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PubMed1980

[Reliability of perfusion manometry in the gastro-esophageal closure mechanism (author's transl)].

Manometric investigation of the gastro-esophageal closure mechanism is an important tool for the classification and adequate therapy of functional disorders in this region. Because of the relatively low pressure differences the reliability of a measuring procedure has to meet all requirements. Manometry by continuously perfused and withdrawn catheters being the most frequently applied measuring procedure got some criticism regarding its reliability and reproducibility. The theoretical basis of this criticism is examined closely. The reproducibility of the recorded pressure curves is studied and quantified in 36 dogs and 122 persons (32 controls, 63 patients with hiatal hernia, 27 patients with achalasia of the cardia). On experimental condition, lower esophagel sphincter pressure shows a high degree of reproducibility (retest reliability r = .98, p less than 0.001), in clinical investigations it is significantly lower (r = .81). There are no statistically significant differences between the patient groups and the controls. The importance of the findings for the reliability and the interpretation of clinical manometric data is discussed.

Animals↗
PubMedDate not supplied

Oesophageal manometry in noncardiac chest pain.

Chest pain of oesophageal origin is an important differential diagnosis in patients with cardiac chest pain. A preliminary survey of 40 patients with noncardiac chest pain (NCCP) revealed oesophageal motility disorder in 47.5%; achalasia cardia being the most frequent disease (47.3%). 15.8% of these patients with motility disorder had features of progressive systemic sclerosis and another 15.8% had non specific oesophageal motility disorder (variants). Compared to barium swallow, oesophageal manometry was found to be superior in the diagnosis of oesophageal motility disorder.

Adult↗
PubMed1994

Upright refluxers without esophagitis differentiated from bipositional refluxers with esophagitis by simultaneous manometry and pH monitoring conducted in two postures before and after a meal.

OBJECTIVE: To determine whether two dissimilar groups characterized by 24-h esophageal pH monitoring would have individual reflux events that occur under the same or different circumstances when challenged by a meal and monitored in different postures. These groups consisted of upright refluxers without esophagitis (n = 10) versus biopositional refluxers with esophagitis (n = 8). METHODS: Our evaluation consisted of a questionnaire completed prior to simultaneous manometry and pH monitoring. This monitoring was conducted over a 120-min period that incorporated the upright and recumbent postures both before and after a meal. Three of our four criteria for reflux were independent of a classic pH event. RESULTS: From the questionnaire, it was apparent that dyspeptic symptoms almost always occurred in the upright refluxers. In addition, provocation for their heartburn had atypical characteristics regarding posture, and their degree of regurgitation was intensified by the postprandial state. During dual monitoring, the upright posture and the meal provoked an increase in frequency of reflux in the upright refluxers, as opposed to only recumbency in the bipositional refluxers. Moreover, reflux events in the upright refluxers usually were associated with Valsalva maneuvers and were recognized as symptoms, two features that were less true in the bipositional refluxers. A similar percentage of reflux events occurred over a low basal lower esophageal sphincter pressure and after a lower esophageal sphincter relaxation, in both groups. CONCLUSION: The two groups manifested distinctively different reflux characteristics, presumably due to dissimilar mechanisms.

Adult↗
PubMed1994

Sensitivity of radionuclide bolus transport and videofluoroscopic studies compared with manometry in the detection of achalasia.

OBJECTIVE: The sensitivity of radionuclide bolus transport and videofluoroscopic studies to confirm manometrically revealed achalasia was investigated prospectively in 77 patients with symptoms indicative of disordered esophageal motor function. METHODS: The studies were performed in random order and were analyzed blindly by strict diagnostic criteria. Transport of radiolabeled water was recorded for 2 min with patients supine. Videofluoroscopy assessed three swallows in prone oblique and one in upright position. Manometry employed four pressure sensors in the esophageal body and the Dent sleeve in the lower esophageal sphincter. RESULTS: Radionuclide and videofluoroscopic studies confirmed 25 and 15, respectively, of 37 manometrically diagnosed achalasias and provided indications for the disorder in another 8 and 16 patients. Using information from both studies increased the sensitivity to detect achalasia from 68% and 41%, respectively, to 73%, and increased detection of disordered esophageal motor function from 81% and 74% to 92%. CONCLUSION: Radionuclide and videofluoroscopic studies represent valuable and complementary, although relatively insensitive, procedures to detect achalasia.

