Is it cost-effective to organize mass screening program of Barrett's esophagus ? J.M. Inadomi (Seattle)
  • What is the impact on cost of care/surveillance and on decreased risk for cancer if all columnar-lined esophagus is included in Barrett esophagus? M. Westerhoff (Seattle)
  • How do different definitions of Barrett esophagus affect our interpretations of results of different 
studies related to risk for dysplasia? What kind of columnar metaplasia increases risk for adenocarcinoma? R.C. Fitzgerald (Cambridge)

Plenary Session 7 Monday, September 3, 2:30 – 4:15 pm
Barrett's esophagus
Endoscopic - Surgical treatments

Chairs:
M. Häfner (Vienna) – T. Ponchon (Lyons)
Discussant: J. Abrams (New York)
Secretary: A.K. Roorda (Morgantown)

  • What is the effect of endoscopic therapy on the BE genotype? N.S. Buttar (Rochester, MN)
  • Should patients with non-dysplastic Barrett esophagus be offered ablative therapy? P.D. Siersema (Utrecht)
  • Should patients with non-dysplastic Barrett esophagus  not be offered ablative therapy? Sharma (Gilbert)
  • Should patients with low-grade dysplastic BE offered ablative therapy? Should patients with low-grade dysplastic Barrett esophagus be offered ablative therapy? V. Sharma (Gilbert)
  • Should patients with low-grade dysplastic Barrett esophagus not be offered ablative therapy? S.J. Sontag (Chicago)
  • EMR or ablation or both for HGD? R.I. Rothstein (Lebanon)
  • How is cryotherapy comparing to radiofrequency for BE ablation? S.J. Sontag (Chicago)
  • How to endoscopically select ablation or EMR for dysplastic BE? J. Abrams (New York)
  • What is the value of trans-nasal endoscopy for BE screening? I.F. Herrmann (Munich)
  • Is ESD preferable to EMR for nodular lesions in Barrett’s esophagus? K.K. Wang (Rochester)
  • What is the current role of confocal endomicroscopy in Barrett's surveillance? T. Ponchon (Lyons)
  • How to approach proximal BE following esophago-gastric anastomosis? S. Szachnowicz (Sao Paulo)
  • Are GERD and BE more prevalent in gastroparesis? J.E. Richter (Tampa)
  • Esophagectomy or endoscopic resection for HGD and early cancer? B. Gayet (Paris)
  • What is the role of fundoplication in BE? A.K. Roorda (Morgantown)

Plenary Session 8 Monday, September 3, 4:30 – 6:15 pm
Barrett's esophagus and cancer

Chairs:
L. Bonavina (Milan ) –  W.A. Phillips (Melbourne)
Discussant: R.C. Fitzgerald (Cambridge)
Secretary: S. Siboni (Milan)

  • Which molecular changes (amplification/deletion/mutation) are associated with progression from Barrett’s to adenocarcinoma? R.C. Fitzgerald (Cambridge)
  • What is the status of predictive biomarkers based on identified molecular genetic changes? R.C. Fitzgerald (Cambridge)
  • Which molecular changes (amplification/deletion/mutation) are associated with EAC? D.G. Beer (Ann Arbor)
  • Which molecular alterations in EAC represent potential targets for therapy? D.G. Beer (Ann Arbor)
  • What is the role of implication of the genes encoding interleukin (IL-1b) and Tumor Necrosis Factor (TNFa)? K. Dvorak (Tucson)
  • Does the Shh/Bmp4/Sox9 pathway have a role in the development of Barrett's oesophagus? W.A. Phillips (Melbourne)
  • Bile acids and nuclear receptors in esophageal carcinogenesis. M.K. Gibson (Pittsburgh)
  • What is the “intrinsic” inflammatory pathway and how does it contribute to carcinogenesis in Barrett’s esophagus? K. Dvorak (Tucson)
  • What is the role of Cox-1 and Cox-2 in progression of non-dysplastic BE to adenocarcinoma? J. Sarosiek (El Paso) 
  • Is limited surgical resection an adequate procedure for submucosal adenocarcinoma of the esophagogastric junction? P.M. Schneider (Zurich)
  • Can sentinel node technology secure limited surgical resections for adenocarcinoma of the esophagogastric junction? S. Perretta (Strasbourg)                      
  • What is the current evidence for various types of resection for adenocarcinoma of the  esophago-gastric junction based on Siewert’s classification? C. Schuhmacher (Munich)
  • Is extended mediastinal lymphadenectomy (2-field-LAD) the gold standard for surgical resection of esophageal adenocarcinoma? S. Law (Hong Kong)
  • What is the influence of prior EMR on complications and outcomes following RFA in BE? R.I. Rothstein (Lebanon)

Plenary Session 9 Tuesday, September 4, 7:30 - 9:30 am
New therapeutic strategies for squamous cell cancer and adenocarcinoma
Chairs: D. Kandioler (Vienna) – D.H. Ilson (New York)
Discussant: M. Krasna (Neptune)

Topic A: Targeted agents and biomarkers in esophageal squamous cell and adenocarcinoma

  1. Trastuzumab: is there a role for distal esophageal adenocarcinoma, or any potential for treatment for esophageal dysplasia/intra-epithelial neoplasia? K. Perez (Providence)         
  2. Are there SNP’s that are potentially prognostic or predictive of therapy outcome in squamous cancers or adenocarcinoma, and are there such biomarkers in potentially high risk populations? D. Vallböhmer (Cologne)
  3. What is the role of phenotype and genotype in selecting patients for targeted therapy for esophageal cancer? B.P. Wijnhoven (Rotterdam)
  4. Are there any promising new targets for new drug development, what targeted agents are in phase II and III trials? W. El Rifai (Nashville)
  5. What is the current role of FDG PET scan in staging, response assessment, and therapy decision making in esophageal squamous cell and adenocarcinoma D.H. Ilson (New York)

Topic B: What is the current role of different surgical approaches and what is the impact of surgical complications?

  1. Does neo-adjuvant treatment increase peri-operative morbidity and/or mortality rates after esophagectomy? B.P. Wijnhoven (Rotterdam)
  2. Do complications really influence long term prognosis? Does it depend on the severity? P.M. Schneider (Zurich)
  3. Is there a place for trans-hiatal esophagectomy in treatment of the esophageal cancer? V.N. Felix (Sao Paulo)
  4. Does the level of the intra-thoracic esophago-gastrostomy matter with respect to outcome? P.M. Schneider (Zurich)

Topic C: Combined modality therapy as preoperative or definitive therapy

  1. How do we treat patients with significant residual disease (N+) after preoperative chemotherapy, and is postoperative chemotherapy justified?
    a.    Yes  B.P. Wijnhoven (Rotterdam)
    b.    No   D.H. Ilson (New York)
  2. Are there indications for neo-adjuvant chemo-radiation in early stage esophageal cancer? D. Kandioler (Vienna)
  3. What is the current role of salvage esophagectomy following local failure of definitive chemo-radiation without prior surgery? P.M. Schneider (Zurich)
  4. Does surgery play a role for stage III squamous cancer after chemoradiotherapy?  
    a.     Yes  R. Van Hillegersberg (Utrecht)
    b.     No   D.H. Ilson (New York)
  5. The optimal preoperative treatment prior to surgery is:
    a.    Chemotherapy K. Perez (Providence)
    b.    Chemoradiotherapy M.J.  Krasna (Neptune)

Topic D: What is the best palliative approach to dysphagia?

