PS01.009: COMPREHENSIVE CLASSIFICATION FOR ANTIREFLUX FUNCTION OF THE ESOPHAGOGASTRIC JUNCTION BASED ON HIGH-RESOLUTION MANOMETRY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 52-52
Author(s):  
Takahiro Masuda ◽  
Balazs Kovacs ◽  
Ross Bremner ◽  
Sumeet Mittal
Keyword(s):  
High Resolution ◽  
Esophagogastric Junction ◽  
Conflicts Of Interest ◽  
Lower Esophageal Sphincter Pressure ◽  
Sphincter Pressure ◽  
Total Acid ◽  
High Resolution Manometry ◽  
Demeester Score ◽  
Cumulative Score ◽  
The Mean

Abstract Background The anatomical configuration of the esophagogastric junction (EGJ) and the thoracoabdominal pressure gradient (TAPG) affect gastric content backflow into the esophagus. A comprehensive antireflux function assessment is needed to identify underlying derangements in patients with gastroesophageal reflux (GER). Herein we propose an objective scoring system for grading EGJ function. Methods We analyzed patients who underwent 24-hour pH study and high-resolution manometry in 2017 at our institution. We assessed three factors: EGJ morphology, lower esophageal sphincter pressure integral, and TAPG. Each factor was scored on a scale of 0–2, and a cumulative score was calculated (Table 1). Patients were divided into 3 groups based on cumulative score: 0, competent EGJ function (Grade I); 1–3, moderate incompetency (Grade II); 4–6, poor competency (Grade III). Results In total, 140 patients were studied. The mean age was 58.6 years, 75 patients (53.6%) were men, and the mean body mass index was 28.6 kg/m2. Fifty-one patients (36.4%) had an abnormal DeMeester score (ie, > 14.72). A significant, progressive increase was seen in number of reflux episodes (I-25.7, II-36.4, III-50.5, rs = 0.207, P = 0.015), total acid exposure time (I-1.0%, II-2.1%, III-5.0%, rs = 0.312, P < 0.001) and prevalence of abnormal pH score (I-13.0%, II-32.0%, III-57.1%, rs = 0.314, P < 0.001) from Grade I to III. Conclusion The proposed grading of the EGJ based on a cumulative score of individual parameters has a good correlation with GER. Disclosure All authors have declared no conflicts of interest.

scholarly journals Adequate Number of Swallows for Pharyngeal Pressure Measurement of a Subject using High-resolution Manometry

2020 ◽  
Author(s):  
Matsusato Tsuyumu ◽  
Takanori Hama ◽  
Takakuni Kato ◽  
Hiromi Kojima
Keyword(s):  
High Resolution ◽  
Major Change ◽  
Upper Esophageal Sphincter ◽  
Rate Of Change ◽  
Sphincter Pressure ◽  
High Resolution Manometry ◽  
Average Value ◽  
Pharyngeal Pressure ◽  
Single Person ◽  
The Mean

Abstract Introduction The number of pressure measurements that need to be recorded using high-resolution manometry (HRM) for the accurate evaluation of pharyngeal function is not well established. Objective The purpose of this study is to clarify the number of swallows required to obtain an accurate pharyngeal manometric profile of a person. Methods Forty healthy adults performed a dry swallow and bolus swallows using 3-, 5-, or 10 ml of water and underwent measurements using the Starlet HRM system. Each subject underwent 10 swallows for each of the four bolus volume conditions. Results The mean of up to seven measurements of maximum pre-swallow upper esophageal sphincter pressure with 10 ml of swallow was close to the mean of up to eight measurements in 95% of the subjects. Similarly, the rate of change of the average for the eighth and ninth measurements and the rate of change for the average of the ninth and tenth measurements were less than 5%. When the other parameters were similarly measured up to the sixth measurement, no major change in the average value was observed even if more measurements were taken. Conclusion A minimum of six measurements are required, and seven swallows are sufficient for evaluating the pharyngeal manometric profile of a single person. This number of measurements can be a useful criterion when performing HRM measurements on individual subjects.

