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Oesophageal motility disorders

Matthew Banks, Rami Sweis
Achalasia is a rare oesophageal motility disorder predominantly causing dysphagia and regurgitation of food and fluids. Diagnosis is made typically after a combination of tests including endoscopy, barium swallow and oesophageal manometry. The advent of high-resolution manometry has led to the Chicago Classification which divided achalasia into three types. This improved the understanding of presentation, prognosis and might also help tailor therapy. Botulinum toxin has been shown to have good, but short-term efficacy...
April 2017: Frontline Gastroenterology
Daphne Ang, Benjamin Misselwitz, Michael Hollenstein, Kevin Knowles, Jeff Wright, Emily Tucker, Rami Sweis, Mark Fox
BACKGROUND: The use of high-resolution manometry (HRM) to diagnose oesophageal motility disorders is based on ten single water swallows (SWS); however, this approach might not be representative of oesophageal function during the ingestion of normal food. We tested whether inclusion of a standardised solid test meal (STM) to HRM studies increases test sensitivity for major motility disorders. Additionally, we assessed the frequency and cause of patient symptoms during STM. METHODS: Consecutive patients who were referred for investigation of oesophageal symptoms were recruited at Nottingham University Hospitals (Nottingham, UK) in the development study and at University Hospital Zürich (Zürich, Switzerland) in the validation study...
July 3, 2017: Lancet. Gastroenterology & Hepatology
Michael Hollenstein, Philip Thwaites, Simon Bütikofer, Henriette Heinrich, Matthias Sauter, Irina Ulmer, Daniel Pohl, Daphne Ang, Daniel Eberli, Werner Schwizer, Michael Fried, Oliver Distler, Mark Fox, Benjamin Misselwitz
BACKGROUND: The factors that determine how people eat when they are healthy or have disease have not been defined. We used high resolution manometry (HRM) to assess pharyngeal swallowing and oesophageal motility during ingestion of a solid test meal (STM) in healthy volunteers and patients with motility disorders. METHODS: This study was based at University Hospital Zurich (Zürich, Switzerland). Healthy volunteers who responded to an advertisement completed HRM with ten single water swallows (SWS) in recumbent and upright positions followed by a 200 g rice STM in the upright position...
July 3, 2017: Lancet. Gastroenterology & Hepatology
Eleni Theocharidou, Ameet Dhar, David Patch
Gastrointestinal motility is impaired in a substantial proportion of patients with cirrhosis. Cirrhosis-related autonomic neuropathy, increased nitric oxide production, and gut hormonal changes have been implicated. Oesophageal dysmotility has been associated with increased frequency of abnormal gastro-oesophageal reflux. Impaired gastric emptying and accommodation may result in early satiety and may have an impact on the nutritional status of these patients. Small intestinal dysmotility might be implicated in small intestinal bacterial overgrowth and increased bacterial translocation...
2017: Gastroenterology Research and Practice
A Jell, D Wilhelm, D Ostler, H Feußner, N Hüser
Diagnosis of oesophageal motility disorders has been well established for many years now, although circadian gastrointestinal motility is still purely understood. So far, high-resolution manometry (HRM) is only available for short-term measurement in clinical practice to evaluate simultaneous pressure conditions throughout the esophagus. Thus, only a very limited period of time can be investigated. There is evidence that disorders in esophageal motility can cause severe discomfort and symptoms even though they only tend to occur spontaneously...
September 2016: Zeitschrift Für Gastroenterologie
Sílvia Roure, Lluís Valerio, Xavier Vallès, Betty Morales, M Immaculada Garcia-Diaz, M Luisa Pedro-Botet, Jordi Serra
BACKGROUND: Immigration-related new diseases pose a growing challenge for healthcare services in receptor countries. Following Latin American migration, Chagas disease has inevitably appeared in Europe. AIM: To determine the prevalence and characteristics of oesophageal motility disorders in immigrants infected with Trypanosoma cruzi, using high resolution oesophageal manometry (HREM). METHODS: In all newly-diagnosed cases with chronic Chagas infection referring upper digestive symptoms, a protocolized clinical evaluation and complementary tests including barium oesophagogram and HREM were carried out...
August 2016: United European Gastroenterology Journal
Stefano Scaringi, Francesco Giudici, Paolo Bechi
No abstract text is available yet for this article.