  1. In what circumstances is surgical palliation better than a self-expansible prosthesis in the treatment of advanced esophageal cancer? M. Schiesser (Zurich)
  2. Palliation of malignant dysphagia: stent, brachy-therapy, both, or chemo-radiation?
    a.    Chemoradiation or stent  K. Dua (Milwaukee)
    b.    Chemotherapy D.H.  Ilson (New York)
  3. Are there advantages in using radioactive or drug eluting stents? K. Dua (Milwaukee)

Plenary Session 10 Tuesday, September 4, 9:40 – 11:25 am
Esophageal cancer
Chairs: P.M. Schneider (Zurich) – J.M. Collard (Brussels)
Discussant: S. Law (Hong Kong)  

  • What testing should be made for targeted therapy in esophageal cancers? D.H. Ilson (New York)
  • Does the level of the intra-thoracic esophago-gastrostomy matter with respect to lymphadenectomy and outcome? M.S. Allen (Rochester, MN)                                                                                                                                   
  • Is minimally-invasive esophagectomy as good as open surgery? J. Räsänen (Helsinki)  
  •  Is there still a role for surgical resection of cervical esophageal squamous cell cancer? S. Law (Hong Kong)      
  • Are pure surgical arms still justified in future randomized trials evaluating multimodality treatment regimens? M. Krasna (Neptune)          
  • Does neo-adjuvant treatment in past randomized trials compensate for low quality surgery or is it truly beneficial? P.M. Schneider (Zurich)
  • Should early FDG-PET response monitoring be performed in neo-adjuvant treatment strategies? D.H. Ilson (New York)
  • What is the current impact of molecular response evaluation in neo-adjuvant treatment strategies? D. Kandioler (Vienna)
  • What is the short and long term toxicity of definitive chemo-radiation and should we follow our patients? B.P. Wijnhoven (Rotterdam)               
  • What type of anastomosis should be performed after subtotal esophagectomy? J.M.  Collard (Brussels)             
  • Should para-aortic lymph node dissection be performed in E-G junction tumors? M. Schiesser (Zurich)        
  • What is the best strategy for T2 esophageal cancer? M. Krasna (Neptune)                                                                   
  • Do m3- sm1 cancers need radical esophagectomy after endoscopic resection for staging? E.D. Pirchi (Buenos Aires)
  • Does EUS provide additional useful information to PET-CT regarding lymph node metastases? N.D. Maynard (Oxford)


Grand Forum 4 Tuesday, September 4, 11:35 am – 1:20 pm
Defining a true inter-disciplinary approach to esophageal disease
The OESO specific format

Chairs: J.G. Brasseur (University Park) – P. Pokieser (Vienna) – M. Ke (Beijing)
and multi-disciplinary panels

The Forum is designed and to be executed with the following characteristics:

  1. As an integrated mixing of disciplines (interdisciplinary), rather than as a serial grouping of presentations and events from different disciplines (multidisciplinary).
  2. Involve strong interaction among the participants.
  3. Include strong interaction between the participants and the audience.
  4. Contain major elements of pedagogy.
  5. Both the audience and the participants leave with higher levels of understanding (a) of the interdisciplinary nature of upper GI function, (b) of the value of an interdisciplinary approach to clinical diagnostics, and (c) with the recognition that interdisciplinary medicine requires continual effort on all sides to learn enough from the other discipline(s) to use multiple approaches to work and learn at a more advanced and effective level in clinical medicine.

Part I:  Pedagogical interdisciplinary discussion on Reflux and Cellular Response:
K. Dvorak (Tucson) - J.G. Brasseur (University Park)  -  M. Kollarik ( Baltimore) – D. Sifrim (London)

  • The basic and clinical sciences
  • Macro and micro scale processes.
    (macroscale muscle physiology and mechanics – microscale cellular/molecular processes)


Part II: Treatment of a clinical case study

The medical benefits of interdisciplinary evaluation                                                     
A.M. Drewes (Aalborg) – J.G. Brasseur (University Park)
Case Discussants: M. Kollarik (Baltimore) - J. Lenglinger (Vienna)  -  R.P. Tatum (Seattle) – D. Sifrim (London)


Part III:  Multidisciplinary teams in clinical science
Transition to interdisciplinary diagnostics and therapeutics.
S.J. Sontag (Chicago)- J. Zacherl (Vienna)

  • Collaborative clinical evaluation
  • Resources
  • Organization, and potential for improved diagnostics and higher levels of medical insight



VILLA MONASTERO (Symposia)


Symposium 1 Sunday, September 2, 8:00 – 9:45 am
The esophageal mucosa and submucosa
Chairs: R.H. Riddell (Toronto) – M. Upton (Seattle)

  • Which cells normally exist in the esophageal epithelium? What is their function? R.H. Riddell (Toronto)
  • What is the function and role of submucosal mucous glands under the esophageal squamous epithelium? J. Sarosiek (El Paso)
  • Are Dilated Intercellular Spaces (DIS) normal? H.H. Wang (Boston)
  • Why/when do DIS occur? H. El-Zimaity (Toronto)
  • Should GEJ biopsies be taken in patients with reflux in the absence of vible BE? J. Abrams (New York)
  • Do cells in the lamina propria reflect those in the epithelium? H.D. Appelman (Ann Arbor)
  • How are stem cells identified in the squamous esophagus? M. Upton (Seattle)
  • Can stem cells be identified in Barrett’s dysplasia? X. Sagaert (Leuven)
  • What proportion of esophageal stem cells are marrow derived? D. Jain (Yale)
  • What is the origin and significance of multilayered epithelium? M. Vieth (Bayreuth)                                                        

The duplicated muscularis mucosae and its implications

  • When/why does duplication of the muscularis mucasae happen? K. Takubo (Tokyo)
  • Are there always 2 layers in BE? – If not, how do we know when are we definitively in the submucosa? C. Streutker (Toronto)
  • What is the function of the muscularis mucosae? X. Sagaert (Leuven)
  • Is the metastasizing potential of early carcinoma dependant on extent of spread through the duplicated muscularis mucosae? S. Abraham (Houston)
  • Does the choice of Endoscopic therapy matter in patients with dysplasia or intramucosal carcinoma R.C. Fitzgerald (Cambridge)
    a)    For initial therapy?
    b)    For subsequent therapy 

Symposium 2 Sunday, September 2, 10:15 am - 12:00 pm
Immuno-histology in GERD and Barrett's esophagus
Chairs:
M. Vieth (Bayreuth) – R. Fiocca (Genoa)
Discussant: N.S. Buttar (Rochester, MN)
Secretary: H. Neumann (Erlangen)

  • How does the stroma in BE differ from that of the normal esophagus? R.C. Fitzgerald (Cambridge)
  • How are the epithelial-stromal interactions and signaling pathways altered in association with fibro-muscular anomaly? R.H. Riddell (Toronto)
  • What is the role of tumor suppressor genes, including p16, p14 and p53 in BE? R. Fiocca (Genoa)
  • What is the role of proto-oncogenes in BE, including EGF, EGFR, HER2-neu? R.D. Odze (Boston)
  • How do immuno-histochemical markers differ comparing intestinal/tubular type adenocarcinomas in BE with carcinomas of fundic or signet-cell types? K. Takubo (Tokyo)
  • Does immuno-histochemistry have a role in grading of neoplasia in BE? As a way to define risk of progression to adenoca? M. Upton (Seattle)
  • Is there a combination of molecular tests and/or immuno-histochemistry that can improve management compared with H&E stained biopsies and surveillance? H.D. Appelman (Ann Arbor)
  • What is the role of CDX1 and CDX2 in squamous and cardiac mucosa? A. Bellizzi (Iowa City)
  • What is the role of desmosomal cadherins and lektins in squamous and cardiac mucosa? H. Neumann (Erlangen)

