Esophageal Motility Disorders in Patients With Esophageal Barium Residue After Videofluoroscopic Swallowing Study

Jintae Park,Sora Baek,Gowun Kim,Seung-Joo Nam,Ji Hyun Kim 대한재활의학회 2022 Annals of Rehabilitation Medicine Vol.46 No.5

Objective To investigate esophageal motility disorders in patients with esophageal residual barium on chest x-rays after videofluoroscopic swallowing studies (VFSS) through high-resolution esophageal manometry (HREM).Methods We reviewed the records of 432 patients who underwent VFSS from September 2019 to May 2021, and 85 patients (19.7%) with large residual barium (diameter ≥1 cm) were included. As a result of HREM, motility disorders were classified as major or minor motility disorders according. Esophagogastroduodenoscopy and chest computed tomography results available were also reviewed.Results Among 85 patients with large residual barium in the esophagus, 16 patients (18.8%) underwent HREM. Abnormal esophageal motilities were identified in 68.8% patient: three patients (18.8%) had major motility disorders—achalasia (n=1), esophagogastric junction (EGJ) outflow obstruction (n=2)—and eight patients (50%) had minor motility disorders—ineffective esophageal motility (n=7), fragmented peristalsis (n=1). In those with normal esophageal motility, three patients of esophageal structure disorders (18.8%)—esophageal cancer (n=1), cardiogenic dysphagia (n=1), slight narrowing without obstruction of EGJ (n=1)—and two patients (12.5%) with chronic atrophic gastritis (n=2) were confirmed.Conclusion Esophageal motility disorders were identified in 68.8% of 16 patients with large esophageal residual barium with three patients in the major and eight patients in the minor categories. Residual barium in the esophagus was not rare and can be a sign of significant esophageal motility disorders.

흉통의 원인으로서 식도성 장애에 관한 연구

황흥곤 世宗醫學硏究所 1993 世宗醫學 Vol.10 No.1

비심인성흉통환자에서의 식도질환의 빈도

송철수,성은영,김광하,허정,송근암,조몽,양웅석 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.2

Mosapride Improves Lower Esophageal Sphincter and Esophageal Body Function in Patients With Minor Disorders of Esophageal Peristalsis

( Sung Eun Kim ),( Moo In Park ),( Seun Ja Park ),( Won Moon ),( Jae Hyun Kim ),( Kyoungwon Jung ),( Hye Jung Kwon ),( Gyung Mi Kim ),( Hee Kyoung Joo ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2020 Journal of Neurogastroenterology and Motility (JNM Vol.26 No.2

Background/Aims High-resolution manometry (HRM) has broadened the awareness of minor esophageal peristaltic disorders. However, the treatments for these minor disorders are limited and the role of prokinetics has been controversial. This study evaluates the effect of mosapride in patients with minor peristaltic disorders. Methods This study prospectively enrolled 21 patients with esophageal symptoms who were diagnosed with minor peristaltic disorders by gastroscopy and HRM using the Chicago classification version 3.0. Patients received mosapride 30 mg daily for 2 weeks. Symptoms were assessed using the abbreviated World Health Organization quality of life scale (WHOQOL-BREF) and a HRM study was performed before and after 2 weeks of treatment. Results HRM metrics of lower esophageal sphincter (LES) respiratory mean pressure (median 14.6 mmHg vs 17.3 mmHg; interquartile range [IQR] 8.7-22.5 mmHg vs 12.5-25.9 mmHg; P = 0.004) and distal contractile integral (median 343.8 mmHg·sec·cm vs 698.1 mmHg·sec·cm; IQR 286.5-795.9 mmHg·sec·cm vs 361.0-1127.6 mmHg·sec·cm; P = 0.048) were significantly increased after treatment. Complete response (≥ 80.0%), satisfactory response (≥ 50.0%), partial response (< 50.0%), and refractory response rates were 19.0%, 52.4%, 14.3%, and 14.3%, respectively. However, there was no statistical difference in all WHOQOL-BREF scores before and after treatment. Univariate analysis showed LES respiratory mean pressure (P = 0.036) was associated with symptom improvement (complete + satisfactory group). However, no statistical difference was found in other factors after multivariate analysis. Conclusions Mosapride improved esophageal symptoms and significantly increased LES respiratory mean pressure and distal contractile integral. Therefore, mosapride could enhance LES and esophageal body contraction pressures in patients with minor peristaltic disorders. (J Neurogastroenterol Motil 2020;26:232-240)

