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PubMed1980

Anorectal manometry in the diagnosis of Hirschsprung's disease in adults.

Anorectal manometry is a useful tool in evaluating the cause of chronic constipation and is reliable in the diagnosis of Hirschsprung's disease. Two adult patients ages 35 and 69 with constipation since birth underwent anorectal manometry. Balloons positioned at the internal and external anal sphincters were connected to pressure transducers and their responses to a distention of rectal balloon were recorded. Both patients demonstrated failure of relaxation of the internal anal sphincter which is characteristic of Hirschsprung's disease. This diagnosis was confirmed at surgery by histologic examination failing to show ganglia. Anorectal manometry is a useful adjunct in the differential diagnosis of adult patients with megacolon.

Adult↗
PubMed1994

[Proven indication for manometry and pH determination of the esophagus].

Manometry and pH-metry are essential in the examination of functional disturbances of the esophagus. Before they are used, morphological lesions have to be excluded. Proven indications for functional methods are symptoms which cannot be clarified otherwise. Indications for manometry are: dysphagia of unknown origin, noncardiac chest pain and necessary preoperative studies. Indications for long-term pH-metry are: atypical reflux symptoms, (in particular chronic respiratory disease), noncardiac chest pain, atypical esophagitis and preoperative examination prior to antireflux surgery. Used critically, manometry and pH-metry can be very helpful as cost-effective diagnostic tools.

Chest Pain↗
PubMed1994

Manometry, profilometry, and endosonography: normal physiology and anatomy of the anal canal in healthy children.

Normal and manometric and profilometric values and normal endosonographic features of the anal canal are required for evaluation of pathological conditions such as slow-transit constipation, anorectal outlet obstruction, and Hirschsprung's disease, status after surgery for imperforate anus, and other anal abnormalities. Anorectal manometry, profilometry (rapid-pull-through, three-dimensional, eight-channel radial manometry), and endosonography were carried out in 13 healthy children. A significant correlation was demonstrated between conventional manometric and profilometric maximal squeeze pressure of the external anal sphincter (EAS). However, the maximal and resting tone of the sphincter complex in profilometry was twice as high as in manometry due to reflexive contraction of a pelvic floor muscle, probably the EAS. With profilometry a positive correlation was found between age and sphincter length. Endosonographically assessed thickness of the EAS, puborectal muscle, and levator ani complex showed a significant correlation with age. However, no correlation was demonstrated between age and internal anal sphincter thickness. Thus, the development of the essential structures of the anal canal in children is age dependent. In addition, these measurements of normal physiology and anatomy of the anal canal provide the basis for detecting pathological conditions of the anorectal region in children.

Adolescent↗
PubMed1996

Laparoscopic esophagomyotomy and antireflux procedure with intraoperative manometry.

We have been routinely performing laparoscopic cholecystectomy and antireflux procedures. Having this experience, we decided to assess the feasibility and safety of performing a laparoscopic esophagomyotomy and antireflux procedure. Here we present a case of a 37-year-old man with a history of progressive dysphagia and a diagnosis of achalasia, made on the basis of clinical, endoscopic, and manometric studies. Preoperative manometry reported a pressure of 52 mm Hg (normal, 15-25 mm Hg) for 4.5 cm (normal, > 3 cm). Laparoscopic esophagomyotomy and anterior fundoplication were performed. The esophagomyotomy included a 6-cm segment of distal esophagus and 2 cm of stomach; postoperative manometry was 18 mm Hg for 3 cm. Eight months postoperatively, a barium swallow demonstrated no reflux. Laparoscopic esophagomyotomy and antireflux procedure can be performed with efficacy and safety, with the advantage of a shorter hospitalization and an early recovery compared with the traditional procedure. Also, we emphasize the importance of the intraoperative manometry in the relevance of a concomitant antireflux procedure.

Adult↗
PubMed1997

Anorectal manometry in women with urinary stress incontinence.