Symposium 3 Sunday, September 2, 2:30 – 4:15 pm
Leaks – Perforations
Stents for benign / malignant strictures

Chairs: K. Dua (Milwaukee) – P. Siersema (Utrecht)
Discussant: B. Wijnhoven (Rotterdam)

  • Are there any predictors of response to endotherapy for corrosive strictures? R. Kochhar(Chandigarh)         
  • Should esophageal stents be used for treating benign esophageal strictures? K.S. Dua (Milwaukee)            
  • Are biodegradable stents better alternative to removable stents? P. Siersema (Utrecht)                               
  • Esophageal perforation: conservative management, endotherapy or surgery? K.L. Goh (Kuala Lumpur)           
  • Endotherapy for esophageal perforation/leaks: clip, stent, suture, fibrin or combinations? E. DeMoura (Sao Paulo)    
  • What determines the optimal stenting period in benign esophageal strictures/leaks? K.L. Goh (Kuala Lumpur)             
  • Do esophageal leaks due to surgery/instrumentation/ulcers/spontaneous require different treatment options? N. Reddy (Hyderabad)
  • What strategy to adopt when a fistula of a cervical anastomosis occurs? V.N. Felix (Sao Paulo)                    
  • Should esophageal leak/fistula communicating with an infected mediastinal cavity be endoscopically closed? If not, what are the alternatives? If yes, should the cavity be drained percutaneously prior to endotherapy? N.M. Guda (Milwaukee)                          
  • How should new fistula secondary to an esophageal stent be treated? E. DeMoura (Sao Paulo)                  
  • How can a malignant stricture close to the upper esophageal stricture be palliated? N.M. Guda (Milwaukee)            
  • Palliation of malignant dysphagia: How to choose an esophageal stent. K.S. Dua (Milwaukee)            
  • Are fully covered expandable stents better than partially covered expandable stents? N. Reddy (Hyderabad)                 
  • Laser therapy for esophageal strictures M. Häfner (Vienna)                                    
  • Management of esophageal leaks with intra-thoracic endoscopy and Argon plasma A. Nieponice (Buenos Aires)

Symposium 4 Sunday, September 2, 4:30- 6:15 pm
Benign esophageal stenoses
New tools and concepts for management

Chairs: G. Costamagna (Rome) – L.L. Swanström (Portland)
Discussant: P. Siersema (Utrecht)

  • Can barium esophagography detect lower esophageal rings or peptic strictures missed on endoscopy? M.S. Levine (Philadelphia) 
  • Are bougie and balloon dilations of benign esophageal strictures similar in efficacy and safety and in what situations one should be preferred over the other? R. Kochhar (Chandigarh)
  • What can be expected from the novel dilator specifically fitted for UES? P. Belafsky (Los Angeles)
  • Does steroid injections into refractory benign esophageal strictures delay their recurrence? If yes, why should it not be used routinely for every benign stricture? P. Siersema (Utrecht)
  • Which esophageal strictures are ideally suited for electrocautery treatment? P. Siersema (Utrecht)                                     
  • Is endotherapy for benign esophageal strictures and perforations delaying and making surgery more difficult? B. Gayet (Paris)
  • Do refractory strictures from different etiologies (radiation, corrosive, post-PDT/ESD, anastomotic) respond differently to endotherapy? E. DeMoura (Sao Paulo)
  • What are the surgical options for benign strictures? K.L. Goh (Kuala Lumpur)
  • How should we manage esophageal webs? K.S. Dua (Milwaukee)
  • How should we manage eosinophilic esophagitis-associated strictures? N.M. Guda (Milwaukee)                                                 
  • What is the optimal dose of intra-lesional steroids, the optimal number of sessions of steroid injections, and the best technique of steroid injections? R. Kochhar (Chandigarh) 
  • Can the response to stricture dilation be predicted by EUS or CT characteristics? N. Reddy (Hyderabad)                                    
  • Should stenoses following severe esophageal burns be treated by esophageal resection or esophageal by-pass? V.N. Felix (Sao Paulo)
  • The patch esophagoplasty with biological scaffolds for treatment of esophageal strictures. A. Nieponice (Buenos Aires)

Symposium 5 Monday, September 3, 7:45 - 10:00 am
Pediatrics

Chairs:
S.R. Jadcherla (Columbus) – S. Nurko (Boston)
Discussant: M. Chehade (New York)

  • What is the definition of GERD in infants and children? S. Nurko (Boston)
  • What is the natural history of GER and GERD that starts in infants and children? M. Thomson (Sheffield)
  • What are the underlying mechanisms that generate symptoms in GERD in children? N. Tipnis (San Diego)
  • What are the upstream and downstream reflexes that protect against esophageal provocation in infants and children? S.R. Jadcherla (Columbus)
  • How do you evaluate GERD? R. Rosen (Boston)
  • What is the best way to determine symptom association with GER events in infants and children? R. Rosen (Boston)
  • Potential biomarkers for GERD R. Rosen (Boston)
  • What are the non-pharmacological approaches of managing GER and GERD in infants and children? S.R. Jadcherla (Columbus)
  • Benefits and risks of pharmacological approaches in managing GER and GERD in infants and children? M. Thomson (Sheffield)
  • Are the new pediatric GERD guidelines applicable to clinical practice? S. Nurko (Boston)

Symposium 6 Monday, September 3, 10:15 am - 12:00 pm
Eosinophilic esophagitis

Chairs: 
R.F. Souza (Dallas) – J.E. Richter (Tampa)
Discussant: S.M. Achem (Jacksonville)

  • What is the definition, prevalence and natural history of EoE? J.E. Richter (Tampa)
  • What is the role of endoscopy in the evaluation of eosinophilic esophagitis? A.J. Lucendo (Ciudad Real)
  • Is EoE a food allergy? M. Chehade (New York)
  • Does a response to PPI therapy distinguish EoE from GERD? R.F. Souza (Dallas)
  • In vivo optical imaging in EoE? K.K. Wang (Rochester, MN)

Symposium 8 Monday, September 3, 4:30 - 6:15 pm
The role of HRM in clinical practice

Chairs:
C.P. Gyawali (St Louis) – R. Tutuian (Bern)
Discussant: J.O. Clarke (Baltimore)

  • The Chicago classification: how does it help? C.P. Gyawali (St Louis)
  • HRM vs HRM + Impedance: a further step forward? F. Zerbib (Bordeaux)
  • Esophageal function: evaluation of reflux mechanisms J. O. Clarke (Baltimore)
  • HRM in patients before and after surgery R.P.  Tatum (Seattle)
  • HRM in rumination and aerophagia R. Tutuian (Bern)

Symposium 9 Tuesday, September 4, 7:45 - 9:30 am
Non specific motility disorders
The irritable esophagus

Chairs: R.W. McCallum (El Paso) – K. Vega (Oklahoma City)
Discussant: R.I. Rothstein (Lebanon)
Secretary: R. Hejazy (El Paso)

