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1.
Ulus Travma Acil Cerrahi Derg ; 30(6): 437-443, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38863287

RESUMO

BACKGROUND: Numerous measurement techniques for intra-abdominal pressure have been explored, with the Kron Technique established as the gold standard. Despite its prominence, the search for alternative methods persists due to its lengthy application time, the requirement for additional equipment, and overall impracticality. This study investigated a quicker, more accessible method for effective intra-abdominal pressure measurement in the emergency department. It aimed to compare intra-abdominal pressure measurements in patients diagnosed with ileus using a digital manometer and the Kron Technique. METHODS: Conducted from October 2022 to February 2023, this single-center, prospective, single-blind method comparison study involved patients diagnosed with ileus at a tertiary emergency department. Intra-abdominal pressure was measured using both the Kron Technique and a digital manometer by separate practitioners blinded to the study results. RESULTS: The study included 30 patients. No statistically significant difference was observed in the intra-abdominal pressure measurements between the two methods (p<0.237). A very strong correlation existed between the two methods (Spearman's Rho = 0.998). Bland-Altman analysis showed a bias value of 0.091 mmHg for the digital manometer, with upper and lower agreement limits of -0.825 and 1.007 mmHg, respectively. The measurement time was significantly shorter with the digital manometer than with the Kron Technique (15 vs. 390.5 seconds; p<0.001). CONCLUSION: We believe that the intra-abdominal pressure measurement technique using a digital manometer is a method that can be effectively employed by healthcare professionals in emergency departments. This technique offers ease of use, requires minimal equipment, provides rapid results, and delivers reliable measurement values compared to the Kron Technique.


Assuntos
Serviço Hospitalar de Emergência , Íleus , Manometria , Pressão , Humanos , Estudos Prospectivos , Feminino , Masculino , Manometria/métodos , Manometria/instrumentação , Pessoa de Meia-Idade , Íleus/diagnóstico , Idoso , Método Simples-Cego , Adulto , Idoso de 80 Anos ou mais
2.
BMJ Open Gastroenterol ; 11(1)2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38844375

RESUMO

BACKGROUND AND AIMS: Peroral endoscopic myotomy (POEM) is a standard treatment option for achalasia patients. Treatment response varies due to factors such as achalasia type, degree of dilatation, pressure and distensibility indices. We present an innovative approach for treatment response prediction based on an automatic three-dimensional (3-D) reconstruction of the tubular oesophagus (TE) and the lower oesophageal sphincter (LES) in patients undergoing POEM for achalasia. METHODS: A software was developed, integrating data from high-resolution manometry, timed barium oesophagogram and endoscopic images to automatically generate 3-D reconstructions of the TE and LES. Novel normative indices for TE (volume×pressure) and LES (volume/pressure) were automatically integrated, facilitating pre-POEM and post-POEM comparisons. Treatment response was evaluated by changes in volumetric and pressure indices for the TE and the LES before as well as 3 and 12 months after POEM. In addition, these values were compared with normal value indices of non-achalasia patients. RESULTS: 50 treatment-naive achalasia patients were enrolled prospectively. The mean TE index decreased significantly (p<0.0001) and the mean LES index increased significantly 3 months post-POEM (p<0.0001). In the 12-month follow-up, no further significant change of value indices between 3 and 12 months post-POEM was seen. 3 months post-POEM mean LES index approached the mean LES of the healthy control group (p=0.077). CONCLUSION: 3-D reconstruction provides an interactive, dynamic visualisation of the oesophagus, serving as a comprehensive tool for evaluating treatment response. It may contribute to refining our approach to achalasia treatment and optimising treatment outcomes. TRIAL REGISTRATION NUMBER: 22-0149.


Assuntos
Acalasia Esofágica , Esfíncter Esofágico Inferior , Imageamento Tridimensional , Manometria , Humanos , Acalasia Esofágica/cirurgia , Masculino , Feminino , Manometria/métodos , Imageamento Tridimensional/métodos , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto , Esfíncter Esofágico Inferior/cirurgia , Esfíncter Esofágico Inferior/fisiopatologia , Estudos Prospectivos , Idoso , Esôfago/cirurgia , Esofagoscopia/métodos , Miotomia/métodos , Software , Cirurgia Endoscópica por Orifício Natural/métodos , Adulto Jovem
3.
Harefuah ; 163(6): 387-392, 2024 Jun.
Artigo em Hebraico | MEDLINE | ID: mdl-38884294

RESUMO

INTRODUCTION: Upper gastrointestinal (UGI) symptoms are very common in the general adult population. Dysphagia, heartburn, regurgitation and non-cardiac chest pain are the most common signs. The clinical approach in managing these symptoms starts with upper GI endoscopy in order to exclude inflammatory, neoplastic and fibrotic disorders that involve the esophagus. Upper GI endoscopy is mandatory especially when alarm signs exist. In patients with no structural abnormalities, physiological testing might aid to better understand the origin of the symptoms and to improve management.


