High-Resolution Esophageal Manometry in Myasthenia Gravis.

Myasthenia gravis (MG) is an autoimmune disease that affects the postsynaptic membrane at the neuromuscular junction. In MG, antibodies bind to acetylcholine receptors inducing muscle weakness. The weakness typically increases with exercise and repetitive muscle use. Improvement of muscular weakness after rest and/or administration of anticholinesterase drugs (edrophonium) are characteristic of MG. We report a patient with unexplained dysphagia, dysphonia, and dysarthria, whose diagnosis was suggested by high-resolution esophageal motility and edrophonium infusion. We highlight the importance of dysphagia as presenting or dominant symptom in MG and review the esophageal motility findings in this rare, but treatable disorder.

[Utility of rabeprazole as a diagnostic test in non-erosive gastroesophageal reflux disease]. / Utilidad del rabeprazol como prueba diagnóstica en la enfermedad por reflujo gastroesofágico no erosiva.

BACKGROUND: Proton pump inhibitor test (PPIt) has been shown adequate diagnostic usefulness and cost-effectiveness in the evaluation of patients with gastroesophageal reflux disease (GERD). However, comparative studies of PPIt with 24 hr esophageal pH-metry (24-pH) in non erosive GERD (NERD) are scarce and the utility of rabeprazole as a PPIt has not been evaluated. OBJECTIVE: To investigate the diagnostic utility of rabeprazole test in patients with NERD. MATERIAL AND METHODS: An open label trial was performed, and NERD patients with heartburn at least 3 times per week were included. Symptomatic evaluation before, during and after rabeprazole 20 mg bid for 7 days was performed. All patients underwent 24-pH before treatment with rabeprazole. Patients were classified in three groups: 1) abnormal pH, 2) normal pH and symptom index (SI) positive, and 3) normal pH and SI negative. A positive rabrepazole test was considered when symptoms improvement was higher than 50% at the end of the test. Sensitivity, specificity, negative predictive value, positive predictive value and positive likelihood ratio were calculated considering the 24-pH as gold standard. RESULTS: Sixty four patients, 47 (72%) female were studied. Forty four percent of the patients had normal pH, 29% with SI positive and 71% with SI negative. Sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ratio were 82%, 47%, 78%, 52% and 1.406 respectively. No adverse events were reported. CONCLUSION: PPI test with rabeprazole 20 mg bid for 7 days is a simple and useful test in the diagnostic approach of patients with NERD.

Trastornos motores del músculo liso del esófago / Motor disorders of the smooth muscle of the esophagus

Los trastornos motores del esófago, son problemas que se manifiestan predominantemente con disfagia y/o dolor torácico; llegan a se incapacitaciones y graves. Se clasifican en dos grandes grupos: primarios cuando se presentan sin relación a alguna otra enfermedad y secundarios, cuando son consecuancia de la efección del esófago por una enfermedad sistémica. El diagnóstico y caracterización de los trastornos motores se realizan mediante manometría. En el presente trabajo se exponen algunos aspectos clínicos relevantes y los criterios de diagnóstico manométricos actuales, se hace referencia a algunas variedades de tratamiento