  • Is there a role for symptom- incomplete bolus clearance correlation in HRIM? (similarly to symptom-reflux correlation) A. Bansal (Kansas City)
  • Does eosinophilic esophagitis contribute to esophageal chest pain? S.R. Achem (Jacksonville)                
  • What is the relationship between hypertensive LES and vigorous achalasia, a single entity? R.W. McCallum (El Paso)   
  • How does Erythomycin affect esophageal motility? A. Lund-Krarup (Aalborg)
  • What is the current understanding of spasms localized to the lower esophagus? D. Sifrim (London)                
  • Is presbyesophagus (aging esophagus) a meaningful term and what is its clinical impact D.O. Castell (Charleston)
  • Does Starlings Law apply to the esophagus? A. Lund-Krarup (Aalborg)                                        
  • Is the irritable esophagus part of spectrum representing a diffuse disorder of alimentary motility? C.P. Gyawali (St Louis)                  
  • What is the impact of HRM on understanding an irritable esophagus? D. Sifrim (London)
  • Do ethnic and gender based norms impact on diagnosis and treatment of esophageal motor disorders? K. Vega (Oklahoma City)

Symposium 10 Tuesday, September 4, 9:40 – 11:25 am
Chest pain and motility disorders
Chairs: S.R. Achem (Jacksonville) – S.J. Sontag (Chicago)
Discussant:  D.O. Castell (Charleston)

  • What are the specific neural structures that serve as mechano-receptive and thermo-receptive receptors involved in chest pain? M. Kollarik (Baltimore)                                 
  • What is the origin of chest pain: central, peripheral, or both? Q. Aziz (London)       
  • Health care and epidemiology of chest pain: a global problem? K. Vega (Oklahoma City)      
  • Does barium esophagogram have a role in NCCP? C.L . Canon (Birmingham, AL)      
  • Does normal pH exclude esophageal pain? M. Frazzoni (Modena)   
  • What is the role of High Resolution Manometry in NCCP? J. Clarke (Baltimore)    
  • What is the role of High resolution US in chest pain? R.K. Mittal (San Diego)
  • What is the meaning of esophageal motility disorders in chest pain? J.E. Richter (Tampa)
  • Should pH impedance be included in the evaluation of NCCP? M. Frazzoni (Modena) 
  • Are there other treatment modalities for NCCP other than PPIs? S.R. Achem (Jacksonville)  
  • Non-traditional therapy for NCCP S.R. Achem (Jacksonville)      
  • What future research steps should be taken in NCCP? D.O. Castell (Charleston)


VILLA CARLOTTA (Topic Fora)

Topic Forum 1 Sunday, September 2, 8:00 – 9:45 am
The LES following surgery
Chairs: I. Braghetto (Santiago) – Lee (Omaha)
Discussant: M. Loviscek (Buenos Aires)

  • What pre-operative testing provides most optimal information on esophageal  function prior to ARS? C.P. Gyawali (St Louis)

Following antireflux procedures:

  • The endoscopic characteristics of the EGJ  following different types of fundoplication. B.A. Jobe (Pittsburgh)
  • The radiologic characteristics of antireflux valves following surgery. D. Cavadas (Buenos Aires)
  • Are distensibility techniques useful  peri-operatively in upper GI surgery? J. Lenglinger (Vienna)
  • Which is the best method to evaluate the LES after surgery? S.Szachnowicz (Sao Paulo)
  • Is there correlation with the endoscopic findings? A. Csendes (Santiago)           
  • Do postoperative radiological findings correlate with manometric findings? R.P. Tatum (Seattle)
  • Postoperative manometry and 24h pH monitoring. G.M. Del Genio (Naples)
  • What happens with LES following antireflux surgery in long segment Barrett esophagus ? A. Csendes (Santiago)
  • The magnetic sphincter. L. Bonavina (Milan)
  • Have Toupet or Dor fundoplication a significant effect on increase of LES? G.M. Del Genio (Naples)

Following other procedures:

  • LES after distal partial gastrectomy O. Korn (Santiago)
  • LES after sleeve gastrectomy I. Braghetto (Santiago)
  • LES after gastric bypass. S. Szachnowicz (Sao Paulo)
  • LES after failed myotomy for achalasia: fibrosis or incomplete myotomy? A. Badaloni (Buenos Aires)
  • Is there a role for HRM in the evaluation of post-gastric banding symptoms? M. Loviscek(Buenos Aires)

Topic Forum 2 Sunday, September 2, 10:15 am - 12:00 pm
Outcomes in esophageal surgery
Chairs: B. Gayet (Paris) – R.P. Tatum (Seattle)
Discussant: M.S. Allen (Rochester, MN)

  • Paraesophagael Hernia: watchful waiting versus elective repair? R.P. Tatum (Seattle)
  • Is bioprosthetic mesh superior to synthetic mesh when used to repair a para-esophageal hiatus hernia? E. Figueredo (Seattle)
  • Esophageal lengthening versus no esophageal lengthening? J.J. Lam (Pittsburgh)
  • Fundoplication versus no fundoplication in para-esophageal hernia repair L.L. Swanström (Portland)
  • Antireflux surgery for the management of extra-esophageal reflux disease
  • Endoluminal antireflux techniques C. Schuhmacher (Munich)
  • Outcomes after endoscopic antireflux procedures L.L. Swanström (Portland)
  • Who is the ideal patient for the transoral incisionless fundoplication (TIF) procedure? R.P. Petersen (Seattle)
  • Options for repair (redo fundoplication, Roux-en-Y, esophagectomy) M. Loviscek (Buenos Aires)
  • Are outcomes of fundoplication in the obese patient population equivalent to those in the non-obese? I. Braghetto (Santiago)
  • Should Roux-en-Y gastric bypass the primary option for treatment of GERD in the morbidly obese? D. Nocca (Montpellier)
  • Outcomes  of revisional antireflux surgery– Surgical and quality of life E.B. Wassenaar (Seattle)
  • Does the routine use of intra-operative esophageal manometry lead to better patient outcomes in antireflux surgery? G.M. Del Genio (Naples)
  • What is the role of HRM in the evaluation of factors responsible for failure of fundoplication? R.V. Soares (Seattle)

Topic Forum 3 Sunday, September 2, 2:30 – 4:15  pm
Imaging
Chairs: P. Pokieser (Vienna) – M.S. Levine (Philadelphia)
Discussant: C.L. Canon (Birmingham, AL)

  • How should the radiologist test for gastroesophageal reflux at fluoroscopy? What is the value of the water-siphon test? C.L. Canon (Birmingham, AL)
  • What is the importance of hiatal hernias for GERD and how are hernias imaged on barium studies? C.L. Canon
  • What are the morphologic findings of reflux esophagitis on double-contrast esophagography and what is the value of this examination? M.S. Levine (Philadelphia)
  • How is scarring (including peptic strictures and rings) from reflux esophagitis manifested on barium esophagography? M.S. Levine
  • Are there characteristic pharyngeal findings on barium studies in patients with reflux disease and what is the value of videofluoroscopy in these patients? P. Pokieser (Vienna)
  • Is there a characteristic form of esophageal dysmotility on barium esophagography in patients with reflux disease? M.S. Levine
  • What are the imaging findings after anti-reflux surgery? C.P. Canon
  • Is there a benefit of recent developments for staging of esophageal cancer with multislice CT? P. Pokieser (Vienna)
  • Endoflip and videofluoroscopy: are the newcomer and the oldtimer complementary or competitive tests? J. Lenglinger (Vienna)

Topic Forum 4 Sunday, September 2, 4:30 - 6:15 pm
Innovative technologies
Chairs: S. Hamdy (Manchester) – R. Van Hillegersberg (Utrecht)
Discussant: K. Bitar (Winston Salem)
Secretary: P. van der Sluijs (Utrecht)

