Evaluation Of Esophageal Motility Research Articles

Value of endoscopic grading of gastroesophageal flap valve in gastroesophageal reflux disease.

To investigate the significance of endoscopic grading (Hill's classification) of gastroesophageal flap valve (GEFV) in the examination of patients with gastroesophageal reflux disease (GERD). One hundred and sixty-two patients undergoing gastroscopy in the Department of Gastroenterology, Xingyi People's Hospital between Apr. 2022 and Sept. 2022 were selected by convenient sampling, and data such as GEFV grade, and findings of esophageal high-resolution manometry (HRM) and esophageal 24-h pH/impedance reflux monitoring, and Los Angeles (LA) classification of reflux esophagitis (RE) were collected and compared. Statistically significant differences in age (F = 9.711, P < 0.001) and hiatal hernia (χ = 35.729, P < 0.001) were observed in patients with different GEFV grades. The resting LES pressures were 12.12 ± 2.79, 10.73 ± 2.68, 9.70 ± 2.29, and 8.20 ± 2.77mmHg (F = 4.571, P < 0.001) and LES lengths were 3.30 ± 0.70, 3.16 ± 0.68, 2.35 ± 0.83, and 2.45 ± 0.62 (F = 3.789, P = 0.011), respectively, in patients with GEFV grades I-IV. DeMeester score (Z = 5.452, P < 0.001), AET4 (Z = 5.614, P < 0.001), acid reflux score (upright) (Z = 7.452, P < 0.001), weak acid reflux score (upright) (Z = 3.121, P = 0.038), liquid reflux score (upright) (Z = 3.321, P = 0.031), acid reflux score (supine) (Z = 6.462, P < 0.001), mixed reflux score (supine) (Z= 3.324, P = 0.031), gas reflux score (supine) (Z= 3.521, P = 0.024) were different in patients with different GEFV grades, with statistically significant differences. Pearson correlation analysis revealed a positive correlation between RE grade and LA classification of GERD (r = 0.662, P < 0.001), and the severity of RE increased gradually with the increase of the Hill grades of GEFV. The Hill grade of GEFV is related to age, hiatal hernia, LES pressure, and the consequent development and severity of acid reflux and RE. Evaluation of esophageal motility and reflux based on the Hill grade of GEFV is of significance for the diagnosis and treatment of GERD.

Evaluation of Esophageal Motility in Obese Patients before and after Bariatric Surgery: Role of Multichannel Intraluminal Impedance and High-resolution Manometry

Abstract Background: A high prevalence of esophageal motor disorders has been reported in obese patients. Roux-en-Y gastric bypass (RYGB) can trigger symptoms of dysphagia by worsening preexisting esophageal motor disorders. Investigation of esophageal motility with multichannel intraluminal impedance (MII) and high-resolution manometry (HRM) is available. Objective: The aim is to compare the results of MII and HRM of nonobese patients with those of obese patients before and after RYGB to identify possible preoperative predictive factors of postoperative dysphagia. Materials and Methods: Twenty-eight obese patients were evaluated with a questionnaire of symptoms, endoscopy, HRM, and MII in different postures (supine and sitting) before and 6 months after laparoscopic RYGB. They were compared with eleven nonobese subjects. Chicago classification parameters were used to characterize esophageal motility disorders. Results: Obese patients evolved with more symptoms of dysphagia after surgery (7.10% preoperatively and 32.10% postoperatively). None had gastrojejunal anastomosis stenosis. After bariatric surgery, there was an increase in distal latency (HRM) and also a decrease in esophageal alimentary bolus progression (MII). Twenty-one percent of obese patients already had some dysmotility before the surgery and 92% of them evolved to dysphagia after the operation. Conclusions: Previous esophageal motility disorder is a good predictive factor of postoperative dysphagia. HRM and MII should be performed in some situations, such as bariatric surgery for older adults and before narrowing the gastrojejunal anastomosis as a treatment for weight recidivism.

Evaluation of Esophageal Motility and Lessons from Chicago Classification version 4.0.