August 2016: American Journal of Gastroenterology
Dejan Micic, Douglas Kyle Hogarth, Robert T Kavitt
Dysphagia is commonly attributed to disorders arising from dysfunction of the oesophageal mucosa or oesophageal motility. Mediastinal structures causing compression of the oesophagus remain a rare presenting cause of dysphagia. We report a case of a woman presenting with dysphagia to solid foods and associated symptoms of weight loss. Traditional evaluation for dysphagia was unrevealing until cross-sectional imaging suggested a mediastinal obstructive process. The finding of a mediastinal granuloma, distinct from mediastinal fibrosis, as the aetiology of dysphagia is a rare finding, with specific treatment implications...
June 14, 2016: BMJ Case Reports
Julie Lyngsø, Jan Bech Pedersen, Peter Rask, Rastislav Kunda, Niels Christian Bjerregaard
Achalasia is a rare oesophageal motility disorder which classically is not associated with obesity. We present the case of a 50-year-old woman who underwent gastric bypass and afterwards was diagnosed with achalasia. Following, she was treated successfully with peroral endoscopic myotomy (POEM). A thorough medical history revealed that symptoms of achalasia had been present for 25 years and were the cause of inappropriate eating habits and consequently morbid obesity. This case story illustrates the importance of being aware of simultaneous occurrence of achalasia and morbid obesity...
May 9, 2016: Ugeskrift for Laeger
Vachan S Hukkeri, Satyaprakash Jindal, Mohd Qaleem, Vivek Tandon, Deepak Govil
An epiphrenic oesophageal diverticulum is most commonly a pulsion diverticulum which develops consequent to protrusion of mucosa through the muscular wall of the distal oesophagus. Most of them are associated with underlying oesophageal motility disorders. The predominant symptoms are dysphagia with regurgitation, and sometimes retrosternal pain, if accompanied by spasm of the oesophagus. Surgical management is recommended for symptomatic patients. Traditional procedures include thoracotomy or laparotomy with excision of the diverticula, but these are associated with high morbidity...
December 2016: Journal of Robotic Surgery
Nishmi Gunasingam, Adam Perczuk, Michael Talbot, Arthur Kaffes, Payal Saxena
Achalasia is a primary esophageal motility disorder. It is the absence of peristalsis in the esophageal body and inability of the lower esophageal sphincter to relax, which characterizes this rare condition. Its features typically include dysphagia, regurgitation, chest pain, and weight loss. The ultimate goal in treating achalasia is to relieve the patient's symptoms, improve esophageal emptying, and prevent further dilatation of the esophagus. Current treatment modalities targeted at achalasia include pharmacological therapy, endoscopic therapy, and surgery...
August 2016: Journal of Gastroenterology and Hepatology
Emma J Molena, Ashwin Krishnamoorthy, Coimbatore Praveen
Achalasia is an idiopathic motility disorder of the oesophagus of increasing incidence. It is characterized by aperistalsis of the lower oesophagus and failure of relaxation of the lower oesophageal sphincter. Patients classically present with chronic symptoms of dysphagia, chest pain, weight loss and regurgitation, and they commonly suffer pulmonary complications such as recurrent microaspiration of static, retained food contents of the upper oesophagus. However, it has also been described, uncommonly, to present with megaoesophagus and secondary tracheal compression...
2016: Journal of Surgical Case Reports
An Moonen, Vito Annese, Ann Belmans, Albert J Bredenoord, Stanislas Bruley des Varannes, Mario Costantini, Bertrand Dousset, J I Elizalde, Uberto Fumagalli, Marianne Gaudric, Antonio Merla, Andre J Smout, Jan Tack, Giovanni Zaninotto, Olivier R Busch, Guy E Boeckxstaens
OBJECTIVE: Achalasia is a chronic motility disorder of the oesophagus for which laparoscopic Heller myotomy (LHM) and endoscopic pneumodilation (PD) are the most commonly used treatments. However, prospective data comparing their long-term efficacy is lacking. DESIGN: 201 newly diagnosed patients with achalasia were randomly assigned to PD (n=96) or LHM (n=105). Before randomisation, symptoms were assessed using the Eckardt score, functional test were performed and quality of life was assessed...
May 2016: Gut
N George, J Abdallah, C Maradey-Romero, L Gerson, R Fass
BACKGROUND: Non-cardiac chest pain is one of the most common functional gastrointestinal disorders. By recognising that gastro-oesophageal reflux disease (GERD), oesophageal dysmotility and oesophageal hypersensitivity are the main underlying mechanisms of NCCP, a more directed therapeutic approach has been developed. AIM: To determine the value of the current therapeutic modalities for NCCP. METHODS: Electronic (Pubmed/Medline/Cochrane central) and manual search...
