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PubMed1996

Effects of meperidine on the pancreatic and biliary sphincter.

BACKGROUND: Opioids are traditionally avoided during sphincter of Oddi manometry because of indirect evidence suggesting that these agents cause sphincter of Oddi spasm. This study was undertaken to determine the direct effects of meperidine on the biliary and pancreatic sphincter. METHODS: Forty-seven patients were prospectively evaluated by sphincter of Oddi manometry in the conventional retrograde fashion. Manometry was initially performed with intravenous diazepam sedation alone. The manometry was repeated 3 to 5 minutes after meperidine was administered. RESULTS: The basal sphincter pressure of the biliary sphincter, pancreatic sphincter, and the combined sphincter group were not significantly altered by meperidine. Concordance (normal versus abnormal) between the basal sphincter pressure before and after meperidine was seen in 44 of 47 patients (94%). Meperidine produced a significant increase in the pancreatic, biliary, and combined sphincter phasic frequency and a significant decrease in the phasic duration. The pancreatic and combined sphincter phasic pressures were significantly reduced following meperidine administration. Seventeen manometry tracings (36%) were believed to be qualitatively better after meperidine, while only four (8.5%; p < .001) were qualitatively better with diazepam alone. CONCLUSION: Meperidine can be used for additional analgesia during sphincter of Oddi manometry if the basal sphincter pressure is the parameter used to determine therapy.

Humans↗
PubMed1997

Pancreatic sphincter hypertension increases the risk of post-ERCP pancreatitis.

BACKGROUND AND STUDY AIMS: The reason for the increased risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) in patients with sphincter of Oddi dysfunction is not known. This study sought to determine whether pancreatic sphincter hypertension might explain some of the increased risk. PATIENTS AND METHODS: The incidence of pancreatitis was determined from a cohort of patients who underwent pancreatic sphincter manometry. Additional data collected included: pancreatic and biliary sphincter manometry results, distal bile duct diameter, chronic pancreatitis grade by pancreatography, and endoscopic treatments. RESULTS: Ten of 32 patients (31%) with pancreatic sphincter hypertension developed post-ERCP pancreatitis, compared to one of 33 (3%) with normal pancreatic manometry (P = 0.002). Patients with pancreatic sphincter hypertension were more likely to undergo endoscopic treatments (88%) compared to those with normal manometry (27%) (P = 0.001). The distal bile duct diameter was significantly smaller (4.5 +/- 0.5 mm) in patients who developed post-ERCP pancreatitis than in those who did not (6.2 +/- 0.3) (P = 0.025). Patients with small distal bile duct diameters (< 5 mm) were three times more likely to develop post-ERCP pancreatitis than those with larger ducts (relative risk [RR] 3.1, 95% confidence interval [CI] 0.9, 10.7). Patients with pancreatic sphincter hypertension were ten times more likely to develop post-ERCP pancreatitis than those with normal pancreatic manometry (RR 10.3, 95% CI 1.5, 76.0). In patients with a small bile duct size, pancreatic sphincter hypertension substantially increased the risk compared to those with normal manometry (RR 18.1, 95% CI 1.1, 287.6). CONCLUSIONS: Pancreatic sphincter hypertension greatly increases the risk of post-ERCP pancreatitis in patients undergoing treatment or evaluation, or both, for sphincter of Oddi dysfunction.

Acute Disease↗
PubMed2003

Effects of droperidol on the pancreatic and biliary sphincters.

BACKGROUND: Performance of sphincter of Oddi manometry at ERCP is technically demanding and requires that the patient be well sedated. Droperidol is frequently administered when adequate sedation cannot be achieved with a benzodiazepine and meperidine. This study examined the effects of droperidol on the biliary and pancreatic sphincters. METHODS: A total of 31 patients were prospectively evaluated by sphincter of Oddi manometry in the conventional retrograde fashion. Manometry was initially performed with intravenous administration of diazepam alone, diazepam plus meperidine or midazolam plus meperidine. Manometry was then repeated 5 minutes after droperidol was administered. RESULTS: The basal pressure of the biliary sphincter and of the pancreatic sphincter were not significantly altered by droperidol. Concordance (normal vs. abnormal) between the basal sphincter pressure before and after droperidol was seen in 30 patients (97%). Droperidol also did not lead to a difference in phasic wave amplitude, duration, or frequency. Thirteen manometry tracings (42%) were judged as being qualitatively better after droperidol, whereas two (6.5%; </= p 0.001) were qualitatively better before droperidol administration. CONCLUSIONS: Droperidol does not significantly affect sphincter of Oddi manometric parameters. It appears that it can be added to the armamentarium of agents needed for performance of sphincter of Oddi manometry. However, further study is needed to determine whether recent safety concerns with droperidol use are valid.

