Ambulatory Esophageal Manometry Research Articles

In memory of Gaston Vantrappen, 1927‐2020

Gaston Vantrappen passed away on February 11, 2020, in the presence of his wife and family. As the youngest of his mentees, I want to reflect on the significance of his life for the field of Neurogastroenterology and Motiliy. With the passing away of Gaston Vantrappen, the world lost a truly remarkable clinician, mentor and researcher, and a man with great leadership qualities. His dedication to Gastrointestinal Motility, as it was called in his pioneering days, and the way he led the field with innovative concepts, techniques, and approaches continue to resonate up to this day. His passion remains a source of inspiration to all those who had the privilege of working with him. Gaston Vantrappen was born in Welle, Belgium, on October 27, 1927. After obtaining his Medical Doctor Degree at Leuven University in 1953, he specialized in internal medicine at Leuven University Hospital Saint Raphael and Northwestern University Medical School in Chicago. He was appointed staff member in Internal Medicine at Leuven University Hospitals in 1962 and professor of Medicine in 1965 at Leuven University. In 1978, he became chief of the newly created service of Gastroenterology, and in 1979 he became chairman of Internal Medicine in the Leuven University Hospitals. Gaston Vantrappen was a true pioneer of motility research. He was among the first to perform esophageal manometry, and he set the standard for achalasia therapy using pneumatic dilations. In the 1970s and 1980s, achalasia patients came from all over the world to be treated by Prof. Vantrappen. He was also the first to describe the migrating motor complex in man and to demonstrate that its absence was associated with small intestinal bacterial overgrowth. His team unraveled the role of motilin as a trigger for human interdigestive motility and also pioneered ambulatory esophageal manometry and intestinal luminal EMG recording, developed, and validated the first gastric emptying breath test in the 1990s and established erythromycin and other macrolides as prokinetics acting through the motilin receptor. He was internationally very active, contributing with multiple abstracts and presentations to European and International Motility meetings and to Digestive Disease Week of the American Gastroenterology Association. He organized international motility meetings in Leuven in 1975 and 1986, and in Bruges in 1992. He founded the European Society of Neurogastroenterology and Motility in Leuven in 1982, together with Martin Wienbeck, David Wingate, and others. His legacy comprises not only the European Motility Society and his accomplishments in clinical research, but also large numbers of national and international internists and gastroenterologists who trained with him, and the very successful gastroenterology clinical and research unit he created in Leuven. In the motility field, he mentored several researchers who made significant contributions, such as Jan Hellemans, Jozef Janssens, Theo Peeters, Yvo Ghoos, Karel Geboes, Georges Coremans, Gilbert Ghillebert and Inge Depoortere in Belgium, and Salvatore Cucchiara, Raymond Jian, Jiande Chen, Anna Accarino, Daniel Sifrim, Apostolos Mantides, and Vito Annese, among others, internationally. We now had to say goodbye to an exceptional clinician and academic, who is one of the true big contributors to our field. His impact is perpetuated through his research, through the gastrointestinal motility bastion which the Leuven group continues to be, and through the large numbers of privileged clinicians, gastroenterologists and researchers who trained with him.

The role of ambulatory 24-hour esophageal manometry in clinical practice.

High‐resolution manometry revolutionized the assessment of esophageal motility disorders and upgraded the classification through the Chicago Classification. A known disadvantage of standard HRM, however, is the inability to record esophageal motility function for an extended time interval; therefore, it represents only a more snapshot view of esophageal motor function. In contrast, ambulatory esophageal manometry measures esophageal motility over a prolonged period and detects motor activity during the entire circadian cycle. Furthermore, ambulatory manometry has the ability to measure temporal correlations between symptoms and motor events. This article aimed to review the clinical implications of ambulatory esophageal manometry for various symptoms, covering literature on the manometry catheter, interpretation of findings, and relevance in clinical practice specific to the evaluation of non‐cardiac chest pain, chronic cough, and rumination syndrome.

Outcomes of laparoscopic sleeve gastrectomy by means of esophageal manometry and pH-metry, before and after surgery.

