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PubMed2004

The gonyautoxin 2/3 epimers reduces anal tone when injected in the anal sphincter of healthy adults.

The primary clinical symptom of Paralytic Shellfish Poisoning is acute paralytic illness produced by paralyzing toxins. Paralytic shellfish poison is formed by a mixture of phycotoxins and their toxicity is due to its reversible binding to a receptor site on the voltage-gated sodium channel on excitable cells, thus blocking neuronal transmission. We studied the effect of the gonyautoxin 2/3 epimers by local infiltration in the anal internal sphincter of healthy voluntary adults in order to reduce anal tone. The toxin was injected after prior clinical evaluation, anoscopy and anorectal manometry. Post injection clinical examination, electromyography and anorectal manometry were performed. Resting and voluntary contraction pressures were measured and the anorectal inhibitory and anocortical reflexes were tested by manometry. Blood and urine samples were obtained from each participant, and hemogram, basic metabolic panel, and urinalysis were done both before and one week after the injection. This study shows, for the first time, that gonyautoxin 2/3 reduces the anal tone by relaxing the anal sphincters in 100 % of the participants. Manometric recordings showed a significant decrease in anal maximal voluntary contraction pressure after the toxin injection, dropping to 55.2+/-6.2 % and 47.0+/-6.8% (Mean Value+/-Std.Dev.) of the baseline values at 2 minutes and at 24 hours respectively after the injection. Post-injection electromyography showed that activity of the muscle was abolished. We conclude that local administration of gonyautoxin 2/3 to the anal sphincter produces immediate relaxation and a statistically significant decrease in the anal tone (p <0.001).

Adult↗
PubMed1987

Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years' experience with 1161 patients.

Records from 910 patients referred to our clinical esophageal manometry laboratory for evaluation of noncardiac chest pain between January 1983 and December 1985 were reviewed and compared with records from 251 patients referred for dysphagia. Evaluation included baseline esophageal manometry, acid perfusion test, and edrophonium provocation. In the chest-pain group, 655 patients (72%) had normal esophageal motility and 255 (28%) had abnormal motility. Nutcracker esophagus was present in 48% of abnormal tracings, suggesting that it is a manometric marker for noncardiac chest pain. Of the total chest-pain group, 243 patients (27%) had their pain reproduced during provocative testing ("definite" esophageal pain); 192 patients (21%) had baseline manometric abnormalities but no pain during provocative testing ("probable" esophageal chest pain). The highest percentage of positive provocative responses (34%) occurred in patients with nutcracker esophagus on baseline manometry. Manometric abnormalities were statistically commoner (p less than 0.001) in patients with dysphagia, occurring in 53%. Achalasia (36%) and nonspecific esophageal motility disorders (38%) were the commonest abnormalities in this group, with nutcracker esophagus being infrequent (10%).

Acids↗
PubMed1999

Abnormal esophageal body function: radiographic-manometric correlation.

Stationary manometry is the gold standard for the evaluation of patients with suspected esophageal motility disorders. Comparison of videoesophagram in the evaluation of esophageal motility disorders with stationary motility has not been objectively studied. Two hundred two patients with foregut symptoms underwent stationary motility and videoesophagram. Radiographic assessment of esophageal motility was done by video recording of five 10-cc swallows of barium. Abnormal esophageal body function was defined by stasis of barium in the middle third of the esophagus on at least four swallows or stasis on at least three swallows in the distal third. Stationary manometry was performed using a five-channel water perfused system. Contraction amplitudes <25 mm Hg in any of the last two channels or the presence of simultaneous or interrupted waves in 10 per cent or more were considered to be abnormal. Sixty-two patients had abnormal manometry. Thirty-four patients also demonstrated abnormal videoesophagrams for an overall sensitivity of 55 per cent. The positive predictive value was 53 per cent; specificity was 79 per cent; and negative predictive value was 80 per cent. Sensitivity was greatest in patients with achalasia (94%) and scleroderma (100%) and in patients presenting with dysphagia (89%). Sensitivity was poor for nonspecific esophageal motility disorders. A videoesophagram is relatively insensitive in detecting motility disorders. It seems most useful in the detection of patients with esophageal dysfunction, for which surgical treatment is beneficial, and in those patients presenting with dysphagia.

