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PubMed2001

Pharyngoesophageal pressure monitoring in sleep apnea syndrome.

OBJECTIVES: This study tests the sensitivity and the specificity of overnight pharyngoesophageal pressure measurement for identification and classification of obstructive sleep apnea (OSA). METHODS: Fifty-nine snoring patients undergoing polysomnography were invited to have simultaneous pharyngoesophageal manometry. We used a soft silicone catheter with 4 microtip pressure sensors at different levels. RESULTS: The apnea hypopnea indexes (AHIs) measured by the 2 methods were highly correlated (r = 0.971). Manometry was 100% sensitive and specific in excluding OSA and identifying severe OSA. It was 90% sensitive in identifying moderate OSA and 80% sensitive in identifying mild OSA. CONCLUSION: Overnight ambulatory pharyngoesophageal manometry is a reliable tool for the exclusion of OSA and identification of severe OSA. It has additional advantages of localizing the level of obstruction and identifying the upper airway resistance syndrome and can be performed at home. It is cost-effective when compared with polysomnography and may aid in treatment selection for individual patients.

Adult↗
PubMed2000

Laparoscopic repair of chronic intrathoracic gastric volvulus.

BACKGROUND: Totally intrathoracic gastric volvulus is an uncommon presentation of hiatal hernia, in which the stomach undergoes organoaxial torsion predisposing the herniated stomach to strangulation and necrosis. This may occur as a surgical emergency, but some patients present with only chronic, non-specific symptoms and can be treated electively. The aim of this study is to describe a comprehensive approach to laparoscopic repair of chronic intrathoracic gastric volvulus and to critically assess the pre-operative work-up. METHODS: Eight patients (median age, 71 years) underwent complete laparoscopic repair of chronic intrathoracic gastric volvulus. Symptoms of epigastric pain and early satiety were universally present. Five patients had reflux symptoms. The diagnostic evaluation included a video esophagogram, upper endoscopy, 24-hour pH measurement, and esophageal manometry in all patients. Operative results and postoperative outcome were recorded and follow-up at 1 year included a barium swallow in all patients. RESULTS: All patients had documented intrathoracic stomach. Five of 8 patients had a structurally normal lower esophageal sphincter. All 4 patients with reflux esophagitis on upper endoscopy had a positive 24-hour pH study, and 2 of these patients had a structurally defective lower esophageal sphincter on manometry. None of the patients had preoperative evidence of esophageal shortening. All procedures were completed laparoscopically. The procedure included reduction of the stomach into the abdomen, primary closure of the diaphragmatic defect, and the construction of a short, floppy Nissen fundoplication. There were no major complications. One patient required repair of a trocar site hernia 6 months postoperatively. At 1-year follow-up, there were no radiologic recurrences of the volvulus. One patient complained of temporary swallowing discomfort and another had recurrent gastroesophageal reflux disease (GERD) symptoms caused by a breakdown of the wrap. All other patients remained asymptomatic during follow-up. CONCLUSIONS: The repair of chronic gastric volvulus can be accomplished successfully with a laparoscopic approach. A preoperative endoscopy and esophagogram are crucial to detect esophageal stricture or shortening, and manometry is needed to access esophageal motility; pH measurements do not affect operative strategy. The procedure should include a Nissen fundoplication to treat preoperative GERD, to prevent possible postoperative GERD, and to secure the stomach in the abdomen. The procedure is safe but technically challenging, requiring previous laparoscopic foregut surgical expertise.

Aged↗
PubMed1995

Cisapride for constipation in spinal cord injured patients: a preliminary report.

Chronic constipation in patients with spinal cord injury (SCI) has significant impact on quality of life. To measure baseline clinical functioning, colonic transit time and anorectal manometry and the effect of cisapride on these clinical and physiological parameters, we studied 12 SCI patients. Patients initially received baseline clinical scoring, measurement of colonic transit time and anorectal manometry. Patients then received cisapride 20 mg orally three times each day. After one and three months of cisapride therapy, all measurements were repeated. The mean duration cisapride treatment was 5.2 months. Six of 12 (50 percent) reported that symptoms of constipation improved. No patient had worsening of symptoms. Prior to cisapride treatment, 23 percent of patients passed colonic transit markers by day five and 57 percent by day seven; baseline anal manometry revealed variable resting and squeeze pressures. After treatment, 33 percent of patients passed their colonic transit markers by day five and 71 percent by day seven. Six of 12 (50 percent) demonstrated a 10 percent or more increase in resting anal canal pressures. We conclude that about 50 percent of SCI patients have subjective improvement in constipation after cisapride therapy. Cisapride appears to improve both colonic and anorectal function.

