This can potentially reduce hiatal hernia. Recent uncontrolled studies demonstrated increase in LES length and LES resting pressure after this procedure.50 However, there are no studies specifically investigating the effect of this technique on TLESR.

The value of acupuncture has been recently evaluated in GERD patients who failed PPI once daily. When compared to doubling the PPI dose (standard of care), adding acupuncture was significantly better in controlling regurgitation and daytime as well as night-time heartburn. This is the first study to suggest that alternative approaches for treating visceral pain may have a role in GERD patients with persistent heartburn despite PPI therapy.51 Patients with poor correlation of symptoms with acid reflux events display a high level of anxiety and hysteria as compared with patients who demonstrate a close correlation between symptoms and acid-reflux events.52 Anxiety and depression have been shown to increase GERD-related symptoms report in population-based studies. Nojkov et al. provided the first evidence that response to PPI treatment may be dependent on the level of psychological distress.53 Thus, it has been proposed that a Stem Cell Compound Library subset of patients who did not respond to PPI therapy

are more likely to have a psychosocial comorbidity than those who were successfully treated with a PPI. In these patients, treatment directed toward underlying psychosocial abnormality may improve patients response to PPI therapy. The main focus for drug development in refractory GERD patients is TLESR reduction and more potent, early and consistent acid suppression. However, due to the diverse causes of PPI failure, one therapeutic strategy may not be the solution for all patients. It is likely that individually tailored therapy would be the most proper therapeutic approach. Ronnie Fass serves as a consultant to Takeda, Vecta, Shire; Given Imaging. Fass has received research support from

AstraZeneca and Reckitt Benckiser. The author also serves as a speaker to Takeda and Nycomed. “
“Diabetic gastroparesis was once thought to be rare, associated with a poor prognosis, and C1GALT1 to affect only patients with type 1 diabetes and irreversible autonomic neuropathy. A landmark study conducted by Horowitz et al. and published in JGH in 1986 paved the way for further studies to examine the pathophysiology, natural history and prognosis of diabetic gastroparesis, as well as its optimal management. This review summarizes the developments in knowledge gained over the last ∼25 years that have led to understanding about normal and disordered gastric emptying in diabetes, with a particular emphasis on the inter-relationship between the rate of gastric emptying and the regulation of blood glucose.