Esophageal motility abnormalities in Egyptian patients using high resolution esophageal manometry: a descriptive study

Abstract Background and aim For many years, esophageal manometry has been used for assessment of upper gastro-intestinal (GI) symptoms. Chicago classification is the key for diagnosis and managing motility disorders as it is considered as a standardized approach for categorization of esophageal abnormalities. The aim of this study is to analyze types of esophageal motility findings in Egyptian cases who were suffering from upper GI complaints. Methods: This descriptive study included 378 subjects who were suffering from upper GI complaints as dysphagia, vomiting, chest pain and regurgitation in the period between 10/2015–7/2020. Esophageal HRM study was performed for all patients (MMS Laborie device). The catheter was positioned and confirmed passing across the EGJ (esophago-gastric junction) using landmarks. Swallows and resting status were recorded. Anatomical landmarks were placed. Results Most of the patients were complaining of upper GI symptoms. Males were 49.2% of cases. Mean age was 41.3. Dysphagia was the prominent symptom while chest pain was the least symptom. Many manometry findings were observed including ineffective motility, achalasia, absent contractility, EGJ outflow obstruction, jackhammer esophagus and normal findings. Type II achalasia was the dominant type in achalasia patients while Type III was the least. LES was normotensive in most of the cases. Hiatus hernia (HH) was detected in 40.2% of the cases. Conclusion This is considered the first Egyptian descriptive study to determine the prevalence of esophageal motility abnormalities in Egyptian patients complaining of upper GI symptoms. HRM is very important for patients complaining of upper GI symptoms.

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Rheumatologic disorders in patients undergoing esophageal manometry: prevalence, symptom characteristics, and manometric findings

Diseases of the Esophagus ◽

10.1093/dote/doaa135 ◽

2021 ◽

Author(s):

Anam Qureshi ◽

Asad Jehangir ◽

Zubair Malik ◽

Henry P Parkman

Keyword(s):

Lupus Erythematosus ◽

Esophageal Motility ◽

Esophageal Manometry ◽

Upper Esophageal Sphincter ◽

Motility Disorders ◽

Ineffective Esophageal Motility ◽

Upper Gi ◽

Gi Symptoms ◽

Esophageal Sphincter ◽

Esophageal Contractility

Summary Rheumatologic disorders (RDs) can have gastrointestinal (GI) manifestations. Systemic sclerosis (SSc) patients often have upper GI symptoms from absent esophageal contractility (AC). Upper GI symptom characteristics and high-resolution esophageal manometry with impedance (HREMI) findings of other RDs have not been well studied. We aimed to: (i) determine the prevalence of RD in patients undergoing HREMI and (ii) assess the symptom characteristics and manometric findings of these patients. Patients undergoing HREMI (July 2018 to March 2020) rated their GI symptoms’ severity. Healthy volunteers (HVs) also underwent HREMI. Of the 1,003 patients, 90 (9%) had RD (mean age: 55.3 ± 1.4 years, 73.3% females), most commonly SSc (n = 27), rheumatoid arthritis (RA, n = 20), and systemic lupus erythematosus (SLE, n = 11). The most severe upper GI symptoms in patients with RD were heartburn, regurgitation, nausea, and dysphagia, with no significant differences in their severities between SSc, RA, and SLE. RD patients had higher upper esophageal sphincter (UES) pressures, lower distal contractile integral (DCI), lower bolus clearance, and more frequent hiatal hernia (HH) on HREMI (all P < 0.05) than HVs. Over half (61.1%) of patients with RD had esophageal motility disorders, most commonly AC (n = 25), ineffective esophageal motility (IEM; n = 18), and esophagogastric junction (EGJ) obstructive disorders (n = 11). Among patients undergoing HREMI, 9% had RD. Upper GI symptom severities did not distinguish different RDs. Patients with RD had higher UES pressures, weaker DCI, lower bolus clearance, and more frequent HH than HVs. Although AC and IEM were most common motility disorders, a considerable minority (12.2%) of our RD patients had EGJ obstructive disorders.

