O34 A SLIGHTLY CRAZY BUT INFORMATIVE EXPERIMENT OF THE EFFECT OF THE HEAD DOWN (HD) POSTURE ON THE CHARACTERISTICS OF OESOPHAGEAL MOTILITY AND OESOPHAGOGASTRIC JUNCTION (OGJ) USING HIGH RESOLUTION OESOPHAGEAL MANOMETRY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Hatem Al-Saadi ◽  
Stephanie Evans ◽  
Alistair Sharples ◽  
SCarl Bradbury ◽  
Vittal Rao ◽  
...  
Keyword(s):  
High Resolution ◽  
Intraabdominal Pressure ◽  
Oesophageal Motility ◽  
High Resolution Manometry ◽  
Chicago Classification ◽  
Oesophagogastric Junction ◽  
Resting Pressure ◽  
Crural Diaphragm ◽  
High Pressure Zone ◽  
Video Fluoroscopy

Abstract Background It is known that posture (Supine Vs Sitting) variations can affect the dynamics and manometric characteristics of the OG junction and Oesophageal motility. Aims To study the effect of the Head Down (HD) upside down posture on the esophageal motility characteristics and dynamics of the OG junction using High resolution manometry. This would partially replicate the effect of Obesity (High Intraabdominal pressure) on the OGJ. Methods A single crazy (but sane) volunteer who had no symptoms of GORD served as the model for this unique experiment. A high-resolution manometry was performed using a solid-state transducer catheter with 36 channels. The study was performed in the sitting, supine and head down posture. Basal characteristics recording followed by wet swallows of 5ml of water and completed by rapid water swallows was done in each posture. Analysis was performed in the standard fashion using Chicago classification metrics. Further correlation of findings with a multipostural barium video oesophagogram is awaited. Results The procedure was completed satisfactorily in all the three postures. Satisfactory progression of swallows in a peristaltic sequence was obtained in all the 3 postures. However it was noted that there was a sequential change in the following parameters from the sitting to the supine to head down postures. Increased residual and contraction pressures in the Cricopharyngeal high pressure zone more pronounced in the HD position. Decreased amplitude of contraction of peristaltic sequences Decrease in slope of the peristaltic wave in the HD posture Diminished resting pressure in the HD position Exaggerated separation of the crural diaphragm (CD) and LES on the HD position Increased intragastric pressures in the HD position. Conclusion The above experiment is the first reported of Oesophageal function and OGJ dynamics in a completely unaided head down position using high resolution manometry and video fluoroscopy. The findings may serve to imitate the effect of Obesity on the OJ junction

scholarly journals How Updates in Chicago Classification Impact Clinical Practice

2021 ◽  
pp. 263451612110398
Author(s):  
Rena Yadlapati ◽  
Peter J. Kahrilas
Keyword(s):  
Clinical Practice ◽  
High Resolution ◽  
Patient Outcomes ◽  
Clinical Application ◽  
High Resolution Manometry ◽  
Chicago Classification

Chicago Classification version 4.0 (CC v4.0), published in 2021, presents several modifications largely aimed at minimizing over-diagnosis of inconclusive patterns on high-resolution manometry (HRM). These include: (1) introduction of a standardized HRM protocol for consistency among centers, (2) emphasis on the need for supportive data in instances of inconclusive manometric patterns, (3) required presence of relevant symptoms in certain instances to reduce over-diagnosis and inappropriate interventions, and (4) classification as disorders of EGJ outflow or disorders of peristalsis. These updates aim to improve the clinical application of HRM and patient outcomes.

Prospective serial diagnostic study: the effects of position and provocative tests on the diagnosis of oesophageal motility disorders by high-resolution manometry

2020 ◽  
Vol 51 (7) ◽  
pp. 706-718 ◽  
Author(s):  
Benjamin Misselwitz ◽  
Michael Hollenstein ◽  
Simon Bütikofer ◽  
Daphne Ang ◽  
Henriette Heinrich ◽  
...  
Keyword(s):  
High Resolution ◽  
Diagnostic Study ◽  
Oesophageal Motility ◽  
Motility Disorders ◽  
High Resolution Manometry

