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PubMed1997

Diffuse oesophageal spasm: diagnosis by ambulatory 24 hour manometry.

BACKGROUND: Diffuse oesophageal spasm (DOS) is a potential cause of intermittent chest pain and/or dysphagia. In the past, the diagnosis of DOS has relied on criteria obtained from standard oesophageal manometry (more than one simultaneous contraction in a series of 10 wet swallows with the rest being peristaltic). As symptoms are intermittent, however, 24 hour manometry may well be more suited to its investigation. AIMS: To determine the ability of 24 hour manometry to detect the symptomatic contractions of DOS and to compare standard, laboratory based manometry with 24 hour manometry in its diagnosis. PATIENTS: Three hundred and ninety consecutive patients referred with suspected oesophageal disorders. METHODS: Standard laboratory based manometry and 24 hour outpatient manometry. RESULTS: Sixteen patients were classified by 24 hour manometry as having DOS on the basis of painful contractions (spasms) of excessive duration and increased amplitude. Laboratory based manometry failed to detect the majority of these patients with DOS (14/16), and 53/55 were incorrectly labelled as having DOS on the basis of asymptomatic manometric findings. CONCLUSION: The detection of symptomatic DOS requires 24 hour manometry.

Adult↗
PubMed1995

Endoscopic esophageal manometry.

OBJECTIVE: We performed through-the-scope-manometry of the esophagus on 12 patients referred for esophageal symptoms. METHODS: A 3-lumen polyvinyl tube was passed through the biopsy channel of a standard video-endoscope. All patients underwent esophagogastroduodenoscopy with through-the-scope-manometry as well as a conventional laboratory-based manometric study; the sequence of the procedures was randomized. RESULTS: Mean lower esophageal sphincter pressure was 18 +/- 11 mm of mercury by both methods. In the lower esophagus, mean wave amplitude was 60 +/- 25 mm of mercury by through-the-scope manometry and 82 +/- 28 by laboratory testing. In the upper esophagus, mean wave amplitude was 50 +/- 26 mm of mercury by through-the-scope manometry and 63 +/- 20 by laboratory testing. Wave duration tended to be lower by through-the-scope manometry than by laboratory testing in the lower and upper esophagus. In nine patients with normal esophageal motility, 54% of swallows resulted in a peristaltic wave by the endoscopic study versus 100% for the laboratory test. CONCLUSION: Through-the-scope-manometry was able to accurately measure lower esophageal sphincter pressure compared with laboratory-based manometry. Peristaltic wave amplitude by through-the-scope manometry was reduced compared with laboratory-based manometry, most likely because of the use of dry swallows. Through-the-scope-manometry has promise as a screening test for esophageal motility disorders.

Endoscopy, Digestive System↗
PubMed1989

Anal manometry improves the outcome of surgery for fistula-in-ano.

The aim of this prospective study is to investigate whether anal manometry is useful in orienting the surgical policy and improving the clinical and functional results following surgery for fistula-in-ano. Anal manometry was performed preoperatively and postoperatively in 96 patients. The results of surgery, in terms of both fecal soiling and recurrence rate, were analyzed and compared with those of another group of 36 subjects. Some operative maneuvers, such as internal sphincterotomy, laying open of the fistula with division of striated muscle, or use of a seton, were carried out according to the preoperative sphincter pattern as shown by anal manometry in the first group. A standard procedure was followed in the control group. The recurrence rate was 3 percent in the anal manometry group and 13 percent in the control group (P less than 0.01); postoperative soiling occurred in 14 percent of patients in the anal manometry group compared with 31 percent of patients in the control group (P less than 0.001). The functional results in transsphincteric and suprasphincteric fistulas, which are usually considered at higher risk for postoperative incontinence, were better in the anal manometry group, due to greater use of the seton. No increase in recurrence rate was observed in these complex fistulas after anal manometry. Internal sphincterotomy led to a disordered continence, mainly when associated with division of striated muscle; a significant decrease in resting tone from 56 +/- 22 to 47 +/- 50 and voluntary contraction from 114 +/- 30 to 85 +/- 28 mm Hg (mean +/- S) was found after surgery in patients with soiling. In conclusion, the routine use of anal manometry may be recommended in the management of patients with fistula-in-ano as it improves the clinical and functional outcome of surgery.

