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PubMed2006

Chronic alcoholism and esophageal motor activity: a 24-h ambulatory manometry study.

BACKGROUND: Stationary esophageal manometry has shown esophageal motor abnormalities in patients with chronic alcoholism. The abnormalities identified in different studies are not consistent. Twenty-four hour ambulatory esophageal manometry enables monitoring of esophageal motor activity under a variety of physiological conditions and gives a more complete assessment. METHOD: Twenty-four hour ambulatory esophageal manometry and pH-metry were performed using a combined pH and pressure catheter. Subjects with chronic alcoholism with no other illness and not in withdrawal were studied with age- and sex-matched healthy controls. Autonomic nerve functions tests were performed in all subjects. RESULTS: Twenty-three chronic alcoholic subjects and 12 control subjects completed the study. The median ethanol consumption was 95 g/day (range 75 -175 g/day) for 12 years (range 5-30 years) among alcoholic subjects. Eight alcoholic subjects had heartburn and regurgitation but none had dysphagia. Ten (43%) alcoholic subjects had autonomic neuropathy and four (17%) had increased gastroesophageal acid reflux. Lower esophageal sphincter hypertension was observed in alcoholic subjects with autonomic neuropathy. Esophageal body motility parameters (i.e. frequency, duration, amplitude and percentage of peristaltic waves) were not significantly different between alcoholic subjects and controls. CONCLUSIONS: Results of ambulatory esophageal manometry on subjects with chronic alcoholism seem to indicate that long-term ethanol intake has no major effects on esophageal motor activity other than lower esophageal sphincter hypertension among those with alcoholic autonomic neuropathy.

Adult↗

PubMed2006

Lower esophageal sphincter analysis using computerized manometry in patients with chagasic megaesophagus.

Due to the introduction of computer technology into manometry laboratories, three-dimensional manometric images of the lower esophageal sphincter can be constructed based on radially oriented pressures, a method termed 'computerized axial manometry.' Calculation of the sphincter pressure vector volume using this method is superior to standard manometric techniques in assessing lower esophageal sphincter function in patients with gastroesophageal reflux disease and idiopathic achalasia. Despite similarities between idiopathic achalasia and chagasic esophagopathy found using clinical, radiological, and manometric studies, controversy around lower esophageal sphincter pressure persists. The goal of this study was to analyze esophageal motor disorders in Chagas' megaesophagus using computerized axial manometry. Twenty patients with chagasic megaesophagus (5 men, 15 women, and average age 50.1 years, range 17-64) were prospectively studied. For three-dimensional imaging construction of the lower esophageal sphincter, a low-complacency perfusion system and an eight-channel manometry probe with four radial channels placed in the same level were used. For probe traction, the continuous pull-through technique was used. Results showed that the lower esophageal sphincter of patients with chagasic megaesophagus have significantly elevated pressure, length, asymmetry, and vector volumes compared to those of normal volunteers (P < 0.05). Aperistalsis of the esophageal body waves was observed in all patients and contraction amplitude was lower than that in normal patients. We conclude that patients with chagasic megaesophagus have hypertonic lower esophageal sphincter and aperistalsis of the esophageal body.

Adolescent↗

PubMed2002

Outcome of endoscopic sphincterotomy in post cholecystectomy patients with sphincter of Oddi dysfunction as predicted by manometry and quantitative choledochoscintigraphy.

BACKGROUND: Sphincter of Oddi dysfunction is diagnosed at manometry and, after cholecystectomy, non-invasively at quantitative choledochoscintigraphy. Patients may benefit from endoscopic sphincterotomy. AIMS: The aim of this study was to assess the usefulness of choledochoscintigraphy compared with manometry in predicting outcome of sphincterotomy in post cholecystectomy patients with sphincter of Oddi dysfunction. PATIENTS AND METHODS: Thirty patients with biliary-type pain complying with the Rome diagnostic criteria of sphincter of Oddi dysfunction and belonging to biliary group I and II were subjected to clinical evaluation, choledochoscintigraphic assessment of the hepatic hilum-duodenum transit time, endoscopic retrograde cholangiopancreatography, and perendoscopic manometry. Twenty two biliary group I and II patients with prolonged hepatic hilum-duodenum transit times were invited to undergo sphincterotomy. Fourteen patients underwent sphincterotomy; eight refused. Clinical and scintigraphic assessments were performed at follow up. RESULTS: Hepatic hilum-duodenum transit time was delayed in all patients with manometric evidence of sphincter of Oddi dysfunction, in all biliary group I patients and in 64% of biliary group II patients. At follow up, all patients who underwent sphincterotomy were symptom free and hepatic hilum-duodenum transit time had either normalised or significantly improved. A favourable post sphincterotomy outcome was predicted in 93% of cases at choledochoscintigraphy and in 57% at manometry. CONCLUSIONS: Quantitative choledochoscintigraphy is a useful and non-invasive test to diagnose sphincter of Oddi dysfunction as well as a reliable predictor of sphincterotomy outcome in post cholecystectomy biliary group I and II patients, irrespective of clinical classification and manometric findings.

