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At least 253 records · Page 14Linked to original sources
PubMed2003

The pattern of esophageal manometry in progressive systemic sclerosis.

OBJECTIVE: The purpose of this paper is to study the esophageal motility pattern and the frequency of acid reflux in patients diagnosed to have progressive systemic sclerosis and compare the results to that of normal controls. METHODS: All consecutive patients diagnosed to have progressive systemic sclerosis between 1417-1419 (Hijra year) at King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia were included (Group I). History of heartburn, dysphagia and regurgitation was reviewed. Drugs that might suppress acid or alter motility were discontinued 2 weeks before inclusion. The results were compared to that of 21 symptomatic controls of similar age and sexes that were seen at the same period (Group II). Esophageal manometry and upper gastrointestinal endoscopy were performed in all patients. Ambulatory 24 hour-pH monitoring was carried out in 6 patients of group 1 and 20 patients of group II. RESULTS: Thirteen progressive systemic sclerosis patients (12 females) mean age was 38.7 years and 21 (19 females) mean age was 34.8 years were included. The symptom scores, lower esophageal sphincter pressure, esophageal contractions amplitude were significantly worse in patients compared to control, dysphagia was mostly due to aperistalsis. All progressive systemic sclerosis patients showed the typical esophageal manometry pattern of lower esophageal sphincter pressure and diminished amplitude with aperistalsis. Gastroesophageal reflux was detected in 83% of patients with progressive systemic sclerosis. Moreover, all 24-hour pH monitoring variables were significantly worse in group I. CONCLUSION: Patients with progressive systemic sclerosis usually present with heartburn, dysphagia and regurgitation. Esophageal manometry typically shows lower pressure and aperistalsis. Gastroesophageal reflux is frequent.

Adult↗
PubMed2003

Esophageal manometry in patients with clinical symptoms mimicking esophageal origin: a hospital-based ten-year experience.

BACKGROUND: Primary esophageal motility disorder, which can cause chest pain or dysphagia, is seldom reported in Chinese. With the introduction of an easy and less uncomfortable method to perform esophageal manometry by low-compliance perfusion system, we studied symptomatic patients for more than 10 years. These data were analyzed and were compared to Western reports. METHODS: From August 1989 to June 1999, 264 patients with symptoms mimicking esophageal origin, such as chest pain, dysphagia or odynophagia, but without secondary motility disorders were enrolled. Esophageal manometry was performed on each patient. RESULTS: Among 264 manometric tracings, 142 (54%) were normal and 122 (46%) were abnormal. In patients with abnormal tracings, 73 were nonspecific esophageal motility disorder (NEMD), 20 were achalasia, 9 were diffuse esophageal spasm (DES), 8 were nutcracker esophagus, 7 were hypotensive low esophageal sphincter (LES), 3 were abnormal provocative test by edrophonium, and 2 were hypertensive LES. As in Western countries, the most common abnormality was NEMD. However, our series did not find many patients with DES, nutcracker esophagus and hypertensive LES. Similar results were noted in patients with NEMD, that most had increased nontransmitted contractions and low contraction amplitude. CONCLUSIONS: We found that primary esophageal motility disorder is not uncommon in Taiwan. Esophageal manometry should always be considered in patients with symptoms mimicking esophageal origin.

Adult↗
PubMed1992

[Esophageal manometry in patients with achalasia].

Fifty-eight patients with achalasia were evaluated by esophageal manometry. In the body of the esophagus, the resting pressure was elevated and the motor waves were typically of low amplitude and presented simultaneously. The LES was of normal or high tone with absent or reduced relaxation in response to deglutition. The authors noticed that the contraction pressure in the pharynx and the resting and closing pressures in the UES were markedly elevated. These features were not documented in the literature. Twenty-two patients were followed up by manometry 4 to 60 months after a Heller's myotomy. The resting pressures in the body of the esophagus and the LES were obviously reduced. We considered that esophageal manometry is an important method in the diagnosis of achalasia.

Adolescent↗
PubMed1992

Comparison of intraoperative and endoscopic manometry of the sphincter of Oddi.

