Changes In Esophageal Motility Research Articles

546. ESOPHAGEAL FUNCTION TESTS BEFORE AND AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY FOR SEVERE OBESITY

Abstract Background Gastroesophageal reflux disease is common in patients with severe obesity. However, changes in esophageal motility and gastroesophageal reflux in patients undergoing sleeve gastrectomy have not been well-studied. In this study, we evaluated the effects of sleeve gastrectomy on esophageal function. Methods All patients undergoing laparoscopic sleeve gastrectomy (LSG) at our institution are entered into a prospectively maintained database. We queried this database to identify patients who underwent pre- and post-LSG esophageal function tests (ie, high-resolution manometry [HRM] and 24-hour pH monitoring). Post-operative was esophageal function tests done at 12 months after surgery. Results A total of 44 patients underwent LSG between Jul. 2018 and Dec. 2022, of which 11 patients underwent both pre and post-LSG esophageal function tests. The study cohort had a mean age of 65.4 years with 5 males. BMI was significantly decreased after LSG (40.0 vs. 27.4 kg/m2，p=0.004). Manometric hiatal hernia was increased post-LSG (0% vs. 45.5% [n=5/11]), though this difference did not reach statistical significance (p=0.063). Esophagogastric junction contractile integral (EGJ-CI), thoraco-abdominal pressure gradient, and distal contractile integral (DCI) were similar between the two groups (p=0.155, p=0.154, and p=0.131, respectively). Post-LSG 24-hour pH monitoring showed higher acid exposure time (0.4% vs. 11.2%, p=0.005) and DeMeester score (3.5 vs. 33.2, p=0.003). Conclusions Gastroesophageal reflux was significantly exacerbated post-LSG, although esophageal motility and EGJ pressures were preserved after LSG. This may indicate that the change in EGJ morphology and disruption of the angle of His have an important role in mechanism of LSG-related GERD.

Changes in esophageal motility and transit after a stroke

Introduction. Stroke is a frequent cause of neurogenic dysphagia, more importantly causing functional and clinical impairments in the oral and pharyngeal phases of swallowing. However, the disease may affect esophageal function as well. Objective. Review of esophageal changes described in patients who had a stroke. Method. The study reviewed articles from 1990 to 2022 in PubMed that assessed esophageal motility and esophageal transit in patients who had a stroke. Results. The review found increased non-peristaltic esophageal contractions, longer esophageal transit, decreased peristalsis proportion in patients with dysphagia than in those without it, longer esophageal clearance, esophageal retention, and retrograde flow. These changes became less frequent with time after the stroke. Conclusion. Stroke may affect esophageal transit and contraction, taking more non-peristaltic contractions and longer for the bolus to pass through the esophagus. These changes became less frequent with time after the stroke.

Esophageal Motility Abnormalities in Lung Transplant Recipients With Esophageal Acid Reflux Are Different From Matched Controls.

There is an increased incidence of gastroesophageal reflux disease (GERD) after lung transplantation (LT) that can be associated with graft dysfunction. It is unclear if the underlying esophageal motility changes in GERD are different following LT. This study aimed to use esophageal high-resolution manometry (HRM) to explore GERD mechanisms in LT recipients compared to matched controls. This was a retrospective study including patients with pathologic acid reflux who underwent HRM and pH testing at our healthcare facility July 2012 to October 2019. The study included 12 LT recipients and 36 controls. Controls were matched in a 1:3 ratio for age, gender, and acid exposure time (AET). LT recipients had less hypotensive esophagogastric junction (EGJ) (mean EGJ-contractile integral 89.2 mmHg/cm in LT vs 33.9 mmHg/cm in controls, P < 0.001). AET correlated with distal contractile integral and total EGJ-contractile integral only in LT group (r = -0.79, P = 0.002 and r = -0.57, P = 0.051, respectively). Following LT, acid reflux is characterized by a less hypotensive EGJ compared to controls with similar AET. The strongest correlation with AET after LT was found to be esophageal peristaltic vigor. These results add to the understanding of reflux after LT and may help tailor an individualized treatment plan.

