Esophageal Manometry In Patients Research Articles

Selective dysfunction of the crural diaphragm in patients with chronic restrictive and obstructive lung disease.

Gastroesophageal reflux (GER) is known to be associated with chronic lung diseases. The driving force of GER is the transdiaphragmatic pressure (Pdi) generated mainly by costal and crural diaphragm contraction. The latter also enhances the esophagogastric junction (EGJ) pressure to guard against GER. The relationship between Pdi and EGJ pressure was determined using high resolution esophageal manometry in patients with interstitial lung disease (ILD, n = 26), obstructive lung disease (OLD, n- = 24), and healthy subjects (n = 20). The patient groups did not differ with respect to age, gender, BMI, and pulmonary rehabilitation history. Patients with ILD had significantly higher Pdi but lower EGJ pressures as compared to controls and OLD patients (p < 0.001). In control subjects, the increase in EGJ pressure at all-time points during inspiration was greater than Pdi. In contrast, the EGJ pressure during inspiration was less than Pdi in 14 patients with ILD and 7 patients with OLD. The drop in EGJ pressure was usually seen after the peak Pdi in ILD group (p < 0.0001) and before the peak Pdi in OLD group, (p = 0.08). Nine patients in the ILD group had sliding hiatus hernia, compared to none in control subjects (p = 0.003) and two patients in the OLD, (p = 0.04). A higher Pdi and low EGJ pressure, and dissociation between Pdi and EGJ pressure temporal relationship suggests selective dysfunction of the crural diaphragm in patients with chronic lung diseases and may explain the higher prevalence of GERD in ILD as seen in previous studies.

Features of the Parameters of 24-Hours pH-Impedance and High-Resolution Esophageal Manometry in Patients with Barrett's Esophagus on Proton Pump Inhibitors

Аim: to identify predictors of insufficient effectiveness of proton pump inhibitors based on the evaluation of the results of 24-hour pH-impedance and high-resolution esophageal manometry in patients with Barrett's esophagus.Materials and methods. 52 patients with histologically confirmed Barrett's esophagus who are on therapy with proton pump inhibitors were examined. All patients underwent daily pH-impedance and high-resolution esophageal manometry.Results. According to daily pH-impedance, group 1 consisted of 37 patients who responded satisfactorily to antisecretory therapy, group 2 of 15 patients who demonstrated insufficient response to acid-suppressive therapy, 11 of whom had no clinical manifestations. The total number of reflux averaged 55 in group 1 and 106 in group 2. The average number of acid reflux in group 1 was 5.68, in group 2 — 48.5. The average number of non-acid reflux prevailed in patients of group 2 and averaged 58, in group 1 the indicator averaged 47. Evaluation of the results of high-resolution esophageal manometry showed that violations of the structure and function of the esophago-gastric junction were detected in 21 patients out of 52. Disorders of the motility of the thoracic esophagus were detected in 31 patients out of 52. When comparing the frequency of motor disorders from the thoracic esophagus in groups 1 and 2, no significant differences were obtained. However, significantly more frequent registration of violations of the structure and/or function of the esophago-gastric junction was found in the group with unsatisfactory effectiveness of proton pump inhibitors.Conclusion. In a number of patients with Barrett's esophagus, there is an insufficient effect of acid-suppressive therapy and at the same time an asymptomatic course of the disease, which may increase the risk of its progression. Predictors of insufficiently successful treatment of patients with Barrett's esophagus may be both insufficient pharmacological effect of proton pump inhibitors themselves, and motility disorders that cause the presence of non-acid reflux, decreased esophageal clearance, which in turn may cause the patient's symptoms to persist and adversely affect the condition of the esophageal mucosa.