Adolescent↗
PubMed1998

Gastroesophageal reflux disease in CAPD patients.

Upper gastrointestinal (GI) symptoms are frequently observed in continuous ambulatory peritoneal dialysis (CAPD) patients. We conducted esophageal manometry and 24-hour esophageal pH monitoring in 4 CAPD patients (Group I) who had upper GI symptoms such as nausea and vomiting and compared them with 9 patients (Group II) who did not. The mean age in Group I was 48.5 +/- 13.7 years, and the male-to-female ratio was 1:3. One patient was diabetic. There were no significant differences in clinical and biochemical data between the two groups. Comparing the results of esophageal manometry, supine lower esophageal sphincter pressure (LESP) at 2000 mL of infused dialysate was significantly lower in Group I than in Group II (23.2 +/- 4.4 vs 31.2 7.1 mmHg, P < 0.05), but supine LESPs at empty state and sitting LESPs were not different. Group I had a significantly higher total number of reflux episodes (89.0 +/- 16.5 vs 26.5 +/- 19.4, P < 0.05), number of reflux episodes longer than 5 minutes (2.3 +/- 2.6 vs 0.3 +/- 0.5, P < 0.05), total time of pH < 4.0 (75.5 +/- 55.5 vs 11.0 +/- 6.8, P < 0.05), and total reflux score (19.7 +/- 10.2 vs 4.2 +/- 2.3, P < 0.05) in 24-hour esophageal pH monitoring. Three of 4 Group I patients met the criteria for abnormal gastroesophageal reflux set by the DeMeester scoring system. CAPD patients with upper GI symptoms such as nausea, vomiting, and epigastric discomfort should be evaluated for gastroesophageal reflux disease with esophageal manometry and pH monitoring.

Esophagus↗
PubMed1999

Intrasphincteric botulinum toxin type A for the diagnosis of sphincter of Oddi dysfunction: a case report.

Biliary-type pain from sphincter of Oddi dysfunction is not uncommon after cholecystectomy. An increased basal pressure of sphincter of Oddi manometry establishes the diagnosis and treatment is usually by endoscopic sphincterotomy. Both procedures carry a significant complication rate. A few patients with elevated sphincter pressure do not respond to therapy; the source of their pain may be elsewhere. This case report describes the use of intrasphincteric botulinum toxin injection for the diagnosis of sphincter of Oddi dysfunction in a patient after repeated attempts at manometry had failed. This may provide a safe and easy method of determining whether sphincter of Oddi dysfunction may be the cause of biliary pain in post/ cholecystectomy patients and help select patients who would benefit from subsequent sphincter ablation, without the risks of sphincter of Oddi manometry. Prospective studies are first needed.

Adult↗
PubMed2000

[The usefulness of lateral internal sphincterotomy combined with hemorrhoidectomy in the treatment of hemorrhoids: a randomized prospective study].

The aim of this prospective randomized study was to investigate anorectal manometric findings in hemorrhoid patients and to evaluate the clinical benefits and physiological consequences of additioning a lateral internal sphincterotomy (LIS) to haemorrhoidectomy. Anorectal manometry was preoperatively performed in forty-eight consecutive patients with prolapsed piles; resting and squeeze pressures, sphincter length and rectoanal inhibitory reflex were recorded. Ten healthy volunteers served as controls. Six patients were excluded because no raised and pressures were found. Forty-two patients were randomised: Group 1 (n = 22) patients underwent haemorrhoidectomy plus LIS; Group 2 (n = 20) patients underwent haemorrhoidectomy alone. Postoperative course was carefully evaluated; all patients were questioned about continence and anorectal manometry was repeated twice. Sphincter anomalies were found in 87.5% of patients. Haemorrhoidectomy alone did not affect anal pressures, which returned into the normal ranges after sphincterotomy. Postoperative course was better in LIS group. Anal stricture was seen in four patients without sphincterotomy; no patients with LIS experienced and incontinence. This study shows that high and pressures are very frequent in hemorrhoid patients; they are not due to hypertensive and cushions and might have a pathogenetic role. Anorectal manometry is very useful to identify patients with raised anal pressures; in these cases additioning a lateral internal sphincterotomy to haemorrhoidectomy seems justified; it significantly improves postoperative course and can be safely performed.

