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At least 163 records · Page 9Linked to original sources
PubMed2003

Clinical, anorectal manometry and surface electromyography in the study of patients with fecal incontinence.

OBJECTIVE: to demonstrate the role of the clinical, anorectal manometry and surface electromyography in the assessment of patients with fecal incontinence. PATIENTS AND METHODS: ninety-three patients with fecal incontinence are retrospectively reviewed and the data obtained from the directed clinical history, physical examination of the anal region, digital rectal examination, anorectal manometry and surface electromyography are analyzed. A treatment was administered in accordance with the alterations encountered and the results evaluated at 3 and 12 months. RESULTS: fecal incontinence was predominant (91.4%) in women age 59.7+/-11. A background of obstetric risks (48.2%) was frequent in women. Also, 73.1% of the patients presented diarrhea. The anorectal manometry (ARM) demonstrated some alterations in 90.3% of the patients, whereas a hypotonic sphincter was the most common finding (85.7%). Rectal sensitivity or distensibility alterations were present in the rest of the patients. In 79.2% ofthe cases, hypotonic sphincter was associated with rectal sensitivity or distensibility alterations. In 65.2% of patients with hypotonic external anal sphincter, damage of the pudendal nerve was found and therefore biofeedback was indicated in 41.9% of them. CONCLUSIONS: the clinical study of the patients, together with the anorectal manometry and surface electromyography enables the identification of the cause of FI and its treatment. These studies demonstrate that in most cases the origin of the incontinence is due to multiple etiologies, however the treatment of some of the factors involved frequently improves the symptomatology.

Adult↗
PubMed2005

[Technical aspects and indications of anorectal manometry].

Anorectal manometry is an important tool in testing anorectal disorders. Water-filled balloons is the most commonly used. The step-by-step anorectal manometry using a small balloon tube is easy to perform, well standardized and reproducible. Parameters studied by anorectal manometry are the rectoanal inhibitory reflex, anal resting pressure, sustained voluntary contraction of anal canal and rectal sensation. Anorectal manometry is also useful for diagnosis of anismus. The most important indications are anal incontinence, distal constipation and preoperative evaluation before sphincteroplasty or surgical rectocele repair.

Anal Canal↗
PubMed1991

[Esophageal manometry as a surgical indication in primary esophageal motility disorders].

Today, esophageal manometry is the diagnostic test that enables one to establish a diagnosis of esophageal motor disorder, to make the correct diagnosis among various forms of esophageal motor dyskinesia and to guide the diagnostician, whether physician or surgeon, in making the proper choice of therapy. Achalasia and diffuse esophageal spasm are two of the better known primitive esophageal motor disorders, in which an investigation into motility makes it possible to reach a diagnosis in physiopathological terms and provides guidance in selecting the appropriate therapy. The surgical indications for these two diseases are indeed conditioned significantly by the pre-operative manometric data. The extension of the extramucous esophageal myotomy is in fact guided by the manometric tracing that precisely defines the anatomic and functional boundaries of the motor disorder. Additional support provided by esophageal manometry occurs when there are indications of repeated surgery after myotomy, whether a cardiomyotomy or a long myotomy. In these cases accurate manometry can in fact clarify the origin of the possible post-operative dysphagia and, therefore, the nature of the possible stenosis, functional or organic. It should therefore be emphasized that, as now universally recognized, it would be rather careless today to confront the chapter of functional esophageal disease without the aid of manometry.

Esophageal Achalasia↗
PubMed1990

Manometry and radiology. Complementary studies in the assessment of esophageal motility disorders.

The relationship between radiological and manometric findings in esophageal motility disorders is poorly understood. Therefore, 20 subjects (4 normal; 13 diffuse spasm; 3 other motility disorders) were studied using synchronous manometry and videofluoroscopy with alternate 5-ml and 10-ml barium swallows. A total of 181 swallows were analyzed. Concordance between manometry and fluoroscopy was excellent for individual swallows (98%), groups of 5 swallows (97%), and final diagnoses (90%). Contraction onset intervals less than 0.8 s apart over 5 cm (velocity greater than 6.25 cm/s) were critical in determining abnormal bolus transit (98% sensitivity and positive predictive value). Radiologically, segmental tertiary activity (complete luminal obliteration) was always associated with disrupted primary peristalsis, but nonsegmental tertiary activity was often seen with normal bolus transit and did not have a specific manometric correlate. Four patterns of interrupted peristalsis radiologically were found--segmental tertiary contractions, a generalized esophageal contraction, absence of motor activity, or discoordinated "to-and-fro" movement. Surprisingly, nearly complete barium clearance occurred by the first two mechanisms in two thirds of swallows. Thus, the authors believe radiology and manometry are both excellent studies for identifying abnormal esophageal peristalsis. In difficult cases, these tests give complementary information because radiology assesses bolus movement while manometry provides quantitative pressure data.