Investigating the diagnostic utility of high-resolution oesophageal manometry in patients with refractory respiratory symptoms

BackgroundThe interaction between the respiratory and gastrointestinal systems, and the role of the latter in the development of respiratory pathology, has been examined with a focus on gastro-oesophageal reflux disease (GORD). However, little data exists examining the link between oesophageal motility and respiratory disease. Aims and objectivesIn this study, we examined patterns in oesophageal motility using high-resolution oesophageal manometry (HROM) in patients with refractory respiratory symptoms. MethodsData were collected retrospectively for all patients that were investigated using HROM at a single centre for refractory respiratory symptoms between January 1st, 2011–December 1st, 2021. Patients were selected for investigation based on airway reflux symptoms, measured by the Hull Airways Reflux Questionnaire (HARQ). Results441 patients were investigated with HROM (64% female, mean age = 56.5 [SD = 13.9]). The commonest diagnoses of these patients were Chronic Cough (77%, n = 339), Asthma (10%, n = 44), and Interstitial Lung Disease (7%, n = 29). The prevalence of oesophageal dysmotility was 66% in our cohort. Those with oesophageal dysmotility had significantly higher HARQ scores than those with normal motility (40.6 vs 35.3, p < 0.001) and there was a significant inverse correlation between HARQ scores and distal contractile integral (DCI), a measure of oesophageal contractility. ConclusionsTwo-thirds of patients with refractory respiratory symptoms were found to have oesophageal dysmotility on HROM. These findings suggest motility disorders of the oesophagus may contribute to the development and progression of respiratory disease. This study highlights the need for further prospective study of the relationship between oesophageal dysmotility and respiratory disease.

S3570 One and Done? Revisiting Need for Repeat Esophageal Manometry in Patients With Persistent Symptoms

Introduction: Achalasia is a motility disorder characterized by the absence of esophageal peristalsis and failure of the LES to relax in response to swallowing. High resolution manometry (HRM) has been established as the gold standard for diagnosis; however, the utility of repeat manometry has been investigated in only a limited number of reports. Whether repeat manometry provides new information or changes the diagnosis remains unclear Case Description/Methods: 70y/o female with GERD, PUD, cervical spondylosis, and rheumatoid arthritis, presented in 2015 with dysphagia to solids. Initial work-up included EGD which showed an esophageal web. She was started on acid suppression therapy without improvement. In 2017 she underwent HRM which showed an abnormal median integrated relaxation pressure of 39.6(n< 15mmHg) and an elevated upper esophageal sphincter relaxation pressure of 13.7(n< 12mmHg). 70% of swallows were failed with 30% of swallows peristaltic with normal distal contractile integral. There was incomplete bolus clearance in all swallows. Patient met Chicago Classification 3.0 criteria for esophagogastric junction outflow obstruction. However, given the large presence of non-peristaltic swallows, the possibility of an evolving achalasia was considered. Due to worsening symptoms, patient underwent barium esophagram (BE) ;in 2018 which did not suggest achalasia. There was however, small residual of contrast in the distal esophagus with delayed emptying suggesting a motility disorder. She then underwent video swallow study which was unrevealing. She again underwent BE; in 2019 revealing a prominent cricopharyngeus muscle causing narrowing of the esophageal lumen during the swallowing phase. She subsequently underwent repeat HRM which was consistent with Type II Achalasia per Chicago classification 3.0. LES pressure was elevated at 43.8 mmHg, UES pressure was normal (6.2 mmHg). 100% of all contractions had pan esophageal pressurization deeming them non-peristaltic. Patient had incomplete bolus clearance in all swallows. Of note, patient was not on any medications, including benzodiazepines or opioids, that would impact motility studies. Due to persistent symptoms, patient underwent peroral endoscopic myotomy with significant improvement of symptoms. Discussion: HRM is the gold standard for identifying causes of esophageal dysmotility. In patients whose symptoms progress over time, there is high utility in performing repeat manometry to evaluate the cause of their dynamic symptoms, as treatment options may change