Tu1803 Dysphagia Post-Fundoplication Evaluated With High-Resolution Manometry (HRM). The Relevance of a Dual High-Pressure Zone

2013 ◽  
Vol 144 (5) ◽  
pp. S-850
Author(s):  
Etsuro Yazaki ◽  
Yu Tien Wang ◽  
Jafar Jafari ◽  
Asma Fikree ◽  
Nora Schaub ◽  
...  
Keyword(s):  
High Pressure ◽  
High Resolution ◽  
High Resolution Manometry ◽  
Pressure Zone ◽  
High Pressure Zone

Sa1320 Manometric Correlates of Radiographic Esophageal Spasm: A Comparison Between the Chicago Classification and Conventional Criteria Using High Resolution Manometry

2013 ◽  
Vol 144 (5) ◽  
pp. S-261-S-262
Author(s):  
Kunjal Gandhi ◽  
Elizabeth S. Rosenblatt ◽  
Sameer Dhalla ◽  
Victor Chedid ◽  
Ellen M. Stein ◽  
...  
Keyword(s):  
High Resolution ◽  
High Resolution Manometry ◽  
Chicago Classification ◽  
Esophageal Spasm

High-Resolution Manometry of the EGJ: An Analysis of Crural Diaphragm Function in GERD

2007 ◽  
Vol 102 (5) ◽  
pp. 1056-1063 ◽  
Author(s):  
John E. Pandolfino ◽  
Hyon Kim ◽  
Sudip K. Ghosh ◽  
John O. Clarke ◽  
Qing Zhang ◽  
...  
Keyword(s):  
High Resolution ◽  
High Resolution Manometry ◽  
Diaphragm Function ◽  
Crural Diaphragm

scholarly journals Novedades acerca de los trastornos motores del esófago tras la reciente clasificación de chicago 4.0

2021 ◽  
Vol 51 (2) ◽  
Author(s):  
Claudia Córdoba ◽  
Agustina Rodil ◽  
Daniel Cisternas
Keyword(s):  
High Resolution ◽  
Incidental Findings ◽  
Esophagogastric Junction ◽  
Outlet Obstruction ◽  
Motor Disorders ◽  
High Resolution Manometry ◽  
Chicago Classification ◽  
Provocation Tests ◽  
Aggressive Management ◽  
Standardized Diagnostic

The Chicago Classification includes esophageal motor disorders diagnosed by high-resolution manometry. Of the manometric patterns, some are always clinically relevant and require treatment (eg, the achalasia), while others may be incidental findings requiring no intervention in which aggressive management would be counterproductive. One of the goals of the new version of the recently published Chicago Classification (CCv4.0) was to distinguish between clinically relevant and non-clinically relevant disorders. With this in mind, the study protocol was modified to include liquid swallows in the supine and sitting positions and provocation tests were standardized. Diagnostic criteria were modified, incorporating the presence of symptoms and the support of complementary studies other than manometry. In this review, we will comment the diagnosis and treatment of esophagogastric junction outlet obstruction and hypomotility disorders based on CCv4.0.

scholarly journals High-resolution manometry in the diagnosis and classification of achalasia in children

2020 ◽  
Vol 50 (1) ◽  
Author(s):  
Erick Toro-Monjaraz ◽  
Rubén Peña-Vélez ◽  
María José Carrillo-Quan ◽  
David Avelar-Rodríguez ◽  
Martha Cecilia Martínez-Soto ◽  
...  
Keyword(s):  
High Resolution ◽  
Pediatric Patients ◽  
Case Series ◽  
Esophageal Achalasia ◽  
Motor Disorder ◽  
High Resolution Manometry ◽  
Chicago Classification ◽  
Diagnosis And Classification ◽  
Esophageal Sphincter

Esophageal achalasia is a primary motor disorder that presents with dysphagia secondary to esophageal body dysfunction and functional obstruction of the lower esophageal sphincter. High-resolution manometry is considered the gold standard for the diagnosis of achalasia and, according to the Chicago classification v3.0; it can be further divided into three different subtypes based on the pressurization patterns. Herein, we present the case series of 6 pediatric patients in whom high-resolution manometry was performed for the diagnosis and classification of esophageal achalasia.

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