Adult↗
PubMedDate not supplied

Effect of cold pressor test and a high-chilli diet on rectosigmoid motility in irritable bowel syndrome.

AIM: Visceral hypersensitivity characterizes the irritable bowel syndrome (IBS). We evaluated the effect of a cold pressor test (CPT)--hand immersion in ice water for 1 minute, which evokes a sympathetic response--on rectosigmoid motility in patients with IBS and normal volunteers. Since many Indian patients with IBS complain of worsening of symptoms following a spicy meal, we also evaluated whether a high-chilli diet affects symptoms or changes rectosigmoid motility. METHODS: Fifteen men with IBS and 13 normal volunteers (all men) were studied. Baseline rectosigmoid manometry was done for 2 h, i.e., 1 h pre- and 1 h post-CPT. The subjects were then kept in hospital on a regular diet (approximately 5 g chilli daily) for 3 days, following which symptoms were reassessed and manometry repeated for 1 h. This was followed by a high-chilli diet (approximately 15 g/day) for 3 days, after which symptoms were reassessed and manometry repeated for 1 h. RESULTS: There was no difference in the baseline study in the pre-CPT period between patients and control subjects. CPT did not change rectosigmoid motility in either group. IBS patients had varied effect on symptoms but no change in rectosigmoid motility after the high-chilli diet. In the normal volunteers, there was increased activity in the low rectum after the high-chilli diet. CONCLUSIONS: Cold pressor test does not affect rectosigmoid motility in patients with IBS or normal subjects. A high-chilli diet has varied effect on symptoms in patients with IBS and does not affect rectosigmoid motility.

Adult↗
PubMed2002

[Scintigraphic assessment of the small intestine transit. Diagnostic investigation of dysmotility with 99mTc-HIDA].

Symptoms from the gastro-intestinal tract are common and often difficult to evaluate. Specialised examination techniques are available only at a limited number of clinics. A technique based on biliary scintigraphy when measuring the transit of contents through the small intestine has been developed. The investigation is simple to perform and convenient for the patient. It can be carried out at any clinic equipped with a gamma camera. 30 healthy individuals were examined in order to obtain reference values. 23 patients were examined with scintigraphy in combination with upper gastrointestinal manometry, 10 of whom had abdominal pain and neurogenic or myogenic pseudoobstruction disclosed by manometry. In another 4 patients, slow transit and pain prevailed in conjunction with normal manometric findings. Rapid transit and diarrhoea was found in 3 patients with various abberations on manometry. Of the remaining patients, 4 had slow transit and diarrhoea with intestinal neuropathy and pseudoobstruction, and 2 had slow transit along with endocrinopathies (diabetes, pituitary insufficiency).

Abdominal Pain↗
PubMedDate not supplied

Upper gut motility of Hirschsprung's disease and its allied disorders in adults.

BACKGROUND/AIMS: To clarify the significance of upper gut motility for Hirschsprung's disease and its allied disorders in adults, we studied the upper esophagogastroduodenal motility of adult patients with Hirschsprung's disease and its allied disorders such as hypoganglionosis and intestinal neuronal dysplasia. METHODOLOGY: Twelve patients (7 men and 5 women, aged between 20 and 55 years with a mean age of 39.6 years) with Hirschsprung's disease (2 cases) or its allied disorders (8 cases of hypoganglionosis and 2 cases of intestinal neuronal dysplasia) were studied. As a control, 15 healthy volunteers (8 men and 7 women aged between 27 and 69 years with a mean age of 49.0 years) were also examined. To obtain the upper gut motility in Hirschsprung's disease, hypoganglionosis, and intestinal neuronal dysplasia, we performed gastrointestinal transit time study, esophageal manometry, and gastroduodenal manometry. RESULTS: On gastrointestinal transit time, barium stagnated in the upper jejunum in 2 cases of hypoganglionosis, in the terminal ileum in one case of hypoganglionosis and intestinal neuronal dysplasia, and in the colon in the remaining patients. In two of the 12 cases of Hirschsprung's disease and its allied disorders such as hypoganglionosis and intestinal neuronal dysplasia, abnormal esophageal motilities, and absence of interdigestive migrating motor complex, phase III from the stomach were observed. These findings suggested that the entire digestive tract might have been affected in these two cases, i.e., these 2 patients had total gut involvement type of hypoganglionosis. CONCLUSIONS: Gastrointestinal transit time and upper esophagogastroduodenal manometry should be performed because of the relatively frequent association of upper gut dysmotilities with these disorders.