High-resolution esophageal manometry in patients with achalasia

Introduction. At present, high-resolution esophageal manometry is the «gold standard» for the diagnosis of esophageal achalasia, based on the determination of the integrated relaxation pressure of the lower esophageal sphincter, the value of which in the case of achalasia must exceed 15 mm Hg (MMS System). However, in some patients with clinically and radiologically confirmed achalasia, this value is normal. There is no unified view of the cause of this phenomenon. We assumed that low pressure figures may be affected by incorrect installation of the manometric catheter.Methods and materials. This research included 149 patients (61 by retrospective estimating the patients data and 88 new patients) with achalasia established during the period from January 2017 to March 2020. When it was impossible to localize the lower esophageal sphincter and take correct measurements during high-resolution manometry in new patients, the X-rays or upper endoscopy was performed to control the manometric catheter placement. If its’ placement was incorrect and the integrated relaxation pressure level was lower than 15 mmHg, repeated high-resolution manometry was performed with the over-the-guidewire manometric catheter placing.Results. In 36 patients of both groups (24.2 %), the manometric data did not correspond to esophageal achalasia; in the prospective group, 12 out of the 19 patients had incorrect manometric data due to inability to visualize lower esophageal sphincter. In the prospective group, the manometric catheter was reinstalled by a guidewire, which allowed visualizing the signs of the lower esophageal sphincter in all cases, and in 15 out of 19 patients (79 %), the integrated relaxation pressure of the lower esophageal sphincter was more than 15 mm Hg.Conclusions. In some cases, the over-the-guidewire installing makes it possible to pass catheter through the lower esophageal sphincter correctly, visualize the lower esophageal sphincter during the high-resolution manometry examination and obtain true pressure values.

Effects of peroral endoscopic myotomy on esophageal motility in patients with achalasia

Objective To evaluate the effects of peroral endoscopic myotomy (POEM) on esophageal motility in patients with achalasia(AC) after POEM. Methods Demographics, clinical and manometric data, and outcomes were collected from the medical records of patients who received POEM as the primary therapy for AC in Beijing Friendship Hospital from January 2012 to June 2016. The rate of treatment success and change in esophageal dynamics before and after treatment were compared in different types of AC. Results At 6 months′ follow-up of POEM, the symptom remission rate of AC patients with type Ⅰ, type Ⅱ, and type Ⅲ was 100.0% (13/13), 95.5% (42/44) and 90.1% (10/11), respectively. Within 6 months after POEM, lower esophageal sphincter resting pressure [10.5 (6.9, 15.8) mmHg VS 24.6 (18.3, 35.1) mmHg, 1 mmHg=0.133 kPa], 4 s integrated relaxation pressure [6.0 (3.7, 8.8) mmHg VS 21.8 (15.3, 28.0) mmHg], upper esophageal sphincter (UES)resting pressure [43.4 (33.7, 57.3) mmHg VS 45.3 (33.2, 71.1) mmHg] and UES residual pressure [1.5 (0.0, 4.6) mmHg VS 3.9 (1.1, 6.9) mmHg] were significantly improved compared with those of pre-operation (all P<0.05). At 6 months after POEM, esophageal dilatation diameter (3.0±0.7 cm VS 3.9±1.1 cm) and Eckardt scores [1 (0, 2) VS 6 (5, 8)] were also significantly improved compared with those of pre-operation (all P<0.001). After POEM, the esophageal body peristalsis did not recover in type Ⅰ AC patients. Four patients (9.1%, 4/44) of type Ⅱ AC recovered weak peristalsis or premature contraction, and 10 patients (90.9%, 10/11) of type Ⅲ AC recovered with more normal peristaltic wave, and the rate of pre-systolic contraction or weak peristalsis increased. Conclusion POEM can improve the esophagogastric junction outflow tract obstruction and change the esophageal body motility.After POEM, part patients have recovery of esophageal body motility, which is most obvious in type Ⅲ AC, followed by type Ⅱ, and type Ⅰ AC patients have no significant change. Key words: Esophageal achalasia; Peroral endoscopic myotomy; Esophageal motility

Suprahyoid Muscle Activity in Patients with Chagasic Megaesophagus

The objective of this investigation was to evaluate the activity of the suprahyoid musculature during swallowing and to correlate the findings with the degree of megaesophagus, oral and pharyngeal videofluoroscopy and esophageal manometry in patients with achalasia caused by Chagas’ disease. Twenty-nine patients with positive serology for Trypanosoma cruzi and dysphagia (Chagas’ disease group) and 29 individuals matched by sex and age (control group) participated in the study. Surface electromyography of the suprahyoid musculature and videofluoroscopy during swallowing of paste and liquid consistencies were performed. Canonical correlation analysis of the MANOVA test results showed that the Chagas’ disease group had lower electromyographic activity when compared with controls. Overlapping circles of radiological findings were found for megaesophagus. The Spearman test showed a positive correlation between the electromyographic activity in the maximum voluntary isometric contraction and the time of pharyngeal transit for both liquid (p = 0.014) and paste (p = 0.047). The logistic regression test showed no association between electromyographic activity of the suprahyoid muscles and esophageal manometry results (p > 0.05). In conclusion, individuals with chagasic megaesophagus have reduced electromyographic activity of the suprahyoid muscles during swallowing, in addition to a greater recruitment of the suprahyoid musculature with increased pharyngeal transit time.