Assuntos
Monitoramento do pH Esofágico , Manometria , Humanos , Manometria/métodos , Monitoramento do pH Esofágico/métodos , Esôfago/fisiopatologia , Adulto , Endoscopia Gastrointestinal/métodos , Doenças do Esôfago/diagnóstico , Doenças do Esôfago/fisiopatologia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Sulfato de Bário/administração & dosagem
4.
Neurogastroenterol Motil ; 36(7): e14818, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38764235

RESUMO

BACKGROUND: Functional lumen imaging probe (FLIP) panometry evaluates esophageal motility, including the contractile response to distension, that is, secondary peristalsis. Impaired/disordered contractile response (IDCR) is an abnormal, but nonspecific contractile response that can represent either hypomotility or spastic motor disorders on high-resolution manometry (HRM). We hypothesized that FLIP pressure could be incorporated to clarify IDCR and aimed to determine its utility in a cohort of symptomatic esophageal motility patients. METHODS: 173 adult patients that had IDCR on FLIP panometry and HRM with a conclusive Chicago Classification v4.0 (CCv4.0) diagnosis were included and analyzed as development (n = 118) and validation (n = 55) cohorts. FLIP pressure values were assessed for prediction of either hypomotility or spasm, defined on HRM/CCv4.0. KEY RESULTS: HRM/CCv4.0 diagnoses were normal motility in 48 patients (28%), "hypomotility" (ineffective esophageal motility, absent contractility, or Type I or II achalasia) in 89 (51%), and "spasm" (Type III achalasia, distal esophageal spasm, or hypercontractile esophagus) in 36 (21%). The pressure at esophagogastric junction-distensibility index (DI) (60 mL) was lower in hypomotility (median [interquartile range] 34 [28-42] mmHg) than in spasm (49 [40-62] mmHg; p < 0.001) and had an area under the receiver operating characteristic curve of 0.80 (95% CI 0.73-0.88) for hypomotility and 0.76 (0.69-0.83) for spasm. For "spasm" on HRM, a threshold FLIP pressure of >35 mmHg provided 90% sensitivity (47% specificity) while >55 mmHg provided 93% specificity (40% sensitivity). CONCLUSION & INFERENCES: Pressure on FLIP panometry can help clarify the significance of IDCR, with low-pressure IDCR associated with hypomotility and high-pressure IDCR suggestive of spastic motor disorders.


Assuntos
Transtornos da Motilidade Esofágica , Manometria , Humanos , Masculino , Feminino , Manometria/métodos , Pessoa de Meia-Idade , Transtornos da Motilidade Esofágica/diagnóstico , Transtornos da Motilidade Esofágica/fisiopatologia , Adulto , Idoso , Contração Muscular/fisiologia , Peristaltismo/fisiologia , Esôfago/fisiopatologia , Pressão
5.
Neurogastroenterol Motil ; 36(7): e14810, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38689439

RESUMO

BACKGROUND: Disruption of external anal sphincter muscle (EAS) is an important factor in the multifactorial etiology of fecal incontinence (FI). OBJECTIVES: We categorize FI patients into four groups based on the location of lesion in neuromuscular circuitry of EAS to determine if there are differences with regards to fecal incontinence symptoms severity (FISI) score, age, BMI, obstetrical history, and anal sphincter muscle damage. METHODS: Female patients (151) without any neurological symptoms, who had undergone high-resolution manometry, anal sphincter EMG, and 3D ultrasound imaging of the anal sphincter were assessed. Patients were categorized into four groups: Group 1 (normal)-normal cough EMG (>10 µV), normal squeeze EMG (>10 µV), and normal anal squeeze pressure (>124 mmHg); Group 2 (cortical apraxia, i.e., poor cortical activation)-normal cough EMG, low squeeze EMG, and low anal squeeze pressure; Group 3 (muscle damage)-normal cough EMG, normal squeeze EMG, and low anal squeeze pressure; and Group 4 (pudendal nerve damage)-low cough EMG, low squeeze EMG, and low anal squeeze pressure. RESULTS: The four patient groups were not different with regards to the patient's age, BMI, parity, and FISI scores. 3D ultrasound images of the anal sphincter complex revealed significant damage to the internal anal sphincter, external anal sphincter, and puborectalis muscles in all four groups. CONCLUSION: The FI patients are a heterogeneous group; majority of these patients have significant damage to the muscles of the anal sphincter complex. Whether biofeedback therapy response is different among different patient groups requires study.