Adjuvants, Anesthesia↗
PubMed2003

Prospective evaluation of droperidol on sphincter of Oddi motility.

BACKGROUND: Droperidol increasingly is used as an effective adjunct for conscious sedation during endoscopic procedures. Given the concern for the effects of narcotics and benzodiazepines on sphincter of Oddi motility, and the potential difficulty in sedating patients undergoing sphincter of Oddi manometry, droperidol could be an ideal agent in this setting. METHODS: Over a 43-month period, consecutive patients undergoing sphincter of Oddi manometry were studied prospectively. Sphincter of Oddi manometry was performed under general anesthesia in all but 10 patients. Standard retrograde pull-through techniques were used to examine the biliary and/or pancreatic sphincter, depending on the indication for sphincter of Oddi manometry. After the initial two pull-throughs, 5 mg of droperidol were given intravenously and measurements were repeated 5 minutes later. RESULTS: A total of 55 patients were studied (42 women [76%], 13 men; mean age 43 years). The basal biliary sphincter pressures measured in 35 patients before and after droperidol were, respectively, 56 mm Hg and 48 mm Hg (p = 0.02); the basal pancreatic sphincter pressures measured in 22 patients before and after droperidol were, respectively, 92 mm Hg and 67 mm Hg (p = 0.29). By using a definition for sphincter of Oddi dysfunction of a basal pressure greater than 40 mm Hg, droperidol would have resulted in a change in diagnosis in 5 patients undergoing biliary manometry (one misclassified as sphincter of Oddi dysfunction, 4 misclassified as normal), and 6 patients undergoing pancreatic sphincter manometry (5 misclassified as sphincter of Oddi dysfunction, one misclassified as normal) (total 19% of procedures). No complication was associated with droperidol use. CONCLUSIONS: Droperidol alters basal sphincter pressures, which in some patients was clinically significant and would have resulted in misclassification. Although safe and well tolerated, droperidol appears to have subtle but clinically significant effects on the sphincter of Oddi.

Adjuvants, Anesthesia↗
PubMed2000

Non-Invasive detection of respiratory effort-related arousals (REras) by a nasal cannula/pressure transducer system.

STUDY OBJECTIVES: The published AASM guidelines approve use of a nasal cannula/pressure transducer to detect apneas/hypopneas, but require esophageal manometry for Respiratory Effort-Related Arousals (RERAs). However, esophageal manometry may be poorly tolerated by many subjects. We have shown that the shape of the inspiratory flow signal from a nasal cannula identifies flow limitation and elevated upper-airway resistance. This study tests the hypothesis that detection of flow limitation events using the nasal cannula provides a non-invasive means to identify RERAs. DESIGN: N/A. SETTING: N/A. PATIENTS: 10 UARS/OSAS and 5 normal subjects INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: All subjects underwent full NPSG. Two scorers identified events from the nasal cannula signal as apneas, hypopneas, and flow limitation events. Two additional scorers identified events from esophageal manometry. Arousals were scored in a separate pass. Interscorer reliability and intersignal agreement were assessed both without and with regard to arousal. The total number of respiratory events identified by the two scorers of the nasal cannula was similar with an Intraclass Correlation (ICC) =0.96, and was essentially identical to the agreement for the two scorers of esophageal manometry (ICC=0.96). There was good agreement between the number of events detected by the two techniques with a slight bias towards the nasal cannula (4.5 events/hr). There was no statistically significant difference (bias 0.9/hr, 95%CI -0.3-2.0) between the number of nasal cannula flow limitation events terminated by arousal and manometry events terminated by arousal (RERAs). CONCLUSION: The nasal cannula/pressure transducer provides a non-invasive reproducible detector of all events in sleep disordered breathing; in particular, it detects the same events as esophageal manometry (RERAs).