Adult↗
PubMed2005

[Frequency of esophageal motor disorders in patients with dysphagia and normal upper gastro-intestinal endoscopy. A manometric study of 289 cases].

289 esophageal manometries performed for 7 years to patients with dysphagia and normal upper gastro-intestinal endoscopy were analyzed, excluding patients with systemic sclerosis and preoperative manometries for gastroesophageal reflux disease. Esophageal motor disorders are frequent in patients with non obstructive dysphagia. Esophageal manometry is important to perform in these patients. Specific treatment is required in patients with achalasia. Systemic sclerosis and gastroesophageal reflux disease should be suspected in patients with esophageal hypomotility.

Adult↗
PubMed1992

The LES locator: accurate placement of an electrode for 24-hour pH measurement with a combined solid state pressure transducer.

Twenty-four-hour esophageal pH monitoring is the gold standard for diagnosing gastroesophageal reflux disease. A possible limitation to the widespread use of this test is that manometry is required for accurate placement of the pH electrode 5 cm above the lower esophageal sphincter. We compared the accuracy of a single solid state pressure transducer, combined with a pH electrode, in determining the proximal border of the lower esophageal sphincter (LES) with the values obtained from stationary manometry in 40 patients referred to our laboratory for 24-h pH studies. Not only was there a strong correlation (r = 0.9) between LES values obtained by the two techniques, but none of the values obtained by the single solid state transducer were outside the clinically accepted range of greater than +/- 3 cm. The presence of a hiatal hernia or low sphincter pressure did not affect these measurements. The larger probe was tolerated somewhat less well (p = 0.02) than a standard antimony electrode during the prolonged pH studies. In conclusion, a single solid state pressure transducer on a pH probe with the help of a LES locator accurately identifies the proximal border of the LES. Therefore, stationary esophageal manometry is no longer needed prior to 24-h pH monitoring, potentially making this important clinical tool available to a wider variety of clinicians at all levels of the health care system, in investigating gastroesophageal reflux and its protean clinical presentations.

Adult↗
PubMed1991

Radiolabelled semisolid test meal clearance in the evaluation of esophageal involvement in scleroderma and Sjogren's syndrome.

Esophageal involvement by scleroderma is frequent. Investigation by manometry or radiography is invasive and nonphysiological. Scintigraphy of the clearance of small radiolabelled liquid boluses in the supine position, while sensitive and noninvasive, may also be nonphysiological and does not allow the simultaneous determination of gastric emptying. We thus studied the esophageal clearance of a semisolid test meal ingested in the upright position. Forty-seven patients with scleroderma and 24 with Sjogren's syndrome were compared with ten normal controls and ten patients with gastric emptying abnormalities but no esophageal involvement. Results of scintigraphy were also correlated with manometry and contrast radiography. Quantitative evaluation of esophageal tracer retention at ten minutes postingestion was: (mean +/- SD), 2.8 +/- 1.0% in normals, 2.9 +/- 0.9% in gastric dysmotility, 4.8 +/- 2.9% in Sjogren's syndrome, and 22.3 +/- 25.0% in scleroderma; similar results were found at 20 and 60 minutes. The T 1/2 of gastric emptying was 47.1 +/- 5.7 minutes in normals, 95.9 +/- 25.3 minutes in gastric dysmotility, 62.9 +/- 19.5 minutes in Sjogren's syndrome, and 52.9 +/- 13.5 minutes in scleroderma. We conclude that esophageal clearance of a semisolid test meal is a sensitive index of esophageal dysmotility and correlates well with results from manometry and contrast radiography but is noninvasive and quantifiable. The simultaneous measurement of gastric emptying is also possible in many cases.