Barium Sulfate↗
PubMed1989

[Endoscopic perfusion manometry: diagnosis of functional biliary disorders].

During the last years the endoscopic perfusion manometry developed many new recognitions about the courses of pressure and motility at the sphincter Oddi. The clinical and experimental application of the method concentrated itself to the proof of functional disturbances. Many results are contradictory and a whole series of questions is unsolved. The own investigations concentrated themselves on pressure measurements in the common bile duct in patients with removed gallbladder, in whom by comprehensive diagnostic measures no organic disease of the biliary tract could be found. Two groups of patients were compared. Patients of group 1 (n = 14) had no biliary symptoms after cholecystectomy. The patients of the second group (n = 20) continued to have biliary complaints after cholecystectomy, or they again occurred after symptom-free interval. At the beginning of the investigation the pressure in the common bile duct was the same in the two groups. In group 1 the pressure remained constant also during the manometry and the patients remained without any complaints. However, in group 2 a gradual increase of pressure and biliary complaints developed during manometry. These occurred after an average pressure increase of 8 Torr. The velocity of the increase of pressure well correlated with the intensity of the complaints. The symptoms during manometry were identical with those cited in the anamnesis. The pressure increase in the common bile duct is regarded as an expression of a functional disturbance of the sphincter of Oddi. The constant perfusion rate (1.3 ml/min) in this group of patients is sufficient as volume load, in order to detect a disturbed drainage capacity of the papilla. On its part the increase of the pressure is responsible for the evocation of the complaints.

Ampulla of Vater↗
PubMedDate not supplied

Esophageal motor function evaluated by scintigraphy, video-radiography and manometry in diabetic patients.

Prolonged esophageal scintigraphic transit time is frequent in diabetic patients and is related to autonomic neuropathy. In this study, esophageal scintigraphic transit time was correlated to esophageal motor function as evaluated by video-radiography and manometry in 13 diabetic patients. An abnormal scintigraphic transit time (greater than 15 s) occurred in 6 patients. All patients with abnormal transit time showed abnormal results at video-radiography (n = 4) and/or manometry (n = 5), which were observed in only 2 of 7 patients with normal transit time (both with abnormal video-radiography and manometry). A prolonged scintigraphic transit appears reliable as an indicator of disturbed esophageal smooth muscle function since it is well correlated with abnormalities shown by a combination of video-radiography and manometry.

Adult↗
PubMed1995

Esophageal hypomotility in primary and secondary Raynaud's phenomenon: comparison of esophageal scintigraphy with manometry.

UNLABELLED: Esophageal motility was assessed by manometry and scintigraphy in 25 patients with primary Raynaud's phenomenon and 24 patients with secondary Raynaud's phenomenon as part of a connective tissue disorder. METHODS: For each scintigraphic study, transit time was evaluated after three separate swallows. Scintigraphy was abnormal if transit time was longer than 15 sec for two or three measurements. RESULTS: In the case of primary Raynaud's phenomenon, manometry was normal in 24 of 25 patients. A similar ratio was found with scintigraphy. In the case of secondary Raynaud's phenomenon manometry was abnormal in 15 of 24 patients, while scintigraphy was abnormal in 13 of 24 patients. Considering manometry as gold standard, overall sensitivity of scintigraphy was 86%, specificity 89%, positive predictive value 75% and negative predictive value 94%. CONCLUSION: Esophageal dysfunction is common in patients with connective tissue disorders but rare in patients with primary Raynaud's phenomenon. Esophageal scintigraphy is a useful noninvasive initial screening test for esophageal dysfunction in patients with Raynaud's phenomenon.

Adolescent↗
PubMed1993

Gastrointestinal manometry: a practical tool or a research technique?