Adult↗
PubMed2001

Effect of somatostatin on the sphincter of Oddi in patients with acute non-biliary pancreatitis.

BACKGROUND: Somatostatin has been used to prevent pancreatitis after endoscopic retrograde cholangiopancreatography but its effect on acute non-biliary pancreatitis is still unclear. AIM: The purpose of this study was to evaluate the function of the sphincter of Oddi (SO) and the effect of somatostatin on patients with non-biliary pancreatitis. METHODS: Twenty patients (18 males, two females) with acute pancreatitis (alcoholic 18, idiopathic two) received SO manometry within one week after admission. After baseline measurement, a bolus dose of somatostatin (Stilamin, Serono) 250 microg was infused slowly, and SO manometry was repeated after five minutes. Continuous infusion of somatostatin 250 microg/h was given for 12 hours after SO manometry. Serum amylase, lipase, glucose, and C reactive protein (CRP) levels were examined before and after somatostatin infusion. RESULTS: SO manometry was unsuccessful in six patients due to contracted sphincter. In the remaining 14 patients, high SO basal pressure (SOBP >40 mm Hg) was found in seven patients. After somatostatin infusion, mean SOBP decreased from 48.8 (29) to 31.9 (22) mm Hg (p<0.01). One patient had a paradoxical reaction to somatostatin (SOBP increased from 30 to 50 mm Hg) while the other 13 patients had a fall in SOBP after somatostatin. One patient developed abdominal pain with a serum amylase level of 2516 IU/l after SO manometry. No other side effects or changes in amylase, lipase, glucose, or CRP levels were observed in the other 19 patients after SO manometry and somatostatin infusion. DISCUSSION: Sphincter of Oddi dysfunction is common in patients with acute non-biliary pancreatitis and in most cases somatostatin can relax the sphincter.

Acute Disease↗
PubMed1994

Manometric and endoscopic localization of airway obstruction after uvulopalatopharyngoplasty.

The most widely reported surgical procedure for obstructive sleep apnea syndrome is uvulopalatopharyngoplasty. The success rate for this procedure is variable, and the reason for failure is incompletely understood. Failure in some patients is postulated to result from tongue-base obstruction. To investigate this, we identified the level of collapse and obstruction in 11 cases of uvulopalatopharyngoplasty failure, using upper airway manometry and videoendoscopy, while patients slept. Airway manometry measured the initial level of complete obstruction. Videoendoscopy identified significant resting airway narrowing (> 75%) at the tongue base on obstructed compared with nonobstructed breaths. Results of manometry indicated that the palate was the primary level of obstruction in eight (73%) compared with the tongue base in three (27%). However, collapse on videoendoscopy at the tongue base was observed in an additional three patients. A total of six patients (54%) demonstrated significant tongue-base abnormalities. In six patients with uvulopalatopharyngoplasty as the only pharyngeal surgery, one (17%) has an obstruction at the tongue base, as measured with manometry. Three of the six also had collapses at the tongue base, as measured endoscopically. Tongue-based abnormalities were identified in four of six (67%). Two additional patients who had failed uvulopalatopharyngoplasty and transpalatal advancement pharyngoplasty had obstructions on manometry at the level of tongue base. Six of eight (75%) palatopharyngoplasty failures demonstrated tongue-base collapse. In the three patients with tongue-base surgery, all had obstructions on manometry at the palate and none had endoscopic tongue-base collapse. These results indicate that in most uvulopalatopharyngoplasty failures the initial level of obstruction occurs at the palate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

[Pudendal neuropathy: correlation with demographic data, severity index and pressoric parameters in patients with fecal incontinence].

