Clinical Symptom Presentation of Hypercontractile Peristalsis in the Era of High-Resolution Manometry: A Single-Center Experience

2020 ◽  
Vol 38 (5) ◽  
pp. 355-363 ◽  
Author(s):  
Máté Csucska ◽  
Takahiro Masuda ◽  
Ross M. Bremner ◽  
Sumeet K. Mittal
Keyword(s):  
High Resolution ◽  
Lower Esophageal Sphincter Pressure ◽  
Categorical Variables ◽  
Sphincter Pressure ◽  
Chi Square ◽  
Nutcracker Esophagus ◽  
Esophageal Function ◽  
High Resolution Manometry ◽  
Single Center Experience ◽  
Patient Reported

Background: Hypercontractile motility of the esophagus is occasionally noted on high-resolution manometry (HRM), but its clinical correlations are unclear. We compared symptom severity and clinical presentation of patients with hypercontractile motility of the esophagus. Methods: This was a retrospective cohort study. We queried a prospectively maintained database for patients who underwent esophageal function testing from October 1, 2016, to October 30, 2018. We included patients with jackhammer esophagus (JE; ≥2 swallows with distal contractile integral [DCI] ≥8,000 mm Hg∙cm∙s), nutcracker esophagus (NE; mean DCI 5,000–8,000 mm Hg∙cm∙s without meeting JE criteria), or esophagogastric junction outflow obstruction ([EGJOO]: abnormal median integrated relaxation pressure (>15 mm Hg) without meeting achalasia criteria, with JE [EGJOO-h], or normal motility [EGJOO-n]). HRM, endoscopy, barium esophagram, ambulatory pH studies, and symptom questionnaires were reevaluated for further analysis. Clinical parameters were analyzed using Spearman Rho correlation. Categorical variables were assessed with Fisher exact or chi-square test. Results: Altogether, 85 patients met inclusion criteria. They were divided into 4 subgroups: 28 with JE, 18 with NE, 15 with EGJOO-h, and 24 with EGJOO-n. Patients with EGJOO-h were the most symptomatic overall. No correlation was seen between symptoms and mean DCI (p ≥ 0.05 all groups) or number of hypercontractile swallows (≥8,000 mm Hg∙cm∙s, p ≥ 0.05). A significant correlation was noted between dysphagia and lower esophageal sphincter pressure (LESP) and LESP integral (p ≤ 0.05). Conclusion: The number of hypercontractile swallows and mean DCI were not associated with patient-reported symptoms. Elevated LESP may be a more relevant contributor to dysphagia.

scholarly journals Assessment of esophageal function using provocative tests during high resolution manometry: A single-center experience

2019 ◽  
Vol 118 (1) ◽  
pp. 244-248 ◽  
Author(s):  
Ming-Wun Wong ◽  
Wei-Yi Lei ◽  
Jui-Sheng Hung ◽  
Tso-Tsai Liu ◽  
Chih-Hsun Yi ◽  
...  
Keyword(s):  
High Resolution ◽  
Single Center ◽  
Esophageal Function ◽  
High Resolution Manometry ◽  
Single Center Experience

PS01.009: COMPREHENSIVE CLASSIFICATION FOR ANTIREFLUX FUNCTION OF THE ESOPHAGOGASTRIC JUNCTION BASED ON HIGH-RESOLUTION MANOMETRY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 52-52
Author(s):  
Takahiro Masuda ◽  
Balazs Kovacs ◽  
Ross Bremner ◽  
Sumeet Mittal
Keyword(s):  
High Resolution ◽  
Esophagogastric Junction ◽  
Conflicts Of Interest ◽  
Lower Esophageal Sphincter Pressure ◽  
Sphincter Pressure ◽  
Total Acid ◽  
High Resolution Manometry ◽  
Demeester Score ◽  
Cumulative Score ◽  
The Mean

Abstract Background The anatomical configuration of the esophagogastric junction (EGJ) and the thoracoabdominal pressure gradient (TAPG) affect gastric content backflow into the esophagus. A comprehensive antireflux function assessment is needed to identify underlying derangements in patients with gastroesophageal reflux (GER). Herein we propose an objective scoring system for grading EGJ function. Methods We analyzed patients who underwent 24-hour pH study and high-resolution manometry in 2017 at our institution. We assessed three factors: EGJ morphology, lower esophageal sphincter pressure integral, and TAPG. Each factor was scored on a scale of 0–2, and a cumulative score was calculated (Table 1). Patients were divided into 3 groups based on cumulative score: 0, competent EGJ function (Grade I); 1–3, moderate incompetency (Grade II); 4–6, poor competency (Grade III). Results In total, 140 patients were studied. The mean age was 58.6 years, 75 patients (53.6%) were men, and the mean body mass index was 28.6 kg/m2. Fifty-one patients (36.4%) had an abnormal DeMeester score (ie, > 14.72). A significant, progressive increase was seen in number of reflux episodes (I-25.7, II-36.4, III-50.5, rs = 0.207, P = 0.015), total acid exposure time (I-1.0%, II-2.1%, III-5.0%, rs = 0.312, P < 0.001) and prevalence of abnormal pH score (I-13.0%, II-32.0%, III-57.1%, rs = 0.314, P < 0.001) from Grade I to III. Conclusion The proposed grading of the EGJ based on a cumulative score of individual parameters has a good correlation with GER. Disclosure All authors have declared no conflicts of interest.

scholarly journals Comparison of Anorectal Function Measured using Wearable Digital Manometry and a High Resolution Manometry System