Assuntos
Canal Anal , Eletromiografia , Incontinência Fecal , Manometria , Humanos , Canal Anal/fisiopatologia , Canal Anal/diagnóstico por imagem , Feminino , Eletromiografia/métodos , Incontinência Fecal/fisiopatologia , Pessoa de Meia-Idade , Manometria/métodos , Adulto , Idoso , Pressão , Ultrassonografia
6.
Korean J Gastroenterol ; 83(5): 179-183, 2024 05 25.
Artigo em Coreano | MEDLINE | ID: mdl-38783618

RESUMO

Patients with chronic constipation (CC) usually complain of mild to severe symptoms, including hard or lumpy stools, straining, a sense of incomplete evacuation after a bowel movement, a feeling of anorectal blockage, the need for digital maneuver to assist defecation, or reduced stool frequency. In clinical practice, healthcare providers need to check for 'alarm features' indicative of a colonic malignancy, such as bloody stools, anemia, unexplained weight loss, or new-onset symptoms after 50 years of age. In the Seoul Consensus on the diagnosis and treatment of chronic constipation, the Bristol stool form scale, colonoscopy, and digital rectal examination are useful for objectively evaluating the symptoms and making a differential diagnosis of the secondary cause of constipation. If patients with CC improve to lifestyle modification or first-line therapies, the effort to determine the subtypes of CC is usually not considered. On the other hand, if conventional therapeutic strategies fail, diagnostic testing needs to be considered to distinguish between the different subtypes of functional constipation (normal-transit constipation, slow transit constipation, or defecatory disorder) because these subtypes of constipation have different therapeutic implications and a correct diagnosis is critical. In the Seoul consensus, physiological testing is recommended for patients with functional constipation who have failed to respond to treatment with available laxatives (for a minimum of 12 weeks and recommended a therapeutic regimen) or who are strongly suspected of having a defecatory disorder. The Seoul consensus contains statements of physiological testing, including balloon expulsion test, anorectal manometry, defecography, and colon transit time.


Assuntos
Constipação Intestinal , Constipação Intestinal/diagnóstico , Humanos , Doença Crônica , Manometria , Colonoscopia , Exame Retal Digital , Defecografia , Trânsito Gastrointestinal
7.
High Blood Press Cardiovasc Prev ; 31(3): 251-259, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38704794

RESUMO

INTRODUCTION: A lower ability to buffer pulse pressure (PP) in the face of increasing mean arterial pressure (MAP) may underlie the disproportionate increase in systolic blood pressure (SBP) in women from young adulthood through middle-aged relative to men. AIM: To evaluate the contribution of MAP to the change in PP and pressure wave contour in men and women from young adulthood to middle age. METHODS: Central pressure waveform was obtained from radial artery applanation tonometry in 312 hypertensive patients between 16 to 49 years (134 women, mean age 35 ± 9 years), 185 of whom were on antihypertensive treatment. RESULTS: Higher MAP levels (≥ 100 mmHg) were significantly associated with higher brachial and central SBP (P < 0.001), PP (P < 0.001), incident wave (P = 0.005), AP (P < 0.001), and PWV (P < 0.001) compared to lower MAP levels. The relationship between MAP and brachial PP (P < 0.001), central PP (P < 0.001), incident wave (P < 0.001), and AP (P < 0.01), but not PWV, strengthens with age. The age-related increase in the contribution of MAP to brachial PP (P < 0.001), central PP (P < 0.001), and incident wave (P < 0.001) was more prominent in women than in men beginning in the fourth decade. In multiple regression analyses, MAP remained a significantly stronger predictor of central PP and incident wave in women than in men, independent of age, heart rate, and antihypertensive treatment. In turn, age remained a significantly stronger predictor of central PP and incident wave in women than in men, independent of MAP, heart rate, and antihypertensive treatment. CONCLUSIONS: Women of reproductive age showed a steeper increase in PP with increasing MAP, despite comparable increases in arterial stiffness in both sexes. The difference was driven by a greater contribution of MAP to the forward component of the pressure wave in women.