  • Can the smart-pill wireless motility capsule provide complementary clinical information in patients with gastro-esophageal disease? A.R. Hobson (London)                                  
  • What is the role of high resolution endoscopy in esophageal disorders? H. Neumann (Erlangen)
  • How much further can HRM take us in understanding motility disorders? A. Bansal (Kansas City)
  • Can MRI be used to assess mucosal/muscle based abnormalities in the esophagus? I. Lips (Utrecht)
  • What is the role of the Functional Lumen Imaging Probe? B. McMahon (Dublin)
  • What is the role of RF ablation of early esophageal cancer. M. Häfner (Vienna)
  • Robotic surgery and navigation in esophageal cancer and reflux disease. R. Van Hillegersberg  (Utrecht)                                                                                              
  • Brain stimulation and the esophagus. S. Hamdy (Manchester)
  • Diffuse Noxious Inhibitory Control  induction and esophageal  EEG C. Brock (Aalborg)
  • Evoked potentials and the esophagus – Clinical application. A. Hobson (London)
  • Can GERD be treated by electro-stimulation? J. Ruurda (Utrecht)
  • What is the role of POEMS? H. Inoue (Yokohama)
  • What is the role of biological scaffolds in esophageal reconstruction? K. Bitar (Winston Salem)
  • Can genetic profiling be used to predict the outcome of esophageal cancer therapy? C.J. Peters (Cambridge)

Topic Forum 5 Monday, September 3, 8:15 - 10:00 am
Natural orifice surgery

Chairs: H. Inoue (Yokohama) – L.L. Swanström (Portland)
Discussant: S. Perretta (Strasbourg)

  • Flexible mediastinoscopy for cancer staging L.L. Swanström (Portland)    
  • Endoscopic management of esophageal perforations. K.L. Goh (Kuala Lumpur)                                                                   
  • NOTES for Achalasia (POEM) H. Inoue (Yokohama)  
  • POEM for spastic motility disorders. E.B. Wassenaar (Seattle)
  • Trans-esophageal procedures  S. Perretta (Strasbourg)                                                   
  • Reaching beyond NOTES from endoscopic to cellular therapy: endoscopic injection of muscle-derived cells to augment gut smooth muscle sphincter function A. Nieponice (Buenos Aires)                                                                              
  • Skinning esophagectomy for superficial esophageal tumors: implication for a novel  therapeutical approach A. Nieponice (Buenos Aires)
  • Noninvasive endoscopic sentinel node MRI based identification for esophageal cancer S. Perretta (Strasbourg)            
  • Novel esophageal anastomosis and reconstruction techniques J. Wall (Palo Alto)                                        
  • Can we truly improve esophageal functional surgery? J.J. Lamb (Pittsburgh)                                                                         
  • Introducing POEM into routine clinical practice: are there yet? L.L. Swanström (Portland)                                                       
  • Per oral endoscopic resection of esophageal leiomyomas H. Inoue (Yokohama)

Topic Forum 6 Monday, September 3, 10:15 am - 12:00 pm
Posters – Oral presentation

Chairs:
R.W. McCallum (El Paso) – M. Upton (Seattle)
Panel: J.G. Brasseur (University Park) – J.O. Clarke (Baltimore) – X. Luke Chen (Durham) – F. Pace (Bergamo) -  M. Schiesser (Zurich)

The program of this session will be determined on Monday September 3 following the selection by the Jury. The names of the Authors of the 12 Posters selected for oral presentation will be posted at the Registration Desk on Monday September 3, at 7:30 am. Don’t forget to drop off your slides at the Slide Center.

Topic Forum 7 Monday, September 3, 2:30 – 4:15 pm
Video Session
Chairs: S. Puntambekar (Pune) – D. Nocca (Montpellier)

  • Transgastric treatment of gastric cancer using single port B. Gayet (Paris)                                                           
  • Laparoscopic gastric bypass R. Caiazzo (Lille)                                                                                                             
  • Laparoscopic sleeve gastrectomy M. Poussier (Montpellier)      
  • The sleeve gastrectomy one port (LESS) G. Pourcher (Paris)
  • Laparoscopic gastrectomy for cancer M. Gualterotti (Naples)                                                                                   
  • Laparoscopic treatment of GERD G.M. Del Genio (Naples)     
  • Extended esophagectomy for cancer by laparoscopic and thoracoscopic approach in prone position F. Lacerda Croider (Barretos)                                                                                   


Topic Forum 8 Monday, September 3, 4:30 - 6:15 pm
Molecular Biology
Chairs: G. Nardone (Naples) – S. Krishnadath (Amsterdam)
Discussant: R.F. Souza (Dallas)
Secretart: A. Pacha (Amsterdam)

  • Is malignant degeneration of Barrett's esophagus a clonal disease? A. Pacha (Amsterdam)
  • Is there a model for  Barrett’s esophagus to predict progression to esophageal adenocarcinoma? K. Parikh (Amsterdam)             
  • Is there a reliable prognostic or diagnostic biomarker test to predict progression of Barrett’s esophagus? A. Pacha (Amsterdam)
  • What genes are involved in the development of esophageal squamous epithelium during embryogenesis and at birth? N.S. Buttar (Rochester, MN)   
  • What is the role of CDX-2 in the development of the gut and esophagus Barrett’s esophagus? D. Tosh (Bath)      
  • Which morphogenes play a role in Barrett’s esophagus? S. Krishnadath (Amsterdam)      
  • Can the in-vitro model of Barrett’s epithelium to EAC be utilized for chemoprevention studies? K. Das (New Brunswick)
  • Which in vivo models do we have for testing chemopreventive drugs for Barrett’s esophagus? N.S. Buttar (Rochester, MN)
  • Is the surgical animal model for Barrett’s esophagus validated at the molecular level? M.K. Gibson (Pittsburgh)           
  • What are the potential  chemopreventive targets in Barrett’s esophagus? N.S. Buttar (Rochester, MN)                    
  • Which existing drugs  can be used for chemoprevention of Barrett’s esophagus? L.X. Chen (Durham)              
  • What junctial proteins predispose patients with reflux to Barrett’s esophagus and esophageal adenocarcinoma? R.C. Orlando (Chapel Hill)            

    Topic Forum 9 Tuesday, September 4, 7:45 – 9:30 am
    Drugs for esophageal disease
    Limitations of the current compounds – Perspectives for the future

    Chairs: C. Scarpignato (Parma) – R. Hunt (Hamilton)
    Discussant: F. Di Mario (Treviso)

    • What are the shortcomings of the delayed-release PPIs (DR-PPIs)? R.H. Hunt (Hamilton)           
    • Can the shortcomings of PPIs be attributed to poor response in reflux patients? R.H. Hunt (Hamilton)
    • How does symptom control compare with healing in RCTs of reflux esophagitis? F. Pace (Milan)
    • What is the acid suppression profile of twice daily DR-PPIs: how much acid is left? R.H. Hunt (Hamilton)           
    • What is the response of reflux esophagitis to twice daily DR-PPIs? F. Pace (Milan)
    • The use of PPis after laparoscopic fundoplication: failure of surgery or failure of physician? C. Scarpignato (Parma)
    • Immediate-release PPIs: do they suppress NAB and improve nighttime symptom control? W.W. Chan (Boston)
    • Acid suppression with extended-release formulations of current PPIs: what is the real therapeutic gain?  F. Di Mario (Treviso)
    • Novel long-lasting PPIs: could they address the unmet clinical needs in GERD? C. Scarpignato (Parma)
    • Reflux inhibitors: pharmacological failure or flawed concept? F. Zerbib (Bordeaux)                        
    • Novel prokinetic compounds: do they still have a role in the treatment of GERD? C. Blandizzi (Pisa)