Adult↗
PubMed1999

Small-bowel motility disturbances: a comparison of small-bowel series and antroduodenal manometry.

RATIONALE AND OBJECTIVES: The authors' purpose was to compare the findings of small-bowel series with those of antroduodenal manometry to determine whether normal findings from a small-bowel series would make it unnecessary to perform antroduodenal manometry. MATERIALS AND METHODS: The findings from 33 small-bowel series performed on patients who had undergone antroduodenal manometry were retrospectively reviewed for abnormalities, including dilatation, transit time, fold thickening, and increased fluid. Antroduodenal manometry findings were classified into the following categories: normal, myopathy, neuropathy, obstructions, or nonspecific conditions. RESULTS: Nine of 12 patients with specific abnormalities at antroduodenal manometry had abnormal results from the small-bowel series. Of seven patients with normal small-bowel series results, three had abnormal antroduodenal manometry results--two had previously undergone vagotomy with neuropathic changes and one had myopathic changes. CONCLUSION: Small-bowel series and antroduodenal manometry are complementary examinations. Only a small number of patients with normal small-bowel series results will have abnormal results at antroduodenal manometry. A large number of patients with motility abnormalities have a combination of nonspecific changes, such as dilatation and increased fluid, at a small-bowel series.

Adolescent↗
PubMed1999

Comparison of ultrasound-secretin test and sphincter of Oddi manometry in patients with recurrent acute pancreatitis.

Manometry is considered the gold standard for evaluating sphincter of Oddi dysfunction. It has recently been demonstrated that the ultrasound (US) secretin test proposed a few years ago as a noninvasive test for the study of sphincter of Oddi dysfunction yields a substantial percentage of pathological findings in patients with acute recurrent pancreatitis. The aim of this study was to compare the results of the US secretin test with sphincter of Oddi manometry findings in a consecutive series of patients with recurrent acute pancreatitis. Forty-seven patients admitted to our gastrointestinal unit suffering from recurrent acute pancreatitis underwent ultrasonographic measurement of the main pancreatic duct at baseline and for 60 min after maximal stimulation with secretin at 1 IU/kg. According to the US secretin test findings in 35 healthy control subjects, the test results were considered to indicate pathology when the duct was still dilated after 20 min. Within three to seven days the same patients underwent perendoscopic manometry. Thirty-six patients (17 men, 19 women; mean age 41 +/- 15 years) had a successful US secretin test and sphincter of Oddi manometry. Eleven patients (30.6%) presented normal manometric findings. Two of these had an abnormal US secretin test. Twenty-five patients had abnormal manometry findings, revealing stenosis in 19 (52.7%) (17 with abnormal US secretin test) and dyskinesia in six (five with an abnormal US secretin test). Compared to manometry findings, the US secretin test sensitivity and specificity for sphincter of Oddi dysfunction were 88% and 82%, respectively. In conclusion, most patients with recurrent acute pancreatitis have sphincter of Oddi dysfunction documented by both at the US secretin test and sphincter of Oddi manometry; results of the US secretin test are reliable compared to sphincter of Oddi manometry, and therefore the US secretin test may offer a valid alternative to the more expensive and invasive manometric procedure for assessing sphincter of Oddi dysfunction in patients with recurrent acute pancreatitis.

Acute Disease↗
PubMed2003

Scintigraphy versus manometry in patients with suspected biliary sphincter of Oddi dysfunction.

