800 ASSOCIATION OF MULTIPLE RAPID SWALLOW PARAMETERS WITH SYMPTOMS IN PATIENTS WITH INEFFECTIVE AND NORMAL ESOPHAGEAL MOTILITY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Deepika Razia ◽  
Deepika Razia ◽  
Sumeet K Mittal
Keyword(s):  
Esophageal Motility ◽  
Motility Disorder ◽  
Study Cohort ◽  
Inclusion Criteria ◽  
Provocative Test ◽  
Chicago Classification ◽  
Patient Reported ◽  
Integrated Relaxation Pressure ◽  
Acid Exposure Time

Abstract   Multiple rapid swallows (MRS) is a provocative test to assess inhibitory swallowing mechanisms and esophageal peristaltic reserve. MRS response has been purposed to predict post-fundoplication dysphagia and has been associated with increased acid exposure time. Recently it was added to the Chicago classification v 4.0 protocol as an adjunctive test. This study aimed to understand the association of MRS parameters with symptoms in patients within ineffective (IEM) or normal esophageal motility (NEM). Methods After IRB approval, a prospectively maintained esophageal motility database was retrospectively reviewed to identify patients with IEM and NEM who also had an MRS evaluation. Patients with previous gastroesophageal surgery, manometric hiatal hernia, or a diagnosed motility disorder (except IEM) were excluded. Patient-reported symptoms (0–4) (heartburn, regurgitation, dysphagia, and chest pain) were grouped by score: 0, 1–2, or 3–4. We compared the prevalence of normal or abnormal MRS and individual MRS parameters (distal contractile integral [DCI], integrated relaxation pressure, distal latency, adequate inhibition, and post-MRS DCI/mean single swallow DCI ratio) with patient-reported symptoms. Results From 2019–2020, a total of 531 patients (254 = IEM, 277 = NEM) met the inclusion criteria and formed the study cohort. The presence of normal or abnormal MRS results was not associated with any patient-reported symptom in either the NEM or IEM group. Furthermore, patient-reported symptoms were not associated with individual MRS parameters in either group. Conclusion In patients with IEM and NEM, adjunct assessment with MRS does not correlate with patient-reported symptoms. Further studies are needed to assess the role of MRS as an adjunctive test during routine manometry.

340 EXPANDING THE ROLE OF POEM TO ESOPHAGEAL EPIPHRENIC DIVERTICULA—FEASIBLE, SAFE AND EFFECTIVE.

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
M Sudarshan ◽  
M Sanaka ◽  
S Adhikari ◽  
S Murthy ◽  
P Thota ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Motility Disorder ◽  
Column Height ◽  
Study Cohort ◽  
Surgical Morbidity ◽  
Esophageal Motility Disorder ◽  
Demeester Score ◽  
Patient Reported ◽  
Epiphrenic Diverticula

Abstract   Epiphrenic diverticula (ED) is a rare disorder which can be associated with significant surgical morbidity. Presence of an esophageal motility disorder, often achalasia, is classically associated with ED with some arguing that symptoms are primarily attributed to the motility disorder rather than the diverticula itself. The role of peroral endoscopic myotomy (POEM) is expanding for palliation of achalasia. The objective of our study is to investigate the outcomes of POEM in patients with epiphrenic diverticula. Methods A retrospective analysis of a prospectively maintained database was conducted in a tertiary care institution between April 2014 and July 2019. A total of 217 patients receiving a POEM during the study time period were identified with 13 patients having ED. Video recordings of POEM with and without ED were compared for technical differences. Patient demographics, prior esophageal procedures and epiphrenic diverticula characteristics were collected. Primary outcome was post-operative Eckardt scores. We also explored integrated resting pressure (IRP) on manometry, barium column height and width, complications and patient reported outcomes. Standard statistical methods were applied using R. Results Among 13 patients with ED (median age 74.2, 69% male), 7 small and 6 large diverticula were identified. No post-operative complications were noted. The median Eckardt score significantly decreased from 8 [IQR 5–9] pre POEM to 0 [IQR 0–2] post POEM, with similar improvements in median IRPs (24.5 mmHg [IQR 16.9–31.3] vs. 4.3 mmHg [IQR 2.4–7.6], 1 min barium column height (9.2 cm [IQR 6.3–17.9] vs. 3.2 cm [IQR 0–7.1] and 1 min barium column width (3.3 cm [IQR 2.7–3.5] vs. 0.75 cm [IQR 0–3.7]. Post-operative pH studies were conducted in 7 (53.8%) patients demonstrating a DeMeester score of more than 14.72 in 5 (71.4%) patients. Conclusion We demonstrate that POEM is technically feasible, safe and associated with excellent outcomes in patients with small and large diverticula. In our study cohort no further surgical therapy was required to address the diverticula. Reflux was managed medically. Considering its low morbidity profile POEM should be considered for therapy in selected patients with epiphrenic diverticula.

scholarly journals Esophageal Motility Disorders: Are We Missing in Our Busy Endoscopy Practice?