Effect of Body Weight and Obesity on Esophageal Function.

The incidence of obesity in the population is gradually increasing. Obesity can cause a variety of complications in the digestive system such as gastroesophageal reflux disease, and impacts the integrity of the esophageal mucosal barrier and esophageal motility. However, not many studies have focused on the effect of varying degrees of obesity on the esophagus. A total of 611 participants were included in this study. We divided them into three groups according to their body mass index (BMI): the normal weight group, the overweight group, and the obesity group. We performed a retrospective comparison between groups based on indicators from high resolution esophageal manometry (HREM) and 24-hour pH impedance monitoring, and did a correlation analysis on multiple indicators such as esophageal mucosal barrier, esophageal motility, and acid reflux. The mean nocturnal baseline impedance (MNBI) in the overweight and obesity groups was lower than that in the normal group. The MNBI of the subjects in Z5-Z6 channels in the overweight group was significantly lower than that in the normal group. With respect to Z3-Z6 channels, MNBI values in the obesity group were significantly lower than those in the normal group. 'The acid exposure time (AET), the DeMeester scores (DMS) and 24-hour total reflux episodes was significantly higher in the obesity group than those in the normal and overweight groups. The upper esophageal sphincter (UES) residual pressure, and intrabolus pressure (IBP) in the overweight and obesity groups were significantly higher than those in the normal group. In addition, lower esophageal sphincter (LES) resting pressure, and esophagogastric junction contractile integral (EGJ-CI) in the obesity group were significantly higher than those in the normal group. We found that increase in body weight affected the integrity of esophageal mucosa, and different degrees of increase associated with different degrees and different aspects of changes in esophageal motility.

Effect of Medicine and Adverse Drug Reactions of Vonoprazan Fumarate Tablets in Patients with Reflux Esophagitis

To investigate the drug effects of vonoprazan fumarate tablets on reflux esophagitis and their adverse drug reactions is the objective of the study. A total of 102 patients with reflux esophagitis admitted to the Department of Gastroenterology of the Affiliated People’s Hospital of Ningbo University from June 2021 to November 2022 were selected and randomly grouped, with 51 cases in the observation group and 51 cases in the control group. The observation group received vonoprazan fumarate tablets and the control group received rabeprazole for 8 w. The drug effects of the two groups were analyzed, including the duration of symptom relief, changes in esophageal motility, the level of serum gastric hormone, the injury degree of esophageal mucosa and the level of inflammatory factors. Adverse drug reactions were analyzed in the two groups. After medication, the symptom remission time, changes in esophageal motility, serum gastric hormone level, esophageal mucosa injury degree and inflammatory factor level in observation group were better than those in control group (p<0.05). The total incidence of dizziness, rash, diarrhea and other adverse drug reactions in the observation group was 3.92 %, which was significantly lower than that in the control group (9.8 %, p<0.05). In conclusion, vonoprazan fumarate tablets has obvious effect on the treatment of reflux esophagitis with low adverse reactions, which is worthy of clinical promotion.