INTRODUCTION: Sphincter of Oddi (SO) manometry is at present the "gold standard" investigation for patients with suspected biliary SO dysfunction. Non-invasive scintigraphy in cholecystectomised patients using a complex scoring system or the transit time from the hepatic hilum to the duodenum (HDTT) have been promoted as sensitive and specific alternatives. AIM: To evaluate the scintigraphic scoring system and HDTT in patients with suspected biliary SO dysfunction undergoing SO manometry. METHODS: Cholecystectomised patients undergoing SO manometry for persistent biliary-type pain, as defined by the Rome II criteria, for which all other causes had been excluded, were prospectively studied. Scintigraphy with cholecystokinin octapeptide infusion was performed within a month prior to manometry. Scoring of the scans and measurement of HDTT was performed by independent blinded observers. Manometry of the biliary sphincter was performed per-endoscopically and defined as abnormal if basal pressure was > or = 40 mm Hg. RESULTS: Thirty two patients were enrolled (30 females, mean age 45.1 years). Three patients were excluded from analysis because manometry from the bile duct was not technically possible. Eight patients had abnormal manometry. Scintigraphic scoring had a sensitivity of 25-38%, a specificity of 86-89%, positive predictive value (PPV) of 40-60%, and a negative predictive value (NPV) of 75-79%. The coefficient of variation for interobserver variation in scores was 0.72. HDTT sensitivity was 13%, specificity 95%, PPV 50%, and NPV 74%. CONCLUSIONS: Our findings indicate that scintigraphy using these methods of analysis correlates poorly with manometry in post cholecystectomy patients with suspected biliary SO dysfunction.

Adult↗
PubMed2001

The effect of anorectal manometry on the outcome of treatment in severe childhood constipation: a randomized, controlled trial.

OBJECTIVE: Approximately 50% of constipated children contract rather than relax the external sphincter complex during a defecation attempt. Although biofeedback training (BF) is able to change this defecation behavior, there is no additional effect of BF to conventional treatment (CT) on clinical outcome compared with CT alone. It has been postulated that the absence of a significant difference between these 2 treatment options might be because of a therapeutic, "demystifying" effect of performing anorectal manometry in conventionally treated children, necessary to obtain basal manometric data. The objective of this prospective, controlled, randomized study was to evaluate the effect of CT with 2 anorectal manometry sessions compared with CT alone (dietary advice, diary, toilet training, oral laxatives, and enemas) on clinical outcome. METHODS: A total of 212 constipated children (143 boys) who were visiting a referral pediatric gastroenterologic practice were randomized prospectively to CT alone (115 patients) or to CT combined with 2 manometry sessions (CTM; 97 patients). Patients were included in the study when they fulfilled at least 2 of the 4 following criteria: stool frequency fewer than 3 per week, 2 or more soiling and/or encopresis episodes per week, periodic passage of very large amounts of stool every 7 to 30 days, or a palpable rectal or abdominal fecal mass. CT comprises dietary advice, a daily diary, toilet training, and oral laxative treatment preceded by rectal disimpaction with enemas on 3 consecutive days. During both manometries, the child and the parent could watch the tracing on the computer screen. No explanation was given to either the child or the parents during the procedure. When the procedure was finished, the tracings were clarified. Successful treatment was defined as a defecation frequency of 3 or more per week and fewer than 1 soiling/encopresis episode per 2 weeks and no use of laxatives. RESULTS: Only 4 and 2 children from the CT and CTM groups showed no soiling and/or encopresis, whereas 76% and 65%, respectively, reported the periodic passage of large stools. In 26% and 30% of the patients, a rectal scybalum was found on physical examination. The success rates at 6, 26, 52, and 104 weeks' follow-up were 4%, 24%, 32%, and 43% and 7%, 22%, 30%, and 35% in the CT and CTM group, respectively. No significant difference in success percentage was observed between the 2 groups at any time of follow-up with relative risks (CT/CTM) and 95% confidence intervals, respectively, of 0.55 (0.16-1.89), 1.13 (0.67-1.89), 1.07 (0.69-1.65), and 1.23 (0.81-1.85). A significant increase in defecation frequency was observed between the first (intake) and second visits, which was sustained at all subsequent visits and stages of follow-up in both groups (not significant). Also in relation to the first visit, a significant decrease in encopresis episodes was shown and a further slow but significant decrease at 52 weeks of follow-up in both groups. The manometric data obtained from the CTM group showed a low percentage of children with normal defecation dynamics, namely 28%, which (significantly) increased to 38% at the last manometry. CONCLUSIONS: Anorectal manometry combined with CT compared with CT alone did not result in higher success rates in chronically constipated children. Therefore, anorectal manometry has no additional demystifying or educational effect on clinical outcome in chronically constipated children. This observation together with the observation in the current and previous studies that no correlation was found between (achievement of) normal defecation dynamics and success and that no relation was observed between volume of urge or critical volume and success leaves no diagnostic or therapeutic role for anorectal manometry in chronic constipated children, except its use as a diagnostic test to exclude Hirschsprung's disease. A simple CT is successful in 30% of severely constipated children who are referred to a tertiary hospital, underscoring the importance of long-lasting and adequate laxative treatment.

