High-resolution Manometry Findings in Patients After Sclerotherapy for Esophageal Varices

( Fernando A M Herbella ),( Ramiro Colleoni ),( Luiz Bot ),( Fernando P P Vicentine ),( Marco G Patti ) 대한소화기기능성질환·운동학회 2016 Journal of Neurogastroenterology and Motility (JNM Vol.22 No.2

Background/Aims Endoscopic therapy for esophageal varices may lead to esophageal dysmotility. High-resolution manometry is probably the more adequate tool to measure esophageal motility in these patients. This study aimed to evaluate esophageal motility using high resolution manometry following eradication of esophageal varices by endoscopic sclerotherapy. Methods We studied 21 patients (11 women, age 52 [45-59] years). All patients underwent eradication of esophageal varices with endoscopic sclerotherapy and subsequent high resolution manometry. Results A significant percentage of defective lower esophageal sphincter (basal pressure 14.3 [8.0-20.0] mmHg; 43% hypertonic) and hypocontractility (distal esophageal amplitude 50 [31-64] mmHg; proximal esophageal amplitude 40 [31-61] mmHg; distal contractile integral 617 [403-920] mmHg·sec·cm; 48% ineffective) was noticed. Lower sphincter basal pressure and esophageal amplitude correlated inversely with the number of sessions (P < 0.001). No manometric parameter correlated with symptoms or interval between last endoscopy and manometry. Conclusions Esophageal motility after endoscopic sclerotherapy is characterized by: (1) defective lower sphincter and (2) defective and hypotensive peristalsis. Esophageal dysmotility is associated to an increased number of endoscopic sessions, but manometric parameters do not predict symptoms. (J Neurogastroenterol Motil 2016;22:226-230)

Raynaud씨 증상이 식도 운동에 미치는 영향

이오영 ( Oh Young Lee ),김태환 ( Tae Hwan Kim ),고희관 ( Hee Kwan Koh ),이제경 ( Je Kyung Lee ),유태석 ( Tae Seok Yoo ),장대국 ( Dae Kook Chang ),심승철 ( Seung Cheol Shim ),전재범 ( Jae Bum Jun ),정성수 ( Sung Soo Jung ),이인홍 ( 대한류마티스학회 1998 대한류마티스학회지 Vol.5 No.1

Objectives: In the connective tissue disease patients, esophageal dysfunction is often closely associated with the presence of Raynaud`s phenomenon. But there are no previous reports concerning the values of esophageal manometry in the connective tissue disease with Raynaud`s phenomenon in Korea. Therefore, we performed this study to evaluate esophageal function in connective tissue disease with Raynaud`s phenomenon. Methods: Total 86 subjects were employed in this study including 30 normal control group, 14 mixed connective tissue disease(MCTD), 21 systemic sclerosis, 16 systemic lupus erythematosus(SLE), and 5 Raynaud`s phenomenon only. In each subject, esophageal manometric study was performed with lower compliance capillary infusion system. Results: The mean age(±SD) of patients and controls were as follows: MCTD 34.1(±8.9), systemic sclerosis 44.9(±9.3), SLE 32.1(±7.9), and normal controls 31.9(±5.3). All patients with MCTD and systemic sclerosis had Raynaud`s phenomenon. Twelve out of 14 patients with MCTD, 17 out of 21 patients with systemic sclerosis, were abnormal in esophageal manometry. Nine out of 16 SLE had Raynaud`s phenomenon. Among 9 SLE with Raynaud`s phenomenon, 5 patients(55.5%) were abnormal in esophageal manometry, and among 7 SLE without Raynaud`s phenomenon, 2 patients(28.6%) were abnormal in esophageal manometry. Among 5 patients with Raynaud`s phenomenon, 3 patients were abnormal in esophageal manometry. Abnormal esophageal manometry finding is more common in the connective tissue disease patients with Raynaud`s phenomenon compared with the patients without Raynaud`s phenomenon (P=0.0219). Conclusions: Abnormal esophageal manometry finding is more common in the connective tissue disease patients with Raynaud`s phenomenon compared with the patients without Raynaud`s phenomenon.