Despite the potential utility of intraoperative manometry of the sphincter of Oddi, limited data are available validating its use. The current study was undertaken to validate the method of intraoperative sphincter of Oddi manometry by comparing the pressure tracings obtained at operation (transduodenal sphincteroplasty and transampullary septoplasty) and endoscopy (preoperative) in the same group of patients. Seventy-four patients with idiopathic pancreatitis or unexplained disabling pancreaticobiliary pain had sphincter of Oddi manometry performed endoscopically and intraoperatively within six weeks of each other. Thirty-five patients had manometric evaluation of the bile duct segment of the sphincter of Oddi. The mean basal sphincter pressure determined endoscopically and intraoperatively was 41.1 +/- 6.4 millimeters of mercury (mean plus or minus standard error of the mean) and 42.0 +/- 6.8 millimeters of mercury (not significantly different, p > 0.05), respectively. There was no significant difference between the biliary sphincter phasic pressure, phasic frequency and phasic duration, as recorded by the two techniques. Fifty-five patients had manometric evaluation of the pancreatic duct sphincter. The mean basal sphincter pressure determined endoscopically and intraoperatively (after biliary sphincteroplasty) was 111.9 +/- 9.9 millimeters of mercury and 102.7 +/- 8.7 millimeters of mercury, respectively (not significantly different, p > 0.05). There was no significant difference in the pancreatic sphincter phasic duration and phasic frequency determined by the two techniques. However, the pancreatic sphincter phasic pressure was significantly higher when measured endoscopically (p < 0.001). Overall, 70 percent of patients benefited from surgical sphincter ablation therapy. Patients with an elevated basal sphincter pressure determined intraoperatively were more likely to improve than those with a normal basal sphincter pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Role of manometry and pH-metry in patients with symptoms and signs of gastroesophageal reflux disease.

To assess the correlation between esophageal manometry and 24-h pH-metry and the clinical, endoscopic and radiological picture, we carried out a retrospective analysis of the data of 175 patients in 2001-2002 with symptoms of gastroesophageal reflux disease and/or the established presence of esophagitis. The data were analyzed on the basis of the mean, standard deviation (SD) and percentage (%). Student's "t"-test was used to calculate statistical significance (P < 0.05). pH-metry was positive in 112 cases (64% R+) and negative in 63 (36% R-). Manometry revealed a significant sphincter hypotonia and a greater involvement of peristalsis in R+ patients. There was no significant relationship between symptoms and response to medical treatment compared to a positive pH-metry. Ninety-three (53%) patients presented esophagitis, while 58 (33%) had a hiatal hernia. Esophagitis was more frequent in R+ patients, while hiatal hernia was equivalent in both groups. In the diagnosis and treatment of gastroesophageal reflux disease, the first step is empirical medical therapy. If symptoms persist, esophagogastroduodenoscopy and barium radiology are performed to evaluate the presence of esophagitis and/or gastroesophageal reflux and any related diseases. Manometry and pH-metry (the gold standard for the diagnosis of gastroesophageal reflux disease) are therefore always performed in patients with atypical symptoms of patients to be subjected to surgical treatment.

Adult↗
PubMed2004

[Motility disorders in oesophageal manometry in children with chronic abdominal pain].

Chronic abdominal pain in children can be dependent from motility disorders. The aim of the work was evaluation the frequency of changes in oesophageal manometry in children with chronic abdominal pain. Manometry studies were performed in 40 children with functional abdominal pain (group A, which was divided into subgroups: A1--functional dyspepsia, A2--irritable bowel syndrome, A3--nonspecific abdominal pain), in 11 children with gastritis (group B) and in 24 children as a control (group C). Disorders of lower oesophageal sphincter (LES) function were observed in 72.5% of group A and 45.5% of group B; transient lower oesophageal sphincter relaxations (TLESR) were noticed in 13.5%. Abnormalities of body function with the features of non-specific oesophageal motility disorders were observed in 62.5% in group A and 54.5% in group B during "dry" swallows and in 47.5% and 18.2% respectively during "wet" swallows. These changes were more frequent in dyspeptic children (85.7%). Statistical differences were established among values of resting LES pressure in analysed groups (group A or B versus group C; p < 0.05). In conclusion we mentioned that in oesophageal manometry abnormalities (LES and body function) were observed in children with functional abdominal pain and with gastritis. Characteristic features can not be defined in each group.

Abdominal Pain↗
PubMed2004

[Evaluation of clinical value of anorectal manometry for diagnosis of Hirschsprung's disease in neonate].