Colloids↗
PubMed1994

Prolonged ambulatory antroduodenal manometry in humans.

OBJECTIVES: To perform prolonged ambulatory recordings of antroduodenal motor activity in humans. METHODS: Antroduodenal manometric recordings were performed in 20 normal subjects (12 male, eight female, ages 19-41 years), using a 5-channel solid state catheter assembly (three antral, two duodenal transducers) positioned under fluoroscopy. A glass electrode simultaneously recorded pH in the antrum. RESULTS: Continuous, simultaneous recordings of antral and duodenal motor activity were obtained for 22.5 +/- 0.3 h. During fasting, 131 complete migrating motor complexes (MMCs) were recorded (6.6 +/- 0.9/subject). The average interval from onset of recording to completion of the first MMC cycle was 498 +/- 19.24 minutes. Significant diurnal variations were observed in MMC frequency (awake vs asleep: 0.25/subject/h vs 0.64/subject/h; p < 0.05), period (shorter during sleep), phase I duration (longer during sleep), and phase II duration (shorter during sleep). Among females, MMCs were more frequent and shorter. After meal administration, duodenal recording sites demonstrated a typical "fed" response; antral distension and/or retrograde catheter movement, on meal ingestion, however, precluded reliable antral "fed" recordings. CONCLUSIONS: Prolonged ambulatory antroduodenal manometry provides detailed and reliable information on fasting antral and duodenal motor activity, antral distension, and/or retrograde catheter migration on meal ingestion; there are limits, however, to the usefulness of this methodology for the evaluation of the fed motor response in the antrum.

Adult↗
PubMedDate not supplied

Anorectal manometry with a microtransducer.

OBJECTIVE: To find out whether the direction of the sensor of the microtransducer or the position of the subject influenced anorectal manometric pressure recordings; to record resting and squeeze pressures and length of anal canal in five groups divided according to age, sex, and parity, and to study rectal sensitivity and response of intrarectal pressure to rectal distension. DESIGN: Open study. SETTING: University Hospital, Linköping, Sweden. SUBJECTS: 87 healthy volunteers with no signs or symptoms of anorectal disease. INTERVENTIONS: Anorectal manometry with a microtransducer. RESULTS: Neither the direction of the sensor nor the position of the subject influenced the recordings in five men and four women whose ages ranged from 40-58 years. In 60 further subjects grouped according to age, sex, and parity there was no difference in mean (SD) resting pressure between the groups. Maximal squeeze pressure was significantly greater among men than women, and there was no significant difference between parous and nulliparous women. The voluntary contractile force of the external sphincter was greater in young than older people, and in men compared with women. The functional length of the anal canal was greatest in older men and least in young parous women. In a further 18 volunteers aged 20-86 years rectal distension was felt at 25 (12) ml, and maximal tolerated volume was 202 (75) ml. Mean threshold volume required to release the rectosphincteric inhibitory reflex was 17 (8) ml. CONCLUSIONS: Neither the direction of the sensor nor the position of the patient influenced the recordings. Resting pressure was the same irrespective of sex, age, or childbirth, but maximal squeeze pressure was significantly higher among men and those less than 50 years old.

Adult↗
PubMed1994

Use of gastroduodenal manometry to differentiate mechanical and functional intestinal obstruction: an analysis of clinical outcome.

OBJECTIVES: Our aim was to assess the outcome of patients whose gastrointestinal motility recording suggested intestinal mechanical obstruction. METHODS: Medical records were reviewed for operative reports and alternative diagnoses during at least 1-yr follow-up. RESULTS: During 1988-1992, 27 of 890 consecutive manometric recordings suggested mechanical obstruction: 20 with non-propagated, prolonged contractions, seven with a pattern of non-propagated clustered contractions that lasted > 30 min. Obstruction was confirmed at laparotomy in 17 (including two with progressive systemic sclerosis) and by radiology in one. In confirmed obstruction, 12 of 18 contrast radiographs performed prior to manometry were either normal or nondiagnostic. One laparotomy was negative for obstruction; nine patients who did not undergo laparotomy were classified as unobstructed. Manometric recordings showed prolonged contractions in two, clustered contractions in three, and a mixed pattern in four. Positive predictive values of these patterns for obstruction were: prolonged contractions, 82%; clustered contractions, 57%; and mixed pattern, 56%. CONCLUSIONS: Thus, non-propagated, prolonged contractions in small bowel should prompt a search for obstruction, even when this is equivocal on barium small bowel radiography.

