22 In a study using 24-h ambulatory MII–pH, Sifrim et al. reported that GERD patients showed

more acid reflux and less non-acid reflux.6 The total rate of reflux episodes was similar in patients and healthy controls. However, GERD patients showed a higher proportion of acid reflux. One-third of reflux episodes were non-acid in both groups. Vela et al. reported that treatment with omeprazole resulted in a significantly decreased number of acid reflux episodes; however, non-acid reflux continued to occur and was responsible for some symptoms.23 When patients with NCCP were divided into GERD-related NCCP and non GERD-related NCCP groups based on MII–pH and upper endoscopy, there were no differences in age, sex, typical esophageal symptoms, improvement with PPI medication, or esophageal dysmotility between the two groups. Improvement of selleck inhibitor symptoms was achieved in 92% of patients when using PPI medication. As for the possible mechanisms for the improvement with PPI in GERD-unrelated NCCP, several mechanisms for NCCP, such as visceral hypersensitivity and psychological comorbidity, have been proposed.10 Although it requires further confirmation,

there are several hypotheses, such as abnormal mechanophysical properties of the esophagus, sustained longitudinal muscle contractions of the esophagus, altered central processing of selleck chemicals esophageal stimuli, and autonomic dysregulation. This suggests that both non GERD-related and GERD-related NCCP respond to PPI therapy and that PPI might be an alternative treatment for non GERD-related NCCP. There are some limitations to the present study. First, the pathological bolus exposure time in the postprandial period was not based on the normal values in healthy volunteers. Second, psychological aspects of NCCP were not sufficiently identified. Nevertheless, this study is important because it investigates the role of pathological

bolus exposure in patients with NCCP using impedance–pH monitoring. In conclusion, the combination of impedance and pH monitoring improves the detection and characterization of NCCP. This study suggests that pathological bolus exposure plays a check details significant role in eliciting NCCP. “
“Colorectal cancer is one of the commonest malignancies in the “developed” world. The liver constitutes the main host organ for its distant metastases which, when present, augur a bad prognosis for the disease. Kupffer cells (KCs) are macrophages that constantly reside within the liver and form an effective first line defence against multiple harmful agents which reach the hepatic sinusoids via the portal circulation. KCs remove chemical compounds and dead or damaged cells, eliminate bacteria and protect against invading tumour cells. They may play a crucial tumouricidal role, exerting cytotoxic and cytostatic functions through the release of multiple cytokines and chemokines.