RA06.01: PATHOLOGICAL IMPLICATIONS OF SWALLOW-ASSOCIATED TRANSIENT LOWER ESOPHAGEAL SPHINCTER ELEVATION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 29-30
Author(s):  
Takahiro Masuda ◽  
Balazs Kovacs ◽  
Ross Bremner ◽  
Sumeet Mittal
Keyword(s):  
Hiatal Hernia ◽  
Conflicts Of Interest ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
Total Acid ◽  
High Resolution Manometry ◽  
Demeester Score ◽  
Distal Esophageal Acid Exposure ◽  
Esophageal Sphincter ◽  
End Stage

Abstract Background We have previously reported that swallow-induced transient hiatal hernia (tHH) is associated with pathological gastroesophageal reflux. In this study, we built upon our previous study of tHH, assessing the pathological implications of swallow-induced tHH in a new, larger cohort. Methods We queried a prospectively maintained database to identify patients who underwent both 24-hour pH monitoring and high-resolution manometry (HRM) between January 2017 and December 2017. We excluded patients with end-stage lung disease, inadequate LES relaxation, major esophageal motility disorders, or manometric hiatal hernia. Significant swallow-induced LES–CD separation was defined as ≥ 1 cm separation in ≥ 30% swallows or ≥ 2 cm separation in ≥ 10% swallows. We used HRM to separate patients into 3 groups, as follows: 1. Persistent tHH (p-tHH): Significant LES–CD separation at the 2nd inspiration after the conclusion of swallow-induced esophageal peristalsis. 2. Incident tHH (i-tHH): Significant LES–CD separation at the 1st inspiration after the conclusion of peristalsis without meeting p-tHH criterion. 3. Non-tHH: Neither p-tHH nor i-tHH was observed. Results In total, 472 patients underwent both HRM and a 24-hour pH study during the study period. Of these, 74 patients met inclusion criteria. The mean age was 51.6 years, and 45 patients (60.8%) were women. Forty-two patients (56.8%) had an abnormal DeMeester score (ie, > 14.72). Fourteen patients (18.9%) were categorized into the p-tHH group, 36 (48.6%) were in the i-tHH group, and 24 (32.4%) were in the non-tHH group. LES pressure, LES pressure integral, esophageal peristaltic vigor, and prevalence of dysmotility were similar among the groups. No significant differences were observed in the pH studies for patients with i-tHH and non-tHH; however, patients in the p-tHH group had a higher prevalence of abnormal DeMeester score and longer total acid reflux time than patients in the non-tHH cohort (78.6 vs 45.8%, P < 0.05; 8.0 vs 3.8%, P = 0.016, respectively). Conclusion We confirm that p-tHH is associated with pathological distal esophageal acid exposure and appears to be an early indicator of LES dysfunction. Disclosure All authors have declared no conflicts of interest.

Clinical Symptom Presentation of Hypercontractile Peristalsis in the Era of High-Resolution Manometry: A Single-Center Experience

2020 ◽  
Vol 38 (5) ◽  
pp. 355-363 ◽  
Author(s):  
Máté Csucska ◽  
Takahiro Masuda ◽  
Ross M. Bremner ◽  
Sumeet K. Mittal
Keyword(s):  
High Resolution ◽  
Lower Esophageal Sphincter Pressure ◽  
Categorical Variables ◽  
Sphincter Pressure ◽  
Chi Square ◽  
Nutcracker Esophagus ◽  
Esophageal Function ◽  
High Resolution Manometry ◽  
Single Center Experience ◽  
Patient Reported