2021 ◽  
Vol 12 (04) ◽  
pp. 196-201
Author(s):  
Anshuman Elhence ◽  
Uday C. Ghoshal
Keyword(s):  
Gold Standard ◽  
Esophageal Motility ◽  
Esophagogastric Junction ◽  
Esophageal Motility Disorders ◽  
Endoscopic Evaluation ◽  
Sitting Posture ◽  
Achalasia Cardia ◽  
Motility Disorders ◽  
Chicago Classification

AbstractEsophageal motility disorders (EMDs) form a significant part of a busy endoscopist's practice. Endoscopy plays an all-encompassing role in the diagnosis and management of EMDs including achalasia cardia. The focus on in-vogue third-space endoscopic procedures such as per-oral endoscopic myotomy often digresses the important role of endoscopy. Endoscopic evaluation forms the part of standard first-line evaluation of any dysphagia and serves to rule out a secondary cause such as an esophagogastric junction malignancy and eosinophilic esophagitis. Moreover, endoscopic evaluation may itself provide corroborative evidence that may contribute to the diagnosis of the motility disorder. Achalasia cardia may present with a wide spectrum of endoscopic findings from being entirely normal and the well-known and pathognomonic dilated sigmoid-shaped esophagus with food residue, to lesser-known ornate signs. The evidence on the role of endosonography in EMDs is conflicting and largely restricted to evaluation of pseudoachalasia. High-resolution manometry (HRM) remains the gold standard in the diagnosis of EMDs. Endoscopists must also keep abreast of the latest iteration of the Chicago classification version 4.0, which differs significantly from its predecessor in being more stringent in making diagnosis of esophagogastric junction outflow obstruction and disorders of peristalsis since these manometric findings may be seen in normal individuals and may be mimicked by opioid use and gastroesophageal reflux. The latest rendition also includes the use of provocative maneuvers and testing in both supine and sitting posture. Despite being the gold standard, there are certain lacunae in the use and interpretation of the Chicago classification of which the users should be well aware. Emerging technologies such as functional lumen imaging probe and planimetry, and timed barium esophagogram fill the lacuna in diagnosis of these motility disorders, which at times is beyond the resolution of HRM.

scholarly journals A PICTORIAL PRESENTATION OF ESOPHAGEAL HIGH RESOLUTION MANOMETRY CURRENT PARAMETERS

2017 ◽  
Vol 30 (1) ◽  
pp. 69-71 ◽  
Author(s):  
Fernanda M. LAFRAIA ◽  
Fernando A. M. HERBELLA ◽  
Julia R. KALLUF ◽  
Marco G. PATTI
Keyword(s):  
High Resolution ◽  
Lower Esophageal Sphincter ◽  
Esophageal Motility ◽  
Clinical Applications ◽  
High Resolution Manometry ◽  
Chicago Classification ◽  
Pictorial Presentation ◽  
New Concepts ◽  
Esophageal Sphincter ◽  
Integrated Relaxation Pressure

ABSTRACT Introduction: High resolution manometry is the current technology used to the study of esophageal motility and is replacing conventional manometry in important centers for esophageal motility with parameters used on esophageal motility, following the Chicago Classification. This classification unifies high resolution manometry interpretation and classifies esophageal disorders. Objective: This review shows, in a pictorial presentation, the new parameters established by the Chicago Classification, version 3.0, aimed to allow an easy comprehension and interpretation of high resolution manometry. Methods: Esophageal manometries performed by the authors were reviewed to select illustrative tracings representing Chicago Classification parameters. Results: The parameters are: Esophagogastric Morphology, that classifies this junction according to its physiology and anatomy; Integrated Relaxation Pressure, that measures the lower esophageal sphincter relaxation; Distal Contractile Integral, that evaluates the contraction vigor of each wave; and, Distal Latency, that measures the peristalsis velocity from the beginning of the swallow to the epiphrenic ampulla. Conclusion: Clinical applications of these new concepts is still under evaluation.