Adolescent↗
PubMed1993

Differences in manometry and 24-H ambulatory pH-metry between patients with and without endoscopic or histological esophagitis in gastroesophageal reflux disease.

UNLABELLED: In this study, our objective was to examine prospectively, by endoscopy and histology of the esophageal mucosa, the severity of reflux esophagitis and any possible correlation between endoscopic and histological findings on the one hand, and manometric and 24-h ambulatory pH-metry measurements on the other. Forty-two patients with gastroesophageal reflux were prospectively examined. The results were compared with those of 18 healthy controls. Methods used were: 1) upper alimentary endoscopy and grading of severity of esophagitis, 2) esophageal mucosa biopsies, to estimate severity of esophagitis on histology, 3) standard esophageal manometry, by using a water perfused catheter with four side holes, and 4) standard 24-h ambulatory esophageal pH-metry. RESULTS: The severity of esophagitis as determined by both endoscopy and histology was significantly inversely related to the amplitude (p < 0.001) and duration (p < 0.01) of esophageal peristalsis at 5 cm proximal to LES; it was significantly related to the pH-metry total composite score (p < 0.001 for endoscopy, p < 0.05-0.01 for histology), the total reflux time (p < 0.001 for endoscopy, p < 0.01 for histology), the duration of longest reflux episode (p < 0.001 for endoscopy, p < 0.01 for histology), the number of reflux episodes lasting more than 5 min (p < 0.05 for endoscopy), and the frequency-duration index of reflux episodes (p < 0.001 for endoscopy, p < 0.01 for histology). Furthermore, strength reduction of peristalsis (< 60 mm Hg x s) was associated with acid exposure greater than 40%, in esophagitis patients. We conclude that the severity of reflux esophagitis, not only through endoscopy but also histologically, is related to the amount of reflux, as expressed by the duration and frequency of the reflux episodes. A very high amount of reflux is in turn associated with impairment of the esophageal body motility, as expressed by the amplitude and strength of esophageal body peristalsis.

Adult↗
PubMed1993

[Achalasia. Diagnosis and therapeutic effect evaluated by esophageal manometry].

Achalasia was diagnosed in 57 patients from 1982 through 1991. 13 patients were evaluated by manometry both before and after pneumatic dilatation of the sphincter. There were no serious complications. All but one patient experienced good symptomatic effect; one patient was operated after two ineffective dilatations. The tonus and length of the lower oesophageal sphincter decreased significantly, but dilatation did not improve the swallow-induced relaxation of the sphincter, nor peristalsis in the oesophageal body. In three randomly selected patients, transcutaneous nervous stimulation did not have any symptomatic effects, nor did it affect the motility pattern of the oesophagus. Pneumatic dilatation of the lower oesophageal sphincter is a safe and effective first-choice treatment for achalasia, with myotomy being reserved for patients whose symptoms are not relieved successfully after two dilatations.

Catheterization↗
PubMed1993

[Multivariate analysis of clinical signs, parameters of anorectal manometry, defecography, transit time of radiopaque markers in 76 patients complaining of fecal incontinence].

The aim of this study was to evaluate clinical symptoms, disease past-history, and parameters of anorectal manometry, defecography, and radiopaque pellet transit time in anal incontinence by multivariate analysis. We studied 76 patients, 68 women and 8 men, who complained of anal incontinence, excluding that due to obstetrical lesions. All patients were asked to complete a standard questionnaire. Results indicated that: a) hemorrhoidectomy, hysterectomy, and cholecystectomy appeared to play a role, b) daily incontinence for air or liquid stools is more frequent after hemorrhoidectomy, c) decreased resting pressure of the upper part of the anal canal was observed mainly after hysterectomy, d) decreased resting pressure of the upper part of the anal canal could be a factor of poor prognosis after treatment, e) anal incontinence in men was secondary to traumatic lesions of the anal sphincter in 7 of 8 cases.