GASTROESOPHAGEAL REFLUX DISEASE

Gastroesophageal reflux disease (GERD) is a chronic disease usually caused by the reflux of acidic gastric and duodenal contents into the distal esophagus. Major symptoms of GERD are acidity, heartburn, acid regurgitation, and chest pain. It is a digestive disease with the direct medical costs estimated around 9.3 billion dollars annually, and with the symptoms portending a low quality of life. The most common and known phenotype of GERD is Reflux esophagitis (RE). Many countries has a high prevalence of GERD, Especially in USA, about 44% of Americans suffer from GERD symptoms at least once monthly, 17% once weekly, and 7% once daily. Traditionally, GERD is less common in Asians. The overall prevalence of RE in Japanese adults is about 16%. Aging causes various physiologic changes in GIT that may increase the risk of developing complications such as GERD. Age-related changes in the physiology of the esophagus can be divided into two categories: motility and sensory. In general, changes in esophageal motility are mild and tend to be quiet in an older patient. It is possible that both the motility and nerve changes observed in the esophagus of older patients, combined with lower comorbidities and medication use, lead to a higher risk of esophageal mucosa to reflux and cause inflammation and development of GERD-related problems. Previously, it was thought that gastric acid release decreased with age, but further research revealed that the underlying mechanism may have been Helicobacter pylori infection that eventually developed atrophic gastritis. As the prevalence of Helicobacter pylori infection has decreased over the last 3-4 decades, more recent studies have shown that gastric acid secretion is maintained normally in more than 80% of elderly subjects. Comorbidity and commonly used drugs can reduce esophageal sphincter tone, esophageal clearance mechanisms, and saliva production.&#x0D; A low-fat diet likely contributes to a more favorable stomach distribution. Male gender, civil servant, smoking, strong tea, alcohol consumption, meat diet and body mass index (BMI) are risk factors associated with GERD. In many countries, dietary fat, cholesterol, saturated fatty acid (SFA), dietary fiber, and other nutrients are associated with GERD. An epidemiological study showed a link between high fat intake and GERD. Also, dietary fiber, particularly cereal fiber, has been found to reduce the risk of adenocarcinoma of the esophagus and stomach, of which GERD is a well-known risk factor. The mechanism may be that dietary fiber reduces the intake of gastric nitrites, which is thought to promote reflux by relaxing the lower esophageal sphincter (LES). A high-fiber diet has played a protective role in GERD. However, dietary fiber reduced the number of gastroesophageal refluxes, but increased their duration, and had no significant effect on gastric emptying and gastric acid secretion. Diet plays an important role in controlling acid reflux symptoms and is the first line of treatment used for people with GERD. Foods high in fiber make you feel full, so you're less likely to overeat, which can contribute to heartburn. So get healthy fiber from these foods, such as whole grains like oatmeal, couscous, and brown rice, root vegetables like sweet potatoes, carrots, and beets, and green vegetables like asparagus, broccoli, and green beans. Lemon juice is generally considered very acidic, but a small amount of lemon juice mixed with warm water and honey has an alkalizing effect, neutralizing stomach acid. In addition, honey has natural antioxidants that protect the health of cells. On the other hand, Ginger is another top digestive aid due to its medicinal properties. It is alkaline in nature and anti-inflammatory, which eases irritation in the digestive tract. Try sipping ginger tea whenever you feel heartburn. The goal is to create a diet based on a healthy variety of foods, including fruits and vegetables, lean protein sources, complex carbohydrates, and healthy fats. If you suspect that food may be triggering or worsening your GERD symptoms, try keeping a daily, weekly diary.

Narrative review of esophageal motility changes after endoscopic therapy for gastroesophageal reflux disease

Narrative review of esophageal motility changes after endoscopic therapy for gastroesophageal reflux disease

Dysphagia in the Older Age Setting

Dysphagia, or difficulty swallowing, is a common condition, especially among the elderly population and can become debilitating. As we age, there are subtle changes in esophageal motility, but by no means is dysphagia ever considered to be a normal result of aging. Dysphagia usually presents with a variety of accompanying symptoms ranging from regurgitation during meals, mild discomfort, to severe chest pain. It can be challenging to localize the dysphagia from the history. The underlying etiology may become evident during subsequent investigations. It is essential to be able diagnose dysphagia as early detection is associated with decreased morbidity and in some cases mortality. In addition, early detection through clinical suspicion, confirmatory imaging or endoscopic evaluation is important as it can lead to early intervention with proper management depending on the underlying etiology, resulting in economic benefit and reduced medical costs. There are various causes of dysphagia, with the majority being benign, but a physician should always be aware of red flags present which may signal more serious causes, such as an underlying malignancy. Our goal in this review article is to focus on detecting the clinical signs of dysphagia and review appropriate further evaluation and update on management of this potentially serious condition in order for elderly patients to achieve an optimal quality of life.

High-resolution impedance manometry and 24-hour multichannel intraluminal impedance with pH testing before and after sleeve gastrectomy: de novo reflux in a prospective series.