    Topic Forum 10 Tuesday, September 4, 9:40 – 11:25 am
    Neurogenic dysphagia - Oro-pharyngeal dysphagia

    Chairs:
    P. Clavé (Mataro) – B. Martin-Harris  (Charleston)
    Discussant:
    P. Belafsky (Los Angeles)
    Secretary: O. Ortega Fernandez (Mataro)

    • What is dysphagia? D.O. Castell (Charleston)
    • What outcome measures matter: clinical, instrumental, nutrition, quality of life? P. Clavé (Mataro)
    • Can we predict models of recovery of oropharyngeal dysphagia based on diagnosis? B. Martin-Harris (Charleston) 
    • Videofluoroscopy and FEES are used as assessments of oropharyngeal swallowing function: do they miss esophageal impairment? P. Pokieser (Vienna)            
    • What are the properties of an optimal stimulus for elicitation of oropharyngeal and esophageal swallowing? P. Clavé (Mataro) 
    • What is the relationship between esophageal muscle function and perception of dysphagia? D. Sifrim (London)
    • How does the UES open in the absence of suprahyoid muscle function? R. Shaker (Milwaukee)               
    • Are there any imaging criteria for myotomy of the UES or botulinum toxin injection in patients with neurologic swallowing impairment? P. Pokieser (Vienna)     
    • What is the value of crico-pharyngeal myotomy? What are the histological findings? P. Belafsky (Los Angeles)           
    • Does pharyngeal peristalsis exist? What are the underlying mechanism(s) and implications for treatment? B. Martin-Harris (Charleston)                  
    • Patients with specific oro-pharyngeal swallowing impairment are sometimes treated by altering head positioning and/or bolus consistency: what are the mechanical mechanisms by which these maneuvers alter function in the oropharynx? A. Ouyang (Hershey)
    • In patients with neurogenic  dysphagia, what medications can be considered as protective against aspiration pneumonia? P.Clavé (Mataro)                         
    • Does respiratory – swallow coordination contribute to dysphagia and if so, can patterns of coordination be trained? B. Martin-Harris (Charleston)       
    • Can esophageal musculature be trained? A. Ouyang (Hershey)                                        
    • Do surgical interventions restore critical components of oro-pharyngeal swallowing function? P. Belafsky (Los Angeles)

    VILLA BALBIANELLO (Special Sessions)

    Special Session 1 Sunday, September 2, 8:00 - 9:45 am
    Esophageal tissue resistance

    Chairs:
    N.J. Buttar (Rochester) – R.C. Orlando (Chapel Hill)
    Discussant: K. Dvorak (Tucson)

    • Developmental biology of esophageal squamous epithelium L.X. Chen (Durham)
    • Endoscopic morphology of esophageal squamous epithelium H. Neumann (Erlangen) 
    • Microscopic morphology of esophageal squamous epithelium H.D. Appelman (Ann Arbor)
    • Ion transport in esophageal squamous epithelium R.C. Orlando (Chapel Hill)
    • Barrier function in esophageal squamous epithelium J. Sarosiek (El Paso)
    • Intraluminal impedance in the evaluation of the esophageal mucosa R. Farre (Leuven)
    • Sensory innervation in esophageal squamous epithelium Q. Aziz (London)
    • Neosquamous epithelium: Comparison with native esophageal squamous epithelium R.D. Odze (Boston)
    • Experimental acid injury to esophageal squamous epithelium D.O. Castell (Charleston)
    • Experimental bile salt (non-acid) injury to esophageal epithelium J.E. Richter (Tampa)
    • Pathology of reflux-induced injury to human esophageal epithelium A.M. Bellizzi (Iowa City)
    • Inflammation in human reflux esophagitis G. Nardone (Naples)
    • Inflammation in eosinophilic esophagitis A.J. Lucendo (Ciudad Real)                                                                      
    • Motor consequences of reflux-induced inflammation in esophageal epithelium S. Bor (Izmir)
    • DNA damage and repair in reflux esophagitis K. Dvorak (Tucson)

    Special Session 2 Sunday, September 2, 10:15 am - 12:00 pm
    GI sensitivity

    Chairs:
    A.M.  Drewes (Aalborg) – G. Nardone (Naples)
    Discussant: M. Kollarik (Baltimore)

    • How does refluxed gastric acid initiate heartburn in those with GERD? R.C. Orlando (Chapel Hill)
    • Are there vagal afferent nociceptive nerves in the esophagus? M. Kollarik (Baltimore)
    • Does ATP play a role in sensory transmission in the esophagus? C. Brock (Aalborg)
    • Are P2X and P2Y receptors involved in esophageal hypersensitivity? A.M. Altomare (Rome)
    • Are neural purinergic receptors upregulated in GERD? C. Lottrup (Aalborg)
    • What role do adenosine receptors play in esophageal pain?  M. Kollarik (Baltimore)
    • Is TRPV1 a major acid receptor in esophageal epithelium? G. Nardone (Naples)
    • What kind of acid sensitive receptors could be involved in the genesis of gastro-esophageal reflux disease symptoms? A. Lund-Krarup (Aalborg)
    • What is known about the cortical perception of refluxed acid in healthy subjects and those with heartburn of GERD? R. Shaker (Milwaukee)
    • What new methods exist for evaluation of esophageal pain? A.M. Drewes (Aalborg)
    • Which morphologic and/or neuro-physiological factors could be responsible for hypersensitivity in 
NERD patients? Q. Aziz (London)
    • Are there histological alterations that can distinguish non-erosive reflux disease (NERD) from erosive reflux disease (ERD) patients? F. Hvid-Jensen (Aalborg)
    • Are inflammatory processes involved in the genesis of NERD symptoms? R.F. Souza (Dallas)
    • Does the impaired esophageal mucosal integrity play a role in the symptoms generation of gastro-
esophageal reflux disease (GERD)  C. Calabrese (Bologna)
    • Is the volume of refluxate involved in the perception of reflux episodes? A.M. Altomare (Rome)

    Special Session 3 Sunday, September 2, 2:30 – 4:15 pm
    Animal Models

    Chairs:
    M.K. Gibson (Pittsburgh) – S. Marks (Los Angeles)

    • Spontaneous models of canine dysphagia. S.L. Marks (Los Angeles)
    • Ovine models of dysphagia. P.C. Belafsky (Los Angeles)
    • Porcine and murine models of oro-pharyngeal function. E. Plowman
    • Use of animal models for the study of cancer drug development and mechanisms in esophageal adenocarcinoma. M.K. Gibson (Pittsburgh)

    Special Session 4 Sunday, September 2, 4:30.- 6:15 pm
    Cancer biology
    Chairs: K. Das (New Brunswick) – X.L. Chen (Durham)
    Discussant: R.C. Fitzgerald (Cambridge)