Gastrointestinal motility disorders constitute a major segment of digestive illness. Therefore, measurement of gut motor activity should be a desired goal. However the practical usefulness of gastrointestinal manometry is controversial. In this report we review the theoretical, technical, and practical problems posed by gastrointestinal manometry in health and in disease. Special emphasis is put on aspects pertaining to the indications and clinical applicability of the technique. New methodological developments that allow measurement of motor functions of the proximal stomach and the antroduodenal junction are also examined. Gastrointestinal manometry is potentially helpful in the diagnostic evaluation of patients presenting with upper gastrointestinal symptoms without demonstrable anatomic alteration as evidence by conventional diagnostic evaluation. It may help to localize the affected region of the gut as well as to monitor the evolution of the motor disorder and to determine the effect of pharmacological treatment. For a complete evaluation of upper gastrointestinal motility it is important to record gastric activity at the same time as in the intestine, during fasting and also postprandially. Manometry may help to determine the type of abnormal motor pattern that occurs in a given motor disorder. However, at the present time no specific abnormalities for specific diseases have been described. Thus, alterations in upper gut motility due to lesions at different levels of the brain-gut axis (central nervous system, autonomic nervous system or myenteric plexus) may produce a similarly deranged manometric pattern. Moreover, relations between a particular motor abnormality and the symptoms that the patient complains of may be quite variable. Still, we conclude that measurement of gastrointestinal motility has matured and proven its value to an extent that its application to clinical gastroenterology in carefully selected instances is appropriate and timely.

Gastric Emptying↗
PubMed1995

Correlation of esophageal manometry and radionuclide esophageal transit in normal subjects.

What was the correlation of esophageal manometry and scintigraphy in Chinese was studied. Thirty-two volunteers (M/F: 18/14, age: 20-57) without evident esophageal motor disturbance and chest deformity underwent manometric measurement in the spine position using a low compliance pneumohydraulic infusion system. These measurements included the location of both upper and lower esophageal sphincter from nostril, and dry or wet swallow elicited peristaltic speed in the lower esophageal segment. Within one week after manometry, they swallowed a technetium-99m colloid bolus to measure radionuclide manifested esophageal transit time in the supine position beneath a gamma-camera. Body heights of enrolled subjects exhibited a significant positive correlation (r = 0.458, p < 0.01) with manometry measured esophageal lengths. Mean radionuclide esophageal transit time was 7.61 +/- 2.51 sec (3.1-13.57 sec). These transit times exhibited a positive correlation with esophageal lengths (r = 0.6, p < 0.001). Radionuclide transit speed was actually slower than either dry swallow or wet swallow elicited speed (p < 0.05). In conclusion, either manometry or scintigraphy manifests their specific benefits to diagnose esophageal motility disorders. Some correlations of measured variables can be obtained if they are simultaneously employed.

Adult↗
PubMedDate not supplied

Endoscopic manometry of the sphincter of Oddi in sphincterotomized patients.

BACKGROUND/AIM: Endoscopic sphincterotomy (ES) of the sphincter of Oddi (SO) has been accepted as an effective method in extraction of common bile duct stones in postcholecystectomy patients. The purpose of this study was to examine the completeness of the performed ES and observe the post sphincterotomy pancreatic duct sphincter (PDS) activity using endoscopic manometry. MATERIALS AND METHODS: Activity of the sphincter of Oddi was examined in 15 sphincterotomized patients using endoscopic manometry one to 2.5 years after endoscopic sphincterotomy for choledocholithiasis. RESULTS: In eight patients absence of choledochoduodenal gradient, baseline pressure and the sphincter of Oddi phasic activity up to 2.5 years after endoscopic sphincterotomy indicated a complete sphincterotomy. In seven patients with incomplete endoscopic sphincterotomy, manometry exhibited either a lower choledochoduodenal gradient and baseline pressure without phasic activity of the sphincter of Oddi (three patients), a sphincter of Oddi activity without choledochoduodenal gradient (one patient), or a complete restitution of the sphincter of Oddi activity 1 to 2 years after endoscopic sphincterotomy (three patients). In five patients, with complete endoscopic sphincterotomy, measurements of pancreatic sphincter activity showed lower values of the pancreatic ductal pressure and baseline pressure, while the pancreatic sphincter phasic activity was equal to that found in the control group. CONCLUSIONS: Endoscopic manometry is method which enables us to test the completeness of endoscopic sphincterotomy and to follow the restitution of the phasic contractile function of the sphincter. Manometric findings reveal pancreatic sphincter in most patients as a separate sphincteric entity, the function of which is reduced but not eliminated by a complete endoscopic sphincterotomy.

Adult↗
PubMed1997

[Endoscopic manometry of Oddi's sphincter].