BACKGROUND: Fecal incontinence stands for inability in maintaining the control of defecation to a socially acceptable and adequate time and place, resulting in unwanted release of gas, liquid or solid stool. The diagnosis needs multiple exams. Anorectal manometry is mandatory for this study. The correlation between manometry with electophysiological studies and symptoms is not yet clear in the literature. AIMS: Correlate values of anal manometry, pudental nerve terminal motor latency and co morbidity in fecal incontinence patients. METHODOLOGY AND PATIENTS: Patients with clinical fecal incontinence, who attended the outpatient department of "Hospital Nossa Senhora da Concei o", Porto Alegre, RS, Brazil, between March 1997 and June 2000, were studied prospectively. Every single patient has undergone a general investigation, incontinence score, anal manometry, bilateral pudendal nerve terminal motor latency and physical examination. For statistical purposes the patients were separated in groups according to the results of the anal manometry, pudendal neuropathy, for age and sex. RESULTS/CONCLUSION: Thirty-nine patients were studied, 85,6% female, average age 60,1 years (+/- 12,89). The average index of the fecal incontinence was of 9,30 (+/- 4,93). In the anorectal manometry 23 patients showed low pressure. The pressures were significantly higher among males. The nerve terminal motor latency and pudental nerve (neuropathy) time was greater in 14 patients (35,9%). The age and the time of pudental nerve terminal motor were significantly co related. The other co relations were not statistically significant.

Adult↗
PubMed1984

Study of electromechanical activity of the stomach in humans and in dogs with particular attention to tachygastria.

The relationship between electric and mechanical activities of the gastric antrum was investigated in both humans and dogs. In 2 patients, in whom platinum monopolar electrodes were implanted on the serosal surface of the antrum and a perfused manometric tube was placed in the stomach, the number of gastric contractions detected by manometry was only less than 50% of the pacesetter potentials accompanied by action potentials or second potentials. No contraction of the stomach was recorded by manometry when pacesetter potentials occurred without action potentials or second potentials. The relationship was further investigated in 11 anesthetized dogs prepared with implanted electrodes and sensitive ministrain gauges implanted on the serosal surface of the stomach and an intragastric manometric tube. In these dogs, phasic contractions were always recorded by the method using ministrain gauges although the electrical activity showed only PSPs without action potentials or second potentials. The manometry, however, could not recognize these phasic contractions. When the stomach was stimulated by bethanechol infusion through the splenic artery, as in the human stomach, the manometry detected less than 50% of gastric contractions detected by the strain gauge recording. The gastric dysrhythmia including tachygastria, tachyarrhythmia, and bradygastria was induced in 10 dogs by epinephrine, 100 micrograms X kg-1 X h-1, infused via the splenic artery. During the period of gastric dysrhythmia, the phasic contractions disappeared and no contraction associated with action potential could be observed. The phasic contractions reappeared as long as the PSPs occurred regularly in a frequency of 4-5 cycles/min during either the control period or during the period of epinephrine infusion. The epinephrine-induced gastric dysrhythmia was blocked or reversed to normal pacesetter potentials by intraarterial infusion of phentolamine. Our study suggests the following: (1) the pacesetter potentials not only pace and direct gastric contraction, but they may also play a role in the genesis of phasic contractions of the stomach, and (2) gastric contractions detected by sensitive strain gauges are not always recorded by the intraluminal manometry and, thus, gastric dysrhythmia may not be detected by the manometry in humans.

Action Potentials↗
PubMed1982

Operative cholangiomanometry as a guide to common duct exploration.

A trial of operative cholangiomanometry was proposed as a guide to common duct exploration to see if this technique would help in reducing the incidence of unnecessary common bile duct explorations and the incidence of retained stones. The technique for operative cholangiomanometry as modified from White is described. This method was used in 21 patients. A very close correlation between manometry and cholangiography in predicting the presence of pathology within the common duct at the time of extrahepatic biliary surgery was shown. Flow was the most accurate diagnostic parameter. Seven patients who were found to have common duct stones had both abnormal manometry and cholangiography. Fourteen patients without stones included 12 with negative cholangiography and manometry, and two in which manometry was normal but cholangiography suggested pathology. Common duct manometry and cholangiography can be used to decrease the number of unnecessary common duct explorations and the incidence of retained stones. The theory that common duct pathology will increase pressure and decrease flow rates is supported by this study. Manometry and cholangiography should be used in combination as they are additive studies. Criteria for deciding when to explore the common duct are presented.

Adult↗
PubMed1996

A study of 111 cases of globus hystericus.