Laparoscopic sleeve gastrectomy (SG) is increasingly popular but concern regarding its effect on gastroesophageal reflux disease remain. The current literature is conflicting, and there have been little objective data. To objectively and more accurately assess the impact of SG on esophago-gastric physiology. Centre of Excellence in Metabolic and Bariatric Surgery, Private Hospital, Australia. Prospective cohort study of 31 patients undergoing SG with high-resolution impedance manometry (HRM), 24-hour multichannel intraluminal impedance combined with pH testing (MII-pH), and Gastroesophageal Reflux Disease Symptom Assessment Scale (GSAS) questionnaire 1 month before and 6 months after SG. There were 31 patients that underwent SG, 20 with synchronous hiatal repair and fixation, and 6 that were excluded. HRM demonstrated significantly increased intragastric pressures (15.5-29.6 mm Hg) and failed swallows (3.1-7.5%) but no other change in esophageal motility. MII-pH did not demonstrate significant changes in acid exposure time (8.5%-7.5%) or number of reflux episodes, although the numbers of long reflux episodes (2.3-4.7) and weak acid reflux episodes were significantly increased (15.4-55.2). DeMeester and GSAS scores were not significantly changed. There was no significant difference in patients with preexisting reflux. However, for patients without preexisting reflux, acid exposure time increased significantly (1.3%-6.7%), as did DeMeester scores (5.8-24.5) and the numbers of long reflux episodes (.1-4.4) and weakly acidic episodes (22.1-89.2). SG was associated with increased intragastric pressures, without changes in esophageal motility or acid exposure. For patients without preexisting reflux, there were increases in acid exposure time, long reflux episodes, weakly acidic reflux episodes, and DeMeester score.

Effect of Bridge Position Swallow on Esophageal Motility in Healthy Individuals Using High-Resolution Manometry

Recently, there has been clinical interest in the effect of different body positions on esophageal motility. This study aimed to identify the effect of three different body positions on esophageal motility using high-resolution manometry. Thirteen healthy adults swallowed 5 mL of water in the upright, supine, and bridge positions. For the bridge position, each subject raised their waist against gravity, placed a cushion under their back, and bent their knees. The proximal contractile integral (PCI) and distal contractile integral (DCI), integrated relaxation pressure (IRP), distal latency (DL), peristaltic breaks (PBs), intrabolus pressure (IBP), and expiratory and inspiratory esophagoesophageal junction (EGJ) pressure were measured. In the bridge position, PCI, DCI, IRP, and expiratory and inspiratory EGJ pressure were significantly higher than those in the upright position (bridge PCI vs. upright PCI [p = 0.001], bridge DCI vs. upright DCI [p < 0.001], bridge IRP vs. upright IRP [p = 0.018], bridge EGJ pressure vs. upright EGJ pressure [expiratory: p = 0.001] [inspiratory: p < 0.001]). PBs were significantly shorter and DL was significantly longer in the bridge position compared to upright (bridge PBs vs. upright PBs [p = 0.001], bridge DL vs. upright DL [p = 0.001]). IBP was significantly higher in the bridge position compared to supine (bridge IBP vs. supine IBP [p = 0.01]). These results demonstrated changes in esophageal motility according to changes in position while swallowing, where esophageal contractions became stronger against gravity. Further study is required to examine the effectiveness of swallowing in the bridge position.