Assuntos
Anti-Hipertensivos , Pressão Arterial , Hipertensão , Análise de Onda de Pulso , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Fatores Sexuais , Fatores Etários , Adulto Jovem , Hipertensão/fisiopatologia , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Adolescente , Anti-Hipertensivos/uso terapêutico , Rigidez Vascular , Manometria , Fatores de Risco , Artéria Radial/fisiologia , Estudos Transversais
8.
Rev Gastroenterol Peru ; 44(1): 21-25, 2024.
Artigo em Espanhol | MEDLINE | ID: mdl-38734908

RESUMO

INTRODUCTION: Treatment of functional disorders of the anorectal unit should focus on the underlying cause. Biofeedback therapy is a functional retraining of the pelvic floor that has proven useful in the treatment of constipation associated with dyssynergia and in the management of fecal incontinence. This study describes the first experiences with this form of biofeedback therapy in Colombia. OBJECTIVE: Describe our experience with biofeedback therapy in the gastrointestinal neurophysiology unit. MATERIALS AND METHODS: This historical cohort included patients with an indication for biofeedback therapy for constipation or fecal incontinence in the gastrointestinal neurophysiology unit during the data collection period. The response to therapy is described by comparing manometricfindings before and after 10 biofeedback sessions. RESULTS: 21 patients were included(71.4% women, the average age was 68, 9 with constipation and 12 with fecal incontinence.Among the patients with constipation there was a significant improvement in 71.4% of those who had rectal hyposensitivity and in 57.1% of those with dyssynergia. Biofeedback therapysignificantly increased the balloon expulsion rate (11.1 vs. 66.7%, p=0.02). In patients with fecal incontinence, there was improvement in 50% of those who had anal hypotonia and in 80% of those who had anal hyposensitivity. CONCLUSIONS: This study demonstrates that biofeedback therapy has a favorable impact on a high number of patients with constipationand fecal incontinence; in our center, the response is similar to that of the world literature.


Assuntos
Biorretroalimentação Psicológica , Constipação Intestinal , Incontinência Fecal , Humanos , Incontinência Fecal/terapia , Constipação Intestinal/terapia , Constipação Intestinal/fisiopatologia , Biorretroalimentação Psicológica/métodos , Feminino , Colômbia , Masculino , Idoso , Pessoa de Meia-Idade , Resultado do Tratamento , Idoso de 80 Anos ou mais , Adulto , Manometria
9.
Neurogastroenterol Motil ; 36(7): e14803, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38676387

RESUMO

BACKGROUND: The objective measurement for esophageal bolus volume and bolus clearance could classify abnormal high-resolution manometry (HRM) beyond the current Chicago classification. We aimed to compare the novel four-dimensional impedance manometry (4D HRM) volume metrics with timed barium esophagram (TBE). METHODS: Adults with esophageal symptoms undergoing HRM and TBE were included. A custom-built program for 4D HRM analysis measured esophageal luminal cross-sectional area (CSA) from impedance and subsequently derived esophageal bolus volume and clearance. 4D HRM volume metrics included pre-swallow residual volume, maximal volume, retention volume, and clearance ratio defined as 1.0-retention volume divided by the maximal volume. An abnormal TBE was defined as a column height >5 cm at 1 min or 5 min. KEY RESULTS: A total of 95 patients (normal motility: 33%; ineffective esophageal motility: 12%; absent contractility: 10%; esophagogastric junction outflow obstruction: 30%; type I achalasia: 5%; type II achalasia: 12%) were categorized into normal TBE (58%), abnormal TBE at 1 min (17%), and abnormal TBE at 5 min (25%). The AUROC demonstrated that, among all 4D HRM volume metrics, the clearance ratio had the best performance in predicting abnormal TBE at 5 min (AUROC, 95% confidence interval: 0.89, 0.82-0.96), and exhibited a strong negative correlation with TBE at 5 min (r = -0.65; p < 0.001). CONCLUSIONS & INFERENCES: Novel 4D HRM volume metrics provide objective measurement of esophageal bolus volume and bolus clearance. The clearance ratio has a strong correlation with TBE and could potentially serve as a substitute for TBE to measure esophageal retention.