Videofluorography (VFG) and manometry were used to evaluate 111 patients who were diagnosed with globus hystericus. Most of the globus patients were affected by functional diseases and the underlying pathology could be revealed by VFG in 73.9 per cent of the series and by manometry in 80.2 per cent. There were 10.8 per cent of the series in which VFG and manometry yieled normal findings. The most common abnormality determined by manometry was esophageal aperistalsis. The most common abnormality revealed by VFG was cricopharyngeal bar. VFG was sensitive for morphologic detection while manometry was sensitive for motility study. Functional disorders can result in morphologic abnormality and vice versa. Therefore, VFG and manometry complement each other and are invaluable tools in the investigation of globus patients.

Adult↗
PubMed2003

Fecal incontinence. Studies on physiology, pathophysiology and surgical treatment.

The thesis consists of ten previously published studies and a review. The physiological and pathophysiological mechanisms in fecal incontinence has been studied by anal manometry, both by standard static anal manometry and by a new method, dynamic anal manometry, where anal sphincter pressure can be measured during simultaneous opening and closing of the anal canal. Patients with fecal incontinence showed abnormal sphincter pressures more frequently when dynamic anal manometry was used compared to standard anal manometry. The physiology and pathophysiology of the rectum was studied using rectal compliance measurements. Patients with normal anorectal function had a large variation in rectal compliance. Patients with fecal incontinence had as a group, lower rectal compliance than continent patients. This may lead to increased frequency of incontinence episodes in patients with fecal incontinence. The relationship between idiopathic fecal incontinence and pudendal nerve terminal latency was studied in 178 patients. The far majority of patients had normal latencies, and there was no correlation between latency and anal manometry. In contrast to previous suggestions, idiopathic fecal incontinence does not seem to be caused by pudendal nerve damage. Reconstruction of the external anal sphincter in patients with fecal incontinence due to obstetric sphincter lesion showed a poorer functional result among patients older than forty years compared to younger. This indicates that the general muscular weakening with age contribute to the incontinence in these patients. The treatment of more complicated forms of fecal incontinence consists of, apart from conservative treatment or colostomi, mainly in muscle transpositions or artificial anal sphincter. Transposition of the distal part of the gluteus maximus muscle to encircle the anal canal, did not lead to acceptable continence in any of the patients studied. Transposition of the gracilis muscle lead to acceptable continence in half the patients. Patients where the transposed muscle were stimulated by a neurostimulator had satisfactory continence in most cases. However, with this method several re-operations were necessary in some patients. In addition, some patients developed severe evacuation difficulties. Implantation of an artificial sphincter resulted in long-term improvement of continence in that half of patients in whom the artificial sphincter remained implanted. The other half of the patients had the artificial sphincter explanted due to various reasons, most frequently due to infection around the device. In selected patients with more complicated fecal incontinence, stimulated gracilis transposition or implantation of an artificial anal sphincter may be offered as an alternative to colostomy. Sacral nerve stimulation is a new method which seems to provide the best results among the more advanced procedures. Its minimally invasive character also contribute to the increasing use of this method in the last few years. Evaluation and treatment of fecal incontinence is presently in a state of rapid change with focus on more elaborate investigative methods and more diversified treatment.

Anal Canal↗
PubMed2005

Surgical sphincteroplasty in 446 patients.

HYPOTHESIS: Pancreaticobiliary sphincter disease is reliably diagnosed by endoscopic and intraoperative manometry. DESIGN: Retrospective review of prospectively collected data. SETTING: A 400-bed urban university hospital. PATIENTS: Between May 1, 1978, and March 27, 2002, 446 patients were treated surgically for dysfunction of the pancreaticobiliary sphincters. There were 376 females and 70 males (mean +/- SD age, 41.6 +/- 12.5 years). There were 372 patients with sphincter of Oddi dysfunction, and 74 with pancreas divisum. Symptoms included abdominal pain (100.0%), nausea/vomiting (80.5%), back pain (57.2%), and pancreatitis (22.4%). INTERVENTIONS: Perfusion manometry has evolved as the gold standard for diagnosis, and intraoperative manometry was done in 214 patients. All patients underwent transduodenal sphincteroplasty and biopsies of the ampullae and transampullar septa. RESULTS: Excellent or good results were seen in 86.8% of the patients with sphincter of Oddi dysfunction and in 63.5% of the patients with pancreas divisum. Common duct and sphincter of Oddi pressures were 0 mm Hg in all patients after sphincteroplasty. Pancreatic duct and pancreatic sphincter manometry results were improved in 82.4% of the patients. Biopsy results of the main and accessory sphincters demonstrated inflammation and/or fibrosis in 33.9% of ampullae and 43.5% of transampullar septa, but this did not correlate with outcome. There was 1 death from a duodenal leak. Complications occurred in 34.8% of patients, with pancreatitis (8.8%), asymptomatic hyperamylasemia (6.0%), and wound/abdominal infection (7.1%) the most common. Predictive factors for good outcome were reduction in pancreatic duct and sphincter pressures following sphincteroplasty. CONCLUSION: Good to excellent results may be achieved by surgical sphincteroplasty when careful patient selection by manometry is used.

