Benign oesophageal disease

2018 ◽  
Author(s):  
Satish Keshav ◽  
Alexandra Kent
Keyword(s):  
Chest Pain ◽  
Reflux Disease ◽  
Mucosal Injury ◽  
High Amplitude ◽  
Lower Oesophageal Sphincter ◽  
Oesophageal Motility ◽  
Eosinophilic Oesophagitis ◽  
Distal Oesophagus ◽  
Low Amplitude ◽  
Oesophageal Dysmotility

Benign oesophageal disease includes several conditions. Gastro-oesophageal reflux disease (GORD) is the reflux of gastric juices into the oesophagus with or without mucosal injury (oesophagitis). Achalasia is an oesophageal dysmotility disorder characterized by aperistalsis in the distal oesophagus, and failure of lower oesophageal sphincter relaxation. Motility disorders include oesophageal spasm, which is characterized by simultaneous, non-propagated contractions; nutcracker oesophagus, which is diagnosed by high-amplitude (≥180 mm Hg) contractions associated with chest pain; and ineffective oesophageal motility, which is characterized by low-amplitude contractions (≤30 mm Hg) in the distal oesophagus. Eosinophilic oesophagitis is diagnosed on a combination of clinical features and oesophageal biopsies confirming the presence of >15 eosinophils per high-powered film

Reflux aspiration associated with oesophageal dysmotility but not delayed liquid gastric emptying

2020 ◽  
Author(s):  
Oleksandr Khoma ◽  
Maite Jeanne Mendu ◽  
Amita Nandini Sen ◽  
Hans Van der Wall ◽  
Gregory Leighton Falk
Keyword(s):  
Gastric Emptying ◽  
Reflux Disease ◽  
Inclusion Criteria ◽  
Treatment Resistant ◽  
Oesophageal Motility ◽  
Oesophageal Manometry ◽  
Oesophageal Dysmotility ◽  
The Relationship ◽  
Clinical Subtype

Abstract Introduction Severe oesophageal dysmotility is associated with treatment resistant reflux and pulmonary reflux aspiration. Delayed solid gastric emptying (SGE) has been associated with oesophageal dysmotility, however the role of delayed liquid gastric emptying (LGE) in the pathophysiology of severe reflux disease remains unknown. The purpose of this study is to examine the relationship between delayed LGE, reflux aspiration and oesophageal dysmotility. Methods Data was extracted from a prospectively populated database of patients with severe treatment resistant gastro-oesophageal reflux disease (GORD). All patients with validated reflux aspiration scintigraphy (RASP) and oesophageal manometry were included in the analysis. Patients were classified by predominant clinical subtype as gastro-oesophageal (GOR) or laryngo-pharyngeal (LPR) reflux. LGE time of 22 minutes or longer was considered delayed. Results Inclusion criteria were met by 631 patients. Normal LGE time was found in 450 patients, whilst 181 had evidence of delayed LGE. Mean liquid half-clearance was 22.81min. Refux aspiration was evident in 240 patients (38%). Difference in the aspiration rates between delayed LGE (42%) and normal LGE (36%) was not significant (p=0.16). Severe ineffective oesophageal motility (IOM) was found in 70 patients (35%) and was independent of LGE time. Severe IOM was strongly associated with reflux aspiration (p<0.001). GOR dominant symptoms were more common in patients with delayed LGE (p=0.03). Conclusion Severe IOM was strongly associated with reflux aspiration. Delayed LGE is not associated with reflux aspiration or severe IOM. Delayed LGE is more prevalent in patients presenting with GOR dominant symptoms.

Oesophageal disorders

2021 ◽  
pp. 16-38
Author(s):  
Thomas Marjot
Keyword(s):  
Chest Pain ◽  
Foreign Body ◽  
Reflux Disease ◽  
Therapeutic Approach ◽  
Core Curriculum ◽  
Curriculum Material ◽  
Eosinophilic Oesophagitis ◽  
Diagnostic Features ◽  
Curriculum Topics

This chapter covers core curriculum topics relating to disorders of the oesophagus. A diagnostic and therapeutic approach to symptoms of gastro-oesophageal reflux disease is covered including physiology testing and the role of anti-reflux surgery. Other benign conditions causing dysphagia and chest pain are presented incorporating disorders of motility, infections, and the management of eosinophilic oesophagitis and oesophageal stricturing. Coverage is given to the investigation and management of patients with foreign body or caustic substance ingestions. There is particular focus on the investigation and management of oesophageal malignancy including in palliative stages, along with the various stages of Barret’s oesophagus. This includes diagnostic features, surveillance intervals and management of dysplasia associated with Barrett’s. Additional curriculum material regarding disorders of the oesophagus will also be covered in the mock examination chapter.