Background: Hypercontractile motility of the esophagus is occasionally noted on high-resolution manometry (HRM), but its clinical correlations are unclear. We compared symptom severity and clinical presentation of patients with hypercontractile motility of the esophagus. Methods: This was a retrospective cohort study. We queried a prospectively maintained database for patients who underwent esophageal function testing from October 1, 2016, to October 30, 2018. We included patients with jackhammer esophagus (JE; ≥2 swallows with distal contractile integral [DCI] ≥8,000 mm Hg∙cm∙s), nutcracker esophagus (NE; mean DCI 5,000–8,000 mm Hg∙cm∙s without meeting JE criteria), or esophagogastric junction outflow obstruction ([EGJOO]: abnormal median integrated relaxation pressure (>15 mm Hg) without meeting achalasia criteria, with JE [EGJOO-h], or normal motility [EGJOO-n]). HRM, endoscopy, barium esophagram, ambulatory pH studies, and symptom questionnaires were reevaluated for further analysis. Clinical parameters were analyzed using Spearman Rho correlation. Categorical variables were assessed with Fisher exact or chi-square test. Results: Altogether, 85 patients met inclusion criteria. They were divided into 4 subgroups: 28 with JE, 18 with NE, 15 with EGJOO-h, and 24 with EGJOO-n. Patients with EGJOO-h were the most symptomatic overall. No correlation was seen between symptoms and mean DCI (p ≥ 0.05 all groups) or number of hypercontractile swallows (≥8,000 mm Hg∙cm∙s, p ≥ 0.05). A significant correlation was noted between dysphagia and lower esophageal sphincter pressure (LESP) and LESP integral (p ≤ 0.05). Conclusion: The number of hypercontractile swallows and mean DCI were not associated with patient-reported symptoms. Elevated LESP may be a more relevant contributor to dysphagia.

scholarly journals Physiological and pathological roles of the accommodation response in lower esophageal sphincter relaxation during wet swallows

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kazumasa Muta ◽  
Eikichi Ihara ◽  
Shohei Hamada ◽  
Hiroko Ikeda ◽  
Masafumi Wada ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Resolution ◽  
Observational Study ◽  
Lower Esophageal Sphincter ◽  
Relaxation Function ◽  
Esophagogastric Junction ◽  
Prospective Observational Study ◽  
Outflow Obstruction ◽  
High Resolution Manometry ◽  
Esophageal Sphincter

AbstractThe preparatory accommodation response of lower esophageal sphincter (LES) before swallowing is one of the mechanisms involved in LES relaxation during wet swallows, however, the physiological and/or pathological roles of LES accommodation remain to be determined in humans. To address this problem, we conducted a prospective observational study of 38 patients with normal high-resolution manometry (HRM) and 23 patients with idiopathic esophagogastric junction outflow obstruction (EGJOO) to assess dry and wet swallows. The LES accommodation measurement was proposed for practical use in evaluating the LES accommodation response. Although swallow-induced LES relaxation was observed in both dry and wet swallows, LES accommodation (6.4, 3.1–11.1 mmHg) was only observed in wet swallows. The extent of LES accommodation was impaired in idiopathic EGJOO (0.6, − 0.6–6 mmHg), and the LES accommodation measurement of patients with idiopathic EGJOO (36.8, 29.5–44.3 mmHg) was significantly higher in comparison to those with normal HRM (23.8, 18–28.6 mmHg). Successful LES relaxation in wet swallowing can be achieved by LES accommodation in combination with swallow-induced LES relaxation. Impaired LES accommodation is characteristic of idiopathic EGJOO. In addition to the IRP value, the LES accommodation measurement may be useful for evaluating the LES relaxation function in clinical practice.

PS01.008: LOWER ESOPHAGEAL SPHINCTER PRESSURE (LESP) AS A MEASURE OF ANTI-REFLUX BARRIER IN PATIENTS WITH HIATUS HERNIA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 51-52
Author(s):  
Balazs Kovacs ◽  
Takahiro Masuda ◽  
Ross Bremner ◽  
Sumeet Mittal
Keyword(s):  
Hiatal Hernia ◽  
Lower Esophageal Sphincter ◽  
Hiatus Hernia ◽  
Conflicts Of Interest ◽  
Holding Time ◽  
Sphincter Pressure ◽  
Total Acid ◽  
Inversion Point ◽  
Type C ◽  
Esophageal Sphincter