    • How do the components of gastric refluxate, especially acid and bile salts, promote carcinogenesis in metaplastic Barrett’s esophagus? R.F. Souza (Dallas)           
      - Effects on DNA damage
      - Effects on proliferation
      -
      Effects on apoptotic resistance
    • Is there a specific cell phenotype in BE that is more prone to development of EAC? K. Das (New Brunswick)
    • What is the role of gastrin in progression of BE to esophageal adenocarcinoma?  J.A. Abrams (New York)             
    • What is the effect of inflammatory cytokines linked to obesity on the activation of cell death pathways and cell survival in BE and esophageal cancer? J.V. Reynolds (Dublin)              
    • Can acid and bile induce chromosomal instability and clonal selection during the progression of BE to EAC? M. Bajpai (New Brunswick)
    • In BE is there a point of “no return” from metaplasia to dysplasia?  Can gene expression panels predict outcomes for patients with esophageal adenocarcinoma? P. Malfertheiner (Magdeburg)
    • Do Barrett’s epithelial cells undergo senescence with the development of dysplasia? K.K. Wang (Rochester, MN)                       
    • What is the role of autophagy in Barrett’s esophagus and esophageal cancer development? K. Dvorak (Tucson)
    • May SNPs in promoter regions of pro-inflammatory genes predict the development of EAC?  D.G. Beer (Ann Arbor)      
    • Is p53 mutation a major event in the carcinogenesis process of benign BE cells to malignancy? G. Prasad (Rochester, MN)
      Can this be utilized for diagnosis and therapeutic purposes?                
    • How the Genome wide changes in DNA methylation and transcription are involved in BE carcinogenesis? A. Verma (New York)
    • What is the role of nitric oxide in promoting invasion and metastasis of Barrett’s-associated esophageal adenocarcinoma? R.C. Fitzgerald (Cambridge) 
    • What is the potential role of microRNA in the development of BE and EAC? K.S. Garman (Durham)  
    • During the early development of chromosomal instability in Barrett’s esophagus, are DNA chromosomal loss or gains focal or widespread? K.K. Wang (Rochester, MN)
    • What animal models may be used for BE and EAC research? X.L. Chen (Durham)

    Special Session 5 Monday, September 3, 8:15 - 10:00 am
    Pharyngeal reflux
    ENT and GERD

    Chairs: P. Belafsky (Los Angeles) – R. Shaker (Milwaukee)
    Discussant: S. Bor (Izmir)

    • What are the current diagnostic tests for LPR? P. Dettmar (Hull)
    • Is pepsin a sensitive and specific marker for LPR? N. Johnston (Milwaukee)
    • What is the prevalence and role of LPR in laryngeal cancer? N. Johnston (Milwaukee)
    • Do in vitro studies support a role for LPR in laryngeal cancer? J. Allen (Auckland)
      – Do animal in vivo studies support a role for LPR in laryngeal cancer?
      – Do human studies support a role for LPR in laryngeal cancer?
    • What laryngo-pharyngeal symptoms are attributable to LPR? P. Belafsky (Los Angeles)
    • What objective evidence supports a role for EER in CRS? J.M. Del Gaudio (Atlanta)
    • Does CRS respond to treatment of EER? What is the appropriate treatment of CRS J.M. Del Gaudio (Atlanta)
    • What is the evidence for airway protective role of aerodigestive reflexes in preventing aspiration? (excluding laryngeal adductor reflex). R. Shaker (Milwaukee)     
    • What are criteria by which gastro-esophageal reflux is not the cause of ENT symptoms? R. Tutuian (Bern)
    • What treatments should we offer patients with ENT symptoms and normal reflux monitoring tests? R. Tutuian (Bern)
    • How long should the PPI trial be in patients with ENT symptoms suspected to be due to GERD? W.W. Chan (Boston)
    • Which ENT symptom is most likely associated with GERD? R. Tutuian (Bern)
    • What are the options for treating hypo-pharyngeal/high cervical esophageal strictures in patients treated for head and neck cancers? K.S. Dua (Milwaukee)    

    Special Session 6 Monday, September 3, 10:15 am - 12:00 pm
    Neuro-physiology of the esophagus

    Chairs:
    A.R. Hobson (London) – Q. Aziz  (London)
    Discussant: A.M. Drewes (Aalborg)
    Secretary: A. Lund-Krarup (Aalborg)

    • What is the role of electrophysiology and inverse brain modeling methodologies in esophageal pain? C. Brock (Aalborg)
    • What is the role of neuroimaging methodologies in esophageal pain? J.B. Frøkjær (Aalborg)
    • What is the role of vagal and spinal afferents in mediating esophageal sensation? A. Blackshaw (London)
    • What is the role of ENS in controlling esophageal sensory and motor function? A. Lund-Krarup (Aalborg)
    • What is the clinical relevance of the difference in the afferent innervation of the proximal and distal esophagus? P. Woodland (London)
    • What is the role of the cortex and brain stem in mediating esophageal function? S. Hamdy (Manchester)  
    • How does the brain process subliminal and luminal human esophageal sensation? S.J. Coen (London)
    • Do psychological factors modulate the brain processing of esophageal sensation? S.J. Coen (London)
    • What is the role of physiological stress response systems (ANS/HPA Axis) in mediating esophageal pain? A. Farmer (London)
    • What are the neural mechanisms of acid induced esophageal hypersensitivity Q. Aziz (London)
    • What is the pharmacological management of esophageal hypersensitivity? Q. Aziz (London)
    • What is the role of mucosa in esophageal hypersensitivity? D. Sifrim (London)
    • What is the role of placebo analgesia in managing esophageal pain? A.R. Hobson (London)
    • What happens to esophageal sensitivity in Barrett’s esophagus? A.M. Drewes (Aalborg)
    • Can neuro-physiological techniques be used to understand the patho-physiology of esophageal hypersensitivity? A.R. Hobson (London)

    Special Session 7 Monday, September 3, 2:30 – 4:15 pm
    Respiratory manifestations of GERD
    Chairs: S.M. Harding Hawkins (Birmingham, AL) – D. Sifrim (London)
    Discussant: P. Belafsky (Los Angeles)

    • Are ENT and pulmonary symptoms the same extra-esophageal manifestations of GERD? R. Tutuian of GERD? (Bern)
    • What is the mechanism of cough induced by GER? K. Blondeau (Leuven)
    • What is the role of Extra Esophageal Reflux in cough? J. Allen (Auckland)
    • Does nonacid GER play a role in cough?  Non-acid GER?  D. Sifrim (London)    
    • When is fundoplication indicated for cough? C.A. Pellegrini (Seattle)
    • Is impedance-manometry necessary for the diagnosis of reflux-related cough? D. Sifrim (London)                      
    • Are reflux and airway stenosis actually related? J. Allen (Auckland)            
    • Does weakly acidic or non-acidic reflux play a role in airway stenosis? J. Blumin (Milwaukee)              
    • What is the role of pH monitoring in these patients?  J. Allen (Auckland)     
    • What are the results of anti-reflux surgery for cough? C.A. Pellegrini (Seattle)
    • Should an empiric trial of baclofen be performed prior to anti-reflux surgery? P. Belafsky (Los Angeles)
    • Can airway obstruction, by lowering LESP and increasing the Nb of reflux episodes, predispose to asthma? S.M. Harding Hawkins (Birmingham, AL)
    • What is the efficacy of PPIs on asthma outcome? W.W. Chan (Boston)       
    • Is a vagally mediated reflex involved in the development of cough? R. Shaker (Milwaukee)
    • Is a vagally mediated reflex involved in the development of asthma? S. Harding Hawkins (Birmingham, AL)

    Special Session 8 Monday, September 3, 4:30 – 6:15 pm
    Endotherapy for GERD
    Chairs: R.I. Rothstein (Lebanon) – P. Siersema (Utrecht)         
    Discussant: T. Ponchon (Lyons)

    • Can gastro-esophageal reflux disease be treated endoscopically? P.D. Siersema (Utrecht)               
    • What is the history of endoluminal devices in GERD. Have we learned anything? (Stretta – Endocinch – Enteryx - Suture devices – Gatekeeper) R.I. Rothstein (Lebanon)
    • RF, plication or injectables – which therapy has the best long-term outcomes at this point? R.I. Rothstein (Lebanon)                                                                 
    • What are the data of current endoluminal devices:  A. Roy-Schapira (Beer Sheva)
      - The Medigus SRS Endoscopy Systems
      - Do we have enough data to go prime time?