PS01.011: PATHOPHYSIOLOGY OF LARYNGOPHARYNGEAL REFLUX DISEASE: ASSOCIATION WITH PULMONARY ASPIRATION ON SCINTIGRAPHY AND INEFFECTIVE OESOPHAGEAL MOTILITY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 52-53
Author(s):  
Oleksandr Khoma ◽  
Michael Falk ◽  
Hans Van Der Wall ◽  
Leticia Burton ◽  
Gregory Falk
Keyword(s):  
Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Pulmonary Aspiration ◽  
Research Database ◽  
Oesophageal Motility ◽  
Upper Airways ◽  
Time Activity ◽  
Predictive Values ◽  
Symptom Profile ◽  
Oesophageal Dysmotility

Abstract Background Gastro-oesophageal reflux disease (GORD) can present with typical symptoms or atypical or laryngopharyngeal reflux (LPR) symptoms. The role of impaired oesophageal motility in these two clinically distinct groups has not been previously examined. Methods This study is a retrospective analysis of 361 consecutive patient records that was extracted from a prospectively populated research database. Patients were categorised by symptom profile as predominantly LPR or GORD (98 GOR and 263 LPR). Presenting symptom profile, pH studies, oesophageal manometry and scintigraphy and the relationship between the above were analysed. Results Severe oesophageal dysmotility was more prevalent in LPR group (P = 0.037). Severe oesophageal dysmotility was strongly associated with isotope aspiration in both groups (P = 0.001). 24 per cent of patients showed evidence of pulmonary aspiration on scintigraphy. Significant correlation was established between total proximal acid on 24-hour pH monitoring and isotope aspiration in both groups (P = 0.00). Rising pharyngeal curves on scintigraphy were the strongest predictors of isotope aspiration (P = 0.00). Conclusion Early research on oesophageal dysmotility has suggested reduced oesophageal clearance in individuals with IOM. This selected group of patients showed a high degree of impaired oesophageal motility, which was associated with rising time-activity curves in both the upper oesophagus and pharynx. The presence of refluxate in the upper oesophagus can stimulate cough via ‘reflex’ afferent pathways and the presence of gastric contents in the pharynx can cause direct irritation to upper airways, both resulting in cough. Reduced pressures in the lower oesophageal sphincter were equally prevalent in LPR and GORD groups and therefore were not discriminatory between the clinical groups. The impairment of oesophageal clearance secondary to diminished oesophageal motility, may offer a plausible explanation for the development of symptoms via combined ‘reflux’ and ‘reflex’ pathways, allowing continued oesophageal exposure or proximal exposure to refluxate. The ROC and cluster analysis demonstrated strong predictive values and linkages between ineffective oesophageal motility and rising pharyngeal time-activity curves for the prediction of lung aspiration. This may form the basis of a new approach to the definitive diagnosis of LPR and lung aspiration. Oesophageal dysmotility is a key factor in pathophysiology of LPR. Severe impaired oesophageal motility is strongly associated with pulmonary aspiration in both LPR and GORD. Disclosure All authors have declared no conflicts of interest.

scholarly journals Cholinergic blockade inhibits gastro-oesophageal reflux and transient lower oesophageal sphincter relaxation through a central mechanism

Gut ◽  
1999 ◽  
Vol 44 (5) ◽  
pp. 603-607 ◽  
Author(s):  
J C Fang ◽  
I Sarosiek ◽  
Y Yamamoto ◽  
J Liu ◽  
R K Mittal
Keyword(s):  
Reflux Disease ◽  
Normal Subjects ◽  
Lower Oesophageal Sphincter ◽  
Central Mechanism ◽  
Oesophageal Reflux ◽  
Anticholinergic Agent ◽  
Oesophageal Motility ◽  
The Third ◽  
Recording Period ◽  
Cholinergic Blockade

BACKGROUNDAtropine, an anticholinergic agent with central and peripheral actions, reduces gastro-oesophageal reflux (GOR) in normal subjects and patients with gastro-oesophageal reflux disease (GORD) by inhibiting the frequency of transient lower oesophageal sphincter relaxation (TLOSR).AIMSTo compare the effect of methscopolamine bromide (MSB), a peripherally acting anticholinergic agent, with atropine on the rate and mechanism of GOR in patients with GORD.METHODSOesophageal motility and pH were recorded for 120 minutes in 10 patients with GORD who were studied on three separate occasions. For the first two recording periods, either atropine (15 μg/kg bolus, 4 μg/kg/h infusion) or saline were infused intravenously. MSB (5 mg orally, four times daily) was given for three days prior to the third recording period.RESULTSAtropine significantly reduced basal LOS pressure (12.6 (0.17) mm Hg to 7.9 (0.17) mm Hg), and the number of TLOSR (8.1 (0.56) to 2.8 (0.55)) and reflux episodes (7.0 (0.63) to 2.0 (0.43)) (p<0.005 for all comparisons). MSB reduced basal LOS pressure (12.6 (0.17) to 8.7 (0.15) mm Hg, p<0.005), but had no effect on the frequency of TLOSR (8.1 (0.56) to 7.5 (0.59)) and reflux episodes (7.0 (0.63) to 4.9 (0.60)) (p>0.05).CONCLUSIONIn contrast to atropine, MSB has no effect on the rate of TLOSR or GOR in patients with GORD. Atropine induced inhibition of TLOSR and GOR is most likely mediated through a central cholinergic blockade.

scholarly journals Oesophageal eosinophilia and oesophageal diseases in children: are the limits clear?