Role of Vajraka Taila in the management of Vrana

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Ranjit Singh ◽  
Upasana Priya ◽  
Mahesh Chand Purvya
Keyword(s):  
The Other ◽  
Inclusion Criteria ◽  
Extrinsic Factors ◽  
External Application ◽  
Major Aspect

In today’s busy and fast life more people are living with conditions that increase their susceptibility to traumatic wounds, due to one or the other cause; thereby taking a heavy toll of life. As per Ayurveda, these type of wounds, which are caused by extrinsic factors are known as Sadyovrana. The major aspect of the management of the traumatic wounds is prevention of the infection, speedy healing, reducing pain, discharge and less discoloration after healing. In Ayurveda, various formulations for debridement are mentioned such as Kwaatha, Kalka, Churna, Rasakriya, Varti, Taila and Ghrita depending on the Avastha of Vrana. In the present study use of Vajraka Taila for external application, has been chosen. Total 30 patients fulfilling the inclusion criteria were selected and the treatment was given for 15 days. The study showed that Vajraka Taila is very effective in Vrana.

scholarly journals The role of EORTC QLQ-C15-PAL scores and inflammatory biomarkers in predicting survival in terminally ill patients with cancer

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nanako Koyama ◽  
Chikako Matsumura ◽  
Yoshihiro Shitashimizu ◽  
Morito Sako ◽  
Hideo Kurosawa ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Cox Regression ◽  
Terminally Ill ◽  
Inflammatory Biomarkers ◽  
Survival Curves ◽  
Patients With Cancer ◽  
Terminally Ill Patients ◽  
Patient Reported ◽  
Eortc Qlq

Abstract Background The clinical use of patient-reported outcomes as compared to inflammatory biomarkers for predicting cancer survival remains a challenge in palliative care settings. We evaluated the role of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative scores (EORTC QLQ-C15-PAL) and the inflammatory biomarkers C-reactive protein (CRP), albumin (Alb), and neutrophil-lymphocyte ratio (NLR) for survival prediction in patients with advanced cancer. Methods This was an observational study in terminally ill patients with cancer hospitalized in a palliative care unit between June 2018 and December 2019. Patients’ data collected at the time of hospitalization were analyzed. Cox regression was performed to examine significant factors influencing survival. A receiver operating characteristic (ROC) analysis was performed to estimate cut-off values for predicting survival within 3 weeks, and a log-rank test was performed to compare survival curves between groups divided by the cut-off values. Results Totally, 130 patients participated in the study. Cox regression suggested that the QLQ-C15-PAL dyspnea and fatigue scores and levels of CRP, Alb, and NLR were significantly associated with survival time, and cut-off values were 66.67, 66.67, 3.0 mg/dL, 2.5 g/dL, and 8.2, respectively. The areas under ROC curves of these variables were 0.6–0.7. There were statistically significant differences in the survival curves between groups categorized using each of these cut-off values (p < .05 for all cases). Conclusion Our findings suggest that the assessment of not only objective indicators for the systemic inflammatory response but also patient-reported outcomes using EORTC QLQ-C15-PAL is beneficial for the prediction of short-term survival in terminally ill patients with cancer.

scholarly journals Malignant Pleural Effusions Impact on Fatigue (IMPE-F): A Prospective Observational Cohort Pilot Study

2021 ◽  
Vol 1 (2) ◽  
pp. 98-104
Author(s):  
Avinash Aujayeb ◽  
Donna Wakefield
Keyword(s):  
Pilot Study ◽  
Health Research ◽  
Patient Reported Outcome ◽  
Pleural Effusions ◽  
Inclusion Criteria ◽  
Malignant Pleural Effusions ◽  
Cancer Related Fatigue ◽  
Patient Reported ◽  
Observational Cohort ◽  
Respondent Fatigue

Introduction: Cancer-related fatigue is well described. Fatigue in patients with a malignant pleural effusion (MPE) has not been directly studied. Methods: A prospective observational cohort pilot study ‘Do Interventions for Malignant Pleural Effusions (MPE) impact on patient reported fatigue levels (IMPE-F study)’ is planned to determine whether pleural interventions reduce fatigue in MPE. Fatigue will be assessed with a validated patient reported outcome measure, FACIT-F. Discussion: MPE-F has funding from Rocket Medical Plc, and is part of a Masters in Clinical Research at Newcastle University. Respondent fatigue will be addressed by the investigators going through the questionnaire with the participants. Inclusion criteria are all patients above 18 years of age with a presumed MPE undergoing a procedure and able to consent. The expected number of participants is 50. Trial registration: The IMPE-F study has Research Ethics Committee (REC) [20/YH/0224] and Health Research Authority (HRA) and Health and Care Research Wales (HCRW) approvals [IRAS project ID: 276451]. The study has been adopted on National Institute for Health Research portfolio [CPMS ID 46430].

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