Disorders Of Upper Gastrointestinal Tract Research Articles

Role of Endoscopy in Motility Disorders of Upper Gastrointestinal Tract

Gastrointestinal motility disorders have a wide range of symptoms and affect patients' quality of life. With the advancement of endoscopy, the diagnostic and therapeutic roles of endoscopy in motility disorders is becoming more significant. Endoscopy is necessary to rule out possible organic diseases in patients with suspected motility disorders and provide significant clues for their diagnosis. Moreover, interventional endoscopy may be a primary or alternative treatment option for selected patients with motility disorders, and it is becoming a promising field as new therapeutic applications are developed and utilized for various motility disorders. This review may provide suitable indications for the use of endoscopy in diagnosing and treating motility disorders of the upper gastrointestinal tract.

Characterization of esophageal motor activity, gastroesophageal reflux, and evaluation of prokinetic effectiveness in mechanically ventilated critically ill patients: a high-resolution impedance manometry study

BackgroundMotility disorders of upper gastrointestinal tract are common in critical illness and associated with significant clinical consequences. However, detailed quantitative and qualitative analyses of esophageal motor functions are lacking. Therefore, we aimed to characterize the key features of esophageal motility functions using high-resolution impedance manometry (HRIM) and to evaluate an objective link between esophageal motor patterns, gastric emptying, and gastroesophageal reflux. We also studied the prokinetic effects of metoclopramide.MethodsWe prospectively performed HRIM for 16 critically ill hemodynamically stable patients. Patients were included if they had low gastric volume (LGV; < 100 mL/24 h, n = 8) or high gastric volume (HGV; > 500 mL/24 h, n = 8). The HRIM data were collected for 5 h with intravenous metoclopramide administration (10 mg) after the first 2 h.ResultsThe findings were grossly abnormal for all critically ill patients. The esophageal contraction vigor was markedly increased, indicating prevailing hypercontractile esophagus. Ineffective propulsive force was observed for 73% of esophageal activities. Panesophageal pressurization was the most common pressurization pattern (64%). Gastroesophageal reflux predominantly occurred with transient lower esophageal sphincter relaxation. The common features of the LGV group were a hyperreactive pattern, esophagogastric outflow obstruction, and frequent reflux. Ineffective motility with reduced lower esophageal sphincter tone, and paradoxically fewer reflux episodes, was common in the HGV group. Metoclopramide administration reduced the number of esophageal activities but did not affect the number of reflux episodes in either group.ConclusionAll critically ill patients had major esophageal motility abnormalities, and motility patterns varied according to gastric emptying status. Well-preserved gastric emptying and maintained esophagogastric barrier functions did not eliminate reflux. Metoclopramide failed to reduce the number of reflux episodes regardless of gastric emptying status.Trial registration ISRCTN, ISRCTN14399966. Registered 3.9.2020, retrospectively registered. https://www.isrctn.com/ISRCTN14399966.

Treatment tactics in patient with articular pathology and concominant disorders of upper gastrointestinal tract

Objective. To study nise efficacy and safety in pts with rheumatic diseases (RD) with concomitant disorders of upper gastrointestinal tract (GIT). Material and methods. An open uncontrolled multicenter nise study was conducted on 600 pts (mean age 54,8 years) with RD (rheumatoid arthritis - RA, osteoarthritis - OA, spine osteochondrosis with radicular syndrome - ОС). 20% of pts had G1 diseases at inclusion. Nise® was administered 200 mg/day for 30 days. An additional examination (esophagogastroduodenoscopy - EGDS, US, laboratory investigation) was performed in 30 pts with RD (20 - OA, 10 - ОС, mean age 48,4 years) and concomitant GI disorders (gastric ulcer in remission, erosive duodenitis, chronic pancreatitis, cholecystilis). Results. Nise® was effective in 40% from 600 pts with RD. (% of pts had non severe GI adverse events. The drug was withdrawn due to dyspepsia in only 0,2% of cases. Pain syndrome was eliminated in 90% from 30 pts with RD and GI disorders. 25 from them completed the trial. Severe adverse events did not appear. EGDS did not revealed exacerbation or appearance of new GI ulcers. Conclusion. Nise® is an effective and relatively safe NSAID which can be administered in pts with RD and concomitant GI disorders with EGDS control.