January 2016: Alimentary Pharmacology & Therapeutics
Stijn Soenen, Christopher K Rayner, Karen L Jones, Michael Horowitz
PURPOSE OF REVIEW: This article reviews the impact of ageing on the gastrointestinal tract, including effects on the absorption of nutrients and drugs and the gastrointestinal tract defence system against ingested pathogens. RECENT FINDINGS: Recent publications support earlier observations of an age-related selective decline in gut function including changes in taste, oesophageal sphincter motility, gastric emptying, and neurons of the myenteric plexus related to gut transit which may impact the nutritional status...
January 2016: Current Opinion in Clinical Nutrition and Metabolic Care
Katarzyna Agnieszka Weterle-Smolińska, Marcin Banasiuk, Marcin Dziekiewicz, Michał Ciastoń, Gabriela Jagielska, Aleksandra Banaszkiewicz
Anorexia nervosa is a disease carrying havoc on many levels of the body functioning. The presence of numerous somatic complications as a consequence of starvation is an important part of the clinical picture of this disease. Symptoms of the gastrointestinal tract are one of the most common complaints reported by patients, especially in the initial period of realimentation. Most common symptoms are associated with gastrointestinal motility disorders. The available data show that as many as half of patients suffering from anorexia nervosa manifest significant gastrointestinal motility disorders (incomplete relaxation of the upper and lower oesophageal sphincter, impaired compliance of the stomach, delayed gastric emptying, intestinal transit extension, decreased motility of the rectum and anus)...
2015: Psychiatria Polska
P Rossi, S Isoldi, S Mallardo, G Biscione, S Oliva, D Rossetti, S Lucarelli, S Cucchiara
BACKGROUND: Patients (pts) with eosinophilic esophagitis (EoE), a chronic immune-mediated disorder, may exhibit symptoms of disturbed food transit (i.e. dysphagia, impaction) or mimicking gastro-oesophageal reflux (GOR). We aimed at characterizing in EoE pts the intra-esophageal pH pattern with 24-h multichannel intraluminal impedance (MII-pH) as well as the esophageal motility with high-resolution manometry (EHRM) METHODS:: during a 30 month period we studied 57 patients (pts), median age 11 years (range: 7-16): 25 with EoE, diagnosed according to widely agreed criteria (JPGN 2014;58:107-18; ESPGHAN guidelines) and 32 with GOR disease (GORD)...
October 2015: Journal of Pediatric Gastroenterology and Nutrition
S M Noor Hossain, John de Caestecker
Acute oesophageal symptoms include acute dysphagia or food bolus impaction (most commonly due to strictures, Schatzki ring and eosinophilic oesophagitis), acute chest pain with odynophagia due to oesophageal infections, motility disorders and acute oesophageal rupture (of which oesophageal intramural haematoma is a subtype). Acute full thickness oesophageal rupture carries a high mortality if not recognised early; the clinical features and conditions with which this may be confused are presented and discussed...
October 2015: Clinical Medicine: Journal of the Royal College of Physicians of London
Muzaffer Ilhan, Ahmet Danalioglu, Seda Turgut, Ozcan Karaman, Elif Arabaci, Ertugrul Tasan
INTRODUCTION: Although prolonged small intestine and colonic transit time has been demonstrated in acromegaly patients, the influence of acromegaly on oesophagus motility and the pathological mechanisms involved are still not clarified. We aimed to investigate manometric measurements to ascertain whether oesophagus motility is affected in active acromegaly patients. MATERIAL AND METHODS: The study was performed in an institutional referral centre at a tertiary care hospital...
2015: Endokrynologia Polska
Mehyar Hefazi Torghabeh, Cheguevara Afaneh, Taha Saif, Gregory F Dakin
Oesophageal achalasia is a rare, but serious condition in which the motility of the lower oesophageal sphincter (LES) is inhibited. This disorder of idiopathic aetiology complicates the peristaltic function and relaxation of the LES that may cause symptoms such as dysphagia, epigastric pain, and regurgitation of an obstructed food. The following case describes achalasia in a patient 5 years following a laparoscopic Roux-en-Y gastric bypass (RYGB). The patient underwent a laparoscopic Heller myotomy without a fundoplication...
July 2015: Journal of Minimal Access Surgery
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