OBJECTIVE: Hirschsprung's disease (HD), one of the most common causes resulting in lower intestinal obstruction in children, is prone to be misdiagnosed or to be missed from diagnosis because of its atypical clinical symptoms and inconspicuous morphological findings by barium enema X-ray. Recently, this situation has been largely ameliorated by increased comprehension of anorectal kinetics and improvement of instrument for measurement of anorectal pressure. By now, anorectal manometry (ARMM) has been regarded as a routine means for functional assessment and diagnosis for anorectal disease. Nevertheless, the accuracy rate of diagnosis of HD in neonate by ARMM remains to be elucidated. In this study the clinical evaluation of anorectal manometry as an early diagnostic method for neonates with Hirschsprung's disease was appraised. METHODS: Forty-two HD patients defined by pathological study of rectal tissue obtained via rectal mucous membrane biopsy or operation were recruited in this study. ARMM was performed in liquid transmission using PC polygraph high rate gastrointestinal dynamical detection system (PC Polygraf HR, CTD-synectics, Sweden), with 4-lumen catheter with which a small 5-cm-long balloon was connected at the terminus. All children were positioned on their left side or back during the procedure and the pressure transducers were placed in the mid-axillary line level. The results of ARMM performed before operation or biopsy were compared with the results of barium enema X-ray testing. The decrease of internal anal sphincter pressure as rectoanal inhibitory reflex (RAIR) was measured based on the fluctuation curve of pressure detected. HD was defined when no decrease of anal catheter pressure was detected after insufflation (RAIR positive), and suspected HD state was assessed with the presentation of incomplete relaxation or positive/negative results coexisted (RAIR abnormal) in canal. RESULTS: Thirty patients (71.43%) were diagnosed as HD by ARMM including 18 patients who showed negative response to RAIR and 12 patients whose response was abnormal. While barium enema examinations were carried out in all the 45 patients, the results showed 5 HD patients and 14 suspected HD patients, giving an overall diagnostic accuracy of 45.24%. There were also 16 patients with positive ARMM response and negative barium enema findings together, and 5 patients with negative ARMM results and positive barium enema findings at the same time. There was a significant difference between the two diagnostic methods (chi(m)(2) = 4.76, P < 0.05). CONCLUSION: Anorectal manometry seems to be a more reliable method for diagnosis of Hirschsprung's disease in neonate than barium enema X-ray. Because ARMM is a simple, safe and non-invasive method, it can be used as a screening test of choice in neonates with clinically suspected HD. But for final diagnosis, it is reasonable to combine ARMM with other diagnostic methods in HD patients.

Anal Canal↗
PubMedDate not supplied

[Anorectal manometry: standardisation of the execution technique].

Anorectal manometry is the basic investigation for the study of anorectal function. The lack of a standard execution technique and of any common definition of the manometric parameters constitutes a major limitation. The aim of the present study is to propose a standard technique for performing manometry. In addition we also focus on those manometric parameters that are easily identified and interpreted for the systematic study of a proctological patient. The protocol used is organised in three phases: (i) tests with a radial channel probe with continuous extraction, which provide information on the length of the anal canal and on the precise site of maximum pressure; (ii) tests with a radial channel probe with stationary extraction, which does not involve reflex contraction of the sphincter apparatus and therefore permits better evaluation of sphincter pressure when the muscles are relaxed as well as the identification of slow and ultra-slow waves; (iii) tests with a helicoidal probe and a balloon for the evaluation of the anorectal inhibitory reflex and of anorectal sensitivity. Using this protocol it is possible to perform manometry in less than 30 minutes and to define the importance of anorectal function with approximately 10 parameters which are easily identified and interpreted.

Clinical Protocols↗
PubMedDate not supplied

Intraoperative manometry of the lower esophageal sphincter pressure during laparoscopic antireflux surgery with a mechanical calibration--early results.

BACKGROUND/AIMS: Persistent postoperative dysphagia diminishes the good effect of laparoscopic anti-reflux surgery. An excessive increase of the intraoperative lower esophageal sphincter pressure (LESp) is supposed to be related to the persistent postoperative dysphagia and its knowledge could lead to the modification of the surgical technique followed by improved clinical outcomes. This study aims to describe the relation between the intraoperative LESp increase and the incidence of postoperative dysphagia and to find whether a combination of intraoperative manometry and mechanical calibration of the wrap is able to decrease the incidence of the persistent postoperative dysphagia. METHODOLOGY: The randomized, prospective, two-branch study included 39 patients suffering from symptoms of gastroesophageal reflux disease. All patients underwent pre- and postoperative manometry, 24-hour pH-metry and laparoscopic anti-reflux surgery. The intraoperative LESp was measured in the study arm only. RESULTS: A higher incidence of persistent postoperative dysphagia was revealed in patients with the intraoperative LESp increase more than 15 mmHg. This complication was not found in patients with the LESp increase under 8 mmHg with no impact on the efficacy of the surgery. The combination of the intraoperative manometry and the mechanical calibration of the wrap seems to bring the benefit only to a small number of the patients. CONCLUSIONS: According to our results, the intraoperative LESp measurement proved to be a useful supplementary method which was easy to perform, and which enables a modification of the surgical technique to decrease the incidence of the persistent postoperative dysphagia.