Abstract Background Hiatus Hernia (HH), with its anatomical/physiological derangement of esophagogastric junction (EGJ) barrier function is a risk factor for pathological gastro-esophageal reflux (GER). However, a subset of patients with HH do not have reflux. The aim of this study is to explore Lower Esophageal sphincter parameters and GER across the EGJ in patients with manometeric type C hiatal hernia (LES-Crural Diaphragm separation > 1cm, and Pressure Inversion Point below LES). Methods An IRB approved, prospectively maintained esophageal testing registry was queried to identify patients who underwent High Resolution Manometry and 24h pH study (within 1 week) between 11/01/2016 and 11/01/2017. HRM characteristics of the EGJ (LES-CD separation, overall length, LESP, LESPI), 24 hour pH score, and pH < 4 holding time were extracted. Spearman's Rho correlation was calculated for all parameters and Receiver operating characteristic (ROC) curve was applied for parameters with significant correlation. Results A total of 1139 patients underwent HRM during the study period, of these 416 also had 24 hour pH study. 76 Patients met criteria for EGJ morphology Type C. After excluding patients with major disorders of peristalsis (16) the remaining 60 patients form the cohort of this study. Hiatal hernia size, overall length of LES, and LESPI did not correlate with 24 hour pH score or pH < 4 holding time. LESP had a significant negative correlation both with 24 hour pH score (R: -0.322; P = 0.011), and total acid holding time (R: -0.348; P = 0.006). A LESP cut-off value of 24.4 mmHg had a sensitivity of 53.8% and a Specificity of 91.2% for predicting pathological reflux. Conclusion A higher LESP (> 24.4 mmHg) appears to provide an effective barrier to pathological GER even when normal EGJ function is compromised by a hiatal hernia. Disclosure All authors have declared no conflicts of interest.

scholarly journals Comparison of Anorectal Function Measured using Wearable Digital Manometry and a High Resolution Manometry System

2020 ◽  
Author(s):  
Ali Attari ◽  
William D. Chey ◽  
Jason R. Baker ◽  
James A. Ashton-Miller
Keyword(s):  
High Resolution ◽  
Fecal Incontinence ◽  
Anal Sphincter ◽  
Chronic Constipation ◽  
Anorectal Function ◽  
Puborectalis Muscle ◽  
Myoelectric Activity ◽  
Sphincter Pressure ◽  
High Resolution Manometry ◽  
Anal Sphincter Pressure

AbstractThere is a need for a lower cost manometry system for assessing anorectal function in primary and secondary care settings. We developed an index finger-based system (termed “digital manometry”) and tested it in healthy volunteers, patients with chronic constipation, and fecal incontinence. Anorectal pressures were measured in 16 participants with the digital manometry system and a 23-channel high-resolution anorectal manometry system. The results were compared using a Bland-Altman analysis at rest as well as during maximum squeeze and simulated defecation maneuvers. Myoelectric activity of the puborectalis muscle was also quantified simultaneously using the digital manometry system. The limits of agreement between the two methods were −7.1 ± 25.7 mmHg for anal sphincter resting pressure, 0.4 ± 23.0 mmHg for the anal sphincter pressure change during simulated defecation, −37.6 ± 50.9 mmHg for rectal pressure changes during simulated defecation, and −20.6 ± 172.6 mmHg for anal sphincter pressure during the maximum squeeze maneuver. The change in the puborectalis myoelectric activity was proportional to the anal sphincter pressure increment during a maximum squeeze maneuver (slope = 0.6, R2 = 0.4). Digital manometry provided a similar evaluation of anorectal pressures and puborectalis myoelectric activity at an order of magnitude less cost than high-resolution manometry, and with a similar level of patient comfort. Digital Manometry provides a simple, inexpensive, point of service means of assessing anorectal function in patients with chronic constipation and fecal incontinence.

scholarly journals 3D-high resolution manometry of the esophagogastric junction

2011 ◽  
Vol 23 (11) ◽  
pp. e461-e469 ◽  
Author(s):  
M. A. Kwiatek ◽  
J. E. Pandolfino ◽  
P. J. Kahrilas
Keyword(s):  
High Resolution ◽  
Esophagogastric Junction ◽  
High Resolution Manometry
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