OBJECTIVE: The aims of this prospective study were to determine the bowel function and the anal sphincter function in women with urinary stress incontinence by means of anorectal manometry and to look for manometric variables which could predict the development of surgery demanding genital prolapse after Burch colposuspension. SUBJECTS: During 1991-1992 twenty-one women with urodynamically proven genuine stress urinary incontinence were consecutively operated upon with the Burch colposuspension. No concomitant prolapse repair surgery was performed. Forty-four healthy subjects without anorectal disorders were used as controls. METHODS: All subjects were investigated with anorectal manometry using a microtransducer catheter. A standardized questionnaire concerning bowel function was answered at interview. The manometry and interview were performed preoperatively and one year after the Burch colposuspension. RESULTS: According to the preoperative questionnaire, fecal incontinence was found in 62%, constipation in 38% and straining at defecation in 71%. There were no significant differences in any of the manometric parameters between the preoperative and the one-year postoperative assessment. The patients with prolapse operations after the colposuspension (n = 6) had a significantly lower anal squeeze pressure area (p = 0.029) preoperatively compared to the control subjects. The patients without prolapse surgery (n = 15) did not differ in manometric parameters from the control subjects. CONCLUSION: Bowel dysfunction is common in women with stress urinary incontinence. The women with low anal squeeze pressure area preoperatively are at risk for the development of genital prolapse after Burch colposuspension.

Adult↗
PubMed1997

Ambulatory 24-hour esophageal manometry and pH-metry in patients with noncardiac chest pain, but no reflux symptoms.

The aim of this study is to determine the diagnostic value of 24-hour ambulatory esophageal manometry and pH-metry for patients with noncardiac chest pain (NCCP), but no reflux symptoms. Twenty-four hour ambulatory esophageal manometry and pH-metry was performed on 34 patients with NCCP, but no reflux symptoms. The pressure transducers were located 3, 8, and 13 cm above the lower esophageal sphincter (LES) and the pH probes were located 5 and 20 cm above the LES. An event marker was triggered by the patient for chest pain. Only 17 patients (50%) had at least one pain episode (total 81 episodes, range 1-19 episodes per person) during a 24-hour recording. Twenty-one chest pain episodes (26%) occurred during abnormal motility, whereas 4 episodes (5%) were associated with pH < 4, and 10 episodes (12%) had both abnormalities. The majority of chest pain episodes, 46 out of 81 events (57%), did not have any association with motility or pH abnormalities. Five of 7 patients (71%) with reflux-related chest pain and 8 of 11 patients (73%) with dysmotility-related chest pain had symptom association probability > 95%, indicating a significant association between chest pain and esophageal dysfunction. Our conclusion is that ambulatory esophageal manometry and pH-metry is a useful tool in the evaluation of NCCP, but only a few additional patients with reflux-related chest pain could be found in patients without reflux symptoms.

Adult↗
PubMed1997

[Initial experience with anorectal manometry with the PC Polygraf apparatus in surgery].

The authors present their initial experience with anal manometry using a PC Polygraph of Synectics Medical Co. They discuss the manometric examination of 14 patients with ulcerative colitis, incl. 12 who were operated. In all 12 patients an ilea-pouch-anal anastomosis was made. By manometry a postoperative drop of pressures at rest was found and partly also of pressures during muscular contraction as well as shortening of the zone of high anal pressure. The resulting values, however, did not influence continence, except for temporary soiling, the frequency of bowel movements being 2-8. Anal manometry is an important objective examination of the sphincter function as it makes it possible to compare values before and after therapy. It must be however combined with other anorectal physiological tests such as endosonography, EMG, defaecography etc.

Adolescent↗
PubMed2003

[Surgical treatment of esophageal achalasia by Heller+Nissen laparoscopic procedure. A 24-hour ambulatory esophageal manometry study].