IntroductionGastroesophageal reflux is a major problem after sleeve gastrectomy. There is still insufficient understanding of how it occurs and whether it is due to the sphincter length, relaxation, or pressure differences.AimThis study evaluates the effect on the lower esophageal sphincter of the laparoscopic sleeve gastrectomy (LSG) technique applied in surgery in cases of morbid obesity using ambulatory 24-h pH monitoring (APM) and esophageal manometry (EM).Material and methodsA retrospective examination was carried out on the APM and EM tests performed preoperatively and postoperatively in cases of LSG. The parameters examined were the body mass index (BMI), amplitude pressure of the esophagus (AP), total length of the lower esophageal segment (LESL), resting pressure of the LES (LESP), residual pressure of the LES (LESR), relaxation time of the LES, intragastric pressure, and the DeMeester score.ResultsA total of 62 cases with available data were evaluated. A statistically significant difference was determined between the preoperative values and the 3-month postoperative values of BMI, LESP, and relaxation time of the LES. A statistically significant increase was determined in the DeMeester score, and the increase in the total number of reflux episodes longer than 5 min was found to be the most responsible for this increase. No significant difference was determined in the other parameters.ConclusionsThe LSG was found to cause a reduction in LESP, and an increase in acid reflux causing an extended relaxation time of the LES. This was confirmed by the increase seen in the DeMeester score.

Mo1503 - Gastroesophageal Reflux Disease Symptom Correlation with Ambulatory PH-Metry and Esophageal High Resolution Manometry in Lung Transplant Candidates

Mo1503 - Gastroesophageal Reflux Disease Symptom Correlation with Ambulatory PH-Metry and Esophageal High Resolution Manometry in Lung Transplant Candidates

Role of gastroesophageal reflux disease in lung transplantation.

Lung transplantation is one of the highest risk solid organ transplant modalities. Recent studies have demonstrated a relationship between gastroesophageal reflux disease (GERD) and lung transplant outcomes, including acute and chronic rejection. The aim of this review is to discuss the pathophysiology, evaluation, and management of GERD in lung transplantation, as informed by the most recent publications in the field. The pathophysiology of reflux-induced lung injury includes the effects of aspiration and local immunomodulation in the development of pulmonary decline and histologic rejection, as reflective of allograft injury. Modalities of reflux and esophageal assessment, including ambulatory pH testing, impedance, and esophageal manometry, are discussed, as well as timing of these evaluations relative to transplantation. Finally, antireflux treatments are reviewed, including medical acid suppression and surgical fundoplication, as well as the safety, efficacy, and timing of such treatments relative to transplantation. Our review of the data supports an association between GERD and allograft injury, encouraging a strategy of early diagnosis and aggressive reflux management in lung transplant recipients to improve transplant outcomes. Further studies are needed to explore additional objective measures of reflux and aspiration, better compare medical and surgical antireflux treatment options, extend follow-up times to capture longer-term clinical outcomes, and investigate newer interventions including minimally invasive surgery and advanced endoscopic techniques.

PTU-129 Ambulatory High Resolution Oesophageal Manometry: A Novel Tool to Investigate Non-Cardiac Chest Pain

