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I Absah, A Rishi, N J Talley, D Katzka, M Halland
BACKGROUND: Rumination syndrome is a functional gastrointestinal disorder characterized by effortless and repetitive regurgitation of recently ingested food from the stomach to the oral cavity followed by either re-swallowing or spitting. Rumination is thought to occur due to a reversal of the esophagogastric pressure gradient. This is achieved by a coordinated abdominothoracic maneuver consisting of a thoracic suction, crural diaphragm relaxation and an increase in intragastric pressure...
October 20, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
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
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
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
Kornilia Nikaki, Joanne Li Shen Ooi, Daniel Sifrim
The Chicago classification (CC) is most valued for its systematic approach to esophageal disorders and great impact in unifying practice for esophageal manometric studies. In view of the ever-growing wealth of knowledge and experience gained by the expanding use of high-resolution manometry (HRM) in various clinical scenarios, the CC is regularly updated. Its clinical impact and ability to predict clinical outcome, both in adults and pediatrics, will be further promoted by recognizing its current limitations, incorporating new metrics in its diagnostic algorithms and adjusting the HRM protocols based on the clinical question posed...
November 2016: Current Gastroenterology Reports
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
Di Ma, Chong-Bo Chen, Jiajian Liang, Zhihao Lu, Haoyu Chen, Mingzhi Zhang
Tono-Pen and TonoVet have been used in rabbits to measure intraocular pressure (IOP) and investigate the effect of IOP lowering therapies. Therefore, their reliability and accuracy are very important and deserve careful evaluation. Our results showed that the with-subject deviation (Sw) and intraclass correlation coefficient (ICC) of the TonoVet and Tono-Pen were 0.61 mmHg/0.83 mmHg and 0.97/0.94, respectively for intrasession repeatability. For intersession reproducibility, the Sw and ICC of TonoVet and Tono-Pen were 1...
October 12, 2016: Scientific 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
Dustin A Carlson, Peter J Kahrilas, Zhiyue Lin, Ikuo Hirano, Nirmala Gonsalves, Zoe Listernick, Katherine Ritter, Michael Tye, Fraukje A Ponds, Ian Wong, John E Pandolfino
OBJECTIVES: Esophagogastric junction (EGJ) distensibility and distension-mediated peristalsis can be assessed with the functional lumen imaging probe (FLIP) during a sedated upper endoscopy. We aimed to describe esophageal motility assessment using FLIP topography in patients presenting with dysphagia. METHODS: In all, 145 patients (aged 18-85 years, 54% female) with dysphagia that completed upper endoscopy with a 16-cm FLIP assembly and high-resolution manometry (HRM) were included...
October 11, 2016: American Journal of Gastroenterology
C A Reddy, A Patel, C P Gyawali
BACKGROUND: High-resolution manometry (HRM) categorizes esophageal motor processes into specific Chicago Classification (CC) diagnoses, but the clinical impact of these motor diagnoses on symptom burden remain unclear. METHODS: Two hundred and eleven subjects (56.8±1.0 years, 66.8% F) completed symptom questionnaires (GERDQ, Mayo dysphagia questionnaire [MDQ], visceral sensitivity index, short-form 36, dominant symptom index, and global symptom severity [GSS] on a 100-mm visual analog scale) prior to HRM...
October 9, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
L Rodriguez, M Sood, C Di Lorenzo, M Saps
BACKGROUND: Over the last few years, the study of the colon and anorectal function has experienced great technical advances that have facilitated the performance of the tests and have allowed a more detailed characterization of reflexes and motor patterns. As a result, we have achieved a much better understanding of the pathophysiology of children with defecation problems. Anorectal and colonic manometry are now commonly used in all major pediatric referral centers as diagnostic tools and to guide the management of children with intractable constipation and fecal incontinence, particularly when a surgical intervention is being considered...
October 9, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
David O Prichard, Taehee Lee, Gopanandan Parthasarathy, Joel G Fletcher, Alan R Zinsmeister, Adil E Bharucha
BACKGROUND & AIMS: Contrary to conventional wisdom, the rectoanal gradient during evacuation is negative in many healthy people, undermining the utility of anorectal high resolution manometry (HRM) for diagnosing defecatory disorders. We aimed to compare HRM and magnetic resonance imaging (MRI) for assessing rectal evacuation and structural abnormalities. METHODS: We performed a retrospective analysis of 118 patients (all female; 51 with constipation, 48 with fecal incontinence, and 19 with rectal prolapse; age, 53±1 years) assessed by HRM, the rectal balloon expulsion test (BET), and MRI at Mayo Clinic, Rochester, Minnesota, from February 2011 through March 2013...