2020 ◽  
Author(s):  
Ali Attari ◽  
William D. Chey ◽  
Jason R. Baker ◽  
James A. Ashton-Miller
Keyword(s):  
High Resolution ◽  
Fecal Incontinence ◽  
Anal Sphincter ◽  
Chronic Constipation ◽  
Anorectal Function ◽  
Puborectalis Muscle ◽  
Myoelectric Activity ◽  
Sphincter Pressure ◽  
High Resolution Manometry ◽  
Anal Sphincter Pressure

AbstractThere is a need for a lower cost manometry system for assessing anorectal function in primary and secondary care settings. We developed an index finger-based system (termed “digital manometry”) and tested it in healthy volunteers, patients with chronic constipation, and fecal incontinence. Anorectal pressures were measured in 16 participants with the digital manometry system and a 23-channel high-resolution anorectal manometry system. The results were compared using a Bland-Altman analysis at rest as well as during maximum squeeze and simulated defecation maneuvers. Myoelectric activity of the puborectalis muscle was also quantified simultaneously using the digital manometry system. The limits of agreement between the two methods were −7.1 ± 25.7 mmHg for anal sphincter resting pressure, 0.4 ± 23.0 mmHg for the anal sphincter pressure change during simulated defecation, −37.6 ± 50.9 mmHg for rectal pressure changes during simulated defecation, and −20.6 ± 172.6 mmHg for anal sphincter pressure during the maximum squeeze maneuver. The change in the puborectalis myoelectric activity was proportional to the anal sphincter pressure increment during a maximum squeeze maneuver (slope = 0.6, R2 = 0.4). Digital manometry provided a similar evaluation of anorectal pressures and puborectalis myoelectric activity at an order of magnitude less cost than high-resolution manometry, and with a similar level of patient comfort. Digital Manometry provides a simple, inexpensive, point of service means of assessing anorectal function in patients with chronic constipation and fecal incontinence.

scholarly journals Adequate Number of Swallows for Pharyngeal Pressure Measurement of a Subject using High-resolution Manometry

2020 ◽  
Author(s):  
Matsusato Tsuyumu ◽  
Takanori Hama ◽  
Takakuni Kato ◽  
Hiromi Kojima
Keyword(s):  
High Resolution ◽  
Major Change ◽  
Upper Esophageal Sphincter ◽  
Rate Of Change ◽  
Sphincter Pressure ◽  
High Resolution Manometry ◽  
Average Value ◽  
Pharyngeal Pressure ◽  
Single Person ◽  
The Mean

Abstract Introduction The number of pressure measurements that need to be recorded using high-resolution manometry (HRM) for the accurate evaluation of pharyngeal function is not well established. Objective The purpose of this study is to clarify the number of swallows required to obtain an accurate pharyngeal manometric profile of a person. Methods Forty healthy adults performed a dry swallow and bolus swallows using 3-, 5-, or 10 ml of water and underwent measurements using the Starlet HRM system. Each subject underwent 10 swallows for each of the four bolus volume conditions. Results The mean of up to seven measurements of maximum pre-swallow upper esophageal sphincter pressure with 10 ml of swallow was close to the mean of up to eight measurements in 95% of the subjects. Similarly, the rate of change of the average for the eighth and ninth measurements and the rate of change for the average of the ninth and tenth measurements were less than 5%. When the other parameters were similarly measured up to the sixth measurement, no major change in the average value was observed even if more measurements were taken. Conclusion A minimum of six measurements are required, and seven swallows are sufficient for evaluating the pharyngeal manometric profile of a single person. This number of measurements can be a useful criterion when performing HRM measurements on individual subjects.

scholarly journals Autologous Dermis Graft Implantation: A Novel Approach to Reinforcement in Giant Hiatal Hernias

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Balázs Kovács ◽  
Mikolt Orosz ◽  
Máté Csucska ◽  
Saurabh Singhal ◽  
Árpád Juhász ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Laparoscopic Approach ◽  
Lower Esophageal Sphincter Pressure ◽  
Anatomical Location ◽  
Sphincter Pressure ◽  
Mesh Graft ◽  
High Resolution Manometry ◽  
Giant Hiatal Hernia ◽  
Dermis Graft ◽  
Graft Implantation

Objectives. Nonreinforced tensile repair of giant hiatal hernias is susceptible to recurrence, and the role of mesh graft implantation remains controversial. Creating a new and viable choice without the use of high-cost biological allografts is desirable. This study presents the application of dermis graft reinforcement, a cost-efficient, easily adaptable alternative, in graft reinforcement of giant hiatal hernia repairs. Methods. A 62-year-old female patient with recurrent giant hiatal hernia (9 × 11 cm) and upside down stomach, immediately following the Belsey repair done in another department, was selected for the pilot procedure. The standard three-stitch nonabsorbable reconstruction of diaphragmatic crura was undertaken via laparoscopic approach. A 12 × 6 cm dermis autograft was harvested from the loose abdominal skin. “U” figure onlay reinforcement of diaphragm closure was secured with titanium staples. The procedure was completed with a standard Dor fundoplication. One- and seven-month follow-ups were conducted. Results. No short-term postoperative complications were observed. One-month follow-up showed normal anatomical location of abdominal viscera on computed tomography imaging. High-resolution manometry showed normal lower esophageal sphincter pressure. Preoperative abdominal complaints were resolved. Procedural costs were lower than the average cost following mesh graft reinforcement. Conclusion. Dermis graft reinforcement is a cheap, easily adaptable procedure in the repair of giant hiatal hernias, even in the setting of laparoscopic reoperative procedure.

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