Adult↗
PubMedDate not supplied

Gastroduodenal dysmotility in patients with gallbladder carcinoma: frequency of occurrence and clinical importance.

BACKGROUND: Gastric stasis, common in patients with gall-bladder carcinoma (GBC), results from anatomical obstruction or motor abnormalities. We studied patients with GBC for antroduodenal motor dysfunction using manometry. METHODS: Forty-one patients with GBC without endoscopic gastric outlet obstruction and 10 healthy controls were evaluated using a symptom scoring system for gastric stasis, saline load test and water perfusion antroduodenal manometry. Fasting, post-prandial and post-octreotide motility were recorded and analysed on a computer using GiPC manometry software. RESULTS: Sixteen of 41 patients (39%) with GBC reported recurrent vomiting; patients with vomiting had a higher symptom score (13 [11-17] v. 6 [4-10], p<0.0001] and higher volume of aspirate on the saline load test (460 ml [210-650] v. 160 ml [70-260], p<0.0001) as compared with those without vomiting. Healthy subjects more often had spontaneous fasting migratory motor complex than patients with GBC (9/10 v. 13/41, p=0.002). The amplitudes of contractions in the antrum and duodenum were significantly lower in patients with GBC than in healthy subjects. Patients with GBC had lower fasting (157 [68-284] v. 190.5 [150-284], p=0.01) and post-prandial (200 [96-395] v. 284 [178-395], p<0.0001) antral motor indices than healthy subjects. Patients with GBC and vomiting had significantly lower contraction amplitude and motility indices than those without vomiting. Motility indices correlated inversely with the symptom score and volume of aspirate on the saline load test (Spearman correlation, p = 0.01 for all). CONCLUSION: Antroduodenal motor abnormalities are common in patients with GBC. These may explain the symptoms of gastric stasis and abnormal results of the saline load test in the absence of anatomical obstruction in such patients.

Adult↗
PubMed1991

Acid-provoked esophageal spasm as a cause of noncardiac chest pain.

A total of 394 patients with noncardiac chest pain underwent both basal esophageal manometry and combined esophageal motility and acid perfusion studies between 1986 and 1988. On basal esophageal manometry, 275 patients had a normal response, 64 patients had findings of high-amplitude peristalsis or "nut-cracker" esophagus, and 11 patients exhibited changes of diffuse esophageal spasm. Of the 275 patients who had normal findings on basal esophageal manometry, 90 patients (33%) had a positive response on combined esophageal motility and acid perfusion studies, that is, reproduction of chest pain with associated abnormal motility changes. The present study focuses on the 90 patients with acid-provoked esophageal spasm. On acid perfusion study, these 90 patients had a 46.2% rise in deglutition response and a 95% increase in duration compared with a 3.2% and a 4.3% change in values for the control group of healthy volunteers. Of the group with acid-induced spasm, 90.1% had excessive dysmotility changes (repetitive waves, multiple peaks, spontaneous or simultaneous contractions) compared with an incidence of 12.5% in the control group.

Adult↗
PubMed1991

Twenty-four-hour esophageal pH monitoring: the most useful test for evaluating noncardiac chest pain.