An Evidence of Esophageal Decompensation in Patients With Achalasia in the View of Its Subtype: A Retrospective Study

이광원,전한호,김지현,윤영훈,박효진,이상인 대한소화기 기능성질환∙운동학회 2013 Journal of Neurogastroenterology and Motility (JNM Vol.19 No.3

Background/Aims Achalasia is a primary motility disorder of esophagus. Many parameters represent esophageal function and morphologic changes, but their interrelationship is not yet established. We hypothesized that esophageal body would need to generate unusual pressure to empty the food bolus through the non-relaxing lower esophageal sphincter in patients with achalasia; therefore, higher is the residual lower esophageal sphincter pressure, greater would be the contraction pressure in the esophageal body in these patients. To verify the hypothesis, correlations among parameters from esophageal manometry, esophagography and esophageal transit study had been investigated. Methods A retrospective review of 34 patients was conducted. Resting lower esophageal sphincter pressure and contraction pressure of esophageal body were obtained from conventional esophageal manometry. Diameter of esophageal body was measured from barium column under esophagography. Radionuclide imaging was performed to assess the esophageal transit, designated as R30, which was the residual radioactivity at 30 seconds after ingesting radioactive isotope. Results In vigorous achalasia group, contraction pressure of esophageal body was negatively correlated to dilated diameter of esophageal body (P = 0.025, correlation coefficient = -0.596). Esophageal transit was more delayed as dimensions of esophageal body increased in classic achalasia group (P = 0.039, correlation coefficient = 0.627). Conclusions Diameter of esophageal body in classic achalasia was relatively wider than that of vigorous achalasia group and the degree of delayed esophageal transit was proportionate to the luminal widening. Patients with vigorous achalasia had narrower esophageal lumen and relatively shorter transit time than that of classic achalasia group. Proper peristalsis is not present in achalasia patients but remaining neuromuscular activity in vigorous achalasia patients might have caused the luminal narrowing and shorter transit time.

Interpretation of Impedance Data on High-resolution Impedance Manometry Studies—A Worldwide Survey

Lev Dorfman,Sherief Mansi,,Khalil El-Chammas,Chunyan Liu,Ajay Kaul 대한소화기 기능성질환∙운동학회 2024 Journal of Neurogastroenterology and Motility (JNM Vol.30 No.1

Background/AimsEsophageal manometry is the gold standard for esophageal motility evaluation. High-resolution esophageal manometry with impedance (HRIM) allows concurrent assessment of bolus transit and manometry. Inconsistencies between concomitant impedance and manometry data pose a clinical dilemma and has not yet been addressed. We aim to assess interpretation trends of HRIM data among gastroenterologists worldwide. MethodsA cross-sectional study using an anonymous survey was conducted among gastroenterologists worldwide. Statistical analysis was performed to compare responses between providers. ResultsWe received responses from 107 gastroenterologists (26 countries). Most were adult providers (69, 64.5%), and most (77, 72.0%) had > 5 years of experience. Impedance was found to be helpful by 83 (77.6%) participants, but over 30% reported inconsistencies between impedance and manometry data. With incomplete bolus clearance and normal manometry 41 (38.7%) recommended observation, 41 (38.7%) recommended 24-hours pH-impedance, and 16 (15.1%) recommended prokinetics. With abnormal manometry and complete bolus clearance, 60 (57.1%) recommended observation while 18 (17.1%) recommended 24-hours pH impedance and 15 (14.3%) recommended prokinetics. A significant difference was found between providers from different continents in treating cases with discrepancy between impedance and manometry findings (P < 0.001). No significant differences were seen in responses between adult versus pediatric providers and between providers with different years of experience. ConclusionsThere is no consensus on interpreting HRIM data. Providers’ approaches to studies with inconsistencies between manometry and impedance data vary. There is an unmet need for guidelines on interpreting impedance data in HRIM studies.

Esophageal Involvement and Determinants of Perception of Esophageal Symptoms Among South Koreans With Systemic Sclerosis

( Joon Seong Lee ),( Hyun-sook Kim ),( Jung Rock Moon ),( Tom Ryu ),( Su Jin Hong ),( Young Sin Cho ),( Junseok Park ),( Tae Hee Lee ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2020 Journal of Neurogastroenterology and Motility (JNM Vol.26 No.4