Review : Clinical Application of Esophageal High-resolution Manometry in the Diagnosis of Esophageal Motility Disorders

( Froukje B Van Hoeij ),( Albert J Bredenoord ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2016 Journal of Neurogastroenterology and Motility (JNM Vol.22 No.1

Esophageal high-resolution manometry (HRM) is replacing conventional manometry in the clinical evaluation of patients with esophageal symptoms, especially dysphagia. The introduction of HRM gave rise to new objective metrics and recognizable patterns of esophageal motor function, requiring a new classification scheme: the Chicago classification. HRM measurements are more detailed and more easily performed compared to conventional manometry. The visual presentation of acquired data improved the analysis and interpretation of esophageal motor function. This led to a more sensitive, accurate, and objective analysis of esophageal motility. In this review we discuss how HRM changed the way we define and categorize esophageal motility disorders. Moreover, we discuss the clinical applications of HRM for each esophageal motility disorder separately. (J Neurogastroenterol Motil 2016;22:6-13)

비효과적 식도운동은 일과성 내압검사 소견인가?

김주형 ( Ju Hyung Kim ),황진기 ( Jin Ki Hwang ),최우석 ( Woo Seok Choi ),이범재 ( Beom Jae Lee ),박종재 ( Jong Jae Park ),김재선 ( Jae Seon Kim ),박영태 ( Young Tae Bak ) 대한소화기기능성질환·운동학회 2008 Journal of Neurogastroenterology and Motility (JNM Vol.14 No.2

목적: 비효과적 식도운동(ineffective esophgeal motility, IEM)은 물을 삼킬 때 유발되는 수축파들 중에서, 하부 식도체부에서 수축파의 압력이 30 mmHg 미만이거나 전달이 안되는 수축파가 전체 수축파의 30%를 넘을 때로 특징 지워진다. IEM은 일상적 식도내압검사에서 가장 흔히 발견되는 이상소견이며, 기존에 분류되었던 비특이적 식도운동장애의 대부분을 차지한다. IEM의 임상적 중요성은 현재 밝혀지고 있는 중이나, 많은 부분이 아직 명확히 규명되지 않은 상태로 남아있다. IEM이라는 질환의 향후 결과가 어떻게 될 지는 명확하지 않으며, 또한 이것이 지속적인 현상일지 향후 소실되는 것인지, 아니면 다른 운동장애질환으로 전환되는지에 대해서는 아직까지 잘 알려져 있지 않다. 이에 저자는 본 병원에서 IEM으로 진단받은 환자들 식도내압검사를 일정기간 경과 후 재시행함으로써, IEM의 임상경과에 대하여 알아보고자 하였다. 대상 및 방법: 식도내압검사에서 IEM으로 진단 받은 65예(남자:여자=27:38예, 나이 44.6±11.6세)에서, 15 (중앙값, 범위 2-89)개월 뒤 추적 식도내압검사를 시행하였다. 결과: 65예 중 38예(58%)는 두 번째 식도내압검사에서도 여전히 IEM을 가지고 있었으며, 27예(42%)는 정상으로 해석되었다. 재시행한 식도내압검사에서 정상으로 진단된 27예 중 11예(41%)에서는 저압성 또는 비전달성 수축이 전체 삼킴의 30%에 해당되어 경계 영역에 위치하였다. 다른 연구자들이 사용하는 대로 비효과적 수축이 30% 이상인 경우를 IEM 진단기준으로 적용한다면, 총 65예 중 49예(75%)가 추적검사에서도 IEM으로 진단된다고 간주할 수 있을 것이다. 결론: IEM으로 첫 진단된 후 수개월 내지 수년이 경과한 다음 재시행한 검사에서도 반 수 이상에서 IEM이 지속적으로 존재하였다. 따라서 IEM은 일과성인 식도내압 이상 소견이 아닌 지속적인 식도운동장애의 하나라고 결론 내릴 수 있었다. Background/Aims: Ineffective esophageal motility (IEM) is the most commonly found manometric abnormality in manometry laboratory, and most cases of nonspecific esophageal motility disorder belong to this diagnosis. The clinical significance of IEM remains unclear, but much part of this entity is still need to be explored. The clinical course of IEM is not known clearly, and whether it will persist, resolve, or convert to other motility disorders is still unrevealed. To elucidate the short and long term clinical course of IEM, the cases with IEM were followed up with esophageal manometry. Methods: In 65 cases (M:F 27:38 cases, age 44.6±11.6 years) with manometrically diagnosed IEM, esophageal manometry was repeated after a median period of 15 (range 2-89) months. Results: Follow up study revealed that 38 cases (58%) still had IEM at the second study, and 27 cases (42%) became to belong to normal range of criteria. Among these 27 cases diagnosed as normal at the second study, ineffective contractions constituted 30% of total swallows in 11 cases (41%). Conclusions: This observation suggests that IEM is a persistent esophageal motility disorder at least in more than half of cases throughout months or years after initial diagnosis. (Kor J Neurogastroenterol Motil 2008;14:103-107)