Adult↗
PubMed1996

Intraocular pressure measurement in cynomolgus monkeys. Tono-Pen versus manometry.

PURPOSE: In living cynomolgus monkey eyes, the authors compared manometrically set and measured intraocular pressure (IOP) with simultaneous IOP readings obtained with the Tono-Pen (TP), a handheld applanation tonometer based on the Mackay-Marg principle. METHODS: In three pentobarbital-anesthetized cynomolgus monkeys, IOP was set and measured manometrically after anterior chamber cannulation through the peripheral cornea with a 26-gauge needle connected to a vertically adjustable reservoir and a pressure transducer. Intraocular pressure was raised in approximately 5 mm Hg steps from 5 mm Hg to 60 mm Hg and then lowered in 5 mm Hg steps to 5 mm Hg, with TP measurements taken at each increment and decrement in open and stopcock modes. RESULTS: Linear regression analysis of TP on manometric readings for grouped data from all six eyes, with each data point representing the average of all the TP readings from one eye at each manometric pressure setting, showed a slope 0.692 +/- 0.016 and 0.683 +/- 0.023 (both significantly different from 1; P < 0.001), intercept 1.21 +/- 0.60 and 1.64 +/- 0.82 mm Hg (both significantly different from 0.0, P < 0.05), and correlation coefficient 0.981 and 0.96 in open stopcock and closed stopcock mode, respectively. There were no striking differences when the data were analyzed for individual eyes or animals, for open versus closed stopcock manometry, or for increasing versus decreasing manometric IOP. CONCLUSIONS: The TP provides reproducible measurements of IOP in cynomolgus monkeys, with measurement accuracy dependent on the generation of an appropriate calibration curve.

Animals↗
PubMed1996

Predictive value of esophageal manometry and gastroesophageal pH monitoring for responsiveness of reflux disease to medical therapy in children.

OBJECTIVES: The aim of the study was to evaluate, in 42 children with gastroesophageal reflux disease, the predictive value of both esophageal manometry and gastroesophageal intraluminal pH on the responsiveness of the disease to medical therapy. METHODS: Motility of lower esophageal sphincter and esophageal body was carried out through a perfused pediatric sleeve-probe; prolonged recording of the sphincteric profile was evaluated at the occurrence of reflux episodes as detected by an esophageal electrode; intraluminal pH of the esophagus and stomach was also measured for 24-h through portable equipment. Children were treated for 8 wk with cisapride and ranitidine and were classified as healed or refractory after endoscopy and clinical evaluation. RESULTS: Twenty one children healed, and 21 were refractory. Compared with healed patients, refractory patients showed, at basal evaluation, an increased esophageal acid exposure (p < 0.05), a reduced basal sphincteric pressure and peristalsis amplitude (p < 0.01), an increased rate of sphincteric pressure drifts (p < 0.01), and a higher rate of transient lower esophageal sphincter relaxations (p < 0.01). The following parameters contributed significantly (p < 0.01) to a multivariate discriminant analysis: peristalsis amplitude, basal sphincter pressure, rate of transient relaxations of the sphincter, and rate of sphincteric pressure drifts. A correct classification of virtually all cases (97.62%) was reached. CONCLUSIONS: Motor dysfunctions of both lower esophageal sphincter and esophageal body are the major factors predicting refractoriness of reflux disease in children to a standard medical treatment. Of the two main mechanisms of reflux, i.e., transient lower esophageal sphincter relaxation and lower esophageal sphincter pressure drift, the latter had the highest predictive value for the refractoriness of reflux disease.

Anti-Ulcer Agents↗
PubMedDate not supplied

Laparoscopic Heller cardiomyotomy with intraoperative manometry in the management of oesophageal achalasia.

Results of an ongoing clinical study treating achalasia patients with laparoscopic Heller myotomy and Dor anterior fundoplication are presented. 18 patients underwent surgery between August 1991 and July 1995. Completeness of myotomies and calibration of fundoplications were measured using intraoperative manometry. Only one intraoperative complication, a perforation of the mucosa sutured laparoscopically, was encountered. There were no surgical mortalities nor postoperative morbidities. Mean hospital stay was 3.4 days. Complete relief of dysphagia and modifications of radiological and manometric patterns were achieved in all patients. All patients remain asymptomatic at 2 to 48 months from surgery. These results compare favourably with those of traditional surgery and of pneumatic dilatation.