Background/Aims Our study aims to characterize esophageal motor function; evaluate the relationships among esophagogastroduodenoscopy (EGD), high-resolution manometry (HRM), and 24-hour esophageal multichannel intraluminal impedance monitoring combined with pH-metry (MII-pH); and elucidate the determinants of esophageal symptom perception in South Koreans with systemic sclerosis (SSc). Methods We reviewed prospectively collected HRM (n = 46), EGD (n = 41), and MII-pH (n = 37) data from 46 consecutive patients with SSc (42 females; mean age 50.1 years) who underwent esophageal tests between June 2013 and September 2018. Results The most common HRM diagnosis was normal (39.1%), followed by ineffective esophageal motility (23.9%) and absent contractility (21.7%). Erosive esophagitis was observed in 12.2% of total SSc patients, with a higher frequency in patients with absent contractility than those with normal motility (44.5% vs 0.0%, P = 0.01). Pathologic acid exposure was observed in 6 patients (20.0%) and positive symptom association in 18 patients (60.0%) in MII-pH tests of symptomatic patients. The proportion of SSc patients with esophageal symptoms not explained by reflux or mucosal or motor esophageal abnormalities was 33.0%. Conclusions Esophageal involvement among South Koreans with SSc was characterized by heterogeneous motility patterns, with a higher prevalence of normal motility and lower prevalence of erosive esophagitis. Reflux hypersensitivity or functional heartburn might be partly attributed to the perception of esophageal symptoms in SSc patients who have neither gastroesophageal reflux disease nor esophageal dysmotility. (J Neurogastroenterol Motil 2020;26:477-485)

관류법과 비관류법 식도내압검사의 성적 비교

김경민(Kyoung Min Kim),송치욱(Chi Wook song),엄중식(Joong Sik Aum),진윤태(Yoon Tae Jeen),문정섭(Jeong Seop Moon),엄순호(Soon Ho Um),김창덕(Chang Duck Kim),류호상(Ho Sang Ryu),현진해(Jin Hae Hyun) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.5

N/A Background/Aims: Esophageal manometry is regarded as the gold standard in diagnosing the esophageal motility disorders. As manometric results are variable according to the methods and systems employed, we have had difficulty in comparing the manometric results measured by different methods and/or systems. To compare the results of esophageal manometry between infusion and non-infusion systems, we performed infusion manometry and non-infusion manometry. Methods: In 32 healthy volunteers and 108 patients with esophageal symptoms, we performed both low compliance pneumohydraulic capillary infusion manometry using 8 channel PVC catheter and non-infusion manometry using solid catheter in random order. Results: In healthy volunteers the manometric results were not significantly different between the two systems except the lower esophageal sphincter pressure, which was significantly higher in infusion system than in non-infusion system. In 108 patients complaining esophageal symptoms, the manometric diagnoses were different in 12 cases between the two systems; 5 cases were normal and nonspecific esophagea1 motility disorder, 3 cases were nonspecific esophageal motility disorder and nc>rmal, and 4 cases were hypertensive lower esophageal sphincter and normal by infusion system and non-infusion system respectively. Conclusions: In healthy volunteers the measured lower esophageal sphincter pressure was significantly higher in infusion system than in non-infusion system. In some symptomatic patients, the different diagnoses were observed between infusion and non-infusion systems, We think that we should consider a possible variation in manometric results derived from the different manometric systems employed in different studies. (Korean J Gastroenterol 1996; 28: 611 - 616)

일상적 식도내압검사에서 발견되는 비효과적 식도운동

김효정 ( Hyo Jung Kim ),연종은 ( Jong Eun Yeon ),박종재 ( Jong Jae Park ),김재선 ( Jae Seon Kim ),변관수 ( Kwan Soo Byun ),박영태 ( Young Tae Bak ),이창홍 ( Chang Hong Lee ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.4

Background/Aims: Esophageal contents either from swallow or reflux are cleared mostly by esophageal peristalsis. Hypotonic or nontransmitted contractions, known to be ineffective esophageal motility (IEM), carry out this function. Most cases of nonspecific esophageal motility disorder (NEMD) by conventional diagnosis belong to IEM. This study was carried out to estimate the prevalence of IEM and other manometric diagnoses among the cases undergoing routine esophageal manometry in Korea. Methods: After excluding patients with known connective tissue diseases, consecutive 1,940 cases undergoing routine esophageal manometry were included. Analysis of the manometric tracings was performed according to the conventional manometric criteria modified from that of Castell et al. and the new criteria modified from that of Fouad et al. Results: Among 347 cases of NEMD by conventional criteria, 331 cases (95.4%) belonged to IEM and the remaining 11 (3.2%) was normal. Among 1,345 cases with normal finding by conventional criteria, 249 cases (18.5%) were classified into IEM. Conclusions: Most cases of NEMD belong to IEM, and a small but significant proportion of cases conventionally considered as normal also belongs to IEM. The IEM is the most frequently observed abnormality from routine esophageal manometry. (Korean J Gastroenterol 2003;41:250-254)