Introduction Non-cardiac chest pain can present a clinical challenge to the gastroenterologist. Many causes remain undiagnosed and untreated. Oesophageal spasm is frequently considered a cause of non-cardiac chest pain, but current diagnostic tools are often poor at making this diagnosis. High resolution oesophageal manometry is now the gold standard oesophageal motility test, and is a swallow-based assessment. Unfortunately most episodes of chest pain in this context are not swallow-related, and are usually sporadic and unpredictable. Thus most manometry assessments occur in the absence of a symptom event. We propose that prolonged, ambulatory high resolution may be a tool that can detect these sporadic chest pain events and allow correlation to symptom episodes. We aimed to test the diagnostic yield of a novel, ambulatory high resolution oesophageal manometry device in the diagnosis of non-cardiac chest pain. Methods We studied 17 patients (7 male, 10 female, age range 14 to 66) with chest pain. All had cardiac pain excluded by cardiology review, and all had been studied with normal upper GI endoscopy. All had also had major oesophageal motor disorder (including spasm) excluded by swallow-based high resolution manometry (with liquid and solid swallows). An ultra-thin high resolution solid-state catheter was inserted transnasally into the oesophagus. This was connected to a small laptop and battery pack carried in a backpack. Patients were sent home and encouraged to mobilise. Patients were asked to keep the catheter in place at least until a symptomatic pain event was perceived. Symptom events were self-marked on a recorder device that was subsequently synchronised with the manometry output. Manometry tracings were read manually, and motor events at the time of symptoms were examined in detail. Results The median duration of recording with the system was 12 hours, 13 minutes (range 5 hours, 30 minutes to 26 hours, 40 minutes). 12 of the 17 patients perceived typical chest pain symptom during recording. Of the 12 with typical symptoms, 3 (25%) had clinically important findings that changed management. They had significant oesophageal spasm, pressurisation and shortening associated with pain events. These have been treated successfully with oesophageal body Botox injections (2 patients) and with long laparoscopic myotomy (1 patient). The remaining 9 patients either had no abnormalities, or minor abnormalities that did not correspond to symptoms. Conclusion Ambulatory high-resolution manometry is a novel tool for investigation of non-cardiac chest pain. In our series, we identified management-altering abnormalities in 3 of 17 patients who had previously been investigated with normal cardiac, endoscopic and stationary manometric evaluation. Disclosure of Interest J. Ooi: None Declared, E. Yazaki: None Declared, K. Nikaki: None Declared, D. Sifrim Grant/research support from: Research grant from Sandhill Scientific, P. Woodland: None Declared

Gastroesophageal reflux disease: A review of surgical decision making.

Gastroesophageal reflux disease (GERD) is a very common disorder with increasing prevalence. It is estimated that up to 20%-25% of Americans experience symptoms of GERD weekly. Excessive reflux of acidic often with alkaline bile salt gastric and duodenal contents results in a multitude of symptoms for the patient including heartburn, regurgitation, cough, and dysphagia. There are also associated complications of GERD including erosive esophagitis, Barrett's esophagus, stricture and adenocarcinoma of the esophagus. While first line treatments for GERD involve mainly lifestyle and non-surgical therapies, surgical interventions have proven to be effective in appropriate circumstances. Anti-reflux operations are aimed at creating an effective barrier to reflux at the gastroesophageal junction and thus attempt to improve physiologic and mechanical issues that may be involved in the pathogenesis of GERD. The decision for surgical intervention in the treatment of GERD, moreover, requires an objective confirmation of the diagnosis. Confirmation is achieved using various preoperative evaluations including: ambulatory pH monitoring, esophageal manometry, upper endoscopy (esophagogastroduodenoscopy) and barium swallow. Upon confirmation of the diagnosis and with appropriate patient criteria met, an anti-reflux operation is a good alternative to prolonged medical therapy. Currently, minimally invasive gastro-esophageal fundoplication is the gold standard for surgical intervention of GERD. Our review outlines the many factors that are involved in surgical decision-making. We will review the prominent features that reflect appropriate anti-reflux surgery and present suggestions that are pertinent to surgical practices, based on evidence-based studies.

Obesity Is Associated With Increasing Esophageal Acid Exposure in Korean Patients With Gastroesophageal Reflux Disease Symptoms

Background/AimsObesity is regarded as an important contributor to the increasing occurrence of gastroesophageal reflux disease. The aims of this study were to determine whether obesity is associated with gastroesophageal reflux in patients with gastroesophageal reflux disease and to identify the factors affecting increased acid exposure in obese patients.MethodsWe retrospectively analyzed the data of patients who underwent ambulatory 24-hour pH monitoring and esophageal manometry at Seoul St. Mary's Hospital. Obesity was classified according to the Asia-Pacific criteria.ResultsA total of 366 patients were analyzed; 18 were underweight, 152 normal weight, 104 overweight, and 92 obese. Obesity was more frequent in men and younger patients. The percentage time of pH < 4 in the total, upright, and postprandial periods was significantly higher in obese patients than in normal or underweight patients. The DeMeester score was also higher in obese patients. Body mass index correlated positively with reflux parameters. Multivariate analysis showed that being male and obesity were significantly associated with abnormal acid exposure (P < 0.005). The total lower esophageal sphincter length shortened as body mass index increased (P < 0.005). The gastroesophageal pressure gradient increased as body mass index increased (P < 0.05).ConclusionsObesity is associated with increasing esophageal acid exposure. The mechanism responsible for the relationship between gastroesophageal reflux disease and obesity may be associated with shortening of the lower esophageal sphincter length and increasing the gastroesophageal pressure gradient.