Adolescent↗
PubMed1996

Electromyography and manometry of the pelvic colon--a contribution to the understanding of its function.

OBJECTIVE: To study the adaptation of the rectum to pressure waves in the sigmoid and the motility response to the administration of a bile salt microenema. DESIGN: Electrical and motor activity was studied in 20 men and 20 women during a 2-h fast and for 2 h after a 1000-kcal meal, and also after a bile salt microenema. METHODS: An intraluminal probe with three sets of two electrodes and one miniballoon was used for simultaneous EMG and manometry recording. RESULTS: Four types of spike bursts were observed: (1) migrating long spike bursts that initiated propagating pressure waves on 99% of occasions; (2) non-migrating long spike bursts that did not originate pressure waves; (3) rhythmic short spike bursts that were also not related to pressure waves; and (4) rhythmic long spike bursts that originated rhythmic segmental pressure waves frequently brought up by a migrating long spike burst. The meal significantly increased the duration of activity of the migrating long spike bursts in the sigmoid colon (from 16.8% before the meal to 21.8% after it, P < 0.05) and the motility index, P < 0.05, both of them in two peaks. A rectosigmoidal pressure gradient was shown. The bile salt microenema produced a desire to defecate and increased motility in only half of the cases. CONCLUSION: The rectosigmoidal pressure gradient was due to: (1) higher-amplitude pressure waves in the sigmoid colon than in the other two sites, and (2) propagating relaxation waves in the rectum and in the rectosigmoid junction.

Adolescent↗
PubMed1996

Discography with manometry and discographic CT: their value in patient selection for percutaneous lumbar nucleotomy.

In minimally invasive spinal surgery and percutaneous disc surgery the exact preoperative structural analysis of the disc herniation becomes a prerequisite in patient selection. Discography including discal manometry and discographic CT (in addition to CT and MRI) are used to review the anatomy of disc herniations prior to surgery. The analysis of the findings of discography in 360 lumbar discs examined from 1988 to 1994 are presented. In 68 discs operated with hemilaminectomy, later intraoperative findings were available for comparison with preoperative discographic findings. The diagnostic accuracy of determining the exact anatomical location of the herniation with discography alone was 75%. The diagnostic accuracy increased to 99.55% with the use of CT discography. The authors conclude that CT discography is an accurate and useful diagnostic aid.

Diskectomy, Percutaneous↗
PubMed1996

[Anorectal pull-through and vector volume manometry].

Anorectal manometry has been developed from an object of clinic oriented scientific interest to an established tool within the spectrum of proctologic diagnostics. At present it represents the only objective diagnostic method with regards to continence disorders; it is routinely applied in the evaluation of constipation, of incontinence, of pre- and postoperative conditions in diseases of the anorectum as well as in the indication and therapeutic control investigations during biofeedback training of the anal sphincter. The new technique of determination of the anal sphincter pressure vector volume allows for the most sensitive functional separation of patients with different degrees of continence; this method delivers a 3-dimensional graphic imaging of the sphincter pressure profile, thus allowing for an objective visualisation of the present mechanic defect and an aid in planning a surgical correction.

Anal Canal↗
PubMed1977

[A critical account on perfusion manometry in the lower esophageal sphincter (author's transl)].

The evaluation of morphology and functional regulation in the closing mechanism of the terminal esophagus is not yet convincingly stated. Manometry by continuously perfused and withdrawn catheters, as applied in the last years, permits only to record the elevated perfusion resistance in narrow segments. This is elucidated considering the physical principles of the measuring procedure. The closing pressure and its variations can only be determined by measuring the perfusing rate under constant pressure levels. The single conditions and the clinical value are discussed in detail.

Animals↗
PubMed1996

[Diagnostic value of stepwise manometry in chronic duodenal obstruction, associated with duodenal ulcer].

Stepwise manometry was performed in 449 patients with chronic duodenal ileus (CDI) combined with duodenal ulcer. Manometric values in CDI appeared diagnostically significant. These were indicative of the disease in 82% of cases. There are 3 types and 8 variants of duodenomanometric curves in respect of the disease stage and form. The curves may be useful in making decision on surgical treatment and assessment of its efficacy.

Adult↗