BACKGROUND: The aim of this work was to evaluate, by means of a 24-h esophageal manometry, the motor activity of esophageal body in achalasic patients before and after Heller's myotomy and Nissen's fundoplication. METHODS: Twenty-five achalasic patients underwent a 24-h esophageal manometry. After surgical treatment they had a further 24-h esophageal manometry during follow-up. RESULTS: A statistically significant increase of amplitude of contraction and an increase, but not statistically significant, of frequency and duration of contractions were observed. The study of peristaltic activity showed an increase of peristaltic activity in total and complete sequences and decrease of dropped and interrupted peristaltic sequences. CONCLUSIONS: These data surprisingly showed the presence of a peristaltic activity (31.2%), in achalasic esophageal body, and complete sequences in 20%. The improvement of peristaltic activity observed after surgical abolition of the functional sphincteral rub, proposes again the question about the fall of the peristaltic activity of the esophageal body, which could be due to the hard transit through the LES. This preliminary data seem to confirm, in qualitative and quantitative manner, the positive effect of Heller's myotomy and the null effect of Nissen's fundoplication on the esophageal transit.

English Abstract↗
PubMed1993

Manometry of individual segments of the distal esophageal sphincter. Its relation to functional incompetence.

The major components of the lower esophageal sphincter, the pressure it exerts, its total length, and the length of sphincter affected by abdominal pressure are usually expressed as means of several recordings from different radial segments of the sphincter. In segmental manometry, the individual readings for these components in each segment, rather than the mean values, are analyzed. We used segmental manometry to study 50 normal volunteers and 200 patients with symptoms suggestive of gastroesophageal reflux. Of the latter, 100 had increased esophageal acid exposure and 100 did not. An increased number of defective segments was associated with a greater prevalence of increased esophageal acid exposure. Segmental analysis disclosed the same number (52) of defective sphincters (defined as sphincters with two or more defective segments) in the 100 patients with increased acid exposure as did standard analysis. However, the relationship between a defective lower esophageal sphincter and the number of reflux episodes was clearer when a defective sphincter was defined using standard analysis. Segmental analysis of the lower esophageal sphincter has no clear advantage over standard analysis.

Adolescent↗
PubMed1985

The detection of renal allograft rejection by fine-needle intrarenal manometry.

The causes of early renal allograft malfunction include rejection, acute tubular necrosis, cyclosporin nephrotoxicity and vascular complications. Fine-needle intrarenal manometry is a potential method of distinguishing rejection from the other causes of malfunction and has been used by Salaman and Griffin in patients' treated with cyclosporin. The technique involves inserting a fine-needle, which is connected to a specially designed manometer, into the substance of the transplant kidney. One hundred and six measurements of intrarenal pressure have been made in 28 patients immunosuppressed with either azathioprine and prednisolone or cyclosporin. Thirteen rejection episodes were identified and confirmed by biopsy. These were treated by pulse steroid (methylprednisolone) therapy. Seven episodes of cyclosporin toxicity were identified and there were fifteen episodes of acute tubular necrosis. The mean intrarenal pressure in the rejecting group was 52.8 mmHg compared with 22.3, 24.1 and 24.3 mmHg for the normal function, acute tubular necrosis and cyclosporin nephrotoxicity groups, respectively (P less than 0.01; Wilcoxon unpaired test). There were no differences within these groups related to the type of immunosuppression used. There were no clinical complications associated with the procedure. Thus in newly transplanted patients, fine-needle intrarenal manometry accurately identified rejection and distinguished it from normal function, acute tubular necrosis and cyclosporin nephrotoxicity in all the patients regardless of the immunosuppressants used.

Cyclosporins↗
PubMed1989

Air-filled microballoon manometry for use in anorectal physiology.

Manometry is fundamental to anorectal physiology but the water-filled manometric systems commonly used have several disadvantages. To investigate the 'new' air-filled microballoon system, we compared it with a standard water-filled equivalent by measuring sphincter length, maximum resting pressure (MRP) and maximum voluntary contraction pressure (MVC) in 44 patients using the station pull-through technique. A good correlation was found for all three parameters (Spearman correlation coefficient rs: sphincter length = 0.86, MRP = 0.86 and MVC = 0.94, P less than 0.001). Repeat studies in 15 patients showed excellent reproducibility (rs: sphincter length = 0.97, MRP = 0.96 and MVC = 0.97, P less than 0.001). Air-filled microballoon manometry gives results similar to a water-filled microballoon system and has many advantages.

