VILLA BALBIANELLO (Special Sessions)

Attenzione: apre in una nuova finestra.

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

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

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

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

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

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)