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Esophageal pressure

Maxwel Capsy Boga Ribeiro, Amanda Bueno de Araújo, Juverson Alves Terra-Júnior, Eduardo Crema, Nelson Adami Andreollo
Background: Surgical treatment of GERD by Nissen fundoplication is effective and safe, providing good results in the control of the disease. However, some authors have questioned the efficacy of this procedure and few studies on the long-term outcomes are available in the literature, especially in Brazil. Aim: To evaluate patients operated for gastro-esophageal reflux disease, for at least 10 years, by Nissen fundoplication. Methods: Thirty-two patients were interviewed and underwent upper digestive endoscopy, esophageal manometry, 24 h pH monitoring and barium esophagogram, before and after Nissen fundoplication...
July 2016: Arquivos Brasileiros de Cirurgia Digestiva: ABCD, Brazilian Archives of Digestive Surgery
Matthias Buechter, Alisan Kahraman, Paul Manka, Guido Gerken, Christoph Jochum, Ali Canbay, Alexander Dechêne
BACKGROUND/AIMS: Portal hypertension (PH) is a common complication of chronic liver disease and results in esophageal and gastric variceal bleeding, which is associated with a high mortality rate. Measurement of the hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing PH and estimating the risk of varices and bleeding. In contrast, upper gastrointestinal (GI) endoscopy (UGE) can reliably demonstrate the presence of varices and bleeding. Both measures are invasive, and HVPG is mainly restricted to tertiary centers...
October 19, 2016: Digestion
T V K Herregods, A J P M Smout, J L S Ooi, D Sifrim, A J Bredenoord
BACKGROUND: With the advent of high-resolution manometry (HRM), a new diagnosis, jackhammer esophagus, was introduced. Little is known about this rare condition, and the relationship between symptoms and hypercontractility is not always straightforward. The aim of our study was to describe a large cohort of patients with jackhammer esophagus and to investigate whether manometric findings are associated with the presence of symptoms. METHODS: All patients from 06, 2014 until 12, 2015 seen at two tertiary centers with at least one hypercontractile swallow (distal contractile integral [DCI] >8000 mm Hg/s/cm) on HRM were analyzed...
October 17, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Mohamed Balaha, Samah Kandeel, Waleed Barakat
Carvedilol is an anti-oxidant non-selective β-blocker used for reduction of portal blood pressure, prophylaxis of esophageal varices development and bleeding in chronic liver diseases. Recently, it exhibited potent anti-inflammatory, anti-fibrotic, anti-proliferative and anti-carcinogenic effects. In the present study, we evaluated the possible suppressive effect of carvedilol on circulating and hepatic IL-6 levels responsible for hepatocarcinogenesis in a rat model of hepatic cirrhosis. Besides, its effect on hepatic STAT-3 levels, function tests, oxidative stress markers, and hydroxyproline content, hepatic tissue histopathological changes and immunohistochemical expression of E & N-cadherin...
October 13, 2016: Toxicology and Applied Pharmacology
R Yadlapati, R N Keswani, K B Dunbar, A J Gawron, C P Gyawali, P J Kahrilas, P O Katz, D Katzka, S J Spechler, R Tatum, J E Pandolfino
BACKGROUND: Competent interpretation of esophageal high-resolution manometry (HRM) is integral to a quality study. Currently, methods to assess physician competency for the interpretation of esophageal HRM do not exist. The aim of this study was to use formal techniques to (i) develop an HRM interpretation exam, and (ii) establish minimum competence benchmarks for HRM interpretation skills at the trainee, physician interpreter, and master level. METHODS: A total of 29 physicians from 8 academic centers participated in the study: 9 content experts separated into 2 study groups-expert test-takers (n=7) and judges (n=2), and 20 HRM inexperienced trainees ("trainee test-taker"; n=20)...
October 13, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Amit Patel, C Prakash Gyawali
The utilization of impedance technology has enhanced our understanding and assessment of esophageal dysmotility. Esophageal high-resolution manometry (HRM) catheters incorporated with multiple impedance electrodes help assess esophageal bolus transit, and the combination is termed high-resolution impedance manometry (HRIM). Novel metrics have been developed with HRIM-including esophageal impedance integral ratio, bolus flow time, nadir impedance pressure, and impedance bolus height-that augments the assessment of esophageal bolus transit...
November 2016: Current Gastroenterology Reports
Shunsuke Akimoto, Saurabh Singhal, Takahiro Masuda, Se Ryung Yamamoto, Wendy Jo Svetanoff, Sumeet K Mittal
BACKGROUND: The Chicago classification has recently added a morphological subclassification for the esophagogastric junction (EGJ). Our aim was to assess the distal esophageal acid exposure in patients with this new Chicago EGJ-type IIIa and IIIb classification. STUDY DESIGN: From a prospectively collected high-resolution manometry (HRM) database, we identified patients who underwent 24-h pH study between October 2011 and June 2015 and were diagnosed with EGJ-type III based on HRM...