Chicago Classification has standardized clinical approach to primary esophageal motility disorders. With new clinical data and advancing treatments, Chicago Classification has undergone multiple revisions to reflect updated findings and enhance diagnostic accuracy. This review will describe the recently published Chicago Classification version 4.0 (CCv4.0), which aimed to enhance diagnostic characterization and limit overdiagnosis of inconclusive esophageal motility diagnoses. Key revisions outlined in CCv4.0 include (1) a modified standardized HRM study protocol performed in supine and upright positions, (2) recommended ancillary testing and manometric provocation for inconclusive manometric diagnoses (3) the required presence of obstructive symptoms for conclusive diagnoses of esophagogastric junction outflow obstruction, distal esophageal spasm and hypercontractile esophagus, and (4) requirement of confirmatory testing for esophagogastric junction outflow obstruction. These key modifications aim to improve diagnostic accuracy and consistency of clinically relevant esophageal motility disorders, and subsequently clinical outcomes.

416 Esophageal Body Dysfunction in Patients With Esophagogastric Junction Outflow Obstruction: A Potential Flaw in the Chicago Classification

INTRODUCTION: High-resolution manometry using the Chicago Classification is standard in the evaluation of esophageal motility. When the relaxation of the esophagogastric junction is impaired and achalasia excluded, esophagogastric junction outflow obstruction (EGJ-OO) is diagnosed and the esophageal body is essentially ignored. We sought to characterize the function of the esophageal body in consecutive patients with EGJ-OO. METHODS: Retrospective review of the esophageal manometry findings in consecutive patients where there was computer recognition of EGJ-OO collected over a 2-month period. In each case, the esophageal body was reviewed manually and results reported independent of the suggested computer diagnosis. RESULTS: 116 patients underwent manometry over a 2-month period and 30 (26%) were identified as having EGJ-OO. The indications for testing included chronic cough (n = 5), GERD (n = 8), dysphagia (n = 9) and esophageal evaluation associated with severe lung disease or transplantation (n = 8). The mean IRP was 20.8 (range 16-33.6) and did not vary depending on indication (P = 0.381). Computer interpretation was EGJ-OO in all patients without mention of the esophageal body. After review, 11 (37%) had an additional esophageal diagnosis. In effective esophageal motility (IEM) was the most prevalent among them (IEM-8, achalasia-2, jackhammer esophagus-1; P = 0.020). The frequency of an additional esophageal diagnosis was significantly different between GERD (0%) and dysphagia (66%; P = 0.004), but not between other groups (i.e. 40% in cough and 37.5% in transplant group). An esophageal body diagnosis was significantly more likely in patients with IRP &gt; 25 (80%) compared with those with IRP &lt; 25 (28%; P = 0.028). CONCLUSION: 1-EGJ-OO is common in patients referred for esophageal manometry. 2-An additional esophageal body diagnosis is common in those with EGJ-OO.3-Esophageal diagnoses are more common in patients with dysphagia and in those with a very high IRP. The body of the esophagus is important in cases of EGJ-OO and should be reported independent of the computer-generated interpretation of the Chicago Classification.

Esophageal provocation tests: Are they useful to improve diagnostic yield of high resolution manometry?

High resolution manometry (HRM) is the gold standard to diagnose esophageal motility disorders but has some limitations. The inclusion of provocative tests might enhance the diagnostic yield of HRM. These tests are easy to perform and to add to the regular manometry protocol. Multiple rapid swallows (MRS; 5 2-mL swallows) is useful to assess the contractile reserve and deglutitive inhibition. The optimal number of MRS to perform might be 3 as suggested by Mauro etal. in this issue of Neurogastroenterology & Motility. The absence of contractile reserve might be associated with gastro-esophageal reflux disease and with an increased risk of post fundoplication dysphagia. Single viscous and solid swallows might enhance the detection of esophageal motility disorders but are not significantly associated with symptom occurrence. Test meal has the advantage to represent a real-life scenario and is promising to depict significant motility findings responsible for esophageal symptoms. Post-prandial recording might also be of interest to diagnose rumination and belching disorders. The best indication of rapid drink challenge test (free drinking of 200mL) is currently the diagnosis of esophago-gastric junction obstruction. Finally, abdominal compression might be an option to evaluate response of esophageal peristalsis in a context of outflow resistance as proposed by Brink etal. in this issue. These provocative maneuvers appear to provide a complementary role in the evaluation of esophageal motility but require prospective studies to determine the validity of the findings and whether they will lead to changes in clinical practice.

