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Medical Evaluation of Functional GI Disorders
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Michael Camilleri, Jeffrey W. Frank
There are three main modalities for evaluation of esophageal functional disorders: esophageal manometry and prolonged and short reflux tests (16). Manometry is a method whereby a series of perfused catheters, with sideholes located at several levels of the esophagus, provide a pressure profile during swallowing of the contractions at different levels of the esophagus (Figure 3) (17). Alternatively, solid-state transducers can be used instead of perfused manometers (Figure 4). Diagnostic profiles are discussed elsewhere in this book. The main indications for esophageal manometry are: the evaluation of barium x-ray or en-doscopy-negative dysphagia, noncardiac chest pain, and in the preoperative assessment of patients about to undergo fundoplication or other hiatal hemia repair for reflux esophagitis.
Paraesophageal Hernia
Published in Stephen M. Cohn, Peter Rhee, 50 Landmark Papers, 2019
Diagnostic modalities include: Plain x-ray of the chest (retrocardiac air−fluid level, vertically oriented loops of bowel, upward displacement of the transverse colon, nasogastric tube coiled above the diaphragm), contrast esophagrams (size and reducibility of the hiatal hernia, relationship of gastroesophageal junction to hiatus, presence of a foreshortened esophagus, or esophageal diverticula), esophagogastroduodenoscopy (presence of esophagitis, biopsies for Barrett esophagus, gastric viability, size and type of paraesophageal hernia), computed tomography (gastric volvulus, intestinal obstruction, presence of additional organs besides stomach, location of gastroesophageal junction, and type of paraesophageal hernia). pH testing to demonstrate abnormal proximal acid exposure (DeMeester score >14.7) identifies sliding-type hiatal hernias that would benefit from operative intervention but is not critical in patients with paraesophageal hernias. Esophageal manometry is critical in selecting the optimal anti-reflux procedure.
Esophageal Motility: Measures and Disorders of Esophageal Motor Function
Published in John F. Pohl, Christopher Jolley, Daniel Gelfond, Pediatric Gastroenterology, 2014
History and physical examination provide important information towards underlying causes, especially for causes secondary to underlying systemic conditions or a past history of esophageal injury or surgery. Most children however, will present with dysphagia or with vomiting. In most cases no specific physical finding is noted. Tests to evaluate disorders of swallowing can be differentiated into: Indirect tests: – Barium swallow (6.1–6.3). – Modified barium swallow (MBS).– Esophageal scintigraphy/transit time.Direct tests: – Esophageal manometry.– pH impedance study.– Combined impedance manometry study.
Reflux scintigraphy in gastro-esophageal reflux disease: a comparison study with 24 hour pH-impedance monitoring
Published in Scandinavian Journal of Gastroenterology, 2022
Lisa S. E. Shim, Meng C. Ngu, Yunki Yau, Robert Russo
Patients (age between 18 and 75 years) referred to our esophageal motility clinic for assessment of reflux symptoms were prospectively recruited. All patients completed a baseline demographic questionnaire, the Gastroesophageal Reflux Disease questionnaire (GerdQ) [15] and a 10 cm visual analogue scale (VAS) assessing the impact of their symptoms on quality of life. They stopped acid suppression therapy (proton pump inhibitors and histamine-2 receptor antagonists) one week prior to the study but were permitted to use antacids up to 6 h prior. Patients with a history of fundoplication, eosinophilic esophagitis, Barrett’s esophagus, sleeve gastrectomy or gastroparesis were excluded from the study. Patients with a major motor disorder detected on esophageal manometry were also excluded. Enrolled patients proceeded to a reflux scintigraphy immediately after the pH-impedance probe was inserted. Patients were enrolled between November 2017 and December 2020. The study was approved by the Human Research Ethics Committee.
Abstracts from the Seventh Annual Baylor University Medical Center Medical Education Research Forum 2021
Published in Baylor University Medical Center Proceedings, 2021
Kashif Waqiee Ahmed, Thomas Cox, Jennifer Olvera, Natalie Gittus, Kirsten Ryan, Cristie Columbus
There is no consensus for when surgical evaluation is indicated in gastroesophageal reflux disease (GERD). We sought to determine if the GERD Health-Related Quality of Life (HRQL) questionnaire scores correlated to objective findings in patients undergoing anti-reflux surgery as a way to predict when surgical consultation was warranted. A prospective database was used to look at patients undergoing anti-reflux surgery. Inclusion criteria included a diagnosis of GERD and an esophageal workup including GERD-HRQL questionnaire, upper endoscopy, barium esophagram, esophageal manometry, and pH monitoring. Logistic regression analysis was used to assess the relationship between the presence of objective findings and GERD-HRQL scores. For the 246 included patients, there was no significant correlation between GERD-HRQL score and DeMeester score (correlation coefficient = 0.23), or the presence or absence of a hiatal hernia regardless of size (P = 0.89). Patients with esophagitis had significantly higher average GERD-HRQL scores than those without esophagitis (40.1 ± 18.9 vs 30.4 ± 19.1, P < 0.0001). Patients with a score of ≥40 had a 42% to 65% probability of having esophagitis, whereas a score of ≤30 lowered the chances of having esophagitis to <35%. Use of the GERD-HRQL questionnaire can potentially predict the chances of having erosive esophagitis despite medical therapy, which could help referring physicians prompt referral for surgical evaluation.
The acute respiratory distress syndrome
Published in Baylor University Medical Center Proceedings, 2020
Christopher Wood, Vivek Kataria, Ariel M. Modrykamien
Lastly, the 2019 trial EPVent 2, following the positive results of the EPVent study, was a multicenter randomized controlled trial of 200 patients that examined the use of esophageal manometry using an esophageal balloon as a surrogate for pleural pressure to titrate PEEP compared with a control group of empiric high PEEP (based on a table from the OSCILLATE trial).31 In the esophageal balloon group, PEEP was titrated to keep end expiratory pleural pressures (estimated by use of the balloon) between 0 and 6 cm H2O to keep the PEEP near the pleural pressure. Upon analysis, no difference was found in 28-day, 60-day, or 1-year mortality in the esophageal balloon group vs placebo, nor any difference in ventilator-free days or ICU length of stay.31 These results point away from the routine use of esophageal manometry in ARDS. There are also deleterious effects of too much PEEP, including reduced venous return and reduced cardiac output due to increased intrathoracic pressure, thus causing negative hemodynamic effects, as well as hyperinflation leading to lung injury.32