Adult↗
PubMed1991

[Functional study of the esophagus in progressive systemic sclerosis: utility of the manometry].

The authors report their experience about the esophageal manometry in patients with Progressive Systemic Sclerosis (PSS). From January 1987 to December 1991, 32 patients (27 females and 5 males, in the ratio of 5.4 to 1; mean age of 56.6 years, range 18-84) were send to our Department with the diagnosis of PSS. The patients were divided in two group according to the presence or absence of esophageal symptoms. The first group (A) of 12 patients without symptoms, was examined only with manometry, while the second (B) was studied with the 24-hour pH-monitoring and esophagoscopy. In the group A the manometry noticed in 9 cases (75%) various degrees of esophageal motility disorders; in B the 90% of cases had a more or less severe disorder of the peristalsis. Moreover the grade of esophagitis and the importance of the gastroesophageal reflux were proportioned to the motility disorders. The conclusion is that also the subjects with PSS, but without esophageal symptoms, have in a high percentage motility disorders of the viscera. The alterations of the peristalsis increases in the group of symptomatic patients associated with esophagitis and severe reflux. On account of the fact that the esophageal lesions involve not only the LES but also the esophageal body, it is clear that the anti-reflux surgical procedures fail and an early medical therapy is the more adequate treatment.

Adolescent↗
PubMed1991

[Intraoperative esophageal manometry in the surgical treatment of achalasia].

Since 1985 we have done intraoperative manometry in 54 patients operated for achalasia. Manometry allows the assessment of the completeness of the division of the high pressure zone and ascertain the length of fundoplication (Nissen) as well as its pressure. In 26 patients pH and manometric controls were done postoperatively. Absence of reflux was noted in all and the pressure level after operation was 12.53 +/- 4.94 mmHg. Pressure measurements were not different from those of a group of 15 healthy subjects (15.2 +/- 2.45 mmHg). Dynamic studies of the high pressure zone revealed a post-deglutition relaxation of 72.5 +/- 16.32% over the basal tone. We believe that intraoperative manometry is essential in the surgical treatment of achalasia as it allows a precise control of myotomy as well as the fashioning of a high pressure zone to avoid reflux.

Adult↗
PubMed1991

[Terminal constipation: priority for anorectal manometry].

Terminal constipation is a common ailment which may be readily suspected by appropriate questioning of the patient. Investigation is by function tests such as anorectal manometry and measurement of colonic transit time. The goal of this investigation was to explore the relative merits of these two methods in terminal constipation. Measurement of colonic transit time did not make it possible to distinguish terminal from other forms of constipation, whereas anorectal manometry allowed this distinction and, in cases of terminal constipation, provided information on the physiopathological mechanisms, thereby permitting appropriate anorectal reeducation by biofeedback. We conclude that, once an organic cause has been excluded by coloscopy, anorectal manometry is the investigation of choice in terminal constipation.

Adolescent↗
PubMed1990

Esophageal 24-h pH monitoring: is prior manometry necessary for correct positioning of the electrode?

In 24-h esophageal pH monitoring, the electrode is usually positioned 5 cm above the manometrically localized esophagogastric junction. In order to replace esophageal manometry for this purpose, we tested whether the esophagogastric junction can be identified correctly by fluoroscopy or the determination of the pH-step between stomach and esophagus, compared with esophageal manometry. The distance from the nares to the esophagogastric junction was determined three times with each of the three methods in 46 patients and 14 volunteers. Fluoroscopy assumed the esophagogastric junction 1.23 +/- 0.23 cm (mean +/- SE) lower than the peak pressure point determined at manometry, pH-step only 0.45 +/- 0.16 cm. With pH-step, only one subject had a difference of more than 3 cm to the manometrically defined esophagogastric junction, whether gastroesophageal reflux disease (as proven by pH monitoring) was present or not. We conclude that the esophagogastric junction can usually be identified with sufficient accuracy by the measurement of the pH-step between stomach and esophagus. Fluoroscopy is far less accurate than pH-step, and should not be used.

Adult↗
PubMed1990

[Possibilities of ultrasonic dopplerography and multi-level manometry in the evaluation of lesions of the arteries of the lower limbs].