    • What is the role for (the newly revived) Stretta in the treatment of GERD related to transient LES relaxation? H. Mashimo (Boston)    
    • TIF and the advanced endoscopy trained gastroenterologist - - Is this a procedure that I should learn or is it better left to a surgical endoscopist? J. Horwhat (Bethesda)
    • What are the valid alternatives to laparoscopic fundoplication? R. Tutuian (Bern)
    • How should future studies be designed to assess mechanisms? R. Lambert (Lyons)                
    • Results of the trial on electrical stimulation of the LES. V. Sharma (Gilbert)                      
    • What is the appropriate outcomes measure for endoluminal ARS: symptom scores or objective testing? J.M. Inadomi (Seattle)
    • How do endoluminal antireflux procedures compare to laparoscopic fundoplication. Is the investment worth the outcome? G. R.Locke (Rochester)   
    • Is there any room for any endoscopic treatment of GERD? T. Ponchon (Lyons)

    Special Session 9 Tuesday, September 4, 7:45 – 9:30 am
    Tailored multi-disciplinary therapeutic approach to the GERD patient
    Chairs: D. Armstrong (Hamilton) – B. Gayet (Paris)
    Discussant: P.O. Katz (Philadelphia)

    • Is SAP of greater value than SI in assessment of symptom reflux association? J.E. Richter (Tampa)
    • What is the clinical relevance of nocturnal acid reflux? V. Savarino (Genoa)
    • Which patients with GERD should have endoscopy? M. Hongo (Sendai)
      – Is there any value for endoscopy in NERD?
    • Inlet patch: is there any indication for biopsies?  for treatment? T. Ponchon (Lyons)
    • Is there a role for esophageal  manometry in the clinical management of GERD? D. Armstrong (Hamilton)
    • Should GERD patients be evaluated, before starting PPI therapy, with respect to their risks for respiratory tract infections, gastrointestinal infections, vitamin B12 deficiency and bone health? D. Armstrong (Hamilton)
    • How should response to a PPI be determined in clinical practice? S. Nasseri-Moghaddam (Tehran)
      – How long PPIs can be used safely?
    • Should ‘step down’ therapy be offered to all GERD patients who have responded to PPI therapy? D. Armstrong (Hamilton)
    • What is the relationship between obesity and PPI resistance? E. Savarino (Genoa)
    • What drugs have proven, sustained and clinically relevant effect on performance of esophageal  peristalsis?               
    • Following PPI failure, is ARS likely to be successful in GERD patients? B. Gayet (Paris)                                                                    
    • How do existing and yet-to-be-developed techniques compare with standard medical or surgical therapy? L.L. Swanström (Portland) 
    • What is the role of pH-impedance in the choice of treatment other than PPI? R. Tutuian (Bern)                                               
    • Do prokinetic agents enhance esophageal contraction amplitude, velocity or peristalsis? P.O. Katz (Philadelphia)
    • What is appropriate patient selection for endoluminal antireflux procedures? R.I. Rothstein (Lebanon)

    Special Session 10 Tuesday, September 4, 9:40 – 11:25 am
    The refractory GERD
    Chairs: V. Savarino (Genoa) – R.K. Wong (Bethesda)
    Discussant: M. Hongo (Sendai)
    Secretary: A.M. Altomare (Rome)

    • What is the difference between GERD hypersensitivity and refractory GERD? F. Di Mario (Treviso)                   
    • What are the data concerning acid hypersensitivity and sensory receptors (vallinoid, TRPV1) causing refractory GERD? F. Zerbib (Bordeaux)
    • How sensitive and specific is an increase in visceral adiposity in determining whether an individual may be refractory to PPIs?  F. Pace (Milan)                
    • What is the effect of gastric components other than acid on refractory GERD?  R. Tutuian (Bern)
    • What is the relevance of weakly acidic reflux in refractory GERD? R. Tutuian (Bern)
    • Is microscopic esophagitis relevant in determining symptoms of NERD? V. Savarino (Genova)
    • Do concomitant functional GI disorders affect the PPI response in NERD?  F. Zerbib (Bordeaux)
    • When a patient has truly refractory GERD? S. Nasseri-Moghaddam (Tehran)
    • What is the contribution of emotional stress in development of refractory GERD? S. Nasseri-Moghaddam (Tehran)
    • How effective are anti-depressives and SSRI’s in treating refractory GERD? F.J.  Moawad (Bethesda)
    • What is the evidence that a functional esophagus is associated with IBS? S. Armbruster (Bethesda) 
    • Why are delayed release PPI’s less effective in NERD? C. Scarpignato (Parma)
    • Are delayed release PPI’s the answer to refractory GERD?  S. Armbruster (Bethesda)
    • What is the role of GABA agonists in the treatment of refractory GERD? S. Armbruster(Bethesda)
    • What is the role of biofeedback in refractory GERD? F.J. Moawad (Bethesda)    
    • What is the best therapeutic choice in patients with functional heartburn? R. Tutuian (Bern)                                     
    • What new endoscopic procedures (NOTES) are being studied to treat refractory GERD? J.D. Horwhat (Washington)


    VILLA PLINIANA (Round tables)


    Round Table

    supported by Nycomed-Takeda

    Sunday, September 2, 10:15 am - 12:00 pm
    Long-term Acid Suppression with PPIs: Current Knowledge and Open Questions
    Chair: C. Scarpignato (Parma)

    Welcome and Introduction. C. Scarpignato 
(Parma)

    • Long-term PPIs: Is There Any Safety Concern? R.H. Hunt (Hamilton)

    - Is PPI-induced hypergastrinemia safe in the long-term?
    - Is there any clinically significant effect of PPIs on electrolyte (Mg, Ca and Fe) and vitamins (B12) absorption?
    - Are GI and non GI infections more frequent in PPI users?

    • Drug-interactions with PPIs: Are They Clinically Relevant? V. Savarino (Genoa)

    - Is there any effect of PPIs on drug absorption?
    - Do PPIs affect the efficacy of anticoagulant and antiplatelet therapy?
    - Is the interaction potential of the different PPIs different?

    • Generic Formulations of PPIs: Are They Similarly Effective? C. Blandizzi 
(Pisa)

    - Why do we need generic formulations?
    - How the bioequivalence of generic PPIs should be ascertained?
    - Do the antisecretory effect of generic PPIs overlap that of the branded formulations?

    Panel Discussion & Questions from the Floor


    Closing Remarks. C. Scarpignato
 (Parma)


    Round Table

    supported by Alfa Wassermann

    Monday, September 3 2012, 10:15 am – 12:00 pm
    Esophageal Mucosal Defence in GERD: a Reappraisal
    Chairmen: J. Sarosiek (El Paso) – C. Scarpignato (Parma)

    • Reflux of Gastric Contents into the Esophagus: It Is Only Acid? V. Savarino (Genoa, Italy)
    • Mechanisms Underlying Esophageal Mucosal Defence R.C. Orlando (Chapel Hill, NC, USA)
    • Role of Saliva and Its Components in Esophageal Mucosal Defence J. Sarosiek (El Paso, Texas)
    • Can esophageal mucosal integrity be strengthened? C. Scarpignato (Parma, Italy)