만성적인 후두증상을 주소로한 환자에서의 식도내압검사 및 24 시간 보행성 pH 검사소견

방춘상(Choon Sang Bhang),노대근(Dae Keun Lo),박수헌(Soo Heon Park),최명규(Myung Gyu Choi),한준열(Jun Yeul Han),정인식(In Sik Chung),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박두호(Doo Ho Park),김부성(Boo Sung Kim),조승호(Seung Ho Ch 대한내과학회 1996 대한내과학회지 Vol.51 No.6

Objectives: The exact causes of nonspecific chronic laryngitis or laryngeal symptoms are unknown, but many cases of this disease are associated with gastroesophageal reflux or motility disorders of esophagus. We suppose that because Korean people have less gastroesaphageal reflux diseases and the life style including food is different from those of western people, the causes of chronic laryngeal symptoms nre different, So we studied the patients who complained the chronic laryngeal symptoms for evaluation of the role of esophageal motility disorders and gastroesophageal reflux. Methods: 19 patients(male 3, female 16, mean age 40(26-66)) with hoarseness, globus sensation, sorethroat of chronic nature(greater than 3-month duration), not response to conventional therapy of otolaryngologist in St. Mary's Hospital were referred to department of internal medicine. A group of normal, 15 healthy subjects(male 7, female 8, mean age39(24-57)) who had no esophageal or laryngeal symptoms was studied as a control group. All patients and normal controls had manometric studies and 24 hour ambulatory pH monitoring. abnormal findings required pathologic reflux or results greater than the mean plus 2 SDs of normal controls. Results: 1) The chronic laryngeal symptoms were hoarseness in 15 patients(79%), globus sensation in 14 patients(74%), sorethroat in 6 patients(32%), pulmonary symptoms in 3 patients(16%), dysphagia in 2 patients(11%) and heartburn in 1 patient(5%). 2) The lower esophageal sphincter pressure by the rapid pull through tecnique(mean±SD, 27,9± 6.9mmHg) in patients was not different compared with normal controls(31,1±11.0nmHg), 3 patients (16%) had esophageal body dysmotility and all of these were non specific motility disorder. 3) The upper esophageal sphincter pressure(mean±SD, 53.2±23.8mmHg) in patients was not different compared with normal controls(40.9±20.8mmHg), but 2 patients(10.5%) had high upper esophageal sphincter pressures(>82,5mmHg), The postrelaxation pressure of upper esophageal sphincter(mean±SD,98.3±32.1mmHg) was not different compared with normal controls(79,8±30.6mmHg), but 2 patients(10.5%) had high postrelaxation pressures of upper esophageal sphincter(>141mmHg). 4) The time(mean±SD, 321±193msec) between lowest point of upper esophageal sphincter relaxation and onset of pharyngeal contraction was not different compared with normal controls(273.5±179,8msec). 5) The percentage of time of pH less than 4 was 2.4±4.7% in total periods, 2.5±2.3% in upright position and 2.4±9.7% in supine position. Two patients (10.5%) had pathologic reflux(more than 4% of percentage of time pH less than 4 in total periods) and one patient with 2.5% of persentage of time pH less than 4 had high symptom index(66.7%(4/6)). 6) According to above results either of abnormal esophageal pressure or dysmotility was seen in 6 patients(32%) and either of more than 4% of persentage time pH less than 4 in total periods or positive symptom index was seen in 3 patients(16%), Positive results in either of two tests were seen in 7 patients(37%). Conclusion We suggest that some patients who complain the chronic laryngeal symptoms in Korean may have abnormal esophageal motility or gastroesophageal reflux.