October 5, 2016: Clinical Gastroenterology and Hepatology
Paola De Nardi, Sabrina Gloria Giulia Testoni, Maura Corsetti, Hulda Andreoletti, Patrizia Giollo, Sandro Passaretti, Pier Alberto Testoni
BACKGROUND: An altered anorectal function is reported after chemoradiotherapy (CRT) and surgery for rectal cancer. AIM: The aim of this study was to clarify the relative contribution of neoadjuvant chemoradiation and surgical resection on the impairment of anorectal function as evaluated by anorectal manometry. METHODS: Thirty-nine patients with rectal cancer, who underwent neoadjuvant CRT and laparoscopic rectal resection, were evaluated with the Pescatori Faecal Incontinence score, and with anorectal manometry: before neoadjuvant therapy (T0), after neoadjuvant therapy and before surgery (T1), 12 months after stoma closure (T2)...
September 22, 2016: Digestive and Liver Disease
A Baumann, P O Katz
Swallowing involves complex coordination of the neuromuscular anatomy and physiology of the oropharynx and esophagus, controlled by the enteric and central nervous systems. Dysphagia is classified as either oropharyngeal or esophageal and results from mechanical or structural disturbances. Videofluoroscopy, fiberoptic endoscopic evaluation of swallowing, barium swallow, manometry, and endoscopy are common modalities utilized in diagnosis, but none is as important as a patient's history. Functional dysphagia is a diagnosis of exclusion and is based on Rome criteria...
2017: Handbook of Clinical Neurology
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
N Nakajima, H Sato, K Takahashi, G Hasegawa, K Mizuno, S Hashimoto, Y Sato, S Terai
BACKGROUND: Histopathology of muscularis externa in primary esophageal motility disorders has been characterized previously. We aimed to correlate the results of high-resolution manometry with those of histopathology. METHODS: During peroral endoscopic myotomy, peroral esophageal muscle biopsy was performed in patients with primary esophageal motility disorders. Immunohistochemical staining for c-kit was performed to assess the interstitial cells of Cajal (ICCs)...
October 3, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Dustin A Carlson, Zhiyue Lin, Peter J Kahrilas, Joel Sternbach, Eric S Hungness, Nathaniel J Soper, Michelle Balla, Zoe Listernick, Michael Tye, Katherine Ritter, Jenna Craft, Jody D Ciolino, John E Pandolfino
OBJECTIVES: We aimed to evaluate the value of novel high-resolution impedance manometry (HRIM) metrics, bolus flow time (BFT), and esophagogastric junction (EGJ) contractile integral (CI), as well as EGJ pressure (EGJP) and the integrated relaxation pressure (IRP), as indicators of treatment response in achalasia. METHODS: We prospectively evaluated 75 patients (ages 19-81, 32 female) with achalasia during follow-up after pneumatic dilation or myotomy with Eckardt score (ES), timed-barium esophagram (TBE), and HRIM...
October 4, 2016: American Journal of Gastroenterology
S Chakraborty, K J Feuerhak, A R Zinsmeister, A E Bharucha
BACKGROUND: While widely used in clinical practice, the reproducibility of high-definition anorectal manometry (HD-ARM) remains unclear. We evaluated the intra-individual reproducibility of HD-ARM and compared pressures measured with HD-ARM and high-resolution anorectal manometry (HR-ARM). METHODS: Thirty-six women with fecal incontinence had an initial HD-ARM (HD-ARM1); on the same day, after randomization, 21 had a second (HD-ARM2). Sixteen women had a third (HD-ARM3) 4 weeks later...
October 2, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
P W Hamer, R H Holloway, R Heddle, P G Devitt, G Kiroff, C Burgstad, S K Thompson
BACKGROUND: Achalasia can be subdivided into manometric subtypes according to the Chicago classification. These subtypes are proposed to predict outcome after treatment. This hypothesis was tested using a database of patients who underwent laparoscopic Heller's cardiomyotomy with anterior fundoplication. METHODS: All patients who underwent Heller's cardiomyotomy for achalasia between June 1993 and March 2015 were identified from an institutional database. Manometry tracings were retrieved and re-reported according the Chicago classification...
October 3, 2016: British Journal of Surgery
Jason Y Huang, Jason B Samarasena, Takeshi Tsujino, John Lee, Ke-Qin Hu, Christine E McLaren, Wen-Pin Chen, Kenneth J Chang
BACKGROUND & AIMS: Portal hypertension (PH) is a serious adverse event of liver cirrhosis. The hepatic venous pressure gradient or portal pressure gradient (PPG) accurately reflects the degree of PH and is the single best prognostic indicator in liver disease. This is usually obtained by interventional radiology (IR) although it is not routinely performed. Recently, we developed a simple novel technique for EUS-guided PPG measurement (PPGM). Our animal studies showed excellent correlation between EUS-PPGM and IR-PPGM...
September 29, 2016: Gastrointestinal Endoscopy
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