Adult↗
PubMed1986

Radionuclide esophageal transit. A screening test for esophageal disorders.

Radionuclide esophageal transit (RET) is a noninvasive method of studying esophageal function. The purpose of this study was to evaluate RET as a screening test for motility disorders in symptomatic patients. Esophageal manometry and RET were performed in 16 volunteers and in 34 patients who were referred for motility evaluation. Each RET study consisted of two swallows of labeled water with the patient in the supine position under a gamma camera. Six patients had achalasia, two had scleroderma, two had diffuse esophageal spasms, and five had a nonspecific motor disorder. In each case the RET time was prolonged (greater than 15 s). Ten patients had reflux esophagitis; two of these had both abnormal manometry results and prolonged RET times. There were nine patients with upper gastrointestinal tract symptoms but normal manometry results and the RET test was positive in two patients. There were no false-negative RET results. The agreement between the RET and manometry results in this series was 96% (48/50). This preliminary experience suggests that RET is as sensitive as manometry for identifying motility disorders.

Adult↗
PubMed1987

The solid bolus oesophageal egg transit test: its manometric interpretation and usefulness as a screening test.

The standardized 99mTc-labelled solid bolus oesophageal egg transit test (OET) was developed for assessing oesophageal motility. Its value in detecting oesophageal motility disorders was compared with oesophageal manometry in 102 symptomatic patients. Of 32 patients with normal OET, 22 (68.8 per cent) had normal manometry, whereas of 61 patients with abnormal manometry, 51 (84 per cent) had abnormal OET (chi 2 = 15.82, P less than 0.001). The computer-generated condensed image of the OET clearly defined five transit patterns: normal (n = 32); oscillatory (n = 21); non-clearance (n = 16); 'step' delay (n = 16) and non-specific delay (n = 17). The oscillatory pattern occurred in only one patient with normal manometry, but in all six with manometrically defined achalasia and two with diffuse oesophageal spasm. The predictive value of a positive (abnormal) OET test in detecting abnormal motility (both specific and non-specific disorders) was 73 per cent, and for specific motility disorders was 100 per cent. The predictive value of a negative (normal) test in excluding specific motor disorders was 94 per cent. Manometric tertiary contractions and low amplitude waves occurred in 6/32 and 1/32 patients with normal OET but in 31/70 and 21/70 with abnormal OET (chi 2 = 5.14, P less than 0.02; chi 2 = 7.85, P less than 0.001 respectively). Patients showing oscillation demonstrated significantly more tertiary contractions (17/21) and low amplitude waves (12/21) compared with 20/81 and 10/81 patients without oscillation (chi 2 = 20.47, P less than 0.001; chi 2 = 17.22, P less than 0.001 respectively). The solid bolus oesophageal transit test provides an objective screening test of specific oesophageal motility disorders and should be performed before oesophageal manometry.

Adult↗
PubMed1994

Anal pressure vectography is of no apparent benefit for sphincter evaluation.