Adult↗
PubMed1992

Meal area index: a new technique for quantitative assessment in achalasia by ambulatory manometry during eating.

Ambulatory non-perfused oesophageal manometry was used to study oesophageal body function during consumption of a full meal in patients with achalasia. A measure of oesophageal body activity (the meal area index) was developed by calculating the total area under the pressure curve during eating, above the preprandial baseline oesophageal pressure, per meal minute. Untreated patients with achalasia (n = 13) were compared with normal subjects (n = 42), patients with benign stricture (n = 9) and patients with achalasia who had undergone Heller's myotomy (n = 17). The results showed a high meal area index in achalasia, due to a rise in baseline oesophageal pressure and frequent high-amplitude contractions during eating. This was not seen in normal subjects or patients with stricture. The high meal area index was abolished by successful Heller's myotomy but remained in two patients with persisting dysphagia. Sustained high intraoesophageal pressure is generated during consumption of a solid meal in untreated achalasia, resulting in a unique manometric profile. Manometry during eating using the meal area index permits quantitative assessment of oesophageal body function in achalasia and may aid in the assessment of response to treatment.

Ambulatory Care↗
PubMed1994

Anorectal manometry in the assessment of anorectal function in Parkinson's disease: a comparison with chronic idiopathic constipation.

We investigated the role of anorectal manometry in evaluating constipation and anorectal function in 15 patients with Parkinson's disease (PD) and compared results with those of 9 patients with idiopathic constipation (IC) and 8 control (C) subjects. Anal sphincter pressures on voluntary squeeze were lower in the PD patients. Sustained squeeze pressures (mm Hg C versus IC versus PD: 46.8 +/- 5.2 versus 31.2 +/- 3.6 versus 26.6 +/- 3.9; p < 0.05 PD versus C), squeeze duration (seconds: 53.6 +/- 2.5 versus 48.5 +/- 4.1 versus 33.6 +/- 9; p < 0.05 PD versus C) and squeeze index (area under the squeeze curve: 44.0 +/- 2.9 versus 34.5 +/- 3.3 versus 21.4 +/- 2.9; p < 0.001 PD versus C) were significantly lower in the PD group in comparison to the control group. In contrast, none of the parameters of anorectal manometry differed between controls and patients with idiopathic constipation. Some Parkinson's disease patients demonstrated an abnormal, hypercontractile response on testing of the rectoanal inhibitory reflex. Anal sphincter length, basal sphincter pressures, maximal squeeze pressures, extent of relaxation on rectoanal inhibitory reflex and threshold volume for rectal sensation were similar in the three groups. We conclude that an impaired squeeze response is a specific feature of anorectal function in Parkinson's disease. This may indicate direct involvement of the pelvic floor musculature by the parkinsonian disease process.

Aged↗
PubMed1989

Intrauterine manometry: technique and application to fetal pathology.

A technique is described for measuring pressure within the amniotic cavity and within fetal vessels and/or body compartments. Two saline-filled catheters were connected at one end to needles inserted during indicated invasive procedures and at the other to silicon strain gauge transducers. In 36 pregnancies with normal liquor volume, stable intra-amniotic pressure (IAP, range 1-14 mmHg) increased with gestation (r = 0.48, p less than 0.01). In pregnancies complicated by severe oligohydramnios, IAP was less than or equal to 1 mm Hg and rose to normal levels with saline amnioinfusion. Raised IAP (range 17-26 mm Hg), found in pregnancies with gross polyhydramnios, fell with drainage of amniotic fluid. Subtraction manometry was used to determine supra-amniotic pressure within the intervillus space, umbilical vein, umbilical artery, abdominal and thoracic cavities, and the urinary tract in normal and/or pathological fetuses. Low intravesical and intrapelvicalyceal pressures (median 6.5, range 2-10 mm Hg) were noted in fetuses with obstructive uropathies. Intrauterine subtraction manometry appears to be a useful tool in the understanding of fetal pathophysiology and may be of clinical benefit in the therapeutic drainage and infusion of amniotic fluid and in the assessment of certain fetal disease states.