High Resolution Esophageal Manometry in Patients with Chagas Disease: A Cross-Sectional Evaluation.

IntroductionGastrointestinal involvement affects 30–40% of the patients with chronic Chagas disease. Esophageal symptoms appear once the structural damage is established. Little is known about the usefulness of high resolution manometry to early identification of esophageal involvement.MethodWe performed a cross-sectional study at the Vall d’Hebron University Hospital (Barcelona, Spain) between May 2011 and April 2012. Consecutive patients diagnosed with Chagas disease in the chronic phase were offered to participate. All patients underwent a structured questionnaire about digestive symptoms, a barium esophagogram (Rezende classification) and an esophageal high resolution manometry (HRM). A control group of patients with heartburn who underwent an esophageal HRM in our hospital was selected.Results62 out of 73 patients that were included in the study fulfilled the study protocol. The median age of the Chagas disease group (CG) was 37 (IQR 32–45) years, and 42 (67.7%) patients were female. Twenty-seven (43.5%) patients had esophageal symptoms, heartburn being the most frequent. Esophagogram was abnormal in 5 (8.77%). The esophageal HRM in the CG showed a pathological motility pattern in 14 patients (22.6%). All of them had minor disorders of the peristalsis (13 with ineffective esophageal motility and 1 with fragmented peristalsis). Hypotonic lower esophageal sphincter was found more frequently in the CG than in the control group (21% vs 3.3%; p<0.01). Upper esophageal sphincter was hypertonic in 22 (35.5%) and hypotonic in 1 patient. When comparing specific manometric parameters or patterns in the CG according to the presence of symptoms or esophagogram no statistically significant association were seen, except for distal latency.ConclusionThe esophageal involvement measured by HRM in patients with chronic Chagas disease in our cohort is 22.6%. All the patients with esophageal alterations had minor disorders of the peristalsis. Symptoms and esophagogram results did not correlate with the HRM results.

Effect of peroral endoscopic myotomy on esophageal manometry in patients with achalasia

Objective To determine the effect of peroral endoscopic myotomy （POEM） on esophageal manometry in patients with aehalasia. Methods Esophageal manometric data of 3 patients with aehala- sia before and after POEM was retrospectively analyzed. Results The post-POEM lower esophageal sphincter pressure （LESP） and upper esophageal sphincter residual pressure （UESRP） were significantly lower than those of before （ P 〈 0. 05 ）. The average post-POEM lower esophageal sphincter residual pressure （LESRP） decreased （P 〉 0. 05 ）, with significant decrease to normal level in 2 patients and almost unchanged （above normal） in the other. The esophageal aperistalsis remained after POEM in all 3 patients. The lower esophageal sphincter relaxing rate （LESRR） remained lower than normal after POEM as before. The average upper esophgeal sphincter pressure （UESP） decreased after POEM without statistical significance. Conclusion POEM can improve the outcomes of esophageal manometry in patients with aehalasia in the short term. Key words: Esophageal aehalasia; Esophageal manometery; Peroral endoscopic myotomy

Utility of software analysis of esophageal manometry studies in patients with aperistalsis