3099 Endoscopic Botulinum Toxin Injection for Tacrolimus-Induced Achalasia in a Renal Transplant Recipient

INTRODUCTION: Multiple medications have been associated with secondary achalasia. Here we present a patient who developed dysphagia 4 days after his renal transplant and was found to have achalasia thought to be due to his tacrolimus; he was successfully treated with botulinum injection. To our knowledge, this is the first case of tacrolimus-induced achalasia ever reported in a renal transplant patient; it is also the first case in a transplant patient to be treated endoscopically with botulinum injection. CASE DESCRIPTION/METHODS: A 58 year old man with a history of end stage renal disease secondary to focal segmental glomerulosclerosis presented with progressive renal failure and underwent deceased kidney transplant without complications. At clinic, follow-up on post-operative day #4, the patient reported difficulty in swallowing since post-operative day two. A modified barium swallow study (Figure 1) demonstrated severe esophageal dysmotility and lower esophageal sphincter dysfunction concerning for achalasia. Upper endoscopy (Figure 2) one week later revealed a dilated esophagus with mild edema but without focal lesions or ulcerations. Esophageal manometry (Figure 3) evidenced outflow obstruction of the esophagogastric junction and weak peristalsis in the esophageal body, confirming the diagnosis of achalasia. Surgical therapy and changing his calcineuron inhibitor for achalasia were considered too high risk in this patient so shortly after transplant. The patient ultimately underwent therapy with endoscopic botulinum toxin injection (100 units) of the lower esophageal sphincter. He had excellent results with immediate and complete resolution of dysphagia. DISCUSSION: The proposed mechanism for CNI induced changes in esophageal motility involves inhibition of nitric oxide synthase by CNIs. Nitric oxide (NO) is responsible for esophageal peristalsis as well as relaxation of the lower esophageal sphincter (LES). Although it is unclear why switching between different CNIs would lead to symptom resolution, individual variation in the reaction to the different chemical structures of tacrolimus and cyclosporine has been proposed. Botulinum toxin can be considered as a therapeutic option in those patients who are not candidates for a change in their immunosupression. To our knowledge, this is the first case of botulinum induced achalasia reported after a kidney transplant and also the first successfully treated with botulinum toxin injection.

Mano-Impedancemetric Diagnosis of Esophageal Function in Children With Dyspepsia

Background. Introduction of new methods of diagnosing functional disorders of the upper gastrointestinal tract into children’s practice will reveal the true cause of changes in esophageal motility in its various pathologies, which will significantly change the treatment tactics, since the selection of therapy will be based on the pathogenetic mechanisms of disease development.Our aim was to highlight the capabilities and benefits of high-resolution mano-impedancemetry in comparison with esophagogastroduodenoscopy, which has been studied and used in pediatric practice for a long time, and to prove that only due to a new method for diagnosing esophageal motility disorders, it is possible to determine the cause of dyspeptic complaints in children.Patients and Methods. The results of our own examination of children aged from 7 to 17 years 11 months (n = 23) with clinical manifestations of functional disorders of the upper gastrointestinal tract have been presented.Results. According to the mano-impedancemetry data, it has been found that the time of the substrate in the esophagus (p&lt;0.02) and the speed of its passage through the esophagus depend on the pressure in the distal esophagus: the lower the pressure in the distal esophagus, the lower the fluid flow rate and the higher the degree of its reflux (р&lt;0.001). Decreased speed indicates hypotonia of the lower esophagus and lower esophageal sphincter, which provides only a correction by physiotherapeutic treatment methods since surgical intervention in such conditions is ineffective.Conclusion. The method of mano-impedancemetry allows to determine the indications for surgical treatment and to predict the efficacy of the conducted anti-reflux surgical correction.

The Predictive Factors of Abnormal Esophageal Motility in Systemic Sclerosis Patients by High Resolution Manometry

AbstractBackground: Esophageal motility changes occur in about 80% of systemic sclerosis (SSc) patients with decreasing the motility of the lower two-thirds of the esophagus and lower esophageal sphincter (LES) pressure.Aim of Study: Using high resolution manometry (HRM) to study the esophageal motility disorder in patients with systemic sclerosis to evaluate the predictive factors associated with esophageal affection.Patients and Methods: A prospective study was done on twenty female patients with SSc. Demographic data and esophageal symptoms including Gastroesophageal Reflux disease (GERD) and dysphagia were evaluated. All patients underwent HRM and High Resolution Computed Tomography (HRCT), Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Hemoglobin level (Hgb), Forced Vital Capacity (FVC).Results: High resolution manometry showed normal upper esophageal contraction in 100% of patients. Middle and lower esophageal contraction were normal in 30%, hypoperestalsis in 5%, and aperestalsis in 65% of patients. Regarding the lower esophageal sphincter pressure, it showed normal pressure in 30%, hypotensive in 65% and hypertensive in 5% of patients. The esophageal involvement was GERD in 70% and dysphagia in 45% of patients. The pulmonary involvement was dyspnea in 70% and cough in 40% of patients. All patients had skin involvement. Abnormal motility was present in 14 out of 20 patients (70%) which was significantly related to Interstitial Lung Disease (SSc-ILD) (p= 0.001), SSc subtypes (p=0.03), dyspnea (p=0.01) and FVC (p=0.046). A significant relation between GERD and ILD (p<0.05) was found.Conclusion: This study confirmed an increased prevalence of esophageal motility disorders in SSc patients with and without esophageal symptoms.