Adult↗

PubMed1986

Progressive systemic sclerosis: radionuclide esophageal scintigraphy and manometry.

Radionuclide esophageal scintigraphy (RES) and manometry were used for prospective evaluation of esophageal involvement and disease severity in 11 patients (nine women and two men; median time since diagnosis, 1 year) with progressive systemic sclerosis (PSS). Quantitation of RES included calculation of the percentage of emptying at 30 seconds, while manometry provided measurements of proximal, distal, and lower esophageal sphincter (LES) pressures. The findings of both RES and manometry were abnormal in all 11 patients. There was a high correlation between the percentage of emptying and either distal esophageal pressure (r = .86, P less than .01) or LES pressure (r = .79, P less than .01). No significant correlation was found between the percentage of emptying and proximal esophageal pressure (r = .28, P = .39). RES is a safe, simple procedure that is readily accepted by patients and can be used in place of manometry for the detection and staging of esophageal involvement in PSS.

Adult↗

PubMed2003

Study of intestinal flow by combined videofluoroscopy, manometry, and multiple intraluminal impedance.

Assessment of patterns of flow in the small bowel is difficult. Multiple intraluminal impedance has been recently used for study of flow dynamics in the esophagus. Our aims were 1) to validate multiple intraluminal impedance by correlating impedance events with intestinal flow as detected by fluoroscopy and 2) to determine intestinal flow patterns in the fasting and postprandial period and their correspondence with manometry. First, six healthy subjects underwent simultaneous video-fluoroscopic, manometric, and impedance recording from the duodenum. Videofluoroscopy was used to validate impedance patterns corresponding with barium flow in the fasting and postprandial periods. Next, 16 healthy subjects underwent prolonged simultaneous recording of impedance and manometry in both periods. Most flow events were short (10 cm or less), with antegrade flow being the most common. Correspondence between impedance and videofluoroscopy increased with increasing length of barium flow. Impedance corresponded better with flow, at any distance, than manometry. However, impedance and manometric events, when analyzed separately as index events, always corresponded with fluoroscopic flow. The fasting and postprandial periods showed comparable patterns of flow, with frequent, highly propulsive manometric and impedance sequences. Motility index was positively and significantly associated with length of impedance events. Phase 3 of the migrating motor complex could be easily recognized by impedance. Multiple intraluminal impedance can detect intestinal flow events and corresponds better with fluoroscopic flow than manometry.

Adult↗

PubMedDate not supplied

Anorectal manometry: the state of the art.

This review deals first with the methodology of anorectal manometry. The methods of recording anorectal pressures with perfused catheters, sleeve catheters, water- or air-filled balloon catheters and microtransducers are presented and discussed as well as the various polygraphs used in this investigation. In the second part, the routine anorectal manometry and the parameters to be studied in this investigation are described. Then, the additional manoeuvres which have been described in anorectal manometry are discussed. Finally, the major results obtained in recto-anal dysfunctions are described, that is manometric findings in constipation in adults and children, in incontinence and in the descending perineum syndrome. The usefulness of anorectal manometry in surgical and various conditions is also discussed.

Age Factors↗

PubMed1986

Studies of the dynamic response of esophageal manometry systems.

Manometry with fluid-filled catheter systems remains an important technique to study esophageal physiology. The influence of mode of infusion, infusion flow rate, and catheter dimensions on the dynamic response and compliance of such systems was studied. To test the dynamic response, a method based on the step response was developed and applied. A pressure impulse--a step function--was produced by burning off a balloon connected to the system. The response to this well-defined impulse recorded by the system--the step response--was analyzed. The highest frequency to which the system responded satisfactorily--the limiting frequency--was calculated and used as a measure of performance. Compliance and inherent postocclusion pressure rise rate were also determined. In low-compliance systems noninfused or infused by hydraulic capillary infusion, limiting frequencies from 8 to 20 Hz were found, and this was much higher than in a high-compliance system infused by a syringe infusion pump. Smaller diameter and increased length of the manometry catheter decreased the limiting frequency. Increased infusion flow rate did not increase the limiting frequency. The step response test seems to be a simple test of dynamic response that can contribute to better understanding of problems involved in pressure recording with fluid-filled catheter systems. Well-performing fluid-filled manometry systems are adequate for esophageal manometry. Inherent postocclusion pressure rise rate is not a measure of dynamic response, and compliance is not the only determinant of performance.