Assuntos
Impedância Elétrica , Transtornos da Motilidade Esofágica , Manometria , Humanos , Manometria/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Transtornos da Motilidade Esofágica/fisiopatologia , Transtornos da Motilidade Esofágica/diagnóstico , Idoso , Esôfago/fisiopatologia , Esôfago/diagnóstico por imagem
11.
Dig Dis Sci ; 69(6): 2132-2139, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38622462

RESUMO

BACKGROUND: Vonoprazan, a potassium-competitive acid blocker, demonstrates more potent acid inhibition than proton pump inhibitors (PPIs). This study aimed to evaluate the effect of vonoprazan in patients with unproven gastroesophageal reflux disease (GERD) by comparing patients with vonoprazan-refractory heartburn with those with PPI-refractory heartburn. METHODS: This study included 104 consecutive patients with vonoprazan- or PPI-refractory heartburn (52 patients each), no erosive esophagitis on endoscopy and who underwent combined multichannel intraluminal impedance-pH (MII-pH) testing with vonoprazan/PPI discontinuation. Patients' backgrounds, symptom scores from four questionnaires, MII-pH results and high-resolution manometry results were compared between the two groups. RESULTS: The vonoprazan group demonstrated significantly higher GERD symptoms and scores of abdominal pain and diarrhea on the Gastrointestinal Symptom Rating Scale questionnaire. MII-pH results revealed that the vonoprazan group demonstrated 40.4%, 17.3%, and 42.3% and the PPIs group exhibited 26.9%, 17.3%, and 55.8% of abnormal acid reflux [true non-erosive reflux disease (NERD)], reflux hypersensitivity and functional heartburn, respectively. The vonoprazan group demonstrated higher true NERD rates but with no significant difference (p = 0.307). Among the vonoprazan group, eight patients with true NERD underwent another MII-pH test on vonoprazan, and all cases demonstrated normal acid exposure times (0.0% [0.0-0.3]). CONCLUSION: Patients with unproven GERD with vonoprazan-refractory heartburn demonstrated more symptoms, including not only GERD symptoms but also functional dyspepsia and irritable bowel syndrome symptoms, than those with PPI-refractory heartburn.


Assuntos
Refluxo Gastroesofágico , Azia , Inibidores da Bomba de Prótons , Pirróis , Sulfonamidas , Humanos , Inibidores da Bomba de Prótons/uso terapêutico , Azia/tratamento farmacológico , Azia/etiologia , Sulfonamidas/uso terapêutico , Masculino , Feminino , Pessoa de Meia-Idade , Pirróis/uso terapêutico , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/fisiopatologia , Adulto , Idoso , Monitoramento do pH Esofágico , Resistência a Medicamentos , Manometria
12.
Surg Laparosc Endosc Percutan Tech ; 34(3): 268-274, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38563118

RESUMO

OBJECTIVE: To investigate the esophageal motility characteristics of gastroesophageal reflux disease (GERD) and their relationship with symptoms. PATIENTS AND METHODS: We examined 101 patients diagnosed with GERD by endoscopy and divided them into 3 groups as follows: nonerosive reflux disease (NERD), reflux esophagitis, and Barrett esophagus. Esophageal high-resolution manometry and the GERD Questionnaire were used to investigate the characteristics of esophageal dynamics and symptoms. In addition, the reflux symptom index was completed and the patients were divided into 7 groups according to symptoms. We then determined the correlation between dynamic esophageal characteristics and clinical symptoms. RESULTS: Upper (UES) and lower (LES) esophageal sphincter pressures and the 4-second integrated relaxation pressure in the RE group were lower than those in the NERD group. The 4-second integrated relaxation pressure in the Barrett esophagus group was also lower than that in the NERD group. In the analysis of extraesophageal symptoms, high-resolution manometry showed significant differences in UES pressures among all groups. Further subgroup analysis showed that compared with the group without extraesophageal symptoms, the UES pressure of the groups with pharyngeal foreign body sensation, throat clearing, and multiple extraesophageal symptoms was lower. CONCLUSIONS: As GERD severity increases, motor dysfunction of the LES and esophageal body gradually worsens, and the LES plays an important role in GERD development. Decreased UES pressure plays an important role in the occurrence of extraesophageal symptoms, which is more noticeable in patients with pharyngeal foreign body sensation and throat clearing.