Esophageal motor disorders are frequent during pre and post lung transplantation. Can they influence lung rejection?

lung transplantation (LTx) is a viable option for most patients with end-stage lung diseases. Esophageal motor disorders (EMD) are frequent in candidates for LTx, but there is very little data about changes in esophageal motility post-LTx. the aim of our study was to assess esophageal motor disorders by high resolution manometry (HRM) both pre-LTx and six months post-LTx in patients with and without organ rejection. HRM (Manoscan®) was performed in 57 patients both pre-LTx and six months post-LTx. HRM plots were analyzed according to the Chicago classification 3.0. EMD were found in 33.3% and in 49.1% of patients pre-LTx and post-LTx, respectively, and abnormal peristalsis was more frequently found post-LTx (p = 0.018). Hypercontractile esophagus was frequently found post-LTx (1.8% and 19.3% pre-LTx and post-LTx, respectively). Esophagogastric junction (EGJ) morphology changed significantly pre-LTx and post-LTx; type I (normal) was more frequent post-LTx (63-2% and 82.5% respectively, p = 0.007). EMD were more frequent post-LTx in both the non-rejection and rejection group, although particularly in the rejection group (43.2% and 69.2% respectively, p = 0.09). EMD such as distal spasm, hypercontractile esophagus and EGJ outflow obstruction were also observed more frequently post-LTx in the rejection group. significant changes in esophageal motility were observed pre-LTx and particularly post-LTx; hypercontractile esophagus was a frequent EMD found post-LTx. EMD were more frequent in the group of patients that experienced organ rejection compared to the non-rejection group. EMD leading to an impaired esophageal clearance should be considered as an additional factor that contributes to LTx failure.

Changes in Esophageal Motility after Acupuncture

BackgroundChinese medicine is widely used in the East with good results for the treatment of many diseases. Acupuncture has been increasingly used and recognized as a complementary medical treatment. Some studies on gastrointestinal motility are available; however, acupuncture effect on esophageal motility is still elusive due to the lack of studies with adequate methodology. This study aims to evaluate acupuncture effect on esophageal motility. MethodsWe studied 16 (50% females, mean age 26 years) volunteers. No individual underwent acupuncture sessions previously. All individuals underwent high-resolution manometry. The test was performed in three phases: basal measurements, 20 min after acupuncture stimulation of the gastrointestinal point (ST36), or 20 min after acupuncture stimulation of a sham point (5 cm medial to ST36) (crossover). ST36 or sham points were alternated in order based on randomization. Lower esophageal sphincter (LES) resting and residual pressure, distal latency (DL) ,and distal contractility integral (DCI) were recorded. All tests were reviewed by two experienced investigators blinded to the acupuncture point. ResultsLES resting pressure was significantly reduced after acupuncture (p = 0.015, Wilcoxon signed-rank test). DL was significantly increased after acupuncture (either Sham or ST36) as compared to basal measurement. ConclusionOur results showed that acupuncture on the digestive point decreases LES basal pressure. Acupuncture may be an alternative treatment to spastic disorders of the LES.

Age-Related Differences in Clinical Characteristics and Esophageal Motility in Patients with Dysphagia.