Esophageal Dysmotility in Children With Eosinophilic Esophagitis

The pathophysiology of dysphagia in patients with eosinophilic esophagitis (EoE) is unknown but may be related to abnormal esophageal motor function. Symptoms rarely occur during stationary esophageal manometry, so it has been difficult to establish an association between symptoms and motor events. Our aim was to evaluate esophageal motor function in children with EoE with the use of stationary manometry and ambulatory prolonged esophageal manometry and pH-metry (PEMP). PEMP was performed in children with EoE and compared with controls and children with gastroesophageal reflux disease (GERD). Peristalsis was considered effective when the esophageal contractions had a normal amplitude and propagation. Results are expressed as mean+/-s.e. Seventeen patients with EoE, 13 with GERD, and 11 controls were studied. Values are expressed as mean+/-s.e. Stationary manometry identified abnormal peristalsis in 41% of children with EoE. During PEMP, children with EoE had an increased number of isolated (16.7+/-3.8 vs. 9.5+/-1.6 vs. 6.5+/-1.1; P<0.03) and high-amplitude contractions (4.1+/-1.2 vs. 1.8+/-0.8 vs. 0.1+/-0.1; P<0.03), and higher percentage ineffective peristalsis both during fasting (70.5%+/-2.5 vs. 57.8%+/-3.0 vs. 53.8%+/-1.9; P<0.05) and during meals (68.4+/-3.4 vs. 55.3+/-2.8 vs. 48.1+/-2.8; P<0.05) when compared with children with GERD and controls. Thirteen patients with EoE experienced 21 episodes of dysphagia, and all correlated with simultaneous abnormal motor function. PEMP allowed the detection of ineffective peristalsis in children with EoE. Symptoms observed in children with EoE may be related to esophageal motor dysfunction.

The Cure(s) of LOTUS

The Cure(s) of LOTUS

Transcutaneous cervical esophagus ultrasound in adults: Relation with ambulatory 24-h pH-monitoring and esophageal manometry

To determine the gastroesophageal refluxate in the cervical esophagus (CE) and measure transcutaneous cervical esophageal ultrasound (TCEUS) findings [anterior wall thickness (WT) of CE, esophageal luminal diameter (ELD), esophageal diameter (ED)]; to compare TCEUS findings in the patient subgroups divided according to 24-h esophageal pH monitoring and manometry; and to investigate possible cut-off values according to the TCEUS findings as a predictor of gastroesophageal reflux (GER). In 45/500 patients, refluxate was visualized in TCEUS. 38/45 patients underwent esophagogastroduodenoscopy (EGD), 24-h pH monitoring and manometry. The 38 patients were grouped according to 24-h pH monitoring as follows: Group A: GER-positive (n = 20) [Includes Group B: isolated proximal reflux (PR) (n = 6), Group C: isolated distal reflux (DR) (n = 6), and Group D: both PR/DR (n = 8)]; Group E: no reflux (n = 13); and Group F: hypersensitive esophagus (HSE) (n = 5). Groups B + D indicated total PR patients (n = 14), Groups E + F reflux-negatives with HSE (n = 18), and Groups A + F reflux-positives with HSE (n = 25). When the 38 patients were grouped according to manometry findings, 24 had normal esophageal manometry; 7 had hypotensive and 2 had hypertensive lower esophageal sphincter (LES); and 5 had ineffective esophageal motility disorder (IEM). The ELD measurement was greater in group A + F than group E (P = 0.023, 5.0 +/- 1.3 vs 3.9 +/- 1.4 mm). In 27/38 patients, there was at least one pathologic acid reflux and/or pathologic manometry finding. The cut-off value for ELD of 4.83 mm had 79% sensitivity and 61% specificity in predicting the PR between Groups B + D and E (AUC = 0.775, P = 0.015). Visualizing refluxate in TCEUS was useful as a pre-diagnostic tool for estimating GER or manometric pathology in 71.1% of adults in our study, but it was not diagnostic for CE WT.