473 Pathophysiology of Gastroesophageal Reflux in Patients With Chronic Pulmonary Obstructive Disease Is Linked to an Increased Transdiaphragmatic Pressure Gradient Not a Defective Esophagogastric Barrier

The association of gastroesophageal reflux disease (GERD) and pulmonary diseases is well known. Early studies showed that gastroduodenal contents may reflux up to the proximal esophagus and cause aspiration. Other studies showed a higher incidence of GERD in patients with asthma, interstitial fibrosis, chronic cough, and chronic obstructive pulmonary disease (COPD). Esophageal (or typical) GERD symptoms (heartburn, regurgitation, and dysphagia) are not always present in these patients, and even when they are reported, they yield a low accuracy for GERD diagnosis. Extra-esophageal symptoms such as cough are common and thus represent a confounding factor. As a consequence, clinical questionnaires are insufficient and objective determination of GERD is mandatory for the correct management of these patients. COPD is attributed to tobacco smoking in the majority of cases, different from adult asthma and pulmonary fibrosis that, although still considered idiopathic, have GERD as a putative etiologic factor. However, a great number of smokers will never develop COPD leading to the suggestion that tobacco alone is not responsible for the disease in every patient and that aspiration of gastroduodenal contents may play a contributory role. In addition, COPD disrupts the ventilatory dynamics, and this may promote abnormal reflux. COPD is probably the main pulmonary disease that lacks a satisfactory number of studies dealing with objective evaluation of esophageal motility and acid exposure by esophageal function tests.We believe that the study of the incidence of GERD, esophageal motility, and ventilatory dynamics by esophageal manometry and ambulatory pHmonitoringmay shed some light on the association between COPD and GERD. This study aims to evaluate in patients with COPD (1) the incidence and profile of GERD, (2) esophageal motility, and (3) the transdiaphragmatic pressure gradient.

Accuracy of esophageal scintigraphy for evaluation ofesophageal motility disorders

Accuracy of esophageal scintigraphy for evaluation ofesophageal motility disorders

Pathophysiology and treatment of patients with globus sensation--from the viewpoint of esophageal motility dysfunction.

"Globus sensation" is often described as the sensation of a lump in the throat associated with dry swallowing or the need for dry swallowing, which disappears completely during eating or drinking and for which no organic cause can be established. Due to the uncertain etiology of "globus sensation", it remains difficult to establish standard treatment strategies for affected patients. Lately most attention has been focused on gastroesophageal reflux disease and several reports have indicated that there is a close relationship between esophageal acid reflux and globus sensation. Nowadays, empirical therapy with a high dose of a proton pump inhibitor (PPI) is considered to be indicated for patients with globus sensation, after excluding organic diseases such as pharyngeal cancer, Zenker's diverticulum, or thyroid enlargement. If patients are nonresponsive to PPI therapy, evaluation of esophageal motility should be done. In our recent study, 47.9% had abnormal esophageal motility, with the most common esophageal motility abnormality being an ineffective esophageal motility in PPI-resistant patients with globus sensation. This suggests that prokinetics alone or adding prokinetics to PPI should be the treatment to be considered, although few studies have investigated the efficacy of prokinetics in the treatment of patients with globus sensation. If patients without any esophageal motility dysfunctions are nonresponsive to PPI therapy, either cognitive-behavioral therapy, anti-depressants, or gabapentin could be helpful, although further well-designed, randomized controlled large-scale studies will be necessary to determine the effectiveness of each treatment strategy on patients with globus sensation.