Dysphagia in elderly patients has a major effect on nutrition and quality of life (QOL). Although several studies have shown that aging itself is associated with changes in esophageal motility, the impact of these changes on dysphagia symptoms and QOL is unknown. This study assessed the manometric diagnoses of elderly patients with dysphagia compared with diagnoses in younger counterparts. Participants included 116 consecutive patients examined for dysphagia from 2007 to 2014. We divided patients into three groups by age: Group A, 66years and older (24 men, 23 women); Group B, 45-65years (18 men, 24 women); and Group C, 44years and younger (15 men, 12 women). The three groups were compared in regard to symptoms, esophageal motility, and health-related QOL (HRQOL). All patients underwent esophageal manometry examination and completed a self-administered questionnaire concerning their symptoms; HRQOL assessment was based on results of the Short Form-8 General Health Survey. Symptoms rated≥4 points on the Likert scale were defined as significant. Although all patients had dysphagia as a major symptom, more elderly patients reported globus sensation, whereas more young patients reported heartburn as the primary symptom. Manometric diagnoses were generally similar across the three groups. Ineffective esophageal motility was more prevalent in Groups A and C than in Group B, although the difference was not statistically significant. No significant differences in manometric parameters or HRQOL were detected among the three groups. Despite differences in symptom patterns, broad manometric diagnoses and impairment of HRQOL in elderly patients with dysphagia are similar to those in younger counterparts.

Long-term esophageal motility changes after thyroidectomy: associations with aerodigestive disorders.

Patients undergoing thyroidectomy often complain aerodigestive disorders. In a previous study we showed the associations between voice impairment and proximal acid reflux, swallowing impairment and Upper Esophageal Sphyncter (UES) incoordination and the decrease in UES pressure in thirty-six patients observed before and soon afterwards uncomplicated thyroidectomy. This study investigated the state of post-thyroidectomy esophageal motility changes and its associations with these disorders after 18-24 months. The thirty-six patients prospectively recruited according to selection criteria (thyroid volume ≤60 ml, benign disease, age 18-65 years, previous neck surgery, thyroiditis, pre- or postoperative vocal cord palsy) underwent voice (VIS) and swallowing (SIS) impairment scores, esophageal manometry and pH monitoring once again. After 18-24 months, both VIS and SIS recovered (respectively: p=0,022; p=0,0001); UES pressure increased (p=0,0001) nearing the preoperative values. The persistence of swallowing complaints were associated with the persistence of esophageal incoordination (p=0,03); the association between voice impairment and proximal acid reflux was confirmed (p<0,001). Our study confirms that aerodigestive disorders after uncomplicated thyroidectomy, largely transient, are strictly connected with upper esophageal motility changes. In this viewpoint, the innervation of upper aerodigestive anatomical structures (larynx, pharynx, upper esophagus) and its variations should be focused.

Esophageal motility after peroral endoscopic myotomy for achalasia.

Peroral endoscopic myotomy (POEM) has been introduced as a novel endoscopic treatment for achalasia. The aim of this work is to assess the changes in esophageal motility caused by POEM in patients with achalasia. Forty-one patients with achalasia underwent POEM from September 2012 to November 2014. Esophageal motility of all patients was evaluated preoperatively and 1 month after POEM utilizing high-resolution manometry, which was performed with ten water swallows, ten steamed bread swallows, and multiple rapid swallows (MRS). In single swallows, including liquid swallows and bread swallows, all the parameters of lower esophagus sphincter resting pressure (LESP), 4-s integrated relaxation pressure (4sIRP), and intra-bolus pressure (IBP) were decreased between pre- and post-POEM patients (all p < 0.05). Postoperatively, the trend of distal contractile integral (DCI) and distal esophageal peristaltic amplitude declined in subtype II and subtype III (subtype II: p < 0.05; subtype III: p > 0.05), but increased in subtype I (subtype I: p > 0.05). In liquid swallows, the Eckardt score of subtype II patients decreased with DCI, and distal esophageal peristaltic amplitude after POEM was significantly lower compared with those showing increased values of those two parameters (p < 0.05). In MRS, the rate of LES relaxation increased from 66.67 to 95.24%, but without normal response in all achalasia patients. POEM reduces LES pressure in achalasia, and partly restores esophageal motility. POEM displayed varying effect on esophageal motility in patients with different patterns of swallowing. In addition, the changes in parameters associated with esophageal peristalsis correlated with decreases in Eckardt score.