Chronic alcoholism and esophageal motor activity: A 24‐h ambulatory manometry study

Stationary esophageal manometry has shown esophageal motor abnormalities in patients with chronic alcoholism. The abnormalities identified in different studies are not consistent. Twenty-four hour ambulatory esophageal manometry enables monitoring of esophageal motor activity under a variety of physiological conditions and gives a more complete assessment. Twenty-four hour ambulatory esophageal manometry and pH-metry were performed using a combined pH and pressure catheter. Subjects with chronic alcoholism with no other illness and not in withdrawal were studied with age- and sex-matched healthy controls. Autonomic nerve functions tests were performed in all subjects. Twenty-three chronic alcoholic subjects and 12 control subjects completed the study. The median ethanol consumption was 95 g/day (range 75 -175 g/day) for 12 years (range 5-30 years) among alcoholic subjects. Eight alcoholic subjects had heartburn and regurgitation but none had dysphagia. Ten (43%) alcoholic subjects had autonomic neuropathy and four (17%) had increased gastroesophageal acid reflux. Lower esophageal sphincter hypertension was observed in alcoholic subjects with autonomic neuropathy. Esophageal body motility parameters (i.e. frequency, duration, amplitude and percentage of peristaltic waves) were not significantly different between alcoholic subjects and controls. Results of ambulatory esophageal manometry on subjects with chronic alcoholism seem to indicate that long-term ethanol intake has no major effects on esophageal motor activity other than lower esophageal sphincter hypertension among those with alcoholic autonomic neuropathy.

Meal area index: a new technique for quantitative assessment in achalasia by ambulatory manometry during eating.

Ambulatory non-perfused oesophageal manometry was used to study oesophageal body function during consumption of a full meal in patients with achalasia. A measure of oesophageal body activity (the meal area index) was developed by calculating the total area under the pressure curve during eating, above the preprandial baseline oesophageal pressure, per meal minute. Untreated patients with achalasia (n = 13) were compared with normal subjects (n = 42), patients with benign stricture (n = 9) and patients with achalasia who had undergone Heller's myotomy (n = 17). The results showed a high meal area index in achalasia, due to a rise in baseline oesophageal pressure and frequent high-amplitude contractions during eating. This was not seen in normal subjects or patients with stricture. The high meal area index was abolished by successful Heller's myotomy but remained in two patients with persisting dysphagia. Sustained high intraoesophageal pressure is generated during consumption of a solid meal in untreated achalasia, resulting in a unique manometric profile. Manometry during eating using the meal area index permits quantitative assessment of oesophageal body function in achalasia and may aid in the assessment of response to treatment.

Effect of physical exercise on esophageal motility in patients with esophageal disease

The most common type of esophageal dysfunction associated with chest pain is gastroesophageal reflux, which may be induced by exercise. The effect of exercise on esophageal function has mainly been investigated in normal subjects or trained athletes. Few studies have investigated exercise and esophageal motility disorders. One hundred and thirty-five patients underwent ambulatory esophageal manometry and pH monitoring, before, during and immediately after moderate exercise. Patients were divided into four groups: Normal, nutcracker, diffuse spasm and gastroesophageal reflux disease (GERD). Ambulatory manometry and pH were monitored while exercising on a treadmill during which standardized boluses of water were administered. Nutcracker and diffuse spasm patients demonstrated a significant fall in esophageal wave amplitude during exercise compared to controls, which returned rapidly to pre exercise values after resting. There was no evidence of acid reflux in the non-reflux groups during exercise. Reflux was noted in 13 patients with GERD during exercise, none of whom had evidence of reflux at the onset of exercise. When these patients were classified by reflux type, the majority, 11 patients, were found to come from the combined or supine reflux group. Esophageal amplitude in nutcracker esophagus does not increase during moderate exercise. Moderate exercise provokes reflux in GERD patients with combined or supine reflux.