BACKGROUND: Endoscopic manometry is the gold standard for the diagnosis of sphincter of Oddi dysfunction. AIM: To report the results of the first 30 endoscopic manometries of sphincter of Oddi performed in a Gastroenterology Service. PATIENTS AND METHODS: Thirty manometries were performed in 28 patients aged 30 to 70 years old (14 females). The papilla was cannulated with a perfused catheter, measuring pressure with external transducers. RESULTS: Deep cannulation of the papilla was achieved in 88%. Procedure-related complications were not observed in these cases. Normal values were registered in 11 cases with a basal sphincter pressure 15.6 +/- 10.7 mm Hg, contractions with an amplitude of 92.3 +/- 35.7 mm Hg and 6.0 +/- 2.4/min frequency. The clinical suspicion of hypertonic dyskinesis was confirmed in 5 cases with an elevated basal pressure of 43.69 +/- 13.3 mm Hg, an increased frequency of contractions ("tachyoddia") in one, and large spastic contractions of high pressure in other case. In 3 of 5 cases with common bile duct stones, a predominance of retrograde propagation of the contractions was observed with normal pressure. Variable manometric results were observed after endoscopic papillotomy observing a scale from the complete absence of motor activity to normal sphincter function. CONCLUSIONS: Endoscopic manometry is a reasonably safe method, of great importance in the diagnosis of functional disorders of the sphincter of Oddi.

Adult↗
PubMed2002

Technical protocol for the use of esophageal manometry in the diagnosis of sleep-related breathing disorders.

A time-tested protocol for intrathoracic pressure monitoring during sleep is described. This method of esophageal manometry uses a fluid-filled catheter to measure variations in transmitted intrathoracic pressure with respiration. Esophageal manometry is an invaluable tool for the sleep specialist in the diagnosis of sleep-related breathing disorders, especially for detecting cases of upper airway resistance syndrome and for distinguishing subtle central apneas from obstructive events. The methods for scoring esophageal pressure, the indications and contraindications for esophageal manometry, the use of esophageal manometry as the 'gold standard' for the measurement of respiratory effort, and directions for future research are also discussed.

Journal Article↗
PubMed1987

Combination fine-needle aspiration cytology and intrarenal manometry at the onset of renal dysfunction.

Twenty-three consecutive cadaveric renal allograft recipients immunosuppressed with cyclosporin have been monitored three times a week by fine-needle aspiration cytology and intrarenal manometry until discharge from hospital or until 30 days post-transplant. Standard criteria were used to determine the cause of allograft dysfunction. The onset of allograft rejection was marked by an elevation of the total corrected increment score by fine-needle aspiration cytology in 80 per cent of rejection episodes whereas intrarenal pressure was raised in only 46.6 per cent. However, intrarenal pressure was greater than 40 mmHg on a single occasion in 16 measurements performed on allografts showing evidence of cyclosporin nephrotoxicity. By combining fine-needle aspiration cytology and intrarenal manometry the sensitivity of these tests for allograft rejection was increased to 93.3 per cent at the onset of renal dysfunction. Our results demonstrate that fine-needle aspiration cytology is more sensitive than intrarenal manometry as a single investigation. However, the combined test may have an important role in the differentiation of allograft rejection and cyclosporin nephrotoxicity in the early management of renal allograft recipients.

Biopsy, Needle↗
PubMed1994

Long-term manometry of tubular esophagus in progressive systemic sclerosis.

Long-term manometry of the tubular esophagus was performed in 20 consecutive patients (18 females, 2 males; median age 56.5 years) with progressive systemic sclerosis (PSS) and a control group of 20 healthy subjects (18 females, 2 males; median age 56.5 years). The measurements were performed via a data logger of 1 MByte memory capacity with the help of two pressure sensors placed 8 and 18 cm above the lower esophageal sphincter. Esophageal contractions were analyzed with respect to pressure amplitudes in the esophagus distal and proximal, quotient of pressure amplitudes distal/proximal, number of contraction waves in a 24-h period, and kind of spreading (propulsive, simultaneous). In the PSS group there was a significant decrease in pressure amplitudes in the distal sensor (median 31.5 versus 39.5 mbar in controls, P < 0.02), in the quotient of pressure amplitudes distal/proximal (median 0.885 versus 1.25 in controls, P < 0.001), in the number of waves in 24 h (median 939.5 versus 1656 in controls, P < 0.01), and in the occurrence of propulsive waves (median 34% versus 57% in controls, P < 0.01). Fifteen patients (75%) had hypomotility disorders as compared to the control group, in which the lower limit of normal values was defined by the 5th percentile of descriptive analysis. These first data of long-term manometry in patients with PSS indicate that long-term manometry may be an effective method for identifying esophageal involvement in PSS.

