Abstract
The aim of this study was to assess the clinical utility of esophageal manometry among Sudanese patients presenting to the National Centre for Gastrointestinal and Liver Diseases, Ibn Sina Hospital, Khartoum, Sudan. Consecutive patients referred for esophageal manometry at the aforementioned center from July 2008 through January 2011 were included in the study. Manometric studies were done after stopping medicines with a known effect on esophageal motility and an overnight fast. Immediately before the manometric study, the patients' history and clinical examination were recorded using a structured questionnaire. The major referral reason was the investigation of dysphagia in 78 patients (60.5%), followed by the evaluation of Gastroesophageal reflux disease (GERD) in 39 patients (30%), while 11 patients (9%) were referred because of non-cardiac chest pain. The manometric diagnosis in the 78 patients with dysphagia, where 51(65.4%) had achalasia, 13(16.7%) had nonspecific motility disorder, the remaining percentage was formed by GERD diffuse esophageal spasm, connective tissue disease, Nutcracker esophagus, hypertensive lower esophageal sphincter, patient manometry suggestive of myasthenia gravis, and normal manometry. GERD and Achalasia were the commonest conditions among the study group. Patients presenting with achalasia manifest the same clinical symptoms as published in the literature. The leading abnormality predisposing to GERD was hypotensive lower esophageal sphincter and weak esophageal clearance function. GERD was main cause of non-cardiac chest pain in the study population. However, it is difficult to generalize the findings of this study for the whole country since it was a single center study.
Highlights
The manometric diagnosis in the 78 patients with dysphagia, where 51 (65.4%) patients had achalasia, 13 (16.7%) patients had nonspecific motility disorder, 5 (6.4%) patients had motility disorder predisposing to Gastroesophageal reflux disease (GERD), 2(2.3%) patients were found to have diffuse esophageal spasm, 2 (2.3%) of those studied were diagnosed with connective tissue disease, 1 (1.65%) patient had Nutcracker Oesophgus,1 (1.65%) patient had hypertensive lower esophageal sphincter, 1 (1.65%) patient had manometry suggestive of myasthenia gravis while in 2 (2.3%) patients the manometry study was absolutely normal
The mean duration of symptoms prior to diagnosis was 28.89 [1-156] months, this contrasts with several previous studies in which the mean duration of symptoms before diagnosis was reported to fall between 4.5 and 7.6 years. [15, 16] Looking at the clinical presentation of achalasia patients it revealed that our population manifest the same clinical profile published in the literature, with the most common presenting complaints at the time of diagnosis being: Dysphagia (82-100% of patients),postprandial and/or nocturnal reflux (59-64%),weight loss(30-91%),chest pain (1795%)and cough (11-46%). [17, 18] It is well known that Achalasia patients may experience gastro esophageal reflux symptoms and even develop esophagitis
GERD and Achalasia were the commonest conditions encountered among Sudanese patients referred for Motility studies
Summary
The aim of this study was to assess the clinical utility of esophageal manometry among Sudanese patients presenting to the National Centre for Gastrointestinal and Liver Diseases, Ibn Sina Hospital, Khartoum, Sudan. Results: The major referral reason was the investigation of dysphagia in 78 patients (60.5%), followed by the evaluation of Gastroesophageal reflux disease (GERD) in 39 patients (30%), while 11 patients (9%) were referred because of non-cardiac chest pain. The manometric diagnosis in the 78 patients with dysphagia, where 51(65.4%) had achalasia, 13(16.7%) had nonspecific motility disorder, the remaining percentage was formed by GERD diffuse esophageal spasm, connective tissue disease, Nutcracker esophagus, hypertensive lower esophageal sphincter, patient manometry suggestive of myasthenia gravis, and normal manometry.
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