Cisapride↗
PubMed2000

Lateral internal sphincterotomy together with haemorrhoidectomy for treatment of haemorrhoids: a randomised prospective study.

OBJECTIVE: To investigate anorectal manometric findings in patients with haemorrhoids and to evaluate the clinical effects and physiological consequences of adding a lateral internal sphincterotomy (LIS) to haemorrhoidectomy. DESIGN: Randomised prospective study. SETTING: Teaching hospital, Naples. PATIENTS: 48 consecutive patients with prolapsed piles who had anorectal manometry; 10 healthy volunteers served as controls. INTERVENTIONS: Resting and squeeze pressures, sphincter length and rectoanal inhibitory reflex were recorded. 6 patients were excluded because anal pressures were not raised, so 42 patients were randomised. 22 patients had haemorrhoidectomy plus LIS; and 20 had haemorrhoidectomy alone. MAIN OUTCOME MEASURES: Morbidity, continence, and anorectal manometry. RESULTS: Sphincter anomalies were found in 87.5% (n = 42) of patients. Haemorrhoidectomy alone did not affect anal pressures, which returned to the normal ranges after sphincterotomy. Those who had LIS did better postoperatively than those who had did not. 4 patients who did not have a sphincterotomy developed anal strictures. No patient who had LIS developed incontinence of faeces. CONCLUSIONS: High anal pressures are common in patients with haemorrhoids suggesting that they may have a pathogenetic role; anorectal manometry is useful in the investigation of anal pressure patterns; and when indicated, lateral sphincterotomy avoids pain, urinary retention, and stenosis, and is safe.

Adult↗
PubMed1998

An investigation into the spatial relationship between complexity and motility within the oesophagus.

Nonlinear analysis techniques have recently been used in the characterization of complex physiological signals seen in pathological disorders such as epilepsy and cardiac fibrillation. In this study a series of controlled swallows from an asymptomatic demonstration group was investigated using oesophageal manometry. The nonlinear measure of complexity, largest Lyapunov exponents and phase portraits were then used to explore the complexity of motility patterns at different points within the oesophagus. Results indicate greater complexity within the region of the striated muscle in the upper oesophagus than that observed within the region of smooth muscle in the lower oesophagus. Phase portraits showed that manometry patterns within the asymptomatic demonstration group could be quite different, highlighting the problems in clinical diagnosis. The characterization of motility disorders associated with complex manometry patterns such as diffuse oesophageal spasm (DOS) and nonspecific motility disorder (NOMD) still represents a diagnostic challenge. The use of nonlinear techniques enabling the quantitative and qualitative measurement of oesophageal complexity is considered in the classification of such disorders.

Adult↗
PubMed1998

Air oesophagogram: a frequent, but not a specific sign of oesophageal involvement in connective tissue diseases.

OBJECTIVE: This study investigates the role of the air oesophagogram in conventional chest X-rays for the diagnosis of oesophageal dysmotility in patients with connective tissue diseases. METHODS: Fifty-one patients with connective tissue diseases were studied by oesophageal manometry and lateral and posterior-anterior chest X-rays. The presence or absence of oesophageal air on chest X-rays were evaluated separately in the upper, middle and distal segment of the oesophagus. Forty-seven chest X-rays of patients without connective tissue diseases, who had undergone manometry for the evaluation of oesophagus-related symptoms and who had normal oesophageal function, were analysed as a control. RESULTS: A total of 23/51 patients with connective tissue diseases showed oesophageal dysfunction in manometry; 16/51 patients (31%) had air in two or more oesophageal segments on the lateral chest X-ray. There was a significant association of manometrically proven oesophageal dysmotility and air in two or three oesophageal segments (P < 0.05; sensitivity 48%, specificity 82%). However, the prevalence of an air oesophagogram showed no significant difference between patients with connective tissue diseases and the control group (10/47; 21%). CONCLUSION: The radiological sign of an air oesophagogram is neither sensitive nor specific enough to omit oesophageal motility studies in patients with connective tissue diseases.

Air↗
PubMed1985

Manometric diagnosis of sphincter of Oddi spasm as a cause of postcholecystectomy pain and the treatment by endoscopic sphincterotomy.