Adult↗
PubMed1993

Ambulatory esophageal manometry, pH-metry, and Holter ECG monitoring in patients with atypical chest pain.

Standard Holter electrocardiographic (ECG) monitoring was combined with ambulatory esophageal manometry and pH-metry in 25 patients with atypical chest pain in order to determine whether an association could be found between spontaneous pain episodes and ischemic ECG changes or esophageal dysfunction. Results of ambulatory testing were compared to those obtained with standard esophageal manometry and provocative testing. Twenty-two of the 25 patients experienced a total of 88 pain episodes during ambulatory testing. Although 15 of the 22 patients (68%) experiencing pain during testing had at least one pain episode that correlated temporally with gastroesophageal reflux, esophageal dysmotility or ischemic ECG changes, 65% of all pain episodes were unrelated to abnormal esophageal events or ECG changes. Seventeen percent of pain episodes were associated with gastroesophageal reflux, 15% with esophageal dysmotility, and 2% with a combined acid reflux and esophageal dysmotility event. Only one pain episode was associated with ischemic ECG changes. Twelve of the 15 patients with chest pain episodes associated with reflux or esophageal dysmotility had other identical pain episodes in which there was no correlation. Reproduction of a patient's pain during standard manometry with provocative testing did not predict a strong correlation between the patient's spontaneous pain episodes and esophageal dysfunction during ambulatory recordings. In summary, patients with atypical chest pain have relatively few spontaneous pain episodes that correlate with gastroesophageal reflux, esophageal dysmotility, or ischemic ECG changes. It appears that different stimuli can trigger identical episodes of chest pain, which suggests that many of these patients may have dysfunction of their visceral pain sensory mechanisms.

Adult↗
PubMed1991

Percutaneous transhepatic manometry of sphincter of Oddi.

A nonoperative examination of the function of the sphincter of Oddi, involving percutaneous transhepatic manometry via the percutaneous transhepatic biliary drainage tract, was developed and clinically applied in 23 patients with biliary disease. Long-term recording of sphincter of Oddi motility, which was impossible using conventional intraoperative or endoscopic manometry, was made possible by means of this method and revealed various changes of sphincter of Oddi motility. The mean recording time was 131.33 +/- 9.77 min. The frequency of contractions of the sphincter of Oddi in basal fasting conditions varied from 0 to 13/min and high-frequency contractions (frequency 9.49 +/- 0.35/min, duration 5.77 +/- 0.54 min) were observed in 12 patients on a total of 19 occasions. In five patients, high-frequency contractions were observed twice during one session of continuous recording and the interval between burst contractions was 85.4 +/- 13.3 min. Long-term continuous recording is advantageous for the evaluation of the function of the sphincter of Oddi and short-term manometry may not be representative of overall sphincter of Oddi motility.

Adult↗
PubMed1993

The use of intraluminal manometry to assess upper esophageal sphincter function.

The UES is a striated muscular structure that exhibits substantial variation in tone in response to a wide variety of stimuli as well as during deglutition. It is an asymmetric structure subject to substantial axial movement. Hence the findings on UES manometry are highly dependent upon the manometry equipment used, positioning of this equipment in relation to the UES, and external stimuli. There is considerable intrasubject and intersubject variation in some parameters from UES pressure recordings. These factors must be taken into accout in the clinical use of UES manometry.

Deglutition Disorders↗
PubMed1989

Accuracy of abbreviated manometry in detecting esophageal motility abnormalities.

We determined whether an abbreviated motility study that is commonly employed in clinical esophageal manometrics was as accurate as an extended manometric evaluation in detecting abnormalities in the esophageal body. One hundred patients underwent both abbreviated (stationary catheter, 10 wet swallows) and extended manometries (stepwise catheter withdrawal, 62 +/- 1 wet swallows). Classification by the two techniques was identical in 83 patients. Abbreviated manometry failed to recognize nine abnormal motility patterns. The abbreviated method was least accurate in the identification of intermittent and focal motility abnormalities (sensitivity = 0.50). Misclassifications were related to catheter position and not solely to differences in the total number of swallows. Of the individual wave parameters measured by each method, detection of multipeaked contraction waves was the most discrepant (R = 0.59). These findings indicate that abbreviated esophageal manometry is reasonably well correlated with a more extended method in detecting esophageal motility disorders and, because of its relative simplicity, appears appropriate for use in clinical practice. Errors related to stationary recording port positions may interfere with the overall accuracy of the abbreviated technique.

Deglutition↗