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Esophageal Manometry with Provocative Testing in Patients with Noncardiac Angina-Like Chest Pain

Canadian Journal of Gastroenterology ◽

10.1155/1991/808793 ◽

1991 ◽

Vol 5 (2) ◽

pp. 51-57 ◽

Cited By ~ 5

Author(s):

William G Paterson ◽

Delia A Marciano-D’Amore ◽

Ivan T Beck ◽

Laurington R Da Costa

Keyword(s):

Chest Pain ◽

Esophageal Motility ◽

Esophageal Manometry ◽

Motility Disorder ◽

Diffuse Esophageal Spasm ◽

Esophageal Motility Disorder ◽

Nutcracker Esophagus ◽

Hypertensive Lower Esophageal Sphincter ◽

Acid Perfusion ◽

Provocative Testing

In a five year period 238 of 594 esophageal manometric studies performed in the authors’ laboratory were done on patients whose major reason for referral was noncardiac angina-like chest pain. Standard eophageal manometry was performed followed by an acid-antacid perfusion period (Bernstein test) and then subcutaneous bethanechol (80 μg/kg to a maximum of 5 mg) was adminstered. Baseline manometry was normal in 38% of patients and was diagnostic of ‘nutcracker’ esophagus, nonspecific esophageal motility disorder, diffuse esophageal spasm and isolated hypertensive lower esophageal sphincter in 24%, 19%, 16% and 3% of patients, respectively. Ninety-six of 238 patients (40%) experienced reproduction of their presenting angina-like chest pain during acid perfusion. In 80% of these patients there were associated esophageal motor abnormal ilies induced by the acid perfusion. Thirty-six of 212 (17%) experienced pain reproduction following the injection of bethanechol; however, 16 of these had already had their presenting chest pain reproduced during the acid perfusion study. In two-thirds of the patients with pain reproduction following bechanechol there was an associated bethanechol-induced esophageal motility disorder. Overall 49% of patients had their pain reproduced during provocative testing. The acid perfusion test reproduced the pain much more frequently than bethanechol simulation. This study reaffirms the value of esophageal manometry and provocative testing in this group of patients.

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Spectrum of Esophageal Motility Disorders in Patients with Motor Dysphagia and Noncardiac Chest Pain ‑ A Single Center Experience

Journal of Digestive Endoscopy ◽

10.4103/jde.jde_85_16 ◽

2017 ◽

Vol 08 (02) ◽

pp. 068-071

Author(s):

Rinkesh Kumar Bansal ◽

Mukesh Nasa ◽

Gaurav Kumar Patil ◽

Vinit Shah ◽

Narendra S. Choudhary ◽

...

Keyword(s):

Chest Pain ◽

High Resolution ◽

Esophageal Motility ◽

Esophageal Manometry ◽

Motility Disorder ◽

Esophageal Motility Disorders ◽

Noncardiac Chest Pain ◽

Esophageal Motility Disorder ◽

Motility Disorders ◽

High Resolution Manometry

ABSTRACT Aims and Objective: High‑resolution esophageal manometry is the most important investigation for the evaluation of patients with dysphagia and noncardiac chest pain (NCCP). Chicago Classification (CC) utilizing an algorithmic approach in analyzing high‑resolution manometry has been accepted worldwide, and an updated version, CC v3.0, of this classification has been developed by the International high‑resolution manometry working Group in 2014. Data on the spectrum of esophageal motility disorders in Indian population are scarce as well as a newer version of CC has not been used to classify. The aim of our study is to evaluate clinical presentation and manometric profile of patients with suspected esophageal motility disorders using CC v3.0. Methodology: In this retrospective study, consecutive patients referred for esophageal manometry at our center from 2010 to 2015 were included in the study. High‑resolution esophageal manometry was performed with 22‑channel water‑perfusion system (MMS, The Netherlands). Newer version of CC (CC v3.0) was used to classify motility disorders. Results: A total of 400 patients were included, with a mean age of 44 years and 67.5% were males. Out of these, 60% (n = 240) patients presented with motor dysphagia while 40% (n = 160) had NCCP. Motility disorder was present in 50.5% (n = 202) of the patients while 49.5% (n = 198) patients had normal manometry. Disorders of esophagogastric junction outflow were the predominant type of disorder, found in 33.75% (n = 135). About 14.25% (n = 57) of the patients had minor disorders of peristalsis while 5% (n = 20) of the patients had other major disorders of peristalsis. Achalasia was the most common motility disorder present in 30% (n = 120) patients. Conclusion: Dysphagia was the most common esophageal symptom followed by NCCP in our series. Achalasia was the most common esophageal motility disorder followed by fragmented peristalsis.