Catheterization↗

PubMed1989

Improved lower esophageal sphincter manometry: application of the end-hole recording technique in vivo.

The recommendation to use a thin end-hole catheter for lower esophageal (LES) manometry has a strong theoretic background supported by previous in vitro studies. The pressure in the closed sphincter is measured, and the problem of pressure asymmetry eliminated. In this study the advantage and applicability of an end-hole catheter compared with the composite side-hole catheter for LES manometry was tested in vivo in dogs and human subjects. Pull-through manometry was performed with a continuously infused composite four-lumen catheter with one central channel and three side-hole channels enabling simultaneous end-hole and side-hole recording of LES pressure. A pull-through produced one end-hole and three side-hole pressure registrations. The end-hole recorded resting sphincter pressure was 19.7 +/- 4.5 cm H2O in 6 dogs and 9.9 +/- 6.8 cm H2O in 89 human subjects (volunteers and patients). The side holes recorded higher pressures, longer high-pressure zones, and obvious differences--asymmetry--between the three channels. The correlation between the side-hole and end-hole recordings was equally poor with regard to both pressure and length, with r values from 0.48 to 0.61. The relative difference between the end hole and side holes was most pronounced in low-pressure sphincters. In the dogs the end-hole and one side-hole channel always recorded LES pressure close to the expected 0 pressure during reflux, whereas the other two side-hole channels recorded high pressures. The present study proved the applicability of the end-hole technique for LES manometry in vivo in man. The end hole seemed to record true sphincter pressure.

Animals↗

PubMed1997

Antroduodenal manometry in children with no upper gastrointestinal symptoms.

BACKGROUND: The interpretation of antroduodenal manometry in children with gastrointestinal motility disorder has been limited by a paucity of data from normal children. The purpose of this study was to define antroduodenal manometry findings in children with no upper gastrointestinal symptoms. METHODS: We reviewed 260 consecutive antroduodenal manometries and selected 18 studies from subjects aged 2-12 years with no symptoms referable to a gastrointestinal motility disorder involving the stomach and/or the small bowel. RESULTS: During fasting, phase 3 of the migrating motor complex (MMC) was present in 14 of 18 children, and it was induced by erythromycin in 4 who failed to have a spontaneous phase 3. Phase 3 propagation velocity increased significantly with age. The cycle length between MMCs showed no age-dependent variation. Phase 3 occupied 3%; phase 1, 10%; and phase 2, 87% of the fasting recording time. CONCLUSIONS: Antroduodenal manometry findings in children with no upper gastrointestinal symptoms are similar to those in adults.

Adult↗

PubMed2006

Technological insights: combined impedance manometry for esophageal motility testing-current results and further implications.

This review focuses on current aspects of the novel technology of combined impedance manometry for esophageal motility testing. It presents methodological features, summarizes current results and discusses implications for further research. The combined technique assesses simultaneously bolus transport and associated peristalsis, thus allowing detailed analysis of the relationships between bolus transit and esophageal motility. Recent studies demonstrate that combined impedance manometry provides important additional information about esophageal motility as compared to conventional manometry: (1) monitoring of bolus transport patterns, (2) calculation of bolus transit parameters, (3) evaluation of bolus clearance, (4) monitoring of swallow associated events such as air movement and reflux, and (5) investigation of the relationships between bolus transit and LES relaxation. Studies with healthy subjects have identified several useful parameters for comprehensive assessment of eosphageal function. These parameters were found to be pathological in patients with classical achalasia, mild GERD, and ineffective esophageal motility. The technology of combined impedance manometry provides an important new tool for esophageal function testing, advancing both clinical and basic research. However, several important issues remain to be standardized to make the technique suitable for widely clinical use.

Deglutition↗

PubMed2006

[Esophageal manometry in patients with non cardiac chest pain].

BACKGROUND: Non cardiac chest pain can be caused by esophageal problems such as gastroesophageal reflux or smooth muscle motor disorders. AIM: To perform esophageal manometry in patients with non cardiac chest pain. MATERIAL AND METHODS: One hundred patients with chest pain in whom coronary problems were discarded, were studied. A computerized esophageal manometry was performed in all and 24 hours esophageal pH measurement was done in 21 patients. RESULTS: Esophageal manometry was normal in eight patients. Nutcracker esophagus was the most common finding, in 36 patients. Twenty eight had a hypotensive sphincter, 16 had unspecific motor disorders, nine had diffuse esophageal spasm, two had a non achalasic esophageal aperistalsis and one had a hypertensive sphincter. CONCLUSIONS: Only eight of 100 patients referred to esophageal manometry for non cardiac chest pain, had a normal study.