Adolescent↗
PubMed2003

Selective use of esophageal manometry and 24-Hour pH monitoring before laparoscopic fundoplication.

BACKGROUND: Preoperative esophageal manometry and 24-hour pH monitoring commonly are used in preoperative evaluation of patients undergoing fundoplication. Here we review our experience with the selective preoperative workup of patients undergoing fundoplication to treat gastroesophageal reflux disease. STUDY DESIGN: A series of 628 consecutive antireflux procedures was reviewed. History and physical examination, upper endoscopy, and upper gastrointestinal videofluoroscopy were obtained preoperatively on all patients; the first 30 patients also underwent esophageal manometry and pH monitoring (routine evaluation group). Thereafter, pH monitoring only was performed for atypical reflux symptoms, and manometry only was performed for a history of dysphagia, odynophagia, or for abnormal motility on videofluoroscopy (selective evaluation group). All patients underwent a laparoscopic floppy Nissen fundoplication, and then endoscopy and fluoroscopy at 3 months and 12 months postoperatively. RESULTS: Eighty-five of the patients in the selective evaluation group (14%) required manometry, and 88 (15%) underwent pH monitoring. Eighteen of the 115 patients who underwent manometry (16%) had evidence of dysmotility. None of these 18 patients had increased dysphagia postoperatively; 8 of 18 reported improvement with swallowing. Five patients in the selective group (0.8%) had persistent postoperative dysphagia caused by technical error (four patients) or with no identifiable cause (one patient). The estimated charge or collection reduction with use of the selective evaluation was 1,253,100 US dollars or 395,000 US dollars, respectively. CONCLUSIONS: Selective use of manometry and pH monitoring was cost effective and safe in this series. Although esophageal manometry and 24-hour pH monitoring might be necessary with abnormal findings on videofluoroscopy or atypical symptoms, in our experience, their routine use is not essential in preoperative evaluation of patients undergoing fundoplication for gastroesophageal reflux disease.

Adolescent↗
PubMed2002

Perception of esophageal manometry.

Esophageal manometry is an important investigation method but its direct impact on patients' well-being has not been studied. A structured questionnaire was given to all patients (n=92) after the manometry during one calendar year. The response rate was 91%. A total of seventy-one patients also reported their health status during the next 24 h. No serious side-effects were recorded. About half of the respondents regarded manometry as an easy or fairly easy investigation. The most common problems were irritation of nose and throat. In total, 48% of the respondents had mild to moderate late symptoms after manometry, usually soreness of the throat or nose lasting for some hours. The manometry was more troublesome to women than to men. It is concluded that esophageal manometry is generally a benign and fairly tolerated investigation, and the high level of anxiety that many patients show before the manometry is not well justified.

Adult↗
PubMed2003

Colonic manometry in children with defecatory disorders. role in diagnosis and management.

OBJECTIVE: The aim of this study was to evaluate the role of colonic manometry in clarifying pathophysiology of childhood defecatory disorders and to evaluate its impact on management. METHODS: We conducted a retrospective review of medical records of children referred to undergo colonic manometry to a tertiary care Motility Center from 1996 to 2001. Families were followed up a median of 20 months after evaluation (range 3-60 months). RESULTS: A total of 150 colonic manometries were performed in 146 children (74 male, median age 79 months, range 4-225 months). Colonic manometry had been requested to clarify the pathophysiology of lower GI symptoms in 68%; as part of diagnostic workup for chronic intestinal pseudo-obstruction in 11%; to decide about reanastomosis of a diverted colon in 7%; and to clarify the pathophysiology of persisting symptoms after surgery for Hirschsprung's disease in 14%. Normal motility was found in the entire colon in 38% of children. In 17%, there was normal motility in the proximal colon with abnormality limited to the dilated distal colon. Abnormal motility was found in 45% of children. After colonic manometry, treatment changes were recommended in 93% of patients. We were able to follow up 65% of the families. When recommendations were followed (96% of the contacted patients), the symptoms improved in 78%, were unchanged in 18%, and were worse in 4% of patients. Among the parents, 88% believed that the suggestions given after colonic manometry had been helpful in improving their children's health. CONCLUSIONS: Colonic manometry may provide information useful in guiding therapy in a subgroup of patients with defecatory disorders.