Esophageal manometry is the gold standard for the diagnosis of esophageal aperistalsis. There is computer software that analyzes peristalsis on esophageal manometry, but this automated analysis has not been formally evaluated. Our primary aim was to evaluate the software analysis of esophageal aperistalsis by esophageal manometry in patients diagnosed with aperistalsis by an experienced clinician. Esophageal manometry studies from January 2006 to November 2007 were retrospectively reviewed for evidence of aperistalsis by an experienced clinician. All studies demonstrating aperistalsis were selected for further review. The automated analysis performed by our software program for each study was recorded. Agreement between the automated analysis and the clinician was measured by the proportion of agreement on the absence of peristalsis. Eighty-seven of the 962 esophageal manometry studies reviewed demonstrated aperistalsis. The automated analysis reported esophageal body peristalsis with wet swallows in 66 out of 87 patients (75.9%). In these patients, the software analyzed an average of 34.2% of the wet swallows as peristaltic. The agreement between the clinician's review and software analysis of aperistalsis was 24.1%. These data suggest there is poor agreement between the automated analysis of peristalsis and that of an experienced reviewer. Automated analysis cannot be relied upon in the diagnostic evaluation of esophageal aperistalsis as it overestimates the presence of peristalsis and may lead to incorrect diagnoses and management strategies.

Estudio mamométrico del esófago en pacientes con dolor torácico no cardíaco

Non cardiac chest pain can be caused by esophageal problems such as gastroesophageal reflux or smooth muscle motor disorders. To perform esophageal manometry in patients with non cardiac chest pain. One hundred patients with chest pain in whom coronary problems were discarded, were studied. A computerized esophageal manometry was performed in all and 24 hours esophageal pH measurement was done in 21 patients. Esophageal manometry was normal in eight patients. Nutcracker esophagus was the most common finding, in 36 patients. Twenty eight had a hypotensive sphincter, 16 had unspecific motor disorders, nine had diffuse esophageal spasm, two had a non achalasic esophageal aperistalsis and one had a hypertensive sphincter. Only eight of 100 patients referred to esophageal manometry for non cardiac chest pain, had a normal study.

Clinical Diagnosis of Achalasia: How Reliable is the Barium X-Ray?

Manometry is considered to be the gold standard for the diagnosis of achalasia. However, many physicians believe that contrast radiography, classically showing esophageal dilation with bird-beak narrowing of the gastroesophageal junction, is also accurate in either diagnosing or excluding the disorder. The aim of the current study was to determine the accuracy of barium x-ray in the diagnosis of achalasia. The radiological diagnosis of all patients manometrically diagnosed with achalasia (using conventional criteria) between January 1994 and June 1998 were reviewed. A total of 51 cases of achalasia were identified. Thirteen patients were excluded because they either did not have contrast radiography before a manometric diagnosis or had their x-rays performed more than six months previously. Of the remaining 38 patients, achalasia was stated as a diagnostic possibility in the radiologists report in only 22 (58%) of those patients. Achalasia was not considered in the remaining 16 patients: two were reported as normal, four as having stenosis/narrowing in distal esophagus, two as having presbyesophagus, one as having mild gastroesophageal reflux and seven as having nonspecific dysmotility. To determine the reason for the diagnostic failure of the barium x-ray, an expert gastrointestinal radiologist reviewed 12 of the nondiagnostic x-rays in a blinded fashion, interspersed with 10 randomly selected esophageal-contrast radiographs from control subjects to avoid bias. Of these initially nondiagnostic x-rays in achalasia patients, typical radiological features of achalasia were deemed to be present in 50%. The present study indicates that contrast radiography lacks sensitivity in the diagnosis of achalasia. This is not only due to radiologist oversight but also because of the absence of the characteristic radiological features in many cases. This reinforces the important role of esophageal manometry in patients with persistent nonstructural dysphagia.

Oesophageal manometry in patients with varices and following oesophageal transection

Thirteen patients who had recently bled from varices underwent oesophageal manometry. A control group of 13 asymptomatic subjects were also studied. Seven of the thirteen variceal patients had manometry before oesophageal transection and repeat manometry at least 1 month following operation. A further group of 17 post-transection patients also underwent manometry at a mean 27.6 months following operation. Comparison between variceal (13) and control subjects (13) showed that the lower oesophageal sphincter pressure, total length and length of the abdominal and proximal portions of the sphincter were similar in the two groups. Pre- and postoperative manometry (7) revealed a significant reduction in lower oesophageal sphincter pressure following transection. The total length of the lower sphincter was shorter postoperatively compared to the pre-operative length. Both the abdominal and the proximal portion of the sphincter were significantly shorter postoperatively. Comparison between post-transection group (24) and control subjects (13) showed that lower oesophageal sphincter pressure was significantly less following transection. Both total length and the length of the abdominal portion of the sphincter were significantly lower in the post-transection group.

