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Psychometric Testing in Functional GI Disorders
Published in Kevin W. Olden, Handbook of Functional Gastrointestinal Disorders, 2020
Patients with another esophageal motility disorder, nutcracker esophagus, were compared to IBS patients and three groups of non-GI-disorder patients by Richter and colleagues (82). Nutcracker esophagus is characterized by noncar-diac chest pain due to high-amplitude peristaltic contractions in the body of the esophagus. Richter et al. used the Millon Behavioral Health Inventory (MBHI) (83), a comprehensive psychosocial measure designed to aid in the psychological understanding of medically ill patients. Both nutcracker and IBS patients scored significantly higher than controls on scales of GI susceptibility to stress and somatic anxiety, and tended to be hypochondriacal and seek early medical care. Nutcracker esophagus patients, however, did not score above normal on general measures of depression and anxiety, while IBS patients did. This may mean that, at least in the case of nutcracker esophagus, patients with functional esophageal disorders may somaticize stress more than patients with lower functional GI disorders. We could speculate that the reason for the conflicting results in the earlier versus later studies of psychological concomitants of globus hystericus (mentioned above) is that later measures may not have adequately measured somaticized symptoms. If this was the case, then patients with functional esophageal disorders should receive psychometric testing that covers somatic aspects of psychological symptoms, or psychological involvement might be missed.
The biopsychosocial approach to NCCP
Published in Elizabeth Marks, Myra Hunter, John Chambers, CBT for Managing Non-cardiac Chest Pain, 2017
Elizabeth Marks, Myra Hunter, John Chambers
The main oesophageal abnormalities are gastro-oesophageal reflux disease (Figure 5.2) and motility disorders including nutcracker or jack-hammer oesophagus (Figure 5.3) (Chambers and Bass, 1990; Fass and Achem, 2011). Nutcracker oesophagus is characterized by high amplitude contractions in the lower oesophagus. A jackhammer oesophagus is an extreme version of this in which the contractions are of very high amplitude, involve the whole oesophagus and have a long duration. Other motility disorders including the hypertensive gastro-oesophageal sphincter or nonspecific motility disorders defined by a deviation from normal ranges with no clear-cut differentiation from normal. These may be associated with NCCP, but the relationship of episodes of chest pain with an organic abnormality is less clear than with nutcracker or jack-hammer oesophagus.
Exploring the role of botulinum toxin in critical care
Published in Expert Review of Neurotherapeutics, 2021
Muhammad Ubaid Hafeez, Michael Moore, Komal Hafeez, Joseph Jankovic
The role of endoscopic BoNT injections has been well documented in treatment of achalasia [66] and other esophageal motility disorders including diffuse esophageal spasm (DES) and nutcracker esophagus [67]. These conditions can potentially lead to recurrent aspiration and increase pulmonary morbidity although literature on long-term outcomes is lacking [66,67]. Single case reports indicate benefit of BoNT in management of certain patients who develop ICU acquired post-extubation dysphagia (PED) [68–71]. PED is usually multifactorial with a higher incidence in advanced age, underlying neurological conditions and prolonged intubations [72]. Dysphagia associated with upper esophageal sphincter (UES) dysfunction in setting of acute ischemic stroke, intracranial hemorrhage or multiple sclerosis has been reported to improve after UES BoNT injections [68–71,73].
Factors predictive of gastroesophageal reflux disease and esophageal motility disorders in patients with non-cardiac chest pain
Published in Scandinavian Journal of Gastroenterology, 2018
Juan Gomez Cifuentes, Rocio Lopez, Prashanthi N. Thota
Review of prior literature showed varied prevalence of esophageal motility disorders in patients with NCCP. Studies prior to the advent of HREM showed a prevalence of 27–30% [8–10] with a higher prevalence of abnormal manometries (58–63%) when including hypotensive LES as a diagnosis [5,13–16]. Most recent studies using HREM reported a prevalence of 40–60% [6,7]. The type of motility abnormalities also varied depending on the population studied. A landmark study by Katz et al described nutcracker esophagus as the most common motility abnormality in NCCP patients [5]. However, this finding has not been replicated in other studies using conventional manometry. Common findings reported were hypotensive LES in 53–61% [14,15], nonspecific esophageal motility disorders in 10–25% [13,15,16] and nutcracker esophagus in 10–19% [14,15]. Two studies reported on HREM findings in patients with NCCP. In one study of 48 patients, all patients with abnormal HREM had hypotensive peristalsis disorders: IEM in 29.1%, fragmented peristalsis in 18.7% and absent contractility in 12.5% [6]. In another study of 59 patients, IEM was seen in 25.4% and EGJ outflow obstruction in 15.2% of the patients [7]. In our study, IEM remained the most prevalent motility abnormality with other abnormalities such as DES, Jackhammer esophagus and achalasia. This may be because of our larger study population and differences in gender distribution with 67.2% being women. Although five patients with achalasia or EGJ outflow obstruction had associated dysphagia, two of them presented with chest pain only. Moreover, we identified that older age and dysphagia were predictors of motility disorders in NCCP. Prior studies analyzing patients with chest pain and/or dysphagia have also shown dysphagia as a marker of motility disorders in conventional esophageal manometry [14,15].