Assuntos
Refluxo Gastroesofágico , Manometria , Humanos , Refluxo Gastroesofágico/fisiopatologia , Refluxo Gastroesofágico/diagnóstico , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Esôfago de Barrett/fisiopatologia , Esofagite Péptica/fisiopatologia , Esofagite Péptica/diagnóstico , Esfíncter Esofágico Inferior/fisiopatologia , Pressão , Índice de Gravidade de Doença
13.
Neurogastroenterol Motil ; 36(6): e14791, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38587047

RESUMO

BACKGROUND: The functional lumen imaging probe (FLIP) is a test of anal sphincter distensibility under evaluation by specialist centers. Two measurement protocols termed "stepwise" and "ramp" are used, risking a lack of standardization. This study aims to compare the performance of these protocols to establish if there are differences between them. METHODS: Patients with fecal incontinence were recruited and underwent measurement with both protocols at a tertiary pelvic floor referral unit. Differences in minimum diameter, FLIP bag pressure, and distensibility index (DI) at rest and during squeeze were calculated at various FLIP bag volumes. KEY RESULTS: Twenty patients (19 female, mean age 61 [range: 38-78]) were included. The resting minimum diameter at 30 and 40 mL bag volumes were less in the stepwise protocol (mean bias: -0.55 mm and -1.18 mm, p < 0.05) along with the DI at the same bag volumes (mean bias: -0.37 mm2/mmHg and -0.55 mm2/mmHg, p < 0.05). There was also a trend towards greater bag pressures at 30 mL (mean bias: +2.08 mmHg, p = 0.114) and 40 mL (mean bias: +2.81 mmHg, p = 0.129) volumes in the stepwise protocol. There were no differences between protocols in measurements of minimum diameter, maximum bag pressure, or DI during voluntary squeeze (p > 0.05). CONCLUSION AND INFERENCES: There are differences between the two commonly described FLIP measurement protocols at rest, although there are no differences in the assessment of squeeze function. Consensus agreement is required to agree the most appropriate FLIP measurement protocol in assessing anal sphincter function.


Assuntos
Canal Anal , Incontinência Fecal , Manometria , Humanos , Feminino , Canal Anal/fisiopatologia , Canal Anal/diagnóstico por imagem , Incontinência Fecal/fisiopatologia , Pessoa de Meia-Idade , Adulto , Idoso , Masculino , Manometria/métodos , Manometria/instrumentação
15.
Am J Physiol Gastrointest Liver Physiol ; 326(6): G726-G735, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38626405

RESUMO

During pharyngeal phase of swallowing, circumferential tension of the cervical esophagus (CTE) increases caused by a biomechanical process of laryngeal elevation pulling the cervical esophagus orad. The esophagus contracts longitudinally during esophageal peristalsis, therefore, we hypothesized that CTE increases during esophageal peristalsis by a biomechanical process. We investigated this hypothesis using 28 decerebrate cats instrumented with electromyographic (EMG) electrodes on the pharynx and esophagus, and esophageal manometry. We recorded CTE, distal esophageal longitudinal tension (DET), and orad laryngeal tension (OLT) using strain gauges. Peristalsis was stimulated by injecting saline into esophagus or nasopharynx. We investigated the effects of transecting the pharyngo-esophageal nerve (PEN), hypoglossal nerve (HG), or administering (10 mg/kg iv) hexamethonium (HEX). We found that the durations of CTE and DET increased and OLT decreased simultaneously during the total extent of esophageal peristalsis. CTE duration was highly correlated with DET but not esophageal EMG or manometry. The peak magnitudes of the DET and CTE were highly correlated. After HEX administration, peristalsis in the distal esophagus did not occur, and the duration of the CTE response decreased. PEN transection blocked the occurrence of cricopharyngeal or cervical esophageal response during peristalsis but had no significant effect on the CTE response. HG transection had no significant effect on CTE. We conclude that there is a significant CTE increase, independent of laryngeal elevation or esophageal muscle contraction, which occurs during esophageal peristalsis. This response is a biomechanical process caused by esophageal shortening that occurs during esophageal longitudinal contraction of esophageal peristalsis.NEW & NOTEWORTHY Circumferential tension of cervical esophagus (CTE) increases during esophageal peristalsis. CTE response is correlated with distal longitudinal tension on cervical esophagus during esophageal peristalsis but not laryngeal elevation or esophageal muscle contraction. CTE response is not blocked by transection of motor innervation of laryngeal elevating muscles or proximal esophagus but is temporally reduced after hexamethonium administration. We conclude that the CTE response is a biomechanical effect caused by longitudinal esophageal contraction during esophageal peristalsis.