Does the combination of solid and liquid swallows improve esophageal manometry in patients with dysphagia

Does the combination of solid and liquid swallows improve esophageal manometry in patients with dysphagia

The role of preoperative oesophageal manometry in patients with gastro-oesophageal reflux disease

Oesophageal manometry has become a standard investigation in the management of functional disorders of the oesophagus. However, the importance of the various manometry parameters for the surgical management of patients with gastro-oesophageal reflux disease (GERD) has not yet been studied adequately. This study examined the importance of manometric findings on surgical treatment results in patients with GERD. Between January 1995 and January 2000, 123 consecutively referred patients with GERD symptoms were studied. Ninety-seven of these (52 women and 45 men, mean age 48 years) underwent Nissen fundoplication in conventional or laparoscopic technique. Preoperatively, each patient received stationary oesophageal manometry with a water perfusion catheter, gastroduodenoscopy and 24h-pH-metry of the oesophagus. Independent of manometric results, patients received 360 degrees fundoplicatio with 2 cm cuff ("floppy Nissen"). Eighty-five of the 97 patients (88 %) had an incompetent lower oesophageal sphincter. Hypomotility was diagnosed in 17 (18 %). Amotile achalasia and diffuse oesophageal spasms were seen in two and one patient, respectively, who were not operated on. Follow-up data were available for 92 % of patients (mean follow-up time 1.8 years). Five and 8 patients (1 and 2 of these with hypomotility) postoperatively developed persistent dysphagia and GERD recurrence, respectively (relative risks 1.2 and 1.6). Two patients (one with hypomotility) required surgical revision. Preoperative oesophageal manometry in GERD patients is useful only for determining the position of the upper boundary of the lower oesophageal sphincter and for ruling out specific motility disorders. In patients with oesophageal hypomotility, "floppy Nissen" fundoplicatio can be performed without an excess risk of dysphagia.

Influence of endoscopic variceal ligation on oesophageal motility.

To determine the change of oesophageal manometry in patients with oesophageal varices before and after oesophageal variceal ligation (EVL). Forty-five patients who had liver cirrhosis and oesophageal varices with high risk of bleeding were managed by EVL. Oesophageal manometry was performed just prior to the ligation and 4-6 weeks after obliteration of varices. Another 45 age- and sex-matched patients without hepatic, oesophageal or systemic disease served as the control group. At 5 cm above the lower oesophageal sphincter (LES), the amplitude of the contractive wave was significantly lower in patients before EVL (56.9 +/- 31.8 vs 80.1 +/- 30.1, P< 1.05) and returned to the level of control subjects after EVL (76.5 +/- 37.0 vs 80.1 +/- 30.1, P> 0.05). At 10 cm above LES, the amplitude of the contractive wave was significantly lower in patients before and after EVL than the control group (54.3 +/- 29.2 vs 68.1 +/- 29.5, 54.2 +/- 26.0 vs 68.1 +/- 29.5, respectively, P< 0.05). The percentage of tertiary waves was significantly higher in patients before and after EVL than in the control group (31.4 +/- 36.6 vs 5.8 +/- 15.1, 26.9 +/- 32.9 vs 5.8 +/- 15.1, respectively, P< 0.05). However, no significant swallowing disturbance was noted in patients after EVL. There was significantly greater LES length in patients before EVL (4.0 +/- 0.9 vs 3.4 +/- 0.7, P<0.05) but there was no significant difference in the LES length after EVL as compared with the control group. Eighty-six per cent (39/45) of patients developed paraoesophageal varices and 31% (14/45) developed new varices 6 months after variceal obliteration. However, there was no significant difference in manometry at the time of variceal obliteration between patients with variceal recurrence and those without. The presence of varices affected oesophageal motility. However, such abnormality had little clinical significance. Endoscopic variceal ligation normalized oesophageal motility and may not induce abnormal oesophageal motility. The manometric change can not be used to predict the recurrence of varices in cirrhotic patients after variceal obliteration.