Adolescent↗
PubMed1990

Pancreatitis after sphincter of Oddi manometry.

The nature, frequency, severity, and possible causes of complications after 207 sphincter of Oddi manometry measurements were studied in 146 patients. Acute pancreatitis was diagnosed in 6% (12 of 207) of the investigations and in 8% (12 of 146) of the patients examined. The pancreatitis was mild in all patients. After cannulation of the pancreatic duct, acute pancreatitis occurred in 10 of 95 (11%) patients compared with one of 93 (1%) when the manometry catheter entered the bile duct only (p less than 0.02). Seven (58%) of the patients who developed acute pancreatitis, however, were found to be suffering from chronic pancreatitis. Some 26% of all sphincter of Oddi manometry measurements on patients with this diagnosis were complicated by an acute attack of pancreatitis compared with 3% (p less than 0.001) in patients without signs of chronic pancreatitis. In all patients the pancreatitis developed within three hours of manometry. We conclude that pancreatitis may occasionally follow sphincter of Oddi manometry measurement, even in patients without pancreaticobiliary disease, and that underlying chronic pancreatitis constitutes a definite risk. Sphincter of Oddi manometry measurement in control subjects should therefore be performed only in centres where the safety of the procedure has been established, and the presence of chronic pancreatitis should be excluded beforehand. Cannulation of the pancreatic duct should be avoided. Manometry can be safely performed, however, as an outpatient procedure.

Acute Disease↗
PubMed1998

Can digital examination substitute anorectal manometry for the evaluation of anal canal pressures?

INTRODUCTION: Anorectal manometry provides objective information on the sphincter function of the anal canal. However, in many centers sphincter function is evaluated by digital examination, due to the unavailability of manometry. OBJECTIVE: A study is made to correlate the sensitivity and specificity of a quantitative digital examination in the analysis of sphincter tone with the pressures recorded by manometry, and to examine the capacity of both techniques to discriminate continent subjects and incontinent patients. PATIENTS AND METHODS: A total of 191 patients were divided into three groups: control (C), obstructive defecation (OD) and fecal incontinence (FI). Subjective quantitative digital evaluation of anal tone was performed on a scale of 0 to 5 points at rest, and 0 to 10 points at squeeze. A correlation analysis was performed, and the sensitivity and specificity of each fecal incontinence diagnostic test was determined. RESULTS: Digital examination found rectal tone to be diminished in elderly patients. A significant correlation was established between the digital and manometric tone readings, both at rest and at squeeze. Both techniques showed a low anal sphincter pressure in the FI group versus the C and OD groups. Differences in tone were recorded between the C and OD groups with manometry, but not with digital examination. The latter was in turn found to be more sensitive but less specific than manometry in differentiating between fecal continence and incontinence. CONCLUSIONS: Although digital examination does not substitute anorectal manometry, a good correlation exists between the two techniques. In this sense, digital examination may afford an approximate clinical evaluation of some fecal continence mechanisms in those centers where manometry is not available.

Adolescent↗
PubMed2003

Randomized, controlled trial of biofeedback with anal manometry, transanal ultrasound, or pelvic floor retraining with digital guidance alone in the treatment of mild to moderate fecal incontinence.