2020 ◽  
Vol 4 (1) ◽  
pp. e000680
Author(s):  
Sarah Esther Diaz-Oliva ◽  
Idalmis Aguilera-Matos ◽  
Oscar Manuel Villa Jiménez ◽  
Angel A Escobedo
Keyword(s):  
Diagnostic Test ◽  
Clinical Features ◽  
Reflux Disease ◽  
Current Knowledge ◽  
Definitive Diagnosis ◽  
Test Results ◽  
Oesophageal Motility ◽  
Eosinophilic Oesophagitis ◽  
Integral Analysis ◽  
Similarities And Differences

Gastro-oesophageal reflux disease, eosinophilic oesophagitis and oesophageal motility disorders are among the most common diseases accompanying oesophageal eosinophilia. They have similarities and their limits are frequently not well defined. This article reviews the main characteristics relating to their similarities and differences, highlighting existing controversies among these diseases, in addition to current knowledge. In the case of a patient with symptoms of oesophageal dysfunction, it is suggested to carry out an integral analysis of the clinical features and diagnostic test results, including histology, while individualising each case before confirming a definitive diagnosis. Future investigation in paediatric patients is necessary to assess eosinophilic infiltration in the various layers of the oesophageal tissue, along with its clinical and pathophysiological implications.

scholarly journals Frequency of Clinical symptoms of Gastroesophageal Reflux Disease in Asthmatic Patients

2019 ◽  
Vol 3 (1) ◽  
pp. 3-9
Author(s):  
Nadeem Hafeez ◽  
Qudrat Ullah ◽  
Asif Hanif ◽  
Zaheer Akhtar ◽  
Muhammad Umar ◽  
...  
Keyword(s):  
Chest Pain ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Sore Throat ◽  
Reflux Disease ◽  
Clinical Symptoms ◽  
Stomach Contents ◽  
Lower Oesophageal Sphincter ◽  
Asthmatic Patients ◽  
Clinical Pictures

Abstract: Background: Gastroesophageal reflex is known as an acid reflex, is long term condition where stomach contents back into the oesophagus resulting in either symptoms or complications. GERD disease is caused by weakness or failure of the lower oesophageal sphincter. Symptoms include the acidic taste behind the mouth, heart burn, chest pain, difficult breathing and vomiting. Complication includes esophagitis, oesophageal strictures and barrettes oesophagus. Objective: The aim of this research was to introduce the symptoms of GERD disease in asthmatic patients and how these symptoms worsen the symptoms of asthma disease and what clinical pictures present with the asthmatic disease. Methodology: A designed performa was used to collect the data and after filling the performa, results were drawn and conclusion through the facts and the information given by patients. Results: In the present study among all 164 asthmatic patients, 70 (42.7%) patients showed dyspepsia, 58 (35.4%) were with chest burning, 23 (14%) were asking about chest pain, with acidic mouth taste were 39 (23.8%), 22 (13.4%) were feeling sore throat and 44 (26.8%) showed regurgitation reflex. Among these 164 patients 16 (9.8%) were smokers and 148 (90.2 %) were non-smokers. 47 (28.7%) were males and 117 (71.3%) were females. Conclusion: It is concluded that gastroesophageal reflux disease in asthmatic patients present symptoms of acidic mouth taste, chest burning, chest pain, dyspepsia, regurgitation reflex and sore throat.

scholarly journals The role of oesophageal physiological testing in the assessment of noncardiac chest pain

2018 ◽  
Vol 9 (12) ◽  
pp. 257-267 ◽  
Author(s):  
Henriette Heinrich ◽  
Rami Sweis
Keyword(s):  
Chest Pain ◽  
High Resolution ◽  
Noncardiac Chest Pain ◽  
Eosinophilic Oesophagitis ◽  
Common Cause ◽  
High Resolution Manometry ◽  
Oesophageal Dysmotility ◽  
Ambulatory Ph ◽  
Rule Out