Endoscopic full-thickness plication for the treatment of GERD: 12-month follow-up for the North American open-label trial

The aim of this study was to assess the intermediate-term (12-month) safety and efficacy of endoscopic full-thickness plication in patients with symptomatic GERD. Sixty-four patients with chronic heartburn that required maintenance antisecretory therapy received a single, endoscopically placed, full-thickness plication in the gastric cardia 1 cm distal to the gastroesophageal junction. At baseline and 12 months after plication, patients completed the GERD Health Related Quality of Life questionnaire, Gastrointestinal Symptom Rating Scale, and SF-36 Health Survey, as well as a medication use diary. Ambulatory 24-hour pH monitoring and esophageal manometry were obtained at baseline and 3 months after plication. At 6 months after plication, the 24-hour pH study was repeated. Of the 57 patients who completed the 12-month follow-up, 40 (70%) were no longer taking a proton pump inhibitor. Median GERD Health Related Quality of Life scores were improved compared with baseline while taking medication (19.0 vs. 5.0; p < 0.0001) and while not taking medication (13.0 vs. 5.0; p < 0.002). At 6 months after the procedure, an improvement in distal esophageal acid exposure was demonstrated in 40 of 51 patients (80%), with a decrease of 39% in the median percentage of time the pH was less than 4 (p < 0.0001). Normal pH scores were observed in 30% of patients. All procedure-related adverse events occurred acutely, as previously reported, and no new adverse event was observed during extended follow-up. Full-thickness plication at the gastroesophageal junction is an effective endoscopic procedure for treatment of patients with symptoms caused by GERD. It reduces reflux symptoms and antisecretory medication use over at least a 1-year period.

Ambulatory combined pH, bile and manometric monitoring of the oesophagus in asymptomatic healthy volunteers

With the development of sophisticated equipment ambulatory studies of oesophageal motor function, pH and bilirubin have gained in popularity. The aim of the study was to present reference values for combined 24 h pH, bilirubin and manometric measurements of the oesophagus. Twenty-six (15 male) healthy volunteers without symptoms of gastro-oesophageal reflux underwent a 24-h ambulatory oesophageal combined three-channel pressure, acid and bilirubin detection. The subjects were studied for a median of 20 h (16-22). The median per cent time with pH < 4 for the whole measured time was 3.1 (0.8-14; 5 and 95 percentiles). Bile was detected for a median of 0.05% (0.0-8.5; 5 and 95 percentiles) of the time. Eighty-one per cent of the contractions were peristaltic, 55% of which were complete. Of these, 53% had a pressure over 30 mmHg at all three pressure points, giving an efficient peristalsis in a median of 29% (13-46; 5 and 95 percentiles) of all registered contractile patterns. No difference between the genders could be observed. This study provides normative data for ambulatory oesophageal manometry, pH and bilirubin studies that can be used for comparing with patients with disease.

Prolonged monitoring of esophageal motor function in healthy children.

To describe diurnal variations of esophageal motor function in children using combined ambulatory 24-hour esophageal manometry and continuous intraluminal pH measurement (MP24). Medical records of all patients referred for the performance of MP24 from 1995 to 2002 at a tertiary care center were reviewed. Patients were selected retrospectively for this study using the following inclusion criteria: (1) no dysphagia, (2) normal upper gastrointestinal barium radiograph, (3) normal esophagogastroduodenoscopy and biopsies, (4) normal stationary esophageal manometry, (5) normal esophageal pH probe, and (6) no gastrointestinal pathology appearing after long-term follow-up. Data from the MP24 of these children were retrospectively analyzed for differences between meal, upright, and supine periods using nonparametric univariate analysis. One hundred twenty-three children had MP24 during the study period. Eleven met the criteria for normality and were included. Their mean age was 12.4 +/- 1.5 years. The number of contractions/minute in the upper, middle, and lower esophageal body differed significantly during meals and in the upright and supine periods (P < 0.01). A significant increase in motor activity occurred during meals (P < 0.01). There was less motor activity observed in the supine position than in the upright position (P < 0.01). There were significant differences in effective (P < 0.05) and total propagated peristalsis among the meal, upright, and supine periods (P < 0.01), with the largest percentage of propagated contractions observed during meals. This study provides the first information on prolonged esophageal motor activity in pediatric patients without esophageal disease. MP24 in children demonstrates significant diurnal variations in esophageal motor function that is similar to the findings in studies of healthy adults.

