Value Of Manometry Research Articles

Long-term clinical outcome of post-cholecystectomy patients with biliary-type pain: results of manometry, non-invasive techniques and endoscopic sphincterotomy.

The purpose of the present study was to investigate prospectively the value of manometry, non-invasive techniques and endoscopic sphincterotomy in biliary type II and III patients with suspected sphincter of Oddi dysfunction. All patients (n = 31) had undergone a cholecystectomy from 1 to 45 years before entry into the study, and had a history of biliary-type pain ranging from 4 to 156 months. In a primary diagnostic work-up, including ERCP, other causes of gastrointestinal disease were excluded. The width of the common bile duct, pain induced by the injection of contrast medium into the common bile duct, delayed contrast drainage and the results of a morphine-neostigmine test were analysed. Manometric measurements of basal sphincter of Oddi pressure were performed. Twenty-three patients with an elevated basal pressure (> 40 mmHg) underwent endoscopic sphincterotomy. During the follow-up period (8-62 months) 83% of the patients became symptom free or experienced an improvement. Basal sphincter of Oddi pressure and long-term clinical outcome of patients correlated to different degrees with the results of non-invasive techniques. Our data suggest that endoscopic sphincterotomy may be an effective therapeutic modality in group II and III patients with sphincter of Oddi dysfunction in whom other gastrointestinal disorders have previously been excluded.

Effects of sedation on motor function of the refluxing esophagus

Among the tests currently available for diagnosis of gastroesophageal reflux (GER), esophageal manometry is the hardest to perform in alert children because of their lack of cooperation. Therefore, it is usually performed under some form of sedation. In an attempt to investigate whether medication by itself modifies esophageal motility, we compared the manometric data of 18 children with pH-probe documented GER before and after sedation (meperidine 1.5 mg/kg, chlorpromazine 1 mg/kg, promethazine 1 mg/kg i.m.). Sedation induced the following changes in motor function compared to that in the unsedated state: (1) lower esophageal sphincter pressure decreased from 16.4 ± 7.3 to 11.4 ± 6.9 (P <0.001), whereas sphincter length remained unchanged; (2) esophageal peristaltic activity almost disappeared in terms of number of waves per hour (106.4 ± 60.1 vs 3.8 ± 6.2, P <0.001) while nonpropulsive activity became predominant, although only in relative terms (percent of tertiary waves 16.5 ± 13.9 vs 75.1 ± 25, P <0.001); (3) the mean pressure of the propulsive waves was also significantly decreased (65.2 ± 20.6 vs 37.9 ± 26.5, P <0.001), and as a result, esophageal motor efficiency (number of primary waves per hour multiplied by the mean pressure of the waves in mmHg) decreased enormously (from 6681.7 ± 4113.7 to 223.9 ± 372.6, P <0.001). Comparison with a group of sedated controls demonstrated that, under equal conditions, both barrier and pump functions were significantly weakened in refluxing patients. The limited diagnostic value of manometry thus remains unquestioned by the present study. Our data suggest that: (1) motor behavior of the esophagus in unsedated children with GER is quite close to that observed in refluxing adults; and (2) sedation of itself substantially modifies the esophageal sphincter barrier and esophageal propulsive “pump”. If sedation is to be used for manometric studies in children, the results so obtained should only be compared to those of controls under the same conditions.

Influence of morphine on the distal oesophagus and the lower oesophageal sphincter--a manometric study.

Basal pressure and relaxation of the lower oesophageal sphincter (LOS) as well as amplitude, duration and propagation velocity of peristaltic waves in the distal third of oesophagus were measured in 15 healthy adults (nine men and six women). A highly standardised technique was used employing manometric equipment including a low-compliance pneumohydraulic infusion system and a triple lumen recording catheter. After establishment of baseline manometry values the catheter was positioned with its distal orifice in the lower oesophageal sphincter. In 10 subjects 0.2 mg/kg body weight of morphine sulphate was then injected subcutaneously. In five others equal volume of saline was given. The manometric data were analysed blindly. Repeated manometric evaluations were carried out 15, 30, 45, 60, and 75 minutes after the injection. Morphine increased slightly LOS-pressure and significantly (p less than 0.001) decreased LOS-relaxation, the maximal effect occurring 30 minutes after the injection. Amplitude of peristaltic waves increased slightly but insignificantly, whereas propagation velocity and duration were uninfluenced. The results of this study suggest that pharmacologic doses of morphine influence normal function of the LOS and possibly the distal oesophagus. The role of endogenous opiates in this respect, however, awaits further studies. It is suggested that abnormalities in opioid neurotransmission may explain some of the non-specific oesophageal motility disorders.