Chest Pain↗

PubMed1999

[Propofol sedation in endoscopic manometry of Oddi's sphincter].

Endoscopic manometry of the sphincter Oddi (SO) is a sophisticated method which requires a cooperative patient. Therefore, during endoscopic manometry sufficient i.v. sedation is crucial, and additionally must no affect SO-motility. In a pilot trial SO-motility was determined in ten patients with suspected SO-dysfunction (SOD) under initial sedation with 4.8 +/- 1 mg midazolam (baseline), and 3 min after an i.v. bolus of 50 mg of propofol. In addition, endoscopic manometry was performed in 57 consecutive patients with suspected SOD from 10/94-9/95 under sedation with midazolam (6.2 +/- 1.6 mg), and from 10/95-9/96 with propofol (268 +/- 111 mg). Sedation was always performed by an independent physician according to a standardized protocol. Neither the SO-baseline pressure nor the parameters of phasic SO-motility were significantly altered by propofol (including two patients with proven SOD). Propofol causes a more rapid onset of sedation, and the time interval to obtain successful biliary cannulation was shorter than under midazolam (p < 0.05). Successful manometric recordings could be obtained in 82% of the patients under midazolam but in 96% of the patients under propofol-sedation (p < 0.05), respectively. The patient cooperation was significantly better rated (by the endoscopist) in the propofol group than in the midazolam group (p < 0.01). The blood pressure and the heart rate were not significantly affected in both groups, however, propofol caused a significant decrease of the oxygen saturation (p < 0.05). Accordingly, an apnea episode had to be mastered by mask ventilation via ambu bag in one patient under propofol-sedation (uneventful recovery). In the midazolam group flumazenil-administration was necessary in four patients. The post-procedure recovery was faster after propofol--than after midazolam-sedation (p < 0.05). In conclusion, propofol is suitable for i.v. sedation during endoscopic manometry of the spincter of Oddi.

Adult↗

PubMed2001

Laparoscopic transcystic sphincter of Oddi manometry is not affected by carbon dioxide pneumoperitoneum.

Sphincter of Oddi (SO) dysfunction as a potential cause of chronic acalculous cholecystitis (CAC) has not been studied in cases for which intraoperative SO manometry was used during laparoscopic cholecystectomy. In this study, we evaluated the effects of carbon dioxide pneumoperitoneum on laparoscopic transcystic SO manometry. In 27 patients with CAC, transcystic SO manometry had been attempted during laparoscopic cholecystectomy. The mean age of the patients was 46 years (range, 22-71). Complete manometric data sets were obtained in 18 patients. The mean SO pressure, phasic SO pressure, and phasic frequency were 35.4 +/- 29.1 mm/Hg versus 30.8 +/- 23.8 mm/Hg, 104.8 +/- 63.0 mm/Hg versus 73.6 +/- 34.6 mm/Hg, and 2.1 +/- 1.8 contractions/min versus 2.8 +/- 3.4 contractions/min with and without pneumoperitoneum, respectively. All differences were nonsignificant (P > 0.05). Two complications (7.4%) were observed: pancreatitis and jaundice. SO manometry is not affected by CO2 pneumoperitoneum. It may be used to study SO motility in patients with CAC.

Adult↗

PubMed1999

[Clinical application of esophageal manometry and 24-hour esophageal pH monitoring].

OBJECTIVE: To evaluate the clinical application of esophageal manometry and 24-hour esophageal pH monitoring. METHODS: From 1990 to 1996, ambulatory esophageal manometry and 24-hour esophageal pH monitoring were performed on 101 patients with different functional esophageal diseases, including Barrett's esophagus 54 patients non-cardiac chest pain (10) and post-cholecystectomy (37). Esophageal motility studies were made to compare the effects of different anti-reflux therapies, to identify primary esophageal motility disorders, to assess the effect of anti-acid drugs, and to study the relationship between esophageal motility disorder and other non-esophageal origin disease. RESULTS: In this study, anti-reflux surgery was better than medical therapy in controlling gastroesophageal reflux (GER) for Barrett's esophagus. Esophageal manometry was the best method for detecting primary esophageal motility disease. Omeprazole was superior to cimetidine in terms of control of GER and reduction of gastric acidity. Cholecystectomy resulted in GER and many symptoms after surgery appeared to have an esophageal origin. CONCLUSIONS: Esophageal manometry and 24-hour esophageal pH monitoring are the most sensitive and specialized methods for detecting esophageal motility disorders. They are superior to other routine diagnostic methods such as radiology and endoscopy.