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)

인후부 및 전흉부 이물감을 호소하는 환자에서의 식도운동 질환

박승국(Soong Kook Park),강영우(Young Woo Kang),한창엽(Chang Yeob Han) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.2

N/A Our aim was to determine whether globus sense in throat or anterior chest could be a manifestation of esophageal motility disorders. We have performed solid state esophageal manometry in, 88 patients who complained of globus in throat or anterior chest without abnormalities on upper gastrointestinal endoscopy, indirect laryngos- copy, chest PA and electrocardiogram. Twenty six patiente had complaint of globus sense in throat, 57 patients in anterior chest and 5 patients in both. Among them, twenty eight patients had esophageal motility disorders: nonspecific esophageal motility disorder in 16 (18%), nutcracker esophagus in 10 (11.4%), and hypertensive lawer esophageal sphincter in 2 (2.3%). While four patients (15.4%) had esophageal motility disorders among 26 patients with globus sense in throat, 22 patients (38.6%) had esophageal motility disorders among 57 patients with globus sense in anterior chest and two patients (40%), among five patients with globus sense in throat and anterior chest. In concluaion, a part of patients with globus sense do have real esophageal motility disorders, especially patients with globus sense in anterior chest

Diagnostic Yield of High-resolution Esophageal Manometry With Chicago Classification Version 3.0 in Thai Patients

( Sawangpong Jandee ),( Kasemsak Jandee ) 대한소화기기능성질환·운동학회 2021 Journal of Neurogastroenterology and Motility (JNM Vol.27 No.4

Background/Aims High-resolution manometry with the Chicago classification scheme has been introduced in clinical practice as a gold standard for esophageal motility test. This study aims to evaluate the diagnostic yield of high-resolution manometry in Thai patients. Methods All available high-resolution esophageal manometry (HREM) studies performed during the study period were retrospectively reviewed and interpreted according to the Chicago classification version 3.0. The main esophageal symptoms and coexisting factors were correlated with the HREM findings. Results Of the 201 patients, nearly half (49.8%) were documented to have dysphagia. The second most common condition was refractory reflux symptoms (17.4%). More than 70.0% of dysphagia patients showed abnormal esophageal motility, contrary to globus patients who mostly had normal test findings (65.4%). Dysphagia still was the most often correlated condition with major esophageal motility disorders (88.7%), particularly the elderly patients who have coexisting weight loss. Endoscopic and/or surgical procedures were revealed for the highest rate among patients with dysphagia but no one in the globus group needed this intervention. The sensitivity and specificity of dysphagia for major esophageal motility disorders were 70.0% and 67.0%. A much lower sensitivity and higher specificity were found in other non-dysphagia symptoms, especially nausea/vomiting or belching (3.0% or 89.0%). The highest positive likelihood ratio (2.10) to detect major abnormalities was also observed in dysphagia. Conclusion Esophageal manometry provided the highest yield in dysphagia; it was not a strongly beneficial test in patients presenting with nondysphagia to identify clinically relevant esophageal motor disorders. (J Neurogastroenterol Motil 2021;27:533-539)