Esophageal manometry in patients with stroke with and without dysphagia

Esophageal manometry in patients with stroke with and without dysphagia

The diagnostic value of oesophageal radionuclide transit in patients admitted for but without acute myocardial infarction.

The use of radionuclide transit (RT) as a screening test for chest pain of oesophageal origin has been debated. The aim of this study was to determine the value of RT as a screening test for oesophageal disorders in comparison with oesophageal manometry in patients admitted with acute chest pain but without acute myocardial infarction (non-AMI patients), and to assess the frequency of oesophageal disease present in these patients. A total of 222 non-AMI patients entered the study. An extensive examination programme comprised noninvasive cardiac studies, pulmonary studies, a careful physical examination of the musculoskeletal system, and oesophago-gastric examinations including endoscopy, pH monitoring of the oesophagus and a Bernstein test. In 91% of the patients one or more diagnoses were obtained. Based on clinical and laboratory data a 'consensus' diagnosis was made. With manometry as the reference RT had a poor sensitivity (35%) but an acceptable specificity (82%). With the consensus diagnosis as the gold standard the sensitivities of both manometry and RT were poor (29%), whereas the specificity of RT, but not of manometry, was very high (97%). Gastrointestinal diagnoses were found in 57% of the patients. In conclusion, none of the applied oesophageal examinations are valuable as single screening tests. Both RT and manometry have low sensitivities. RT may be used as a cheap, noninvasive and rapid supplementary examination. When positive, it strongly supports further invasive studies of the oesophagus in non-AMI patients with unexplained chest pain.

Esophageal motor function in primary Sjögren's syndrome: correlation with dysphagia and xerostomia.

The incidence of dysphagia in patients with primary Sjogren's syndrome (pSS) has been underestimated and all too often ascribed to xerostomia, without considering the possible presence of esophageal motor abnormalities affecting other nonscleroderma connective tissue diseases. Esophageal and salivary functions were prospectively evaluated in 27 females who met the four criteria proposed by Fox for the diagnosis of pSS, using esophageal manometry after wet swallows and Saxon's test, respectively. Dysphagia was graded using a standard symptoms questionnaire and results were compared with those obtained in a group of 21 healthy controls. Seven patients with pSS (26%) had no swallowing discomfort, 2 (7.4%) had mild dysphagia, 7 (26%) had moderate dysphagia, and 11 (40.6%) had severe dysphagia. Saxon's test revealed an overall decrease in the salivary flow rate compared to controls, with no difference between patients with or without dysphagia. Esophageal manometry demonstrated the absence of any lower or upper esophageal sphincter function abnormalities in all patients. In the patients with pSS as a whole, manometric study of the esophageal body showed a motor pattern comparable with that of controls, with no difference between patients with and without dysphagia. Defective peristalsis, ie, the presence of simultaneous contractions in more than 30% of wet swallows was detected, however, in the distal tract of the esophagus of six patients (22.2%) and in the proximal tract of three (11.1%). All these patients had severe dysphagia and the modified Saxon's test revealed a salivary secretion comparable with that of patients with a normal peristalsis. Dysphagia is a very common complaint in patients with pSS and does not seem to correlate with xerostomia, which is a constant and typical finding of the disease. About one third of patients with pSS have an abnormal esophageal peristalsis that is responsible for severe dysphagia, whereas decreased salivary outflow exacerbates the swallowing discomfort. This has to be taken into account and justifies the routine use of esophageal manometry in patients with pSS. The cause of dysphagia in pSS patients without peristaltic disorders of the esophagus has to be investigated.

24-hour ambulatory esophageal manometry in patients with achalasia of the esophagus: [formula omitted], ∗M. Bortolotti, V. Maffettone, G. Izzo, L. Monaco and A. Del Genio. Dept. of Digestive Surgery, 2 nd University of Naples - ∗ 1 st Medical Clinic, University of Bologna - ITALY

24-hour ambulatory esophageal manometry in patients with achalasia of the esophagus: [formula omitted], ∗M. Bortolotti, V. Maffettone, G. Izzo, L. Monaco and A. Del Genio. Dept. of Digestive Surgery, 2 nd University of Naples - ∗ 1 st Medical Clinic, University of Bologna - ITALY