Anal pressure vectography is an attractive study which can provide colorful 3-dimensional video images to assess radial asymmetry. However, the value of this test is still uncertain. The aim of this study was to assess prospectively the correlation among APV and other anorectal physiological tests, such as anal manometry, anal sphincter electromyography (EMG), and anal ultrasonography. Fifty consecutive patients with faecal incontinence were evaluated. All 50 patients had APV and anal manometry during the same visit. APV revealed mean maximal resting and mean maximal squeeze pressures of 83.1 +/- 28.4 mmHg and 106.3 +/- 34.5 mmHg, respectively. Anal manometry showed mean maximal resting and mean maximal squeeze pressures of 55.9 +/- 19.4 mmHg and 57.7 +/- 29.4 mmHg, respectively. The difference between APV and manometry for both mean maximal resting and mean maximal squeeze pressures were significant (P < 0.05). Thirty-four of the 50 patients (68%) showed global defects of the sphincters on cross-sectional vectogram. Forty-six patients also had anal sphincter mapping with electromyography; 38 patients had isolated decreased EMG activity in a single quadrant. However, only five of the 38 patients (13.2%) had the same defect localized by APV. Lastly, 33 patients had anal ultrasonography; 27 patients had anal sphincter defects. However, only 3 of the 27 patients (11.1%) had the same defects localized by APV. In conclusion, APV had poor correlation with other anorectal physiological tests, including anal manometry, anal sphincter EMG, and anal ultrasonography. Therefore, APV has no apparent advantages, so its use cannot be supported.

Anal Canal↗
PubMed1991

The effect of intravenous diazepam on esophageal motility in normal subjects.

Controversy exists over whether diazepam can be used for sedation during esophageal manometry studies without affecting the results. To evaluate the effect of diazepam, 20 healthy asymptomatic volunteers were studied using a standard manometry protocol employing an Arndorfer capillary infusion system. Following a baseline manometry, each subject received 0.1 mg/kg diazepam intravenously over 1 min and underwent repeat manometry 5 min after completion of the injection. All manometry recordings were coded and read blindly. The amplitude of the lower esophageal sphincter was significantly reduced by diazepam from 26.2 +/- 10.9 and 30.0 +/- 10.9 mm Hg to 18.8 +/- 7.6 and 24.5 +/- 9.7 mm Hg by rapid and station pull-through methods, respectively (P less than 0.01 both methods). Esophageal contraction wave duration was significantly increased following diazepam at 3, 8, and 13 cm above the lower esophageal sphincter (P less than 0.01 all levels). There was a trend toward increased contraction wave amplitude following diazepam administration in the lower three fourths of the esophagus. On the basis of these results, we conclude that diazepam sedation may produce misleading results when used during esophageal manometric testing. It is recommended that diazepam not be used in manometric studies of normal subjects or patients with reflux esophagitis and that manometric findings in patients with hypertensive or spastic disorders be interpreted with caution if diazepam is given as a premedication.

Adult↗
PubMed1994

Biofeedback training is useful in fecal incontinence but disappointing in constipation.

BACKGROUND: Successful biofeedback therapy has been reported in the treatment of fecal incontinence and constipation. It is uncertain which groups of incontinent patients benefit from biofeedback, and our impression has been that biofeedback is more successful for incontinence than for constipation. PURPOSE: This study was designed to review the results of biofeedback therapy at the Lahey Clinic. METHODS: Biofeedback was performed using an eight-channel, water-perfused manometry system. Patients saw anal canal pressures as a color bar graph on a computer screen. Assessment after biofeedback was by manometry and by telephone interview with an independent researcher. RESULTS: Fifteen patients (13 women and 2 men) with incontinence underwent a mean of three (range, 1-7) biofeedback sessions. The cause was obstetric (four patients), postsurgical (five patients), and idiopathic (six patients). Complete resolution of symptoms was reported in four patients, considerable improvement in four patients, and some improvement in three patients. Manometry showed a mean increase of 15.3 (range, -3-30) mmHg in resting pressure and 35.7 (range, 13-57) mmHg in squeezing pressure after biofeedback. A successful outcome could not be predicted on the basis of cause, severity of incontinence, or initial manometry. Twelve patients (10 women and 2 men) with constipation underwent a mean of three (range, 1-14) biofeedback sessions. Each had manometric evidence of paradoxic nonrelaxing external sphincter or puborectalis muscle confirmed by defography or electromyography. All patients could be taught to relax their sphincter in response to bearing down. Despite this, only one patient reported resolution of symptoms, three patients had reduced straining, and three patients had some gain in insight. CONCLUSIONS: Biofeedback helped 73 percent of patients with fecal incontinence, and its use should be considered regardless of the cause or severity of incontinence or of results on initial manometry. In contrast, biofeedback directed at correcting paradoxic external sphincter contraction has been disappointing.

Adolescent↗