STUDY OBJECTIVE: To compare the diagnostic capabilities of traditional esophageal tests (manometry and provocative testing with acid and edrophonium) and 24-hour esophageal pH monitoring in identifying an esophageal cause of chest pain. DESIGN: A prospective study of 100 consecutive patients referred by cardiologists to the esophageal laboratory for evaluation of esophageal causes of chest pain. SETTING: Tertiary-referral university hospital. METHODS: Esophageal manometry performed with 10 wet swallows of water. Acid perfusion (0.1 N hydrochloric acid) and edrophonium (80 micrograms/kg intravenously) tests were placebo-controlled with a positive study defined as replication of typical chest pain. Esophageal pH monitoring identified (1) abnormal acid exposure times in the upright, supine, or combined position, and (2) correlation between symptoms and acid reflux, i.e., symptom index. The esophagus was identified as "probably" contributing to chest pain only if the acid or edrophonium test was positive or if there was a positive correlation between symptoms and acid reflux during pH monitoring. RESULTS: Esophageal manometry was abnormal in 32 patients (32%), but patients were asymptomatic during the study. The acid perfusion test was positive in 18 of 95 patients (19%), and the edrophonium test was positive in 15 of 78 patients (19%). Abnormal acid exposure times were found in 48 patients (48%). Of the 83 patients with spontaneous chest pain during 24-hour pH testing, 37 patients (46%) had abnormal reflux parameters and 50 patients (60%) had a positive symptom index (mean positive score 56%, range 6% to 100%). CONCLUSIONS: Acid reflux is a common and potentially treatable cause of noncardiac chest pain. Traditional esophageal tests usually miss this diagnosis. Twenty-four-hour esophageal pH monitoring with symptom correlation is the single best test for evaluating patients with noncardiac chest pain.

Adult↗
PubMed1991

Abnormal esophageal motility. An analysis of concurrent radiographic and manometric findings.

The findings of concurrent esophageal videofluoroscopy and manometry in 15 patients with major disturbances of esophageal motor function were evaluated and the data were analyzed from a fluid mechanical perspective. Each of 153 fluoroscopic barium swallow sequences was analyzed on a swallow-by-swallow basis. Two distinct pressure domains were identified: intrabolus pressure and pressure within a bolus-free contracting esophageal segment. Analyses in terms of these pressure domains showed specific and consistent correlations between the radiographic and manometric findings. Radiography was insensitive to contractions occurring in esophageal segments devoid of bolus fluid, whereas manometry was insensitive to contractions that did not occlude the lumen. It is concluded that using fluid mechanical principles of bolus transport allows meaningful comparison of esophageal motility as recorded by radiography and intraluminal manometry. However, the inherent limitations in the range of physical phenomena recorded by each modality make these techniques complementary for evaluating esophageal motor function.

Adult↗
PubMedDate not supplied

[Defecation disorders. Characteristics of manometric studies and rehabilitation].

The authors review the literature and their personal experience about the systematic exploration of defecation disorders by anorectal manometry and colpocystodefecography. They stress the importance of combining functional and morphological evaluation, in order to avoid inappropriate surgery. Concerning anorectal manometry, the determination of the smallest volume of rectal distention inducing a complete relaxation of the internal anal sphincter was found more useful than the maximal tolerable volume in the exploration of defecation disorders. Finally, the authors report the results of biofeedback conditioning prescribed in 30 patients (27 women, 3 men, mean age: 55 years) with defecation disorders (terminal constipation in 21, fecal incontinence in 9 patients). Several characteristics of anorectal manometry and of defecography were significantly improved after biofeedback conditioning.

Adult↗
PubMed1989

Esophageal achalasia. Diagnostic and therapeutic implications.

Over an 11-year period, 15 patients underwent surgery for achalasia (Heller's operation with added antireflux procedure). Thereafter due to the use of manometry 25 other achalasic patients were diagnosed and 17 of them underwent the same surgical procedure. Manometry was done by means of a triple-lumen catheter as described by Arndorfer. Surgical results in the first group were good in 80% and moderate in 20% with no recurrence or organic complications due to acid reflux, while in the second group good results were 95%. In 16 cases of the second group, diagnosis was based on manometric recordings, since the radiological findings were lacking. Early diagnosis enabled to operate on selected patients according to the motor findings of the esophageal body. Follow-up by manometry revealed in some cases an increase in post-deglutitory motor activity and in two cases a return of a coordinated peristalsis. Clinical and functional results are discussed and the role of manometric studies is stressed in order to improve the knowledge of the pathophysiology of functional diseases of the esophagus.

Adult↗