Assuntos
Esôfago , Peristaltismo , Peristaltismo/fisiologia , Esôfago/fisiologia , Esôfago/inervação , Animais , Fenômenos Biomecânicos , Gatos , Manometria , Masculino , Deglutição/fisiologia , Eletromiografia , Contração Muscular/fisiologia , Faringe/fisiologia , Feminino
16.
Curr Opin Gastroenterol ; 40(4): 314-318, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38661336

RESUMO

PURPOSE OF REVIEW: To compare different therapeutic modalities and determine their role in the treatment of esophageal achalasia. RECENT FINDINGS: The last 3 decades have seen a significant improvement in the diagnosis and treatment of esophageal achalasia. Conventional manometry has been replaced by high-resolution manometry, which has determined a more precise classification of achalasia in three subtypes, with important treatment implications. Therapy, while still palliative, has evolved tremendously. While pneumatic dilatation was for a long time the main choice of treatment, this approach slowly changed at the beginning of the nineties when minimally invasive surgery was adopted, initially thoracoscopically and then laparoscopically with the addition of partial fundoplication. And in 2010, the first report of a new endoscopic technique - peroral endoscopic myotomy (POEM) - was published, revamping the interest in the endoscopic treatment of achalasia. SUMMARY: This review focuses particularly on the comparison of POEM and laparoscopic Heller myotomy (LHM) with partial fundoplication as primary treatment modality for esophageal achalasia. Based on the available data, we believe that LHM with partial fundoplication should be the primary treatment modality in most patients. POEM should be selected when surgical expertise is not available, for type III achalasia, for the treatment of recurrent symptoms, and for patients who had prior abdominal operations that would make LHM challenging and unsafe.


Assuntos
Acalasia Esofágica , Fundoplicatura , Miotomia de Heller , Laparoscopia , Acalasia Esofágica/cirurgia , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/fisiopatologia , Humanos , Miotomia de Heller/métodos , Laparoscopia/métodos , Fundoplicatura/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Resultado do Tratamento , Miotomia/métodos , Esofagoscopia/métodos , Manometria/métodos
17.
Clin Transl Gastroenterol ; 15(5): e00702, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38597402

RESUMO

INTRODUCTION: Empiric esophageal dilation (EED) remains a controversial practice for managing nonobstructive dysphagia (NOD) secondary to concerns about safety and efficacy. We examine symptom response, presence of tissue disruption, and adverse events (AEs) after EED. METHODS: We examined large-caliber bougie EED for NOD at 2 tertiary referral centers: retrospectively evaluating for AEs. Esophageal manometry diagnoses were also reviewed. We then prospectively assessed EED's efficacy using the NIH Patient-Reported Outcomes Measurement Information System disrupted swallowing questionnaire to assess dysphagia at baseline, 1, 3, and 6 months after EED. Treatment success was defined by improvement in patient-reported outcome scores. RESULTS: AE rate for large-caliber dilation in the retrospective cohort of 180 patients undergoing EED for NOD was low (0.5% perforations, managed conservatively). Visible tissue disruption occurred in 18% of patients, with 47% occurring in the proximal esophagus. Obstructive motility disorders were found more frequently in patients with tissue disruption compared with those without (44% vs 14%, P = 0.05). The primary outcome, the mean disrupted swallowing T -score was 60.1 ± 9.1 at baseline, 56.1 ± 9.5 at 1 month ( P = 0.03), 57 ± 9.6 at 3 months ( P = 0.10), and 56 ± 10 at 6 months ( P = 0.02) (higher scores note more symptoms). EED resulted in a significant and durable improvement in dysphagia and specifically solid food dysphagia among patients with tissue disruption. DISCUSSION: EED is safe in solid food NOD and particularly effective when tissue disruption occurs. EED tissue disruption in NOD does not preclude esophageal dysmotility.