Seventeen patients with postcholecystectomy pain and nine controls were studied by nonoperative biliary manometry with stimulation of sphincter of Oddi spasm by morphine. The controls remained asymptomatic despite an elevation of bile duct pressure after morphine. In 13 patients with postcholecystectomy pain, morphine induced pain paralleling a pressure rise. Three other patients had pain not paralleling a pressure change, and another showed a pressure rise without pain. None of the controls, four with the parallel pain-pressure change, and one with the discordant pain-pressure correlation were positive at the traditional morphine-Prostigmin test. Endoscopic sphincterotomy provided complete (8), moderate (3), or slight (1) relief of pain to 12 patients with the parallel pain-pressure relationship. Postsphincterotomy manometry showed disappearance of both the pressure elevation and pain induction, and the morphine-Prostigmin test turned negative. It is concluded that morphine-induced bile duct pressure elevation coinciding with pain is diagnostic of sphincter spasm as a cause of postcholecystectomy pain, the morphine-Prostigmin test, although helpful, is less specific and less sensitive in diagnosing sphincter spasm than the manometry, and endoscopic sphincterotomy relieves the pain due to this condition in most cases.

Adult↗
PubMed1989

Detection of clustered gastrointestinal contractions in partial intestinal obstruction by surface vibration analysis.

Gastrointestinal contraction "clusters" with alternating quiescence occur in partial intestinal obstruction and are conventionally detected by intraluminal manometry. Surface Vibration Analysis (SVA), which is a noninvasive test, was evaluated in this study in experimental and clinical situations. In the experimental situation, former SVA was assessed against simultaneous manometry in two volunteers, in whom partial obstruction had been induced by intrajejunal balloon distension. Manometry showed typical contraction "clusters" with alternating quiescence, each of two to four minutes duration, in obstructed jejunum proximal to the balloon. The distal jejunum was inhibited. SVA showed a pattern of hyperactivity and quiescence corresponding to proximal jejunal activity. In the clinical situation, SVA recordings taken after a standard meal in nine patients with suspected chronic obstruction adhesive obstruction, (subsequently proven in seven patients and disproved in two), and 36 volunteers were compared. All patients with proved obstruction showed an SVA pattern of alternating hyperactivity and quiescence. This pattern was not observed in volunteers or nonobstructed patients.

Abdomen↗
PubMed1993

Cervical dysphagia is associated with gastric hyperacidity.

There is some controversy regarding the association of upper esophageal symptoms and acid gastroesophageal reflux. We carried out gastric acid analysis, 24-h esophageal pH measurement, and esophageal manometry in 150 patients with symptoms suggestive of gastroesophageal reflux disease. Of these, 22 (15%) had gastric acid hypersecretion [basal acid output level > 5 mmol/h (19 patients) or maximum acid output level > 30 mmol/h (13 patients)]. They were compared to 25 consecutive patients with normal gastric acid secretion. An incompetent lower esophageal sphincter was identified in a similar number of hypersecretors (HS) (59.1%) and normosecretors (NS) (44%). Esophageal acid exposure was more common in HS than in NS (score, 70 vs. 36.1, p < 0.05). This was reflected as a higher incidence of esophagitis in HS (67 vs. 14%, p < 0.0025). Symptoms of cervical dysphagia were present in eight of 22 HS and one of 25 NS (p = 0.009). There was no anatomical lesion on endoscopy to explain the dysphagia. Upper esophageal sphincter (UES) manometry showed normal pharyngeal pressure, resting UES pressure, and length in both groups. The mean closing UES pressure was 127 mm Hg in HS and 114 mm Hg in NS (0.1 > p > 0.05). The HS with cervical dysphagia were no different from HS without dysphagia in any respect. We conclude that patients with gastric acid hypersecretion have more acid reflux, esophagitis, and cervical dysphagia. This is not associated with demonstrable abnormality in stationary manometry. Prolonged measurement may be required to show any change.

Adult↗
PubMed1993

Is histological diagnosis of neuronal intestinal dysplasia related to clinical and manometric findings in constipated children? Results of a pilot study.