BACKGROUND: A prospective, three-armed, randomized, controlled trial was performed to assess whether pelvic floor exercises with biofeedback using anal manometry or transanal ultrasound are superior to pelvic floor exercises with feedback from digital examination alone in terms of continence, quality of life, physiologic sphincter strength, and compliance. Its secondary objectives were to assess whether there are any differences in these outcomes between biofeedback with transanal ultrasound vs. anal manometry and to correlate the physiologic measures with clinical outcome. METHODS: One hundred twenty patients with mild to moderate fecal incontinence were randomized into one of three treatment groups: biofeedback with anal manometry, biofeedback with transanal ultrasound, or pelvic floor exercises with feedback from digital examination alone. Commencing one week after an initial 45-minute assessment session, patients attended monthly treatments for a total of five sessions. Each session lasted 30 minutes and involved sphincter exercises with biofeedback that involved instrumentation or digital examination alone, and patients were encouraged to perform identical exercises twice per day between outpatient visits. RESULTS: One hundred two patients (85 percent) completed the four-month treatment program. Across all treatment allocations, patients experienced modest but highly significant improvements in all nine outcome measures during treatment, with 70 percent of all patients perceiving improvement in symptom severity and 69 percent of patients reporting improved quality of life. With the possible exception of isotonic fatigue time, there were no significant differences between the three treatment groups in compliance, physiologic sphincter strength, and clinical or quality-of-life measures. Correlations between physiologic measures and clinical outcomes were much stronger with ultrasound-based measures than with manometry. CONCLUSIONS: Although patients in this study who completed pelvic floor exercises with feedback from digital examination achieved no additional benefit from biofeedback and measurement with transanal ultrasound or manometry, it may be that the guidance received through digital examination alone offered patients in the pelvic floor exercise group an effective biofeedback mechanism. Contrary to our hypothesis, the use of transanal ultrasound offered no benefit over manometry, but the use of ultrasound for isotonic fatigue time and isometric fatigue contractions provided potentially important physiologic measures that require further study. This study has confirmed, through a large sample of patients, that pelvic floor retraining programs are an effective treatment for improving physiologic, clinical, and quality-of-life parameters in the short term.

Aged↗
PubMed1992

Dynamic anal manometry: physiological variations and pathophysiological findings in fecal incontinence.

A recently developed technique for dynamic anal manometry was used to study 40 healthy volunteers and 23 patients with fecal incontinence. Seven parameters of anal function were measured. Intraindividual variation of the parameters was studied in 5 females and 5 males. The results of dynamic anal manometry were compared with standard pull-through static anal manometry and correlated well. During opening of the anal sphincter at rest, compliance increased with increasing distension. Males had higher maximal closing pressures during squeeze and lower anal compliance during squeeze than females. There was no sex differences of the sphincter measurements at rest. Age had little effect, and gender had no effect on the measurements. With standard anal manometry, 6 of 23 patients with fecal incontinence both had maximal resting pressure and maximal squeeze pressure within the normal range. When dynamic anal manometry was used, all 23 patients showed one or more abnormal values. The method of dynamic anal manometry provides an opportunity for a more thorough assessment of anal sphincter function than previous manometric methods.

Adult↗
PubMedDate not supplied

Meperidine need not be proscribed during sphincter of Oddi manometry.

Meperidine is routinely proscribed during sphincter of Oddi manometry because narcotics have been associated with spasm of the sphincter of Oddi. We have performed a prospective study of the effect of meperidine on sphincter of Oddi manometry in 18 patients undergoing manometry for suspected sphincter dysfunction. After diagnostic manometry using only intravenous diazepam sedation, the endoscope remained in the duodenum while 1 mg/kg intravenous meperidine was given. Five minutes later sphincter manometry was repeated. There was no difference in the baseline sphincter pressure before and after meperidine in all patients. The frequency of phasic contractions increased after meperidine (p = 0.001). Baseline sphincter pressure is generally the only manometric criteria used to diagnose sphincter dysfunction and this did not change after meperidine. We conclude that meperidine may be used for additional analgesia during sphincter manometry. This may improve patient tolerance and the success rate of this procedure.

Adult↗
PubMed1999

Role of oesophageal manometry in clinical practice.