Amniotic Fluid↗
PubMed1989

Problems in diagnosis of Hirschsprung's disease by anorectal manometry.

The purpose of this study is to analyze the results of anorectal manometry and to evaluate the merits and disadvantages of this technique for the diagnosis of Hirschsprung's disease. Studies were performed in 268 patients with constipation, including 95 cases of Hirschsprung's disease. It is concluded from the results that Hirschsprung's disease can be confidently diagnosed by manometric studies. If the studies are performed carefully with a suitable probe, reliability is over 95%. Manometry is the most useful method to differentiate Hirschsprung's disease from other conditions, such as extremely short segment aganglionosis, colonic stenosis, and idiopathic megacolon.

Adolescent↗
PubMed1995

Laparoscopic extramucosal myectomy with anterior fundoplication (Dor) for esophageal achalasia using intraoperative manometry.

Laparoscopic extramucosal myectomy with anterior fundoplication according to the Dor technique was performed on a 24-year-old-woman. Intraoperative inflation of a pneumatic balloon made the operative procedures such as extended submucosal dissection quite easy. Intraoperative gastrofiberscopy was useful for confirming that the remaining mucosal layer was not injured after completion of myectomy. Intraoperative manometry confirmed a complete decompression of the high-pressure zone in the lower esophageal sphincter. Complete relief of the symptoms has been recognized for 6 months after operation without any medication. It is considered that these laparoscopic procedures including intraoperative inflation of a pneumatic balloon, gastrofiberscopy, and intraoperative manometry can be used as a standard operation for esophageal achalasia.

Adult↗
PubMed1994

Alteration of maximum anal resting pressure by digital rectal examination prior to manometry: analysis of agreement between repeat measurements.

To study whether digital examination preceding anal manometry causes significant alteration of maximum resting pressure reading and to quantify the discrepancies, 78 individuals (64 incontinent, 14 controls) were investigated. Recordings of maximum resting pressure were taken before and after digital rectal examination. There was a mean discrepancy of only -1.8 cms H2O between the readings and excellent correlation, but analysis of agreement revealed a bias that tended to be greater with smaller measurements and unacceptable variability between test results. Furthermore, the bias was not related to age, gender, the grade of incontinence, maximum voluntary contraction, functional anal canal length and threshold volume. Digital rectal examination prior to manometry causes unpredictable results especially in patients with lower maximum resting pressures and should strictly be avoided.

Adult↗
PubMed1989

Long-term endoscopic injection sclerotherapy of bleeding esophageal varices. A prospective analysis of results by endoscopy, manometry and 24-h pH-monitoring.

From 1 January 1986 to 1 January 1988, 91 consecutive patients who had undergone repeated paravariceal endoscopic injection sclerotherapy (PEIS) for bleeding esophageal varices over a period of up to 10 years were followed up prospectively by endoscopy, manometry and 24-h pH monitoring. In 39% nonfatal complications occurred after two phases of PEIS. The number of complications tended to decrease with increasing phases and was only 12% after five or more phases of PEIS. Endoscopy is undoubtedly the most important method in the follow-up of these patients. Early and long-term complications are mostly diagnosed by direct view and thus can be managed or sometimes even prevented in the follow-up. No significant motility disorders were found. Only 12 patients showed significant gastroesophageal reflux. No correlation was found between the severity of reflux and the number of phases of PEIS. No correlation between clinical symptoms and changes in the manometric and pH metric results could be found. The effects and side effects of PEIS can be closely monitored by manometry and pH monitoring and therapy can be tailored accordingly. Our results suggest that PEIS is a superb method with a low complication rate, both short- and long-term. It has proven to be an effective long-term treatment of bleeding esophageal varices.

Adolescent↗