The Relevance of Spastic Esophageal Disorders as a Diagnostic Category.

PURPOSE OF REVIEW: This review addresses the similarities and differences between the spastic esophageal disorders, including jackhammer esophagus, distal esophageal spasm (DES), and type III (spastic) achalasia. The pathophysiology, diagnosis, and treatment of each separate disorder are discussed herein, with an emphasis on overlapping and discordant features. RECENT FINDINGS: The Chicago Classification is a hierarchical organizational scheme for esophageal motility disorders, currently in its third iteration, with direct impact on the definitions of these three disorders. Complementary diagnostic tools such as impedance planimetry and novel manometric parameters continue to evolve. The suite of potential treatments for these disorders is also expanding, with progressive interest in the role of peroral endoscopic myotomy alongside established pharmacologic and mechanical interventions. Although jackhammer esophagus, distal esophageal spasm, and type III achalasia frequently overlap in terms of their clinical presentation and available management approaches, the divergences in their respective diagnostic criteria suggest that additional study may reveal additional mechanistic distinctions that lead in turn to further refinements in therapeutic decision-making.

Clinical Guidelines Update on the Diagnosis and Management of Barrett's Esophagus.

Barrett's esophagus is a condition in which metaplastic columnar epithelium replaces stratified squamous epithelium in the distal esophagus. This condition occurs due to chronic gastroesophageal reflux disease and is a risk factor for the development of esophageal adenocarcinoma. Multiple clinical guidelines have been published around the world in recent years to assist gastroenterologists in the management of these patients and have evolved as new data have become available. While some information such as surveillance technique has not drastically changed, there has been an evolution over the years in diagnostic criteria, screening and endoscopic therapy with a variety of subtle differences among the different guidelines. Herein, we highlight areas of agreement and disagreement on definitions, screening, surveillance, and treatment techniques among these guidelines for the optimal management of Barrett's esophagus patients.

An Automated Text Message Navigation Program Improves the Show Rate for Outpatient Colonoscopy.

Background. Numerous barriers to outpatient colonoscopy completion exist, causing undue procedure cancellations and poor bowel preparation. We piloted a text message navigation program to improve colonoscopy adherence. Method. We conducted a prospective study of patients aged 18 to 75 years scheduled for outpatient colonoscopy at an urban endoscopy center in April 2018. An intervention arm consisting of bidirectional, automated text messages prior to the procedure was compared with a usual care arm. We enrolled 21 intervention patients by phone and randomly selected 50 controls. Outcomes included colonoscopy appointment adherence, bowel preparation quality, and colonoscopy completion. Results. The arms had similar demographics and comorbidities. Intervention patients had higher colonoscopy appointment adherence (90% vs. 62%, p = 0.049). There were no significant differences in preparation quality or procedure completeness. Poststudy surveys indicated high patient satisfaction and perceived usefulness of the program. Conclusion. A bidirectional, automated texting navigation program improved colonoscopy adherence rates as compared with usual care.