Su1460 High Resolution Manometry (HRM) Evaluation of Esophageal Motility After Radiofrequency Ablation in Patients With Barrett's Esophagus

Radiofrequency ablation (RFA) is a minimally invasive form of endoscopic therapy for eliminating Barrett's mucosa at risk for transformation to esophageal adenocarcinoma. The effects of RFA are reportedly limited to the mucosal layer of esophagus with no effects on deeper esophageal tissues. However, the effects of RFA on esophageal motility are not known.

Evaluation of esophageal motility and reflux in children treated for congenital diaphragmatic hernia with the use of combined multichannel intraluminal impedance and pH monitoring

Background Gastroesophageal reflux (GER) is frequently observed in children treated for congenital diaphragmatic hernia (CDH) at birth, as well as esophageal dysmotility, that has been hypothesized to be caused by innervatory anomalies. The aim of this study is to evaluate GER and dysmotility in young patients with CDH using pH-multichannel intraluminal impedance. Methods Thirty children (17 boys and 13 girls) who underwent repair for CDH between 2002 and 2007 with a median age of 5.2 years (range, 3-10 years) were included in the study. All patients were operated on with a subcostal laparotomy incision and had a left-sided diaphragmatic defect. The defect repair required an artificial patch (Goretex, Gore Medical, Flagstaff, AZ) in 8 patients (27%) because of its size. We described impedance reflux parameters and some specific motility parameters studied on 10 standardized swallows. Results The incidence of GER was 86%. Reflux was mainly nonacidic, postprandial, and short-term and reached only the distal esophagus. Esophageal dysmotility was observed only in the distal esophagus. Conclusions With the use of pH-multichannel intraluminal impedance, both GER and esophageal motility in patients with congenital malformations can be analyzed. In patients with CDH, impaired motility seems to involve only the distal esophagus. In this group, the specific pattern of reflux is probably caused by the involvement of gastroesophageal junction, without significant intrinsic innervation abnormalities as observed in patients with esophageal atresia.

“Evaluation of Esophageal Motility Using Multichannel Intraluminal Impedance in Healthy Children and Children With Gastroesophageal Reflux”: Comments

Objective: Multichannel intraluminal impedance (MII) directly evaluates esophageal bolus transport. There is a good correlation between MII and manometry in healthy adults, but there are no reports concerning children. The aim of the present study was to determine normal values of esophageal motility using only impedance measurements in healthy children and in a pediatric population with gastroesophageal reflux (GER). Patients and Methods: We described in the present study 60 children submitted to pH-MII for 24 hours for suspected GER. Patients were divided into 2 different groups on the basis of their pH-MII report. Group 1 patients showed acid GER, whereas group 2 patients had negative pH-MII analysis for GER despite symptoms. We described impedance reflux and motility parameters on 10 standardized swallows: number of reflux, mean acid clearing time, median bolus clearing time, bolus presence time, total bolus transit time, segmental transit time, and total propagation velocity. Results: In group 1, the median mean acid clearing time was 151 seconds, whereas the median mean bolus clearing time was 25 seconds. In group 2 patients, all of the reflux parameters were normal. In group 1 the median bolus presence time at each measuring site, the median total bolus transit time, and the median segmental transit time were significantly greater and total propagation velocity lower than values reported in group 2 (P < 0.001), if compared with those described for adult patients. Conclusions: The pH-MII is an ideal test in children because it studies GER with its characteristics and motility pattern. Our report summarizes for the first time impedance motility parameters in healthy children.

The evaluation of esophageal motility in patients with persistent dysphagia after fundoplication