Antacids↗

PubMedDate not supplied

[The importance of ano-rectal manometry in irritable bowel syndrome].

UNLABELLED: Irritable Bowel Syndrome (IBS) represents a frequent cause for gastroenterological referral. 50% of all gastroenterological consultations are for functional gastrointestinal disorders (IBS included). Multiple motility abnormalities were described in IBS. The AIM of the study was to evaluate the role of ano-rectal manometry in the diagnosis of IBS. STUDY DESIGN: 24 patients with IBS (mean age 50.8 +/- 15.4) and a control group of 10 subjects with no abdominal symptoms (mean age 48.1 +/- 12.3) had each an ano-rectal manometry examination. RESULTS: After exclusion of constipation predominant IBS subjects, the IBS patients presented lower perception threshold (22.1 +/- 10.9 ml) than the control group (60.2 +/- 11.3 ml) (p < 0.05) and than the constipation predominant group (81.3 +/- 44.0) (p < 0.05). In 44% of constipation predominant IBS concomitant pathology, revealed by manometry, was present: megarectum or hemorrhoids (spasm). CONCLUSION: Anorectal manometry could be a useful tool for the evaluation of IBS patients.

Adult↗

PubMed2000

[Usefulness of anorectal manometry in the neonatal diagnosis of Hirschsprung disease].

During 1992 through 1998 anorectal manometry studies have been carried out on 32 newborn, with age between 48 hours and 28 days and weight range of 1,400 and 4,200 g at the test moment. The test has been prescribed due to a retard in meconial evacuation in the 32 patients, moreover, 13 out of them also presented an intestinal obstruction or subobstruction. The anorectal manometry is carried out with a probe especially designed by us for newborn and a Hellige polygraph. Presence or absence or rectoanal inhibitory reflex (RAIR) is assessed. The test is repeated after one and three weeks from the first study in the cases of RAIR absence. A barium enema was carried out in case of RAIR absence. The RAIR was present in 20 out of the 32 newborn, which allowed the exclusion of Hirschsprung's disease (HD) in these patients. Of the remaining 12 patients, in 11 it was shown the absence of RIAR in the first anorectal manometry study, making it possible the early diagnosis of HD in 9 patients and transient functional obstruction of the colon in 2 newborns. This former diagnosis was corroborated by the findings of the enema, which showed a small left colon and by the presence of RAIR in a later anorectal manometry control. There was a doubtful case in the first study, showing later the absence of RAIR. The first enema in 10 newborn with HD was considered normal in 3 cases and with transitional zone in 4 newborns and microcolon in 1 case.

Hirschsprung Disease↗

PubMed2002

Small intestinal manometry.

Gastrointestinal motility is an integrated process including myoelectrical and contractile activity, tone, compliance and transit. The techniques for the assessment of gastrointestinal motility are multiple and all have their advantages and disadvantages. In the case of suspected abnormal upper gut transit, gastric and small bowel transit scintigraphy followed by small intestinal (antroduodenojejunalileal) manometry is recommended. Small bowel manometry can identify patterns suggestive of myopathy, neuropathy or obstruction. Information on procedures, indications, significance, pitfalls and guidelines for small bowel manometry is provided in this paper. In this context the potentials of small intestinal manometry for scientific experimental study of neurohumoral agents, such as serotonin receptor agonists and antagonists, on small intestinal motility is presented.

Enteric Nervous System↗

PubMedDate not supplied

Importance of oesophageal manometry in the diagnosis of oesophageal motility disorders. Report of two cases.

Two cases of dysphagia, in which radiology led to an incorrect diagnosis, are described. In case I the X-ray barium swallow showed only minor oesophageal dilatation with no apparent delay in emptying or abnormality of the cardias, yet achalasia was diagnosed by oesophageal manometry. In case 2, although the barium swallow strongly suggested achalasia, manometry showed a less severe motility disorder characterized by lower oesophageal sphincter dysfunction and normal peristalsis. Correct diagnosis obtained with manometry was supported by the different clinical course of the two patients during a 2 year follow up. Oesophageal manometry should always be performed when radiology and/or the patient's history suggest the presence of a motility disorder of the oesophagus since a correct diagnosis is essential for appropriate treatment and follow-up.

Adult↗