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Enterogastric Reflux: an Uncommon Diagnosis Analyzed by Hepatobiliary Imaging

Journal of Case Reports in Medicine ◽

10.25149/jcrm.v8i2.178 ◽

2019 ◽

Vol 8 (2) ◽

Author(s):

Peter Wang

Keyword(s):

Abdominal Pain ◽

Digestive Enzymes ◽

Gallbladder Disease ◽

Hepatobiliary Scintigraphy ◽

Hepatobiliary Imaging ◽

Upper Gi ◽

Gi Symptoms ◽

Upper Abdominal ◽

Enterogastric Reflux

Enterogastric reflux (EGR) is the reflux of bile and digestive enzymes from the small bowel into the stomach. While it is a normal physiologic process in small amounts, excessive reflux and chronic EGR can cause upper GI symptoms often mimicking more common diseases such as gallbladder disease and GERD that often leads to its underdiagnosis. Identifying EGR is significant as it has been associated with the development of gastroesophogeal pathology including gastritis, esophagitis, ulcers, and mucosal metaplasia. This article presents a 22-year-old male with enterogastric reflux causing upper abdominal pain and will discuss the role of hepatobiliary scintigraphy in its diagnosis.

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Faculty Opinions recommendation of Diagnostic yield of 24-hour esophageal manometry in non-cardiac chest pain.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726248449.793522320 ◽

2016 ◽

Author(s):

Rami Sweis

Keyword(s):

Chest Pain ◽

Esophageal Manometry ◽

Diagnostic Yield

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Su1887 The Role of Esophageal Manometry and 24 Hour pH With Impedance Studies in the Evaluation of Patients With Non-Cardiac Chest Pain

Gastroenterology ◽

10.1016/s0016-5085(13)61852-1 ◽

2013 ◽

Vol 144 (5) ◽

pp. S-501

Author(s):

Rashad C. Wilkerson ◽

Fouad J. Moawad ◽

Corinne L. Maydonovitch ◽

Lavern Belle ◽

Yen-Ju Chen

Keyword(s):

Chest Pain ◽

Esophageal Manometry

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Reliability and validity of a modified questionnaire of upper GI symptoms utilized in a disease management program of patients on chronic acid suppression

Gastroenterology ◽

10.1016/s0016-5085(03)82556-8 ◽

2003 ◽

Vol 124 (4) ◽

pp. A505

Author(s):

Braden Kuo ◽

Timothy Ferris

Keyword(s):

Disease Management ◽

Disease Management Program ◽

Reliability And Validity ◽

Management Program ◽

Acid Suppression ◽

Upper Gi ◽

Gi Symptoms

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Spastic Motility Disorders: Diagnosis and Management in the Era of the Chicago Classification

Foregut: The Journal of the American Foregut Society ◽

10.1177/26345161211044971 ◽

2021 ◽

Vol 1 (3) ◽

pp. 254-262

Author(s):

Mario Costantini ◽

Renato Salvador ◽

Andrea Costantini

Keyword(s):

Chest Pain ◽

Esophageal Motility ◽

Current Knowledge ◽

Unexpected Finding ◽

Diffuse Esophageal Spasm ◽

Extreme Caution ◽

Motility Disorders ◽

Diagnosis And Management ◽

Chicago Classification ◽

Esophageal Spasm

Spastic esophageal motility disorders are represented, as per the Chicago classification 4.0, by diffuse esophageal spasm and hypercontractile esophagus. They are very rare and therefore poorly understood. The diagnosis is usually made by manometry in presence of dysphagia or chest pain, but often it is often an unexpected finding. In this paper, the authors review the current knowledge and possible treatments of these disorders, when needed. They underline that invasive treatments, as surgical myotomy or POEM, are rarely necessary and that the indications for them are based on low quality studies. Therefore, they should be used with extreme caution in treating spastic motility disorders other than achalasia.

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