A Study of Esophageal Acidity and Motility Change after a Gastrectomy for Stomach Cancer

Purpose: Some patients develop gastroesophageal reflux disease (GERD) after a gastrectomy for stomach cancer. Therefore, we conducted this research to gain an understanding of esophageal acidity and motility change. Materials and Methods: From July 2002 to March 2004, the cases of 15 randomized patients with stomach cancer who underwent a radical subtotal gastrectomy (RSG) with Billroth I(B-I) reconstruction (n=12) or a radical total gastrectomy (RTG) with Roux-en-Y (R-Y) gastroenterostomy (n=3) were analyzed. We investigated the clinical values of the ambulatory 24-hour pH monitoring and esophageal manometry in these patients, just before discharge from the hospital after an operation. Results: GERD was present in three patients (). Compared with two reconstructive procedures, 3 of the 12 patients in the RSG with B-I group had GERD; however, none of RTG with R-Y group had GERD. Compared with pathologic stage, 2 of 9 patients in stage I, 1 of 2 patients in stage II, none of 3 patients in stage III, and none of 1 patient in stage IV had GERD. Esophageal manometry was performed in 10 patients. Nonspecific esophageal motility disorder (NEMD) was present in 7 patients. Conclusion: Some patients had GERD as a complication following a gastrectomy for stomach cancer. We suspect that the postoperative esophageal symptom is due to not only bile reflux but also gastroesophageal acid reflux. Therefore, careful observation is recommended for the detection of GERD.

Reference values for stationary and 24-hour ambulatory esophageal manometry and pH data in hispanic population

Background It has not yet been determined whether values obtained with stationary esophageal motility test are similar to those obtained with the 24-h procedure. Furthermore, there are no normal values established for esophageal pH and motility parameters in a Hispanic population. Methods Reflux symptoms, endoscopy, Helicobacter pylori, stationary esophageal manometry, and combined 24-h pH-manometry were evaluated in 12 healthy volunteers. Three subjects also underwent 24-h esophageal bilirubin monitoring. Results Mean lower esophageal sphincter pressure measured stationary was lower ( p<0.05) compared with 24-h ambulatory procedure. Mean duration of contraction waves was greater with stationary method ( p<0.05). Esophageal contraction mean amplitude was not different between both procedures. Total percent of time with pH<4 was 0.16±0.21. Total 24-h acid reflux episodes were 5.5±6.6, with no episodes >5 min. No high bilirubin reflux episodes were recorded. Conclusions These results suggested that physiologic motility parameters differed depending on the method employed for its evaluation. Values obtained with stationary and 24-h ambulatory esophageal manometry are identical when evaluating amplitude of contractions but differ in duration of contractions and lower esophageal sphincter pressure. In addition, these results provide for the first time reference values for stationary and 24-h ambulatory esophageal manometry and pH data in a Hispanic population.

Twenty-Four-Hour Ambulatory versus Stationary Esophageal Manometry in the Evaluation of Esophageal Motility in Patients with Gastroesophageal Reflux Disease

Background: Although stationary manometry commonly reveals esophageal body motility disorders in patients with gastroesophageal reflux disease (GERD), esophageal function cannot be fully and precisely assessed during normal daily activities by this investigatory modality. Aim: To compare the results of 24-hour ambulatory manometry with those of stationary manometry and to determine the specificity and accuracy of the former to detect motility disorders in patients with GERD. Patients and Methods: 15 patients with documented GERD were included in the study. Clinical assessment, upper alimentary endoscopy and stationary manometry as well as 24-hour ambulatory manometry with concomitant 24-hour monitoring of the esophageal pH were performed in each patient. Results: 24-hour ambulatory manometry revealed a significant number of dropped or interrupted esophageal contractions in patients who were found to have only complete peristalsis on stationary manometry. Furthermore, in certain patients, ambulatory manometry detected an increased incidence of dropped or interrupted contractions as compared to those recorded during stationary manometry. Ineffective contractions, suggestive of poor esophageal motility, although absent on stationary manometry, were detected in a large number of patients during a 24-hour period of recording. Also, the amplitude of esophageal contractions was clearly overestimated when evaluated by stationary manometry. Conclusions: 24-hour ambulatory esophageal manometry reveals esophageal motor abnormalities to a greater extent than those demonstrated at stationary manometry, in patients with GERD. This might be of significance in designing the treatment and predicting possible outcome.