Gastroesophageal reflux disease in COPD: links and risks.

COPD is a long-term condition associated with considerable disability with a clinical course characterized by episodes of worsening respiratory signs and symptoms associated with exacerbations. Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal conditions in the general population and has emerged as a comorbidity of COPD. GERD may be diagnosed by both symptomatic approaches (including both typical and atypical symptoms) and objective measurements. Based on a mix of diagnostic approaches, the prevalence of GERD in COPD ranges from 17% to 78%. Although GERD is usually confined to the lower esophagus in some individuals, it may be associated with pulmonary microaspiration of gastric contents. Possible mechanisms that may contribute to GERD in COPD originate from gastroesophageal dysfunction, including altered pressure in the lower esophageal sphincter (which normally protect against GERD) and changes in esophageal motility. Proposed respiratory contributions to the development of GERD include respiratory medications that may alter esophageal sphincter tone and changes in respiratory mechanics, with increased lung hyperinflation compromising the antireflux barrier. Although the specific cause and effect relationship between GERD and COPD has not been fully elucidated, GERD may influence lung disease severity and has been identified as a significant predictor of acute exacerbations of COPD. Further clinical effects could include a poorer health-related quality of life and an increased cost in health care, although these factors require further clarification. There are both medical and surgical options available for the treatment of GERD in COPD and while extensive studies in this population have not been undertaken, this comorbidity may be amenable to treatment.

Tu1182 High Resolution Esophageal Manometry in Italian Healthy Volunteers: A Comparison With North-American and North-European Values

G A A b st ra ct s GERD symptoms before seeking medical attention, and so the manometric changes of new onset RE have not been evaluated prospectively in humans. To elucidate those changes, we induced acute RE by discontinuing PPI therapy in patients who had severe RE that was healed by PPIs, and we studied changes in esophageal motility using high resolution esophageal manometry. Methods: Patients with a prior endoscopy showing LA grade C RE were treated with BID PPIs for at least one month before a baseline endoscopy to document healing, after which PPIs were stopped. High resolution esophageal manometry, multichannel intraluminal impedance(MII)/pH monitoring, endoscopy, and GERD-HRQL symptom scoring were performed at baseline (on PPI) and 2 weeks after stopping PPIs. Esophageal mucosal baseline impedance was calculated at study start and 2 weeks after stopping PPIs, by measuring the impedance at the beginning of the MII/pH study, 5 cm above the LES. Results: 14 patients enrolled; 3 were excluded when baseline endoscopy showed LA B RE, 1 was withdrawn for an unrelated adverse event, and 10 completed the study (9 men, 1 woman, mean age 56.5, range 29-69 years). Comparing baseline values to those 2 weeks after stopping PPIs for the 10 patients, the mean esophageal acid exposure (total % time pH<4) increased from 6.0%±11.4% SD to 27.2%±23.0% (p=.005) and mean GERD-HRQL scores increased from 7.7±9.5 to 12.5±9.2 (p=.02). Esophageal mucosal baseline impedance decreased from 2519±340V at week 0 to 1509±194V (p=.009) 2 weeks after stopping PPIs. 8 of the 10 patients developed moderate-to-severe endoscopic RE by 2 weeks (4 LA grade B, 4 LA grade C). In those 8 patients, the mean distal contractile integral (DCI) decreased from 1184.9±932.8 mmHg.s.cm to 798.9±666.6 mmHg.s.cm (p=.025), the mean LES pressure decreased from 15.9±8.2 mmHg to 12.6±9.0 mmHg (p=.16), and the integrated relaxation pressure (IRP) decreased from 4.8±4.7 mmHg to 0.4±5.4 (p=.01) mmHg. Conclusions: Discontinuing PPIs for 2 weeks in patients who had LA C RE healed by PPI therapy is a valid model of acute RE. These patients can develop severe RE associated with a significant increase in esophageal acid exposure and a significant decrease in esophageal impedance values within those 2 weeks. Our finding that acute RE causes a significant decrease in DCI demonstrates that moderate-to-severe GERD is a cause of hypocontractile esophageal motility alterations.