Persistent postoperative dysphagia (PPD) is a relatively rare but troublesome complication of laparoscopic fundoplication in patients with gastroesophageal reflux disease. Although it is mainly attributed to impaired distal esophageal body (EB) function, it may develop in patients with preserved motility as well. Since little is known about the pre- and postoperative motility patterns of such patients we aimed to compare the esophageal motor function in patients with PPD and a matched control group of patients without swallowing problems after fundoplication. Patients, Methods: Eleven patients (M/F 3/8, mean age: 52.6 ys., BMI: 24.2) with PPD after laparoscopic fundoplication were evaluated. Standard water perfusion esophageal manometry was performed before and 3 months after fundoplication in all subjects and results were compared to an age, sex, BMI and preoperative dysphagia score matched group of 11 control patients without PPD. Results: Preoperative esophageal manometry showed similar lower esophageal sphincter (LES) length, pressure, relaxation time, and EB peristaltic wave duration in both groups. The amplitude of contractions in the distal EB were also similar, while patients with PPD had significantly lower amplitudes in the proximal esophagus than controls after dry (25.5 vs. 61.8mmHg, p=0.01) and wet (45.1 vs. 76.7mmHg, p=0.05) swallows. Propagation velocity of the contractions were slower in patients with PPD after wet swallows (2.56 vs. 3.27cm/s, p=0.05). The number of simultaneous contractions tended to be higher in PPD. Postoperatively both groups had similarly improved LES function. In the EB, distal contraction amplitudes were decreased in patients with PPD (95.6 vs. 75.5mmHg, p=0.05) but not in controls, compared to the preoperative values. After fundoplication the number of simultaneous contractions were significantly higher in patients with PPD than in controls. Conclusions: In patients with preserved distal EB contraction amplitudes, decreased peristaltic wave propagation velocity, and proximal amplitudes may be predictive for PPD after fundoplication. Patients with PPD have decreased distal EB contraction amplitudes after fundoplication compared to their preoperative results. TÁMOP421/B09/1, ETT340/09

Evaluation of esophageal motility and reflux in children treated for esophageal atresia with the use of combined multichannel intraluminal impedance and pH monitoring

BackgroundGastroesophageal reflux (GER) and dysmotility are frequent in patients treated for esophageal atresia (EA). This aim of this study is to evaluate GER and dysmotility in young EA patients using pH–multichannel intraluminal impedance (pH-MII). MethodsFifteen patients with a mean age of 7.5 years (group 1) have been studied and compared with 15 children without congenital malformation, submitted to pH-MII for suspected GER (group 2). These latter patients serve as a control group of healthy subjects. The following impedance reflux and motility parameters have been studied on 10 standardized swallows: number of reflux episodes, mean acid clearing time, median bolus clearing time, bolus presence time, total bolus transit time, segmental transit time, and total propagation velocity. ResultsIn the group of EA patients, mean acid clearing time and median bolus clearing time were pathological. In the control group, all reflux parameters were normal. Patients with EA had significantly longer median bolus presence time at each measuring site, median total bolus transit time, and median segmental transit time and slower total propagation velocity (P < .001). ConclusionspH–multichannel intraluminal impedance evaluates both GER and motility patterns. Our report studies impedance parameters of esophageal motility in healthy children and in EA patients using only pH-MII.

Evaluation of Esophageal Motility Using Multichannel Intraluminal Impedance in Healthy Children and Children With Gastroesophageal Reflux

Multichannel intraluminal impedance (MII) directly evaluates esophageal bolus transport. There is a good correlation between MII and manometry in healthy adults, but there are no reports concerning children.The aim of the present study was to determine normal values of esophageal motility using only impedance measurements in healthy children and in a pediatric population with gastroesophageal reflux (GER). We described in the present study 60 children submitted to pH-MII for 24 hours for suspected GER. Patients were divided into 2 different groups on the basis of their pH-MII report. Group 1 patients showed acid GER, whereas group 2 patients had negative pH-MII analysis for GER despite symptoms. We described impedance reflux and motility parameters on 10 standardized swallows: number of reflux, mean acid clearing time, median bolus clearing time, bolus presence time, total bolus transit time, segmental transit time, and total propagation velocity. In group 1, the median mean acid clearing time was 151 seconds, whereas the median mean bolus clearing time was 25 seconds. In group 2 patients, all of the reflux parameters were normal. In group 1 the median bolus presence time at each measuring site, the median total bolus transit time, and the median segmental transit time were significantly greater and total propagation velocity lower than values reported in group 2 (P < 0.001), if compared with those described for adult patients. The pH-MII is an ideal test in children because it studies GER with its characteristics and motility pattern. Our report summarizes for the first time impedance motility parameters in healthy children.

