153 THE CLINICAL SIGNIFICANCE OF INCOMPLETE BOLUS CLEARANCE IN PATIENTS WITH DYSPHAGIA

Abstract The primary function of the esophagus is to facilitate bolus transport to the stomach. High-resolution manometry assesses the functions of esophageal motility, but not the clearance of bolus transit through the esophagus. The development of combined multichannel intraluminal impedance and manometry (MII-EM) has enabled simultaneous measurement of bolus transport and manometry. This study investigated the effects of bolus transit on esophageal motility disorders and its effect on the quality of life of patients with dysphagia. Methods A total of 810 wet swallows were reviewed and analyzed in 81 patients with dysphagia who underwent MII-EM. Incomplete bolus clearance (IBC) was defined based on impedance measurement. IBC was classified into four types (A: normal, B: incomplete clearance in the upper esophagus, C: incomplete clearance in the lower esophagus, D: incomplete clearance of the whole esophagus), and was also evaluated according to the appearance rate of complete bolus transit. Then, the clinical significance of IBC was determined by our previously validated dysphagia symptom score and the SF8 quality of life instrument (physical component summary and mental component summary). Results There were 16 cases of esophageal achalasia (Ach), 9 of esophagogastric junction outflow obstruction (EGJOO), 8 of distal esophageal spasm (DES), 7 of Jackhammer esophagus (JE), 2 of absent contractility (AC), 10 of ineffective esophageal motility (IEM) and 29 normal cases. The figure shows the breakdown of IBC for each disorder. Complete bolus transit was found in 27.8% in EGJOO, 52.5% in DES, 14.2% in JE, 4.0% in IEM, and 83.3% in normal; no CBT was found in Ach and AC. Patients with IBC had significantly higher dysphagia symptom scores (p < 0.05) and lower mental component summaries (p < 0.05) than those without. Conclusion Patients with dysphagia with esophageal dysmotility were classified into two groups: those with and without IBC. Assessment of bolus transport is an important clinical marker for patients with dysphagia, because those with IBC had a significantly higher dysphagia symptom scores and impaired quality of life.

Download Full-text

Ineffective Esophageal Motility in Patients with GERD is no Contraindication for Nissen Fundoplication

World Journal of Surgery ◽

10.1007/s00268-019-05229-y ◽

2019 ◽

Vol 44 (1) ◽

pp. 186-193 ◽

Cited By ~ 1

Author(s):

Milena Nikolic ◽

Katrin Schwameis ◽

Ivan Kristo ◽

Matthias Paireder ◽

Aleksa Matic ◽

...

Keyword(s):

Quality Of Life ◽

Esophageal Motility ◽

Nissen Fundoplication ◽

Symptom Relief ◽

Gastrointestinal Symptoms ◽

Postoperative Outcome ◽

Ineffective Esophageal Motility ◽

Increased Risk ◽

Significant Difference

Abstract Background Patients with preoperative ineffective esophageal motility (IEM) are thought to be at increased risk for postoperative dysphagia leading to the recommendations for tailoring or avoiding anti-reflux surgery in these patients. The aim of this study was to evaluate if IEM has an influence on postoperative outcome after laparoscopic Nissen fundoplication (LNF). Methods Seventy-two consecutive patients with IEM underwent LNF and were case-matched with 72 patients without IEM based on sex, age, BMI, HH size, total pH percentage time, total number of reflux episodes and the presence of BE. Standardized interview assessing postoperative gastrointestinal symptoms, proton pump inhibitor intake, GERD-health-related-quality-of-life (GERD-HRQL), alimentary satisfaction and patients’ overall satisfaction was evaluated. Results Although a higher rate of preoperative dysphagia was observed in patients with IEM (29% IEM vs. 11% no IEM, p = 0.007), there was no significant difference in rates of dysphagia postoperatively (2 IEM vs. 1 no IEM, p = 0.559). Furthermore, no distinction was found in the postoperative outcome regarding symptom relief, quality of life, gas bloating syndrome, ability to belch and/or vomit or revision surgery between the two groups. Conclusion Although preoperative IEM has an influence on GERD presentation, it has no effect on postoperative outcome after LNF. IEM should not be a cause for avoiding LNF, as is has been shown as the most effective and safe anti-reflux treatment.

Download Full-text

How to Cope with Big Data in Functional Analysis of the Esophagus

Visceral Medicine ◽

10.1159/000511931 ◽

2020 ◽

Vol 36 (6) ◽

pp. 439-442

Author(s):

Alissa Jell ◽

Christina Kuttler ◽

Daniel Ostler ◽

Norbert Hüser

Keyword(s):

