Incomplete Upper Esophageal Sphincter Relaxation: Association with Achalasia but Not Other Esophageal Motility Disorders

Dysphagia ◽  
1997 ◽  
Vol 12 (3) ◽  
pp. 157-160 ◽  
Author(s):  
Kenneth R. DeVault
Keyword(s):  
Esophageal Motility ◽  
Upper Esophageal Sphincter ◽  
Esophageal Motility Disorders ◽  
Motility Disorders ◽  
Esophageal Sphincter

Outcomes of Laparoscopic Nissen Fundoplication in Patients with Manometric Patterns of Esophageal Motility Disorders

2013 ◽  
Vol 79 (4) ◽  
pp. 361-365 ◽  
Author(s):  
Bruna Dell'Acqua-CassÃO ◽  
Fernando Augusto Mardiros-Herbella ◽  
JosÉ F. Farah ◽  
Adorisio Bonadiman ◽  
Luciana C. Silva ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Lower Esophageal Sphincter ◽  
Esophageal Motility ◽  
Nissen Fundoplication ◽  
Esophageal Motility Disorders ◽  
Motility Disorders ◽  
Control Subjects ◽  
Esophageal Sphincter ◽  
Laparoscopic Nissen ◽  
Manometric Pattern

The manometric pattern of either diffuse esophageal spasm (DES), nutcracker esophagus (NE), or hypertensive lower esophageal sphincter (HLES) in the presence of gastroesophageal reflux disease (GERD) is considered a secondary finding and treatment should be directed toward GERD. This study aims to evaluate the outcomes of laparoscopic Nissen fundoplication (LNF) in patients with manometric patterns of esophageal motility disorders. Patients with GERD confirmed by pH monitoring and manometric pattern of DES (simultaneous contractions 20 to 90% of wet swallows), NE (increased mean distal amplitude greater than 180 mmHg), or HLES (lower esophageal sphincter pressure greater than 45 mmHg) who underwent LNF were studied. A group of 50 consecutive patients with normal esophageal motility who underwent LNF were used as control subjects. Groups were comparable to control subjects for age, gender, preoperative symptoms, hiatal hernia, and Barrett's esophagus, except for NE that had younger individuals and a lower rate of hiatal hernia. Symptomatic outcome was similar when groups were compared with control subjects. Transient dysphagia was present in the postoperative period in 33, 7, 0, and 20 per cent of the patients with HLES, DES, NE, and control subjects, respectively. LNF is an adequate treatment for patients with GERD and manometric patterns of esophageal motility disorders.

Rheumatologic disorders in patients undergoing esophageal manometry: prevalence, symptom characteristics, and manometric findings

2021 ◽  
Author(s):  
Anam Qureshi ◽  
Asad Jehangir ◽  
Zubair Malik ◽  
Henry P Parkman
Keyword(s):  
Lupus Erythematosus ◽  
Esophageal Motility ◽  
Esophageal Manometry ◽  
Upper Esophageal Sphincter ◽  
Motility Disorders ◽  
Ineffective Esophageal Motility ◽  
Upper Gi ◽  
Gi Symptoms ◽  
Esophageal Sphincter ◽  
Esophageal Contractility

Summary Rheumatologic disorders (RDs) can have gastrointestinal (GI) manifestations. Systemic sclerosis (SSc) patients often have upper GI symptoms from absent esophageal contractility (AC). Upper GI symptom characteristics and high-resolution esophageal manometry with impedance (HREMI) findings of other RDs have not been well studied. We aimed to: (i) determine the prevalence of RD in patients undergoing HREMI and (ii) assess the symptom characteristics and manometric findings of these patients. Patients undergoing HREMI (July 2018 to March 2020) rated their GI symptoms’ severity. Healthy volunteers (HVs) also underwent HREMI. Of the 1,003 patients, 90 (9%) had RD (mean age: 55.3 ± 1.4 years, 73.3% females), most commonly SSc (n = 27), rheumatoid arthritis (RA, n = 20), and systemic lupus erythematosus (SLE, n = 11). The most severe upper GI symptoms in patients with RD were heartburn, regurgitation, nausea, and dysphagia, with no significant differences in their severities between SSc, RA, and SLE. RD patients had higher upper esophageal sphincter (UES) pressures, lower distal contractile integral (DCI), lower bolus clearance, and more frequent hiatal hernia (HH) on HREMI (all P < 0.05) than HVs. Over half (61.1%) of patients with RD had esophageal motility disorders, most commonly AC (n = 25), ineffective esophageal motility (IEM; n = 18), and esophagogastric junction (EGJ) obstructive disorders (n = 11). Among patients undergoing HREMI, 9% had RD. Upper GI symptom severities did not distinguish different RDs. Patients with RD had higher UES pressures, weaker DCI, lower bolus clearance, and more frequent HH than HVs. Although AC and IEM were most common motility disorders, a considerable minority (12.2%) of our RD patients had EGJ obstructive disorders.

scholarly journals How to Cope with Big Data in Functional Analysis of the Esophagus

2020 ◽  
Vol 36 (6) ◽  
pp. 439-442
Author(s):  
Alissa Jell ◽  
Christina Kuttler ◽  
Daniel Ostler ◽  
Norbert Hüser
Keyword(s):  
Esophageal Motility ◽  
Learning Algorithm ◽  
Supervised Machine Learning ◽  
Esophageal Motility Disorders ◽  
Motility Disorders ◽  
High Resolution Manometry ◽  
Evaluation Time ◽  
Core Evaluation

<b><i>Introduction:</i></b> Esophageal motility disorders have a severe impact on patients’ quality of life. While high-resolution manometry (HRM) is the gold standard in the diagnosis of esophageal motility disorders, intermittently occurring muscular deficiencies often remain undiscovered if they do not lead to an intense level of discomfort or cause suffering in patients. Ambulatory long-term HRM allows us to study the circadian (dys)function of the esophagus in a unique way. With the prolonged examination period of 24 h, however, there is an immense increase in data which requires personnel and time for evaluation not available in clinical routine. Artificial intelligence (AI) might contribute here by performing an autonomous analysis. <b><i>Methods:</i></b> On the basis of 40 previously performed and manually tagged long-term HRM in patients with suspected temporary esophageal motility disorders, we implemented a supervised machine learning algorithm for automated swallow detection and classification. <b><i>Results:</i></b> For a set of 24 h of long-term HRM by means of this algorithm, the evaluation time could be reduced from 3 days to a core evaluation time of 11 min for automated swallow detection and clustering plus an additional 10–20 min of evaluation time, depending on the complexity and diversity of motility disorders in the examined patient. In 12.5% of patients with suggested esophageal motility disorders, AI-enabled long-term HRM was able to reveal new and relevant findings for subsequent therapy. <b><i>Conclusion:</i></b> This new approach paves the way to the clinical use of long-term HRM in patients with temporary esophageal motility disorders and might serve as an ideal and clinically relevant application of AI.

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