Assuntos
Transtornos de Deglutição , Dilatação , Manometria , Humanos , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Transtornos de Deglutição/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Dilatação/métodos , Dilatação/efeitos adversos , Idoso , Resultado do Tratamento , Esôfago/fisiopatologia , Esôfago/patologia , Esôfago/diagnóstico por imagem , Estudos Prospectivos , Adulto , Medidas de Resultados Relatados pelo Paciente , Deglutição
19.
J Pediatr Gastroenterol Nutr ; 78(6): 1217-1224, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38682419

RESUMO

OBJECTIVES: Abnormal motility of the residual colon has been reported in post-pull-through Hirschsprung disease (PT-HSCR) patients with persistent defecation problems. We reviewed the role of colonic manometry (CM) in the management of defecation disorders in these patients. METHODS: We retrospectively reviewed the medical record of PT-HSCR children who underwent CM for persistent symptoms of abnormal defecation. We reviewed their clinical course and its relation to CM findings. RESULTS: Thirty PT-HSCR patients underwent CM, of which five were diagnosed with transition zone pull-through and were excluded. Of the remaining 25 patients, 16 had colonic dysmotility, 8 had normal CM, and one had colonic hypermotility. In patients with dysmotility, five responded to ongoing medical management, three required surgical intervention (ileostomy), three remained symptomatic with medical management but not yet received surgical intervention, and five were lost to follow-up. In patients with normal CM, four responded to ongoing medical therapy, two required additional surgery (antegrade enema procedure), and two were lost to follow-up. The patient with hypermotility improved with adding loperamide. CONCLUSIONS: Colonic dysmotility can occur in PT-HSCR patients with persistent defecation problems. CM was helpful in delineating the degree of colonic neuromuscular dysfunction. CM results were used in conjunction with other clinical data to determine optimal management. Our findings support that medical management should first be optimized before consideration of colonic manometry and surgical interventions.


Assuntos
Colo , Motilidade Gastrointestinal , Doença de Hirschsprung , Manometria , Humanos , Doença de Hirschsprung/cirurgia , Doença de Hirschsprung/fisiopatologia , Manometria/métodos , Estudos Retrospectivos , Colo/fisiopatologia , Colo/cirurgia , Feminino , Masculino , Lactente , Pré-Escolar , Criança , Defecação , Constipação Intestinal/fisiopatologia , Constipação Intestinal/etiologia
20.
J Pediatr Gastroenterol Nutr ; 78(6): 1225-1233, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38623953

RESUMO

OBJECTIVES: Using high resolution impedance manometry (HRIM), this study characterized the esophago-gastric junction (EGJ) dynamics in children with esophageal atresia (EA). METHOD: Esophageal HRIM was performed in patients with EA aged less than 18 years. Objective motility patterns were analyzed, and EGJ data reported. Controls were pediatric patients without EA undergoing investigations for consideration of fundoplication surgery. RESULTS: Seventy-five patients (M:F = 43:32, median age 1 year 3 months [3 months-17 years 4 months]) completed 133 HRIM studies. The majority (64/75, 85.3%) had EA with distal tracheo-esophageal fistula. Compared with controls, liquid swallows were poorer in patients with EA, as evident by significant differences in distension pressure emptying and bolus flow time (BFT). The integrated relaxation pressure for thin liquid swallows was significantly different between EA types, as well as when comparing patients with EA with and without previous esophageal dilatations. The BFT for solid swallows was significantly different when compared with EA types. CONCLUSIONS: We have utilized HRIM in patients with EA to demonstrate abnormalities in their long-term EGJ function. These abnormalities correlate with poorer esophageal compliance and reduced esophageal peristalsis across the EGJ. Understanding the EGJ function in patients with EA will allow us to tailor long-term management to specific patients.


Assuntos
Impedância Elétrica , Atresia Esofágica , Junção Esofagogástrica , Manometria , Humanos , Atresia Esofágica/cirurgia , Atresia Esofágica/fisiopatologia , Manometria/métodos , Feminino , Lactente , Masculino , Junção Esofagogástrica/fisiopatologia , Pré-Escolar , Criança , Adolescente , Deglutição/fisiologia , Estudos de Casos e Controles , Fístula Traqueoesofágica/cirurgia , Fístula Traqueoesofágica/fisiopatologia
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