October 11, 2016: Digestive Diseases and Sciences
Renan Maloni Augusto, André Luis Pereira Albuquerque, Thomas Jaeger, Carlos Roberto Ribeiro de Carvalho, Pedro Caruso
BACKGROUND: The use of esophageal catheters with microtransducer promises advantages over traditional catheters with air-filled balloons. However, performance comparisons between these 2 types of catheters are scarce and incomplete. METHODS: A catheter with a 9.5-cm air-filled balloon at the distal tip and a catheter with a microtransducer mounted within a flexible silicone rubber were tested in vitro and in vivo. In vitro, the response times of both catheters were compared, and the drift of the baseline pressure of the microtransducer catheter was evaluated over a 6-h period...
October 11, 2016: Respiratory Care
Darío Villalba, Viviana Feld, Valeria Leiva, Mariana Scrigna, Eduardo Distéfano, Romina Pratto, Matías Rodriguez, Jesica Collins, Ana Rocco, Amelia Matesa, Damián Rossi, Laura Areas, Sacha Virgilio, Nicolás Golfarini, Gregorio Gil-Rosetti, Pablo Diaz-Ballve, Fernando Planells
OBJECTIVE: To describe and compare the work of breathing (WOB) during spontaneous breathing under four conditions: (1) breathing through a tracheostomy tube with an inflated cuff, (2) breathing through the upper airway (UA) with a deflated cuff and occluded tube, (3) breathing through the UA with an occluded cuffless tube, and (4) postdecannulation. PATIENTS AND METHODS: Patients who tolerated an occluded cuffless tube were included. Ventilatory variables and esophageal pressure were recorded...
July 2016: International Journal of Critical Illness and Injury Science
Mike G Laukoetter, Rudolf Mennigen, Philipp A Neumann, Sameer Dhayat, Gabriele Horst, Daniel Palmes, Norbert Senninger, Thorsten Vowinkel
BACKGROUND: Perforations and anastomotic leakages of the upper gastrointestinal (GI) tract cause a high morbidity and mortality rate. Only limited data exist for endoscopic vacuum therapy (EVT) in the upper GI tract. METHODS: Fifty-two patients (37 men and 15 women, ages 41-94 years) were treated (12/2011-12/2015) with EVT for anastomotic insufficiency secondary to esophagectomy or gastrectomy (n = 39), iatrogenic esophageal perforation (n = 9) and Boerhaave syndrome (n = 4)...
October 5, 2016: Surgical Endoscopy
Francesco Torresan, Daniele Mandolesi, Alexandros Ioannou, Simone Nicoletti, Leonardo Henry Eusebi, Franco Bazzoli
Gastroesophageal reflux disease (GERD) is recognized to be a multifactorial disease and several mechanisms leading to reflux have been described, nevertheless its pathophysiology has not been fully clarified. Hiatus hernia is a known risk factor for GERD since it impairs the esophagogastric junction, leading to: reduction in lower esophageal sphincter pressure; increase in the frequency of the transient lower esophageal sphincter relaxation; and impairment of esophageal clearance. Last generation diagnostic techniques have improved the understanding of these mechanisms...
October 2016: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
Helle Ø Kristensen, Jakob Kirkegård, Daniel Willy Kjær, Frank Viborg Mortensen, Rastislav Kunda, Niels Christian Bjerregaard
BACKGROUND: Peroral endoscopic myotomy (POEM) is an emerging procedure in the treatment of esophageal achalasia, a primary motility disorder. However, the long-term outcome of POEM in patients, who have previously undergone a Heller myotomy, is unknown. METHODS: Using a local database, we identified patients with esophageal achalasia, who underwent POEM. We compared patients with a previous Heller myotomy to those, who had received none or only non-surgical therapy prior to the POEM procedure...
October 3, 2016: Surgical Endoscopy
Grace Hofmann, Lutana Haan, Jeff Anderson
Esophageal balloons are used in the respiratory monitoring of critical care patients. After the esophageal pressure is measured, the corresponding pleural pressure in the thorax can be projected, enabling lung-thorax compliance to be partitioned into chest-wall compliance and lung compliance. The esophageal balloon allows determination of transpulmonary pressures and a correspondingly individually tailored approach to respiratory care, such as patient-specific titration of positive end-expiratory pressure for patients with extrapulmonary acute respiratory distress syndrome...
October 2016: Critical Care Nurse
Abdulghani Sankari, Sukanya Pranathiageswaran, Scott Maresh, Arwa Mohammad Hosni, M Safwan Badr
RATIONALE: Current scoring criteria of non-apneic events (i.e. hypopnea) require the presence of oxyhemoglobin de-saturation and/or arousal. However, other sleep study parameters may help to identify abnormal respiratory events and assist in making more accurate diagnosis. OBJECTIVES: To investigate whether non-apneic respiratory events without de-saturation or cortical arousal are associated with respiratory and cardiac consequences. METHODS: Thirteen participants with sleep disturbances (snoring and/or excessive day time sleepiness), were screened using attended in laboratory polysomnography (PSG) while monitoring pressure and airflow via a nasal mask with an attached pneumotach...