Dopplerographic and manometric examination was conducted in 429 patients with obliterating lesions of the lower limb arteries in order to find optimal diagnostic combinations. The data of noninvasive diagnosis were verified in 119 cases. The data obtained bore evidence that coincidence of the findings of ultrasonic dopplerography and multilayer manometry is indicative, with a high degree of probability, of the presence or absence of lesions of the lower limbs. The findings of ultrasonic dopplerography are the main criteria in appraising affections of the aortoiliac segment and those of multilayer manometry--in appraising affections of the femoropopliteal segment. The findings of both methods are of equal significance in appraising the tibial segment. Multilayer manometry allows indirect appraisal of the condition of arteries in the channel of the deep femoral artery.

Adult↗
PubMed1990

Sincalide-augmented quantitative hepatobiliary scintigraphy (QHBS): definition of normal parameters and preliminary relationship between QHBS and sphincter of Oddi (SO) manometry in patients suspected of having SO dysfunction.

Sphincter of Oddi (SO) dysfunction presents with vague abdominal pain and/or abnormal liver function tests, and is presumably due to SO stenosis or spasm. Clinical, laboratory, and imaging methods of diagnosis have been less than ideal. Initially, we determined normal quantitative hepatobiliary scintigraphy (QHBS) parameters both pre- and post-sincalide administration. Thirty-one "normals" were analyzed, and post-sincalide common bile duct (CBD) dynamics could be satisfactorily determined in 29 (94%) subjects. Normal values at sincalide-augmented QHBS are reported. Next, 10 patients suspected of having SO dysfunction were studied prospectively using SO manometry and QHBS. The two tests were in agreement in seven cases (4: normal CBD dynamics, 3: abnormal). In one case of advanced SO stenosis, QHBS was abnormal, but SO manometry could not be performed. In the two remaining cases, SO manometry and QHBS gave discordant results. Of greatest importance, no significant correlation existed between the quantitative parameters of these two tests. Sincalide-augmented QHBS is possible and may, in the future, be of value in the diagnosis of SO dysfunction and/or partial CBD obstruction.

Adult↗
PubMed1989

Intrarenal manometry in the diagnosis of acute rejection superimposed on acute tubular necrosis in renal transplantation.

We used fine-needle intrarenal manometry as a guide for detection of acute rejection superimposed on protracted oliguric acute tubular necrosis occurring in the postoperative course of human renal transplantation. We followed intrarenal pressure (IRP) in 31 patients who received 32 renal transplants, 12 from living related donors and 20 from cadaveric donors. There were 19 rejection episodes and 10 episodes of transient cyclosporin A (CyA) nephrotoxicity. Nine patients had posttransplant acute renal failure. Levels of IRP (mmHg) in acute rejection were (mean +/- SD) 48.6 +/- 11.1, significantly higher (p less than 0.001) than the levels in CyA nephrotoxicity (28.2 +/- 5.21), acute tubular necrosis (24.5 +/- 5.5) and normal functioning grafts (26.4 +/- 6.63). Antirejection treatment was associated with return to normal of IRP after 10 days. Intrarenal manometry was performed routinely ever 2-3 days in patients who had postoperative acute renal failure. Increments in IRP were detected on the 7-10th postoperative day in 7 patients who had 10-25 days of post-transplant oliguria. Renal biopsy findings were compatible with acute rejection, and the patients responded to intravenous bolus of steroids. We suggest that fine-needle intrarenal manometry is a reliable test for the detection of acute rejection in circumstances when traditional parameters of altered renal function cannot be evaluated.

Acute Kidney Injury↗
PubMed1984

Contribution of intraoperative biliary manometry for the diagnosis of bile duct stones.

Sixty patients with cholecystitis and gallstones, with and without biliary duct calculi, were submitted to intraoperative biliary manometry and cholangiography. The patients were subdivided into two groups of 30: Group A, without biliary duct calculi, and Group B, with biliary duct calculi. The pathology had been diagnosed before surgery for 24 patients in group B (B1), and for 6 (B2), diagnosis was made on the basis of intraoperative manometry which showed higher pressure values than those encountered in the main bile ducts of patients without calculi, and of intraoperative cholangiography. Choledocotomy, which was performed on all 6 patients, confirmed the presence of calculi. When three successive sequences of pressure measurements were performed on the common bile duct of patients with biliary duct stones there was an increase in pressure at 10, 15 and 20 s from the first compared to the third sequence. Intraoperative manometry suggested the presence of biliary duct calculi, which was confirmed by intraoperative cholangiography in the 20% of patients in group B for whom calculi had not been previously diagnosed, and decreased unnecessary choledocotomy.

Adolescent↗