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Interdisciplinary intervention in adolescents with rumination syndrome
Published in Clarissa Martin, Terence Dovey, Angela Southall, Clarissa Martin, Paediatric Gastrointestinal Disorders, 2019
Anthony Alioto, Carlo Di Lorenzo, Michela I Parzanese
A test that often provides added diagnostic value is gastroduodenal manometry, an invasive test requiring significant technical and interpretive expertise. While manometry is not necessary in order to diagnose RS, it may be beneficial in ‘clinching’ the diagnosis when the patients, their family or the medical providers still need to be convinced that RS is the appropriate diagnosis (Di Lorenzo and Youssef, 2010). Recent data have shown that the combined use of high-resolution manometry and stationary oesophageal impedance also provide excellent diagnostic accuracy (Kessing et al., 2011; Rommel et al, 2010). The manometric pattern associated with RS is characterised by a rise in intra-gastric pressure (spikes termed ‘R waves’) generated by a voluntary contraction of the abdominal wall musculature, preceded or coincident with retrograde intra-oesophageal passage of gastric contents that can be detected by impedance (Amarnath et al., 1986).
Chronic Aspiration
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Guri S. Sandhu, Khalid Ghufoor
Oesophageal motility disorders can lead to retained secretions in the hypopharynx and risk aspiration. They result from either primary diseases of the musculature or from an imbalance between excitatory and inhibitory innervations. Historically the diagnosis has been based on VF but high-resolution manometry with oesophageal pressure topography has become the current gold standard.
The oesophagus
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Manometry is now widely used to diagnose oesophageal motility disorders. Electronic microtransducers that are not influenced by changes in patient position during the test have gradually supplanted perfusion systems. High-resolution manometry uses a multiple (up to 36) microtransducer catheter with the results displayed as spatiotemporal plots, and this has now largely supplanted earlier manometry systems. This system provides comprehensive information about oesophageal body function and associated behaviour of the LOS.
Endoscopic measurement of hiatal hernias: is it reliable and does it have a clinical impact? Results from a large prospective database
Published in Postgraduate Medicine, 2023
Charles Christian Adarkwah, Oliver Hirsch, Merlissa Menzel, Joachim Labenz
Hiatal hernias were measured both endoscopically and manometrically. Endoscopy and HRM were performed by different investigators unaware of the result of the other method. During endoscopy, the longitudinal extent of a hiatal hernia was measured at the end of the procedure after deflation of the stomach as the distance between the top of gastric folds and the diaphragmatic impression. Data collected during EGD include the presence of erosive esophagitis (ERD) according to the Los Angeles Classification [18,19], presence and extent of metaplasia in the distal esophagus according to the Prague classification system [20], hernia size in centimeters, and any focal abnormalities. Routine biopsy samples obtained from the duodenum, the stomach, the Z-line, and the tubular esophagus were analyzed by an experienced pathologist as were biopsies from suspected Barrett’s metaplasia and other focal findings. Due to the use of pH impedance measurement, the percentage of time (%) with pH < 4 (AET, acid exposure time) in both upright and supine positions, as well as the symptom-associated probability (SAP), was examined and noted. In addition, the DeMeester score and the number of acid and nonacid reflux events were determined. Resting pressure, lower esophageal sphincter relaxation, hernia size (in cm), and esophageal motility disorders were measured by high-resolution manometry (HRM) according to the Chicago classification [21,22].
Difference in meal-related esophageal intraluminal impedance change between gastroesophageal reflux disease and functional disorders
Published in Scandinavian Journal of Gastroenterology, 2023
Yutang Ren, Xiaojuan Guo, Yunting Cai, Xueru Huo, Xiaofang Ying, Qiuxiang Lu, Xuan Jiang, Bo Jiang
This study was conducted in the Outpatient Clinic of Gastroenterology at a tertiary hospital. Patients with esophageal symptoms were collected from July 2016 to July 2018. The electronic clinical profiles of those patients were reviewed. The profile included patients’ medical history, endoscopy reports, 24-hour esophageal pH-impedance monitoring and high-resolution manometry. Patients with GERD and functional disorders with esophageal symptoms were included for the study. GERD was diagnosed with typical reflux symptoms, positive response to PPIs, abnormal acid exposure time and/or visible reflux esophagitis under endoscope. Functional disorders such as functional heart burn, functional chest pain, reflux hypersensitivity and globus were diagnosed according to Rome IV criteria [3]. Belching disorder was also included because excessive belch is also a common symptom of GERD. Patients with on-PPI pH-impedance recordings were excluded. All patients had given written informed consent for the study. The study protocol adhered to the Declaration of Helsinki and was proved by the Institutional Review Board of Beijing Tsinghua Changgung Hospital (BTCH-EC-FJ-21-1.0).
Diagnosing complications and co-morbidities of fibrotic interstitial lung disease
Published in Expert Review of Respiratory Medicine, 2019
George A. Margaritopoulos, Maria A. Kokosi, Athol U. Wells
Therefore, in principle, the identification of GER allows early anti-reflux interventions to reduce the progressiveness of IPF. GER manifests with typical oesophageal symptoms such as heartburn, acidic reflux, chest pain and non-oesophageal symptoms such as cough, dental erosions, and laryngitis. Other extra-esophageal symptoms include epigastric pain, dyspepsia, nausea, bloating, and belching. Invasive methods used to identify the presence of GER include (a) oesophageal manometry which measures the competence of the lower oesophageal sphincter, (b) ambulatory 24 h catheter pH monitoring which allows direct measurement of oesophageal acid exposure, reflux episode frequency and association between symptoms and reflux episodes, (c) a combination of pH plus impedance monitoring in order to identify both acid and non-acid reflux events in the esophagus, as well as the height and volume of the reflux and (d) upper endoscopy identifying erosive oesophagitis and Barrett’s esophagus. It should be stressed that reflux episodes associated with non-oesophageal symptoms are not always detected by standard oesophageal tests, which have low sensitivity for gaseous or aerosolized reflux [37]. Newer investigations, including high-resolution manometry, appear better able to identify subtle defects in oesophageal motility, which are associated with an increased propensity towards reflux [38].