Esophageal Motility ◽

Learning Algorithm ◽

Supervised Machine Learning ◽

Esophageal Motility Disorders ◽

Motility Disorders ◽

High Resolution Manometry ◽

Evaluation Time ◽

Core Evaluation

Introduction: Esophageal motility disorders have a severe impact on patients’ quality of life. While high-resolution manometry (HRM) is the gold standard in the diagnosis of esophageal motility disorders, intermittently occurring muscular deficiencies often remain undiscovered if they do not lead to an intense level of discomfort or cause suffering in patients. Ambulatory long-term HRM allows us to study the circadian (dys)function of the esophagus in a unique way. With the prolonged examination period of 24 h, however, there is an immense increase in data which requires personnel and time for evaluation not available in clinical routine. Artificial intelligence (AI) might contribute here by performing an autonomous analysis. Methods: On the basis of 40 previously performed and manually tagged long-term HRM in patients with suspected temporary esophageal motility disorders, we implemented a supervised machine learning algorithm for automated swallow detection and classification. Results: For a set of 24 h of long-term HRM by means of this algorithm, the evaluation time could be reduced from 3 days to a core evaluation time of 11 min for automated swallow detection and clustering plus an additional 10–20 min of evaluation time, depending on the complexity and diversity of motility disorders in the examined patient. In 12.5% of patients with suggested esophageal motility disorders, AI-enabled long-term HRM was able to reveal new and relevant findings for subsequent therapy. Conclusion: This new approach paves the way to the clinical use of long-term HRM in patients with temporary esophageal motility disorders and might serve as an ideal and clinically relevant application of AI.

Download Full-text

The clinical significance of glaucoma-related quality of life studies

Clinical and Experimental Ophthalmology ◽

10.1111/j.1442-9071.2011.02655.x ◽

2011 ◽

Vol 40 (4) ◽

pp. e235-e236 ◽

Cited By ~ 1

Author(s):

Georgios Labiris ◽

Athanassios Giarmoukakis ◽

Roman Larin ◽

Maria G Gkika ◽

Vassilios P Kozobolis

Keyword(s):

Quality Of Life ◽

Clinical Significance ◽

Related Quality

Download Full-text

Treatment with desloratadine improves quality of life and symptom scores, including nasal congestion, in patients with seasonal allergic rhinitis*1

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2003.12.053 ◽

2004 ◽

Vol 113 (2) ◽

pp. S27 ◽

Cited By ~ 2

Author(s):

A PRADALIER

Keyword(s):

Quality Of Life ◽

Allergic Rhinitis ◽

Seasonal Allergic Rhinitis ◽

Nasal Congestion ◽

Symptom Scores

Download Full-text

Disease-specific health-related quality of life in patients with esophageal achalasia before and after therapy

Neurogastroenterology & Motility ◽

10.1111/j.1365-2982.2010.01515.x ◽

2010 ◽

Vol 22 (7) ◽

pp. 739-745 ◽

Cited By ~ 3

Author(s):

V. Garrigues ◽

V. Ortiz ◽

C. Casanova ◽

L. Bujanda ◽

E. Moreno-osset ◽

...

Keyword(s):

Quality Of Life ◽

Esophageal Achalasia ◽

Health Related Quality ◽

Before And After ◽

Related Quality ◽

Health Related ◽

Disease Specific ◽

Specific Health

Download Full-text

Agitated Behavior of Elderly and Alternative Simple Treatments: Individualized music – A feasibility study (the ABrEAST-iM feasibility study)

10.21203/rs.3.rs-42657/v1 ◽

2020 ◽

Author(s):

Anastasia Mallidou ◽

Anne-Marie Boström ◽

Daphne Kaitelidou ◽

Jennifer Brett ◽

Sara John Fowler ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Positive Affect ◽

Clinical Significance ◽

Residential Care ◽

Feasibility Study ◽

Residential Care Facilities ◽

Care Facilities ◽

Individualized Music

Abstract Background Behavioral and psychological symptoms of dementia (BPSD) influence older persons’ quality of life. Non-pharmacological interventions such as individualized music (iM) are promising to reduce BPSD and sustain interpersonal connectedness that contributes to quality of life. The purpose of this study was to assess the practicalities (e.g., process, results) of iM activities application on older adults over 65 years of age diagnosed with dementia living in residential care facilities. Our objectives were to: a) evaluate the recruitment process; b) explore the process of iM activity implementation; c) assess the clinical significance of the outcomes. Methods A concurrent mixed methods feasibility study designed and was conducted in two residential care facilities in British Columbia, Canada to assess the practicalities (i.e., recruitment, acceptability of the intervention, adherence to it, and clinical significance) of iM activities implementation on older adults diagnosed with dementia living in residential care facilities. Data were collected from residents, their families and staff using administrative records, observations, surveys, and interviews. Our primary outcomes were affect and quality of life. Results The observed iM activities were feasible, acceptable and adhered to by residents with clinical significance. Specifically, about 47% of eligible residents, their families and staff agreed to participate in and completed the study (recruitment); approximately 86% of participants enthusiastically received and were satisfied with the iM activity (acceptability); more than 70% of participants completed at least seven of the nine iM sessions (adherence); about 55% of participants experienced an increase in positive affect scores and 29% had a decrease in negative affect scores after the intervention; more than 43% of participants had a reduction in BPSD (clinical significance). Finally, participants reported improvement of quality of life and positive effects of iM intervention and provided insights and suggestions to improve it. Conclusions Individualized music activities can be successfully implemented (i.e., feasible, acceptable, adherent) with significant clinical outcomes. Participants reported positive affect emotions, increase in quality of life and well-being. With this feasibility study, we developed a process to identify challenges and their solutions that may assist us in a following pilot study with similar iM intervention.

Download Full-text