Oesophageal physiology testing plays an important role in the diagnosis of noncardiac chest pain (NCCP) after cardiac, structural and mucosal abnormalities have been ruled out. Endoscopy can establish the presence of structural causes of chest pain such as cancer, oesophageal webs and diverticula. Even if macroscopically normal, eosinophilic oesophagitis is a common cause of chest pain and needs to be ruled out with an adequate biopsy regimen. In the remaining cases, diagnosis is focused on the identification of often subtle mechanisms that lead to NCCP. The most common oesophageal aetiologies for NCCP are gastro-oesophageal reflux disease (GORD), oesophageal dysmotility and functional chest pain. Ambulatory pH studies (with or without impedance or wireless measurements) can establish the presence of GORD, nonerosive reflux as well any association with symptoms of chest pain. High-resolution manometry, particularly with the inclusion of adjunctive testing, can rule out major motility disorders such as spasm, hypercontraction or achalasia. The EndoFLIP device can help define disorders with reduced distensibility, not easily appreciated with endoscopy or manometry. When all tests remain negative, a diagnosis of oesophageal hypersensitivity is normally made and therapy is shifted from targeting a disease to treating symptoms and patient affect.

scholarly journals Effect of atropine on gastro-oesophageal reflux and transient lower oesophageal sphincter relaxations in patients with gastro-oesophageal reflux disease

Gut ◽  
1998 ◽  
Vol 43 (1) ◽  
pp. 12-16 ◽  
Author(s):  
I Lidums ◽  
H Checklin ◽  
R K Mittal ◽  
R H Holloway
Keyword(s):  
Reflux Disease ◽  
Normal Subjects ◽  
Lower Oesophageal Sphincter ◽  
Interquartile Range ◽  
Oesophageal Reflux ◽  
Oesophageal Motility ◽  
Recording Period ◽  
Oesophageal Reflux Disease ◽  
Pharmacological Control

Background—Atropine reduces the rate of reflux episodes in normal subjects by inhibition of transient lower oesophageal sphincter (LOS) relaxations. The aim of this study was to investigate the effect of atropine on the rate and mechanisms of reflux in patients with reflux disease.Methods—Oesophageal motility and pH were recorded for one hour after a meal in 15 patients with reflux disease. On separate days, atropine (15 μg/kg bolus intravenously, 4 μg/kg/h infusion) or saline were given and maintained for the recording period.Results—Atropine significantly reduced basal LOS pressure from 7.1 (2.2) to 2.9 (1.3) mm Hg (mean (SEM)). Atropine also reduced the rate of reflux episodes from 5.0 (2.0–8.75) to 1.0 (0–6.25) per hour (median (interquartile range)) largely because of a decrease in the rate of transient LOS relaxations from 2.0 (0–4.75) to 0 (0–0) per hour and abolition of reflux during swallow induced LOS relaxation. There was no change in the rate of reflux episodes because of absent basal LOS pressure.Conclusions—Atropine inhibits reflux in patients with reflux disease largely by inhibition of transient LOS relaxations and swallow induced LOS relaxation. These findings suggest that pharmacological control of reflux through control of transient LOS relaxations is possible in patients with reflux disease.

scholarly journals Impaired Esophageal Mucosal Integrity May Play a Causative Role in Patients With Nongastroesophageal Reflux Disease–Related Noncardiac Chest Pain

Medicine ◽  
2015 ◽  
Vol 94 (51) ◽  
pp. e2295 ◽  
Author(s):  
Yang Won Min ◽  
Kyu Choi ◽  
Jeung Hui Pyo ◽  
Hee Jung Son ◽  
Poong-Lyul Rhee
Keyword(s):  
Chest Pain ◽  
Reflux Disease ◽  
Noncardiac Chest Pain ◽  
Causative Role ◽  
Mucosal Integrity

Frequency Response Analysis of Piecewise Nonlinear Vibration Isolator

2005 ◽  
Author(s):  
Patrick Stahl ◽  
G. Nakhaie Jazar
Keyword(s):  
Low Frequency ◽  
High Amplitude ◽  
Relative Displacement ◽  
Response Analysis ◽  
Frequency Response Analysis ◽  
State Behavior ◽  
Vibration Isolators ◽  
Short Period ◽  
Secondary Suspension ◽  
Low Amplitude

Non-smooth piecewise functional isolators are smart passive vibration isolators that can provide effective isolation for high frequency/low amplitude excitation by introducing a soft primary suspension, and by preventing a high relative displacement in low frequency/high amplitude excitation by introducing a relatively damped secondary suspension. In this investigation a linear secondary suspension is attached to a nonlinear primary suspension. The primary is assumed to be nonlinear to model the inherent nonlinearities involved in real suspensions. However, the secondary suspension comes into action only during a short period of time, and in mall domain around resonance. Therefore, a linear assumption for the secondary suspension is reasonable. The dynamic behavior of the system subject to a harmonic base excitation has been analyzed utilizing the analytic results derived by applying the averaging method. The analytic results match very well in the transition between the two suspensions. A sensitivity analysis has shown the effect of varying dynamic parameters in the steady state behavior of the system.

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