Neuronal intestinal dysplasia (NID) of the colon has been reported in adults and children with chronic constipation. However, it is unknown whether these histological abnormalities are related to the severity of symptomatology or the findings of anorectal manometry. We studied 57 children (2 weeks to 17 years old, 33 boys) who had chronic constipation and/or soiling or obstructive symptoms early in life and evaluated anamnestic data, symptoms, outcome after 6 months of conventional therapy, rectal biopsies for signs of dysganglionosis, and results of anorectal manometry. In cooperative patients, defectaion dynamics were recorded during manometry with simultaneous surface electromyogram of the external anal sphincter. In 30 older patients, severity of constipation was assessed by measurement of colonic transit time with radiopaque markers. Histology confirmed Hirschsprung's disease in nine (excluded from further analysis), hyperganglionosis of the plexus submucosus (classic NID) in six, heterotopic ganglion cells without hyperganglionosis (abortive NID) in 18, and no signs of dysganglionosis in 24 patients. The rectoanal inhibitory reflex was more often absent or abnormal in children with classic NID (six of six) and abortive NID (11 of 17) compared with children with normal histology (four of 22) (p < 0.001). All other manometric parameters analyzed, colonic transit times, and clinical outcomes were not related to histological diagnosis. In contrast, the severity of constipation and outcome was significantly worse in children with abnormal defecation dynamics. These results suggest that histological signs of NID in the submucous plexus are of uncertain value in assessing the clinical picture and should not influence decisions concerning further treatment, especially surgical interventions.

Adolescent↗
PubMed1998

Bisacodyl and high-amplitude-propagating colonic contractions in children.

BACKGROUND: The purpose of these studies was to determine the suitability of bisacodyl for stimulating high-amplitude-propagating contractions in pediatric studies of colonic manometry. METHODS: Water-perfused manometry catheters were inserted into the right colon of children referred for evaluations related to defecation disorders. Colonic motility was measured in a 3-hour test session: an hour fasting, an hour after a meal, and 30 minutes after administration of a provocative agent. RESULTS: Bisacodyl was superior to edrophonium as a stimulant for inducing high-amplitude-propagating contractions. Bisacodyl-induced high-amplitude-propagating contractions were similar in amplitude, duration, propagation velocity, and sites of origin and extinction to naturally occurring high-amplitude-propagating contractions. The effect of intrarectal bisacodyl was similar to that of intracecal bisacodyl, except for a delay of 10 minutes in onset. Bisacodyl induced high-amplitude-propagating contractions in all 28 children (22 with spontaneous high-amplitude-propagating contractions) without evidence of neuromuscular disease and in 2 of 9 children with a colonic neuromuscular disorder and no spontaneous high-amplitude-propagating contractions. CONCLUSIONS: Bisacodyl-induced high-amplitude-propagating contractions were quantitatively and qualitatively similar to naturally occurring high-amplitude-propagating contractions. In selected cases, such as in children receiving total parenteral nutrition or restricted fluid intake, it may be possible to shorten diagnostic colonic manometry using bisacodyl rather than waiting for spontaneous high-amplitude-propagating contractions.

Adolescent↗
PubMed2006

Colorectal motor and sensitivity features in patients affected by ulcerative proctitis with constipation: a radiological and manometric controlled study.

BACKGROUND AND AIM: Constipation may be present in ulcerative proctitis (UP), but its pathogenesis has not yet been evaluated. The aim of this article is to investigate functional and morphologic features of the anorectal region in patients with UP and constipation. MATERIALS AND METHODS: Eleven patients with quiescent clinical, endoscopic, and histological UP and constipation and 10 patients with functional constipation (FC) underwent radiologic evaluation of intestinal transit time, anorectal manometry, and defecography. Transit time was measured with radiograms at 72 h after ingestion of radiopaque markers. Manometry was carried out using a continuous perfused catheter and a balloon inflated with increasing volumes of air. Defecography was performed after the injection of a barium-sulfate solution in the rectum, with the registration of videotapes during straining, squeezing, and evacuation. RESULTS: Manometry showed in UP significantly lower values of rectal compliance than those in FC (3.10 and 5 mL/mmHg, respectively) (P = 0.03). Rectal sensitivity threshold was increased but without significant differences in UP and FC (30 and 50 mL air, respectively). At defecography, the median value of rectosacral space was increased in UP in comparison with FC (1.30 vs 0.8; P = 0.002). Lateral rectal diameter in UP was lower than in FC (6 and 8.8 cm, respectively; P = 0.016). Nonsymptomatic rectocele, mucosal prolapse, descending perineum, and abdominopelvic dyssynergy were equally present in UP and FC. The majority of UP patients showed a prolonged intestinal transit time similar to FC patients, and, more frequently, they showed low transit in the left colon in comparison with the right colon in comparison with FC patients. CONCLUSIONS: This study suggests that constipation in UP may be correlated with rectal fibrosis, which reduces the transit of stools from the left colon. The concomitance of asymptomatic anorectal organic or functional alteration may contribute to worsen constipation.