September 26, 2016: Sleep
Margaret Freede, A Renee Leasure, Howard M Proskin, Daniel Hatch, Karethy Edwards, MaryAnn Pascucci, Patsy R Smith
This study tested the primary hypothesis that there is a correlation of maximum pain threshold (MPT) in the esophagus and rectum in persons with functional heartburn. Secondary aims evaluated correlations with initial perception threshold (IPT) and pain threshold (PT). This study explored objective sensory endpoints of IPT, PT, and MPT in the esophagus and rectum of 14 females with functional heartburn to determine whether visceral hypersensitivity is generalized or organ-specific. Data on volume and pressure measurements at IPT, PT, and MPT with esophageal and rectal barostat distention were collected...
September 2016: Gastroenterology Nursing: the Official Journal of the Society of Gastroenterology Nurses and Associates
Fuzeng Su, Cheng Zhang, Limu Ke, Zhi Wang, Yiliang Li, Huiling Li, Zhi Du
OBJECTIVE: To compare the efficacy and safety among laparoscopic Nissen, Toupet and Dor fundoplication in the treatment of hiatal hernia complicated with gastroesophageal reflux disease (GERD). METHODS: Clinical data of 276 patients of hiatal hernia complicated with GERD undergoing operation in our hospital from December 2012 to January 2015 were retrospectively analyzed, including 149 patients of laparoscopic Nissen fundoplication (Nissen group), 41 of laparoscopic Toupet fundoplication (Toupet group), and 86 patients of laparoscopic Dor fundoplication (Dor group)...
September 25, 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Mariangela Giunta, Dario Conte, Mirella Fraquelli
The development of liver cirrhosis and portal hypertension (PH), one of its major complications, are structural and functional alterations of the liver, occurring in many patients with chronic liver diseases (CLD). Actually the progressive deposition of hepatic fibrosis has a key role in the prognosis of CLD patients. The subsequent development of PH leads to its major complications, such as ascites, hepatic encephalopathy, variceal bleeding and decompensation. Liver biopsy is still considered the reference standard for the assessment of hepatic fibrosis, whereas the measurement of hepatic vein pressure gradient is the standard to ascertain the presence of PH and upper endoscopy is the method of choice to detect the presence of oesophageal varices...
September 21, 2016: World Journal of Gastroenterology: WJG
V Becker, D Ostler, H Feussner, S Nennstiel, B Haller, R M Schmid, M Bajbouj, A Schneider
BACKGROUND: Esophageal bougination is a worldwide standard endoscopic procedure. Clinical methods and recommendations are based on clinical experiences only. Mechanical properties have never been described. Aim of the study was to establish a realistic ex vivo training model. Therefore, detailed assessment of relevant mechanical features of esophageal bougination should be evaluated ex vivo and in patient setting and correlated against. PATIENTS AND METHODS: A three-step concept was used to evaluate mechanical properties at stenosis level...
September 26, 2016: Surgical Endoscopy
X-L Xiang, A Wang, L Tu, M-Y Ke, Y-S Yang, B Jiang, L Lin, N Dai, S-S Zhang, L Tao, H Xu, X-M Liang, X-C Fang, Z-W Xia, X Wang, J-N Wu, M-F Wang, H-J Zhang, Y-F Fang, C Shen, J Wang, L-H Peng, W-Y Li, Z-F Wang, K Wang, N Liu, X-H Hou
BACKGROUND: It is gradually accepted that solid bolus swallow needs to be added to the procedure of manometry. The motility differences in the upper esophageal sphincter (UES) and lower esophageal sphincter (LES) were not well described. Sierra Scientific Instruments solid-state high-resolution manometry (HRM) system, the most popular HRM system in China, lacks the Chinese normative values for both liquid and solid bolus swallow parameters. METHODS: The esophageal HRM data of 88 healthy volunteers were analyzed...
September 25, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
D A Carlson, T Omari, Z Lin, N Rommel, K Starkey, P J Kahrilas, J Tack, J E Pandolfino
BACKGROUND: High-resolution impedance manometry (HRIM) allows evaluation of esophageal bolus retention, flow, and pressurization. We aimed to perform a collaborative analysis of HRIM metrics to evaluate patients with non-obstructive dysphagia. METHODS: Fourteen asymptomatic controls (58% female; ages 20-50) and 41 patients (63% female; ages 24-82), 18 evaluated for dysphagia and 23 for reflux (non-dysphagia patients), with esophageal motility diagnoses of normal motility or ineffective esophageal motility, were evaluated with HRIM and a global dysphagia symptom score (Brief Esophageal Dysphagia Questionnaire)...
September 20, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
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