11th Global Gastroenterologists Meeting- The management of gastroesophageal reflux disease: Medical, surgical and endoscopic therapy; a clinical review and scientific literature - Antonio Iannetti - Sapienza University of Rome

Introduction: The incidence of gastroesophageal reflux disease in the population of industrialized countries is high and ranges from 20 to 40% in the age groups between 45-64 years, with a further increase in the incidence in the age between 64-74 years. The natural history of the disease requires continuous recrudescence alternated with quiescent phases. In view of these epidemiological data, importance of the social problem and the high health costs is cleared. It follows the interest of pharmaceutical companies, the companies of electromedical and producing toolkits endoscopic and surgical companies. Objective: In this session, I intend, with the participation of colleagues internists and surgeons, to make a brief stock of the situation, about the gastro-esophageal reflux disease. I will make a tour of the clinical presentation, the increase of incidence, especially of so-called atypical forms and symptoms of gastro-pharingeal reflux (high reflux), emphasizing how many patients are refractory to therapy. Patients who benefit from medical treatment, they become dependent on care. Whereas, many are young and that medical therapy has adverse side effects, such as anemia, osteoporosis, and infections, is the need for alternative therapies. Physiotherapy global posture, for example, can be a transient and partial support. The ultimate solution is or should be surgical. Considerations: Surgical therapy makes use of minimally invasive or laparoscopic method, which shortens the hospital stay. But an endoscopic surgery, easy, repeatable, free from postoperative complications, can be performed in day surgery, would be ideal for this type of chronic disease. In reviewing the different techniques, that have been proposed over the last 20 years, I relate the considerations, derived from the international literature. This presentation is concluded by presenting a last device, manufactured in Germany, derived from its precursor, the NDO Plicator, which is making use of the addition of heads polytetrafluoroethylene (PTFE), which retain the suture threads from the traction, exerted by the tissues, seem to improve the seal in time. Conclusions: I carry scientific studies that have compared the operations, performed with GERD-X Plicator, to surgical interventions of fundoplication, with satisfactory results. My invitation is to continue to seek solutions with endoscopic surgery, which is the most appropriate technique for this type of pathology.

COVID-19 patients can experience GI symptoms and probably fecal-oral transmission. In patients with COVID-19, the disease caused by the novel coronavirus, there are multiple expressed gastrointestinal symptoms and a potential fecal-oral transmission. According to evidence from previous SARS research, SARS coronavirus (SARS-CoV) gastrointestinal tract (intestine) tropism has been confirmed by viral identification in biopsy specimens and stools, also in discharged patients, which can partially provide explanations for gastrointestinal symptoms, possible recurrence and SARS transmission from persistently shedding humans as well. Patients with these symptoms had longer periods from diagnosis to admission, and their prognosis was worse than patients with no symptoms. Digestive symptoms, such as diarrhea, may be a characteristic of COVID-19, and the alarm level will need to be elevated early in patients with digestive symptoms at risk, rather than waiting for respiratory symptoms to appear. Patients with COVID-19 may complain of weak appetite, nausea, vomiting, diarrhea, elevated liver enzymes or exacerbation of symptoms or disease activity for pre-existing digestive diseases such as inflammatory bowel disease (IBD). Odor loss following a viral infection is the second most common cause of odor loss, possibly accounting for around 12 percent of all cases; ENT surgeons around the globe have reported reports that they have seen patients suffering anosmia indicating the role of anosmia and hyposmia as a possible COVID-19 associated symptom. After the infection, around 40 per cent of cases of anosmia occur. Because SARS-CoV-2 can be extracted in feces by cultivation and rRT-PCR attention should be paid to feces contaminated environment that can lead to touch or aerosol transmission and medical staff treating suspected COVID patients with GI problems should be shielded from fecal contamination.

According to Market research the Global Gastrointestinal Drugs Market Revenue by Region in 2016, North America was the highest by getting the revenue of 17,288 US Dollar Million, while the Middle East and Africa Continent was having least generation of revenue. The global gastrointestinal endoscopic devices market accounted for approximately USD 5.6 Billion in 2015 and is expected to reach approximately USD 8.5 Billion by 2021, growing at a CAGR of around 7.0% between 2016 and 2021. Celiac disease utilized to be considered a uncommon disease restricted nearly exclusively to the region of Europe and the age group of children. However, the first comprehensive tests, propelled in the 1980s, have uncovered a exceptionally different reality. Celiac disease is one of the most frequent of all long lasting diseases, influences children and adults in rise to measure and is more common in ladies ­(ratio men/women = 1:1.5-2). In Italy and for the most part in Europe where a incredible deal of research on celiac disease has been conducted there are varieties in the rate of predominance in the distinctive nations. This can too be seen in the Americas, where the rate is as it was 0.2 to 0.6 % in Brazil but 1.5-3.5 % in Mexico. New Technological advancements will continue to precede the gastrointestinal endoscope market. Recent generations of endoscopes will continue to progressively promote on visualization and detection technologies. It is projected to exceed $1.7 billion by 2020. In the United States, 20 per cent to 30 per cent of individuals living with HIV are co infected with HCV. Hepatitis C is common among individuals living with HIV. This implies that approximately 225,000 to 330,000 individuals in the United States are living with both viruses. The larger part of individuals living with hepatitis C does not know they have it. The most common course of transmission in the UK is utilizing non-sterile needles and other equipment for infusing drugs. 90 per cent of individuals who got HIV from infusing drugs are moreover infected with HCV. This is since both infections can be spread effectively through blood and blood products. The demand for ambulatory surgery center is high in Europe and Asia Pacific owing to the government initiatives to overcome the shortage of medical facilities in remote areas of developing countries such as India and China. The North America ambulatory surgery center market is expected to witness significant growth rate in future due to the enough outpatient surgery centers and government regulations governing the preference for outpatient surgery centers in order to expand the reach of medical facilities.


Antonio Iannetti

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