High Resolution Esophageal Manometry Superior to the SmartPill System for Evaluation of Esophageal Motility

High Resolution Esophageal Manometry Superior to the SmartPill System for Evaluation of Esophageal Motility

6. The Evaluation of Esophageal Motility Using High Resolution Manometry Achalasia (II)

6. The Evaluation of Esophageal Motility Using High Resolution Manometry Achalasia (II)

Novas técnicas ambulatoriais para avaliação da motilidade esofágica e sua aplicação no estudo do megaesôfago

Brazilian surgeons deal routinely with esophageal motility disorders, because achalasia is highly prevalent in Brazil due to Chagas' disease. In the last years new technologies for the evaluation of esophageal motility became available. High resolution manometry and the combination of barometric parameters and intraluminal impedance are the new frontiers on this topic. The authors reviewed current, national and international, literature about achalasia with multichannel intraluminal impedance and high resolution manometry studies. The new technologies described are promising, however few studies have been published and further studies are still expected for achalasia patients.

The evaluation of esophageal motility in patients with esophageal columnar metaplasia (ECM)

Patients with specialized intestinal metaplasia (SIM) of the esophagus were shown to have more acidic and biliary reflux than patients with oxynthic or cardia type metaplasia (OM), which was further increased in patients with dysplasia. Although this led to the hypothesis that the esophageal motility disorder may be severe in this patient group, detailed prospective evaluation of this question has not been carried out. Aim: To evaluate the esophageal motility by manometry, in patients with different histological types of ECM with or without dysplasia. Patients, methods: Esophageal motility was prospectively evaluated by standard water perfusion esophageal manometry in 132 patients [M/F 79/53, mean age 55.5(26–81) ys] with endoscopic and histological evidence for ECM. Parameters studied: pressure and relaxation time of the lower esophageal sphincter (LES); peristaltic wave amplitude, duration and propagation velocity in the esophageal body (EB). The type of metaplasia and the presence of dysplasia were established by immunohistochemistry and cytometry. Results: Patients with SIM had decreased EB peristaltic amplitudes in the distal esophagus (3cm-s above the LES, p<0.01) compared to patients with OM. Other parameters were similar. On the other hand patients with IM with dysplasia had significantly lower LES pressure (p<0.05), EB peristaltic amplitude and duration (3 and 8cm-s above the LES, p<0.05) compared to those without dysplasia. Conclusions: Our results provided data that both LES and EB motility is impaired in patients with ECM. Furthermore, they support the hypothesis that esophageal motility abnormalities are more pronounced in patients with more severe histopathological stage of the disease.

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.

Radionuclide esophageal transit test to detect esophageal disorders in patients with mitra valve prolapse

The origin of chest discomfort in patients with mitral valve prolapse (MVP) is controversial. Our aim was to prospectively determine the incidence of esophageal disorders in MVP patients with or without chest pain. Twenty-five MVP patients with chest pain (group A) and 25 MVP patients without chest pain (group B) underwent evaluation of esophageal motility. None of the total of 50 MVP patients had significant coronary artery disease on cardiac catheterization. Esophageal motility including esophageal mean transit time (MTT), residual fraction (RF), and retrograde index (RI) was analyzed by the radionuclide esophageal transit test (RETT). In comparison with 25 age and sex-matched healthy volunteers, the results showed that: (1) 19 patients in group A (76%) had abnormal RETT findings (48% of cases with prolonged MTT, 44% of cases with higher RF, and 60% of cases with higher RI); (2) 3 patients in group B (12%) had abnormal RETT findings (8% of cases with prolonged MTT, 4% of cases with higher RF, and 8% of cases with higher RI). In addition, mean values of MTT, RF, and RI in group A patients were significantly higher than in group B patients and healthy volunteers. We found that the chest pain in some MVP patients may be related to abnormal esophageal motility, based on the evidence from a simple and noninvasive RETT.