비심인성 흉통에서 고해상식도내압검사의 역할

장원영,김승완,이진욱,이주엽 계명대학교 의과대학 2021 계명의대학술지 Vol.40 No.2

The most common cause of noncardiogenic chest pain is gastroesophageal reflux disease, and other esophageal motility disorders are also frequent. Esophageal manometry is important for diagnosing esophageal motility disease. Recently, high resolution manometry (HRM) has emerged and is reported to be more useful than conventional esophageal manometry in evaluating primary esophageal motility disease. In this study, the role and usefulness of HRM in noncardiac chest pain were investigated. From August 2018 to April 2021, 136 patients with chest pain were enrolled. Classification was carried out according to Chicago classification version 3.0, and 95 out of 136 patients showed normal findings, and 23 patients showed ineffective esophageal motility. When gastroesophageal reflux disease was classified according to Los Angeles (LA) classification, LA-M was 20% (6/30), LA-A was 63.3% (19/30), LA-B was 16.6% (5/30), and LA-C was, there were no patients with LA-D. Through this study, it was confirmed that about 22% of patients with noncardiogenic chest pain had reflux esophagitis, and about 30% of patients had esophageal motility disease. High-resolution esophageal manometry appears to be useful for the differentiation of noncardiogenic chest pain caused by esophageal motility disorders other than reflux esophagitis. After diagnosis of esophageal motor disease, follow-up studies on whether non-cardiac chest pain improves after drug treatment is required.

How to Interpret a Functional or Motility Test: How to Perform and Interpret Upper Esophageal Sphincter Manometry

( Shobna J Bhatia ),( Chirag Shah ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2013 Journal of Neurogastroenterology and Motility (JNM Vol.19 No.1

Manometry of the pharynx and the upper esophageal sphincter (UES) provides important information on the swallowing mechanism, especially about details on the pharyngeal contraction and relaxation of the UES. However, UES manometry is challenging because of the radial asymmetry of the sphincter, and upward movement of the UES during swallowing. In addition, the rapidity of contraction of the pharyngoesophageal segment requires high frequency recording for capturing these changes in pressure; this is best done with the use of solid state transducers and high-resolution manometry. UES manometry is not required for routine patient care, when esophageal manometry is being performed. The major usefulness of UES manometry in clinical practice is in the evaluation of patients with oropharyngeal dysphagia. (J Neurogastroenterol Motil 2013; 19:99-103).

삼킴곤란의 진단: 고해상도 내압 검사 및 엔도플립

차보람 ( Boram Cha ),정기욱 ( Kee Wook Jung ) 대한소화기학회 2021 대한소화기학회지 Vol.77 No.2

Esophageal motility disorders were re-defined when high-resolution manometry was employed to better understand their pathogenesis. Newly developed parameters including integrated relaxation pressure (IRP), distal contractile integral, and distal latency showed better diagnostic yield compared with previously used conventional parameters. Therefore, Chicago classification was formulated, and its diagnostic cascade begins by assessing the IRP value. However, IRP showed limitation due to its inconsistency, and other studies have tried to overcome this. Recent studies showed that provocative tests, supplementing the conventional esophageal manometry protocol, have improved the diagnostic yield of the esophageal motility disorders. Therefore, position change from supine to upright, solid or semi-solid swallowing, multiple rapid swallows, and the rapid drink challenge were newly added to the manometry protocol in the revised Chicago classification version 4.0. Impedance planimetry enables measurement of bag cross-sectional area at various locations. The functional lumen imaging probe (FLIP) has been applied to assess luminal distensibility. This probe can also measure pressure, serial cross-sectional areas, and tension-strain relationship. The esophagogastric junction’s distensibility is decreased in achalasia. Therefore, EndoFLIP can be used to assess contractility and distensibility of the esophagus in the patients with achalasia, including repetitive antegrade or retrograde contractions. EndoFLIP can detect achalasia patients with relatively low IRP, which was difficult to diagnose using the current high-resolution manometry. EndoFLIP also provides information on the contractile activity and distensibility of the esophageal body in patients with achalasia. The use of provocative tests, newly added in Chicago classification 4.0 version, and EndoFLIP can expand understanding of esophageal motility disorders. (Korean J Gastroenterol 2021;77:64-70)