Adult↗
PubMed2007

Predictors of outcomes after biliary and pancreatic sphincterotomy for sphincter of oddi dysfunction.

BACKGROUND: There are few data on combined pancreatic and biliary sphincterotomy for sphincter of Oddi dysfunction (SOD), especially regarding clinical features that might predict outcomes. We sought to examine the relative importance of various clinical features and the presence or absence of objective biliary abnormalities in determining responses to endoscopic therapy. METHODS: A cohort of consecutive patients with suspected SOD was treated with biliary sphincterotomy, with additional pancreatic sphincterotomy at initial or subsequent endoscopic retrograde cholangiopancreatography if there was abnormal pancreatic manometry in conjunction with pain refractory to biliary sphincterotomy, continuous pain, or a history of amylase elevation. Repeat intervention was offered until response was achieved or complete ablation of all treated sphincters was achieved. Response was assessed by patients using a 5-point Likert scale, and multivariate logistic regression analysis used to identify predictors of response. RESULTS: Of 121 patients, 112 (92%) were female, 105 (87%) postcholecystectomy, and by modified Milwaukee biliary classification 18 (15%) were type I, 53 (44%) type II, and 50 (41%) type III. All patients underwent biliary sphincterotomy and 49 (40%) pancreatic sphincterotomy. Good or excellent response at final follow-up was reported by 83 (69%) of 121 patients, including 37 (61%) of 61 patients requiring repeated intervention. Response was not significantly different between biliary types I, II, and III. Patient characteristics (with adjusted odds ratios) that were significant predictors of poor response were normal pancreatic manometry (4.6), delayed gastric emptying (6.0), daily opioid use (4.0), and age <40 (2.7). Abnormal liver function tests or dilated bile duct were not significant. CONCLUSIONS: For the treatment of SOD incorporating pancreatic and biliary sphincterotomy, patient characteristics and pancreatic sphincter manometry may be more important predictors of outcome than the traditional classification based on liver chemistries and bile duct dilation.

Adolescent↗
PubMed1982

Manometric assessment of oesophageal involvement in progressive systemic sclerosis, morphoea and Raynaud's disease.

Oesophageal function was studied by radiography and manometry in fifty-one patients with progressive system sclerosis (PSS), fourteen patients with morphoea, twelve patients with Raynaud's disease and twenty-one normal subjects. Upper oesophageal sphincter pressure was not affected. Peristaltic contractions of the upper third of the oesophagus were significantly decreased in PSS and morphoea, but the lower two-thirds were affected only in PSS. Lower oesophageal sphincter pressure was significantly decreased in PSS but was normal in morphoea and Raynaud's disease. There was a significant correlation between oesophageal dysfunction and the duration of PSS. Manometry was better than radiography at detecting motor abnormalities, with a positivity of 86% compared with 66% for radiography. Oesophageal manometry should be employed routinely in the investigation of patients with suspected PSS or morphoea.

Adolescent↗
PubMed2005

Disposable balloon-based oesophageal motility catheters: comparison with solid-state transducers.

BACKGROUND: Current oesophageal manometry systems use either water-perfused or solid-state pressure transducers. Recently developed single-use disposable catheters use small balloons prefilled with air that transmit the pressure of oesophageal contractions to external transducers. AIM: To compare data obtained from single-use disposable balloon catheters to data from solid-state systems. METHODS: Healthy volunteers, patients with ineffective oesophageal motility and nutcracker oesophagus were studied to include a broad range of pressures. A single-use disposable Clinical Innovations (CI) catheter was placed adjacent to a solid-state Konigsberg Instruments (KI) catheter with pressure transducers at 5, 10, 15 and 20 cm above the lower oesophageal sphincter (LOS). Subjects received liquid and viscous swallows at 30-s intervals. Healthy volunteers received additional sets of swallows while having only one catheter in the oesophagus. RESULTS: When both catheters were present in the oesophagus, no differences were noted between mean pressure measurements in the distal oesophagus and there was good correlation between pressures recorded in response to individual swallows. When present alone in the oesophagus the CI catheter recorded lower mean pressures compared with the KI catheter. Overall there was good agreement in classifying swallows as normal, ineffective and simultaneous. CONCLUSION: Single-use oesophageal manometry catheters are promising alternatives to solid-state manometry systems in measuring intra-oesophageal pressures.