The present study evaluates the role of oesophageal manometry in clinical practice. Over 5 years, 347 consecutive patients were evaluated in our oesophageal laboratory. The reasons for referral were: dysphagia (11.5%), gastro-oesophageal reflux disease (GORD) (46.7%), non-cardiac chest pain (28.5%), connective tissue disease (6.9%) and other symptomatology (6.3%). Patients were classified into the following five groups according to the referral diagnosis: dysphagia (40 patients), gastro-oesophageal reflux disease (GORD) (162 patients), non-cardiac chest pain (99 patients), connective tissue disease (24 patients) and other symptomatology (22 patients). Abnormalities in oesophageal motility were detected in 90% of patients with dysphagia, in 40.1% of patients with GORD, in 47.5% of subjects with non-cardiac chest pain, in 45.8% of patients with connective tissue disease and in 18.2% of subjects with other symptomatology. The high prevalence of abnormalities in the dysphagia group was statistically significant (p < 0.001), and the range of 95% confidence intervals (0.81-0.99) suggests that the value found may be a reasonably good estimate of percentage of anomalies detectable in the dysphagia patient population. In the dysphagia group, the initial diagnosis was confirmed in 40% of patients and changed in 52.5%; in only 7.5% of cases were the manometry results not relevant for determining an appropriate diagnosis. Manometry substantially contributed to patients receiving the correct treatment in 82.5% of cases (p < 0.001 among all groups). In the GORD group and in the non-cardiac chest pain group, the results of manometry were not relevant for confirming or changing a diagnosis in 59.8% and 53.5% of cases respectively; nevertheless, in both groups, on the basis of manometry results, the treatment was changed in 42.5% of patients (p < 0.01 vs. other symptomatology group). In conclusion, on the basis of the present data, we can emphasize the usefulness of oesophageal manometry assessment in patients with dysphagia or non-cardiac chest pain, with negative routine examinations, and also in patients with refractory GORD who have been considered for antireflux surgery.

Aged↗
PubMed1997

[Risk factors in endoscopic manometry for suspected dysfunction of Oddi's sphincter].

OBJECTIVE: An increased incidence of pancreatitis having been reported after endoscopic manometry (EM) of the sphincter of Oddi, its incidence and severity as well as potential risk factors were investigated prospectively. PATIENTS AND METHODS: Between June 1988 and June 1996, standardised manometry was performed in 207 patients with suspected biliary and 23 with suspected pancreatic sphincter of Oddi dysfunction (SOD). All patients had been observed in hospital for at least 24 hours before the test. The diagnostic criteria of post-manometric pancreatitis (PMP) were epigastric pain and a rise in the concentration of serum amylase to at least three times normal. Potential risk factors for PMP were elucidated by uni- and multivariate analysis. RESULTS: Pancreatitis occurred in 19 patients (9%) with suspected biliary and in 6 (26%) with suspected pancreatic SOD (P < 0.01), 17 of mild and 8 of moderate degree. There were no deaths and no lasting sequelae. Previous pancreatitis after endoscopic retrograde cholangiopancreatography and the presence of SOD were identified as patient-associated risk factors (P < 0.01 for each). Method-associated risk factors were duration of manometry of more than 5 min (P < 0.05) and manometry in the pancreatic duct system (P < 0.05). The risk of pancreatitis was reduced by simultaneous endoscopic sphincterotomy for SOD (P < 0.01). CONCLUSION: Specific and often avoidable risk factors for postmanometric pancreatitis were identified: technical procedure, pancreatitis, SOD. With short duration of manometry, avoiding of manometry in the pancreatic duct system and with patient's informed consent for simultaneous endoscopic sphincterotomy risk of pancreatitis may be lowered.

Adult↗
PubMed2001

Manometry of the gastrointestinal tract: toy or tool?

In the eyes of scientific researchers, there are various manometric techniques that are useful tools for studying the motility of the gastrointestinal tract. Clinicians, however, regard most of these techniques as toys, either because they do not lead to clinically relevant results, or because they are too cumbersome in clinical practice. Nevertheless, a number of manometric techniques have reached the status of clinically relevant diagnostic procedure in gastroenterology. Among these, oesophageal manometry is the most important. Not only has conventional oesophageal manometry been added to the diagnostic armamentarium of many hospitals, but also prolonged ambulatory recording of oesophageal pressures (usually combined with pH monitoring). Small intestinal manometry has also gained the status of a diagnostic tool, in particular in patients in whom the existence of pseudo-obstruction syndrome is suspected and in patients in whom total colectomy is considered because of intractable constipation. Sphincter of Oddi manometry is another example of a clinically relevant manometric technique to be used in particular in patients with suspected dyskinesia of the sphincter of Oddi. The value of anorectal manometry may have been overestimated in the past. The most important indication is the exclusion of Hirschsprung disease. The contribution of anorectal manometry to the diagnosis of anismus and to the work-up of patients with faecal incontinence is limited.

Digestive System Physiological Phenomena↗