Adult↗
PubMed2004

'Efficacy' of esophageal peristalsis: a manometric parameter to quantify esophageal body dysfunction.

Esophageal motor abnormalities are currently categorized into separate entities based on standard manometry. The clinical significance of these categories is controversial. We evaluated whether ambulatory 24-h esophageal motility monitoring improves the assessment of patients thought to have a primary esophageal motor disorder. Standard and ambulatory 24-h esophageal motility records of 30 healthy volunteers and 136 symptomatic patients were compared. Regression analysis was used to identify parameters that relate to the presence of nonobstructive dysphagia. Prolonged ambulatory esophageal monitoring showed a marked circadian variation in the esophageal motor pattern and significant discrepancies to the findings on standard manometry in 47% of the 136 patients. Discrepancies were particularly frequent in patients categorized on standard manometry as having a 'nutcracker esophagus' or a nonspecific motor disorder. Of all data obtained, the prevalence of 'effective contractions', i.e. peristaltic contractions with an amplitude > 30 mmHg, during meal periods provided the best correlation with the presence of nonobstructive dysphagia. Of the 78 patients with nonobstructive dysphagia 71 (92%) had less than 50% of 'effective contractions' during meals. In five patients who had frequent simultaneous wave forms and less than 70%'effective contractions' during meals a long myotomy markedly reduced the severity of dysphagia. The 'efficacy' of esophageal contractions during meals best relates to patients' symptoms and allows expression of esophageal body dysfunction on a linear scale. This obviates the need for the current categories of esophageal motor disorders, permits an objective assessment of medical therapy and may improve the identification of patients that benefit from a surgical myotomy of the esophageal body.

Adolescent↗
PubMed2001

The effect of sildenafil on lower esophageal sphincter and body motility in normal male adults.

OBJECTIVE: Sildenafil relaxes smooth muscle by blocking type 5 phosphodiesterase, which destroys nitric oxide-stimulated cyclic guanosine monophosphate. The aim of this study is to investigate the change of lower esophageal sphincter (LES) and body motility with the lapse of time after sildenafil infusion in normal male adults. METHODS: After basal esophageal manometry in eight healthy male adult volunteers, we infused a 50-mg tablet of sildenafil dissolved in water in the stomach through the manometry catheter and observed the changes of LES and body motility with the lapse of time. We randomized the study population into two groups, and esophageal manometry was repeated in LES and body sequence in four volunteers and in body and LES sequence in the other four volunteers immediately after sildenafil infusion. RESULTS: LES resting pressure significantly decreased after sildenafil infusion. The body peristaltic amplitude gradually decreased and eventually disappeared, and the latency increased significantly after sildenafil infusion in both the proximal and distal esophagus. CONCLUSIONS: These data support that nitric oxide mediates LES relaxation and the timing of esophageal peristalsis. In the future, sildenafil can be tried in some esophageal motor disorders, which have defects in nitric oxide neuromuscular communication.

Adult↗
PubMed2004

Pathophysiology of gastroesophageal reflux diseases in Chinese--role of transient lower esophageal sphincter relaxation and esophageal motor dysfunction.

BACKGROUND AND AIMS: Transient lower esophageal sphincter relaxation (TLESR) is the major mechanism for gastroesophageal reflux in the Western population. The major reflux mechanism in Chinese patients with GERD has not been studied before. METHODS: Fifty-four patients with GERD and 28 controls underwent stationary baseline manometry and the 24-h ambulatory esophageal pH monitoring. TLESRs were measured before and after an 850 kcal meal in the supine position. Primary peristalsis, secondary peristalsis, and esophageal acid clearance were measured by esophageal manometry. RESULTS: Total time esophageal pH </= 4 (7.3 vs 1.5, p= 0.001) was significantly higher in patients with GERD when compared to controls. Majority of acid reflux episodes was due to TLESR in both patients with GERD and controls. The frequency of TLESRs after meal was similar between patients with GERD and controls (1.0 vs 1.3/h, p= 0.34). There was no difference in the distribution of reflux mechanism between patients with GERD and controls. However, patients with GERD had a significantly lower successful primary peristalsis (59%vs 70%, p= 0.043) when compared to controls. CONCLUSION: The frequency of TLESRs was similar between patients with GERD and controls during stationary manometry. Primary peristalsis was impaired in Chinese patients with GERD. Esophageal motor dysfunction may contribute to the pathophysiology of GERD in the Chinese population.

Asian People↗